March 08, 2018
July 2019

Scope of practice for NPs and RPNs to expand

Recently, the Ministry of Health and Long-Term Care asked us to begin the work required to expand NPs’ and RPNs’ scope of practice. This expanded scope will increase patients' choice of and access to health care services.   

Recently, the Ministry of Health and Long-Term Care asked us to begin the work required to expand the scope of practice for NPs and RPNs. This change will increase patients’ choice of and access to health care services.

What’s changing for NPs

By late 2020, NPs will have the authority to:

  • order magnetic resonance imaging tests (MRIs) and computed tomography (CTs) scans

  • perform point-of-care testing

What’s changing for RPNs

In June 2020 we will submit a regulation to the government for review that will allow RPNs to have the authority to independently initiate the following controlled acts:

  • Irrigating, probing, debriding and packing of a wound below the dermis or below a mucous membrane

  • venipuncture in order to establish peripheral intravenous access and maintain patency, in certain circumstances

  • putting an instrument, hand or finger beyond the individual’s labia majora for the purpose of assessing or assisting with health management activities

  • putting an instrument or finger beyond an artificial opening into the client’s body for the purpose of assessing or assisting with health management activities

Currently RPNs with relevant competence can perform these activities if they have an order. Initiation is the process of independently deciding that the procedure is required, then performing that procedure without an order. These changes will take effect once government approves the regulation.

While nurses may have access to perform controlled acts, they may not be able to do so in certain practice settings because of legislation or facility policies. For example, RNs and RPNs who practice in hospitals will always need an order. This is a requirement under the Public Hospitals Act, 1990. To learn more about initiation, read the Authorizing Mechanisms practice guideline.

What happens now?

Over the coming months, we’ll be working closely with government, nurses, educators, academics and others to create regulations for the Nursing Act, 1991, to expand the RPN’s scope of practice. We will review entry requirements, practice standards, enforcement requirements and our Quality Assurance Program to enable nurses to practice safely and competently within the new RPN scope.

Laws related to NPs performing diagnostic tests are captured under three different pieces of legislation (Regulated Health Professions Act, 1991, Healing Arts Radiation Protection Act and the Laboratory and Specimen Collection Centre Licensing Act). Since CNO has the authority to only create regulations under the Nursing Act, 1991, it is the government’s responsibility to amend the laws to expand the NP scope of practice. We will let you know when these changes take effect and share the updates in The Standard.

RN scope is also changing

These aren’t the only scope of practice changes we’re working on. For the past three years, we’ve been working to expand RNs’ scope of practice. The changes we’ve proposed will enable RNs to communicate diagnoses and prescribe drugs for certain non-complex conditions. We estimate that these changes will take effect by the end of 2019.

We will keep you informed about our work and let you know about upcoming consultations on these changes. Watch cno.org, The Standard, and our social media channels including Facebook, Twitter, LinkedIn and Instagram for more info.

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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