CCRNR is overseeing the implementation of a new regulatory framework for NPs and CNO has been part of this national discussion since 2018. The initiative will change Ontario’s framework for registering NPs by removing the specialty certificates (NP-Primary Health Care, NP-Pediatrics, NP-Adult) and replacing them with one classification of NP registration.

This new vision for NP regulation will:

• enable the appropriate level of national regulation in the public’s interest, focusing on patient and cultural safety
• promote consistency in regulation across jurisdictions
• facilitate collaboration among regulators
• reduce unnecessary barriers and advance labour mobility activities across the country

Currently, CCRNR’s NP Regulation Framework Implementation Plan Project (NPR-FIPP) is dependent on a few factors such as unique jurisdictional implementation plans, Council and/or government approval of regulation changes, curriculum changes, program approval and a new national single-entry exam.

For more information about the project, check out A single classification of Nurse Practitioners (NPs).

NPs across Canada will be educated based on common NP entry-level competencies, take a common NP single entry-level exam and be ready to practice across patient populations and practice settings as a beginner NP. For the most part, regulators will no longer regulate population-specific NP practice but will continue to require NPs to practice within their individual competence and regulated scope of practice.

Currently, Ontario NP practice (regardless of speciality certificate) is subject to the same legal scope of practice, the same national entry-level competencies and governed by the same CNO practice standard. This will not change.

No. In fact, a single classification of NPs will increase the NP’s flexibility for making career changes serving broader patient populations and offer health system partners more opportunities for health human resource planning.

Currently, each provincial or territorial regulator has its own set of regulations and by-laws, NP exams, registration requirements and standards of practice. A consistent NP regulatory approach across Canadian jurisdictions will advance labour mobility and minimize regulatory barriers to practice.

Current NP registrants (NP-Adult, NP-Pediatrics and NP-PHC) will be transitioned to the new framework without having to complete further education, examinations or training. These NPs will continue to work within their current education (and patient population), training and competence, and maintain their competencies by participating in CNO’s Quality Assurance program.

Under the proposed new framework, an NP with education / training in NP-Pediatrics or NP-Adult can practice with a different patient population (outside of their education and training) provided they have the competence to do so. NPs are required to reflect on their practice and identify gaps in their knowledge, skill and judgement to ensure they have the education/training to provide safe, competent care for the setting and patient population at hand.

If proposed regulation changes are approved in Ontario by CNO Council and the government, Primary Health Care, Pediatrics and Adult specializations will no longer be protected titles. NPs already have the authority, under the regulations, to use the Nurse Practitioner title or Registered Nurse (Extended Class).

NPs across Canada would receive education aligned with entry-level competencies, take a common NP entry-level exam and be prepared to provide care across patient populations and practice settings. NPs can further enhance their knowledge and expertise over time and may pursue additional specialization, if they desire. 

If you are a current NP within the existing framework and wish to move from Adult to PHC or Pediatrics, you will need to complete the necessary education and exam to meet registration requirements for that specialty certificate in Ontario. 

It is important to note, this is a national multi-year project with proposed plans for implementation in 2026. In the interim, all current NPs need to adhere to the current regulation framework and requirements.

Currently, CNO regulates the NP-PHC, Pediatric and Adult specialties. If an NP is currently registered in one of those three specialties and wants to switch to one of the other specialties, they would be required to complete the full education program and the entry level exam for that specialty. CNO does not regulate other NP “specialties” (example, renal, cardiac, palliative, etc.) but supports NPs wanting to specialize through its Quality Assurance program (continuing competence). In the proposed future model, CNO will regulate the single classification of “Nurse Practitioner”. As regulated health care professionals, NPs will assess whether they have the knowledge, skill and judgement to practice safely and competently in a given specialty area.

Given the legislative framework in Ontario, RN (EC) needs to remain in the regulations under nursing. However, as is currently the case, CNO will continue to communicate with the public, system partners and government using the term Nurse Practitioner and will continue to reinforce NP roles, scope and title.

Furthermore, in the proposed regulation changes under the Nursing Act, 1991, the term “Nurse Practitioner” is to be added to the definition “Registered Nurse Extended Class” to clarify that the terms are synonymous.

This is not within the project objectives of the national NP regulation framework.

NP entry-level education programs across Canada are working toward integrating the new national competencies into their programs to prepare NPs for practice across the lifespan and practice settings.

