April 03, 2018
May 2018

Two changes to NP practice

Recently, two significant changes to NP scope of practice came into effect. First, NPs can now order ultrasounds and X-rays without restrictions. They can also prescribe diacetylmorphine (heroin) and methadone.

Recently, two significant changes to NP scope of practice came into effect. First, NPs can now order ultrasounds and X-rays without restrictions. They can also prescribe diacetylmorphine (heroin) and methadone. The College is providing regulatory oversight for these changes to protect the public’s right to safe nursing care.

Ordering ultrasounds and X-rays

As of April 1, 2018, NPs have the authority to order ultrasounds and X-rays without restrictions. This change does not include computerized tomography (CT) scans.

Previously, NPs could only order ultrasounds and X-rays based on lists under the Regulated Health Professions Act, 1991, and the Healing Arts Radiation Protection Act, 1990, respectively. The new authority eliminates these lists.

When ordering tests, NPs are accountable to the expectations in the College’s practice standards, including Decisions About Procedures and Authority and Nurse Practitioner.

NPs are expected to have the knowledge, skill and judgment to order appropriate tests, and to communicate clinically significant results and their implications to clients.

For more information about these changes, visit: www.cno.org/nps-ultrasound-xray.

Prescribing diacetylmorphine and methadone

As of May 19, 2018, NPs are authorized to prescribe diacetylmorphine (heroin) and methadone. This new authorization results from changes under the Controlled Drugs and Substances Act.

Previously, NPs were only authorized to prescribe or administer methadone if they had an exemption under section 56 of the Act. Now that the government has changed the Act, NPs can prescribe and administer methadone without an exemption. Also, diacetylmorphine is included on the list of controlled substances that NPs can prescribe.

These changes are part of government’s response to the national opioid crisis. The liberal use of opioids for treating chronic non-cancer pain has contributed to opioid addiction in North America. The government is making efforts to increase health care access for Canadians who need treatment for substance use disorder.

Learn more about the risks associated with these controlled substances, as well as your accountabilities when prescribing medication (including diacetylmorphine and methadone) at: www.cno.org/np and read our FAQs.

About CNO

The College of Nurses of Ontario (CNO) is the regulator of the nursing profession in Ontario. It is not a school or a nursing association. CNO acts in the public interest by:

  • assessing qualifications and registering individuals who want to practice nursing in Ontario.
  • setting the practice standards of the profession that nurses in Ontario are expected to meet.
  • promoting nurses' continuing competence through a quality assurance program.
  • holding nurses accountable to those standards by addressing complaints or reports about nursing care.

The College was founded in 1963. By establishing the College, the Ontario government was acknowledging that the nursing profession had the ability to govern itself and put the public's well-being ahead of professional interests.

For the latest information, please see our Nursing Statistics page.

Anyone who wants to use a nursing-related title — Registered Nurse (RN), Registered Practical Nurse (RPN) or Nurse Practitioner (NP) must become a member of CNO.

Frequently Asked Questions

Go to the public Register, Find a Nurse, to conduct a search for the nurse. Contact us if you can't find the person you are looking for.

All public information available about nurses is posted in the public Register, Find a Nurse, which contains profiles of every nurse in Ontario. Publicly available information about nurses include their registration history, business address, and information related to pending disciplinary hearings or past findings.

Unregistered practitioners are people who are seeking employment in nursing or holding themselves out as being able to practice nursing in Ontario, but who are not qualified to do so. They are not registered members of CNO. Only people registered with CNO can use nursing-related titles or perform certain procedures that could cause harm if carried out by a non-registered health professional. CNO takes the issue of unregistered practitioners seriously. See Unregistered Practitioners for more information.

To ensure procedural fairness for both the patient (or client) and the nurse, the Regulated Health Professions Act requires that information gathered during an investigation remain confidential until the matter is referred to the Discipline Committee or Fitness to Practise Committee. CNO will not disclose any information that could identify patients (or clients) or compromise an investigation. See Investigations: A Process Guide for more information.

Information obtained during an investigation will become public if the matter is referred to a disciplinary hearing. If a complaint is not referred to a hearing, no information will be available publicly.

See CNO's hearings schedule, which is updated as hearing dates are confirmed. Hearings at CNO are open to the public and the media. For details on how to attend a hearing, contact the Hearings Administration Team.

A summary of allegations and the disciplinary panel outcomes can be found on the public Register, Find a Nurse. Full decisions and reasons are also available.

Where a disciplinary panel makes a finding of professional misconduct, they have the authority to reprimand a nurse, and suspend or revoke a nurse's registration. Terms, conditions and limitations can also be imposed on a nurse's registration, which restricts their practice for a set period. Nurses can also be required to complete remedial activities, such as reviewing CNO documents and meeting with an expert, before returning to practice.

For detailed information see the Sexual Abuse Prevention section.

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