Scope of Practice

Effective July 1, 2023

Table of Contents

Introduction 3

Authority 4

Context 8

Competence 9

Glossary 10

Appendix A: Exceptions for controlled acts 11

Appendix B: Requirements for delegating 12

Appendix C: Requirements for accepting delegation 14

Appendix D: RN and RPN initiation 15

OUR PURPOSE
Our purpose is to protect the public by promoting safe nursing practice.

Scope of Practice Pub. No. 49041

ISBN 978-1-77116-159-6
Copyright © College of Nurses of Ontario, 2023.
Commercial or for-profit redistribution of this document in part or in whole is prohibited except with the written consent of CNO. This
document may be reproduced in part or in whole for personal or educational use without permission, provided that:
• Due diligence is exercised in ensuring the accuracy of the materials reproduced;
• CNO is identified as the source; and
•T
 he reproduction is not represented as an official version of the materials reproduced, nor as having been made in affiliation with,
or with the endorsement of, CNO.
First published July 2023. Updated August 2023 to align with Emergency Class regulation changes.
College of Nurses of Ontario
101 Davenport Rd.
Toronto, ON M5R 3P1
www.cno.org
Ce fascicule existe en français sous le titre : Champ d’application, Publication N°. 59041
 3
SCOPE OF PR ACTICE

Introduction To meet the expectations of this standard, a nurse

Nurses1 often face decisions about whether they can must consider each of the following key concepts:
perform specific activities. This practice standard
outlines the legislated scope of nursing practice and ■ Authority: Nurses must know their legislated
other key requirements for nurses when deciding scope of practice, including controlled acts, and
whether to perform an activity for safe client care. authorizing mechanisms.
The term client care is used broadly to represent
nursing practice across the system with individuals, ■ Context: Nurses must determine if their practice
families, communities or populations and includes environment or setting supports the performance
paid or volunteer roles. of an activity and has the available resources to
support safe client care.
Scope of practice refers to a range of activities that
nurses’ have the legislated authority to perform. ■ Competence: Nurses must ensure they have the
This authority is defined in legislation, namely individual knowledge, skill and judgment to
the Nursing Act, 1991 and the Regulated Health perform an activity.
Professions Act, 1991 (RHPA). Employer policies
and practice setting requirements, as well as the Each concept includes a set of nursing accountabilities
individual nurse’s competence, also impact nurses’ which are described in this practice standard.
decisions and accountability related to scope of To ensure it is appropriate to perform an
practice. This standard outlines the expectations activity, nurses are expected to demonstrate these
for all nurses when determining if they have the accountabilities.
authority to perform a specific activity, if it is
appropriate for them to perform and if they are This practice standard integrates information from
competent to safely perform the activity. and replaces the Decisions about Procedures and
Authority practice standard and two guidelines,
The Nursing Act, 1991, defines the nursing Authorizing Mechanisms, and the RN and RPN
scope of practice as: Practice: The Client, the Nurse, and the Environment.

The practice of nursing is the promotion of health Bolded terms are defined in the glossary.
and the assessment of, the provision of care for, and
the treatment of health conditions by supportive,
preventive, therapeutic, palliative and rehabilitative
means in order to attain or maintain optimal
function 2.

This standard expands the accountabilities found

in the Code of Conduct (the Code), the central
practice standard. Nurses are expected to practice
in compliance with relevant legislation, the
Code and all other CNO practice standards.
Contravening legislation or failing to meet
the standards of practice could be professional
misconduct.

1
In this document, nurse refers to a Registered Nurse (RN), Registered Practical Nurse (RPN), and Nurse Practitioner (NP).
2
See section 3 of the Nursing Act, 1991.

