Members and the public attend Council meetings as observers. Observers do not participate in the meeting.

Transcription

1 Observer Guidelines OBSERVER PACKAGES A PDF observer package will be available at least one week before the Council meeting from the College s website: Observers may download the package onto a personal device in advance or access the College s guest Wi-Fi during the meeting. Instructions are provided with observer packages. Depending on demand, the Wi-Fi may go down. ATTENDING THE MEETING Council meetings begin at 9 a.m. and are held in the Council chambers at the College of Nurses (101 Davenport Road). If a portion of the meeting is closed to the public, it will be identified as such with the agenda posted on the website. There are morning and afternoon refreshment breaks and a one-hour break for lunch.. Members and the public attend Council meetings as observers. Observers do not participate in the meeting. Do not try to speak with, or pass notes and information to, Council members during the meeting. You may use devices (cell phones, tablets, laptops) to access the background papers. Please turn off pagers and the ringer to your cell phone while in Council chambers. Observers should limit comings and goings throughout the meeting. If you need to leave the Council Chambers between scheduled breaks, use the door marked "Council Chamber Exit" at the north end of the Council chamber, where the observer seating is located. Observers are welcome to have refreshments in the observer lounge at the north end of the Council chambers. An hour-long break is provided to allow observers time to have lunch outside the College. The Council lounge is private and observers are not allowed. Observers are asked to be quiet during the meeting. The acoustics in the Council chamber are particularly good and side conversations are distracting to others. If you wish to have a discussion, you are free to leave the meeting and rejoin it later. Refrain from wearing perfume, scented lotion or aftershave. Observers who come wearing scented products will not be allowed to go into Council chambers. Please note there is no on-site parking for observers. (Map to off-site parking) To attend a meeting, or if you have any questions about Council or committees, contact Jenna Hofbauer, Council Affairs Coordinator, at (toll-free in Ontario ext. 7566) or by at jhofbauer@cnomail.org.

2 Agenda Council Meeting Thursday, June 9, :00 a.m. 5:00 p.m. 9:00 a.m. 1. Agenda Review Decision 9:05 a.m. 2. Minutes Decision 2.1 Minutes of the Meeting of March 10, Confidential Appendix to the Minutes of the Council Meeting of March 10, Business Arising out of the Minutes 9:10 a.m. 3.1 Appointment of the public members of the Executive Committee Decision 4. Correspondence 9:30 a.m. 4.1 Correspondence and advice from Legal Counsel Information 5. Strategic Issues 9:50 a.m. 5.1 Proposed changes to the registration regulation Decision 10:30 a.m. Break 10:45 a.m. 5.2 Number of writes for the NCLEX-RN examination Decision 11:30 a.m. 5.3 Annual report of the College Audited financial statements Audited statements of the Pension Plan Trust Fund Blair MacKenzie, Hilborn LLP presenting Decision

3 Council Agenda Page 2 June 9, :15 a.m. 5.4 Celebrating Success Information 12:30 p.m. Lunch 1:30 p.m. 5.5 Fee increase by-law amendment for circulation Decision 1:50 p.m. 5.6 Medical Assistance in Dying Information and discussion 2:30 p.m. 5.7 Nurse Practitioner Practice Standard Direction 3:00 p.m. Break 6. Reports 3:15 p.m. 6.1 Executive Director Update Information 3:45 p.m. 6.2 Executive Committee meeting of May 12, 2016 Information 4:00 p.m. 6.3 Finance Committee meeting of May 25, Appointment of the auditors for :30 p.m. 7. Council Operations and Governance Decision Discussion 7.1 Committee appointments Next Meetings: Thursday, September 22, :00 a.m. to 5:00 p.m.

4 Agenda Item 2.1 Council Thursday, March 10, 2016 at 9:00 a.m. Minutes Present N. Sears, Chair L. Asheri C. Barnet C. Beemer Y. Blackwood D. Burger S. Corkey C. Egerton C. Evans A. Fox G. Fox D. Graystone M. Hogard J. Jamieson A. Jewell R. MacKay M. MacMillan-Gilkinson C. Manning S. McGeachy A. Molloy N. Osbourne James A. Plumton D. A. Prillo G. Rudanycz L. Sanderson M. Sloan M. Tuomi D. Walia C. Ward H. Whittle C. Williams Regrets J. Attwood R. Davidson D. Mattina Staff J. Anderson A. Coghlan J. Hofbauer, Recorder K. McGovern S. Mills C. Stanford Agenda The agenda had been circulated. The President flagged that some agenda items might be addressed out of order. Motion 1 Moved by A. Molloy, seconded by C. Williams, That the agenda for the Council meeting of March 10, 2016 be approved as circulated. CARRIED - 1 -

5 Council Minutes March 10, 2016 Closed Session A closed session is proposed for 1:30 p.m. Motion 2 Moved by C. Egerton, seconded by H. Whittle, CARRIED Minutes That the public be excluded from Council at 1:30 p.m. pursuant to clauses 7(2)(b) and 7(2)(e) of the Health Professions Procedural Code of the Regulated Health Professions Act, 1991 because personal or other matters may be disclosed of such a nature that the harm created by the disclosure would outweigh the desirability of adhering to the principle that meetings be open to the public and further because opinions will be received from the solicitor for the College. Minutes of the Council meeting of December 3, 2015 had been circulated. Motion 3 Moved by D. Burger, seconded by L. Sanderson, CARRIED That the minutes of the Council meeting of December 3, 2015 be approved as circulated. Confidential minutes of the closed session held on December 3, 2015 had been distributed. Motion 4 Moved by M. Hogard, seconded by A. Molloy, CARRIED That the minutes of the closed session of Council held on December 3, 2015 be approved as circulated

6 Council Minutes March 10, 2016 Bylaw editorial amendment In December 2015, when approving by-laws related to the removal of cautions in person and specified continuing education or remediation programs, a clarifying editorial change was suggested. Legal counsel confirmed that the edit does not change the intent. Motion 5 Moved by G. Fox, seconded by A. Jewell, CARRIED That the editorial changes to Article regarding removal of cautions in person and article regarding removal of specified continuing education or remediation programs, as they appear in attachment 1 to the briefing note, be approved. Follow-up Action Amend by-laws and post on cno.org Executive Director and CEO Fee increase In December 2015, the Finance Committee flagged that a fee increase is needed beginning in A commitment was made to bring options to Council in March. The Finance Committee is recommending a lump sum increase of $35 in 2017 followed by smaller increases in 2018 ($10), 2019 ($5) and 2020 ($5). No increase is proposed for It was noted that a key decision-making criterion for the Finance Committee was that the increase maintains the College s surplus within the following guideline approved by Council: six months of operating expenses and three months of operating expenses. The assumptions on which the options were based were highlighted. In response to a question it was confirmed that the assumptions include anticipated savings from the College s participation in the information system consortium and from automation of processes. It was noted that the proposed fee is the same for RNs, RPNs and NPs. The fee is based on the cost of regulation spread equally across the number of nurses registered with the College. There was a review to determine if different fees were warranted, for example to address the higher cost for quality assurance for Nurse Practitioners. It was determined that a fee differential is not warranted at this time. There was discussion about whether a large one-time increase would be preferable to a series of increases. Since members can be anticipated to react negatively to fee increases, annual increases might be an ongoing irritant

7 Council Minutes March 10, 2016 The Finance Committee s recommendation is based on the most responsible use of member fees. A smaller lump sum increase followed by annual increases allows the College to collect less money from members overall while remaining within the surplus guidelines. It was noted that following a decision by Council, a communication plan will be developed, including circulation of the proposed fee by-law over the summer. Motion 6 Moved by C. Barnet, seconded by H. Whittle, CARRIED That a by-law proposal for a fee increase be prepared for Council review in June of 2016, based on option 3 as it appears in the table on page 4 of the briefing note. Follow up action Prepare draft fee by-law amendment for Council review in June 2016 Executive Director and CEO Annual report on the Strategic Plan Monitoring the strategic plan is a joint Council/staff accountability. In 2015, Council provided feedback and input into the new reporting framework and the key performance indicators. It was noted that key performance indicators provide valid objective measures. They report on outcomes that are measurable, where the College can influence the outcome. They do not report on everything that is done to move forward the strategic objectives. In some cases, the College has deliberately chosen to report on challenging processes where the indicators reflect a need for focusing resources for improvement. The report identifies the challenges faced and the potential influences the College can have on outcomes. It was noted that the College is continually improving its ability to collect and leverage data. In the future a more in-depth analysis of the key performance indicators may be possible. There was discussion about whether the key performance indicator for nurse engagement includes all of the relevant data. It was suggested that consideration be given to inclusion of involvement in the election, participation in the quality assurance program, contacting the College by telephone and accessing the website

8 Council Minutes March 10, 2016 There was discussion about the value of employer commitment to public safety. It was suggested that information on how employers support quality assurance and address complaints might be helpful. There was also discussion about the low use of the automated annual verification of renewal service available to employers. As it is a public safety issue to ensure only nurses whose registration is current are practising, it was suggested that the College explore strategies to encourage more employers to access this service. In discussion about opportunities for engaging nurses, it was pointed out that the College is careful in selecting its approaches to ensure that they reflect its public protection mandate. For example, in Nursing Week, the College takes the opportunity to highlight the commitment of nurses and the College to the provision of safe and ethical nursing services to the public. There was discussion about the number of days taken to register international applicants. The indicator intentionally measures the full process at the College, including aspects over which the College has no control, such as the time taken for applicants and third parties to submit required documentation. It was clarified that the indicator does not include the time taken by processes undertaken by the National Nursing Assessment Service. There was discussion about the time taken at the National Nursing Assessment Service. Council was informed that there are timelines for assessments and the board monitors that information. Information about the National Nursing Assessment Service will be shared with Council in the future. It was noted that the College is working with a variety of stakeholders, including educators and government, to influence changes that will decrease the time that international applicants require to become registered with the College. There was discussion about the potential impact of the length of the process on international applicants being able to meet the three year practice requirement. It was noted that the College has shortened the time it takes for an international applicant to be assessed as eligible to take the registration examination. There was a question about collaboration with the government and educational sector to address the education needed to support international applicants in addressing gaps identified in the assessment. The College has been in discussion with educators and a collaborative has put together a proposal. To date, funding has not been confirmed. It was pointed out that the dashboard is a very effective tool for governors. It was noted that as the new system is implemented, the College hopes to be able to provide a variety of dashboards. Council was informed that the government is exploring the concept of consistent indicators across regulators. The College hopes to be involved with that initiative and ensure that the new technology supports the College in collecting and analyzing the needed data

9 Council Minutes March 10, 2016 It was pointed out that there is a significant gap between the current situation and the goal for Council and committee member use of technology. Council members reported that the College has addressed the password issues with the current Council portal. RN Prescribing In December, Council was advised that the Minister of Health and Long-Term Care had announced that RN prescribing will be implemented in Ontario. The Health Professions Regulatory Advisory Council was asked by the Minister to recommend a model for RN prescribing. There was a short consultation timeframe. The College circulated its draft response to the Executive Committee for input; however, there was not time for it to be brought to Council. Council members received a copy of the College s response, which identified a number of key regulatory questions. Council members commended staff for a thoughtful, responsible and comprehensive response. It was clarified that the response is public and can be shared. The College noted that once a model is selected, Council will need to put in place the regulatory mechanisms to ensure safe prescribing. It was pointed out that any changes regarding RN prescribing will have an impact on the College s quality assurance program. Statutory committee reports N. Sears noted that the work of statutory committees is critical to the College s regulatory mandate. The committee reports are an important accountability mechanism. She identified that it is a requirement of Section 11 of the Health Professions Procedural Code that statutory committees present reports to Council each year. Members of Council had received the committee reports. Inquiries, Complaints and Reports Committee N. Sears noted that a major focus for the Inquiries, Complaints and Reports Committee was to implement the risk framework for assessing cases that was supported by Council in June In the new framework, each level of risk has specific outcomes. N. Sears noted that as of December 15, 2015, oral cautions and specified continuing education or remediation programs are included on the register. Council was informed that 54% of complaints were addressed through resolutions in Patient Relations Committee N. Sears noted that the Patient Relations Committee report highlights the work of the Inquiries, Complaints and Reports and Discipline committees with respect to client abuse and nurse/client boundary violations. Council was informed that the committee approved funding for a client who had been sexually abused by a nurse

10 Council Minutes March 10, 2016 Discipline Committee M. Hogard highlighted the report of the Discipline Committee. He noted that fewer cases were completed this past year than in recent years. He reported that the committee held two reinstatement hearings, with one successful applicant. He reported that the media attended two high-profile hearings related to privacy issues. Fitness to Practise Committee M. Tuomi noted that the Fitness to Practise Committee addressed 103 cases in This is a 10% increase over She noted that the committee received and granted eight applications for removal of information from the register. Quality Assurance Committee A. Jewell reported that 676 randomly selected members participated in the program in It was identified that there was a significant drop in the number of participants from the general class between 2014 and This was as a result of resource availability impacted by staff involvement in the College s business transformation project. Registration Committee C. Egerton highlighted the report of the Registration Committee. She noted that the committee addressed a significant number of international applicants. Most of the appeals to the Health Professions Appeal and Review Board dealt with language competency issues or applicants who had failed the entry-to-practice examination three times. The Board confirmed the majority of the committee s decisions. N. Sears thanked the chairs and the members of the statutory committees for the contributions that they make to nursing regulation. Executive Director Update A. Coghlan informed Council that at the end of March, the College will be releasing the 2015 NCLEX-RN exam results, including the program specific results, as part of its annual exam report. It was noted that one of the challenges in monitoring implementation of the new examination was that results were available on a daily basis rather than at the end of each exam writing cycle. This makes the results of analyses fluid and difficult to report in a reliable way during the calendar year. The College now has a full year of results. B. Knowles previewed some of the data from the 2015 annual exam report. The report for all categories of registration has been enhanced by adding the ultimate pass rate. The ultimate pass rate is the percentage of all candidates who took the exam during the year and passed. Unlike earlier reports, it is not limited to first time writers. The NCLEX-RN ultimate pass rate was 83.8%, which is comparable to the previous examination, with the exception of 2014 results which had a higher than usual pass rate

11 Council Minutes March 10, 2016 The French-language examination has a small number of writers, making analysis of the results difficult to compare reliably across years. Not all graduates of French-language programs choose to write the exam in French. A. Coghlan outlined the outreach activities that the College has undertaken now that the full year results are available, including meeting with each education program to review the results. There has been extensive communication with government including the Ministries of Health and Long-Term Care; Training, Colleges and Universities and Francophone Affairs. A. Coghlan informed Council that an independent review of the translation was undertaken by the Translation Bureau of the government of New Brunswick. She reported that the report was just received. Anecdotally, the report is positive. Following further study and analysis, the results will be shared with Council and with the Ministry of Francophone Affairs. It was confirmed that the information on pass rates by programs will be available to students and to individuals considering a career in nursing when the report is posted on the College s website at the end of March. It was noted that the RPN entry-to-practice exam is moving to computer based writing in May. It was clarified that this computer based approach is not the same as a computer adaptive examination. The College is hosting teleconferences with educators. An e-learning webcast for students is available on the website along with updates to the frequently asked questions. In December, Council was informed of the policy work being undertaken to determine whether the three time exam writing limit is required for public safety for the NCLEX-RN. A national review is being undertaken by the Canadian Council of Registered Nurse Regulators. The goal is a national recommendation which will meet the public protection purpose of the examination and promote national consistency to support mobility. The recommendation will be presented to Council in June. The Ministry of Health and Long-Term Care has expressed interest in this work and has asked the College to consider options for expediting a regulation change. The College usually brings the policy work for a regulation change to a Council meeting for direction and then brings the regulation forward to Council for review at a subsequent meeting. To expedite the process, Council will have a policy discussion in June. The draft regulation will also be provided, should Council support the need for change. To further expedite the process, the Ministry has signalled that the Minister might be willing to use the provisions of the legislation to shorten the period of time required for consultation regarding a change in the regulation limiting writing opportunities for the RN entry-to-practice exam

12 Council Minutes March 10, 2016 Motion 7 Moved by S. McGeachy, seconded by C. Egerton, CARRIED That, in accordance with subsection 95(1.6) of the Health Professions Procedural Code, Council requests that the Minister of Health and Long-Term Care abridge the 60-day consultation period referred to in subsection 95(1.4) of the Code to 45 days or such lesser period as the Minister may determine for proposed amendments to the registration regulation (Part II of Ontario Regulation 275/94, made under the Nursing Act, 1991, as amended), should Council approve the amendments for circulation in June of Follow up action 1. Send letter to Minister of Health and Long-Term Care requesting abridged consultation President 2. Prepare policy paper and draft regulation for Council review in June Executive Director and CEO Council was updated on the College s work related to medical assistance in dying. Executive committee Council members had received the draft minutes of the Executive Committee meeting of February 23, It was noted that the focus of the meeting was on preparing materials for Council. There were no questions. Finance Committee C. Barnet highlighted the report of the Finance Committee meeting of February 23, The Finance Committee had reviewed the unaudited financial statements for the year ended December 31, She noted that, despite a significant write-off, the year-end surplus of $184,000 was $1.1 million more than the budgeted deficit of $910,000. She noted that the Finance Committee had a robust discussion about the financial statements and the reasons for the variances. Motion 8 Moved by C. Barnet, seconded by A. Molloy, CARRIED That Council accept the unaudited financial statements for the year ended December 31,

13 Council Minutes March 10, 2016 In-camera session Minutes of the in-camera session are in a confidential appendix to the meeting minutes. Practical nurse program approval It was noted that it is Council s accountability, under the registration regulation, to approve nursing education programs. H. Siu, Entry to Practice Consultant, provided an overview of the current approval process for RPN programs. The process has been designed to provide an unbiased, objective, evidencebased review of all programs. The President informed Council that to address conflict of interest, decision making about the approval process will take place on a category by category basis. The President asked that any member of Council involved in a program recommended for category 1 approval declare a conflict. The President noted that she has a conflict and has asked C. Barnet to chair the meeting in her absence. D. Burger and A. Jewell also declared conflicts. D. Burger, A. Jewell and N. Sears left the meeting. C. Barnet assumed the Chair. Motion 9 Moved by R. MacKay, seconded by M. Hogard, That the approval statuses of the following practical nurse programs remain Category 1 Approved: Colleges with full Diploma programs: Algonquin, Boreal, Cambrian, Canadore, Conestoga, Confederation, Durham, Fanshawe, Fleming, Georgian, Humber, Lambton, Loyalist, Mohawk, Niagara, Northern, Sault, Sheridan, St. Clair, St. Lawrence College with specified program for International Applicants Centennial CARRIED D. Burger, A. Jewell and N. Sears rejoined the meeting. N. Sears assumed the Chair. The President called for conflicts of interest with respect to programs being recommended for Category 2 approval. None were declared

14 Council Minutes March 10, 2016 Motion 10 Moved by A. Molloy, seconded by M. Tuomi, CARRIED That the approval statuses of the following full diploma practical nurse programs remain Category 2 Approved with Conditions: Centennial College George Brown College Seneca College The President called for conflicts of interest with respect to the proposed Category 3 program. A. Jewell declared a conflict and left the room. The President noted that there have been changes since posting of the original Council briefing note about program approval, including fruitful discussions with La Cité College. As a result, a new recommendation is proposed. Motion 11 Moved by R. MacKay, seconded by A. Plumton, CARRIED That Council defer the decision on whether to continue to approve La Cité s Practical Nurse Program for the purposes of subparagraph 1(i) of subsection 3(1) of the College s Registration Regulation (being Part II of Ontario Regulation 275/94, as amended, made under the Nursing Act, 1991) until Council s December, 2016 meeting, provided that La Cité continue to voluntarily suspend new admissions to that program. A. Jewell returned to the meeting. Follow up action 1. Inform Colleges of approval status and any outstanding action required 2. Include final decision re. approval of La Cité s program on the agenda for the December 2016 Council meeting. Executive Director and CEO Content of Council minutes In December, Council referred the issue of the content and format of the Council minutes to the Governance Task Force. The Task Force is recommending the inclusion of action in the minutes. There was some discussion about how the action items will be tracked. Council was reminded that an annual plan is one of the quick wins and will be presented in June. One option is to

15 Council Minutes March 10, 2016 include the actions and outcomes in the annual plan. It was also suggested that a summary list of actions could be prepared and outcomes tracked. Motion 12 Moved by J. Jamieson, seconded by C. Beemer, CARRIED That, beginning in March 2016, Council minutes include the action arising from Council decisions and direction. Follow up action Include decisions in Council minutes, beginning with March Executive Director and CEO Filling a vacancy The resignation of C. Balcom created a vacancy. A. Jewell declared a conflict of interest and left the meeting. In accordance with the By-Laws, the Election and Appointments Committee is recommending appointment of the runner up in the election. Motion 13 Moved by M. Hogard, seconded by C. Egerton, CARRIED That Joanne Furletti be appointed to Council until June 2017, to fill the RN Council member vacancy from the Eastern District. A. Jewell returned to the meeting. Follow up action Inform Joanne Furletti of her appointment. Executive Director and CEO Scrutineers for the election of officers S. McGeachy, Chair of the Election and Appointments Committee drew the names of three scrutineers at random

16 Council Minutes March 10, 2016 Motion 14 Moved by A. Molloy, seconded by S. Corkey, CARRIED That D. Burger, A. Fox and G. Fox be scrutineers for the election of the Council officers. Election of Officers S. McGeachy, Chair of the Election and Appointments Committee, chaired the election of Council officers. She reviewed the candidates who had been nominated: President: Cheryl Beemer Megan Sloan Vice-President, RN Cheryl Barnet Vice-President, RPN Laura Sanderson S. McGeachy called for nominations from the floor. There were no nominations. Motion 15 Moved by R. MacKay, seconded by G. Rudanycz, CARRIED That nominations for the election of the Council officers be closed. S. McGeachy informed Council that the following have been elected by acclamation: Vice-President, RN Cheryl Barnet Vice-President, RPN Laura Sanderson Candidates for President each made a short speech and each answered four questions from the floor. At the request of the Chair, ballots were distributed to all Council members. After a pause and at the request of the Chair, the scrutineers collected the ballots in the ballot box. Council broke to allow time to count the ballots

17 Council Minutes March 10, 2016 Election results After Council reconvened, S. McGeachy informed Council that M. Sloan was elected President. Her term of office will take effect at the June meeting of Council. S. McGeachy informed the candidates for election as President that they can request the numerical results of the election from her until the end of March. Motion 16 Moved by C. Williams, seconded by R. MacKay, CARRIED That the ballots for the election of the Council officers be destroyed. N. Sears returned to the Chair. The newly elected officers briefly addressed Council. Statutory Committee Chairs The Executive recommends the Chairs of statutory committees. Motion 17 Moved by C. Williams, seconded by G. Fox, That the following be the Statutory Committee Chairs: Discipline M. Hogard Fitness to Practise M. Tuomi Quality Assurance A. Jewell Registration D. Burger CARRIED Appointment to committees Council members had received a report of the process the Election and Appointments Committee used in making committee appointments. The proposed committee membership was reviewed for Council. There was discussion about the process used in recommending the public members of the Executive. It was decided to review and approve the committee membership separately

18 Council Minutes March 10, 2016 Motion 18 Moved by G. Fox, seconded by A. Plumton, CARRIED That Council confirm appointment of the Council and committee members of the Finance Committee as recommended by the Election and Appointments Committee and set out in appendix 1 to the minutes. Motion 19 Moved by A. Fox, seconded by M. Hogard, CARRIED That Council confirm appointment of the Council and committee members of the Registration Committee as recommended by the Election and Appointments Committee and set out in appendix 1 to the minutes. Motion 20 Moved by M. Tuomi, seconded by C. Manning, CARRIED That Council confirm appointment of the Council and committee members of the Quality Assurance Committee as recommended by the Election and Appointments Committee and set out in appendix 1 to the minutes. Motion 21 Moved by A. Plumton, seconded by S. McGeachy, CARRIED That Council confirm appointment of the Council and committee members of the Inquiries, Complaints and Reports Committee as recommended by the Election and Appointments Committee and set out in appendix 1 to the minutes

19 Council Minutes March 10, 2016 Motion 22 Moved by D. Burger, seconded by D. Walia, CARRIED That Council confirm appointment of the Council and committee members of the Fitness to Practise Committee as recommended by the Election and Appointments Committee and set out in appendix 1 to the minutes. In reviewing the proposed membership for the Discipline Committee, it was pointed out that one of the proposed members had resigned. Motion 23 Moved by C. Evans, seconded by C. Manning, CARRIED That Council confirm appointment of the Council and committee members of the Discipline Committee as recommended by the Election and Appointments Committee, as corrected, and as set out in appendix 1 to the minutes. The current process for selecting the public members on the Executive Committee was highlighted. It was noted that the structure, membership and role of the Executive Committee is under review as a part of the governance review, as is the process for members appointments to committees. Motion 24 Moved by C. Manning, seconded by M. Tuomi, DEFEATED That Council confirm appointment of the following members of the Executive Committee: Megan Sloan, President; Cheryl Barnet, Vice-President, RN; Laura Sanderson, Vice-President, RPN; Yvonne Blackwood and Debra Mattina