In Ontario, CNO’s Council supported the revised NP entry-level competencies in December 2022. CNO is working closely with academic institutions to facilitate its implementation through CNO’s Program Approval process. Current specialty programs (Adult and Pediatric education) are being sunset. In September 2024, Ontario universities that provide NP education programs have started to address NP practice across the lifespan and practice settings.

According to CCRNR’s 2015 and 2024 practice analysis review, evidence shows that NPs in Canada use similar competencies regardless of their specialty certificates. With the new model, all new NPs will complete a foundational education program that will prepare them to practice across patient populations and practice settings. This means NPs will have the option to work in the practice setting of their choice within their regulated scope of practice. There is no requirement for new NPs to practice in a primary health care setting. NPs entering practice will have the foundational knowledge, skills, and judgment to provide advanced nursing care in most practice settings. Then, similar to an RN, an NP can choose to pursue a specialization after entering practice, which may be obtained through formal courses, experience, continuing education and other opportunities.

Numerous educational opportunities are available to support this, including Continuing Medical Education (CME), conferences and educational days offered by organizations such as Canadian Hypertension Education Program Guidelines (CHEP), Diabetes Canada, Hypertension Canada, Osteoporosis Canada and many others across various clinical areas like primary health care, women's health and dermatology. As part of NPs' professional accountabilities, it is essential for Nurse Practitioners to maintain and enhance their competence.

Employers also play a vital role in supporting Nurse Practitioners through orientation, mentoring and continuing competence training to meet their practice settings' unique needs. It is important to report to your employer and refrain from engaging in activities if you do not have the necessary competence for certain activities or practice settings.

CNO does not regulate mandatory clinical hours for any nursing programs (NP, RN, RPN). This is the expertise of faculty developing curriculum for entry-level programs. Through Program Approval, CNO ensures that entry-level competencies are integrated into the curriculum, including clinical practicums.

No. CNO does not regulate specialties/continuing education.

Discussion with academics around continuing competence and specialization certificates continue to evolve to ensure NPs have opportunities for professional development and training, if needed, to support their practice-specific needs (like neonatology, gerontology, to name a few.) 

Many health care organizations already provide practice-setting-related training, such as emergency residency, cardiac residency, neurosurgery etc. Leveraging these training opportunities is a great option for NPs who are hired to work in practice settings that may need specialized skills.

CNO does not provide education programs, but we are engaging with our academic partners regarding continuing education for NPs.

Entry level NP education programs will incorporate clinical placements, simulation, labs, etc., to integrate learning opportunities across the lifespan and practice settings.

A 2015 NP practice analysis study commissioned by CCRNR was the catalyst for exploring this regulatory framework. Results showed that regardless of clinical practice setting or patient population, NPs were using similar competencies (knowledge, skill and judgement) in their nursing practice regardless of the patient population they are caring for. As a result, consistent NP entry-level competencies for Adult, Primary Health care and Pediatric patient populations were developed and supported by CNO Council in 2022.

In 2024, a separate national NP Practice Analysis study was conducted to gather current evidence on relevant NP practice within patient populations and practice settings. About 12.5% of NPs across Canada participated in this voluntary national survey. Results from the 2024 NP practice analysis highlight that Canadian NPs continue to use similar foundational, entry-to-practice competencies regardless of their patient population or practice setting.  

We are engaging with NPs and collecting feedback along the way. For example, in March 2024, NPs across Canada received an email from CNO to participate in CCRNR’s NP practice analysis validation survey. Input from this survey will inform a new NP single entry-to-practice exam.

CNO has engaged with national nursing regulators, NPR-FIPP and provincial partners like academics, employers, associations and government. 

• In March 2024, CNO asked Ontario NPs to participate in a national voluntary NP practice analysis survey to inform the new single-entry NP exam 
• CNO held a town hall meeting on September 5, 2024 to discuss the national NP regulation framework and its impact on NPs in Ontario. You can watch the town hall recording here
• CNO engaged with NPs at the Nurse Practitioner Association of Ontario (NPAO), Annual Conference in September 2024

CNO will continue to create space with NPs and system partners to have meaningful conversations on impact, transition planning and implementation.

In the new framework, NPs will have the foundational knowledge, skills, and judgment to provide NP care. Still, like other nurses, they will require orientation to the specific practice setting or specialized areas of practice. 

Employers can continue to leverage their existing onboarding and orientation programs to meet their practice settings' unique needs. Many health care organizations already provide practice-setting-related training, such as emergency residency, cardiac residency, neurosurgery etc. Using these training opportunities is a great option for NPs who are hired to work in practice settings that may need specialized skills.