College of Nurses of Ontario Scope of Practice

4
SCOPE OF PR ACTICE

Authority

Nurses must ensure they have the legal authority 1. Performing a prescribed procedure below
prior to performing any activity. This includes the dermis or a mucous membrane.
ensuring their practice complies with all relevant
legislation, that they have the appropriate 2. Administering a substance by injection or
authorizing mechanisms in place, and they have inhalation.
assessed the context of their practice and their
own competence to ensure they can provide safe 3. Putting an instrument, hand or finger
client care. i. Beyond the external ear canal
ii. Beyond the point in the nasal passages
Legislation where they normally narrow
Nurses are accountable to practice in compliance
iii. Beyond the larynx
with the regulations under the RHPA and
the Nursing Act, 1991. The RHPA applies to all iv. Beyond the opening of the urethra
regulated health professions, while the Nursing v. Beyond the labia majora
Act, 1991 is specific to the nursing profession. These vi. Beyond the anal verge
Acts give nurses the legal authority to perform
vii. Into an artificial opening into the body
activities, including controlled acts.
4. Treating, by means of psychotherapy technique,
Other legislation may also be relevant to a nurse’s delivered through a therapeutic relationship,
practice. Nurses are accountable to comply with an individual’s serious disorder of thought,
all legislation that applies to their practice or cognition, mood, emotional regulation,
practice setting. perception, or memory that may seriously impair
the individual’s judgement, insight, behaviour,
Controlled acts communication, or social functioning.
Controlled acts are defined in the RHPA as
acts which may only be performed by authorized 5. Dispensing a drug
regulated health professionals. The Nursing
Act, 1991 authorizes nurses to perform specific Controlled Acts Authorized to Nurse
controlled acts when providing health care services Practitioners
to an individual. Controlled acts are considered Nurse Practitioners (NPs) have an extended scope
potentially harmful if performed by someone who of practice and are authorized to diagnose, order
does not have the knowledge, skill and judgment. and interpret diagnostic tests, prescribe medications
and order other treatments for clients. NPs are
Controlled acts authorized to RNs and RPNs autonomous practitioners and are accountable
Registered Nurses (RNs) and Registered Practical for their own practice and to employer policies.
Nurses (RPNs) are authorized to perform the Controlled acts are not the only legislated
following five controlled acts3 , if ordered by a authority informing a NPs scope of practice and
physician, dentist, chiropodist, midwife or NP 4 , accountabilities. For more information related to
or if initiated in accordance with conditions NP’s scope of practice and accountabilities, please
set out in the regulation, and as authorized in review the Nurse Practitioner practice standard.
their practice setting5:

3
See sections 4 and 5 of the Nursing Act, 1991
4
See subsection 5(1), paragraph (b) of the Nursing Act, 1991
5
Subject to the terms, conditions and limitations imposed of the certificate of registration.

College of Nurses of Ontario Scope of Practice

 5
SCOPE OF PR ACTICE

Nurse Practitioners are authorized to perform individual’s serious disorder of thought, cognition,
the following eight controlled acts6,7: mood, emotional regulation, perception or
memory that may seriously impair the individual’s
1. Communicating to a client or client’s judgement, insight, behaviour, communication or
representative a diagnosis made by the NP social functioning
identifying as the cause of a client’s
symptoms, a disease or disorder Exceptions
The RHPA permits nurses, under some conditions,
2. Performing a procedure below the dermis to perform specific controlled acts that they would
or a mucous membrane not otherwise be authorized to perform8. The
RHPA also provides several exceptions that allow
3. Putting an instrument, hand or finger persons who are not authorized as members of
i. Beyond the external ear canal a regulated health profession (e.g., unregulated
ii. Beyond the point in the nasal passages care providers) to perform controlled acts in some
where they normally narrow situations, including emergency situations. See
Appendix A: Exceptions for controlled acts, for a
iii. Beyond the larytnx detailed list.
iv. Beyond the opening of the urethra
v. Beyond the labia majora Authorizing mechanisms: orders and
vi. Beyond the anal verge delegation
There are two ways RNs and RPNs obtain
vii. Into an artificial opening into the body
authority to perform a controlled act: orders
4. Applying or ordering the application of and delegation.
a prescribed form of energy
Orders
5. Setting or casting a fracture of a bone or An order is a prescription for a procedure,
dislocation of a joint treatment, drug or activity. Orders include direct
orders and directives. An order9 is required when an
6. Administering a substance by injection or activity:
inhalation, in accordance with the regulation or ■ Is a controlled act authorized to nursing (with the
when it has been ordered by another health care exception of initiation)
professional or physician who is authorized to
order the procedure ■ Does not fall within any controlled act, but is
required as part of the client’s plan of care and/or
7. Prescribing, dispensing, selling and compounding practice-setting policies
a drug in accordance with the regulation.
■ Is delegated and does not fall under a controlled
8. Treating, by means of psychotherapy technique, act authorized to nursing
delivered through a therapeutic relationship, an
■ Is a requirement of other legislation

