Competencies Entry -to -Prac Tice - CNO

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Entry-to-PracticeCompetenciesfor RegisteredPractical NursesRevised: April 2019

Table of ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Purpose of the document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Document background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Definition of client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Competency framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Competency statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10AcknowledgementsThe College of Nurses of Ontario thanks the nurses, educators and other stakeholders whoparticipated in reviewing and revising this document. CNO also recognizes and thanksthe Revisions of Entry-Level Competencies Working Group of the Canadian Council ofPractical Nurse Regulators for the foundational work on entry-to-practice competencies.Entry-to-Practice Competencies for Ontario Registered Practical NursesPub. No. 41042ISBN 978-1-77116-142-8Copyright College of Nurses of Ontario, 2019.Commercial or for-profit redistribution of this document in part or in whole is prohibited except with the written consent of CNO. Thisdocument 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 The 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 September 1999, revised June 2009, June 2011. Updated 2014 for Controlled Acts. Updated Feb 2018. Updated March2018 for Controlled Acts. Revised April 2019 based on the National Competencies for RPNs in effect September 2020 title changed toEntry-to-Practice Competencies for Registered Practical Nurses.Additional copies of this booklet may be obtained by contacting CNO’s Customer Service Centre at 416 928 -0900or toll-free in C anada at 1 800 387-5526 .College of Nurses of Ontario101 Davenport Rd.Toronto ON M5R 3P1www.cno.org2 College of Nurses of OntarioEntry-to-Practice Competencies for Registered Practical Nurses

IntroductionThe College of Nurses of Ontario (CNO) is theregulatory body for nursing in Ontario. Throughprovincial government legislation (Nursing Act,1991 and Regulated Health Professions Act, 1991),CNO is accountable for public protection byensuring that nurses in Ontario practice safely,competently and ethically. CNO fulfills itsmandate through a variety of regulatory activities,including the following:registrationmaintaining standards of nursing practice andeducationenforcing nursing standardsconducting continuing competence reviewsestablishing competencies required for nursingpractice.Approval of nursing education programs:The competencies are used by CNO in evaluatingpractical nursing education programs to ensurethat the curriculum prepares graduates tosuccessfully achieve professional practice standardsbefore entering practice.Registration and membershiprequirements: CNO uses the competencies toinform its decisions about registration eligibility. Entry-to-practice competencies are the foundationfor nursing practice. This document outlines thecompetencies measured for Registered PracticalNurses (RPNs) upon initial registration with CNOand entry to practice in Ontario. The competenciesalso guide the assessment of nurses’ continuingcompetence for maintaining registration with CNO.Purpose of the documentThis document outlines the entry-to-practicecompetencies for practical nurses, organized byunderlying assumptions for RPN practice andregulatory principles, which include professionalpractice, ethical practice, legal practice,foundations of practice and collaborative practice.The document is a guide to entry-level practiceexpectations for RPNs in Ontario and includesa glossary of terms and references to help readersunderstand and interpret the document.The competencies for RPN practice at entry levelare established for the following purposes.Protection of the public: Through governmentlegislation (Nursing Act, 1991 and Regulated HealthProfessions Act, 1991), CNO is mandated by thepublic to promote and ensure safe, competent andethical nursing in Ontario.Practice reference: The competencies assistRPNs in understanding entry-level practiceexpectations and ongoing applications within theirprofessional roles.Legal reference: The legal definition ofnursing practice included in the Nursing Act, 1991establishes the basis for the scope of practice inwhich any nurse may engage. The competenciesare the expectations for RPNs upon their entryto practice in Ontario, and are used as a referencewhen evaluating the RPNs’ standard of care.Public information: The competencies informthe public, employers and other health careproviders about RPN practice, and assist withaccurate expectations for RPN practice at entrylevel.Continuing competence: In accordancewith CNO’s Quality Assurance Program, thecompetencies are used by nurses annually whenself-assessing their nursing practice and developingtheir professional learning goals.Document backgroundEntry-to-practice competencies for RPNs were firstpublished by CNO in 1999. Since then, CNO hasregularly reviewed and revised the competencies toensure they remain relevant with current practices.In 2020, CNO will adopt these national entryto-practice competencies for practical nurses.Consistency between jurisdictions supports theworkforce mobility requirements of the CanadianFree Trade Agreement.In 2019, CNO worked as part of the CanadianCouncil of Practical Nurse Regulators to revisethe national entry-to-practice competenciesfor practical nurses. A task force, comprised ofrepresentatives from jurisdictions that license,register or regulate RPNs across Canada (withQuebec as an observer), led the project. Thisdocument was validated by the RPN communityand key stakeholder groups across Canada.College of Nurses of OntarioEntry-to-Practice Competencies for Registered Practical Nurses 3

