August 29, 2019
October 2020

Moving forward with RPN scope of practice expansion

At its September meeting, CNO’s Council approved a proposal to expand the RPN scope of practice. The change will allow RPNs to initiate components of four specific controlled acts. This means RPNs who have the relevant competence will be able to independently decide that a procedure is required, then safely perform the procedure without an order from a prescriber...

At its September meeting, Council approved proposed regulations that will expand the RPN scope of practice.

The change will allow RPNs to initiate components of four specific controlled acts. This means RPNs who have the relevant competence will be able to independently decide that a procedure is required, then safely perform the procedure without an order from a prescriber.

The Minister of Health requested these regulation changes, which will amend the Nursing Act, 1991, and asked us to develop the regulations that would put patient safety first and enable RPNs to initiate four controlled acts.

Currently, RPNs with relevant competence can perform these controlled acts only if they have an order. The regulation change removes the need for an order. However, before initiating care, the nurse must consider if they have the required knowledge, skill and judgment to proceed, and if they are restricted by other legislation, such as requirements under the Public Hospitals Act, 1990.

How your feedback informs Council

When developing the regulations, we worked closely with government, nurses, educators and academics. We also reviewed entry-to-practice requirements, practice standards, professional conduct requirements and the requirements of our Quality Assurance program, to make sure nurses can practice safely and competently within the new scope.

In March 2020 the proposed regulations were circulated to nurses, including RNs, RPNs and NPs, as well as educators, employers, academics, nursing associations, unions and the public for their feedback. This consultation process lasted 60 days (as required by law) and more than 3,150 individuals and organizations provided feedback about expanding RPN scope of practice.

At the September meeting Council members carefully reviewed all the data, including comments from those in favour of, as well as opposed to, the changes. Those who will be most affected by this change (namely nurses at the point of care and patients) said that having competent RPNs safely initiate these controlled acts would increase access to care and remove a barrier for patients in need. Council, making their decision with the best interests of patients in mind, decided to submit the new regulations to the Ministry of Health for their review and approval.

What happens now?

The RPN scope of practice changes are currently with the Ministry of Health for review and approval. To stay up-to-date and hear when the changes are implemented, read updates on www.cno.org and The Standard, and follow us on Facebook, Twitter, LinkedIn and Instagram.

Currently, scope of practice changes are in development for NPs, RNs and RPNs. To read more about the proposed changes, go to our new Scope of Practice – Proposed Changes page.

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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