6
See subsection 5.1(1) of the Nursing Act, 1991
7
Subject to the terms, conditions and limitations imposed on the certificate of registration
8
See Sections 4.1, 7, 7.1, s. 8(2)-(6), 13, and 15 of O. Reg. 107/96. Specified procedures permitted to certain classes of nurses,
under certain conditions, included diagnostic ultrasound, acupuncture, prescribing normal saline for venipuncture, and administering
COVID-19 vaccines by injection.
9
See subsection 5(1) of the Nursing Act, 1991. The procedure is ordered by a person who is authorized to do the procedure by section 5.1
of the Nursing Act or by the Chiropody Act, 1991, the Dentistry Act, 1991, the Medicine Act, 1991 or the Midwifery Act, 1991.

College of Nurses of Ontario Scope of Practice

6
SCOPE OF PR ACTICE

Direct orders Delegation to nurses

A direct order is client-specific regarding an activity. Nurses can receive delegation for controlled acts
It may be written or verbal (oral). Verbal orders that they are not authorized to perform. Nurses
must only be used in emergency situations or when who perform controlled acts that are delegated to
the prescriber is unable to document the order, them are responsible for the decision to carry
such as in the operating room. out the controlled act and for the performance
of the act.
Directives
A directive is an order for an activity or series of A nurse’s responsibility may include delegating
activities that may be implemented for a number activities and accepting delegation of activities
of clients when specific conditions are met and according to regulation, which specifies
specific circumstances exist. A directive is always requirements that must be met. See Appendix
written by a regulated health professional who has B: Requirements for delegating and Appendix C:
the legislated authority to order the activity and Requirements for accepting delegation.
for which they have the ultimate responsibility.
For more information, see the Directives practice Delegation restrictions
guideline. The following are delegation restrictions for nurses:

Delegation ■ Nurses cannot delegate a controlled act that

Delegation occurs when a regulated health has been delegated to them. This is referred to
professional (delegator), who is legally authorized as sub-delegation10
and competent to perform a controlled act,
temporarily grants their authority to perform ■ Nurses in the Temporary Class11 and the
that act to another individual (delegatee). Emergency Class12 are not permitted to delegate
or accept delegation.
Delegation by nurses
Nurses who are authorized to perform controlled ■ Nurses in the Special Assignment Class13 are
acts can delegate them to certain individuals, not permitted to delegate to other health care
including other regulated health professionals or professionals.
unregulated care providers (e.g., family members of
clients). A nurse who delegates a controlled act is ■ RNs and RPNs cannot delegate the controlled
responsible for the decision to delegate and ensuring acts14 of
the delegatee is competent to perform the
controlled act.  Treating, by means of psychotherapy
technique, delivered through a therapeutic
relationship, an individual’s serious disorder
of thought, cognition, mood, emotional
regulation, perception, or memory that may
seriously impair the individual’s judgement,
insight, behaviour, communication or
social functioning
 Dispensing a drug

10
See subsection 41(2) of O. Reg 275/94
11
See subsection 5.1(1), paragraphs 5 and 6 of O. Reg. 275/94
12
See subsection 7(5)5 and 7(5)6 of O. Reg. 275/94
13
See subsection 6(5)5 of O. Reg. 275/94
14
See subsections 35(2) and 35(3) of O. Reg. 275/94

College of Nurses of Ontario Scope of Practice

 7
SCOPE OF PR ACTICE

■ NPs cannot delegate the controlled acts15 of Nursing accountabilities: authority