The revised competencies are based on resultsof an environmental scan, literature review andstakeholder consultation.Each province’s and territory’s practical nurseregulatory body validates and approves the entryto-practice competencies that apply within itsjurisdiction. Each regulatory body also confirmsthat the competencies are consistent withprovincial and territorial legislation.CNO practice documents, including ProfessionalStandards, Ethics and the Code of Conduct areexpected to be used in entry-level practice. complexity and work collaboratively with thehealth care team to maximize client outcomesRPNs demonstrate leadership by fosteringcontinued self-growth to meet the challenges ofan evolving health care systemRPNs follow a systematic approach to deliversafe, competent and ethical care by using thenursing processRPNs advocate for the implementation and useof evidence-informed practice.Definition of clientAssumptionsThe client is the central focus of practical nursingpractice. In the context of this document, “client”refers to a person who receives health care servicesfrom a nurse. In most circumstances, the clientis an individual, but the client can include familymembers or substitute decision-makers. A clientalso can be a group, community or population. Competency frameworkThe following assumptions apply to the practiceof practical nursing in Canada and to the entryto-practice competencies included later in thisdocument:The foundation of practical nursing is definedby: entry-to-practice competencies professional nursing standards of practice of theregulatory authority nursing code(s) of ethics and ethical standards scope of nursing practice applicable in thejurisdiction provincial, territorial and federal legislation andregulations that direct practiceRPN practice is built upon the four concepts ofperson, environment, health and nursing, andis grounded within the context of the currentCanadian health care system, primary healthcare and emerging health trendsRPNs possess competencies that are transferableacross all areas of responsibility (for example,direct care, administration, education andresearch)RPNs are active participants in healthpromotion, illness prevention and harmreduction activitiesRPNs practice in any setting or circumstancewhere health care is deliveredRequisite skills and abilities are required toattain the RPN entry-to-practice competenciesRPNs practice autonomously, safely, competentlyand ethically along the continuum of care insituations of health and illness across a client’slifespanRPNs practice in situations of varying The 79 entry-level competencies are organized infive categories:1. professional practice2. legal practice3. ethical practice4. foundations of practice5. collaborative practice.The order of the categories and competencies is notan indication of priority or importance.Bolded terms are defined in the Glossary. 4 College of Nurses of OntarioEntry-to-Practice Competencies for Registered Practical Nurses

