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How are nurses governed?

All your questions about how nursing is regulated—plus how you need to be protected

It makes sense that protecting the public is the focus of registered nursing (RN) regulation in Canada, since it is the very objective of the profession. Legislation assures the public that they receiving safe and ethical care from competent, qualified RNs. Plus, it defines boundaries of the profession. However, nurses essentially regulate each other. Confused? Here’s what you need to know.
How is nursing regulated?
There is no national licensing of nurses in Canada. Each province/territorial government is responsible for its health care, including granting responsibility for nursing regulation to professional bodies. Ontario-based registered nurses (RNs), registered practical nurses (RPNs) and nurse practitioners (NPs) are governed in a self-regulating capacity through the College of Nurses of Ontario (CNO).
The CNO regulates the profession by establishing requirements for entry to practice; articulating and promoting practice standards, administering a Quality Assurance program, and enforcing standards of practice conduct.
Self-regulation is a privilege granted to those professions that show they can put the interests of the public ahead of their own interests.
Are there regulations nurses must follow?
Yes. There is legislation, the Nursing Act, 1991, which contains a scope of practice statement and controlled acts that nurses are permitted to do. It also includes definitions around classes of nursing registration, and qualifications for becoming a nurse.  
Nurses are also regulated by the Regulated Health Professions Act, 1991. The RHPA defines 13 controlled acts that can only be performed by a regulated health profession or under specific circumstances, and nurses are permitted to perform the following three under certain circumstances:
*performing a prescribed procedure below the dermis or a mucous membrane;
*administering a substance by injection or inhalation; and
*putting an instrument, hand or finger, in seven specific body areas.
Of course nurses do so much more than these acts. Read more in Quiz: What Do Nurses Really Do? [THROW TO NEW TO NURSING KNOWLDEGE PROFESSION PIECE/MYTHS]
So how are nurses held accountable?
In order to ensure nurses act within the scope of their practice and adhere to excellent standards of care, there is a system of accountability in place. Specifically, through the College of Nurses of Ontario (CNO) the public can make a complaint about a nurse’s conduct; and employers and facility operators have a mandatory obligation to inform the CNO when they terminate or intend to terminate the employment of CNO members. 
How can I protect myself?
In Ontario, The College of Nurses of Ontario (CNO) is in the process of implementing a requirement that all nurses in Ontario have personal professional liability protection. Members of the RNAO are eligible for the benefits offered through the  Canadian Nurses Protective Society (CNPS), a non-profit society, owned and operated by nurses for nurses. It offers professional liability protection related to nursing practice to Registered Nurses (RNs), by providing information, education, and financial and legal assistance.
CNPS is automatic with membership in the Registered Nurses’ Association of Ontario.
You can also protect yourself by upholding the following:
*Follow the Code of Ethics for Registered Nurses (available at Canadian Nurses Association)
*Know and follow standards of practice mandated by your provincial regulatory body
*Seek out opportunities to develop and maintain competencies
Sign up for RNAO’s In the Loop to learn about workshops in your area.
*Get involved with RNAO’s best practice guideline program.
“I landed my dream job because I contributed to BPGs,” ARTICLE TO COME.
Do I need any other protection?
RNAO membershave access to legal assistance on a case-by-case basis through the voluntary Legal Assistance Program (LAP), established by RNAO in 1986 (it is an extra cost). The program provides financial support to RNAO members for access to legal counsel. A few items LAP covers include: appearance before the CNO as a result of a letter of complaint, a report or other investigation, and appearance as a witness at an inquest or inquiry resulting from a job related incident. 
Over 19,000 RNAO members currently subscribe to LAP. To join LAP now contact the RNAO membership department or call 1-800-567-4527 or 416-599-1925.

It makes sense that protecting the public is the focus of registered nursing (RN) regulation in Canada, since it is the very objective of the profession. Legislation assures the public that they receiving safe and ethical care from competent, qualified RNs. Plus, it defines boundaries of the profession. However, nurses essentially regulate each other. Confused? Here’s what you need to know.

How is nursing regulated?
There is no national licensing of nurses in Canada. Each province/territorial government is responsible for its health care, including granting responsibility for nursing regulation to professional bodies. Ontario-based registered nurses (RNs), registered practical nurses (RPNs) and nurse practitioners (NPs) are governed in a self-regulating capacity through the College of Nurses of Ontario (CNO).

The CNO regulates the profession by establishing requirements for entry to practice; articulating and promoting practice standards, administering a Quality Assurance program, and enforcing standards of practice conduct.

Self-regulation is a privilege granted to those professions that show they can put the interests of the public ahead of their own interests.

Are there regulations nurses must follow?
Yes. There is legislation, the Nursing Act, 1991, which contains a scope of practice statement and controlled acts that nurses are permitted to do. It also includes definitions around classes of nursing registration, and qualifications for becoming a nurse. 

Nurses are also regulated by the Regulated Health Professions Act, 1991. The RHPA defines 13 controlled acts that can only be performed by a regulated health profession or under specific circumstances, and nurses are permitted to perform the following three under certain circumstances:

  • performing a prescribed procedure below the dermis or a mucous membrane;
  • administering a substance by injection or inhalation; 
  • putting an instrument, hand or finger, in seven specific body areas.

Of course nurses do so much more than these acts. Read more in Quiz: What Do Nurses Really Do?

So how are nurses held accountable?
In order to ensure nurses act within the scope of their practice and adhere to excellent standards of care, there is a system of accountability in place. Specifically, through the College of Nurses of Ontario (CNO) the public can make a complaint about a nurse’s conduct; and employers and facility operators have a mandatory obligation to inform the CNO when they terminate or intend to terminate the employment of CNO members. 

How can I protect myself?
In Ontario, The College of Nurses of Ontario (CNO) is in the process of implementing a requirement that all nurses in Ontario have personal professional liability protection. Members of the RNAO are eligible for the benefits offered through the  Canadian Nurses Protective Society (CNPS), a non-profit society, owned and operated by nurses for nurses. It offers professional liability protection related to nursing practice to Registered Nurses (RNs), by providing information, education, and financial and legal assistance.CNPS is automatic with membership in the Registered Nurses’ Association of Ontario.

You can also protect yourself by upholding the following:

Check out RNAO’s calendar of events to learn about workshops in your area.
Get involved with RNAO’s best practice guideline program.

Do I need any other protection?
RNAO members have access to legal assistance on a case-by-case basis through the voluntary Legal Assistance Program (LAP), established by RNAO in 1986 (it is an extra cost). The program provides financial support to RNAO members for access to legal counsel. A few items LAP covers include: appearance before the CNO as a result of a letter of complaint, a report or other investigation, and appearance as a witness at an inquest or inquiry resulting from a job related incident.

Over 19,000 RNAO members currently subscribe to LAP. To join LAP now contact the RNAO membership department or call 1-800-567-4527 or 416-599-1925.

  • Ontario’s Quality Assurance Program

    In Ontario, nurses registered in the General, Transitional and Extended Classes in Ontario are required to participate in the College of Nurses’ of Ontario’s Quality Assurance program. The program measures a member’s knowledge, nursing standards and related competencies. 

    The scope of practice of nurses, according to Ontario regulation, is this:

    The practice of nursing is the promotion of health and the assessment of, the provision of care for, and the treatment of health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function.