20 Council Minutes March 10, 2016 Concern was expressed about lack of transparency and opportunity in the current process of appointment of public members to the Executive Committee. Concern was also expressed that the proposed membership does not provide for succession planning as both proposed public members have one more year remaining in their term on Council. Since the current Executive continues to serve until the new Council has its first meeting in June, it was suggested that appointing the public members of the Executive be deferred and be addressed as the first item on the June Council agenda. The newly elected officers will form a quorum at the June meeting until the appointment. All public members will be provided with an opportunity to express an interest in serving on the Executive. Motion 25 Moved by J. Jamieson, seconded by R. MacKay, CARRIED That appointment of the public members on the Executive Committee be deferred until the June 2016 Council meeting. Motion 26 Moved by A. Molloy, seconded by C. Egerton, That the Executive Committee be the elected officers and that there be two public member vacancies to be filled in June given due consideration to the recommendation from the Election and Appointments Committee, based on a review of information submitted by public members volunteering to serve on the Executive Committee. CARRIED Follow up action Circulate a request for volunteers to serve on the Executive Committee to all public members. Add appointment of the public members on the Executive Committee to the June Council agenda. Executive Director and CEO Election and Appointments Committee The Executive is recommending the members of the Election and Appointments Committee

21 Council Minutes March 10, 2016 Motion 27 Moved by C. Williams, seconded by L. Sanderson, CARRIED That the following be the Chair and members of the Election and Appointments Committee: M. Tuomi, Chair; G. Fox, M. Hogard, C. Manning, C. Ward, and H. Whittle. Sub-Committee on Compensation The Finance Committee recommends the members and the Executive recommends the Chair of the Sub-Committee on Compensation. Motion 28 Moved by H. Whittle, seconded by C. Egerton, CARRIED That the following be the Chair and members of the Sub-Committee on Compensation: Pam Hubley, Chair, Ella Ferris, and Dennis Stapinsky. Conclusion At 5:00 p.m. it was, Motion 29 Moved by A. Plumton, seconded by S. McGeachy, That Council conclude. CARRIED Chair

22 Council Minutes March 10, 2016 Appendix Committee Members (Term begins June 9, 2016) Executive Committee Megan Sloan, RPN, President Cheryl Barnet, NP, Vice-President - RN Laura Sanderson, Vice-President - RPN 2 public member vacancies Inquiries, Complaints and Reports Committee: Megan Sloan, RPN, Chair Pedro Andrade, RN Shana Anjema, RN* Cheryl Barnet, NP Laura Black, RPN* Yvonne Blackwood, PM Dalton Burger, PM David Head, RPN* Debra Mattina, PM Kyle Nielsen, RN* Nicole Osbourne James, PM Sandra Robinson, RN Katharina Skrzypek, RN* Laura Sanderson, RPN 2 public member vacancies Discipline Committee Michael Hogard, RPN, Chair Dawn Cutler, RN Renate Davidson, PM Samantha Diceman, RPN* Spencer Dickson, RN* Tanya Dion, RN David Edwards, RPN* Catherine Egerton, PM Cheryl Evans, RN Grace Fox, NP Tammy Hedge, RPN* Terry Holland, RPN Shiraz Irani, RN* Lina Kiskunas, RN* Karen LaForet, RN* Rob MacKay, PM Mary MacMillan-Gilkinson, PM Ashleigh Molloy, PM Winsome Plummer, RN* Desiree-Ann Prillo, RPN Susan Roger, RN* Donna Rothwell, RN* George Rudanycz, RN Heather Stevanka, RN* Margaret Tuomi, PM Devinder Walia, PM Cathy Ward, PM Chuck Williams, PM Ingrid Wiltshire-Stoby, RN * Appointed committee member

23 Council Minutes March 10, 2016 Fitness to Practise Committee Margaret Tuomi, PM, Chair Candace Bretzer, RPN* Renate Davidson, PM Cathy Egerton, PM Ashley Fox, RPN Barbara Frayne, RN* Fotyne Georgopoulos, RPN* Deborah Graystone, NP Michael Hogard, RPN Mary MacMillan-Gilkinson, PM Christine Miller, NP* Christine Noels, RN* David Remy, RN* Sheelagh Rutherford, RN* Sarah Schell, RPN* Fern Tarzia, RN* Chuck Williams, PM Finance Committee Cheryl Barnet, NP, Vice President - RN, Co-Chair Laura Sanderson, Vice-President - RPN, Co-Chair Megan Sloan, RPN, President Catherine Egerton, PM Ashley Fox, RPN Pam Hubley, RN* Andrea Jewell, RN Cathy Ward, PM Quality Assurance Committee Andrea Jewell, RN, Chair Kevin Boake, RPN* Sarah Flogen, RN* Joe Jamieson, PM Debra Mattina, PM Rob MacKay, PM Janice McCallum, RN* Desiree-Ann Prillo, RPN Devinder Walia, PM Heather Whittle, NP Registration Committee Dalton Burger, PM, Chair Cheryl Beemer, RN Sabrina Cestola, RPN* Cathy Egerton, PM Carrie Heer, NP* Connie Manning, RPN Ashleigh Molloy, PM Maureen Ralph, RN* Sara Salah, RN* Cathy Ward, PM * Appointed committee member

24 Agenda Item 3.1 Decision Note June 2016 Council Meeting Public Members of the Executive Committee Contact for questions or more information Anne Coghlan, Executive Director and CEO Decision for consideration re. recommendation of the Election and Appointments Committee That Dalton Burger and Debra Mattina be appointed as the public members of the Executive Committee. Background In March, when discussing the Election and Appointment Committee recommendations regarding the public members of the Executive Committee, concern was expressed that: all public members were not provided with an opportunity to volunteer to serve on the Executive Committee; and that the recommended membership does not provide any guarantee of continuity between the and Executives. Council asked that all public members be provided an opportunity to volunteer to serve on the Executive and that the Election and Appointments Committee recommend the public members of the Executive Committee to Council in June. All public members received the attached memo from Susannah McGeachy, Chair of the Election and Appointments Committee, inviting them to volunteer to serve on the Executive. A reminder was also sent to any public members who had not responded mid-way through the timeframe for response. Three members volunteered to serve on the Executive. The Election and Appointments Committee received all of the information submitted by the volunteers. They also received information about the terms of office of the volunteers and the committees on which they currently serve. 1

25 The Election and Appointments Committee noted that all volunteers were highly qualified and would be excellent on the Executive. The Election and Appointments Committee wanted Council to know that it was not an easy decision. The members of the Election and Appointments Committee considered the characteristics or attributes that they thought would be useful for a member of the Executive. Those included: clear and consistent focus on the College s public interest mandate a demonstrated understanding of, and commitment to, the College s regulatory role thoughtful and well-spoken contributor to the Council leadership experience, either within our outside of the College, or both. It was noted that Council will be making decisions about future governance in December of The Executive Committee may be tasked with some aspect of implementation of governance. It was identified that it may be helpful to have members with experience in governance and leadership on boards outside of the College. As requested by Council, the Election and Appointments Committee considered providing continuity from the previous Executive and the possibility of continuity going forward. This was considered in the context of the elected officers who are the other members of the Executive Committee. Ultimately, the Election and Appointments Committee recommended one member with experience on the Executive (Debra Mattina) and a new member to bring fresh perspectives to the group (Dalton Burger). The Chair of the Election and Appointments Committee followed up with all volunteers. Members Election and Appointments Committee Susannah McGeachy, Chair Michael Hogard Margaret Tuomi Devinder Walia 2

26 Date: April 4 Attachment 1 From: To: Subject: Susannah McGeachy, Chair Election and Appointments Committee Public Members of Council Volunteering to serve on the Executive Committee for response by April 22nd In March, Council deferred appointment of the public members of the Executive Committee in order to allow all public members an opportunity to identify if they wish to serve on the Executive. If you wish to volunteer to serve on the Executive, please to Jenna Hofbauer (jhofbauer@cnomail.org). Provide any information you believe will assist the Election and Appointments Committee (EAC) in recommending candidates for the Executive Committee to Council. At Council, it was suggested it might be helpful if volunteers shared the reason they wish to serve on the Executive. The role of the Executive is to support effective Council and committee functioning. Attached, for your information, are the terms of reference for the Executive Committee. Also attached is the mandate of the Inquiries, Complaints and Reports Committee (ICRC). In accordance with Article of the General By-Law, all members of the Executive serve on the ICRC. To avoid any potential issues regarding prior knowledge, members of the ICRC do not serve on the Discipline or Fitness to Practise committees. Should a member who currently serves on the Discipline and/or Fitness to Practise Committee be recommended for the Executive, the Election and Appointments Committee will also recommend members to fill the vacancies created on the Discipline and/or Fitness to Practise committee. For your information, the time commitment for the Executive and ICRC follow: Executive Committee Meets at least quarterly for half a day. Additional meetings may be held as needed, in person or by teleconference. ICRC Panels meet for one day each month Significant preparatory work, usually 2 days per day of meeting 3

27 In accordance with the direction from March Council, the Election and Appointments Committee will bring its recommendations regarding the public members of the Executive Committee and any other public appointments that are necessary as a result of those recommendations to Council in June. 4

28 EXECUTIVE COMMITTEE TERMS OF REFERENCE OVERVIEW: The Executive Committee is a statutory committee of Council. It has the following broad responsibilities: Statutory: to act on behalf of Council in circumstances requiring immediate action; and to carry out the statutory role of the Patient Relations Committee. Governance: to facilitate Council s efficient and effective functioning; and to facilitate the efficient and effective functioning of statutory committees. A. STATUTORY MANDATE: 1. Acts on behalf of Council when necessitated by time constraints and reports to Council. Section 12(1) 2. Carries out the functions of the Patient Relations Committee with respect to the Patient Relations Program as required in the Procedural Code, in particular: a) Approving funding for therapy for victims of sexual abuse by nurses; and b) Reporting to and advising Council on the College s Patient Relations Program. Section 85.7(3) Section 85 B. GOVERNANCE FACILITATING EFFECTIVE COUNCIL FUNCTIONING: 1. Facilitates the effectiveness of Council governance by reviewing processes related to the governance of Council and making recommendations to Council. 2. Reviews and approves the agenda for Council meetings as prepared by the Executive Director for clarity and priority, identifies items for which Council meetings may be closed to observers in accordance with s. 7(2) of the Procedural Code and recommends closure, with rationale to Council. 3. Reviews briefing materials for Council for clarity and comprehensiveness, for planning the appropriate approach for presentation, and may make recommendations to Council. May identify additional background that would assist Council in discussing specific items. 4. Reviews the evaluations of Council meetings to identify process improvements. 5. Receives updates on key trends and issues in the regulatory environment. 5

29 6. Participates in the strategic planning process. 7. Gives instruction regarding Discipline/Fitness to Practise committee appeals to the Superior Court of Justice (Divisional Court), or in respect of judicial review applications. 8. Recommends membership on standing and special committees, including the expert member of the Finance Committee, and the Election and Appointments Committee. 9. Makes recommendations to Council on the appointment of the Executive Director. 10. Approves the terms of the employment contract of the Executive Director. 11. Ensures the regular review of the terms of reference of standing committees and sub-committees of Council; role descriptions of Council members, officers, and committee chairs; the by-laws, and the legislation, and makes recommendations to Council regarding amendments to maintain relevancy. 12. Authorizes unbudgeted expenses in accordance with Article of the by-laws. 13. Reviews and recommends changes in expense and stipend policies biennially. C. GOVERNANCE FACILITATING EFFECTIVE COMMITTEE FUNCTIONING: 1. Reviews processes related to the governance of statutory committees and makes recommendations to Council. 2. Recommends statutory committee chairs to Council in June, based on the chair attributes and process approved by Council. 3. Makes appointments to statutory committees to fill vacancies, including appointments from the list of eligible members provided by the Election and Appointments Committee. 4. Disqualifies an appointed committee member in accordance with the provisions of Article 54.3 of the General By-Law. 5. Removes the chair of a committee, other than the Executive or Finance committees, on receipt of a requisition signed by at least two-thirds of the members of the committee, identifies a new chair for recommendation to Council and appoints the recommended individual as an interim chair pending Council s decision at its next meeting. 6

30 ACCOUNTABILITIES: The Executive Committee is accountable for acting in accordance with the Code, Nursing Act, regulations, By-Laws and any laws that apply to its processes and decision making. The Executive Committee is accountable to Council for fulfilling its governance role. The Executive Committee minutes, other than confidential appendices, are shared with Council MEMBERSHIP: The Executive is made up of the President, two Vice-Presidents (one RN and one RPN), and two public members. The President and Vice-Presidents are Officers of the College and are elected by the Council. The public members are appointed by the Council on recommendation of the Election and Appointments Committee. EFFECTIVE MARCH 2,

31 INQUIRIES, COMPLAINTS AND REPORTS COMMITTEE MANDATE KEY REGULATORY FUNCTION: To protect and serve the public interest, the Inquiries, Reports and Complaints Committee (ICRC) supports the enforcement component of the regulatory framework. Enforcement reflects the College s commitment to the public that concerns about practice and conduct are addressed. STATUTORY MANDATE: In accordance with the provisions in the Health Professions Procedural Code and the principles of procedural fairness: A panel selected to investigate a complaint: 1. Receives notice from complainants and members that they have reached a resolution and determines whether to: cease its investigation and adopt the proposed resolution; or continue investigating the complaint. s.25.1(4) 2. Determines, when the panel is satisfied that the complaint is frivolous, vexatious, made in bad faith, moot or an abuse of process, to take no action. s. 26(4)(5) 3. Considers the results of a complaint investigation and may do one or more of the following: refer allegations of professional misconduct or incompetence to the Discipline Committee, refer the member to another ICRC panel for incapacity proceedings, require the member to appear to be cautioned, require the member to complete a specified continuing education or remediation program, take any other action that is not inconsistent with the Act, s.26(1)(2)(3) make an interim order suspending or imposing terms, conditions and limitations on the member s certificate after referring a member to the Discipline Committee. s. 37 A panel selected to consider a report by the Executive Director under s. 79(a): 1. Considers the Executive Director s report of investigation and may do one or more of the following: refer allegations of professional misconduct or incompetence to the Discipline Committee, refer the member to another ICRC panel for incapacity proceedings, require the member to appear to be cautioned, require the member to complete a specified continuing education or remediation program, take any other action that is not inconsistent with the Act, s.26(1)(2)(3) make an interim order suspending or imposing terms, conditions and limitations on the member s certificate after referring a member to the Discipline Committee. s. 37 8

32 INQUIRIES, COMPLAINTS AND REPORTS COMMITTEE MANDATE A panel selected to inquire into whether a member is incapacitated under s. 58(1): 1. Determines, after conducting appropriate inquiries, whether to: require the member to submit to an examination conducted by a specified health professional; make an interim order suspending the member s certificate of registration if the member fails to submit to an examination. s Determines, after giving a copy of its report to the member, whether to: refer the matter to the Fitness to Practise Committee; s. 61 make an interim order suspending or imposing terms, conditions and limitations on the member s certificate. s. 62 The Inquiries, Complaints and Reports Committee 1. Determines, where appropriate, whether to: Approve the Executive Director s appointment of an investigator, s. 75(1)(a) Request that the Executive Director conduct an investigation after receiving a report from the Quality Assurance Committee, s. 75(1)(b) Request that the Executive Director appoint an investigator to investigate a complaint, s. 75(1)(c) Specify a period of time less than 30 days in which a member may make written submissions. s. 25.2(1) 2. Receives decisions of the Health Professions Appeal and Review Board (HPARB) respecting complaints and, where applicable: considers HPARB s recommendations; or takes action as directed by HPARB. s.35(2) 3. Monitors and evaluates its processes and submits an annual report of its activities to Council. s.11(1) IMPACT ON THE REGISTER: The following ICRC decisions are required to be noted on the Register in accordance with section 23 of the Code and Article 44.1 of the College s General By-Law: o Referrals to the Discipline Committee that have not yet been resolved. o Referrals to the Fitness to Practise Committee that have not yet been resolved. o Every suspension of a certificate of registration. o The terms, conditions and limitations that are in effect on each certificate of registration. o Where the ICRC has accepted a member s agreement to resign permanently as the final disposition of a complaint or Executive Director report of investigation. 9

33 INQUIRIES, COMPLAINTS AND REPORTS COMMITTEE MANDATE ACCOUNTABILITIES AND APPEALS: The ICRC is accountable for acting in accordance with the Code, the Nursing Act, regulations, By-Laws and any laws that apply to its processes and decision making. The ICRC is accountable to complainants, members and the public for procedural fairness in considering matters and for providing written reasons for its decisions. Decisions of the ICRC related to complaints, other than referrals to the Discipline Committee or to another ICRC panel for incapacity inquiries can be reviewed by the Health Professions Appeal and Review Board at the request of the complainant or the member. All other decisions of the ICRC can be judicially reviewed by the Divisional Court on application by the member. MEMBERSHIP: Council Members 3 RNs, 1 RPN, 6 public members Ranges: 3-4 RNs, 1-2 RPNs, 6-10 public members Appointed Committee Members: 3 RNs, 2 RPNs Ranges 3-6 RNs, 2-3 RPNs The Council President is the Chair of the ICRC. All members of Executive serve on ICRC The Chair of the ICRC is the committee s accountability link to Council. The Chair s role includes selecting panels of the committee to review matters. 10

34 INQUIRIES, COMPLAINTS AND REPORTS COMMITTEE MANDATE June

35 Agenda Item 5.1 Second Briefing Decision Note June 2016 Council Proposed Registration Regulation Changes Contact for Questions or More Information Kevin McCarthy, Manager of Strategy Motion for Consideration re. Recommendation from Staff That the proposed amendments to Part II (Registration) of Ontario Regulation 275/94 (General) under the Nursing Act, 1991, as shown in Attachment 3, be approved for notice and circulation to members and stakeholders. Public Interest Rationale The College is responsible for ensuring there are mechanisms in place to ensure individuals are safe to practise nursing. We want to ensure that only those who are safe to practise are able to register with the College. We also don t want to create barriers that would keep qualified individuals out of the profession. The proposed regulatory changes make it easier for someone to enter and remain in the profession by giving more flexibility to demonstrate they meet our requirements, while meeting our public protection mandate. What are the Proposed Changes? Council last approved changes to the registration regulation in These were subsequently approved by Government and came into effect January 1, In 2014, CNO staff began a review of the implementation of the changes to the registration regulation. The focus of the review was to determine whether the public interest goals were met and whether the changes remain the best approach to achieve those goals. As part of any review, the College considered evidence, feedback from stakeholders and explored changes in the regulatory environment. In 2015, following implementation of the new NCLEX-RN exam that was approved by Council in 2013, staff also began a review of this implementation. For more detail about the chronology of events, see Attachment 2. The changes proposed, which are described in detail in Attachment 1, are as follows: 1) changes to exam requirements; 2) changes to the declaration of practice; and, 3) minor corrections

36 1 - Changes to Exam Requirements The exam is just one of the requirements to become a member of CNO. It is all the entry-topractice requirements together that indicate to the College that an individual is safe to practise nursing in Ontario. The exam changes would apply to Registered Practical Nurse (RPN), Registered Nurse (RN) and Nurse Practitioner (NP) applicants. This is to support consistent application of the regulations for all applicants - now and in the future. The proposed changes make it easier for someone to meet the exam requirement, while still protecting the public interest. Entry exams, as approved by Council, have changed over the years. The proposed changes give more flexibility for Council to make decisions about future exam requirements. In other words, there is more flexibility to make evidence-informed decisions about the exam, in the public interest, without having to make changes to the regulation (especially given the fact that regulatory changes take time often years). Issue Attempts on the exam are limited to three writes. Where there is more than one exam approved for one class of registration (e.g., two exams approved for NP-Adult), the applicant is not given three writes for each exam but a combination of three writes for the exams (a combined total of three attempts). If an individual fails the exam three times, they must complete a new education program before getting additional exam attempts and the current regulation limits this to certain types of education programs Proposed Change The current regulation doesn t enable Council to make evidence-informed decisions in the public interest about the number of writes for a particular exam. The proposed change gives Council the authority to decide if an exam should be limited (three or more writes) or unlimited. Where there is evidence to support more than three writes, an applicant would have more than three writes making it easier for the applicant to be registered with CNO while still protecting the public. When Council approves an exam, each exam is approved as a valid, reliable and fair measure of the exam requirement. The proposed change would allow the applicant to write each exam the number of times approved by Council. This may give an applicant more opportunities to demonstrate they meet the exam requirement while ensuring the public is protected. The proposed changes remove the provisions requiring the specific programs. The applicant would still have to complete a new nursing education program before getting additional writes on a limited write exam; yet, there is - 2 -

37 (e.g., a new degree for RN applicants). This has been a barrier to enter the profession many applicants are not able to find a school that will enable them to take the specified program. more flexibility in the type of program they can complete to meet the requirement. 2 - Changes to the Declaration of Practice The declaration of practice is not an entry-to-practice requirement. It is a requirement that members must meet. Having recent nursing practice is one mechanism that supports a member s ability to practise safely. To maintain registration in the general or extended classes, at annual renewal, members must declare whether or not they have practised nursing in Ontario during the past three years. This requirement was supported by Council in If members aren t able to meet this declaration, they can move to the non-practising class or resign. Council considered one aspect of the declaration of practice requirement: the requirement that recent practice be in Ontario at their September and December 2015 Council meetings. When the issue was discussed at the September 2015 Council meeting, the minutes state that Council identified that nurses are accountable for meeting standards wherever they are practising and that on return to Ontario they have a professional responsibility to ensure they can meet Ontario standards. There was general support that the in Ontario provision is not needed to protect the public interest. However, Council asked staff to consider different scenarios (e.g., a member who worked outside of Canada without first having consolidating their knowledge here). Staff brought an options paper to December 2015 Council and Council supported the following motion: That Council supports removing in Ontario from the declaration of practice requirements set out in Part II of Regulation 275/94 under the Nursing Act, Minor Corrections The regulation has different options to meet the recent nursing practice requirement, which is one of the entry-to-practice requirements. For example, this could be met through a nursing program where the individual had an opportunity to apply their nursing knowledge, skill and judgement or through recent nursing practice. Regardless of the option to meet recent nursing practice, it has to be met in the last three years. However, for temporary class applicants, some options require them to have recent practice in the last 12 months. This is an inconsistency with the rest of the regulation and isn t in line with the evidence that supported the three year requirement; therefore, the change proposes that three years apply for temporary class registration regardless of the option to meet recent practice. There are also some proposed corrections (e.g., typos and incorrect references to subsections)

38 Legislative Framework Council s Authority In relation to the changes proposed, the Regulated Health Professions Act, , gives Council regulation making authority: (b) respecting applications for certificates of registration or classes of them and the issuing, suspension, revocation and expiration of the certificates or classes of them (c) prescribing standards and qualifications for the issue of certificates of registration (f) requiring, for purposes associated with the registration of members, the successful completion of examinations as set and approved, from time to time, by the College Communication Strategy The Communications Team is developing communications strategies to support implementation of the proposed regulation changes. Because the changes are quite detailed and extensive, and impact many types of stakeholders, the strategies will focus on three main areas: 1. exam writes; 2. removing in Ontario from annual declaration of practice; and, 3. miscellaneous (e.g., corrections). The communications strategies will consider the effect of the changes on external and internal audiences and how we will manage responses and reactions to the changes from these audiences. Audiences include applicants, members, educators, employers, the public, the Ministry of Health and Long-Term Care, CNO staff, other health care stakeholders and media. The focus of the communications will be: regulatory changes described including an indication of stakeholders impacted, timing and responsibilities; timely and accurate updates on known information and any changes that may impact stakeholders; and, maintenance of public safety. Next Steps With Council s approval, the proposed regulation will be circulated to stakeholders including members and they will be given an opportunity to provide input. At the next Council meeting, Council will have an opportunity to consider feedback received. Council will consider if any of the feedback changes Council s perspective that the regulation is drafted in the public interest. If approved at the next Council meeting, the proposed regulation would be submitted to Government for their review and approval processes. Attachments 1. Clause-by-clause description of the proposed changes 1 Subsection 95(1) of the Health Professions Procedural Code

39 2. Chronology of events 3. Redline version of proposed amendments to Part II (Registration) of Ontario Regulation 275/94 (General) under the Nursing Act,

40 Attachment 1 Clause-by-clause description of the proposed changes The purpose of this document is to give a detailed overview of the proposed changes to the registration regulation (Part II of regulation 275/94 under the Nursing Act, 1991). 1 - Proposed Exam Changes Current Provision Proposed Change Rationale 2(1)2 The applicant must have successfully completed the examination for registration as a registered nurse at the time when the examination was approved by Council or have successfully completed another examination approved by Council for that purpose, at a time when he or she was eligible to take the examination. 2(1)2 The applicant must have successfully completed thean examination for registration as a registered nurse at thea time when thethat examination was approved by Council orand at a time when he or she was eligible under section 9 to take that examination, or must have successfully completed another an examination approved by Council for that purpose, at a time when he or she was eligible to take the 3(1)2 The applicant must have successfully completed the examination for registration as a registered practical nurse at a time when the examination was approved by Council or have successfully completed another examination approved by Council for that purpose, at a time when he or she was eligible to undertake it. 4(1)3 The applicant, i. must be eligible to take the examination in the specialty for which he or she applied examination. 3(1)2 The applicant must have successfully completed thean examination for registration as a registered practical nurse at a time when thethat examination was approved by Council orand at a time when he or she was eligible under section 9 to take that examination, or must have successfully completed another an examination approved by Council for that purpose at a time when he or she was eligible to undertake it. i. must be eligible to take the examination in the speciality for which he or The wording allows for two scenarios: 1. A new applicant, such as a recent Ontario graduate, would meet our exam eligibility criteria then write the Council approved exam. This is the most common scenario. 2. When a new exam is approved by Council, Council could approve the exam retroactively (e.g., an applicant applying from another jurisdictions who already passed the new exam would meet the exam registration requirement without having to meet our exam eligibility criteria). An exam = there can be more than one exam approved for one class of registration. Each exam would be a valid, reliable and fair measure of the exam registration requirement.