Competency statements1. Professional PracticeRegistered Practical Nurses (RPNs) adhereto practice standards. They are responsibleand accountable for safe, competent andethical nursing practice. They are expected todemonstrate professional conduct as reflectedthrough personal attitudes, beliefs, opinions andactions. RPNs focus on personal and professionalgrowth. RPNs are expected to use knowledge,critical thinking, critical inquiry and research tobuild an evidence-informed practice.12345678910111213141516171Demonstrates accountability and acceptsresponsibility for own decisions and actions.Practices autonomously within legislated scopeof practice.Displays self-awareness and recognizes when toseek assistance and guidance.Adheres to regulatory requirements ofjurisdictional legislation.Practices within own level of competence.Initiates, maintains and terminates thetherapeutic nurse-client relationship.Provides client care in a non-judgmentalmanner.Adapts practice in response to the spiritualbeliefs and cultural practices of clients.Supports clients in making informed decisionsabout their health care, and respects theirdecisions.Engages in self-reflection and continuouslearning to maintain and enhance competence.Integrates relevant evidence into practice.Collaborates in the analysis, development,implementation and evaluation of practice andpolicy.Integrates continuous quality improvementprinciples and activities into nursing practice.Demonstrates a professional presence, honesty,integrity and respect in all interactions.Demonstrates fitness to practice.Maintains current knowledge about trendsand issues that impact the client, the RPN, thehealth care team and the delivery of healthservices.Identifies and responds to inappropriatebehaviour and incidents of professionalmisconduct.18 Recognizes, responds and reports own andothers’ near misses, errors and adverse events.19 Distinguishes between the mandates ofregulatory bodies, professional associationsand unions.2. Ethical PracticeRPNs use ethical frameworks (e.g. Code of Ethics,ethical standards) when making professionaljudgments and practice decisions. They engagein critical thinking and critical inquiry toinform decision-making and use self-reflection tounderstand the impact of personal values, beliefsand assumptions in the provision of care.20 Establishes and maintains professionalboundaries.21 Takes action to minimize the impactof personal values and assumptions oninteractions and decisions.22 Demonstrates respect for the values, opinions,needs and beliefs of others.23 Applies ethical frameworks and reasoning toidentify and respond to situations involvingmoral and ethical conflict, dilemma or distress.24 Obtains knowledge of and responds to theCalls to Action of the Truth and ReconciliationCommission of Canada¹.25 Preserves the dignity of clients in all personaland professional contexts.26 Advocates for equitable access, treatmentand allocation of resources, particularlyfor vulnerable and/or diverse clients andpopulations.27 Advocates for clients, especially when they areunable to advocate for themselves.28 Adheres to the duty to provide care.3. Legal PracticeRPNs adhere to applicable provincial/territorialand federal legislation and regulations, professionalstandards and employer policies that directpractice. They engage in professional regulationby enhancing their competence, promoting safepractice and maintaining their fitness to practise.RPNs recognize that safe nursing practice includesknowledge of relevant laws and legal boundarieswithin which RPNs must practise.See: Truth and Reconciliation Commission of Canada: Calls to Action - http://trc.ca/assets/pdf/Calls to Action English2.pdfCollege of Nurses of OntarioEntry-to-Practice Competencies for Registered Practical Nurses 5

29 Practices according to legislation, practicestandards, ethics and organizational policies.30 Practices according to relevant mandatoryreporting legislation.31 Recognizes, responds and reports questionableorders, actions or decisions made by others.32 Adheres to the duty to report.33 Protects clients’ rights by maintainingconfidentiality and privacy in all personal andprofessional contexts.34 Respond to the clients’ right to health careinformation in adherence within relevantprivacy legislation.35 Documents according to establishedlegislation, practice standards, ethics andorganizational policies.36 Obtains informed consent to support theclient's informed decision-making.4. Foundations of PracticeRPNs use critical thinking, reflection andevidence integration to assess clients, plan care,implement interventions, and evaluate outcomesand processes. Foundational knowledge includes:nursing theory, health sciences, humanities,pharmacology and ethics.37 Completes comprehensive health assessmentsof clients across the lifespan.38 Selects and uses information andcommunication technologies (ICTs) in thedelivery of client care.39 Researches and responds to relevant clinicaldata.40 Engages in evidence-informed practice byconsidering a variety of relevant sources ofinformation.41 Comprehends, responds to and reportsassessment findings.42 Formulates clinical decisions consistent withclient needs and priorities.43 Identifies nursing diagnoses.44 Develops the care plan with the client, healthcare team and others.45 Implements nursing interventions based onassessment findings, client preferences anddesired outcomes.46 Responds to clients’ conditions by organizingcompeting priorities into actions.6 College of Nurses of Ontario47 Assesses clients’ health literacy, knowledgeand readiness to learn.48 Assesses, plans, implements and evaluates theteaching and learning process.49 Provides information and access to resourcesto facilitate health education.50 Evaluates the effectiveness of healtheducation.51 Applies principles of client safety.52 Engages in quality improvement and riskmanagement to promote a quality practiceenvironment.53 Evaluates the effectiveness of nursinginterventions by comparing actual outcomesto expected outcomes.54 Reviews and revises the plan of care andcommunicates accordingly.55 Assesses implications of own decisions.56 Uses critical thinking, critical inquiry andclinical judgment for decision-making.57 Demonstrates professional judgment in usinginformation and communication technologies(ICTs) and social media.58 Recognizes high-risk practices and integratesmitigation strategies that promote safe care.59 Applies strategies to prevent, de-escalateand manage disruptive, aggressive or violentbehaviour.60 Recognizes and responds immediately when aclient’s condition is deteriorating.61 Demonstrates knowledge of nursing theory,pharmacology, health sciences, humanitiesand ethics.62 Applies knowledge of pharmacology andprinciples of safe medication practice.5. Collaborative PracticeRPNs work collaboratively with clients and othermembers of the health care team. They recognizethat collaborative practice is guided by sharedvalues and accountability, a common purposeor care outcome, mutual respect, and effectivecommunication.63 Engages clients in identifying their healthneeds, strengths, capacities and goals.64 Communicates collaboratively with the clientand the health care team.65 Provides essential client information to theclient and the health care team.Entry-to-Practice Competencies for Registered Practical Nurses