Nurses are expected to demonstrate the following
 Prescribing, dispensing, selling or nursing accountabilities in relation to authority:
compounding medication
 Ordering the application of a form of energy ■ Know and work in compliance with legislation,
 Setting a fracture or joint dislocation including:
 Treating, by means of psychotherapy
technique, delivered through a therapeutic  Ensuring appropriate authority is in place
relationship, an individual’s serious disorder in the form of direct orders or directives
of thought, cognition, mood, emotional  Following orders that are clear, complete
regulation, perception or memory that may and appropriate
seriously impair the individual’s judgement,
 Ensuring delegation (in addition to
insight, behaviour, communication or
an order) is permitted and in place before
social functioning
performing a controlled act that is not
authorized under the Nursing Act, 1991
When an Authorizing Mechanism is not  Ensuring that the initiation of activities
Required: Initiation complies with the regulatory and practice-
Initiation16 occurs when RNs or RPNs are specific legislation and employer policies
permitted by regulation to independently assess
and perform specific controlled acts without an ■ Document orders and activities performed
order. Not all nurses will be able to initiate specific or initiated as outlined in the Documentation
controlled acts, as this authority may not apply to practice standard
certain practice settings because of legislation17 or
facility policies. As with all activities, nurses must ■ Obtain informed consent as outlined in the
ensure they have informed consent. See Appendix D: Consent practice guideline
List of Controlled Acts RNs and RPNs can initiate.

15
See section 36 of O. Reg. 275/94
16
See sections 15 and 15.1 of O. Reg. 275/94 and [incorporate Sections of O. Reg. 107/96 that allow initiation] of the Nursing Act, 1991.
17
For example, nurses are not allowed to initiate controlled acts under The Public Hospital’s Act.

College of Nurses of Ontario Scope of Practice

8
SCOPE OF PR ACTICE

Context

A nurse who has the legal authority to perform Nursing accountabilities: context
an activity must also consider if it is appropriate Nurses are expected to demonstrate the following
to do so within the context of their practice setting. accountabilities in relation to context:
Context may include the broader environment in
which nurses work, the health care setting, and the ■ Ensure practice setting policies permit and
available resources to support the nurse and client. support nurses to perform an activity
A quality practice setting is a workplace that
supports nursing practice, fosters professional ■ Assess and advocate for the necessary resources
development, and promotes the delivery of quality to support the performance of an activity and to
care. This includes where and how care is manage outcomes
provided to ensure all safety precautions are taken.
■ Support the development of a practice
Nurses must ensure their practice complies environment that enhances collaboration and
with all applicable legislation including practice leads to improved client outcomes
specific legislation and employer policies. Nurses
must recognize that employers can limit but ■ Consider any environmental risks that could
cannot expand their legislated scope of practice. impact the ability to safely perform an activity
When employer policies conflict, nurses’ primary
accountability is to meet the CNO standards ■ Consult and advocate to the employer for clear
of practice. Nurses must ensure compliance with employer policies and procedures
practice standards and advocate for policies
that support safe client care. ■ Collaborate and communicate with other health
care team members for safe and effective client
Client safety is a shared responsibility and requires care and as needed, escalate to an appropriate
partnership. As partners, both employers and nurses, health care provider
share accountability for creating environments that
support quality practice. Nursing is a profession ■ Refrain from any activity that is not appropriate
focused on collaborative relationships that promote or safe for clients in the practice setting or
the best possible outcomes for clients. Nurses under workplace policies
foster interprofessional relationships and routinely
collaborate and communicate with the health ■ Perform activities in practice settings where
care team to provide safe client care. health services are routinely performed

■ Comply with all safety requirements,

(e.g., infection, prevention and control) using
best available evidence to inform practice