41 Current Provision Proposed Change Rationale in the extended class at the she applied in the extended time he or she undertakes it, class at the time he or she and undertakes it, andii. must ii. must have successfully have successfully completed completed the examination thean examination in that in that specialty in the extended class for which he specialty in the extended or she applied at a time class for which he or she when the examination was applied at a time when approved by Council or must have successfully completed thethat examination was approved by Council and at a another examination time when he or she was approved by Council for that eligible under section 9.1 to purpose. take that examination, or must have successfully completed another an examination approved by Council for that purpose. 5.1(2) 3 Receipt of notification of the failure of the examination referred to in N/A (new) N/A (new) Receipt of notification of the failure of thean examination referred to in 8.1 (1) Where Council approves an examination for the purpose of paragraph 2 of subsections 2 (1) or 3 (1) or paragraph 3 of subsection 4 (1), Council shall determine whether the examination is one for which applicants shall be permitted an unlimited number of attempts to successfully complete that examination or whether the examination is one for which there shall be a limited number of attempts to successfully complete that examination. (2) Subject to subsection (3), where Council determines that an examination is one for More than one exam can be approved by Council for one class of registration an is more reflective of this. Council has the authority to decide if an exam should be limited or unlimited. An exam is often limited because of the potential to memorize content and have false positive results. To protect the public, we want the exam to be a true measure of an applicant s competence. Where possible, this will align with a national approach. Council can decide on the number of writes for an exam that has a limited number of writes.

42 Current Provision Proposed Change Rationale which there shall be a limited number of attempts, If there are multiple exams Council shall determine the approved for one class of maximum number of registration, the applicant would be able to write each attempts which an exam the limited number of applicant shall be permitted times approved by Council (for to successfully complete a limited write exam). Each that examination. exam and the number of writes approved for that exam would be a reliable, valid and fair measure of the exam N/A (new) N/A (new) N/A (new) (3) Where Council makes a determination under subsection (2), it shall provide for at least three attempts to successfully complete that examination. 4) Where Council approved an examination before [*NTD: the coming into force of this section] Council shall make a determination as to whether the examination is one for which applicants shall be permitted an unlimited number of attempts to successfully complete that examination or whether the examination is one for which there shall be a limited number of attempts to successfully complete that examination. (5) Where Council fails to determine the maximum number of attempts applicable to an examination under subsection (2) or (4), Council shall be deemed to have determined that an applicant shall be permitted a maximum of three registration requirement. If Council decides that the exam should be a limited number of writes, Council has to limit to a minimum of three attempts. This supports fairness to applicants giving applicants at least three attempts. With respect to exams already approved by Council, Council shall determine if those exams should have limited writes or no limit. The date in this provision will be the date this new regulation becomes law. If Council does not determine the number of writes for an exam that is already approved, the previous exams approved by Council will be limited to three writes. This ensures we can carry out current operations.

43 Current Provision Proposed Change Rationale attempts to successfully complete that examination. N/A (new) 9(2) An applicant who meets the following requirements is eligible to attempt the examination referred to in paragraph 2 of subsection 2 (1) for a General certificate of registration as a registered nurse 9(2) 4 The person must not have failed, on three previous occasions, an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered nurse in the General class. 9(3) An applicant who meets the following requirements is eligible to attempt the examination referred to in paragraph 2 of subsection 3 (6) Nothing in subsection (4) shall prevent Council from subsequently determining the maximum number of attempts applicable to an examination under subsection (2). An applicant who meets the following requirements is eligible to attempt thean examination referred to in paragraph 2 of subsection 2 (1) for a General certificate of registration as a registered nurse In respect of an examination for which Council has determined there shall be a limited number of attempts, the person must not have failed, on three previous occasions, an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered nurse in the General class. O. Reg. 175/12, s. 1.exhausted, after having met the requirement of paragraph 1 of subsection 2 (1), all of the attempts which Council determined were allowable for the applicant to successfully complete that examination. An applicant who meets the following requirements is eligible to attempt thean examination referred to in paragraph 2 of subsection After making a decision about exam writes, Council can alter that decision (e.g., should new evidence come to light). More than one exam can be approved by Council for one class of registration an is more reflective of this. Where an exam is limited, the applicant will be refused registration for not meeting the exam registration requirement. 2(1)1 referred to in this provision relates to the education requirement. An education program is part of the exam eligibility criteria. More than one exam can be approved by Council for one class of registration an is more reflective of this.

44 Current Provision Proposed Change Rationale (1) for a General certificate of registration as a registered practical nurse (1) for a General certificate of registration as a registered practical nurse 9(3) 4 The person must not have failed on three previous occasions an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered practical nurse in the General class. 9(4) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 4 of subsection (2) may only take the examination if the applicant obtains a new degree that meets the requirement of subparagraph 1 i or ii of subsection 2 (1). In respect of an examination for which Council has determined there shall be a limited number of attempts, the person must not have failed on three previous occasions an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered practical nurse in the General class. O. Reg. 175/12, s. 1.exhausted, after having met the requirement of paragraph 1 of subsection 3 (1), all of the attempts which Council determined were allowable for the applicant to successfully complete that examination. 9(4) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 4 of subsection (2) may only take the examination if the applicant obtains a new degree that meets the requirement of subparagraph 1 i or ii of subsection 2 (1) Where an exam is limited, the applicant will be refused registration for not meeting the requirement. 3(1)1 referred to in this provision relates to the education requirement. An education program is part of the exam eligibility criteria. We are proposing to remove the requirement for completion of a specific new program (e.g., a degree) to get additional writes for an exam that has limited writes. This has been a barrier for applicants. Ontario universities will not allow an individual to complete a program for which they have already received a credential (e.g., a Bachelor of Science in Nursing). Applicants would still need a new program to gain additional writes (for a limited write exam) but there would be additional options for meeting the program

45 Current Provision Proposed Change Rationale requirement (not as restrictive as this provision). For example, an individual could complete a program that is not equivalent to an Ontario program then meet any identified gaps so it is equivalent to an Ontario program. 9(5) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 4 of subsection (3) may only take the examination if the applicant obtains a new diploma that meets the requirement of subparagraph 1 i or ii of subsection 3 (1) or a new degree that meets the requirement of subparagraph 1 i or ii of subsection 2 (1). 9(6) An applicant who obtains a new degree in accordance with subsection (4) is ineligible to attempt the examination referred to in paragraph 2 of subsection 2 (1) if he or she failed, on three occasions after obtaining the new degree, an examination which would, if successfully completed, have met the examination requirement for 9(5) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 4 of subsection (3) may only take the examination if the applicant obtains a new diploma that meets the requirement of subparagraph 1 i or ii of subsection 3 (1) or a new degree that meets the requirement of subparagraph 1 i or ii of subsection 2 (1). 9(6) An applicant who obtains a new degree in accordance with subsection (4) is ineligible to attempt the examination referred to in paragraph 2 of subsection 2 (1) if he or she failed, on three occasions after obtaining the new degree, an examination which would, if successfully completed, have met the examination We are proposing to remove the requirement for completion of a specific new program to get additional writes for an exam that has limited writes. This has been a barrier for applicants. Although some Ontario Colleges will allow someone to complete a new program, this is dependent on volume (e.g., they will only take someone for a new program if they have the capacity). Applicants would still need a new program to gain additional writes (for a limited write exam) but there would be additional options for meeting the program requirement (not as restrictive as this provision). For example, an individual could complete a program in another jurisdiction. No longer applicable should 9(4) be removed.

46 Current Provision Proposed Change Rationale the issuance of a certificate for a registered nurse in the General class. requirement for the issuance of a certificate for a registered nurse in the 9(7) An applicant who obtains a new diploma or degree in accordance with subsection (5) is ineligible to attempt the examination referred to in paragraph 2 of subsection 3 (1) if he or she failed, on three occasions after obtaining the new diploma or degree, an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered practical nurse in the General class. 9.1(2) An applicant who meets the following requirements is eligible to attempt the examination referred to in paragraph 3 of subsection 4 (1) for an extended certificate of registration as a registered nurse 9.1(2) 5 The person must not have failed on three previous occasions an examination for a specialty which would, if successfully completed, have met the examination requirement for registration in the extended class. General class. 9(7) An applicant who obtains a new diploma or degree in accordance with subsection (5) is ineligible to attempt the examination referred to in paragraph 2 of subsection 3 (1) if he or she failed, on three occasions after obtaining the new diploma or degree, an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered practical nurse in the General class. An applicant who meets the following requirements is eligible to attempt thean examination referred to in paragraph 3 of subsection 4 (1) for an extended certificate of registration as a registered nurse In respect of an examination for which Council has determined there shall be a limited number of attempts, the person must not have failed on three previous occasions an examination for a specialty which would, if successfully completed, have met the examination requirement for registration in the extended class. O. Reg. 175/12, s. 1.exhausted, after having met the requirements of No longer applicable should 9(5) be removed. More than one exam can be approved by Council for one class of registration an is more reflective of this. Where an exam is limited, the applicant will be refused registration for not meeting the requirement. 4(1)1 and 2 referred to in this provision relate to previous registration as an RN and the NP education requirement. These are part of the exam eligibility criteria.

47 Current Provision Proposed Change Rationale paragraphs 1 and 2 of subsection 4 (1), all of the attempts which Council determined were allowable for the applicant to successfully complete that examination. 9.1 (3) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 5 of subsection (2) may only take the examination again if the applicant successfully completes a new program that meets the requirements set out within subparagraph 2 i, ii or iii of subsection 4 (1). O. Reg. 175/12, s (4) An applicant who successfully completes a new program in accordance with subsection (3) is ineligible to attempt the examination referred to in paragraph 3 of subsection 4 (1) if he or she failed, on three occasions after completing the new program, an examination for a specialty which would, if successfully completed, have met the examination requirement for registration in the extended class. (3) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 5 of subsection (2) may only take the examination again if the applicant successfully completes a new program that meets the requirements set out within subparagraph 2 i, ii or iii of subsection 4 (1). O. Reg. 175/12, s (4) An applicant who successfully completes a new program in accordance with subsection (3) is ineligible to attempt the examination referred to in paragraph 3 of subsection 4 (1) if he or she failed, on three occasions after completing the new program, an examination for a specialty which would, if successfully completed, have met the examination requirement for registration in the extended class. We are proposing to remove the requirement for completion of a specific new program to get additional writes for an exam that has limited writes. This has been a barrier for applicants. Ontario universities will not allow an individual to complete a program for which they have already received a credential. Applicants would still need a new program to gain additional writes (for a limited write exam) but there would be additional options for meeting the program requirement (not as restrictive as this provision). For example, an individual could complete a program in another jurisdiction. No longer applicable should 9.1(3) be removed

48 2 - Proposed Declaration of Practice Changes Current Provision Proposed Change Rationale 11(1) Every member holding a General or extended certificate of registration shall make a declaration, at the request of the Executive Director or at the time he or she pays the annual membership fee required under the by-laws, about whether the member has engaged in the practice of nursing in Ontario during the previous three years, 11(1) Every member holding a General or extended certificate of registration shall make a declaration, at the request of the Executive Director or at the time he or she pays the annual membership fee required under the by-laws, about whether the member has engaged in the practice of nursing in Ontario during the previous three years, 11(2) If a member mentioned in clause (1) (a), (b) or (c) declares that he or she has not engaged in the practice of nursing in Ontario during the previous three years, all of the member s certificates of registration shall be revoked. 11(3) If a member mentioned in clause (1) (c) declares that he or she has engaged in the practice of nursing in Ontario during the previous three years but has not practised in any specialty for which the member holds a specialty certificate, 11(4) If a member who is a registered nurse in the General class and a registered practical nurse in the General class declares that he or she has not practised as a registered nurse in Ontario during the previous three years, but has practised as a registered practical nurse, the member s General certificate of registration as a registered nurse shall be revoked. 11(5) If a member who is a registered nurse in the General 11(2) If a member mentioned in clause (1) (a), (b) or (c) declares that he or she has not engaged in the practice of nursing in Ontario during the previous three years, all of the member s certificates of registration shall be revoked. 11(3) If a member mentioned in clause (1) (c) declares that he or she has engaged in the practice of nursing in Ontario during the previous three years but has not practised in any specialty for which the member holds a specialty certificate, 11(4) If a member who is a registered nurse in the General class and a registered practical nurse in the General class declares that he or she has not practised as a registered nurse in Ontario during the previous three years, but has practised as a registered practical nurse, the member s General certificate of registration as a registered nurse shall be revoked. 11(5) If a member who is a registered nurse in the General Nurses, to maintain membership in the general or extended classes, will have to have practised as a nurse within the past three years (not limited to practice in Ontario). Stakeholder feedback was the catalyst for looking at this item. Around 2013, when the change was implemented, the College received negative feedback from dozens of members and other stakeholders including the following: by moving to the nonpractising class they are unable to meet the employment requirements in other jurisdictions (e.g., nurse educators in Qatar, nurses practising in Michigan); and, they are working for embassies or the federal government and they are required to be registered in a Canadian jurisdiction. Council, informed by evidence (e.g., internal data, a review of other regulatory bodies, literature) supported this change in principle at their December 2015 Council meeting.

49 Current Provision Proposed Change Rationale class and a registered practical nurse in the General class declares that he or she has not practised as a registered practical nurse in Ontario during the previous three years, the member s General certificate of registration as a registered practical nurse shall be revoked. class and a registered practical nurse in the General class declares that he or she has not practised as a registered practical nurse in Ontario during the previous three years, the member s General certificate of registration as a registered practical nurse shall be revoked. 11(6) If a member who is a registered nurse in the extended class and a registered practical nurse in the General class declares that he or she has not practised as a registered practical nurse in Ontario during the previous three years, the member s General certificate of registration as a registered practical nurse shall be revoked. 11(7) If a member who is a registered nurse in the extended class and a registered practical nurse in the General class declares that he or she has not practised in any of the specialties related to his or her extended certificate during the previous three years in Ontario, the member s extended certificate of registration, along with all the specialty certificates, shall be revoked. 11(8) If a member who is a registered nurse in the extended class declares that he or she practised as a nurse in Ontario during the previous three years in one or more of the specialties related to his or her extended certificate, but did not practise in one or more 11(6) If a member who is a registered nurse in the extended class and a registered practical nurse in the General class declares that he or she has not practised as a registered practical nurse in Ontario during the previous three years, the member s General certificate of registration as a registered practical nurse shall be revoked. 11(7) If a member who is a registered nurse in the extended class and a registered practical nurse in the General class declares that he or she has not practised in any of the specialties related to his or her extended certificate during the previous three years in Ontario, the member s extended certificate of registration, along with all the specialty certificates, shall be revoked. 11(8) If a member who is a registered nurse in the extended class declares that he or she practised as a nurse in Ontario during the previous three years in one or more of the specialties related to his or her extended certificate, but

50 Current Provision Proposed Change Rationale of the other specialties related to his or her extended certificate, the one or more specialty certificates in which the member did not practise during the previous three years shall be revoked. did not practise in one or more of the other specialties related to his or her extended certificate, the one or more specialty certificates in which the member did not practise during the previous three years shall be revoked. 3 - Proposed Minor Corrections Current Provision Proposed Change Rationale 2.1(3) Without in any way limiting the generality of subsection (1), good standing shall include the fact that, 2.1(3) Without in any way limiting the generality of subsection (12), good standing shall include the fact that, Incorrect reference to subsection (1). 3(4) Subject to subsections (2) and (3) and section 3.1, the requirements in subsection (1) are nonexemptible. 3.1(3) Without in any way limiting the generality of subsection (1), good standing shall include the fact that, 4(3)(a) was enrolled before December 31, 2011, in an Ontario university program designed to educate and train registered nurses to practise the speciality for which the applicant applied in the extended class that was approved by the Council of Ontario University Programs in Nursing and the Senate or Governing Council of the Ontario university that offered the program 4.1(3) Without in any way limiting the generality of subsection (1), good standing shall include the 3(4) Subject to subsections (2) and subsection (3) and section 3.1, the requirements in subsection (1) are nonexemptible. 3.1(3) Without in any way limiting the generality of subsection (12), good standing shall include the fact that, 4(3)(a) was enrolled before December 31, 2011, in an Ontario university program designed to educate and train registered nurses to practise the speciality specialty for which the applicant applied in the extended class that was approved by the Council of Ontario University Programs in Nursing and the Senate or Governing Council of the Ontario university that offered the program 4.1(3) Without in any way limiting the generality of subsection (12), good standing shall include the fact that, Incorrect reference. Incorrect reference to subsection (1). Typo. Incorrect reference to subsection (1).

51 Current Provision Proposed Change Rationale fact that, 5(2) (a) the requirement was met within one year before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered nurse 5(2) (a) the requirement was met within one year three years before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered nurse 5(3) (a) the requirement was met within one year before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered practical nurse 5(3) (a) the requirement was met within one year three years before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered practical nurse Applicants have different options to demonstrate they meet the recent practice requirement (e.g., through recent completion of a nursing program or through recent nursing practice). For all other classes, for all options to meet recent practice, applicants have to have recent practice in last three years. Within the temp class, some options to meet the recent practice requirement are within 12 months others within three years. This is inconsistent with the rest of the regulation and the evidence associated with the three year requirement. 5.2 (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by a Temporary certificate of registration at any time in the 12 months immediately before the date of that applicant s (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by a Temporary certificate of registration at any time in the 12 monthsthree years immediately before the date of that applicant s application, the applicant must meet any further requirement to In terms of additional measures for public protection, for the temp class, there are terms, conditions and limitations on their certificate of registration (e.g., the member s practice must be monitored). We can t have a more onerous requirement for labour mobility applicants compared with other applicants. In fact, we made a decision to operationalize it this way (i.e., having recent practice in the last three years) following discussions with the Ministry and legal counsel after the regulations came into effect in 2013.

52 Current Provision Proposed Change Rationale application, the applicant must meet any further requirement to undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. 8(5) 2. The member shall not hold himself or herself out as a person qualified to practise in Ontario as a nurse, nurse practitioner, registered nurse, practical nurse, registered practical nurse, or in any speciality of nursing (3) The Executive Director may reinstate the member s extended certificate of registration and one or more speciality certificates previously held by the member if, 10.8 (2) If a former member s extended class certificate of registration is reinstated under subsection (1), any speciality certificate that he or she held shall be reinstated unless otherwise ordered. 8(5) 2 The member shall not hold himself or herself out as a person qualified to practise in Ontario as a nurse, nurse practitioner, registered nurse, practical nurse, registered practical nurse, or in any speciality specialty of nursing (3) The Executive Director may reinstate the member s extended certificate of registration and one or more speciality specialty certificates previously held by the member if, (2) If a former member s extended class certificate of registration is reinstated under subsection (1), any specialityspecialty certificate that he or she held shall be reinstated unless otherwise ordered. Typo. Typo. Typo

53 Attachment 2 Chronology of events 2009 In 2009, Council supported a policy change that a recent nursing practice requirement for members was in the public interest. At that time, for example, a member may not have practised nursing for 20 years but could still be registered in the general class (as safe to practise nursing in Ontario). We were the only nursing regulatory body in Canada without this requirement, which was an issue for labour mobility. One source of evidence that Council considered was a literature review that described how knowledge fades without practice and decreases over time with non-use. Council also considered the in Ontario requirement in relation to the nonpractising class Council considered and approved substantive changes to the registration regulation in The main catalyst for making these changes was because the Ontario Labour Mobility Act, 2009 set new limitations on the kinds of assessments that could be applied to applicants from other Canadian provinces and territories. We had strict timelines to make changes to our regulation to ensure we complied with these new requirements. The College also took the opportunity to address public interest and operational issues that had arisen with the previous registration regulation & 2013 The revised regulation was approved by government in June 2012 and came into effect on January 1, In March 2013, Council approved the NCLEX-RN exam as a new entry-to-practice exam for individuals seeking Ontario registration as a RN. In other words, Council approved this exam as a valid, reliable and fair measure of the exam requirement - to ensure RN applicants have the minimum competencies to support safe, effective and ethical nursing care in Ontario. The exam was implemented January 1, & 2015 In 2014, CNO staff began a review of the implementation of the changes to the registration regulation. The focus of the review was to determine whether the public interest goals were met and whether the changes remain the best approach to achieve those goals. As part of any review, the College considered evidence, feedback from stakeholders and explored changes in the regulatory environment

54 In 2015, following implementation of the new NCLEX-RN exam, staff also began a review of this implementation (e.g., an analysis of exam data). Input was sought from both internal (subject matter experts) and external stakeholders (e.g., the Ministry of Health and Long-Term Care, the Office of the Fairness Commissioner, regulatory bodies across Canada)

55 Attachment 3 Redline version of proposed amendments to Part II (Registration) of Ontario Regulation 275/94 (General) under the Nursing Act, 1991 Legend: Insertion Deletion Moved from Moved to Nursing Act, 1991 Loi de 1991 sur les infirmières et infirmiers ONTARIO REGULATION 275/94 GENERAL Consolidation Period: From January 1, 2014 to the e-laws currency date. Last amendment: O. Reg. 268/13. This Regulation is made in English only. CONTENTS Sections PART I INTERPRETATION PART II REGISTRATION CERTIFICATES OF REGISTRATION APPLICATION FOR CERTIFICATE OF REGISTRATION 1.3 REQUIREMENTS FOR ISSUANCE OF CERTIFICATE OF REGISTRATION, ANY CLASS 1.4 TERMS, ETC., OF EVERY CERTIFICATE 1.5 GENERAL CERTIFICATES OF REGISTRATION REGISTERED NURSE 2 MOBILITY WITHIN CANADA 2.1 TITLES REGISTERED NURSE 2.2 GENERAL CERTIFICATES OF REGISTRATION REGISTERED PRACTICAL NURSE 3 MOBILITY WITHIN CANADA 3.1 TITLES REGISTERED PRACTICAL NURSES

56 EXTENDED CERTIFICATES OF REGISTRATION 4 MOBILITY WITHIN CANADA 4.1 TITLES 4.2 TEMPORARY CERTIFICATES OF REGISTRATION MOBILITY WITHIN CANADA 5.2 SPECIAL ASSIGNMENT CERTIFICATES OF REGISTRATION 6 LABOUR MOBILITY SPECIAL ASSIGNMENT CLASS EMERGENCY ASSIGNMENT CERTIFICATES OF REGISTRATION 7 NON-PRACTISING CERTIFICATES OF REGISTRATION 8 EXAMINATIONS GENERAL CLASS 9 EXAMINATIONS EXTENDED CLASS 9.1 RESIGNATION 10 SUSPENSION FOR FAILURE TO PROVIDE INFORMATION 10.1 PART III PART IV SUSPENSION FOR FAILURE TO PROVIDE EVIDENCE OF PROFESSIONAL LIABILITY PROTECTION 10.2 LIFTING OF CERTAIN SUSPENSIONS 10.3 REVOCATION 10.4 REINSTATEMENT, ON APPLICATION 10.5 REINSTATEMENT, NON-PRACTISING 10.6 REINSTATEMENT, EXTENDED CLASS 10.7 REINSTATEMENT, PURSUANT TO ORDER 10.8 TERMS, ETC DECLARATION 11 TRANSITION CONTROLLED ACTS INTERPRETATION 13.2 PROCEDURES PRESCRIBING, DISPENSING, SELLING AND COMPOUNDING A DRUG 16 PRESCRIBING 17 DISPENSING 18 COMPOUNDING 19 SELLING 19.1 ADMINISTRATION OF A SUBSTANCE BY INJECTION OR INHALATION 20 QUALITY ASSURANCE GENERAL MEMBER ASSESSMENT PRACTICE ASSESSMENT AND REMEDIATION

57 PART V DELEGATION Schedule In this Regulation, PART I INTERPRETATION registered nurse in the extended class means a member who holds an extended certificate of registration as a registered nurse; registered nurse in the General class means a member who holds a General certificate of registration as a registered nurse; registered practical nurse in the General class means a member who holds a General certificate of registration as a registered practical nurse. O. Reg. 175/12, s Where the provisions of this Regulation are inconsistent with the provisions of the Emergency Management and Civil Protection Act, the provisions of that Act shall prevail and the provisions of this Regulation, to the extent that they are inconsistent with that Act, shall not apply. O. Reg. 175/12, s. 1. PART II REGISTRATION CERTIFICATES OF REGISTRATION 1. (1) The following are prescribed as classes of certificates of registration for registered nurses: 1. General. 2. Extended. 3. Temporary. 4. Special Assignment. 5. Emergency Assignment. 6. Non-Practising. O. Reg. 175/12, s. 1. (2) A registered nurse may not hold more than one class of certificate of registration as a registered nurse at one time. O. Reg. 175/12, s (1) The following are prescribed as classes of certificates of registration for registered practical nurses: 1. General. 2. Temporary. 3. Special Assignment. 4. Emergency Assignment

