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Scope of Practice – Proposed changes
The Ministry of Health and Long-Term Care has asked us to work on regulations to expand the scope of practice for NPs, RNs and RPNs. These changes will increase patients’ choice of and access to health care services.
To be notified about ongoing work on changes to nursing scope of practice, watch the News section of cno.org The Standard, and our social media channels, including Facebook, Twitter, LinkedIn and Instagram for more info.
Nurse Practitioners (NPs)
The Ministry of Health is exploring changes to expand NP scope of practice. These changes are intended to increase patient access to timely health care services and reduce barriers to patient care.
Stay tuned for more information.
Registered Nurses (RNs)
CNO has proposed changes to permit RNs to prescribe medication and to communicate diagnoses for the purpose of prescribing medication for certain non-complex conditions.
We've submitted draft regulations to the Ministry of Health. Government approval is required for the regulation to take effect.
We will provide updates on www.cno.org when we have more information from government about these changes.
Registered Practical Nurses (RPNs)
The Ministry of Health has approved changes under the Nursing Act, 1991 that allow RPNs 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
RPNs with relevant competence can currently 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. 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, RPNs who practice in hospitals will always need an order. This is a requirement under the Public Hospitals Act. To learn more about initiation, read the Scope of Practice standard.
- Ministry of Health request letter
- Joint RNAO and ONA letter to CNO – Sep. 16, 2020
- Joint RNAO and ONA letter to Premier and Minister of Health – Sep. 22, 2020
- CNO response to RNAO and ONA – Sep. 25, 2020
- FAQs: Expanding RPN scope of practice