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FAQs: Expanding RPN scope of practice
General questions
What is the purpose of expanding the RPN scope?
In their letter, the Ministry of Health shares that expanding the RPN scope will provide patients more timely access to healthcare services, therefore reducing barriers to patient care.
What are the differences between nurse categories?
The main difference between RNs and RPNs is foundational education. While RNs and RPNs study from the same body of nursing knowledge, RNs study for a longer period of time, allowing for a greater depth and breadth of foundational knowledge.
Who can initiate controlled acts?
The Nursing Act, 1991 identifies which controlled act procedures a nurse can initiate in certain situations. This means that a nurse can independently decide if a specific procedure is required and safely perform it without an order from an NP or physician. CNO’s Scope of Practice standard includes a list of the controlled act procedures RNs ad RPNs can initiate.
While nurses may have access to perform or initiate 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.
Additionally, nurses must always have the competence, support and an environment/location that allows them to initiate controlled acts. If any of these are missing, a nurse must not initiate the controlled act, even if they have the legal authority to do so.
Why this change? In the past, CNO gave examples of what areas of practice were not appropriate for RPN practice.
Nursing practice is always evolving and CNO must respond to these changes. The current revisions to the RPN scope reflect the reality of nursing practice today and remove unnecessary barriers to patient care.
What is the difference between an RN and an RPN now?
Years of foundational education continues to be the distinguishing difference between RNs and RPNs. Nursing practice is broad profession constantly expanding its scope of practice. In the near future, RNs will be permitted to prescribe medication and communicate diagnoses for the purpose of prescribing medication for certain non-complex conditions.
Will a change in nurses’ salary accompany this scope expansion?
CNO’s only mandate is to ensure nursing is safe for the public. You can learn more about CNO’s role here. CNO does not have the authority to determine a nurse’s salary.
Why is CNO not requiring specific education for RPNs to initiate controlled acts?
The competencies needed to initiate controlled acts are built on the foundational education of all nurses but are generally developed through continuing learning activities and experience in practice. All nurses must continually reflect on their practice and identify if they have the competence to initiate a controlled act. If a nurse identifies that initiating a controlled act is beyond their competency but this aspect of care would benefit their patient population, they should outline a plan to attain the needed competence.
In short, this scope expansion gives RPNs who already have the competence to perform the controlled act the legal authority to independently decide that the act is required and safely perform it without an order. If the RPN does not have the competence to perform the act, they should not do so.
How is CNO ensuring public safety with this change?
Research and feedback from our consultation determined that existing regulatory mechanisms are sufficient to ensure public protection. As these changes are implemented, CNO will raise awareness of these mechanisms before these changes come into effect.
Where can I get more information about changes to nursing scope of practice?
CNO will keep you informed about all changes to nursing scope of practice via cno.org and our monthly online magazine, The Standard. You can also stay up-to-date by following us on social media: including Facebook, Twitter, LinkedIn and Instagram.
Practice-related questions
How do I determine if I can initiate a controlled act?
It is important to be aware of the limits of your individual competence and practice. Determining if you have the necessary authority to initiate a controlled act is only step one. You must always evaluate your knowledge and skills and use your judgement to determine if it is appropriate for you to provide patient care. If a patient requires care beyond your knowledge and skill, you must consult and collaborate with the health care team to best meet the patient’s needs, or request that care be transferred to another nurse.
Is there specific education I need to initiate the expanded controlled acts?
CNO is not requiring RPNs to engage in specific education before engaging in this expanded area of practice, because we recognize that while nurses enter practice with the foundational competencies, the knowledge to safely initiate a controlled act is built over time through experience in practice, as well as continuing competence activities.
If an RPN identifies that initiating any of these procedures is a need for their patient, they must consider if they have the competence to do so before proceeding and outline a plan to attain competence, if needed.