58 5. Non-Practising. O. Reg. 175/12, s. 1. (2) A registered practical nurse may not hold more than one class of certificate of registration as a registered practical nurse at one time. O. Reg. 175/12, s (1) The following are defined as specialties for certificates for a member who is a registered nurse in the extended class: 1. Primary Health Care. 2. Paediatrics. 3. Adult. 4. Anaesthesia. O. Reg. 175/12, s. 1. (2) A registered nurse in the extended class shall hold a certificate in a specialty mentioned in subsection (1). O. Reg. 175/12, s. 1. (3) A registered nurse in the extended class who is issued a certificate in a specialty mentioned in subsection (1) may be issued additional specialty certificates if he or she meets all the requirements in this Regulation relating to those specialty certificates. O. Reg. 175/12, s. 1. (4) For greater clarity, a specialty certificate defined under subsection (1) is not a class of certificate of registration. O. Reg. 175/12, s. 1. APPLICATION FOR CERTIFICATE OF REGISTRATION 1.3 (1) A person may apply for a certificate of registration in any class by completing an application in the form provided by the Executive Director and submitting it along with any supporting documentation requested by the Executive Director and the applicable fees. O. Reg. 175/12, s. 1. (2) If a person applies for an extended class certificate of registration, he or she must apply for a specialty certificate in at least one of the specialties of the extended class. O. Reg. 175/12, s. 1. (3) A person who files an application for a certificate of registration may not make another application for the same class of certificate until the outstanding application has been finally disposed of. O. Reg. 175/12, s. 1. REQUIREMENTS FOR ISSUANCE OF CERTIFICATE OF REGISTRATION, ANY CLASS 1.4 (1) The following are registration requirements for the issuance of a certificate of registration for any class: 1. The applicant must provide details to the Executive Director of any of the following that relate to the applicant at the time that the applicant submits the application, and of any of the following that come to relate to the applicant after the application is submitted and before a certificate of registration is issued: i. A finding of guilt for any criminal offence, any offence relating to the use, possession or sale of drugs, any offence under the Controlled Drugs and Substances Act (Canada), or any other offence in relation to the practice of nursing or another profession in any jurisdiction

59 ii. A finding of professional misconduct, incompetence, incapacity, professional negligence, malpractice or any similar finding against the applicant in relation to the practice of nursing or another profession in any jurisdiction. iii. A current investigation, inquiry or proceeding for professional misconduct, incompetence or incapacity or any similar investigation or proceeding in relation to the practice of nursing or another profession in any jurisdiction. iv. A current proceeding in respect of any offence in any jurisdiction. v. A refusal to register the applicant to practise as a nurse or in another profession in any jurisdiction. 2. The applicant s past and present conduct, in the opinion of the Executive Director or a panel of the Registration Committee, must afford reasonable grounds for the belief that the applicant, i. does not suffer from any physical or mental condition or disorder that could affect his or her ability to practise nursing in a safe manner, ii. will practise nursing with decency, honesty and integrity and in accordance with the law, iii. has sufficient knowledge, skill and judgment to competently engage in the practice of nursing authorized by the certificate of registration, and iv. will display an appropriately professional attitude. 3. The applicant must have paid any fees required under the by-laws for the issuance of the certificate of registration. O. Reg. 175/12, s. 1. (2) It is a registration requirement for the issuance of a certificate of registration for any class, other than the Emergency Assignment and Non-Practising classes, that the applicant must be a Canadian citizen or permanent resident of Canada or must hold the appropriate authorization under the Immigration and Refugee Protection Act (Canada) to permit the applicant to engage in the practice of nursing in Ontario. O. Reg. 175/12, s. 1. (3) The requirements under subsection (1) are non-exemptible. O. Reg. 175/12, s. 1. (4) An applicant must meet all of the requirements for registration within two years from the day that he or she filed his or her application, but this does not prevent an applicant from filing a new application. O. Reg. 175/12, s. 1. (5) An applicant shall be deemed not to have satisfied the requirements for the issuance of a certificate of registration of any class if the applicant makes a false or misleading statement or representation in his or her application or supporting documentation. O. Reg. 175/12, s. 1. TERMS, ETC., OF EVERY CERTIFICATE 1.5 (1) Every certificate of registration is subject to the following terms, conditions and limitations: 1. The member shall provide to the Executive Director the details of any of the following that relate to the member and occur or arise on or after the day that the member was issued a certificate of registration: i. A finding of guilt arising in any jurisdiction relating to any offence

60 ii. A charge arising in any jurisdiction relating to any offence. iii. A finding of professional misconduct, incompetence or incapacity or any similar finding, in relation to the practice of nursing or another profession in any jurisdiction. iv. A current investigation, inquiry or proceeding for professional misconduct, incompetence or incapacity or any similar investigation or proceeding in relation to the practice of nursing or another profession in any jurisdiction. 2. The member shall, at the request of the Executive Director, provide information that is required pursuant to the Act, the Regulated Health Professions Act, 1991, regulations under those Acts or the by-laws in the form and manner requested by the Executive Director. O. Reg. 175/12, s. 1. (2) Every certificate of registration, other than an Emergency Assignment or Non-Practising certificate of registration, is subject to the following terms, conditions and limitations: 1. The member shall not engage in the practice of nursing unless the member is a Canadian citizen or permanent resident of Canada or has authorization under the Immigration and Refugee Protection Act (Canada) permitting the member to engage in the practice of nursing in Ontario. 2. The member shall immediately advise the Executive Director in writing in the event that the member ceases to be a Canadian citizen or permanent resident of Canada or to have authorization under the Immigration and Refugee Protection Act (Canada) permitting the member to engage in the practice of nursing in Ontario. 3. If a member to whom paragraph 2 applies subsequently obtains Canadian citizenship, becomes a permanent resident of Canada or attains authorization under the Immigration and Refugee Protection Act (Canada) permitting the member to engage in the practice of nursing in Ontario, he or she shall immediately advise the Executive Director in writing of that fact. 4. The member shall maintain professional liability protection in accordance with the requirements, if any, set out in the by-laws. 5. The member shall, at the request of the Executive Director, provide evidence satisfactory to the Executive Director that the member meets the condition required in paragraph 4, in the form and manner requested by the Executive Director. O. Reg. 175/12, s. 1. (3) Every Emergency Assignment certificate of registration is subject, in addition to the terms, conditions and limitations set out in subsection (1), to the following terms, conditions and limitations: 1. The member shall maintain professional liability protection in accordance with the requirements, if any, set out in the by-laws. 2. The member shall, at the request of the Executive Director, provide evidence satisfactory to the Executive Director that the member meets the condition required in paragraph 1, in the form and manner requested by the Executive Director. O. Reg. 175/12, s

61 GENERAL CERTIFICATES OF REGISTRATION REGISTERED NURSE 2. (1) The following are additional requirements for the issuance of a certificate of registration as a registered nurse in the General class: 1. The applicant, i. must have a minimum of a baccalaureate degree in nursing evidencing the successful completion of a program specifically designed to educate and train persons to be practising registered nurses, A. awarded by a university in Canada as a result of successful completion of a program that was approved by Council or that was accredited or approved by a body approved by Council for that purpose, or B. awarded by a university as a result of successful completion of a program that was approved by Council or that was accredited or approved by a body approved by Council for that purpose, ii. must have a minimum of a baccalaureate degree in nursing evidencing the successful completion of a program specifically designed to educate and train persons to be practising registered nurses other than a program mentioned in subparagraph i, which program was approved by the Registration Committee as one whose graduates should possess knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in sub-subparagraph i A, or iii. must have successfully completed a program in nursing specifically designed to educate and train persons to be practising registered nurses, other than a program mentioned in subparagraph i or ii, and, A. must have successfully completed a program that, at the time the applicant commenced it, was approved by Council as one whose graduates should possess knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in sub-subparagraph i A, or B. must have paid any fees required under the by-laws, undergone an evaluation approved by Council and satisfied the Executive Director or a panel of the Registration Committee that he or she has successfully completed further education or training or combination of education and training approved by the Registration Committee that was identified in the evaluation as being necessary to evidence that the applicant possesses knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in sub-subparagraph i A. 2. The applicant must have successfully completed thean examination for registration as a registered nurse at thea time when thethat examination was approved by Council orand at a time when he or she was eligible under section 9 to take that examination, or must have successfully completed anotheran examination approved by Council for that purpose, at a time when he or she was eligible to take the examination. 3. The applicant,

62 i. must have been awarded the degree mentioned in subparagraph 1 i or ii no more than three years before the day that the applicant met all other requirements for the issuance of the certificate of registration, ii. must have successfully completed all requirements of one of sub-subparagraph 1 iii A or B no more than three years before the day that the applicant met all other requirements for the issuance of the certificate of registration, iii. must demonstrate evidence of practice as a registered nurse no more than three years before the day on which the applicant met all other requirements for the issuance of the certificate of registration, or iv. must have paid any fees required under the by-laws, undergone an evaluation approved by the Registration Committee at a time when the evaluation was approved by the Registration Committee and met requirements regarding additional training, experience, examinations or assessments specified by a panel of the Registration Committee within the period of time specified by the panel. 4. The applicant must, within five years before the day that the applicant is issued the certificate of registration, have successfully completed the examination in nursing jurisprudence that is approved by Council for applicants for the issuance of a certificate of registration as a registered nurse. 5. The applicant must have demonstrated language proficiency and the ability to communicate and comprehend effectively, both orally and in writing, in either English or French at a date no more than two years before the day that he or she is issued the certificate of registration, or such longer period of time as specified by a panel of the Registration Committee, unless, i. the applicant, on the day he or she submits the application, holds a certificate of registration as a registered nurse, other than a certificate in the Emergency Assignment or Non-Practising class, or ii. the applicant previously held a certificate of registration as a registered nurse, other than a certificate in the Emergency Assignment, retired or Non-Practising class and since the date that the applicant last held that certificate no more than two years or such longer period of time as specified by a panel of the Registration Committee has elapsed. O. Reg. 175/12, s. 1. (2) The requirements in subparagraph 1 ii or iii of subsection (1) shall be deemed not to have been met if the nursing program which the applicant relies on to meet that requirement was not recognized or approved in the jurisdiction in which the program was taken as qualifying the applicant to practise as a registered nurse in that jurisdiction. O. Reg. 175/12, s. 1. (3) The requirements in paragraphs 1 and 2 of subsection (1) do not apply to an applicant who previously held a certificate as a registered nurse in the General or extended class. O. Reg. 175/12, s. 1. (4) An applicant is exempt from the requirements in paragraphs 1, 2 and 5 of subsection (1) if the applicant holds a certificate of registration in the extended class at the time that he or she applies for the issuance of a certificate of registration as a registered nurse in the General class. O. Reg. 175/12, s

63 (5) Subject to subsections (3) and (4) and section 2.1, the requirements in subsection (1) are nonexemptible. O. Reg. 175/12, s. 1. MOBILITY WITHIN CANADA 2.1 (1) Where section of the Health Professions Procedural Code applies to an applicant for a certificate of registration as a registered nurse in the General class, the requirements of paragraphs 1, 2 and 3 of subsection 2 (1) of this Regulation are deemed to be met by the applicant. O. Reg. 175/12, s. 1. (2) Despite subsection (1), it is a non-exemptible requirement that an applicant referred to in subsection (1) provide, for each jurisdiction where the applicant holds an out-of-province certificate, a certificate, letter or other evidence satisfactory to the Executive Director or a panel of the Registration Committee confirming that the applicant is in good standing as a nurse in that jurisdiction. O. Reg. 175/12, s. 1. (3) Without in any way limiting the generality of subsection (12), good standing shall include the fact that, (a) the applicant is not the subject of any discipline or fitness to practise order or of any proceeding or ongoing investigation or of any interim order or agreement as a result of a complaint, investigation or proceeding; and (b) the applicant is in compliance with the continuing competency and quality assurance requirements of the regulatory authority that issued the applicant the out-of-province certificate as a registered nurse. O. Reg. 175/12, s. 1. (4) An applicant referred to in subsection (1) is deemed to have met the requirements of paragraph 5 of subsection 2 (1) where the requirements for the issuance of the applicant s out-of-province certificate of registration included language proficiency requirements equivalent to those required by that paragraph. O. Reg. 175/12, s. 1. (5) Despite subsection (1), a requirement set out in paragraph 1, 2 or 3 of subsection 2 (1) will continue to apply to an applicant where that requirement is a requirement described in subsection (3) of the Health Professions Procedural Code. O. Reg. 175/12, s. 1. (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by a General certificate of registration as a registered nurse at any time in the three years immediately before the date of that applicant s application, the applicant must meet any further requirement to undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. O. Reg. 175/12, s. 1. TITLES REGISTERED NURSE 2.2 (1) Subject to subsection (2), a registered nurse in the General class shall only use the title Registered Nurse or the abbreviation RN when practising as a nurse. O. Reg. 175/12, s. 1. (2) If a member is a registered nurse in the General class and a registered practical nurse in the General class, he or she shall only use the title Registered Practical Nurse or the abbreviation RPN when practising the profession as a registered practical nurse. O. Reg. 175/12, s

64 GENERAL CERTIFICATES OF REGISTRATION REGISTERED PRACTICAL NURSE 3. (1) The following are additional requirements for the issuance of a certificate of registration as a registered practical nurse in the General class: 1. The applicant, i. must have a diploma in practical nursing evidencing the successful completion of a program specifically designed to educate and train persons to be practising registered practical nurses, A. awarded by a College of Applied Arts and Technology in Ontario whose program was approved by Council or by a body approved by Council for that purpose, or B. awarded as a result of successful completion of a program that was approved by Council or by a body approved by Council for that purpose, ii. must have a diploma in practical nursing evidencing the successful completion of a program specifically designed to educate and train persons to be practising registered practical nurses, other than a program mentioned in subparagraph i, which program was approved by the Registration Committee as one whose graduates should possess knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in sub-subparagraph i A, iii. must have successfully completed a program in practical nursing specifically designed to educate and train persons to be practising registered practical nurses, other than a program mentioned in subparagraph i or ii, and, A. must have successfully completed a program that, at the time the applicant commenced it, was approved by Council as one whose graduates should possess knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in sub-subparagraph i A, or B. must have paid any fees required under the by-laws, undergone an evaluation approved by Council and satisfied the Executive Director or a panel of the Registration Committee that he or she has successfully completed further education or training or combination of education and training approved by the Registration Committee that was identified in the evaluation as necessary to evidence that the applicant possesses knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in sub-subparagraph i A. iv. must have satisfied the requirements of paragraph 1 of subsection 2 (1), or v. must, if the applicant has not satisfied the requirements of paragraph 1 of subsection 2 (1), have successfully completed a program in nursing, specifically designed to educate and train persons to be practising registered nurses, must have paid any fees required under the by-laws, undergone an evaluation approved by Council and satisfied the Executive Director or a panel of the Registration Committee that he or she has successfully completed further education or training or combination of education and training approved by the Registration Committee that was identified in the evaluation as

65 necessary to evidence that the applicant possesses knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in sub-subparagraph i A. 2. The applicant must have successfully completed thean examination for registration as a registered practical nurse at a time when thethat examination was approved by Council orand at a time when he or she was eligible under section 9 to take that examination, or must have successfully completed anotheran examination approved by Council for that purpose at a time when he or she was eligible to undertake it. 3. The applicant, i. must have been awarded the diploma mentioned in subparagraph 1 i or ii no more than three years before the day that the applicant met all other requirements for the issuance of the certificate of registration, ii. must have successfully completed all the requirements of subparagraph 1 iii, iv or v no more than three years before the day that the applicant met all other requirements for the issuance of the certificate of registration, iii. must demonstrate evidence of practice as a registered practical nurse no more than three years before the day on which the applicant met all other requirements for the issuance of the certificate of registration, or iv. must have paid any fees required under the by-laws, undergone an evaluation approved by the Registration Committee at a time when the evaluation was approved by the Registration Committee and met requirements regarding additional training, experience, examinations or assessments specified by a panel of the Registration Committee within the period of time specified by the panel. 4. The applicant must, within five years before the day that the applicant is issued a certificate as a registered practical nurse, have successfully completed the examination in nursing jurisprudence that is approved by Council for applicants for the issuance of a certificate as a registered practical nurse. 5. The applicant must have demonstrated language proficiency and the ability to communicate and comprehend effectively, both orally and in writing, in either English or French at a date no more than two years before the day that he or she is issued a certificate in the General class, or such longer period of time as specified by a panel of the Registration Committee, unless, i. the applicant, on the day he or she submits the application, holds a certificate of registration as a registered practical nurse, other than a certificate in the Emergency Assignment or Non-Practising class, or ii. the applicant previously held a certificate of registration as a registered practical nurse, other than a certificate in the Emergency Assignment, retired or Non-Practising class and since the last date that the applicant held that certificate no more than two years or such longer period of time as specified by a panel of the Registration Committee has elapsed. O. Reg. 175/12, s. 1. (2) The requirements of subparagraph 1 ii, iii or v of subsection (1) shall be deemed not to have been met where the nursing program which the applicant relies on to meet that requirement was not

66 recognized or approved in the jurisdiction in which the program was taken as qualifying the applicant to practise as a registered practical nurse in that jurisdiction. O. Reg. 175/12, s. 1. (3) The requirements in paragraphs 1 and 2 of subsection (1) do not apply to an applicant who previously held a certificate as a registered practical nurse in the General class. O. Reg. 175/12, s. 1. (4) Subject to subsections (2) andsubsection (3) and section 3.1, the requirements in subsection (1) are non-exemptible. O. Reg. 175/12, s. 1. MOBILITY WITHIN CANADA 3.1 (1) Where section of the Health Professions Procedural Code applies to an applicant for a certificate of registration as a registered practical nurse in the General class, the requirements of paragraphs 1, 2 and 3 of subsection 3 (1) of this Regulation are deemed to be met by the applicant. O. Reg. 175/12, s. 1. (2) Despite subsection (1), it is a non-exemptible requirement that an applicant referred to in subsection (1) provide, for each jurisdiction where the applicant holds an out-of-province certificate, a certificate, letter or other evidence satisfactory to the Executive Director or a panel of the Registration Committee confirming that the applicant is in good standing as a nurse in that jurisdiction. O. Reg. 175/12, s. 1. (3) Without in any way limiting the generality of subsection (12), good standing shall include the fact that, (a) the applicant is not the subject of any discipline or fitness to practise order or of any proceeding or ongoing investigation or of any interim order or agreement as a result of a complaint, investigation or proceeding; and (b) the applicant is in compliance with the continuing competency and quality assurance requirements of the regulatory authority that issued the applicant the out-of-province certificate as a registered practical nurse. O. Reg. 175/12, s. 1. (4) An applicant referred to in subsection (1) is deemed to have met the requirements of paragraph 5 of subsection 3 (1) where the requirements for the issuance of the applicant s out-of-province certificate of registration included language proficiency requirements equivalent to those required by that paragraph. O. Reg. 175/12, s. 1. (5) Despite subsection (1), a requirement set out in paragraph 1, 2 or 3 of subsection 3 (1) will apply to an applicant if that requirement is a requirement described in subsection (3) of the Health Professions Procedural Code. O. Reg. 175/12, s. 1. (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by a General certificate of registration as a registered practical nurse at any time in the three years immediately before the date of that applicant s application, the applicant must meet any further requirement to undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. O. Reg. 175/12, s

67 TITLES REGISTERED PRACTICAL NURSES 3.2 (1) Subject to subsections (2) and (3), a registered practical nurse in the General class shall use only the title Registered Practical Nurse or the abbreviation RPN when practising as a nurse. O. Reg. 175/12, s. 1. (2) If a member is a registered practical nurse in the General class and a registered nurse in the General class, he or she shall use only the title Registered Nurse or the abbreviation RN when practising the profession as a registered nurse. O. Reg. 175/12, s. 1. (3) If a member is a registered practical nurse in the General class and a registered nurse in the extended class, he or she shall use only the title Registered Nurse Extended Class or Nurse Practitioner and the abbreviation RN(EC) or NP when practising the profession as a registered nurse in the extended class. O. Reg. 175/12, s. 1. EXTENDED CERTIFICATES OF REGISTRATION 4. (1) The following are additional requirements for the issuance of a certificate of registration as a registered nurse in the extended class: 1. The applicant, i. must be or have been registered as a registered nurse in the General class by the College, ii. must meet the registration requirements as a registered nurse in the General class set out in paragraphs 1 and 2 of subsection 2 (1), or iii. must be or have been registered as a registered nurse by the health regulatory authority in a province or territory of Canada, in one of the states of the United States of America or in another jurisdiction approved by Council. 2. The applicant, i. must have graduated from an Ontario university nursing program specifically designed to educate and train a registered nurse to practise in the specialty for which he or she applied in the extended class and which program was approved by Council or a body approved by Council for that purpose, ii. must have graduated from a university nursing program specifically designed to educate and train a registered nurse to practise in the specialty for which he or she applied in the extended class and which program was approved by Council or a body approved by Council for that purpose, iii. must have graduated from a university nursing program specifically designed to educate and train a registered nurse to practise in the specialty for which he or she applied in the extended class, other than a program mentioned in subparagraph i or ii, which program was approved by the Registration Committee as one whose graduates should possess knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in subparagraph i, or

68 iv. must have graduated from a program in nursing specifically designed to educate and train a registered nurse to practise in the specialty for which he or she applied in the extended class other than a program mentioned in subparagraph i, ii or iii, and, 3. The applicant, A. must have successfully completed a program approved by Council as one whose graduates should possess knowledge, skill and judgment at least equivalent to current graduates of a program mentioned in subparagraph i, or B. must have paid any fees required under the by-laws, have undergone an evaluation approved by Council and satisfied the Executive Director or a panel of the Registration Committee that he or she has successfully completed any further education or training or combination of education and training approved by the Registration Committee that was identified by the evaluation as being necessary to evidence that the applicant possesses knowledge, skill and judgment at least equivalent to those of current graduates of a program mentioned in subparagraph i. i. must be eligible to take the examination in the speciality for which he or she applied in the extended class at the time he or she undertakes it, andii. must have successfully completed thean examination in that specialty in the extended class for which he or she applied at a time when thethat examination was approved by Council and at a time when he or she was eligible under section 9.1 to take that examination, or must have successfully completed anotheran examination approved by Council for that purpose. 4. The applicant, i. must have graduated from a university nursing program referred to in subparagraph 2 i, ii or iii no more than three years before the day that he or she met all other requirements for the issuance of a certificate as a registered nurse in the extended class, ii. must have successfully completed all the requirements of one of sub-subparagraph 2 iv A or B no more than three years before the day that he or she met all other requirements for the issuance of a certificate as a registered nurse in the extended class, iii. must demonstrate evidence of practice as a registered nurse no more than three years before the day on which the applicant met all other requirements for the issuance of a certificate as a registered nurse in the extended class, and in such a case the practice must include, A. clinical practice within each specialty in the extended class for which the applicant applied, and B. a nursing role within that specialty that required him or her to use, in the treatment of patients, advanced knowledge and decision-making skill in assessment, diagnosis and therapeutics, or iv. must have paid any fees required under the by-laws, undergone an evaluation approved by the Registration Committee at a time when that evaluation was approved by the Registration Committee and met requirements regarding additional training, experience,

69 examinations or assessments specified by a panel of the Registration Committee within the period of time specified by the panel. 5. The applicant must, within five years before the day that the applicant is issued a certificate as a registered nurse in the extended class, have successfully completed the examination in nursing jurisprudence that is approved by Council for applicants for the issuance of a certificate as a registered nurse in the extended class. 6. The applicant must have demonstrated language proficiency and the ability to communicate and comprehend effectively, both orally and in writing, in either English or French at a date no more than two years before the day that he or she is issued a certificate in the extended class, or such longer period of time as specified by a panel of the Registration Committee, unless, i. the applicant, on the day that he or she submits the application, holds a certificate of registration issued by the College, other than an Emergency Assignment or Non- Practising class, or ii. the applicant previously held a certificate of registration, other than an Emergency Assignment, retired or Non-Practising class, and no more than two years has elapsed since the date that the applicant last held that certificate or such longer period of time as specified by a panel of the Registration Committee. O. Reg. 175/12, s. 1. (2) The requirements of subparagraph 2 iii or iv of subsection (1) shall be deemed not to have been met where the nursing program which the applicant relies on to meet that requirement was not recognized or approved in the jurisdiction in which the program was taken as qualifying the applicant to practise as a registered nurse or a registered nurse in the extended class in that jurisdiction. O. Reg. 175/12, s. 1. (3) An applicant is deemed to have met the requirements of subparagraph 2 i of subsection (1) if he or she, (a) was enrolled before December 31, 2011, in an Ontario university program designed to educate and train registered nurses to practise the specialityspecialty for which the applicant applied in the extended class that was approved by the Council of Ontario University Programs in Nursing and the Senate or Governing Council of the Ontario university that offered the program; and (b) graduated after December 31, 2011 from the program referred to in clause (a). O. Reg. 175/12, s. 1. (4) The requirements in paragraphs 1, 2 and 3 of subsection (1) do not apply with respect to an applicant who previously held an extended class certificate of registration as a registered nurse. O. Reg. 175/12, s. 1. (5) Subject to subsections (3) and (4) and section 4.1, the requirements of subsection (1) are nonexemptible. O. Reg. 175/12, s. 1. MOBILITY WITHIN CANADA 4.1 (1) Where section of the Health Professions Procedural Code applies to an applicant for a certificate of registration as a registered nurse in the extended class, the requirements of paragraphs 1, 2, 3 and 4 of subsection 4 (1) of this Regulation are deemed to be met by the applicant. O. Reg. 175/12, s

