Action Alert: STOP further action on CNO council decision to expand RPN scope

The College of Nurses of Ontario (CNO) made a stunning decision approving a regulation change for the Registered Practical Nurse (RPN) scope of practice at its CNO Council meeting on September 17, 2020 that will seriously jeopardize the safety of the public and render the Registered Nurse (RN) and Registered Practical Nurse (RPN) scope of practice identical.

RNAO and ONA value the significant contributions of RPNs to Ontario’s health system. However, scope of practice limitations guided by entry level education are a critical component of self-regulation that exists to protect the public. This is why this entry level major regulatory change is dangerous for Ontarians. Within this context, we are strongly opposed to this regulation change to the RPN scope due to its potentially damaging shortfalls in relation to: 

  1. Protection of patient safety
  2. Knowledge and judgment required for independently  “initiating” a procedure as different from “performing” a procedure with an order that are not part of the RPN skill set
  3. Adherence to the CNO’s three factor framework of client complexity, predictability and risk of negative outcomes
  4. The CNO’s mandate to regulate two major categories of nurse-- RNs and RPNs-- with distinct bodies of knowledge, abilities and skill sets that define and differentiate scope of practice.

RNAO and ONA urge Premier Ford and Minister Elliott to  stop action on the September 17, 2020 CNO Council decision to expand RPN scope of during this time, given the pandemic has profoundly impacted the nursing profession, the public and the health system. RNAO strongly believes this matter should be referred to the Health Professionals Regulatory Advisory Council (HPRAC) for arm’s length consultation

To our alarm, the approval of the expansion of RPN scope of practice allows RPNs to independently initiate without an order, four controlled acts that are currently reserved for the registered nurse (RN) scope of practice. 

Reiterating the strong opposition to this regulatory change expressed by each of our organizations individually, RNAO and ONA are jointly taking a stand against any further action by the Ontario government to move forward with the proposed RPN regulation change. The rationale for our action is clearly laid out in our respective letters to CNO, included in the June 2020 Council Briefing Package, and is addressed in our joint letter. This change made without due process because of COVID-19, lack of full disclosure of ONA and RNAO’s joint position, and misinformation related to the evidence regarding patient need and patient safety is unconscionable. In summary, this decision that allows RPNs to perform the above intrusive procedures without an order from an appropriate provider was made in the absence of evidence regarding the safety of and the need for this scope of practice change, thus jeopardizing the safety of Ontarians receiving nursing and health care. Despite this, the majority of nurses consulted were against the change and based on CNO's own survey results, 86% of the public who responded oppose this change. 

Tell Premier Ford and Minister Christine Elliott that you want government to STOP further action on the CNO September 17, 2020 Council to expand the RPN scope of practice until post COVID-19 and refer this matter to HPRAC for arm’s length consultation.

Copy will be sent to the following:

Christine Elliott
Minister of Health, Progressive Conservative Party of Ontario
Hon. Doug Ford
premier of Ontario and provincial minister of intergovernmental affairs
Your local MP
Your local MPP