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

This new vision for NP regulation:

• enables the appropriate level of national regulation in the public’s interest, focusing on patient and cultural safety
• promotes consistency in regulation across jurisdictions
• facilitates collaboration among regulators
• reduces unnecessary barriers so nurses can work anywhere across the country

NPs across Canada will be educated to practice across patient populations and practice settings as a beginner NP. For the most part, regulators will no longer regulate population-focused 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 registration certificate) is subject to the same legal scope of practice and 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 to serve broader patient populations. It will also 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 help nurses who want to practice in another jurisdiction.

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 new framework, an NP with education and 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 judgment to ensure they have the education and training to provide safe, competent care for the setting and patient population.

Under the regulation amendment in effect on July 1, 2026, Primary Health Care, Pediatrics and Adult certificates 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).

CNO has never regulated other NP “specialties” outside of Adult, Pediatric and PHC (for example, renal, cardiac, palliative) but supports NPs who want to specialize through its Quality Assurance program (continuing competence). Under the single classification, CNO will regulate the “Nurse Practitioner” designation. As regulated health care professionals, NPs will assess whether they have the knowledge, skill and judgment to practice safely and competently in a given clinical focus.

Because of the legislative framework in Ontario, the RN (EC) language needs to remain in the regulations under nursing. However, 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.

To clarify that the terms are synonymous, the term “Nurse Practitioner” is added to the definition “Registered Nurse Extended Class” under regulation amendments under the Nursing Act, 1991.

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

Ontario NP entry-level education programs have integrated the revised national competencies to prepare NPs for practice across patient populations and practice settings.

In Ontario, CNO’s Council supported the revised NP entry-level competencies in December 2022. In September 2024, Ontario universities began providing NP education programs that address NP practice across patient populations and practice settings.

With the single classification model, all new NPs complete a foundational education program that prepares them to practice across patient populations and practice settings. This means NPs 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 specialization, 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 NPs to maintain and enhance their competence.

Employers also play a vital role in supporting NPs 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 them.

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 or continuing education.

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

Discussions 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 and so on.)

Many health care organizations already provide practice-setting-related training, such as emergency residency, cardiac residency, neurosurgery and so on. 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 and so on, to integrate learning opportunities across patient populations 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 judgment) in their nursing practice. 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 September 2024, Ontario NPs received an email from CNO to participate in a public consultation on proposed Ontario NP regulation amendments under the Nursing Act, 1991. Feedback from this consultation was shared with registrants through a news release and informed CNO Council’s decision to submit proposed regulation amendments to the Ministry of Health for consideration in April 2025. In December 2025, CNO asked its registrants via email to share their feedback on CNO’s by-law amendments to enable a single NP class in Ontario. Input from this consultation will come to CNO’s Council in early 2026.

CNO has engaged with national nursing regulators, CCRNR 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.
• In September 2024, CNO asked Ontario NPs to participate in a public consultation on proposed NP regulation amendments under the Nursing Act, 1991.
• CNO engaged with NPs at the Nurse Practitioner Association of Ontario (NPAO), Annual Conference in September 2024 and 2025, with the Registered Nurses Association of Ontario (RNAO) at their NP Symposium in November 2025 and at other conferences, webinars and events.

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

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

Employers can continue to use 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 or neurosurgery. Using these training opportunities is a great option for NPs who are hired to work in practice settings that may need specialized skills.

The national framework will support the mobility of NPs across provinces and territories because 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.

Ontario legislation supports full labour mobility for nurses registered in Canada who want to practice in Ontario. If you are currently registered in another Canadian jurisdiction and have not registered with CNO before, you can apply to register in Ontario using automatic recognition. This process allows you to register in two business days by completing an application, signing an attestation form confirming good standing and good character, and paying your application fee and the registration fee.

“Good standing” means:

• you are not the subject of any discipline or fitness to practice orders, ongoing investigations, interim orders or agreements resulting from complaints or proceedings
• you are complying with the continuing competency and quality assurance requirements where you are currently registered to practice in Canada

Providing false or misleading information and/or documents in support of your application for registration may result in a refusal of your application for registration or the cancellation of any certificate that may have been issued.

To learn more about automatic recognition, read the Canada (registered outside Ontario) registration guide.

If you are a nurse who will remain registered to practice in one or more Canadian jurisdiction(s) while also registering with CNO in the same category, you may be considered an interjurisdictional applicant. Learn more about Interjurisdictional Nurse Licensure (INL) . As an interjurisdictional applicant you will receive a 25% rebate on your annual fee. Learn more about fees .

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. It will be easier for an NP to move to another province, but 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.

NP applicants who have taken a program related to a specific area of practice or patient population will have their education and experience 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.

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 is 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.

In December 2025, CNO’s Council approved the new Canadian Nurse Practitioner Licensure Exam (CNPLE) with an in-effect date of July 1, 2026 in Ontario.

An exam blueprint describes how a licensure exam is to be developed. It provides instructions and guidelines on how competencies and practice statements (knowledge, skills, attributes and judgments) are to be expressed within the exam to accurately assess 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.

NP students who are currently in a client population- or setting-focused education program (Primary Health Care or Adult) will have access to the corresponding registration exam. These registration exams will continue to be available for a period of time for these NP students. Details about current exam availability beyond 2026 are being worked on and will be shared in 2026.

Information about the current NP licensure exams can be found on our Nurse Practitioner Examinations page.