66 Promotes effective interpersonal interaction.67 Uses conflict resolution strategies to promotehealthy relationships and optimal clientoutcomes.68 Articulates own role based on legislated scopeof practice, individual competence and carecontext, including employer policies.69 Determines their own professional andinterprofessional role within the team byconsidering the roles, responsibilities and thescope of practice of others.70 Advocates for the use of Indigenoushealth knowledge and healing practices incollaboration with the client.71 Demonstrates leadership, direction andsupervision to unregulated health workersand others.72 Participates in emergency preparedness anddisaster management.73 Participates in creating and maintaining aquality practice environment that is healthy,respectful and psychologically safe.74 Fosters an environment that encouragesquestioning and exchange of information.75 Initiates and fosters mentoring relationships.76 Applies the principles of team dynamics andgroup processes in interprofessional teamcollaboration.77 Demonstrates formal and informal leadershipin practice.78 Organizes workload, assigns/coordinatesnursing care, sets priorities and demonstrateseffective time-management skills.79 Prepares client and collaborates with healthcare team in transition and transfer ofresponsibility of care.College of Nurses of OntarioEntry-to-Practice Competencies for Registered Practical Nurses 7

GlossaryAccountabilityThe obligation to answer for the professional,ethical and legal responsibilities of one’s activitiesand duties, including high standards for individualpractice and responsibility for exemplary clientcare. (Davis, C. 2017)Adverse eventAn event that results in unintended harm tothe patient, and is related to the care or servicesprovided to the patient rather than to the patient’sunderlying medical condition. (Canadian PatientSafety Institute. 2015)AdvocateTo actively support a right or cause; to supportothers when speaking for themselves or whenspeaking on behalf of those who cannot speak forthemselves. It can be direct or indirect and oftenaddresses inequity or inequality issues in healthcare. (Canadian Nurses Association. 2019)Autonomous practiceHaving the authority to make decisions andthe freedom to act in accordance with one’sprofessional knowledge base. (Skår, R. 2010)ClientA person with whom the nurse is engaged in atherapeutic relationship. In most circumstances,the client is an individual but the client mayinclude family members or substitute decisionmakers. The client also can be a group (forexample, therapy), community (for example, publichealth) or population (for example children withdiabetes). (Canadian Patient Safety Institute. 2019)Client safetyThe pursuit of the reduction and mitigation ofunsafe acts within the health care system, andthe use of best practices shown to lead to optimalpatient outcomes. (Canadian Patient SafetyInstitute. 2017).Conflict resolutionThe various ways individuals or institutions addressconflict (for example, interpersonal, work) to movetoward positive change and growth. (College ofRegistered Nurses of Nova Scotia. (2012)8 College of Nurses of OntarioCritical inquiryA process of purposive thinking and reflectivereasoning through which practitioners examineideas, assumptions, principles, conclusions, beliefsand actions within a particular context. (vanGraan, A. C., Williams, M. J. S., & Koen, M. P.(2016) (Brunt, B. A. (2005)DiversityThe concept of acceptance and respect, andunderstanding that each individual is different.These differences include race, ethnicity, gender,sexual orientation, socio-economic status, age,physical abilities, religious beliefs, political beliefsor other ideologies. (College of Nurses of Ontario.2019)Duty to reportA legal and ethical duty to report incompetent orimpaired practice or unethical conduct of regulatedhealth professionals. Most provinces or territorieshave legislation setting out the duty for nurses toreport situations in which there is a good reason tobelieve a health professional's practice is impaired orincompetent and may pose a significant risk to thepublic. The duty to report also requires nurses toreport any sexual misconduct of a health professional.(British Columbia College of Nursing Professionals.2019) (College of Nurses of Ontario. 2019)Evidence-informed practiceHow nursing decisions are made with clients, usingan ongoing process that incorporates research,clinical expertise, client preferences and otheravailable resources. (Canadian Nurses Association.2010)Fitness to practiseFreedom from any cognitive, physical,psychological or emotional condition ordependence on alcohol or drugs that impairsability to provide nursing care. (College of Nursesof Ontario. 2019)Health care teamA number of health care providers from differentdisciplines (often including both regulatedprofessionals and unregulated workers) workingtogether to provide care for and with persons,families, groups, communities or populations.(Canadian Nurses Association. 2017a)Entry-to-Practice Competencies for Registered Practical Nurses

