FAQs: Quality Assurance
Changes are coming to QA! New self-assessment tools will be available in the new year.
Check back often.
The Regulated Health Professions Act, 1991 requires CNO to establish and administer a QA Program that assists nurses in maintaining competence and continually evaluating their practice. CNO’s QA Program consists of three components:
- Practice Assessment
- Peer Assessment
What is Self-Assessment?
All nurses registered in the General and Extended classes are required to complete Self-Assessment. Each year, they must:
- reflect on their practice
- develop and maintain a Learning Plan
Keep a copy of your Learning Plan for two years as a record of participating in the QA Program.
What is Practice Assessment?
Each year, CNO randomly selects nurses from the General and Extended classes to participate in Practice Assessment. Nurses selected for Practice Assessment must submit their Learning Plan and complete objective multiple-choice tests online using myQA. In addition, we will select a subset of NPs for a clinical assessment.
What is Peer Assessment?
If you are selected for Practice Assessment, a Peer Assessor will review your Learning Plan and assessment results. A Peer Assessor is a CNO-assigned nurse with an in-depth understanding of our practice standards, guidelines and QA requirements. The Peer Assessor will write a report for the QA Committee. You will receive a copy of this report.
How can I link my employer performance evaluation to the QA Program?
CNO encourages nurses to share the requirements of the QA Program with their employers. You can link regulatory requirements with your employer performance assessments. Use the Learning Plan to develop your learning goals based on your practice reflection and learning needs. You can also incorporate the learning needs or activities in your employer performance evaluation into your Learning Plan.
Are there resources to help me with the QA Program requirements?
Yes, CNO has developed several resources to help you meet the requirements of the QA Program. Visit the QA Resources page for more information.
Do I have to participate in the QA Program if I am newly registered with CNO?
Yes. It is mandatory for nurses registered in the General and Extended classes to participate in the QA Program. You can do this by completing your annual Self-Assessment once you become registered. Nurses in these classes are eligible for selection for Practice Assessment two years after they have been registered with CNO.
If I am registered with CNO in the General or Extended Class but I am not practicing nursing, do I have to participate in Self-Assessment?
Yes, it is mandatory for every nurse registered in the General and Extended Classes to participate in the QA Program and complete their annual Self-Assessment. Nurses in the Non-Practising Class are not required to participate in the QA Program. For more information about the Non-Practising Class, go to the Registration Classes section of this website.
I am the only nurse in my practice setting. As part of practice reflection, I need input from a peer. Who is a peer in my practice setting?
CNO defines a peer as a member of the interprofessional team who understands your role as a nurse. A peer does not have to be in the same role as you are. As well, they can work within or across practice settings. For example, a peer can be a physician you work with or the team manager. Feedback you receive from your peers provides greater awareness of your strengths, areas for improvement and learning needs.
I’m registered in the General Class, but not currently working. How do I reflect on my practice and create a Learning Plan?
Even if you aren’t currently working, you can still reflect on your nursing practice experiences to determine your strengths, areas for improvement and learning needs. These experiences can include previous formal employment, or student placements if you are a new graduate.
You can also reflect on relevant new information and think about how it might influence your practice. For example, is there new evidence or legislation that may change how you would deliver care?
Part of practice reflection is getting feedback from peers. You can get that from a colleague who is familiar with your recent nursing roles, or include feedback from a clinical evaluation.
Once you have identified your learning needs from this reflection, you can plan your learning goals, and the activities you need to do to achieve them in your Learning Plan.
How will I know I have been selected for Practice Assessment?
CNO mails notification letters to nurses who are selected. The letter will explain what you have to do.
Do I have to participate in Practice Assessment if I am registered with CNO in the General or Extended Class, but not practising nursing?
Yes. It is mandatory for nurses registered in the General and Extended classes to participate in Practice Assessment when selected. Nurses registered in these classes are eligible for selection for Practice Assessment, even if they are not practising nursing.
Nurses in the Non-Practising Class are not required to participate in the QA Program, and they will not be selected for Practice Assessment. For more information about the Non-Practising Class, go to the Classes of Registration section.
What happens if I don’t participate in Practice Assessment?
The QA Committee addresses non-compliance with the QA Program in different ways.
- direct the Executive Director to impose terms, conditions or limitations on a member’s Certificate of Registration for a specific time. This will be posted on the public Register (Find A Nurse)
- report a member to the Inquiries, Complaints and Reports Committee if they believe the member’s lack of cooperation can be viewed as professional misconduct
- require a member to complete additional Practice Assessment components at a fee of $1,500.
For more information, see regulations, legislation and by-laws.
How do I prepare for Practice Assessment?
Find the information you need in the Practice Assessment Guide. CNO also hosts teleconferences in February to explain the Practice Assessment process and answer questions.
As an NP, what do I have to do for Practice Assessment?
All NPs must submit a Learning Plan and write three objective tests. Some NPs will be selected for a clinical assessment (Practice Simulation assessment).
What does the Practice Simulation assessment involve?
This assessment is for NPs who have been selected for a clinical assessment as part of Practice Assessment.
During Practice Simulation, an NP rotates through a series of stations using standardized patients. The assessment provides a standardized way to assess the NP’s competence in conducting physical examinations, taking history, and diagnosing and developing a plan of care for treating clients. The competencies that are assessed are based on the Entry to Practice Competencies for Nurse Practitioners.
The Practice Simulation is held in Toronto. If you are selected for Practice Simulation assessment, more information will be sent to you by email.
What happens if I do not do well in Practice Assessment?
If you have unsatisfactory Practice Assessment results, the QA Committee will require you to participate in remedial activities. These may include case examples, learning goal revisions or specified continuing education.
For example, if you are unsatisfactory on one objective test, you can demonstrate your knowledge of that Practice Standard by submitting a case example. Case examples are a structured essays, using specified templates to show how you apply the Practice Standard and indicators in your practice setting.
The QA Committee does not have the authority to suspend or revoke your Certificate of Registration.
I have been selected for Practice Assessment. Can I tell my colleagues about it?
When you start the Practice Assessment process, you agree to keep the content of the tests and other assessments confidential. Breaching this confidentiality may result in an investigation and a finding of professional misconduct.
You can tell your colleagues about the overall process of Practice Assessment. You can explain that you wrote the multiple-choice tests and submitted your Learning Plan. You can mention that a Peer Assessor reviewed your Learning Plan and assessment results, and wrote a report for the QA Committee. But you cannot tell them specifics about the assessments such as questions on a test or part of a clinical assessment.
Can I delay participating in Practice Assessment?
You may be able to delay participation if you have an exceptional circumstance. To be considered for a deferral, contact the QA Program team to request a Deferral Request Form.
Complete and submit the form and supporting documentation to the QA Committee. The committee will review your submissions and decide if you can delay your participation.