CNO Standards and Regulations in Nursing

CNO as a Regulatory Body

• CNO establishes requirements for entry into nursing practice.
• It sets and promotes practice standards and guidelines.
• CNO administers the Quality Assurance Program.
• It enforces standards of practice and conduct for the protection of the public.
• CNO utilizes a disciplinary process when needed.

CNO Documents

• Practice Standards: Authoritative statements define the legal and professional basis of nursing practice. Specific statements outline each nurse's accountability and responsibilities. Standards describe the expected level of performance.
• Practice Guidelines: These guidelines help nurses with practice issues, encompassing areas such as pandemic planning, consent, and guidance during medically assisted dying.
• CNO Code of Conduct: This code outlines the responsibilities nurses have towards clients, employers, colleagues, and the public. It explains expected behaviour, professionalism, competence, and ethical delivery of safe client care.
• The code applies to all registered nurses (RN), registered practical nurses (RPN), and practical nurses (PN), regardless of role, title, or responsibility. Employers, educators, and students should also utilize the code.

Nursing Principles

• Respect Client Dignity (Principle 1): Caregivers must respect client needs with empathy, compassion, and clear communication. Respect for privacy, confidentiality, informed consent, as well as recognition of personal beliefs are core behaviours.
• Provide Inclusive & Culturally Safe Care (Principle 2): Cultural humility via self-reflection and advocating for equitable care are paramount. This involves understanding how personal and social contexts impact client care.
• Provide Safe & Competent Care (Principle 3): Nurses must work within their legal scope of practice, education, experience, knowledge, skill, and judgment to provide safe, competent care. This includes adherence to standards, advocating for patients, and appropriate use of knowledge, skills, and judgment.
• Work Respectfully with the Healthcare Team (Principle 4): Nurses must remain accountable to each other and build respectful relationships with the entire healthcare team. This necessitates self-reflection on biases, avoiding stereotypes, and professionalism in all contexts including social media.
• Act with Integrity in Clients' Best Interest (Principle 5): Honest, fair practice focuses on building trust and a therapeutic nurse-client relationship. Nurses must advocate for resources, protect client privacy, avoid conflicts of interest, maintain professional boundaries, and protect clients from harm.
• Maintain Public Confidence in Nursing (Principle 6): This principle involves promoting dignity, portraying professionalism, and showing leadership through complying with laws, taking accountability for decisions, omissions, and outcomes. It also includes reporting errors, unsafe behaviours, and maintaining accountability within the QA program.

Nursing Scope of Practice

• Controlled Acts: Some acts, outlined by the RHPA (potentially harmful if performed by untrained personnel), should only be performed by authorized health professionals (e.g., performing a procedure below the dermis, administering a substance by injection, or treating serious disorders of thought). There are 14 controlled acts. Five controlled acts were defined in 1991.

• Orders:

  • Direct Orders: Individualized prescriptions for procedures, treatments, or interventions for a specific client and time. May be written or verbal (only in emergencies or when the prescriber cannot document).
  • Medical Directives: Written orders for a variety of clients under specific circumstances and conditions (e.g., implementing a community clinic flu shot program for eligible clients).

• Delegation: A legally authorized health professional (delegator) temporarily grants authority to perform a controlled act to another individual (delegatee), but assumes responsibility of ensuring the delegatee's competence. Sub-delegation is not permitted. Certain classes of nurses have additional restrictions on delegation of controlled acts.

• Initiation: Under certain permitted regulations, RNs and RPNs can independently assess and perform some controlled acts without an order (e.g., some assessment activities). The types of specific acts permitted are not universally applicable, and will vary by legislation and facility policies

Essential Employability Skills

• Essential employability skills include communication, problem-solving, respect for others, teamwork, time management, and accountability.

What is Nursing Practice?

• Nursing practice is diverse and encompasses promotion of health, assessment of health conditions, care provision, treatment, and support to maintain optimal functioning.

Nursing in Ontario

• Ontario has two categories of nursing registration: Registered Nurse (RN) and Registered Practical Nurse (RPN).
• The regulatory body is the College of Nurses of Ontario (CNO).
• All nurses in Ontario must be registered with CNO.
• Nurse roles can include clinical care, administration, education, counseling, leadership, and research across the lifespan in various settings.

Nursing in Canada

• Each province/territory has its own regulations but "nurse" is a protected title across Canada.
• Different classes of nurses exist in Canada, including General, Extended, Temporary, Special Assignment, Emergency Assignment, and Non-Practicing classes.

Requirements for Registration and Maintenance

• Registration requirements include completion of an approved nursing program, passing the necessary exams (REx-PN for practical nurses, RN/RPN Jurisprudence exams).
• Maintenance requires updating contact information, reporting any changes in profession or jurisdiction, reporting relevant offences, and participating in the Quality Assurance program (QA), including self-assessment and development of a learning plan.

Reflective Practice

• Reflective practice is an intentional process for analyzing and learning, often involving identifying strengths, areas for improvement, and learning needs.
• Nurses reflect throughout their careers, using methods like completing reflective papers, debriefing after training or simulations, and providing peer and self-feedback.
• Reflection is a key aspect of continued competence for nurses.

Summary Questions

• A registration class (category) of nursing is a grouping of nurses in a particular regulatory framework.
• Nurses register to practice to comply with legal requirements, maintain professionalism, and be recognized as qualified practitioners.
• Registration involves graduating from an accredited program and passing assessments.
• The majority of nurses fall under the General or Extended class.
• Your Professor's type of registration (class) is not listed in this text.
• Reflection is identifying strengths and weaknesses to develop learning strategies. Nurses reflect to improve client care quality, critical thinking, and personal/professional growth.
• A practicing nurse is actively engaged in nursing practice; a non-practicing nurse is not actively practicing.

Explore the essential regulatory frameworks established by the College of Nurses of Ontario (CNO) that govern nursing practice. This quiz covers entry requirements, standards of practice, and the ethical guidelines nurses must adhere to. Test your knowledge on how these regulations protect the public and ensure quality care.