CNO - College of Nurses of Ontario Scope of Practice Questions and Answers — Questions and Answers
Question 1: According to the CNO Scope of Practice standard, which of the following is the primary basis for a nurse's authority to practice?
- The policies and procedures of the employing healthcare facility.
- The orders provided by a physician or nurse practitioner.
- Provincial legislation, including the Nursing Act, 1991 and the Regulated Health Professions Act, 1991. (Correct answer)
- The nurse's individual competence and years of clinical experience.
Correct answer: Provincial legislation, including the Nursing Act, 1991 and the Regulated Health Professions Act, 1991.
The CNO's Scope of Practice standard states that a nurse's authority to perform activities is defined in legislation, specifically the Nursing Act, 1991 and the Regulated Health Professions Act, 1991 (RHPA). While employer policies, orders, and individual competence are crucial factors in decision-making, the legal authority to practice originates from provincial law.
Question 2: A Registered Practical Nurse (RPN) working in a community clinic is asked by a physician to administer a substance by injection, a controlled act. The RPN has not performed this specific type of injection before. What is the most appropriate initial action for the RPN to take?
- Administer the injection as ordered, as it is a controlled act authorized to nursing.
- Decline to perform the procedure and report the physician for inappropriate delegation.
- Reflect on their individual competence and inform the physician they lack the knowledge, skill, and judgment to perform the act safely. (Correct answer)
- Ask a Registered Nurse (RN) colleague to perform the injection for them.
Correct answer: Reflect on their individual competence and inform the physician they lack the knowledge, skill, and judgment to perform the act safely.
The CNO's Scope of Practice standard requires nurses to consider three key concepts: authority, context, and competence. While the RPN has the authority to perform the controlled act with an order, they are accountable for ensuring they have the individual competence (knowledge, skill, and judgment) to do so safely. The most appropriate action is to recognize their limitations and communicate this to the ordering provider.
Question 3: Which of the following statements about an employer's role in a nurse's scope of practice is correct?
- Employers can expand a nurse's legislated scope of practice by creating advanced-practice policies.
- Employer policies take precedence over CNO standards of practice if there is a conflict.
- Employers can limit a nurse's scope of practice but cannot expand it beyond what legislation permits. (Correct answer)
- Employers are solely responsible for determining a nurse's competence to perform procedures.
Correct answer: Employers can limit a nurse's scope of practice but cannot expand it beyond what legislation permits.
According to the CNO, employers can establish policies that may restrict or limit what a nurse can do in a specific practice setting. However, they cannot authorize a nurse to perform activities that fall outside the legislated scope of nursing practice. A nurse's primary accountability is to meet CNO standards, even if they conflict with employer policies.
Question 4: A Registered Nurse (RN) delegates the task of performing a simple dressing change, which is below the dermis, to an Unregulated Care Provider (UCP) for a stable client. Who is ultimately accountable for the decision to delegate this controlled act?
- The UCP, as they are the one performing the task.
- The client, as they consented to the care.
- The healthcare facility, as it has policies on task assignment.
- The RN who delegated the task. (Correct answer)
Correct answer: The RN who delegated the task.
The CNO's Scope of Practice standard clarifies that when a nurse delegates a controlled act, they are responsible for the decision to delegate. This includes ensuring that the delegatee is competent to perform the act safely. While the UCP is responsible for performing the task properly, the delegating nurse retains accountability for the delegation decision itself.
Question 5: An RN in a public hospital independently decides to insert a finger beyond the anal verge to assess for fecal impaction, which is a controlled act. In this setting, the nurse requires which of the following to perform this act?
- A direct order from a physician or Nurse Practitioner. (Correct answer)
- Confirmation of their own competence and the client's consent.
- A personal liability insurance policy.
- Verbal permission from the charge nurse.
Correct answer: A direct order from a physician or Nurse Practitioner.
While RNs and RPNs can initiate certain controlled acts in some settings, the Public Hospitals Act restricts this authority. In a hospital, an order from an authorized provider (like a physician or NP) is required for a nurse to perform most controlled acts, including putting a finger beyond the anal verge.
Question 6: To determine if performing a specific activity is within their scope of practice, a nurse must consider three essential components. These are:
- Orders, Experience, and Facility Policy.
- Authority, Context, and Competence. (Correct answer)
- Client Preference, Team Consensus, and Time Availability.
- Risk Assessment, Documentation, and Peer Review.
Correct answer: Authority, Context, and Competence.
The CNO's Scope of Practice standard is structured around three key concepts that a nurse must consider before performing any activity: Authority (do I have the legal right?), Context (is it appropriate in this setting?), and Competence (do I have the knowledge, skill, and judgment?).
CNO - College of Nurses of Ontario Scope of Practice Questions and Answers
According to the CNO Scope of Practice standard, which of the following is the primary basis for a nurse's authority to practice?