70 (2) Despite subsection (1), it is a non-exemptible requirement that an applicant referred to in subsection (1) provide, for each jurisdiction where the applicant holds an out-of-province certificate, a certificate, letter or other evidence satisfactory to the Executive Director or a panel of the Registration Committee confirming that the applicant is in good standing as a nurse in that jurisdiction. O. Reg. 175/12, s. 1. (3) Without in any way limiting the generality of subsection (12), good standing shall include the fact that, (a) the applicant is not the subject of any discipline or fitness to practise order or of any proceeding or ongoing investigation or of any interim order or agreement as a result of a complaint, investigation or proceeding; and (b) the applicant is in compliance with the continuing competency and quality assurance requirements of the regulatory authority that issued the applicant the out-of-province certificate as a registered nurse in the extended class. O. Reg. 175/12, s. 1. (4) An applicant referred to in subsection (1) is deemed to have met the requirement of paragraph 6 of subsection 4 (1) where the requirements for the issuance of the applicant s out-of-province certificate of registration included language proficiency requirements equivalent to those required by that paragraph. O. Reg. 175/12, s. 1. (5) Despite subsection (1), a requirement set out in paragraph 1, 2, 3 or 4 of subsection 4 (1) will continue to apply to an applicant where that requirement is a requirement described in subsection (3) of the Health Professions Procedural Code. O. Reg. 175/12, s. 1. (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by an extended class certificate of registration at any time in the three years immediately before the date of that applicant s application, the applicant must meet any further requirement to undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. O. Reg. 175/12, s. 1. TITLES 4.2 (1) Subject to subsections (2), (3), (4) and (5) and 3.2 (3), a registered nurse in the extended class shall use the title Nurse Practitioner or the abbreviation NP or the title Registered Nurse Extended Class or the abbreviation RN(EC) when practising as a nurse. O. Reg. 175/12, s. 1. (2) A member holding a primary health care specialty certificate may use the title Nurse Practitioner Primary Health Care or the abbreviation NP PHC when practising in that role. O. Reg. 175/12, s. 1. (3) A member holding a paediatrics specialty certificate may use the title Nurse Practitioner Paediatrics or the abbreviation NP Paediatrics when practising in that role. O. Reg. 175/12, s. 1. (4) A member holding an adult specialty certificate may use the title Nurse Practitioner Adult or the abbreviation NP Adult when practising in that role. O. Reg. 175/12, s. 1. (5) A member holding an anaesthesia specialty certificate may use the title Nurse Practitioner Anaesthesia or the abbreviation NP Anaesthesia when practising in that role. O. Reg. 175/12, s

71 (6) Except as permitted by the Act or this Regulation, no other title, designation, variation, abbreviation or an equivalent in another language shall be used by a registered nurse in the extended class. O. Reg. 175/12, s. 1. (7) No member shall use the title Nurse Practitioner or any variation or abbreviation thereof, or the designation Registered Nurse Extended Class or any variation or abbreviation thereof, unless the member holds an extended class certificate of registration. O. Reg. 175/12, s. 1. (8) No member shall refer to himself or herself as a specialist in any specialty of the extended class unless the member holds a specialty certificate in that specialty. O. Reg. 175/12, s. 1. TEMPORARY CERTIFICATES OF REGISTRATION 5. (1) The following are additional requirements for the issuance of a certificate of registration in the Temporary class: 1. The applicant must not have previously held, i. a Temporary certificate of registration as a registered nurse, in the case of a registered nurse applicant, or ii. a Temporary certificate of registration as a registered practical nurse, in the case of a registered practical nurse applicant. 2. The applicant must meet the educational requirements for a General certificate of registration which are set out in, i. paragraph 1 of subsection 2 (1), in the case of a registered nurse applicant, or ii. paragraph 1 of subsection 3 (1), in the case of a registered practical nurse applicant. 3. Since meeting the requirements mentioned in paragraph 2, the applicant must not have failed, i. an examination mentioned in paragraph 2 of subsection 2 (1), in the case of a registered nurse applicant, or ii. an examination mentioned in paragraph 2 of subsection 3 (1), in the case of a registered practical nurse applicant. 4. The applicant must have a written offer of employment with an Ontario facility described in Schedule 1, or approved by a panel of the Registration Committee, i. as a registered nurse, in the case of a registered nurse applicant, or ii. as a registered practical nurse, in the case of a registered practical nurse applicant. 5. The applicant, within five years before the day that he or she is issued a Temporary certificate, must have successfully completed the examination in nursing jurisprudence approved by Council for, i. a registered nurse, in the case of a registered nurse applicant, or ii. a registered practical nurse, in the case of a registered practical nurse applicant. 6. The applicant must have demonstrated language proficiency and the ability to communicate and comprehend effectively, both orally and in writing, in either English or French within two

72 years before the issuance of the certificate or such longer period of time as approved by a panel of the Registration Committee. 7. The applicant must have successfully completed a nursing program that was, at the time the applicant completed the program, recognized or approved in the jurisdiction in which the program was taken as qualifying the applicant, i. to practise as a registered nurse in that jurisdiction, in the case of an applicant for a Temporary certificate of registration as a registered nurse, or ii. to practise as a registered practical nurse in that jurisdiction, in the case of an applicant for a Temporary certificate of registration as a registered practical nurse. O. Reg. 175/12, s. 1. (2) The requirement of subparagraph 2 i of subsection (1) shall be deemed not to have been met unless, (a) the requirement was met within one yearthree years before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered nurse; (b) the applicant demonstrates evidence of practice as a registered nurse no more than three years before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered nurse; or (c) the applicant pays any fees required under the by-laws, undergoes an evaluation approved by the Registration Committee, at a time when that evaluation was approved by the Registration Committee, and meets requirements regarding additional training, experience, examinations or assessments specified by a panel of the Registration Committee within three years before the day on which the applicant met all other requirements for the issuance of a temporary certificate as a registered nurse. O. Reg. 175/12, s. 1. (3) The requirement of subparagraph 2 ii of subsection (1) shall be deemed not to have been met unless, s. 1. (a) the requirement was met within one yearthree years before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered practical nurse; (b) the applicant demonstrates evidence of practice as a registered practical nurse no more than three years before the day on which the applicant met all other requirements for the issuance of a Temporary certificate as a registered practical nurse; or (c) the applicant pays any fees required under the by-laws, undergoes an evaluation approved by the Registration Committee, at a time when that evaluation was approved by the Registration Committee, and meets requirements regarding additional training, experience, examinations or assessments specified by a panel of the Registration Committee within three years before the day on which the applicant met all other requirements for the issuance of a temporary certificate as a registered practical nurse. O. Reg. 175/12, s. 1. (4) Subject to section 5.2, the requirements of subsection (1) are non-exemptible. O. Reg. 175/12,

73 5.1 (1) The following are terms, conditions and limitations of a Temporary certificate of registration: 1. The member shall practise the profession only within the facility mentioned in paragraph 4 of subsection 5 (1) and only within the scope of his or her employment with that facility. 2. The member s practice must be monitored and directed by a member of the College holding a General or extended class certificate of registration. 3. The member shall not perform a controlled or authorized act, unless the act is ordered, i. pursuant to clause 5 (1) (b) of the Act, or ii. by a registered nurse in the General class. 4. The member shall not supervise, monitor or direct the performance of a controlled or authorized act or the practice of another member in any class. 5. The member shall not accept the delegation of a controlled or authorized act from another member or any other person. 6. The member shall not delegate to another member or any other person the authority to perform a controlled or authorized act. 7. The member shall at all times when providing nursing services identify himself or herself as a Temporary member. 8. The member shall be restricted to the use of the following title: i. in the case of the holder of a Temporary certificate of registration as a registered nurse, Registered Nurse (Temporary) or RN (Temp), or ii. in the case of the holder of a Temporary certificate of registration as a registered practical nurse, Registered Practical Nurse (Temporary) or RPN (Temp). O. Reg. 175/12, s. 1. (2) A member s Temporary certificate of registration is automatically revoked on the occurrence of one of the following events, whichever occurs first: 1. The expiry of six months from the date the certificate was issued. 2. The issuance of a General class certificate of registration, i. as a registered nurse, in the case of a member holding a Temporary certificate of registration as a registered nurse, or ii. as a registered practical nurse, in the case of a member holding a Temporary certificate of registration as a registered practical nurse. 3. Receipt of notification of the failure of thean examination referred to in, i. paragraph 2 of subsection 2 (1), in the case of a member holding a Temporary certificate of registration as a registered nurse, or ii. paragraph 2 of subsection 3 (1), in the case of a member holding a Temporary certificate of registration as a registered practical nurse. O. Reg. 175/12, s

74 (3) Where a member holding a Temporary certificate of registration obtains alternate or additional employment as a nurse in the same class for which the Temporary certificate of registration was issued, the member may only practise the profession under that employment if, (a) the employment is with an Ontario facility that is described in Schedule 1 or approved by a panel of the Registration Committee; and (b) the member has first filed with the College a written offer of employment from that facility. O. Reg. 175/12, s. 1. MOBILITY WITHIN CANADA 5.2 (1) Where section of the Health Professions Procedural Code applies to an applicant for a certificate of registration in the Temporary class, the requirements of paragraphs 2 and 7 of subsection 5 (1) of this Regulation are deemed to be met by the applicant. O. Reg. 175/12, s. 1. (2) Despite subsection (1), it is a non-exemptible requirement that an applicant referred to in subsection (1) provide, for each jurisdiction where the applicant holds an out-of-province certificate, a certificate, letter or other evidence satisfactory to the Executive Director or a panel of the Registration Committee confirming that the applicant is in good standing as a nurse in every jurisdiction where the applicant holds an out-of-province certificate. O. Reg. 175/12, s. 1. (3) Without in any way limiting the generality of subsection (2), good standing shall include the fact that, (a) the applicant is not the subject of any discipline or fitness to practise order or any proceeding or ongoing investigation or any interim order or agreement as a result of a complaint, investigation or proceeding; and (b) the applicant is in compliance with the continuing competency and quality assurance requirements of the regulatory authority that issued the applicant the out-of-province certificate as a registered nurse in the case of an application for a Temporary certificate as a registered nurse, or as a registered practical nurse in the case of an application for a Temporary certificate as a registered practical nurse. O. Reg. 175/12, s. 1. (4) An applicant referred to in subsection (1) is deemed to have met the requirements of paragraph 6 of subsection 5 (1) where the requirements for the issuance of the applicant s out-of-province certificate included language proficiency requirements equivalent to those required by that paragraph. O. Reg. 175/12, s. 1. (5) Despite subsection (1), a requirement set out in paragraph 2 or 7 of subsection 5 (1) will continue to apply to an applicant where that requirement is a requirement described in subsection (3) of the Health Professions Procedural Code. O. Reg. 175/12, s. 1. (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by a Temporary certificate of registration at any time in the 12 monthsthree years immediately before the date of that applicant s application, the applicant must meet any further requirement to undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. O. Reg. 175/12, s

75 SPECIAL ASSIGNMENT CERTIFICATES OF REGISTRATION 6. (1) The following are additional requirements for the issuance of a certificate of registration as a registered nurse in the Special Assignment class: s The applicant must have successfully completed the examination in nursing jurisprudence approved by Council for applicants for a General class certificate of registration as a registered nurse within five years before the day that he or she is issued a certificate as a registered nurse in the Special Assignment class. 2. The applicant must have demonstrated language proficiency and the ability to communicate and comprehend effectively, both orally and in writing, in either English or French within two years before the issuance of the certificate or such longer time as may be specified by a panel of the Registration Committee. 3. The applicant must have successfully completed a nursing program that was, at the time the applicant completed the program, recognized or approved in the jurisdiction in which the program was taken as qualifying the applicant to practise as a registered nurse in that jurisdiction. 4. The applicant, i. must have met the program requirement mentioned in paragraph 3 within three years before the day on which the applicant met all other requirements for the issuance of a Special Assignment class certificate as a registered nurse, ii. must demonstrate evidence of practice as a registered nurse no more than three years before the day on which the applicant met all other requirements for the issuance of a Special Assignment class certificate of registration as a registered nurse, or iii. must have paid any fees required under the by-laws, undergone an evaluation approved by the Registration Committee when that evaluation was approved by the Registration Committee and met requirements regarding additional training, experience, examinations or assessments specified by a panel of the Registration Committee within three years before the day on which the applicant met all other requirements for the issuance of a Special Assignment class of certificate of registration as a registered nurse. 5. The applicant must not have been previously registered with the College as a registered nurse except as the holder of a Special Assignment or Emergency Assignment class certificate. 6. The applicant must have an appointment or special assignment as a registered nurse with an Ontario facility described in Schedule 1 or another assignment approved by a panel of the Registration Committee. 7. The applicant must not have previously held a Special Assignment certificate for the same assignment or appointment. O. Reg. 175/12, s. 1. (2) Subject to section 6.1, the requirements of subsection (1) are non-exemptible. O. Reg. 175/12, (3) The following are additional registration requirements for the issuance of a certificate as a registered practical nurse in the Special Assignment class:

76 s The applicant must have successfully completed the examination in nursing jurisprudence approved by Council for applicants for a General class certificate of registration as a registered practical nurse within five years before the day that he or she is issued a certificate as a registered practical nurse in the Special Assignment class. 2. The applicant must have demonstrated language proficiency and the ability to communicate and comprehend effectively, both orally and in writing, in either English or French at a date no more than two years before the day that he or she is issued the certificate or such longer time as may be specified by a panel of the Registration Committee. 3. The applicant must have successfully completed a nursing program that was, at the time the applicant completed the program, recognized or approved in the jurisdiction in which the program was taken as qualifying the applicant to practise as a registered practical nurse in that jurisdiction. 4. The applicant, i. must have met the program requirement mentioned in paragraph 3 within three years before the day on which the applicant met all other requirements for the issuance of a certificate as a registered practical nurse in the Special Assignment class, ii. must demonstrate evidence of practice as a registered practical nurse no more than three years before the day on which the applicant met all other requirements for the issuance of a certificate as a registered practical nurse in the Special Assignment class, or iii. must have paid any fees required under the by-laws, undergone an evaluation approved by the Registration Committee at a time when that evaluation was approved by the Registration Committee and met requirements regarding additional training, experience, examinations or assessments specified by a panel of the Registration Committee within three years before the day on which the applicant met all other requirements for the issuance of the certificate of registration. 5. The applicant must not have been previously registered with the College as a registered practical nurse except as the holder of a Special Assignment or Emergency Assignment class certificate. 6. The applicant must have an appointment or special assignment as a registered practical nurse with an Ontario facility described in Schedule 1 or another assignment approved by a panel of the Registration Committee. 7. The applicant must not have previously held a Special Assignment certificate for the same assignment or appointment. O. Reg. 175/12, s. 1. (4) Subject to section 6.2, the requirements of subsection (3) are non-exemptible. O. Reg. 175/12, (5) The following are terms, conditions and limitations of a Special Assignment certificate of registration: 1. The member shall practise the profession only within the scope of his or her appointment or special assignment and only within the facility named in the certificate

77 2. The member s practice must be monitored and directed by a member of the College holding a General or extended class certificate of registration. 3. The member shall not perform a controlled or authorized act, including one which is delegated to him or her, unless the act is ordered, i. pursuant to clause 5 (1) (b) of the Act, or ii. by a registered nurse in the General class. 4. The member shall not supervise, monitor or direct the performance of a controlled or authorized act or the practice of another member in any class. 5. The member shall not delegate to another member or any other person the authority to perform a controlled or authorized act. 6. The member shall at all times when providing nursing services identify himself or herself as a Special Assignment member. 7. The member shall be restricted to the use of the following title: i. in the case of the holder of a Special Assignment certificate of registration as a registered nurse, Registered Nurse (Special Assignment) or RN (Spec. Assign.), or ii. in the case of a holder of a Special Assignment certificate of registration as a registered practical nurse, Registered Practical Nurse (Special Assignment) or RPN (Spec. Assign.). O. Reg. 175/12, s. 1. (6) A Special Assignment certificate of registration is automatically revoked on the occurrence of one of the following events, whichever occurs first: 1. The date specified in the certificate or, if no date is specified, the day that is one year from the date the member was issued the certificate. 2. The last day of the appointment or Special Assignment. O. Reg. 175/12, s. 1. (7) If a member who holds a Special Assignment certificate of registration does not receive a certificate of another class before the revocation of the Special Assignment certificate, he or she shall be deemed to have resigned as a member at the end of the last day the Special Assignment certificate is valid. O. Reg. 175/12, s. 1. LABOUR MOBILITY SPECIAL ASSIGNMENT CLASS 6.1 (1) Where section of the Health Professions Procedural Code applies to an applicant for a Special Assignment certificate of registration as a registered nurse, the requirements of paragraphs 3 and 4 of subsection 6 (1) of this Regulation are deemed to be met by the applicant. O. Reg. 175/12, s. 1. (2) Despite subsection (1), it is a non-exemptible requirement that an applicant referred to in subsection (1) provide, for each jurisdiction where the applicant holds an out-of-province certificate, a certificate, letter or other evidence satisfactory to the Executive Director or a panel of the Registration Committee confirming that the applicant is in good standing as a nurse in that jurisdiction. O. Reg. 175/12, s

78 (3) Without in any way limiting the generality of subsection (2), good standing shall include the fact that, (a) the applicant is not the subject of any discipline or fitness to practise order or of any proceeding or ongoing investigation or of any interim order or agreement as a result of a complaint, investigation or proceeding; and (b) the applicant has complied with continuing competency and quality assurance requirements of the regulatory authority that issued the applicant the out-of-province Special Assignment certificate as a registered nurse. O. Reg. 175/12, s. 1. (4) An applicant referred to in subsection (1) is deemed to have met the requirement of paragraph 2 of subsection 6 (1) where the requirements for the issuance of the applicant s out-of-province certificate of registration included language proficiency requirements equivalent to those required by that paragraph. O. Reg. 175/12, s. 1. (5) Despite subsection (1), a requirement set out in paragraphs 3 and 4 of subsection 6 (1) will apply to an applicant if that requirement is a requirement described in subsection (3) of the Health Professions Procedural Code. O. Reg. 175/12, s. 1. (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by a Special Assignment certificate of registration as a registered nurse at any time in the three years immediately before the date of that applicant s application, the applicant must meet any further requirement to undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. O. Reg. 175/12, s (1) Where section of the Health Professions Procedural Code applies to an applicant for a Special Assignment certificate of registration as a registered practical nurse, the requirements of paragraphs 3 and 4 of subsection 6 (3) of this Regulation are deemed to be met by the applicant. O. Reg. 175/12, s. 1. (2) Despite subsection (1), it is a non-exemptible requirement that an applicant referred to in subsection (1) provide, for each jurisdiction where the applicant holds an out-of-province certificate, a certificate, letter or other evidence satisfactory to the Executive Director or a panel of the Registration Committee confirming that the applicant is in good standing as a nurse in that jurisdiction. O. Reg. 175/12, s. 1. (3) Without in any way limiting the generality of subsection (2), good standing shall include the fact that, (a) the applicant is not the subject of any discipline or fitness to practise order or of any proceeding or ongoing investigation or of any interim order or agreement as a result of a complaint, investigation or proceeding; and (b) the applicant is in compliance with the continuing competency and quality assurance requirements of the regulatory authority that issued the applicant the out-of-province Special Assignment certificate as a registered practical nurse. O. Reg. 175/12, s

79 (4) An applicant referred to in subsection (1) is deemed to have met the requirement of paragraph 2 of subsection 6 (3) where the requirements for the issuance of the applicant s out-of-province certificate of registration included language proficiency requirements equivalent to those required by that paragraph. O. Reg. 175/12, s. 1. (5) Despite subsection (1), a requirement set out in paragraphs 3 and 4 of subsection 6 (3) will apply to an applicant if that requirement is a requirement described in subsection (3) of the Health Professions Procedural Code. O. Reg. 175/12, s. 1. (6) If an applicant to whom subsection (1) applies is unable to satisfy the Executive Director or a panel of the Registration Committee that the applicant practised the profession of nursing to the extent that would be permitted by a Special Assignment certificate of registration as a registered practical nurse at any time in the three years immediately before the date of that applicant s application, the applicant must meet any further requirement to undertake, obtain or undergo material additional training, experience, examinations or assessments that may be specified by a panel of the Registration Committee. O. Reg. 175/12, s. 1. EMERGENCY ASSIGNMENT CERTIFICATES OF REGISTRATION 7. (1) The following are additional requirements for the issuance of a certificate as a registered nurse in the Emergency Assignment class: 1. The Government of Ontario has requested that the College assist it by issuing Emergency Assignment certificates of registration to qualified applicants. 2. The applicant must satisfy the Executive Director that he or she has language proficiency, in either English or French, to be able to communicate and comprehend effectively, both orally and in writing. 3. The applicant must have successfully completed a nursing program that was, at the time the applicant completed the program, recognized or approved in the jurisdiction in which the program was taken as qualifying the applicant to practise as a registered nurse in that jurisdiction. 4. The applicant must satisfy the Executive Director that he or she practised as a registered nurse within three years before the day on which the applicant met all other requirements for the issuance of the certificate of registration. O. Reg. 175/12, s. 1. (2) The requirements of subsection (1) are non-exemptible. O. Reg. 175/12, s. 1. (3) The following are additional requirements for the issuance of a certificate of registration as a registered practical nurse in the Emergency Assignment class: 1. The Government of Ontario has requested that the College assist it by issuing Emergency Assignment class certificates of registration to qualified applicants. 2. The applicant must satisfy the Executive Director that he or she has language proficiency, in either English or French, to be able to communicate and comprehend effectively, both orally and in writing. 3. The applicant must have successfully completed a nursing program that was, at the time the applicant completed the program, recognized or approved in the jurisdiction in which the

80 program was taken as qualifying the applicant to practise as a registered practical nurse in that jurisdiction. 4. The applicant must satisfy the Executive Director that he or she practised as a registered practical nurse within three years before the day on which the applicant met all other requirements for the issuance of the certificate of registration. O. Reg. 175/12, s. 1. (4) The requirements of subsection (3) are non-exemptible. O. Reg. 175/12, s. 1. (5) Every certificate of registration in the Emergency Assignment class is subject to the following terms, conditions and limitations: 1. The member shall practise the profession only within the scope of his or her Emergency Assignment certificate. 2. The member shall at all times when providing nursing services identify himself or herself as an Emergency Assignment member. 3. The member shall be restricted to the use of the following title: i. in the case of a member holding an Emergency Assignment certificate of registration as a registered nurse, Registered Nurse (Emergency Assignment) or RN (Emerg. Assign.), or ii. in the case of a member holding an Emergency Assignment certificate of registration as a registered practical nurse, Registered Practical Nurse (Emergency Assignment) or RPN (Emerg. Assign.). O. Reg. 175/12, s. 1. (6) An Emergency Assignment certificate of registration is automatically revoked on the occurrence of one of the following events: 1. The expiry of 60 days from the date the certificate was issued, unless the Executive Director extends the certificate for one or more extensions under subsection (7). 2. The date the Executive Director extended the certificate under subsection (7). 3. The issuance of a General, extended or Special Assignment class certificate of registration as a registered nurse or a General or Special Assignment certificate of registration as a registered practical nurse. 4. The date that the Executive Director revokes the certificate. O. Reg. 175/12, s. 1. (7) The Executive Director may extend an Emergency Assignment certificate of registration for one or more periods, each of which is not to exceed 60 days, if, in the opinion of the Executive Director, it is advisable or necessary to do so. O. Reg. 175/12, s. 1. NON-PRACTISING CERTIFICATES OF REGISTRATION 8. (1) The following are additional requirements for the issuance of a certificate of registration as a registered nurse in the Non-Practising class: 1. The applicant must be a member of the College holding a General or extended class certificate of registration as a registered nurse or have previously been a member of the College holding a General or extended class certificate of registration as a registered nurse

