On March 19, 2025, CNO’s Council approved, for submission to government, regulation changes that will facilitate Nurse Practitioner (NP) labour mobility and create a more agile NP workforce across the country as part of a national NP regulation framework.
Currently in Ontario there are three registration certificates for NPs: Primary Health Care, Adult and Pediatric. The proposed legislative changes, if passed, will mean that there will be a single NP classification, so that NPs and employers will have flexibility and agility to deliver accessible services across patient populations.
Under this new framework, NPs will be educated based on common NP entry-level competencies, take a common NP entry-level exam, and be ready to provide care across patient populations and practice settings as entry-level NPs. The framework development is being led by the Canadian Council of Registered Nurse Regulators (CCRNR) and will be enacted by jurisdictions across Canada, excluding Quebec. CNO has been part of these discussions since 2018 and represents Ontario at CCRNR.
Between Sept. 26 and Nov. 24, 2024, CNO accepted feedback from NPs, other nurses, employers, academics, and other partners about the proposed regulation changes over a 60-day consultation period. We received 2,400 responses. We want to thank everyone who participated in the consultation and who shared feedback and reflections with us.
The majority (69%) of consultation respondents were in favour of this change, noting it would support human health resource needs, create a consistent and flexible model for Canada-wide NP regulation and build on NPs’ foundational education and knowledge.
One Registered Nurse said that this change “Allows NPs to flexibly provide care within their community when a need arises and makes them more accessible,” while another Registered Practical Nurse stated, “NP are needed throughout the country and especially in the northern areas of each province, as well as Indigenous communities. Allowing them to act under one umbrella will allow them to use more of the skills they have in our harder to reach communities.”
One NP with primary health care registration certification noted, “Allowing NPs to change practice areas based on the needs of the population benefits the public. Further allowing professional growth and development helps retain experienced NPs. There is significant overlap in the 3 specialties at present and many PHC-NPs practice in acute care and with pediatric populations and vice versa. It is the responsibility of the NP to determine if they have the knowledge and skill to practice in any area."
Members of the Citizen Advisory Group, a public and patient safety advisory group, met in November 2024 to discuss CNO’s proposed NP regulation changes. They “saw benefits in combining NP classifications, such as improved continuity of care and easier navigation for patients, as NPs could serve individuals across the client’s lifespan without age-based restrictions. This change could streamline care delivery and expand access to services.”
While the majority of the respondents from the public consultation were in favour of this change, those who were in opposition or unsure highlighted that NPs would need to have sufficient skills, knowledge and judgment to provide the appropriate care to distinct patient populations, like pediatrics. This concern is related to a shift in NP education: in anticipation of this new framework being enacted, Ontario universities introduced NP education programs in the fall of 2024 to educate nursing students to practice across patient populations based on the revised national NP entry-level competencies.
The proposed regulation changes will not change a nurse’s accountability to practice within their scope and competence (knowledge, skill and judgment) and these expectations for all nurses are set out in CNO’s Code of Conduct. Under this new framework, if an NP does not have the competence to provide care to children, for example, they should not do so until they gain additional competence. These expectations are further supported by CNO’s reflective Quality Assurance Program, which ensures all nurses—including NPs—are accountable for their practice, as well as identifying and meeting any learning needs to support safe patient care.
In addition, CNO and other jurisdictions continue to have discussions with academic partners about opportunities to expand bridging programs. These programs could support current NPs who might want to move from their current population-specific practice to a broader population focus that will service more health care needs of Ontarians.
Now that CNO’s Council has approved the draft regulations, they will be forwarded to government for their review and consideration. Government approval will be required for the regulation changes to take effect. Throughout 2025 and 2026, this multi-year project will move forward with implementation, evaluation and change management planning to support the next phase of this work.
For more information, read A single classification of Nurse Practitioners as well as A single classification of Nurse Practitioners (NPs): FAQS.