July 2019

Scope of practice for NPs and RPNs to expand

Recently, the Ministry of Health and Long-Term Care asked us to begin the work required to expand the scope of practice for NPs and RPNs. This change will increase patients’ choice of and access to health care services.

What’s changing for NPs

By late 2020, NPs will have the authority to:

  • order magnetic resonance imaging tests (MRIs) and computed tomography (CTs) scans

  • perform point-of-care testing

What’s changing for RPNs

In June 2020 we will submit a regulation to the government for review that will allow RPNs to have the authority to independently initiate the following controlled acts:

  • Irrigating, probing, debriding and packing of a wound below the dermis or below a mucous membrane

  • venipuncture in order to establish peripheral intravenous access and maintain patency, in certain circumstances

  • putting an instrument, hand or finger beyond the individual’s labia majora for the purpose of assessing or assisting with health management activities

  • putting an instrument or finger beyond an artificial opening into the client’s body for the purpose of assessing or assisting with health management activities

Currently RPNs with relevant competence can perform these activities if they have an order. Initiation is the process of independently deciding that the procedure is required, then performing that procedure without an order. These changes will take effect once government approves the regulation.

While nurses may have access to perform controlled acts, they may not be able to do so in certain practice settings because of legislation or facility policies. For example, RNs and RPNs who practice in hospitals will always need an order. This is a requirement under the Public Hospitals Act, 1990. To learn more about initiation, read the Authorizing Mechanisms practice guideline.

What happens now?

Over the coming months, we’ll be working closely with government, nurses, educators, academics and others to create regulations for the Nursing Act, 1991, to expand the RPN’s scope of practice. We will review entry requirements, practice standards, enforcement requirements and our Quality Assurance Program to enable nurses to practice safely and competently within the new RPN scope.

Laws related to NPs performing diagnostic tests are captured under three different pieces of legislation (Regulated Health Professions Act, 1991, Healing Arts Radiation Protection Act and the Laboratory and Specimen Collection Centre Licensing Act). Since CNO has the authority to only create regulations under the Nursing Act, 1991, it is the government’s responsibility to amend the laws to expand the NP scope of practice. We will let you know when these changes take effect and share the updates in The Standard.

RN scope is also changing

These aren’t the only scope of practice changes we’re working on. For the past three years, we’ve been working to expand RNs’ scope of practice. The changes we’ve proposed will enable RNs to communicate diagnoses and prescribe drugs for certain non-complex conditions. We estimate that these changes will take effect by the end of 2019.

We will keep you informed about our work and let you know about upcoming consultations on these changes. Watch cno.org, The Standard, and our social media channels including Facebook, Twitter, LinkedIn and Instagram for more info.

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