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Nurses in Ontario

Nursing is one health care profession in Ontario with two categories of registration as defined by the College of Nurses of Ontario (CNO) :

Registered Nurses (Registered Nurses [RNs] which include Registered Nurses in the Extended Class [RN(EC)s] and
Registered Practical Nurses (RPNs).

Both categories can use the protected title “nurse” in Ontario.

RNs in the Extended Class (EC) have expanded knowledge and scope and are commonly known as primary health care nurse practitioners.

Number of Nurses in Ontario

According to the latest College of Nurses of Ontario Membership Statistics Report (2005) :

There are 29,415 RPNs registered with the CNO and 23,705 employed in nursing in Ontario
There are 108,943 RNs registered with the CNO and 86,829 employed in nursing in Ontario
There are 653 RN(EC)s registered with the CNO and 582 employed in nursing in Ontario

Different nurses, different education levels, different practices

RNs and RPNs study from the same body of nursing knowledge.

RNs are required to complete a baccalaureate degree in nursing, allowing for greater depth and breadth of foundational knowledge in the areas of clinical practice, decision-making, critical thinking, leadership, research utilization and resource management.
RPNs study for a shorter period of time and are required to complete a practical nursing diploma program from a College of Applied Arts and Technology. They have a more focused body of foundational knowledge in the areas identified above.
RN(EC)s have expanded knowledge and scope and are commonly known as Primary Health Care Nurse Practitioners (PHCNPs). They must graduate from an approved nurse practitioner program in primary health care and pass an additional exam and practice review.
RN(EC)s have a well defined scope of practice and have the authority to perform controlled acts beyond those authorized to RNs (e.g. prescribing certain medications, ordering laboratory and diagnostic tests (e.g., x-rays, ultrasounds), diagnosing and communicating diagnoses). Nurse practitioners work collaboratively with physicians and other health care professionals to provide the most comprehensive primary health care services required by their patients.
Acute Care Nurse Practitioners (ACNPs) are RNs who hold a master’s degree and have specialized clinical knowledge in a defined area. The RN(EC) designation does not pertain to this group. The CNO is investigating the extension of the Extended Class designation to ACNPs. ACNPs work primarily in hospitals and require a medical directive to order medications, lab tests, etc.

Many nurses pursue voluntary specialty certification through professional organizations and certifying bodies.

Only nurses with a valid Certificate of Registration from the CNO are permitted to practice and are authorized to perform the controlled acts authorized to nursing.

Where Do Nurses Work?

Nurses work in a variety of settings including :

Hospitals
Long-term care homes
Rehabilitation facilities
Community health centres
Clinics and family practices
Workplaces
Schools and your community
Home health agencies
Universities and Colleges
Government

What do nurses do?

Nurses help to “restore, maintain and advance the health of individuals, groups or entire communities” (CNO, 2005). In order to achieve this, they apply their nursing knowledge, skills and judgment in various situations. Most nurses work in direct practice; others are involved in different sectors such as research, education and administration.

Practice Expectations of Nurses (CNO website, 2005 – RNs and RPNs working together)

The complexity of a person's condition influences the nursing knowledge required to provide quality care. The more complex the situation and the more dynamic the environment, the greater the need for the RN to provide the full range of care required. (CNO, 2004)

Comparisons between the scope of practice for RNs and RPNs are, therefore, most accurately made in relation to the care needs of the patients, clients or residents they are caring for, rather than the tasks being performed.

For example, after carrying out a client assessment, an RPN is required to determine if she/he is able to meet the client care needs or if consultation with an RN is required. The consultation may result in a sharing of ideas and approaches or, in fact, may involve transferring the care to an RN, depending on the complexity and acuity of the client and the environmental factors.

An RN, drawing on a more in-depth theoretical and clinical knowledge base, has a greater range of care delivery options from which to select when adopting a plan of care. He/she can carry out a broader, more in-depth assessment, and is expected to be able to analyze and synthesize client data to a greater extent than an RPN. An RN is prepared to address complex, unpredictable client care needs.

While both categories may be capable of performing a patient care intervention, technical performance alone is not sufficient. The technical performance must be accompanied by a specific level of cognitive ability (i.e., critical thinking, decision-making, professional judgment). The presence of these cognitive competencies in the care provider, in combination with client and environmental characteristics, are critical to decisions around staff mix and assignments of care providers to clients.

Collaboration among RNs and RPNs is an essential determinant in supporting ongoing decision-making about matching care providers’ competencies and skills with client care needs.

RN(EC)s have an expanded scope of practice that allows them to perform some of the activities traditionally limited to physicians. Specifically they may order diagnostic tests, such as x-rays and blood work, and prescribe certain medications. However, a nurse practitioner’s scope of practice is based on an in-depth and advanced nursing knowledge and the corresponding skills required to meet patients’ primary health care needs.

Note : Compiled from material from the College of Nurses of Ontario



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