81 2. The applicant must not be in default of payment of fees, penalties or any other amount owing to the College on the date of the issuance of the certificate. O. Reg. 175/12, s. 1. (2) The requirements of subsection (1) are non-exemptible. O. Reg. 175/12, s. 1. (3) The following are additional requirements for the issuance of a certificate of registration as a registered practical nurse in the Non-Practising class: 1. The applicant must be a member of the College holding a General class certificate of registration as a registered practical nurse or have previously been a member of the College holding a General class certificate of registration as a registered practical nurse. 2. The applicant must not be in default of payment fees, penalties or any other amount owing to the College on the date of the issuance of the certificate. O. Reg. 175/12, s. 1. (4) The requirements of subsection (3) are non-exemptible. O. Reg. 175/12, s. 1. (5) Subject to subsection (6), every Non-Practising class certificate of registration is subject to the following terms, conditions and limitations: 1. The member shall not engage in the practice of nursing in Ontario. 2. The member shall not hold himself or herself out as a person qualified to practise in Ontario as a nurse, nurse practitioner, registered nurse, practical nurse, registered practical nurse, or in any specialityspecialty of nursing. 3. The member shall be restricted to the use of the following title: i. in the case of a holder of a Non-Practising class certificate of registration as a registered nurse, Registered Nurse, Non-Practising, or RN Non-Practising, or ii. in the case of a holder of a Non-Practising class certificate of registration as a registered practical nurse, Registered Practical Nurse, Non-Practising or RPN Non-Practising. O. Reg. 175/12, s. 1. (6) A member holding a Non-Practising class certificate of registration shall not be considered to be in breach of paragraph 1 of subsection (5) if, (a) the member is engaged in continuing education or remediation directed by a committee or a panel of a committee of the College, approved by the Executive Director or as required to obtain the reinstatement of a General or extended class certificate of registration which he or she formerly held; and (b) the member maintains professional liability protection in accordance with the requirements, if any, set out in the by-laws for a member holding the class of certificate for which he or she is seeking reinstatement. O. Reg. 175/12, s. 1. (7) All certificates of registration held by the member shall be revoked automatically at the time that the member is issued a certificate of registration as a registered nurse or registered practical nurse in the Non-Practising class. O. Reg. 175/12, s. 1. EXAMINATIONS

82 8.1 (1) Where Council approves an examination for the purpose of paragraph 2 of subsections 2 (1) or 3 (1) or paragraph 3 of subsection 4 (1), Council shall determine whether the examination is one for which applicants shall be permitted an unlimited number of attempts to successfully complete that examination or whether the examination is one for which there shall be a limited number of attempts to successfully complete that examination. (2) Subject to subsection (3), where Council determines that an examination is one for which there shall be a limited number of attempts, Council shall determine the maximum number of attempts which an applicant shall be permitted to successfully complete that examination. (3) Where Council makes a determination under subsection (2), it shall provide for at least three attempts to successfully complete that examination. (4) Where Council approved an examination before [*NTD: the coming into force of this section] Council shall make a determination as to whether the examination is one for which applicants shall be permitted an unlimited number of attempts to successfully complete that examination or whether the examination is one for which there shall be a limited number of attempts to successfully complete that examination. (5) Where Council fails to determine the maximum number of attempts applicable to an examination under subsection (2) or (4), Council shall be deemed to have determined that an applicant shall be permitted a maximum of three attempts to successfully complete that examination. (6) Nothing in subsection (4) shall prevent Council from subsequently determining the maximum number of attempts applicable to an examination under subsection (2). EXAMINATIONS GENERAL CLASS 9. (1) The College shall ensure that an examination that is a requirement for a General class certificate of registration for a registered nurse in the General class or a registered practical nurse in the General class is held at least once every six months. O. Reg. 175/12, s. 1. (2) An applicant who meets the following requirements is eligible to attempt thean examination referred to in paragraph 2 of subsection 2 (1) for a General certificate of registration as a registered nurse: 1. The person must file a completed examination application form. 2. The person must pay the required examination fee. 3. The person must meet the requirement of paragraph 1 of subsection 2 (1). 4. In respect of an examination for which Council has determined there shall be a limited number of attempts, the person must not have failed, on three previous occasions, an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered nurse in the General class. O. Reg. 175/12, s. 1.exhausted, after having met the requirement of paragraph 1 of subsection 2 (1), all of the attempts which Council determined were allowable for the applicant to successfully complete that examination

83 (3) An applicant who meets the following requirements is eligible to attempt thean examination referred to in paragraph 2 of subsection 3 (1) for a General certificate of registration as a registered practical nurse: 1. The person must file a completed examination application form. 2. The person must pay the required examination fee. 3. The person must meet the requirement of paragraph 1 of subsection 3 (1). 4. In respect of an examination for which Council has determined there shall be a limited number of attempts, the person must not have failed on three previous occasions an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered practical nurse in the General class. O. Reg. 175/12, s. 1.exhausted, after having met the requirement of paragraph 1 of subsection 3 (1), all of the attempts which Council determined were allowable for the applicant to successfully complete that examination. (4) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 4 of subsection (2) may only take the examination if the applicant obtains a new degree that meets the requirement of subparagraph 1 i or ii of subsection 2 (1). O. Reg. 175/12, s. 1. (5) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 4 of subsection (3) may only take the examination if the applicant obtains a new diploma that meets the requirement of subparagraph 1 i or ii of subsection 3 (1) or a new degree that meets the requirement of subparagraph 1 i or ii of subsection 2 (1). O. Reg. 175/12, s. 1. (6) An applicant who obtains a new degree in accordance with subsection (4) is ineligible to attempt the examination referred to in paragraph 2 of subsection 2 (1) if he or she failed, on three occasions after obtaining the new degree, an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered nurse in the General class. O. Reg. 175/12, s. 1. (7) An applicant who obtains a new diploma or degree in accordance with subsection (5) is ineligible to attempt the examination referred to in paragraph 2 of subsection 3 (1) if he or she failed, on three occasions after obtaining the new diploma or degree, an examination which would, if successfully completed, have met the examination requirement for the issuance of a certificate for a registered practical nurse in the General class. O. Reg. 175/12, s. 1. EXAMINATIONS EXTENDED CLASS 9.1 (1) The College shall ensure that an examination in each of the specialties that is a requirement for an extended class certificate of registration, other than anaesthesia, is available at least once every year. O. Reg. 175/12, s

84 (2) An applicant who meets the following requirements is eligible to attempt thean examination referred to in paragraph 3 of subsection 4 (1) for an extended certificate of registration as a registered nurse: 1. The person must file a completed examination application form. 2. The person must pay the required examination fee. 3. The person must meet the requirements of paragraph 1 of subsection 4 (1). 4. The person must meet the requirements of paragraph 2 of subsection 4 (1) for that specialty to which the examination relates. 5. In respect of an examination for which Council has determined there shall be a limited number of attempts, the person must not have failed on three previous occasions an examination for a specialty which would, if successfully completed, have met the examination requirement for registration in the extended class. O. Reg. 175/12, s. 1.exhausted, after having met the requirements of paragraphs 1 and 2 of subsection 4 (1), all of the attempts which Council determined were allowable for the applicant to successfully complete that examination. (3) An applicant who is ineligible to take the examination because he or she failed to meet the requirement in paragraph 5 of subsection (2) may only take the examination again if the applicant successfully completes a new program that meets the requirements set out within subparagraph 2 i, ii or iii of subsection 4 (1). O. Reg. 175/12, s. 1. (4) An applicant who successfully completes a new program in accordance with subsection (3) is ineligible to attempt the examination referred to in paragraph 3 of subsection 4 (1) if he or she failed, on three occasions after completing the new program, an examination for a specialty which would, if successfully completed, have met the examination requirement for registration in the extended class. O. Reg. 175/12, s. 1. RESIGNATION 10. (1) A member may resign as a member of the College by giving written notice to the College. O. Reg. 175/12, s. 1. (2) A resignation under this section is effective on the date set out in the resignation or on the date it is received by the College, whichever is later. O. Reg. 175/12, s. 1. (3) A resignation under subsection (1) automatically revokes the certificate or certificates of registration and any specialty certificates to which it applies at the time the resignation becomes effective. O. Reg. 175/12, s. 1. SUSPENSION FOR FAILURE TO PROVIDE INFORMATION 10.1 (1) If a member fails to provide to the College information about the member in the manner and form required under the by-laws, the Executive Director shall give the member notice of intention to suspend the member and may suspend one or more of the member s certificates of registration for failure to provide the information where at least 30 days have passed after notice is given. O. Reg. 175/12, s

85 (2) Where the Executive Director suspends a member s certificate of registration under subsection (1), the Executive Director shall lift the suspension upon being satisfied that the required information has been filed with the College and that any fees required under the by-laws for the lifting of that suspension have been paid. O. Reg. 175/12, s. 1. SUSPENSION FOR FAILURE TO PROVIDE EVIDENCE OF PROFESSIONAL LIABILITY PROTECTION 10.2 (1) If the Executive Director requests evidence that the member holds professional liability protection in accordance with the requirements, if any, set out in the by-laws and the member fails to provide that evidence within 14 days of having been requested to do so or such longer period as is specified by the Executive Director, the Executive Director shall give the member notice of intention to suspend the member and may suspend the member s certificate of registration for failure to provide the evidence where at least 30 days have passed after notice is given. O. Reg. 175/12, s. 1. (2) If a member holds more than one certificate of registration, a suspension mentioned in subsection (1) applies only to the certificate or certificates in respect of which notice was given. O. Reg. 175/12, s. 1. (3) Where the Executive Director suspends the member s certificate of registration under subsection (1), the Executive Director shall lift that suspension upon being satisfied that the member holds professional liability protection in accordance with the requirements, if any, set out in the by-laws and that any fees required under the by-laws for the lifting of that suspension have been paid. O. Reg. 175/12, s. 1. LIFTING OF CERTAIN SUSPENSIONS 10.3 Where the Executive Director suspended a certificate of registration pursuant to section 24 of the Health Professions Procedural Code, the Executive Director shall lift the suspension upon being satisfied that, (a) all amounts owing to the College at the time of the suspension have been paid; and (b) any fees required under the by-laws for the lifting of the suspension have been paid. O. Reg. 175/12, s. 1. REVOCATION 10.4 (1) The Executive Director shall revoke the certificate of registration of a member where, (a) his or her certificate of registration was suspended pursuant to section 24 of the Health Professions Procedural Code and that suspension continued for at least 30 days; or (b) his or her certificate of registration was suspended pursuant to subsection 10.1 (1) or 10.2 (1) of this Regulation and the suspension continued for at least 30 days. O. Reg. 175/12, s. 1. (2) The Executive Director may revoke a certificate of registration of a member if the member has more than one certificate of registration and gives written notice to the College asking that one of his or her certificates of registration be revoked. O. Reg. 175/12, s. 1. (3) All specialty certificates are revoked at the time that a member s extended class certificate of registration is revoked. O. Reg. 175/12, s

86 (4) The Executive Director shall revoke a specialty certificate of a registered nurse in the extended class if he or she gives written notice to the College asking that his or her specialty certificate be revoked. O. Reg. 175/12, s. 1. REINSTATEMENT, ON APPLICATION 10.5 (1) A former member who held a General certificate of registration as a registered nurse or registered practical nurse or an extended certificate of registration as a registered nurse, and who resigned pursuant to section 10 or whose certificate was revoked pursuant to section 10.4 or a predecessor to one of those provisions may apply for the reinstatement of his or her certificate of registration by submitting a completed application to the Executive Director in the form provided by the Executive Director. O. Reg. 175/12, s. 1. (2) A former member who applies for reinstatement of a certificate of registration as a registered nurse in the extended class under subsection (1) shall also apply for reinstatement of one or more specialty certificates that he or she previously held. O. Reg. 175/12, s. 1. (3) Subject to subsection (4), the Executive Director may reinstate the former member s certificate of registration if, (a) the Executive Director is satisfied that the former member has corrected the deficiency or deficiencies that provided the grounds for the revocation of the former member s certificate pursuant to section 10.4, if applicable; (b) the application for reinstatement was submitted to the Executive Director within three years of the date on which the former member s certificate of registration was revoked; (c) the former member has paid, (i) the reinstatement fees required under the by-laws, (ii) any other applicable fees required under the by-laws, (iii) any other money otherwise owed by the former member to the College at the date the application for reinstatement is submitted, including, without limitation, any costs or expenses ordered to be paid under section 53.1 of the Health Professions Procedural Code, any costs awarded to the College by a court and any amount owing to the College under a by-law or former regulation made under the Act; and (d) the former member, (i) satisfies the Executive Director that he or she completed all education, experience and training requirements for the issuance of the certificate of registration that is the subject of the application for reinstatement within the three years immediately preceding the date on which the applicant satisfied all other requirements for reinstatement, or (ii) demonstrates evidence of practice within the three years immediately preceding the date on which the applicant satisfied all other requirements for reinstatement, (A) as a registered nurse, if he or she is applying for reinstatement of a General certificate of registration as a registered nurse,

87 (B) as a registered practical nurse, if he or she is applying for reinstatement of a General certificate of registration as a registered practical nurse, or (C) as a registered nurse in the extended class, if he or she is applying for reinstatement of an extended certificate of registration as a registered nurse and in such a case the practice must include, (1) clinical practice within each specialty in the extended class for which the former member is seeking reinstatement, and (2) a nursing role within that specialty that required him or her to use, in the treatment of patients, advanced knowledge and decision-making skill in assessment, diagnosis and therapeutics. O. Reg. 175/12, s. 1. (4) A former member is ineligible for reinstatement under subsection (3) if he or she, (a) was, after he or she ceased to be a member, found guilty of any criminal offence in any jurisdiction or of any offence involving the use, possession or sale of drugs in any jurisdiction; (b) was, after he or she ceased to be a member, found guilty of any offence in any jurisdiction relating to the practice of nursing or any other profession; (c) has been the subject of an inquiry or investigation by the Executive Director that was not completed on its merits prior to the time that the applicant ceased being a member or that resulted in the member s resignation; (d) was, at the time he or she ceased to be a member, the subject of an outstanding order of a Committee or of a panel of a Committee or a Board of Inquiry of the College; (e) was, at the time he or she ceased to be a member, in breach of an order of a Committee or of a panel of a Committee or a Board of Inquiry of the College; (f) was, prior to the time he or she ceased to be a member, selected or directed to undergo an assessment or reassessment under the College s Quality Assurance Program unless the assessment or reassessment was completed and any continuing education or remedial program required by a panel of the Quality Assurance Committee was completed before the time he or she ceased to be a member; (g) was, at the time he or she ceased to be a member, in breach of any written agreement with or undertaking provided to the College; (h) was, after he or she ceased to be a member, refused registration in any jurisdiction either in nursing or any other profession; or (i) was, after he or she ceased to be a member, the subject of a finding of professional negligence or malpractice in any jurisdiction in relation to nursing or any other profession. O. Reg. 175/12, s. 1. REINSTATEMENT, NON-PRACTISING 10.6 (1) A member holding a Non-Practising certificate of registration may apply for reinstatement of the General certificate of registration as a registered nurse or registered practical nurse or the extended certificate of registration as a registered nurse that he or she previously held by submitting a completed

88 application to the Executive Director in the form provided by the Executive Director. O. Reg. 175/12, s. 1. (2) A member who applies for reinstatement of a certificate of registration as a registered nurse in the extended class under subsection (1) shall also apply for reinstatement of one or more specialty certificates that he or she previously held. O. Reg. 175/12, s. 1. (3) Subject to subsection (4), the Executive Director may reinstate the member s certificate of registration if, (a) the member has paid, (i) the reinstatement fees required under the by-laws, and (ii) any other applicable fees required under the by-laws; (b) the member demonstrates evidence of practice within the three years immediately preceding the date on which the applicant satisfies all other requirements for reinstatement, (i) as a registered nurse, if he or she is applying for reinstatement of a General certificate of registration as a registered nurse, (ii) as a registered practical nurse, if he or she is applying for reinstatement of a General certificate of registration as a registered practical nurse, or (iii) as a registered nurse in the extended class if he or she is applying for reinstatement of an extended certificate of registration as a registered nurse, and in such a case the practice must have included, (A) clinical practice within each specialty in the extended class for which the member is seeking reinstatement, and (B) a nursing role within that specialty that required him or her to use, in the treatment of patients, advanced knowledge and decision-making skill in assessment, diagnosis and therapeutics; (c) the member demonstrates language proficiency and the ability to communicate and comprehend effectively, both orally and in writing, in either English or French, unless the member held a certificate of registration, other than an Emergency Assignment, retired or Non-Practising certificate of registration, less than two years before applying for reinstatement or within such longer period as specified by the Executive Director; and (d) the member successfully completed the examination in nursing jurisprudence approved by Council for applicants for the issuance of the class of certificate for which he or she is seeking reinstatement within five years before the date on which the member met all of the other requirements for reinstatement, unless the member held a certificate of registration, other than an Emergency Assignment, retired or Non-Practising certificate of registration, less than five years before applying for reinstatement. O. Reg. 175/12, s. 1. (4) A member is ineligible for reinstatement under subsection (3) if any of the provisions set out in clauses 10.5 (4) (a) to (i), with necessary modifications, apply to the member. O. Reg. 175/12, s

89 REINSTATEMENT, EXTENDED CLASS 10.7 (1) A member who holds a General certificate of registration as a registered nurse and who formerly held an extended certificate of registration as a registered nurse may apply for the reinstatement of his or her extended certificate of registration by submitting a completed application to the Executive Director in the form provided by the Executive Director. O. Reg. 175/12, s. 1. (2) A member who applies for reinstatement of a certificate of registration as a registered nurse in the extended class under subsection (1) shall also apply for reinstatement of one or more specialty certificates that he or she previously held. O. Reg. 175/12, s. 1. (3) The Executive Director may reinstate the member s extended certificate of registration and one or more specialityspecialty certificates previously held by the member if, (a) the member has paid, (i) the reinstatement fees required under the by-laws, and (ii) any other applicable fees required under the by-laws; (b) the member demonstrates evidence of practice as a registered nurse in the extended class within the three years immediately preceding the date on which the applicant satisfied all other requirements for reinstatement, and in such a case the practice must have included, (i) clinical practice within each specialty in the extended class for which the member is seeking reinstatement, and (ii) a nursing role within that specialty that required him or her to use, in the treatment of patients, advanced knowledge and decision-making skill in assessment, diagnosis and therapeutics; and (c) the member successfully completed the examination in nursing jurisprudence approved by Council for applicants for the issuance of an extended certificate of registration within five years before the date on which the member met all of the other requirements for reinstatement, unless the member held an extended class certificate of registration as a registered nurse less than five years before applying for reinstatement. O. Reg. 175/12, s. 1. REINSTATEMENT, PURSUANT TO ORDER 10.8 (1) If a former member s certificate of registration is ordered to be reinstated by a panel of the Discipline Committee or of the Fitness to Practise Committee, the Executive Director shall reinstate the certificate of registration upon payment of, (a) the reinstatement fee required under the by-laws; and (b) any other applicable fees required under the by-laws. O. Reg. 175/12, s. 1. (2) If a former member s extended class certificate of registration is reinstated under subsection (1), any specialityspecialty certificate that he or she held shall be reinstated unless otherwise ordered. O. Reg. 175/12, s

90 TERMS, ETC (1) The Executive Director may impose on a member s certificate of registration that is reinstated under this Regulation any terms, conditions or limitations that were imposed on the member s previously held certificate of registration. O. Reg. 175/12, s. 1. (2) Nothing in sections 10.5, 10.6 or 10.7 prevents a member or former member from making an application for a new certificate of registration. O. Reg. 175/12, s. 1. (3) An applicant for reinstatement under sections 10.5, 10.6 or 10.7 must meet all the requirements for reinstatement within two years of the date of filing his or her completed application to the Executive Director, but this does not prevent the member or former member from filing a new application for reinstatement. O. Reg. 175/12, s. 1. (4) An applicant for reinstatement under sections 10.5, 10.6 or 10.7 shall be deemed not to have satisfied the requirements for reinstatement if he or she makes a false or misleading statement or representation in the application or supporting documents. O. Reg. 175/12, s. 1. DECLARATION 11. (1) Every member holding a General or extended certificate of registration shall make a declaration, at the request of the Executive Director or at the time he or she pays the annual membership fee required under the by-laws, about whether the member has engaged in the practice of nursing in Ontario during the previous three years, (a) as a registered nurse in the General class, if he or she holds that certificate; (b) as a registered practical nurse in the General class, if he or she holds that certificate; or (c) as a registered nurse in the extended class, if he or she holds that certificate, and such a member must also declare whether that practice included, (i) clinical practice within each specialty in the extended class for which the member holds a specialty certificate, and (ii) a nursing role within that specialty that required him or her to use, in the treatment of patients, advanced knowledge and decision-making skill in assessment, diagnosis and therapeutics. O. Reg. 175/12, s. 1. (2) If a member mentioned in clause (1) (a), (b) or (c) declares that he or she has not engaged in the practice of nursing in Ontario during the previous three years, all of the member s certificates of registration shall be revoked. O. Reg. 175/12, s. 1. (3) If a member mentioned in clause (1) (c) declares that he or she has engaged in the practice of nursing in Ontario during the previous three years but has not practised in any specialty for which the member holds a specialty certificate, (a) the member is deemed to have met all the requirements for the issuance of a certificate of registration as a registered nurse in the General class and the Executive Director shall issue that certificate to the member; and (b) the extended class certificate of registration that the member previously held, along with all of the specialty certificates that the member held, shall be revoked. O. Reg. 175/12, s

91 (4) If a member who is a registered nurse in the General class and a registered practical nurse in the General class declares that he or she has not practised as a registered nurse in Ontario during the previous three years, but has practised as a registered practical nurse, the member s General certificate of registration as a registered nurse shall be revoked. O. Reg. 175/12, s. 1. (5) If a member who is a registered nurse in the General class and a registered practical nurse in the General class declares that he or she has not practised as a registered practical nurse in Ontario during the previous three years, the member s General certificate of registration as a registered practical nurse shall be revoked. O. Reg. 175/12, s. 1. (6) If a member who is a registered nurse in the extended class and a registered practical nurse in the General class declares that he or she has not practised as a registered practical nurse in Ontario during the previous three years, the member s General certificate of registration as a registered practical nurse shall be revoked. O. Reg. 175/12, s. 1. (7) If a member who is a registered nurse in the extended class and a registered practical nurse in the General class declares that he or she has not practised in any of the specialties related to his or her extended certificate during the previous three years in Ontario, the member s extended certificate of registration, along with all the specialty certificates, shall be revoked. O. Reg. 175/12, s. 1. (8) If a member who is a registered nurse in the extended class declares that he or she practised as a nurse in Ontario during the previous three years in one or more of the specialties related to his or her extended certificate, but did not practise in one or more of the other specialties related to his or her extended certificate, the one or more specialty certificates in which the member did not practise during the previous three years shall be revoked. O. Reg. 175/12, s. 1. (9) At the request of the Executive Director, a member who makes a declaration under subsection (1) shall provide evidence that, in the opinion of the Executive Director, is satisfactory to support the declaration, within 14 days, or such longer period as approved by the Executive Director. O. Reg. 175/12, s. 1. TRANSITION 12. (1) A member holding a retired certificate of registration as a registered nurse immediately before January 1, 2013 shall be deemed to be the holder of a Non-Practising certificate of registration as a registered nurse. O. Reg. 175/12, s. 1. (2) A member holding a retired certificate of registration as a registered practical nurse immediately before January 1, 2013 shall be deemed to be the holder of a Non-Practising certificate of registration as a registered practical nurse. O. Reg. 175/12, s Subject to section 12, every certificate of registration that was in existence immediately before January 1, 2013 is continued as the equivalent certificate of registration under this Regulation and is subject to any terms, conditions and limitations imposed on the certificate of registration. O. Reg. 175/12, s If a certificate of registration of a former member was suspended for failure to pay a fee required under the by-laws or any previous legislation before January 1, 2013 and that suspension was in effect immediately before January 1, 2013, that certificate shall be deemed to be revoked 30 days after January 1, O. Reg. 175/12, s

92 Agenda Item 5.2 Decision Note 1 June 2016 Council NCLEX-RN: Number of Writes Contacts for Questions or More Information Kevin McCarthy, Manager of Strategy Suzanne Vogler. Manager of Entry-to-Practice Motion for Council That Council approve the removal of a limit on the number of attempts for the National Council Licensure Examination for Registered Nurses (NCLEX-RN), subject to approval by Council and the Government of changes to Part II (Registration) of Ontario Regulation 275/94 (General) under the Nursing Act, 1991, such changes to allow Council to determine the number of writes for the NCLEX-RN. Background What are the registration requirements? The College is responsible for ensuring there are appropriate entry requirements to ensure that an individual registering as a nurse in Ontario is safe to practise. Registration requirements vary in the regulation (e.g., for a new applicant versus a reinstatement applicant) but in general, the requirements are as follows: 1. Nursing education: approved programs incorporate entry-to-practice competencies in curriculum. 2. Recent nursing practice (within the last three years): the application of nursing knowledge, skills and judgement. 3. Registration examination: ensures entry-level nurses possess the minimum competencies to provide safe, effective and ethical nursing care. 4. Jurisprudence examination (within the last five years): ensures the applicant s knowledge and understanding of the laws, regulations, by-laws, practice standards and guidelines that govern the nursing profession in Ontario. 5. Proficiency in English or French (within the last two years): the ability to communicate and comprehend effectively, both orally and in writing. 6. Citizenship 7. Past offences and findings: assessed from a public safety perspective. 1 The majority of this note was adapted from the national paper: Number of Attempts to Pass the National Council Licensure Examination for Registered Nurses. This paper was developed for the Canadian Council of Registered Nurse Regulators (CCRNR) by a working group under CCRNR