College of Nurses of Ontario Scope of Practice

 9
SCOPE OF PR ACTICE

Competence

A nurse who has the legal authority and has assessed Nursing accountabilities: competence
the context of their practice environment must also Nurses are expected to demonstrate the following
ensure they have the competence to safely perform nursing accountabilities in relation to competence:
an activity. Competence is the knowledge, skill and ■ Demonstrate the knowledge, skill, and
judgment required to perform an activity safely judgment to perform an activity safely and
within a nurse’s role and practice setting. Nursing effectively, including
competence also includes leadership, decision-making  Understanding the client’s overall condition
and critical-thinking skills. Nurses are accountable and needs
to continually reflect on their practice and determine
 Understanding the purpose of the
their learning needs to ensure they can provide safe
intervention
client care.
 Understanding the indications and
An individual nurse’s competence can evolve over contraindications
time. Being self-reflective and committed to life-long  Assessing the risks and benefits
learning is a critical part of providing safe client care.
Nurses participate in quality assurance activities  Demonstrating cognitive and technical
throughout their careers. This includes continually competence to perform the activity
self-reflecting, identifying learning needs and  Managing potential outcomes and
developing a learning plan to maintain competence. modifying
Nurses must also participate in CNO’s Quality actions as appropriate
Assurance program, which is a legislated requirement
in the RHPA18. ■ Determine if the client’s condition warrants
the performance of the activity
The requirements needed to achieve the competence
to safely perform a particular activity is specific to ■ Perform an activity that is based on the best
each nurse and includes education, training and interests of the client and includes the client’s
experience. Nurses are expected to communicate wishes
with their employer if they require additional
learning or professional development to provide ■ Consult or transfer care to another care provider
safe client care. when necessary for safe client care

■ Refrain from performing any activity when not

competent to perform and, as needed, escalate
to an appropriate health care provider

■ Self-reflect, identify learning needs, and

continuously seek out and integrate learning to
improve their knowledge, skill and judgement
in relation to their practice

■ Participate in CNO’s Quality Assurance

Program

18
See the Health Professions Procedural Code in Schedule 2 of the Regulated Health Professions Act, 1991

College of Nurses of Ontario Scope of Practice

10
SCOPE OF PR ACTICE

Glossary Direct orders: Client specific orders that may be

Activity: An Intervention, procedure, or action written or verbal. A health care professional, such
taken to promote, manage and support client care. as a physician, midwife, dentist, chiropodist or
NP, can give a direct order for a specific activity
Authority: Refers to when a nurse is authorized to be administered at a specific time.
to perform an activity by the RHPA, the Nursing
Act, 1991 and the regulations under those Acts, Directive: An order for an activity or series of
is permitted by setting-specific legislation and activities that may be implemented for a number of
employer policies, and the required authorizing clients, when specific conditions are met, and specific
mechanisms are in place. circumstances exist. A directive is always written
by an individual or a group, who are authorized
Authorizing mechanism: A means by which the regulated health provider(s), who have the legislated
authority to perform an intervention is obtained or authority to order the activity and for which they
the decision is made to perform an activity. have ultimate responsibility.

Client: An individual, family, group, community or Initiation: A process where RNs or RPN are
population receiving nursing care, including, but not permitted to independently assess and perform
limited to, “patients” or “residents”. specific controlled acts without an order in certain
settings pursuant to the authority and conditions
Competence: The knowledge, skill and judgment set out in the regulation.
required to perform an activity safely and manage
outcomes within a nurse’s role and practice setting. Professional misconduct: An act as defined in
Section 51(1) of the Code to the RHPA or the
Context: Includes the broader environment in Professional Misconduct regulation, that contravenes
which nurses work, the health care setting, and the or fails to meet a standard of practice of the
available resources to support the nurse and client. profession.

Delegatee: The individual receiving delegation from

a regulated health professional who has the authority
and competence to perform an intervention under
one of the controlled acts.

Delegation: A formal process through which a

regulated health professional (delegator), who has
the authority and competence to perform a
procedure under one of the controlled acts, delegates
the performance of that procedure to another
individual (delegatee).

Delegator: An authorized regulated health

professional who transfers the authority to perform
an intervention under one of the controlled acts
to another individual.

College of Nurses of Ontario Scope of Practice

 11
SCOPE OF PR ACTICE

APPENDIX A: Exceptions for Additionally, some nurses may perform

controlled acts specificprocedures a under certain conditions,
including:
Exceptions
The RHPA provides several exceptions19 that allow ■ diagnostic ultrasound23
persons who are not authorized as members of a ■ acupuncture
regulated health profession to perform controlled acts. ■ prescribing normal saline for venipuncture, and
These exceptions include ■ administering COVID-19 vaccines by injection