Health literacyThe ability to access, comprehend, evaluate andcommunicate information as a way to promote,maintain and improve health in a variety ofsettings across the life-course. (Rootman, I. &Gordon-El-Bihbrety, D. 2008)Informed consentThe client received information about the proposedtreatment’s nature, expected benefits, risks andside effects, alternative courses of action andlikely consequences of not receiving treatment.The individual also must have an opportunity toobtain additional requests for information prior togranting permission to the proposed care. (Collegeof Nurses. 2017)Interprofessional team collaborationThe process of developing and maintainingeffective working relationships with learners,practitioners, patients/clients/families andcommunities to enable optimal health outcomes.(Canadian Interprofessional Health Collaborative.2010)Near missA client’s safety incident that did not reach theclient and therefore resulted in no harm. (CanadianPatient Safety Institute. 2015)Nursing diagnosisA clinical judgment based on human response tohealth conditions or life processes, affecting anindividual, family, group or community. It providesthe basis for choosing nursing interventions thataddress client care goals, for which the nurse hasaccountability. (Nanda International. 2019)Professional boundariesThe point at which the relationship changes fromprofessional and therapeutic to unprofessionaland personal; the limits of the professional role.Crossing a boundary means that the care provideris misusing the relationship’s power to meetpersonal needs, rather than the client’s needs, orare behaving in an unprofessional manner with theclient. The misuse of power does not have to beintentional to be considered a boundary crossing.(College of Nurses of Ontario. 2006) (RegisteredNurses Association of Ontario. 2006)Professional misconductBehaviour outside the boundaries of what isconsidered acceptable or worthy of its membershipby a profession’s governing body; any nursingconduct that is harmful or detracts from theprofessional caring relationship with a client and isinconsistent with the Code of Conduct or expectedprofessional standards. (College of Nurses ofOntario. 2019)Quality improvementA systematic, formal approach to the analysisof practice performance and efforts to improveperformance. (Canadian Patient Safety Institute.2015)ResearchA systematic inquiry using scientific methodsto advance knowledge, establish facts, answerquestions or solve problems. Conducting researchinvolves identifying a research question, using anappropriate methodology to answer the questionand disseminating the results. A nurse who collectsdata as part of a project, may be “participating” inresearch, but not “conducting” research. (Loiselle,C. G., Profetto-McGrath, J., Polit, D. F., & Beck,C. T. 2011)Scope of practiceThe expectations and limitations of duties andresponsibilities of Registered Practical Nurses whoare legislated, educated, and authorized to performroles, responsibilities and functions, as defined inSection 3 of the Nursing Act, 1991: “The practice ofnursing is the promotion of health and assessmentof, the provision of, care for, and the treatmentof, health conditions by supportive, preventive,therapeutic, palliative and rehabilitative meansin order to attain or maintain optimal function.”(College of Nurses of Ontario. (2018)Social mediaSoftware applications (web-based and mobile)allowing creation, engagement and sharing of newor existing content, through messaging or videochat, texting, blogging and other social mediaplatforms. (Bodell, S., & Hook, A. 2014)College of Nurses of OntarioEntry-to-Practice Competencies for Registered Practical Nurses 9