93 8. Health and conduct: CNO must believe the applicant will practise nursing with decency, honesty and integrity, and in accordance with the law; have sufficient knowledge, skill and judgement to competently engage in the practice of nursing; and, display an appropriately professional attitude. All of the above requirements together indicate someone is safe to practise in Ontario. What is the NCLEX-RN and when was it approved? The NCLEX-RN was originally developed by the National Council of State Boards of Nursing (NCSBN). The exam tests if applicants have the minimum competencies to support safe, effective and ethical RN practice. Although NCSBN is based in the US, the exam is not an American or a Canadian exam it s a nursing exam. Canadian nurses from the ten provinces/territories using the test participated in the development of the NCLEX-RN currently in use. They continue to participate in its development and review to ensure it meets the needs of regulators. In March 2013, Council approved the NCLEX-RN as a new entry-to-practice exam for individuals seeking Ontario RN registration. The NCLEX-RN meets our requirement for being a reliable, valid and fair exam that also meets the needs of writers, such as year-round access to the exam and fast issuing of exam results. The exam was implemented January 1, 2015 by all RN regulators in Canada (with the exception of Quebec). When the NCLEX-RN was implemented, RN regulators maintained their existing policies on maximum number of attempts. National work As part of the decision to adopt the NCLEX-RN, RN regulators in Canada decided to accept, as an approved entry-to-practice exam, the NCLEX-RN writes dating back to What this means is that any applicant who can demonstrate they passed the NCLEX-RN since 1982 will not be required to re-write the NCLEX-RN. As part of this decision, RN regulators, with the exception of New Brunswick, decided to accept the passing NCLEX-RN result, regardless of the number of attempts the candidate took to pass the exam, if the pass was obtained between 1982 and December 31, After January 1, 2015, all new applicants are required to pass the NCLEX-RN within three attempts. In November 2015, the Canadian Council of Registered Nurse Regulators (CCRNR), comprised of the CEOs and Executive Directors of the RN regulators across Canada, recommended that a national working group be struck to examine the issue of the total number of exam attempts to be granted to new NCLEX-RN candidates in Canada. The purpose of the working group was to conduct a thorough analysis of the legal, psychometric, ethical and public safety principles surrounding the number of attempts that should be granted to candidates attempting to pass the NCLEX-RN. Given the Agreement on Internal Trade, it is ideal to have consistency across Canada. Once an applicant is licenced in a Canadian jurisdiction, they can apply to be licenced in any other - 2 -

94 jurisdiction in Canada without having to meet certain requirements such as the entry-to-practice exam. What makes NCLEX-RN unique? The exam is: a computerized adaptive test (CAT) using item response theory (IRT) which improves the precision of measuring the candidate's ability; designed and administered to prevent candidates from becoming familiar with exam content; and, safeguarded with robust security features to ensure the exam is not compromised. Two main theories are used to predict and improve the reliability of testing in high stakes entryto-practice examinations: classical test theory (CTT) and item response theory (IRT). In CTT, a candidate s observed score is the combination of the candidate s true score plus error (chance happenings such as guessing). CTT does not factor in item difficulty or candidate ability, and measurement is at the test level (not item level). Conversely, with IRT, a candidate s odds (the probability of the candidate answering correctly versus incorrectly) is based on item difficulty as well as the candidate s ability. IRT enables increased precision of measurement. The previous RN exam that was approved by Council was a linear CTT exam - containing a same set number of predetermined questions, organized in the same predetermined sequence and administered to all exam candidates. The number of exam attempts was historically limited to ensure the exam was testing a candidate s competencies and not testing measurement error or the candidate s learned familiarity with exam content. Permitting retakes also takes into account that an exam failure may be attributed to other factors, such as test anxiety. With the NCLEX-RN, no two sessions of exams are identical. Every time an exam candidate answers an item on the exam, the computer re-estimates the candidate s ability based on all the previous answers and the difficulty of those items. The computer then selects the next item that the candidate should have a 50% chance of answering correctly. This algorithm reduces the number of easy items that high-ability candidates receive, which is preferable because easy items tell little information about a high performer s ability and is an inefficient way to measure a high-ability candidate s competence. This system also reduces the number of difficult items that low-ability candidates receive, which is preferable because candidates may guess on items that are too difficult, which increases the chances of the candidate answering incorrectly. The algorithm re-estimates the candidate s ability after every answer, tailoring the difficulty of each question to the candidate. Technical design and administrative safeguards A review of the technical design safeguards of NCLEX-RN, as well as an analysis of pass-rate data from the US was conducted. NCLEX-RN design controls for item exposure in the following ways: item and test format vary for each candidate; - 3 -

95 each candidate receives a unique test based on their ability level (computerized adaptive test); the item pool is very large; item pools are rotated on a quarterly basis (completely different questions every three months); and, a candidate retaking an exam is guaranteed not to receive the same question in a two year period (after two years, a candidate may see the same question but this is unlikely given the large pool of questions and the exam always varies so, even after two years, they would never see the same exam). The administration policy is such that a candidate retaking an exam can only do so every 45 days, a maximum of eight times per year. This policy helps ensure the candidate will not see the same question in a two-year period. Statistics demonstrate that on a candidate s second attempt at the exam, there is an increase in the candidate s ability to pass the exam. This suggests the candidate did something to increase their ability. But after the second attempt, the ability and overall pass rate drops considerably. Several security features ensure items on the NCLEX-RN are not compromised. A number of external security and cyber firms are used to support exam security. For example, social media sites are monitored. If there is any indication that an item may be compromised, it is removed (even in the absence of evidence). In summary, the design of the NCLEX-RN (CAT using IRT) increases the reliability of the exam and decreases concerns about false positives (candidates passing the exam when they are not competent). Additional design features and exam administration policies minimize item exposure and security breaches. Stakeholder feedback Nationally, there has been a lot of feedback about the NCLEX-RN exam from a variety of stakeholders including from applicants, nursing associations, nurse educators and governments. For example, stakeholders were concerned about the NCLEX-RN first-time pass rate being low. Some RN regulators began to receive requests from stakeholders to increase the number of permissible attempts to pass the NCLEX-RN. Some of the feedback compared Canadian policies with US policies. The majority of US RN regulators do not limit the number of attempts candidates have to pass the NCLEX-RN. Legal review A legal review was conducted of Canadian case law to determine what legal principles emerged with respect to entry-to-practice exams in Canada. Highlights from the review and analysis are described below

96 Regulators have a legislated mandate to regulate the profession. The regulator is granted statutory authority to determine the standards and qualifications that are appropriate and necessary for membership in the profession. Courts recognize that regulators have the expertise required to make entry-to-practice decisions. This expertise, combined with the regulator s statutory mandate, has resulted in courts showing considerable deference to a regulator s entry-to-practice decisions. Courts and tribunals have held that an exam attempt policy is a reasonable exercise of a regulator s registration role where the policy is set out in the enabling legislation (regulations or by-laws) and was not imposed solely by policy. If set out in policy, this would be examined to determine if the policy is implicitly authorized. For example, the policy has to be reasonable. A regulator s actions are not immune from scrutiny. Courts maintain jurisdiction to review a regulator s decisions and procedures to ensure they are fair. Examples of such cases include the Court reviewing whether: an exam requirement was outside the regulator s statutory authority; an exam requirement was discriminatory; the regulator exercised its discretion in an improper way; the applicant was denied procedural fairness; and, the applicant demonstrated extraordinary circumstances that justified an annulment of the results. In cases where applicants have successfully challenged the entry-to-practice exam or procedures, the matter is typically sent back to the regulator s decision maker for reconsideration (e.g., the Registration Committee). However, in one human rights case, the tribunal ordered the regulator to take specific action. Literature reviews A few literature reviews were conducted. The first related to the evidence regarding number of exam attempts. The vast majority of literature about high stakes testing is related to traditional exam formats based on CTT (not relevant to the NCLEX-RN). Specifically, literature in support of limiting exam attempts is based on linear CTT exams. However, there is some literature that suggests that no limit on writes is acceptable when using adaptive technology and alternate item formats. The second literature review related to currency: how long individuals are competent after a break following nursing school graduation or practising nursing. The majority of the findings suggest that knowledge and skills fade over time. Some studies found this decay happened very quickly in a matter of weeks. Other studies found that nearly all knowledge and skills were lost within one to two years. Other studies suggested a greater period of time; although, in general, there was a positive correlation with the amount of knowledge and skills lost, and time. Some of these variations may be attributed to the fact that many factors influence knowledge and skill retention (e.g., amount of practice before the break, the length of the break)

97 A third literature review explored how long after graduation individuals should be permitted to attempt an entry-to-practice exam. There were no significant findings related to this question. Two studies noted the amount of time between graduation and completion of the examination did not significantly impact the candidate s score. Reference lists for these reviews can be found in attachment 1. Exam data The number of three time fails The data below, from March 28, 2016, describes the number of RN applicants to the College with three time exam fails. This gives us a sense of how many individuals may reapply pending Council s decision Educated in Ontario Educated in another Canadian jurisdiction Educated in an international jurisdiction Total Exam data associated with conduct CNO conducted an exploratory analysis of exam data related to conduct records. The research question was: is there any correlation between number of exam attempts and conduct records? In other words, is there anything to indicate that someone who passed on their third attempt is not as safe to practise as someone who passed on their first attempt? The number of members with conduct records is low for third-attempt passers (55 RNs since 2008). However, when taken as a percentage, the resulting proportion looks significantly higher than for first- or second-attempt RN passers (5.6% of third-time writers had conduct records versus 2.6% of first-time writers). Although the numbers are small, this might support the notion that someone who passes on a third attempt is not as safe to practise as someone who passes on a first attempt. The data can be looked at from another perspective based on the number of records a member has (a member can have more than one conduct record). This analysis shows that the number of records for third-time writers is much smaller than records for first and second time writers. Most third-time writers have only one conduct record. Although the numbers are small, this might support the notion that someone who passes on a third attempt is safe to practise. The data can again be looked at from another perspective related to the level of risk associated with the conduct record (high, medium, low or no risk). The majority of records were low/no-risk. The majority of high-risk conduct records belong to first-time writers. Again, - 6 -

98 although the numbers are small, this might support the notion that someone who passes on a third attempt is safe to practise. Overall, based on this exploratory analysis, it is difficult to conclude that an increase in the number of exam attempts taken to pass relates to future instances of conduct records. There may be other confounding factors that influence the patterns seen in this data such as: demographics - gender, age, location of initial nursing education; and, employment - sector, position, number of years practising nursing, working status. NCLEX-RN data On March 31, 2016, CCRNR published an analysis of the first year NCLEX-RN results for all Canadian educated candidates. The report can be found here: ccrnr-report-final-for-release-31-mar-2016.pdf. CNO s annual exam report can be found here: At the previous Council meeting, some highlights were provided of the 2015 annual exam report. The NCLEX-RN ultimate pass rate 2 was 83.8%, which is comparable to the previous examination, with the exception of 2014 results which had a higher than usual pass rate. Other regulatory bodies Prior to the NCLEX-RN being implemented in Canada, Canadian RN regulators had a harmonized policy on the number of attempts which limited exam candidates to three opportunities to pass the entry-to-practice exam. However, there were variations to this policy if the jurisdiction permitted additional attempts due to exceptional circumstances. On December 8, 2015, the Nurses Association of New Brunswick passed a new rule putting no limit on the number of writes for applicants within a three year period, which, following NCLEX-RN s policy, would be a maximum of 24 writes over the three year period. With respect to our US counterparts, 38 states have no limits on the number of writes to pass the NCLEX-RN. In addition, one state permits 5-6 attempts, four states permit 3-4 attempts and one state permits 1-2 exam attempts. Among Ontario healthcare regulators, who offer a variety of different exams, there is variation in exam policy: some have limited write exams (found in regulation and policy); some rely on a third party to set limits, if any (e.g., a national body providing the exam); and, a couple have no limit on the number of writes. 2 The ultimate pass rate is the percentage of all candidates who took the exam during the year and passed by their latest attempt that year

99 Summarizing the evidence Exam results need to be valid and reliable. They need to be a true measure of the candidate s competencies. This is why, historically, regulators have had exam policies to minimize the effect of potential measurement error - limiting the number of attempts for a linear CTT exam. The information above indicates that there is no evidence to support limiting the number of attempts of the NCLEX-RN. Each successful attempt is a valid and reliable measure of the exam registration requirement. Successful completion of the exam indicates the individual has the minimum competencies to provide safe nursing care. This, along with other registration requirements, supports the registration of nurses who are safe to practise in Ontario. Communication Strategy The primary objectives of the communication strategy would be to ensure: the public understands that by increasing the number of writes on the NCLEX-RN there would be no adverse impact on public safety; graduates and students of RN nursing programs as well as current and past applicants who did not pass the exam would be informed that there would be no limit on the number of attempts for the NCLEX-RN (they also have to meet other registration requirements); and, writers of other regulatory exams (e.g., practical nurse applicants) understand the reasons why the same change would not be made to the number of writes for their exam. With respect to tactics, a variety of communication methods will be used, as appropriate for each audience, including: personalized letters/ s; updates on the College s website; Facebook posts; messaging for the College s Customer Service Team; articles in The Standard; briefing notes; and, requests for other stakeholder groups to share information with their members. Attachments 1. Reference Lists - 8 -

100 Attachment 1 Reference Lists Literature review #1 related to number of exam attempts Academy of Royal Medical Colleges. (2010). National postgraduate professional examinations GMC consultation. Retrieved February 2016 from view/9342-gmc-national-postgraduate-professional-examinations-consultation-academyresponse Bar Standards Board. (2012). Analysis of responses to BSB Consultation on the Bar Course Aptitude Test. Retrieved February 2016 from s_to_the_consultation_march_2012.pdf Brown, M., & Works, J.C. (2004). The case of the repeating licensure examination candidate: Psychometric, policy, and legal issues. Presentation to the CLEAR Annual Conference Retrieved February 2016 from Clauser, B. E., & Nungester, R.J. (2001). Classification accuracy for tests that allow retakes. Academic Medicine, 76(10), S108-S110. Council on Licensure, Enforcement and Regulation. (n.d.). Considerations for exam readministration. Retrieved February 2016 from FAQ/Considerations_for_Exam_Readministration.pdf Doverspike, D. (2015). To retest or not to retest: That is the question (Part 1) [Web log post]. Retrieved February 2016 from Doverspike, D. (2015). To retest or not to retest: Answers (Part 2) [Web log post]. Retrieved February 2016 from Geving, A.M., Webb, S., & Davis, B. (2005). Opportunities for repeat testing: Practice doesn t always make perfect. Applied H.R.M. Research, 10(2),

101 Horwitz, P. (2015). Other data I would like on bar passage--and some questions not entirely susceptible to data analysis [Web log post]. Retrieved February 2016 from Kleeman, J. (2014). Get trustable results: How many test or exam retakes should you allow? [Web log post]. Retrieved February 2016 from trustableresults-how-many-test-or-exam-retakes-should-you-allow Law Society of Upper Canada Professional Development & Competence Committee. (2011). Report to convocation. Retrieved February 2016 from McManus, I. C. (1992). Does performance improve when candidates resit a postgraduate examination. Medical Education, 26, McManus, I. C., & Ludka, K. (2012). Resitting a high-stakes postgraduate medical examination on multiple occasions: Nonlinear multilevel modelling of performance in the MRCP(UK) examinations. BMC Medicine, 10(60). Millman, J. (1989). If at first you don t succeed: Setting passing scores when more than one attempt is permitted. Educational Researcher, 18(6), 5-9. O Connell, C. B, & Palfreyman, L. (2015). Retesting: Helpful remediation or academic crutch? Presentation at the PAEA Education Forum, Washington, DC. Retrieved February 2016 from O Neill, T.R., Marks, C.M., & Reynolds, M. (2005). Re-evaluating the NCLEX-RN passing standard. Journal of Nursing Measurement, 13(2), Pell, G., Boursicot, K., & Roberts, T. (2009). The trouble with resits. Assessment & Evaluation in Higher Education, 34(2), Rust, C. (n. d.). Purposes and consequences of re-assessment. Retrieved February 2016 from ssessment.pdf Simkovic, P. (20153). Failed the bar exam? Try again. [Web log post]. Retrieved February 2016 from

102 Simpson, L., & Baird, J-A. (2013). Perceptions of trust in public examinations. Oxford Review of Education, 39(1), UK Department of Education. (2013).Toughened up skills tests ensure only the best train to teach. Retrieved from February Werner, E., (1992). Guidelines for readministration. CLEAR Exam Review, 3(1). Wheadon, C. (2010). The impact of re-sitting on the fairness of grading. Retrieved February 2016 from Wormeli, R. (2011, November). Redos and retakes done right. Educational Leadership, 69(3), Literature review #2 related to currency Bacon, D. R., & Stewart, K. A. (2006). How Fast Do Students Forget What They Learn in Consumer Behavior? A Longitudinal Study. Journal of Marketing Education, 28(3), Braun, L., Sawyer, T., Kavanagh, L., & Deering, S. (2014). Facilitating physician reentry to practice: perceived effects of deployments on US army pediatricians' clinical and procedural skills. Journal of Continuing Education in the Health Professions, 34(4), Bultas, M. W., Hassler, M., Ercole, P. M., & Rea, G. (2014). Effectiveness of High-Fidelity Simulation for Pediatric Staff Nurse Education. Pediatric Nursing, 40(1), 27-32, 42. Conway, M. A., Cohen, G., & Stanhope, N. (1991). On the very long-term retention of knowledge acquired through formal education: Twelve years of cognitive psychology. Journal of Experimental Psychology: General, 120(4), D'Angelo, A. D., Ray, R. D., Jenewein, C. G., Jones, G. F., & Pugh, C. M. (2015). Residents' perception of skill decay during dedicated research time. Journal of Surgical Research, 199(1),

103 Darland, D. C., & Carmichael, J. S. (2012). Long-Term Retention of Knowledge and Critical Thinking Skills in Developmental Biology. Journal of Microbiology & Biology Education, 13(2), Farr, M.J. (1987). The Long-Term Retention of Knowledge and Skills. New York: Springer- Verlag. Federation of State Medical Boards. (2012). Report of the Special Committee on Reentry to Practice. Retrieved on October 1, 2015 from General Medical Council (UK). (2014). Skills fade literature review. Retrieved on October 1, 2015 from Grace, E. S., Korinek, E. J., Weitzel, L. B., & Wentz, D. K. (2010). Physicians reentering clinical practice: characteristics and clinical abilities. Journal of Continuing Education in the Health Professions, 30(3), Gronlund, S.D., & Kimball, D.R. (2013). Remembering and Forgetting From the Laboratory Looking Out. Retrieved on May 10, 2016 from and_kimball_decay_chapter_final_ pdf Iserbyt, P., & Mols, L. (2014). Retention of CPR skills and the effect of instructor expertise one year following reciprocal learning. Acta Anaesthesiologica Belgica, 65(1), Jarrell, J. L., O Neill, D. G., & Hasse, L. A. (2009). A clinical research training efficacy study with a comparison of subjects who did and did not use learning within 4 months of training. Journal of Chemical Health and Safety, 16(2), Jenison, E. L., Gil, K. M., Lendvay, T. S., & Guy, M. S. (2012). Robotic surgical skills: Acquisition, maintenance, and degradation. Journal of the Society of Laparoendoscopic Surgeons, 16(2), Kenagy, G., Schneidman, B., Barzansky, B., Dalton, C., Sirio, C., & Skochelak, S. (2011). Physician Reentry into Clinical Practice: Regulatory Challenges. Journal of Medical Regulation, 97(1),

104 Madden, C. (2006). Undergraduate nursing students acquisition and retention of CPR knowledge and skills. Nursing education today, 26, Mosley, C., Dewhurst, C., Molloy, S., & Shaw, B. N. (2012). What is the impact of structured resuscitation training on healthcare practitioners, their clients and the wider service? A BEME systematic review: BEME Guide No. 20. Medical Teacher, 34(6), e Patel, J., Posencheg, M., & Ades A. (2012). Proficiency and retention of neonatal resuscitation skills by pediatric residents. Pediatrics, 130(3), Rawson, K. A., Dunlosky, J., & Sciartelli, S. M. (2013). The Power of Successive Relearning: Improving Performance on Course Exams and Long-Term Retention. Educational Psychology Review, 25(4), Semb, G. B., Ellis, J. A., & Araujo, J. (1993). Long-term memory for knowledge learned in school. Journal of Educational Psychology, 85(2), Smith, A., Gray, A., Atherton, I., Pirie, E., & Jepson, R. (2014). Does time matter? An investigation of knowledge and attitudes following blood transfusion training. Nurse Education in Practice, 14(2), Winfred, A. Jr., Winston, B. Jr., Stanush, P. L., & McNelly, T. L. (1998). Factors that Influence skill decay and retention: A Quantitative Review and Analysis. Human Performance, 11(1), Literature review #3 related to how long after graduation individuals should be permitted to attempt an entry-to-practice exam Academy of Royal Medical Colleges. (2010). National postgraduate professional examinations GMC consultation. Retrieved February 2016 from view/9342-gmc-national-postgraduate-professional-examinations-consultation-academyresponse American Educational Research Association. (2000). Position statement on high stakes testing. Retrieved February 2016 from AssociationPolicies/PositionStatementonHigh-StakesTesting/tabid/11083/Default.aspx Beeman, P.B. & Waterhouse, J.K. (2003). Post-graduation factors predicting NCLEX-RN

105 success. Nurse Educator, 28(6), Condon, J., & Barefield, A. (2012). Assessment of success on the RHIA Certification Examination: A comparison of baccalaureate program graduates and postbaccalaureate certificate program graduates. Perspectives in Health Information Management, 9. Doverspike, D. (2015). To retest or not to retest: That is the question (Part 1) [Web log post]. Retrieved February 2016 from that-is-the-question-part-1/ Faculty of Pharmaceutical Medicine and the National Deanery of Pharmaceutical Medicine. (2010). GMC national postgraduate professional examinations consultation. Retrieved February 2016 from Geving, A. M., Webb, S., & Davis, B. (2005). Opportunities for repeat testing: Practice doesn t always make perfect. Applied H.R.M. Research, 10(2), International Test Commission. (2014). The ITC Guidelines on the security of tests, examinations, and other assessments. Retrieved February 2016 from Kleeman, J. (2014). Get trustable results: How many test or exam retakes should you allow? [Web log post]. Retrieved from many-test-or-exam-retakes-should-you-allow Woo, A., Wendt, A., & Liu, W. (2009). NCLEX pass rates: An investigation into the effect of lag time and retake attempts. JONA S Healthcare Law, Ethics, and Regulation, 11(1),

106 Agenda Item 5.3 Setting the direction Leading the way for safe nursing Off to a safe start Holding ourselves accountable Meeting patients needs Safety in numbers College of Nurses of Ontario Annual Report 2015

107 President s Message As CNO s 2015/16 Council President, one of my roles was to make sure nurses and the public would see CNO accomplish process and service improvements it had committed to in the 2014 Annual Report. While nothing worthwhile happens easily or quickly, two major developments demonstrate that the commitment to advance was taken seriously and was achieved. The public has access to more information about nurses than ever before. I firmly believe that nurses want to provide great care to clients and patients. It stands on its own merits that recipients of nursing care expect and deserve this great care. However, in rare instances, CNO receives reports of circumstances in which someone thinks a nurse could have done better. We take every such report seriously, and have found that deficiencies in communication and perception often lie at the root. To improve how CNO manages these situations within our mandate to protect the public interest, we expanded the transparency with which we operate and are providing more information to the public about the nurses providing their care. Now, when CNO issues a caution to a nurse about their practice, or requires a nurse to review standards to improve their delivery of care, we provide this information on the public register. In 2015, CNO, along with most other Registered Nurse regulators across Canada, changed the entry-to-practice exam for those entering the RN profession. Graduates from nursing programs must bring their A-game forward and demonstrate that the public can trust the care they will provide as new RNs. Success in this new testing approach depends not only on the complex and extensive knowledge and skills RN students develop during their education, but also on their ability to use that knowledge and those skills to make decisions that will guide safe practice during their first year as an RN. It is this A-game that the new exam tests for. As a nursing educator and as president of CNO, I watched from two directions as we saw the results of the new NCLEX-RN exam. Early on, the pass rate appeared low and some speculated as to why. However, by year s end, it was clear that passing the new exam was a goal that most applicants could and did achieve. CNO, along with educators and RN regulators across Canada, continue to develop supports for applicants who will write the NCLEX-RN entry-to-practice exam in 2016 and in the years beyond. Nancy Sears, RN, PhD Council President 2 College of Nurses of Ontario 2015 Annual Report

108 Leading the way for safe nursing The College of Nurses of Ontario exists for one primary reason: to ensure Ontarians receive safe nursing care. As the province s regulator of nursing, the College of Nurses of Ontario (CNO) sets the standards nurses must meet and holds nurses accountable to those standards. We work with the province s 160,000 nurses to ensure they have the knowledge, skill and judgment to provide safe and ethical care to the public. Nurses are committed to providing safe care, and Ontarians have great trust in them to do so. Continuing to meet the public s expectations and maintaining this confidence in nurses are what guide our decisions and daily activities. Our focus is firmly on the public s safety. To improve public safety, in 2015 CNO s efforts included: asking Ontarians what they need to know to make informed decisions about health care providers, which resulted in CNO making available to the public more information about nurses being the public s voice on several issues, such as sharing our expertise with government on what can be done to prevent privacy breaches and the sexual abuse of patients, and holding nurses accountable for maintaining the confidentiality of patient information implementing a new exam for those applying to be Registered Nurses (RNs) helping nurses understand what they need to do to work safely in the ever-changing health care environment working to ensure both new and experienced nurses have the skills, knowledge and judgment to provide safe nursing care improving our processes, including those related to approving nursing education programs and nurses working across borders. In 2016, we ll continue to find ways to work with other health care stakeholders and involve them in CNO s work. We ll continue to share our knowledge and expertise to positively influence health care outcomes. You ll see new approaches to gathering the public s input in order to guide our work. We want to hear from you. Anne Coghlan, RN, MScN Executive Director and CEO 3 College of Nurses of Ontario 2015 Annual Report