■ Providing first aid or temporary assistance in an Emergency Situations

emergency The RHPA allows members of the public and
regulated health care providers to perform controlled
■ Under the supervision or direction of a member acts without authorization when providing first aid
of the profession, a student is learning to become or temporary assistance in an emergency24. CNO
a member of that profession and the performance maintains, however, that in situations in which it is
of the procedure is within the scope of the anticipated that emergencies will likely occur, such
professional’s practice as in a hospital or long-term care facility, nurses
should ensure a standardized process to enable nurses
■ Treating a person by prayer or spiritual means in to attain and maintain competence in performing
accordance with the religion of the person giving emergency procedures that are outside the controlled
the treatment acts authorized to nursing. This process includes

■ Treating a member of a person’s household and ■ Education and ongoing assessment of competence
the procedure is within the second20 or third21 with the involvement of a health professional
controlled act authorized to nursing authorized and competent to perform
the procedure
■ Assisting a person with his/her routine activities
of living and the procedure is within the second or ■ Documentation of the process
third controlled act authorized to nursing
■ Written criteria to select appropriate clients and
■ Ear piercing or body piercing for the purpose of identify treatment parameters
accommodating a piece of jewelry22;
■ Necessary authority and/or resources to manage
■ Electrolysis; and tattooing client outcomes

■ Male circumcision as part of a religious tradition or

ceremony

■ Taking a blood sample by a person employed by

a laboratory licensed under the Laboratory and
Specimen Collection Centre Licensing Act

19
See subsection 30(5) in the Regulated Health Professions Act, 1991
20
Administering a substance by injection or inhalation
21
Putting an instrument, hand or finger as listed in subsection 4(3) of the Nursing Act, 1991
22
Regulated Health Professions Act O. Reg. 107/96, s. 8; S.O. 2006, c. 27, s. 19 (1).
23
See section 4.1 in O. Reg. 107/96
24
See subsection 29(1) in the Regulated Health Professions Act, 1991

College of Nurses of Ontario Scope of Practice

12
SCOPE OF PR ACTICE

APPENDIX B: Requirements for Requirement 7

delegating After taking reasonable steps, the nurse is satisfied
that the delegatee is a person who is permitted to
As outlined in the regulation under the Nursing Act, accept the delegation and is
1991, a nurse may delegate when all the following
requirements25 are met: ■ A member of CNO who has a nurse-client
relationship with the client
Requirement 1
The nurse has the authority under the Nursing Act, ■ A health care provider who has a professional
1991 to perform the controlled act. relationship with the client

Requirement 2 ■ A person in the client’s household, or

The nurse has the knowledge, skill and judgment to
perform the controlled act safely and ethically. ■ A person who routinely provides assistance or
treatment for the client
Requirement 3
The nurse has a nurse-client relationship with the Requirement 8
client for whom the controlled act will be performed. When the delegatee is a nurse or other regulated
health professional, the nurse must be satisfied that
Requirement 4 the delegatee has the knowledge, skill and judgment
The nurse has considered whether the delegation of to perform the controlled act safely and ethically.
the controlled act is appropriate, bearing in mind the
best interests and needs of the client. When the delegatee is not a regulated health
professional, the nurse must be satisfied that
Requirement 5 the delegatee has the knowledge, skill and judgment
After taking reasonable steps, the nurse is satisfied to perform the controlled act safely and ethically
that sufficient safeguards and resources are available and that the delegation is appropriate for the client.
to the delegatee so that the controlled act may be
performed safely and ethically. Requirement 9
If the nurse has delegated a controlled act but has
Requirement 6 reasonable grounds to believe that the delegatee no
The nurse has considered whether delegation of the longer has the ability to perform the controlled act
controlled act should be subject to any conditions safely and ethically, the nurse must immediately
to ensure that it is performed safely and ethically and cease to delegate the controlled act to that delegatee.
has made the delegation subject to conditions.

25
See sections 37, 39 and 42 of O. Reg. 275/94 of the Nursing Act, 1991

College of Nurses of Ontario Scope of Practice

 13
SCOPE OF PR ACTICE

Requirement 10
The delegating nurse shall
■Ensure that a written record of the particulars
of the delegation is available in the place where
the controlled act is to be performed, before it is
performed

■ Ensure that a written record of the particulars of

the delegation, or a copy of the record, is placed
in the client record at the time the delegation
takes place or within a reasonable period of time
afterwards, or

■ Record particulars of the delegation in the client

record either at the time the delegation takes place
or within a reasonable period of time afterwards

Any record of the particulars of a delegation must

include

■ The date of the delegation

■ The delegator’s name, if the controlled act was

delegated to the nurse

■ The delegatee’s name, if the controlled act was

delegated by the nurse

■ The conditions, if any, applicable to the delegation

College of Nurses of Ontario Scope of Practice

14
SCOPE OF PR ACTICE

APPENDIX C: Requirements for Requirement 7

accepting delegation Nurses who perform a controlled act that was
delegated to them must record the particulars
As outlined in the regulation under the of the delegation in the client record, unless:
Nursing Act, 1991, a nurse may accept delegate
when all the following requirements26 are met: ■ A written record of the particulars of the
delegation is available in the place where the
Requirement 1 controlled act is to be performed
The nurse has the knowledge, skill and judgment to
perform the controlled act safely and ethically. ■ A written record of the particulars of the
delegation, or a copy of the record, is in
Requirement 2 the client record, or
The nurse has a nurse-client relationship with
the client for whom the controlled act is to be ■ The particulars of the delegation have already
performed. been recorded in the client record.

Requirement 3 Any record of the particulars of a delegation must

The nurse has considered whether performing the include
controlled act is appropriate, bearing in mind the
best interests and needs of the client. ■ The date of the delegation

Requirement 4 ■ The delegator’s name, if the controlled act

After taking reasonable steps, the nurse is satisfied was delegated to the nurse
that there are sufficient safeguards and resources
available to ensure that the controlled act can be ■ The delegatee’s name, if the controlled act
performed safely and ethically. was delegated by the nurse, and

Requirement 5 ■ The conditions, if any, applicable to

The nurse has no reason to believe that the delegator the delegation
is not permitted to delegate that controlled act.

Requirement 6
If the delegation is subject to any conditions, the
nurse has ensured that the conditions have been met.

26
See sections 41 and 42 of O. Reg. 275/94 of the Nursing Act, 1991

College of Nurses of Ontario Scope of Practice

 15
SCOPE OF PR ACTICE

APPENDIX D: List of procedures RNs 5. For the purposes of assessing a client or assisting
and RPNs can initiate the client with health management activities that
require putting an instrument, hand, or finger
As outlined in the regulation under the Nursing Act, beyond the
1991, RNs and RPNs may initiate27 the following: ■ Labia majora

1. Care of a wound below the dermis or below a 6. Treating, by means of psychotherapy technique,
mucous membrane: delivered through a therapeutic relationship, an
Cleansing
■ individual’s serious disorder of thought, cognition,
Soaking
■ mood, emotional regulation, perception or
memory that may seriously impair the individual’s
Irrigating
■

judgement, insight, behaviour, communication or

Probing
■
social functioning.
Debriding
■

Packing
■
RNs authorized to initiate the controlled acts listed
Dressing
■ in Appendix D, can provide an order for a RN or
RPN to perform those controlled acts.
2. Venipuncture to
Establish peripheral venous access and
■ RPNs authorized to initiate the controlled acts
maintain patency when client requires medical listed in Appendix D, cannot order another nurse to
attention and delaying venipuncture is likely perform those controlled acts.
to be harmful
0.9% NaCl only
■

3. For the purposes of assisting the client with health

management activities that require putting an
instrument beyond the
Point in the nasal passages where they normally
■

narrow
Larynx
■

Opening of the urethra

■

4. For the purpose of assessing the client or assisting

the client with health management activities that
require putting an instrument or finger beyond the
■Anal verge, or
■Artificial opening into the client’s body

27
See sections 15 and 15.1 of O. Reg. 275/94 and [incorporate Sections of O. Reg. 107/96 that allow initiation] of the Nursing Act, 1991.

College of Nurses of Ontario Scope of Practice

101 Davenport Rd.
Toronto, ON
M5R 3P1
www.cno.org
Tel.: 416 928-0900
Toll-free in Canada: 1 800 387-5526
Fax: 416 928-6507
E-mail: [email protected]

SEPT 2023
49041
2023-51