Team dynamicsThe effect developed when two or more peoplewho interact interdependently and adaptivelytoward a common goal, and which influence ateam’s behaviour and performance. (CanadianPatient Safety Institute. 2015)Therapeutic nurse-client relationshipA connection a nurse establishes and maintainswith a client, through the use of professionalknowledge, skills and attitudes, to provide nursingReferencesBodell, S., & Hook, A. (2014). Developingonline professional networks for undergraduateoccupational therapy students: An evaluation ofan extracurricular facilitated blended learningpackage. British Journal of Occupational Therapy,77(6), 320-323. itish Columbia College of Nursing Professionals.(2019). Taking action on concerns about practice.Retrieved from https://www.bccnp.ca/Standards/all nurses/cases/dutytoreport/Pages/Default.aspxBrunt, B. A. (2005). Critical thinking in nursing:An integrated review. The Journal of ContinuingEducation in Nursing, 36(2), 60-67. ian Interprofessional Health Collaborative.(2010). A national interprofessional competencyframework. Retrieved from https://www.cihc.ca/files/CIHC IPCompetencies Feb1210.pdfCanadian Nurses Association. (2010). Positionstatement: Evidence-informed decision-makingand nursing practice. Retrieved from singpractice.pdfCanadian Nurses Association. (2017a). Code ofethics. Retrieved from e.pdf10 College of Nurses of Ontariocare expected to contribute to the client’s wellbeing. (Canadian Nurses Association. (2017a)Unregulated health workerA health care worker who is not part of a regulatedhealth profession, and who provides care toclients under the guidance of a regulated healthprofessional or employer. (College of Nurses ofOntario. (2013)Canadian Nurses Association. (2019). Policy andadvocacy. Retrieved from https://www.cna-aiic.ca/en/policy-advocacyCanadian Patient Safety Institute. (2015).Patient safety and incident managementtoolkit. Retrieved from /Glossary.aspCanadian Patient Safety Institute. (2017). Generalpatient safety. Retrieved from es/generalpatient-safety.aspxCanadian Patient Safety Institute. (2019).Patient safety and incident managementtoolkit. Retrieved from /Glossary.aspxCollege of Nurses. (2017). Practice guideline:Consent. Retrieved from http://www.cno.org/globalassets/docs/policy/41020 consent.pdfCollege of Nurses of Ontario. (2006). Practicestandard: Therapeutic nurse-client relationship,revised 2006. Retrieved from http://www.cno.org/globalassets/docs/prac/41033 therapeutic.pdfCollege of Nurses of Ontario. (2013). Practiceguideline: Working with unregulated care providers.Retrieved from http://www.cno.org/globalassets/docs/prac/41014 workingucp.pdfEntry-to-Practice Competencies for Registered Practical Nurses

College of Nurses of Ontario. (2018). Legislationand regulation: An introduction to the NursingAct, 1991. Retrieved from http://www.cno.org/globalassets/docs/prac/41064 fsnursingact.pdfCollege of Nurses of Ontario. (2019). Practicestandard: Code of conduct. Retrieved from http://www.cno.org/globalassets/docs/prac/49040 codeof-conduct.pdfvan Graan, A. C., Williams, M. J. S., & Koen, M.P. (2016). Professional nurses' understandingof clinical judgement: A contextual inquiry.Health SA Gesondheid, 21, 280-293. https://doi.org/10.1016/j.hsag.2016.04.001College of Nurses of Ontario. (2019). ReferenceDocument: Professional misconduct. Retrievedfrom http://www.cno.org/globalassets/docs/ih/42007 misconduct.pdfCollege of Registered Nurses of Nova Scotia.(2012). Standards for nursing prac

The College of Nurses of Ontario thanks the nurses, educators and other stakeholders who participated in reviewing and revising this document. CNO also recognizes and thanks the Revisions of Entry-Level Competencies Working Group of the Canadian Council of Practical Nurse Regulators for the foundational work on entry-to-practice competencies.