Registered Nurses in the Extended Class [RN(ECs)], more commonly known as Nurse Practitioners (NPs) are graduate-prepared Registered Nurses, regulated since 1998 in the Extended Class by the College of Nurses of Ontario (CNO). NPs must meet rigorous requirements and standards to enter and maintain ongoing registration in Ontario. NPs independently, and in collaboration with health care professionals, provide health care services for all ages and across the health spectrum (e.g., primary care, acute care and long-term care). In Ontario, NPs are authorized to:
- Complete a comprehensive health history and assessment;
- Formulate and communicate a diagnosis, taking a differential diagnosis into consideration;
- Prescribe all medications including controlled drugs and substances;
- Dispense, sell, and compound medications;
- Set and cast fractures and dislocated joints;
- Order and interpret all laboratory tests;
- Admit, treat and discharge patients from hospitals; and
- Order some diagnostic imaging tests (CNO, 2016).
Every province and territory regulates NPs and, while scope of practice continues to evolve, there is much consistency in regards to scope of practice, educational preparation at the graduate level, and regulation of the profession across the country (Spence, Agnew, & Fahey-Walsh, 2015).
To become an NP and to gain access and authority to autonomously and safely perform additional controlled acts such as communicating a diagnosis, prescribing medications, and ordering treatments and diagnostic tests, the RN must become an NP. Today, to be eligible to become an NP in Ontario the RN must be a graduate of a four-year Baccalaureate degree in Nursing and must have at least two years of full-time clinical practice experience (although the average is 17 years according to CRaNHR, 2012). This is followed by successful completion of a Master’s program. The Master’s program is two years (seven courses) and takes two full calendar years or 24 months to complete. The program includes courses in advanced health assessment, advanced pathophysiology, therapeutics, and roles and responsibilities, as well as 728 clinical practice hours in the primary health care NP program and 800 clinical hours in the Paediatric or Adult NP program. Courses are sequenced, coordinated and integrated so that each course builds on the previous one. For example, over the course of the program NP students develop increasingly complex sub-concepts and processes such as diagnostic reasoning, formulation of a differential diagnosis and treatment plan, and prescription. The completion of the course work and integrated clinical practicum leads to the final exam and Objective Structured Clinical Evaluation (OSCE). These final exams ensure that students have acquired the necessary knowledge and skills to be competent, safe and ethical NPs.
Following successful completion of the NP program, graduates are then eligible to write and must successfully complete the NP exam for the specialty area of practice, as designated by the College of Nurses (CNO), to become registered as an NP. To maintain registration, NPs are scrutinized through CNO’s rigorous quality assurance program that may include online tests, an Objective Structured Clinical Evaluation (OSCE) and/or a practice assessment (chart audit) (CNO, 2014a). This advanced education prepares the NP to develop a differential diagnosis, which is a critical component of prescribing knowledge, skill and judgment.
NPs have demonstrated high levels of efficacy, safety and cost-effectiveness. No other group of health care professionals has been studied as much as NPs (Horrocks, Anderson, & Salisbury, 2002; Venning, Durie, Roland, et al., 2000; Stanik-Hutt, Newhouse, White, et al., 2013; and Martin-Meisener, Harbman, Donald, et al., 2015).
NP Specialty Certificates & Scope of Practice:
There are four types of NP certificates identified under the Nursing Act in Ontario: NP – Primary Health Care, NP – Adult, NP – Paediatric and NP – Anaesthesia. The majority of NPs in Ontario
For up to date Nurse Practitioner Registration Statistics please click on the link to the College of Nurses of Ontario “Membership Totals at a Glance”:
For more details about NP scope of practice in Ontario and across Canada see