Registed Nurses' Association of Ontario

Publications & Resources

Key Drivers

Legislative and Regulatory Amendments

In December, 2009 the Government of Ontario passed Bill 179, the Regulated Health Professions Statue Law Amendment Act, 2009 for the purpose of enabling timely, efficient and effective care, thereby:

  • Increasing access to care for Ontarians by enabling the scopes of practice of certain regulated health professions,
  • Removing barriers to the provision of care,
  • Promoting greater inter-professional collaboration among health professions and
  • Optimizing the provision of services, while ensuring patient safety.

Twenty-six acts required amendment in order to fully enact Bill 179. Amendments to Regulation 965 of the Public Hospitals Act, 1990 maximize the effectiveness of Bill 179 and showcase Ontario as the first jurisdiction in Canada to legally authorize Nurse Practitioners (NPs) to admit, treat, transfer and discharge hospital inpatients. The most significant amendments to the various acts / regulations are included in Table 1.0. In particular, Regulation 965 improves patient flow and increases hospital efficiency by eliminating the need for most medical directives while enhancing and clarifying NPs’ independent accountability for their practice.

Table 1.0
Regulation / Legislation Amendment Date Effective
Regulation 965 of the Public Hospitals Act, 1990
  • Enable NPs to treat, transfer and discharge hospital in-patients
July 1, 2011
  • Enable NPs to admit hospital in-patients
July 1, 2012
Nursing Act, 1991
  • Remove prescription "lists"
October 1, 2011
  • Allow RNs and RPNs to accept care orders from an NP to perform controlled act procedures
October 1, 2011
  • Remove laboratory "lists"
October 1, 2011
Regulated Health Professions Act, 1991
  • Apply a prescribed form of energy
October 1, 2011 however regulations required to enable NP practice are pending from the College of Nurses
  • Set or cast a fracture of a bone or dislocation of a joint
October 1, 2011
  • Dispense, sell, compound or broadly prescribe drugs
October 1, 2011
Vital Statistics Act, 1990
  • Complete medical certificates of death in hospitals
July 1, 2011
Regulation 552 of the Health Insurance Act, 1990
  • Ensure laboratory tests ordered by nurse practitioners in independent health facilities and health services ordered by nurse practitioners in hospitals are insured services for patients.
June 3, 2011
Healing Arts Radiation Protection Act, 1990
  • Remove current restrictions on types of x-rays NPs can order, enabling them to order any x-ray appropriate for client care (and CT scans)
Pending Proclamation
Regulation 682 of the Laboratory and Specimen Collection Centre Licensing Act, 1990
  • Remove Appendix C, which limited the ability of NPs to order laboratory tests according to a prescribed list
July 1, 2011

Note: Amendments to the Controlled Drugs and Substances Act, 1996 will further remove many of the restrictions for NP prescription of narcotics and other controlled substances. Final federal amendments are expected in the spring of 2012. Provincial regulations will subsequently be required to enable the legislation.

Other Relevant Legislation and Regulations

College of Nurses of Ontario NP Practice Resources

On October 1st, 2011, amendments to the Nursing Act, 1991 came into effect enabling NPs to broadly prescribe medications and laboratory testing. The College of Nurses of Ontario (CNO) incorporated these and other legislative changes by swiftly issuing the following documents online:

As a result of this enabling authority, time and effort previously used to develop and seek approval for bureaucratic medical directives can now be redirected to quality improvement initiatives that streamline and optimize inter-professional practice patterns in the healthcare system. While these amendments provide legislative authority for NP practice in hospital settings, it is the responsibility of each hospital to identify how to operationalize and support NP practice concerning treatment and discharge now and admission starting July 1, 2012.

Health Professions Regulatory Advisory Council (HPRAC) Reports

According to the 2008 HPRAC report on the Review of the Scope of Practice for Registered Nurses in the Extended Class, “Nurse Practitioners will improve the availability and efficiency of patient care and lead to better and more comprehensive and coordinated services.” Two relevant HPRAC reports about NP practice are:

Professional Association Policy Documents

Given the tremendous potential for improved health and health care system outcomes, professional associations have produced numerous documents outlining the evidence supporting the implementation of Nurse Practitioners in a variety of settings. Policy documents that relate to the hospital setting include the following: