The Canadian Nurses Association is the national and global professional voice of Canadian nursing. We represent registered nurses, nurse practitioners, licensed and registered practical nurses, registered psychiatric nurses and retired nurses across all 13 provinces and territories. All rights reserved. Permission to reproduce is permitted without changes and for non-commercial use. Refer to www.cna-aiic.ca/en/terms-and-conditions-of-use#Copyright for all terms and conditions to reproduce. © Copyright 2021 This report was prepared by Dr. Joan Almost, RN, PhD, Associate Professor, School of Nursing, Queen’s University, and Scholar in Residence, Canadian Nurses Association. Suggested citation Almost, J. (2021). Regulated nursing in Canada: The landscape in 2021. Canadian Nurses Association. Canadian Nurses Association 50 Driveway Ottawa, Ont. 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Cover photo: Deva Darshan/Unsplash ISBN 978-1-55119-452-3 Table of Contents Foreword ...............................................................................................................v Introduction ......................................................................................................... 1 Nursing in Canada: Statistics ........................................................................... 3 Nursing in Canada: An overview .................................................................... 7 LICENSED PRACTICAL NURSES ................................................................................. 10 REGISTERED PSYCHIATRIC NURSES ......................................................................... 11 REGISTERED NURSES .................................................................................................. 12 NURSE PRACTITIONERS ............................................................................................. 13 ADVANCED PRACTICE NURSING .............................................................................. 16 Clinical Nurse Specialists ...................................................................................... 17 General Comparison of Clinical Nurse Specialist Roles and Nurse Practitioner Roles ................................................................................ 19 Nurse Midwives ...................................................................................................... 20 Specialty practice ........................................................................................................ 22 Nursing Structures and Roles ........................................................................ 25 REGULATORS .............................................................................................................. 27 Licensed Practical Nurse Regulators .................................................................... 29 Registered Psychiatric Nurse Regulators ............................................................. 29 Registered Nurse Regulators ................................................................................ 30 Nurse Practitioner Regulators ............................................................................... 31 PROFESSIONAL ASSOCIATIONS ............................................................................... 31 Licensed Practical Nurses’ Professional Associations .......................................... 32 Registered Psychiatric Nurses’ Professional Associations ................................... 33 Registered Nurses’ Professional Associations ..................................................... 33 Nurse Practitioners Professional Associations ..................................................... 35 EDUCATIONAL ASSOCIATIONS ................................................................................ 36 Licensed Practical Nurses Education Associations .............................................. 37 Registered Nurses and Nurse Practitioners Education Associations ................. 37 NURSING UNIONS ....................................................................................................... 39 Regulated Nursing in Canada: The Landscape in 2021 i Nursing Education .............................................................................................41 LICENSED PRACTICAL NURSE EDUCATION ............................................................ 42 REGISTERED PSYCHIATRIC NURSE EDUCATION ..................................................... 44 REGISTERED NURSE EDUCATION ............................................................................. 46 NURSE PRACTITIONER EDUCATION ......................................................................... 48 GRADUATE EDUCATION ............................................................................................ 50 DOCTORAL EDUCATION ............................................................................................ 50 Scope of Practice .............................................................................................. 53 OUTER LIMITS OF SCOPE OF PRACTICE .................................................................. 54 Legislation and Profession Regulation ................................................................. 54 Regulation ............................................................................................................. 56 Professional Standards and Guidelines ................................................................ 56 ACTUAL SCOPE OF PRACTICE .................................................................................. 57 Environment or Setting Context ........................................................................... 57 Individual Nurse ..................................................................................................... 57 The Client, Patient, Community and/or Population ............................................ 59 LICENSED PRACTICAL NURSES ................................................................................. 60 Requisite Skills and Abilities ................................................................................ 60 Entry-Level Competencies .................................................................................... 61 Registration Requirements ................................................................................... 62 Standards of Practice ............................................................................................. 63 REGISTERED PSYCHIATRIC NURSES ......................................................................... 64 Requisite Skills and Abilities ................................................................................. 64 Entry-Level Competencies .................................................................................... 64 Registration Requirements .................................................................................... 65 Standards of Practice ............................................................................................. 66 REGISTERED NURSES .................................................................................................. 67 Requisite Skills and Abilities ................................................................................. 67 Entry-Level Competencies ................................................................................... 67 Registration Requirements .................................................................................... 68 Standards of Practice ............................................................................................. 69 Registered Nurse Prescribing ...................................................................................... 71 British Columbia .................................................................................................... 71 Alberta ................................................................................................................... 72 Saskatchewan ........................................................................................................ 72 ii Manitoba ................................................................................................................ 73 Nova Scotia ............................................................................................................ 74 Ontario .................................................................................................................. 74 Quebec .................................................................................................................. 74 NURSE PRACTITIONERS ............................................................................................. 74 Entry-level competencies ..................................................................................... 74 Registration Requirements .................................................................................... 76 Standards of Practice ............................................................................................. 77 Unregulated Care Providers ...........................................................................81 Physician Assistants ......................................................................................... 85 NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS ......................................... 87 Conclusion and Next Steps ...........................................................................