CNO continues to engage with system partners, including associations on this national NP regulation change. At a national and provincial level, for example, CNO has been engaging with the Nurse Practitioner Association of Ontario.

On September 5, 2024, CNO held a virtual town hall to share information and seek NP and system partner feedback to inform transitional planning. Associations were in attendance.  

NP engagement has included:  

• two practice analysis studies (individual NPs surveyed in 2015 and 2024) 
• town hall meeting to share information on the NP regulation framework and impacts to Ontario NPs. Invitations were sent to all Ontario NPs and current NP applicants. NPs had an opportunity to ask questions at the town hall and those questions are included in this FAQ
• all NPs were encouraged to provide feedback during the September to November 2024 public consultation on the proposed NP draft regulation changes
• NPs were consulted and involved in the development of the revised NP ELCs
  

The national framework will support the mobility of NPs across provinces and territories as NPs will be educated based on the same entry-level competencies and be prepared to practice across patient populations and practice settings as entry-level NPs.

At present, within the current regulatory framework, NPs moving to another jurisdiction with an equivalent certificate of registration will need to meet labour mobility requirements. 

Through labour mobility laws, there are very few registration requirements CNO assesses (such as acknowledgement of good standing, compliance with Quality Assurance, no discipline or fitness to practice orders or ongoing investigation, jurisprudence exam, recent practice and language proficiency).

Early discussions on interjurisdictional nurse licensing are happening in real time to understand what this might mean in the future for NPs practicing in different provinces or territories. More information will be made available in the future.

In the future, a new national entry-to-practice exam will be one step toward registering with CNO as an NP. Ontario NP applicants will also need to complete their other entry-to-practice registration requirements with CNO to practice in Ontario. If that NP wants to move to another province, labour mobility will be easier. They will still need to register with the nursing regulator in the province.

No. The United States is not part of this national NP regulation framework. This applies only to Canadian provinces and territories.

For NP applicants who have taken a program related to a specific area of practice or patient population, their education and experience will be assessed against the NP entry-level competencies and registration requirements to meet CNO’s entry-level requirements. If competency gaps are identified, the CNO registration team will inform the NP of the gaps in their education that need to be met. This is our current process, which aligns with requirements in law that are not changing.

All NP applicants from other countries (including the United States) will be assessed as part of our existing registration processes to meet CNO’s registration requirements including for education, recent NP practice and registration examination in order to practice in Ontario. An IENP applying to practice in Ontario may be assessed to have gaps that will need to be addressed before they can be registered.

The exam will be a linear-on-the-fly (LOFT) format. This means that all test-takers will receive the same number of questions and will be able to navigate forward and backward throughout the exam. Each test-taker will receive a unique batch of exam questions that will be based on the exam blueprint and will be of equal difficulty.

Details about the exam, including how often it will be offered, are being determined. More information will be available in 2025.

An exam blueprint describes how a licensure exam is to be developed. It provides instructions and guidelines on how competencies and practice statements (i.e., knowledge, skills, attributes and judgments) are to be expressed within the exam to enable accurate decisions to be made on a candidate’s readiness to practice safely, effectively and ethically. Having a blueprint provides consistency in the exam design and helps align the percentage of questions focused on various competencies to their level of importance for public protection.  

The blueprint indicates the total number of questions on the exam and the target percentage of questions coming from each domain or practice statement section.

The exam blueprint will be used to provide direction to exam developers and item writers about content for the exam and to ensure the exam content has adequate representation of questions from each domain or practice statement section. 

It is important that exam blueprints help maintain transparency and fairness so that no test-taker is surprised about the nature of the exam when they sit for it. To this end, subject matter experts will use the blueprint to review and judge the appropriateness of test questions, determining if the question is at the appropriate level of difficulty or complexity. As well, educators will use the blueprint to help students prepare to take the exam.  

The blueprint includes the following structural elements to guide exam development:  

• Examination length – the number of questions on the exam to ensure reliability and content validity
• Question format and presentation – the types of questions to include (e.g., multiple choice or case base) and how the questions will be presented
• Questions by domains – the number of questions to be included for each domain or practice statement section
• Cognitive level of questions – for example: comprehension, application, and critical thinking 
• Contextual variables to include in question development – including healthcare clients, client lifespans / ages, health focus (e.g., various body systems and illnesses/ injuries), considerations for population diversity, healthcare environment and setting