109 Maintaining your trust in nurses 93% of people trust nurses in Ontario to provide them with safe nursing care. Here s how we re working to maintain that trust. Our 2015 survey of 3,000 Ontarians found that 93% trust nurses to provide them with safe nursing care. The result didn t surprise us; nursing is one of the most trusted professions. To maintain that trust, we need to continually improve. In the survey, members of the public told us they want nurses to involve them in decisions about their health care, and they want clarity about the nurse s role. For some Ontarians, it s as simple as nurses introducing themselves when providing care. We ll be working to ensure these expectations are clear in the standards that nurses know and use every day in their practice. Trust requires openness. Being transparent clear, open and forthright about our processes and decision-making is one way we do this. Transparency also means ensuring that information about the nursing profession in Ontario can be accessed easily by the public, applicants and nurses. Last year, we increased the amount of information available on Find a Nurse, the public register of every nurse in Ontario. We also revised much of our correspondence, messaging and processes to be clearer, more concise and easier to understand. We continue to make these improvements in all areas of CNO. Giving you a voice In 2015, we addressed some important issues in the public s interest, including the prevention of sexual abuse of patients, and maintaining privacy and confidentiality of health information. We re here to give a voice to Ontarians who have concerns about nursing care. The vast majority of nurses provide high-quality care. But, if you should have concerns about the care a nurse provides, you can express them to CNO and we will respond to them. Last year, we addressed some important issues in the public s interest. In January, we provided information to the Minister of Health and Long-Term Care s task force on the prevention of sexual abuse of patients. This information focuses on ways to strengthen the provisions dealing with sexual abuse. Another area of great public concern involves the privacy and confidentiality of health information. We take breaches of confidential health information seriously. In 2015, CNO prosecuted several nurses who accessed the health records of patients who were not in their care. On a wider scale, the Office of the Information and Privacy Commissioner of Ontario held a panel discussion about what can be done to prevent privacy breaches. We shared our 4 College of Nurses of Ontario 2015 Annual Report

110 expertise on the issue and our perspective that more discussion is needed about the harm patients experience when privacy is breached. In addition, CNO is part of the International Nurse Regulator Collaborative (INRC), an international group of nurse regulators committed to developing standards to protect the public through the regulatory process. As nurses increasingly work across borders, either to take new jobs or travel with patients, they need to be clear about which country s standards and processes they must follow. In 2015, the INRC began the important work of ensuring patient safety is considered as each regulator determines how to deal with issues related to cross-border health care. The group agreed to work from the common basis that a nurse must be regulated by, and practise according to, the laws of the jurisdiction in which the patient is receiving care. Nurses must also identify their registration status to patients when practising between countries. Ensuring new nurses can provide safe care One of the biggest changes we made last year was implementing a new exam for those applying to be Registered Nurses. The new exam known as the NCLEX-RN tests for basic knowledge, skills and judgment nurses need in their first year in order to provide patients with safe care. Another important safety feature is enhanced rigour and security in the examination process. By the end of 2015, 84% of writers had passed the exam. We re pleased with this overall result, which is in line with results of the previous exam. Many of those exam writers who had not yet been successful by the end of the year still had attempts remaining (currently, Ontario applicants are permitted three attempts to pass the regulatory exam). During this major change, we gained stronger working and information-sharing ties with other health care stakeholders, particularly nurse educators. We worked to improve the level of understanding about this exam and its contents, including new statistics showing outcomes of exam writers. And we re working with government and educators to help determine why pass rates for those writing the exam in French continue to be low. We re confident in the exam and we re confident the curriculum being taught in Ontario s schools prepares nursing graduates to pass this exam and provide safe care. 5 College of Nurses of Ontario 2015 Annual Report

111 Setting the direction The College of Nurses of Ontario s Council (board of directors) sets the direction for regulating the nursing profession in Ontario. Made up of members of the public and nurses, Council is committed to making decisions that strengthen the public s trust in nursing. Helping you make informed decisions In 2015, after considering the public s views and undertaking two consultations with nurses, Council decided to increase the amount of information about nurses that CNO makes available to the public. This decision was controversial with some nurses and nursing organizations, particularly the choice to include details about nurses who receive a caution about their practice, or who are required to review nursing standards to improve their delivery of care. However, the public was clear they needed better information to make informed choices about nurses caring for them or their family members. For this reason, Council agreed to expand the information on the register. (Read more on what was added to the public register here.) Governing effectively In any organization, occasionally the board of directors needs to review its structure and processes against best practices to be sure they remain effective. In 2015, Council began such a review by forming a task force of people with expertise and experience in governance. This Leading in Regulatory Governance Task Force was asked to provide Council with recommendations based on evidence that would transform how CNO is governed. The task force has been gathering input from governance experts, other regulators and literature. Council members completed a survey on and were interviewed about current governance. The result was an expert report on current governance, which identified opportunities for strengthening governance. Council and the task force are using the report to consider changes. Additional 2015 actions Last year, Council acted on such issues as approving new standards and monitoring CNO s performance. During 2015, Council: approved a new Medication Practice Standard that provides clear, principle-based direction to all nurses about safely administering medications supported a change allowing those applying to CNO to use any recent nursing practice completed outside Ontario as evidence needed for their registration provided input into the key performance indicators that will assist Council in monitoring the strategic plan monitored the results of the new examination (the NCLEX-RN) that individuals must pass as part of becoming a registered nurse in Ontario participated in an education session about sexual abuse and boundary violations. 6 College of Nurses of Ontario 2015 Annual Report

112 Off to a safe start Before a nurse begins working in Ontario, it s important to ensure they are able to provide safe and ethical care. As part of its mandate to protect the public interest, the CNO sets the requirements for a nurse to enter the profession in the province. In 2015, CNO continued its work to find ways to add efficiencies to the time it takes an applicant to get through the registration process, implemented a new exam for Registered Nurse (RN) applicants, and prepared to deliver by computer the exam for those applying to become Registered Practical Nurses (RPNs). Improving the registration process In 2015, 10,632 people applied to CNO to practise nursing in Ontario. Currently, this application process is paper-based. Last year, half of Canadianeducated applicants made it through the registration process in fewer than 129 days for RNs, and fewer than 152 days for RPNs. CNO wants to reduce this median time to 63 days and 112 days, respectively, by For internationally educated nurses, the median time from the initial application to registration is significantly longer. In 2015, it was 1,102 days for those applying to practise in Ontario as RNs, and 734 days for those applying to practise as RPNs. We estimate that the registration process for an internationally educated nurse could be accomplished in 189 days if all requirements are met. The application process involves actions that both CNO and the applicant must complete. While in some cases, the time it takes the applicant to complete certain requirements is out of our control, we re working to help applicants understand what is needed and manage this process. Our goal is to reduce, as much as is safely possible, the time it takes to become registered. (See Applicants Summary 2015 for more details). 7 College of Nurses of Ontario 2015 Annual Report

113 Testing for skills, knowledge and judgment As Ontario s nurse regulator, we re responsible for testing to make sure a new nurse is ready to safely care for you. When a nurse starts their first job, you need to feel confident they can assess your health care needs and respond to any changes they see. Nurses must be able to evaluate your need for pain management, safely administer your medications, and maintain your confidentiality and respect your privacy. These are some of the basic knowledge, skills and judgment we all expect of any new nurse in Ontario. As Ontario s nurse regulator, we re accountable to you to ensure that nurses have these basics to practise safely. We re responsible for testing to make sure a new nurse is ready to safely care for you. New RN examination In January 2015, we launched the National Council Licensure Examination for Registered Nurses known as the NCLEX-RN which those applying for RN registration must pass. This exam is a computer-based test that adapts to the examinee s ability level. This computeradaptive exam supports our efforts to improve our registration process by: testing for the skills, knowledge and judgment a nurse needs to practise safely in Ontario; getting exam results to applicants faster; and improving the integrity and reliability of the exam results. As with any major change, some groups raised concerns about the exam. Most concerns presented to CNO centred on misinformation and rumours, including: wrongly stating that the exam and its content were American ; that writers were not being successful on the exam; or that nursing programs would have to change their curriculum to match the exam s content. By the end of 2015, almost 84% of writers of the new exam had passed it, and many who had not yet been successful still had opportunities to write the exam in 2016 (currently, Ontario applicants get three attempts at a registration exam). This percentage is in line with the pass rate on the previous exam (read full details in the Nursing Registration Exams Report 2015). All exam questions are reviewed by Canadian nurses and regulators. Any question that would bias a Canadian writer is removed. The content tests for basic skills, knowledge and judgment taught in Ontario nursing programs. CNO is confident Ontario schools can provide the education needed for an applicant to pass. We continue to be confident the NCLEX-RN is meeting our needs to ensure an applicant who passes the exam is able to provide safe care to you once they begin working as a nurse. Improving access to the RPN exam Before someone can become a Registered Practical Nurse (RPN) in Ontario, they must successfully complete the Canadian Practical Nurse Registration Examination (CPNRE). This examination measures the competencies required of nurses at the beginning of their practice. 8 College of Nurses of Ontario 2015 Annual Report

114 In 2015, CNO began work to change this exam from paper-based to computer-based. Computer-delivered registration exams are a widely accepted and growing practice. This change, which occurred in May 2016, allows the exam to be offered more often and at more testing sites across Canada. The exam s content remains the same. The change simply means that exam writers answer questions directly on a computer in a test centre, rather than replying to questions on a paper answer sheet. The CPNRE continues to be offered in English and French. Enhancing program approval CNO began discussing ways to improve the processes used to approve nursing programs in Ontario. In 2014, CNO s Council agreed to a framework and new standards for approving nursing programs. The framework and standards will: be regulatory focused make the approval process more consistent across RN, RPN and NP programs be based on evidence be sustainable. In 2015, CNO began discussions with health care stakeholders about improving the processes currently used to approve nursing programs in the province. 9 College of Nurses of Ontario 2015 Annual Report

115 Meeting patients needs Health care is being enhanced and improved rapidly, and nursing must keep pace. The way nurses must do their job and what you should expect from them are in a state of continual change. As changes happen, we provide nurses with what they need in order to understand any new standards, so they can continue to provide you with safe care. We also work to keep you informed about what you can expect from nurses. Keeping nurses in the know In 2015, we provided Ontario nurses with information about changes in health care and nursing standards. In 2015, we updated and reminded Ontario nurses about health care and standards changes needed for their work, including: Medication standard: Implemented in May 2015, the Medication practice standard describes all nurses accountabilities when administering, dispensing, storing, managing inventory, and disposing of medications. These accountabilities focus on having the needed authority and competency, as well as ensuring nurses promote and contribute to a culture of safety. After the standard was approved, we gave nurses time to incorporate it into their work. We re monitoring how nurses are applying this standard in order to learn what we can apply when implementing future standards. Psychotherapy: Nurses can no longer use the title psychotherapist. In April 2015, the Psychotherapy Act, 2007 came into effect, restricting the use of the title psychotherapist to members of the College of Registered Psychotherapists and Registered Mental Health Therapists of Ontario (read more here). Conversion therapy: In response to the Ontario Minister of Health and Long-Term Care s statement that the use of conversion (or reparative) therapy to change an individual s sexual orientation is outdated and potentially damaging to patients, CNO reminded nurses they are accountable for meeting the standards in all aspects of their nursing practice. The Professional Standards are clear that nursing care be based on evidence and meet clients needs. Any therapy not supported by evidence cannot be considered to be in the client s best interest. Suggesting that a client undergo such a therapy may be considered professional misconduct. CNO s Ethics practice standard outlines how nurses can handle situations in which their personal beliefs conflict with those of patients to the point that they feel they cannot provide care. End-of-life care and Medical assistance in dying: With changes occurring rapidly in this 10 College of Nurses of Ontario 2015 Annual Report

116 area, we have provided nurses with the most up-to-date information available, directing them to various standards. Guiding safe practice CNO provides support for applying nursing standards in practice, to help nurses work through complex practice and ethical situations. In 2015, we continued to respond to telephone and inquiries about applying various standards. In addition, we shared information through teleconferences, online webcasts and learning modules. For example, when the new medication standard was released, CNO conducted several teleconferences throughout the year, posted webcasts and created a decision tool for nurses. We heard from nurses that these resources helped them apply the standard safely and effectively to their work. Nursing across borders Nursing care is becoming increasingly mobile. Some patients take nursing caregivers with them when they travel. Nurses accompany patients to out-of-province care facilities. Some nurses provide telehealth services beyond the jurisdiction in which they are registered to practise. In 2015, CNO worked with the International Nurse Regulator Collaborative (INRC) a group of regulators from around the world to agree on guidelines each regulator could use when developing standards about nurses providing care across borders. The three guiding principles are: 1. A nurse must be licensed/registered in the country where the patient is located, unless practising under a mutual recognition licensure/registration agreement between countries 2. A nurse must practise in accordance with the nurse practice laws of the country in which the patient is located 3. When practising between countries, nurses have a responsibility to identify themselves to patients by name, licence type, number and country of licensure/registration. Making it easier for NPs to work anywhere in Canada Nurse practitioners (NPs) are registered nurses who have met additional education, experience and exam requirements set by CNO. They re authorized to diagnose, order and interpret diagnostic tests, and prescribe medication and other treatment. To advance the harmonization of the requirements needed by an NP to practise anywhere in Canada, CNO collaborated with other provincial and territorial regulators to determine which entry-level knowledge, skills and abilities required by NPs vary across the country. The study, which the federal government s Foreign Credential Recognition Program funded, showed that NPs use the same competencies both across Canada and across the various specialties studied (that is, family, adult and pediatric). Find more information about the study at the Canadian Council of Registered Nurse Regulators website, 11 College of Nurses of Ontario 2015 Annual Report

117 Quality Assurance Nurses must remain competent in their practice and do what s necessary to make improvements. In Ontario, nurses show their commitment to remaining competent in their practice by participating in our Quality Assurance program. All nurses must complete a selfassessment that includes reflecting on their learning needs. Then, they must develop goals and plans to address these needs. In addition, each year we randomly select nurses to participate in a practice assessment and have a review done by their peers. In 2015, CNO selected 600 Ontario nurses for this assessment. CNO has been working to improve the number of nurses who complete this assessment within the year. In 2015, 92% did so (compared to approximately 69% in 2013 and 91% in 2014). To improve this measure, we re using technology, revising our web-based resources for nurses, and ensuring that the materials we provide are clearly written and easy to understand. Establishing a Nurse Health Program CNO has been reviewing its process for addressing when nurses may suffer from substance use or mental health issues that may impact their ability to practise safely. CNO, the Ontario Nurses Association, the Registered Nurses Association of Ontario, and the Registered Practical Nurses Association of Ontario have been collaborating to develop a treatment and monitoring program as an alternative to the current regulatory process. This program would help to protect the public and promote professional accountability. In 2015, CNO worked with a consultant to determine if funding sources exist for such a program, and to begin looking at how such a program might be implemented. This early research helped CNO prepare for discussion with the other nursing organizations. 12 College of Nurses of Ontario 2015 Annual Report

118 Holding ourselves accountable We re accountable for ensuring nurses provide you with safe care. Therefore, it s part of our responsibility to hold nurses accountable to working to the nursing standards that have been set. We take every complaint and report about nursing care seriously, whether it comes from a member of the public, an employer or another health care member. We continually look for ways to make improvements so we can ensure that public protection remains the focus of what we do. Complaints can be addressed in two ways: 1. Resolutions: During this voluntary process, the complainant and the nurse work with the College of Nurses of Ontario (CNO) to develop an acceptable resolution that addresses the issues raised and promotes quality nursing care. 2. Investigations: When resolution is not suitable, CNO investigates the complaint. This investigation may include obtaining health records, interviewing the complainant and witnesses, and giving the nurse an opportunity to respond in writing. We re focused on meeting the legislated timeline of 150 days to complete the complaint process. The percentage of resolutions completed within 150 days increased from 20% in 2013 to 70% in In 2015, CNO had a backlog of investigations that were completed but awaiting a written decision. After increasing available staff resources, we reduced this backlog. Maintaining your confidence Making more information available allows you to make informed decisions about who provides your care. In December 2015, CNO made more information about Ontario s nurses available on Find a Nurse, the register of the nurses who are its members. Supplying more information allows you to make informed decisions about who provides your care, and gives employers more information about who they re hiring. It also allows nurses to demonstrate that they actively participate in addressing issues about their practice and understand their accountabilities as health professionals. The following information became available on Find a Nurse in 2015: Discipline hearing status Full notice of hearing 13 College of Nurses of Ontario 2015 Annual Report

119 Criminal findings of guilt Bail conditions related to practice Cautions Remedial activities Registrations in other jurisdictions Discipline findings in other jurisdictions Criminal charges relevant to the nurse s practice Health facility privileges (for Nurse Practitioners). In 2015, nurses had several opportunities to provide feedback about these changes through The Standard (CNO s digital magazine for nurses) and other vehicles. In addition, more than 3,000 Ontarians were asked what they felt they needed to know to make informed decisions about their health care providers. More than 80% said they would want to know either some or all details about complaints made against nurses, doctors, dentists and other health care providers. A set of transparency principles helped guide decision-making about which information would and would not be made public. We conducted discussions with a focus on providing information that is relevant, credible and accurate, and that balances the principles of public protection with fairness and privacy for nurses and complainants. Sharing data across Canada When nurses move between jurisdictions and must register to practise in other provinces, other regulators seek information about them. In 2015, as part of the Canadian Council of Registered Nurse Regulators, we began working to find a way to share nurse information across provinces and territories. The National Council of State Boards of Nursing (NCSBN) maintains an online systems called Nursys, which allows U.S. boards of nursing to share information about U.S. nurses registration and discipline. We are working with NCSBN to develop a similar system for Canadian nursing regulators. The data would reside in Canada. This initiative will be phased in over multiple years. Sexual abuse task force When receiving care from a nurse, you can expect them to be professional, respectful, knowledgeable, skillful and ethical. Sexual relations between a nurse and patient are always unethical and abusive, and are a serious breach of trust. In 2015, Dr. Eric Hoskins, Minister of Health and Long- Term Care, asked for information about the status of CNO s measures for preventing and dealing with sexual abuse of patients. The request, which went out to all health regulatory colleges in the province, resulted from the Minister s Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, CNO provided a comprehensive response to this task force, in which we recommended improvements to funding for victims and assistance with the discipline process. 14 College of Nurses of Ontario 2015 Annual Report

120 Employer verification of nurses To reduce the risk of harm to the public, employers must ensure that only nurses who are entitled to practise in Ontario are employed at their organizations. Read more. In 2015, 120 employers made use of CNO s service for checking a nurse s membership status. Known as the Automated Annual Verification of Renewal of Membership (AAVR) service, it provides nursing employers, facility operators and others with an efficient way to check the membership of nurses they employ on a full-time, part-time, casual or contractual basis. In addition to the AAVR service, employers can perform this check in other ways, including using CNO s Find a Nurse. In 2016, CNO will conduct a review to determine if there are ways to promote AAVR and reduce the cost to employers. 15 College of Nurses of Ontario 2015 Annual Report

121 Safety in numbers This section contains statistical information about professional conduct and practice assessment outcomes, as well as select membership data for Membership in the general and extended classes The following membership statistics appeared in CNO s Membership Statistics Report For compete statistical data, visit CNO s website. Total membership RN 112, , ,401 RPN 41,996 42,018 44,195 NP 2,242 2,362 2,567 Total 156, , ,163 Employment status RN Employed in nursing 99,194 97,217 97,292 In Ontario 94,386 95,787 96,007 Employed in non-nursing only 2, On leave 3,671 2,508 2,450 Not employed 6,746 3,738 3,828 Not specified Total 112, , ,401 RPN Employed in nursing 35,695 37,560 39,402 In Ontario 35,286 37,284 39,111 Employed in non-nursing only 1,816 1,080 1,239 On leave 1,423 1,133 1,133 Not employed 3,062 2,242 2,421 Not specified Total 41,996 42,018 44,195 NP Employed in nursing 2,125 2,250 2,449 In Ontario 2,056 2,209 2,407 Employed in non-nursing only On leave Not employed Total 2,242 2,362 2, College of Nurses of Ontario 2015 Annual Report

122 New Members New members are nurses who have registered with CNO after successfully meeting the requirements for nursing in Ontario. They may have become new members at any point in Number of new RNs by location of initial nursing education # % # % # % Ontario 3, , , Other Canadian jurisdiction International Total 3, , , Number of new RPNs by location of initial nursing education # % # % # % Ontario 2, , , Other Canadian jurisdiction International , , Total 3, , , Top five countries of education for internationally educated RN new members United States 48 (12.4%) Philippines 30 (7.8%) Jordan 18 (4.7%) India 188 (48.7%) Jamaica 13 (3.4%) Other countries 89 (23.1%) Top five countries of education for internationally educated RPN new members Philippines 424 (34.2%) Iran 16 (1.3%) Pakistan 14 (1.1%) China 13 (1.0%) Other countries 92 (7.4%) India 680 (54.9%) 17 College of Nurses of Ontario 2015 Annual Report

123 Members employed in nursing in Ontario: Overall working status Overall working status RN # % # % # % Full-time 62, , , Part-time 24, , , Casual 7, , , Total 94, , , RPN # % # % # % Full-time 20, , , Part-time 12, , , Casual 3, , , Not specified Total 35, , , NP # % # % # % Full-time 1, , , Part-time Casual Total 2, , , Number of positions held by members employed in nursing in Ontario, by employment sector RN # % # % # % Hospital 67, , , Community 21, , , Long-term care 10, , , Other 10, , , Not specified Total 110, , , RPN # % # % # % Hospital 16, , , Community 7, , , Long-term care 16, , , Other 1, , , Not specified Total 43, , , NP # % # % # % Hospital , , Community 1, , , Long-term care Other Not specified Total 2, , , During membership renewal, CNO asks nurses to report if they have multiple current employers. This means that the number of members and number of employers are not equal; therefore the numbers in this table exceed the number of members. 18 College of Nurses of Ontario 2015 Annual Report

124 Professional Conduct Discipline outcomes Reprimands, suspensions and terms, conditions or limitations Revocation Fine Fitness-to-Practise outcomes Consent orders Terms, conditions or limitations Voluntary surrender Contested hearings Suspensions Terms, conditions or limitations Complaint outcomes Resolution Take no action Letter of concern or caution Oral caution Specified remediation program Refer to Discipline Report investigations outcomes Take no action Letter of concern or caution Oral caution Specified remediation program Refer to Discipline Permanent resignation Health inquiry outcomes Take no action Cease inquiry Suspended until attends assessment Accept undertaking Refer to Fitness-to-Practise College of Nurses of Ontario 2015 Annual Report

125 Quality Assurance Practice Assessment outcomes General Class (RNs and RPNs) # % # % # % Successful Remediation Follow-up Deferred Reported to the ICRC Signed undertaking Non-practising Resigned/retired Total Practice Assessment outcomes Nurse Practitioners # % # % # % Successful Remediation Follow-up Deferred Reported to the ICRC Signed undertaking Non-practising Resigned/retired Total Remediation may include additional activities, such as continuing education courses. 2 Follow-up activities may include resubmission, reflections or completion of case studies. 20 College of Nurses of Ontario 2015 Annual Report

126 Committees CNO s committees fulfil its statutory public protection functions as defined in legislation. Committees are made up of Council and non-council members. Executive Committee The Executive Committee provides leadership to Council. It supports the efficient and effective functioning of Council and committees, and makes decisions between Council meetings. In addition, members of the Executive Committee form the Patient Relations Committee. Each year, this committee presents to Council a report about patient abuse, including sexual abuse. Registration Committee The Registration Committee determines if individuals who want to become nurses have the knowledge, skill, judgment and character to provide safe and ethical care. Quality Assurance Committee The Quality Assurance Committee ensures that nurses comply with the requirements of the Quality Assurance program to maintain their ongoing competence. Inquiries, Complaints and Reports Committee The Inquiries, Complaints and Reports Committee reviews and acts on public complaints and other reports of concern about a nurse s practice, conduct or health. Discipline Committee The Discipline Committee determines whether nurses have committed professional misconduct or are incompetent, and, if so, determines the action that will best protect the public. For example, the committee may suspend a nurse, which means they cannot practise, or the committee may place restrictions on a nurse s ability to practise. Discipline decisions are available on Find a Nurse and cno.org. Fitness-to-Practise Committee The Fitness-to-Practise Committee determines whether a nurse is suffering from a physical or mental condition or disorder that is affecting, or could affect, their practice. Finance Committee The Finance Committee advises Council on CNO s financial affairs, and recommends and monitors fiscal policies. 21 College of Nurses of Ontario 2015 Annual Report