Bill 179 = GP RIP

800 ONTARIO NURSE PRACTITIONERS

FAQ: Bill 179

The following FAQs help members and stakeholders understand the changes to nursing practice outlined in Bill 179 (the Regulated Health Professions Statute Law Amendment Act, 2009).

1. What is Bill 179?   

Bill 179 is the Regulated Health Professions Statute Law Amendment Act, 2009. It amends 26 health-related statutes, including the Regulated Health Professions Act, 1991 and Nursing Act, 1991, and introduces a number of significant changes for nursing practice.

2. When does Bill 179 take effect?   

Although Bill 179 was passed in December 2009, the provisions will only take effect once relevant regulations are amended and approved by the provincial government. Given the number of acts and regulations that need to be amended, the government has been making the necessary regulatory changes in phases.
Some of the regulatory amendments that affect nursing practice were proclaimed in July and October 2011. Others are yet to be reviewed and approved by the government. Both the College and Ministry of Health and Long-Term Care continue to work together to develop the regulatory amendments needed to proclaim the remaining provisions in Bill 179 that affect nursing practice.

3. What changes to nursing practice have been proclaimed?

To date, the changes to nursing practice that have been proclaimed relate specifically to Nurse Practitioner (NP) practice. The table below summarizes the new authorizations approved for NPs, the effective date of the change to practice, and the legislation that was amended to support the change.

New authorizations for NPs	Effective Date of Change	Amended Statute or Regulation
Admit persons to hospitals.	July 1, 2012	Regulation 965 under the Public Hospitals Act
Provide client care orders to be implemented by RNs and RPNs for procedures related to diagnosing and treating clients (e.g., venipuncture to obtain blood samples).	October 1, 2011	Nursing Act, 1991
Broadly prescribe drugs appropriate for client care (i.e., NPs no longer have to prescribe from a list of drugs).	October 1, 2011	Nursing Act, 1991  and Regulation 275/94
Dispense, COMPOUND, and SELL drugs in keeping with the regulation.	October 1, 2011	Nursing Act, 1991 and Regulation 275/94
Set or cast a fracture of a bone or dislocation of a joint.	October 1, 2011	Nursing Act, 1991
Order any laboratory test appropriate for client care (i.e., NPs no longer have to order from a list of laboratory tests).	July 1, 2011	Regulation 682 under the Laboratory and Specimen Collection Centre Licensing Act
Order diagnostics and treatments for hospital in-patients and discharge patients from hospital. (This does not change the diagnostic test list, which is still in effect for all NPs in all practice settings.)	July 1, 2011	Regulation 965 under the Public Hospitals Act
Order services for which patients are insured. (These amendments support the previously noted changes related to ordering laboratory tests and treating hospital patients).	July 1, 2011	Regulation 552 under the Health Insurance Act

For more information about these new authorities, see the Nurse Practitioner practice standard and FAQs: Scope of Practice and Nurse Practitioners.
Bill 179 also requires all health regulatory colleges, including the College of Nurses of Ontario, to promote interprofessional collaboration in their quality assurance programs. The College has included this interprofessional collaboration element in its Quality Assurance (QA) Program by requiring nurses to incorporate the element of interprofessional care into their self-assessments. For information and examples of how nurses can incorporate interprofessional care into their goals and activities when developing their learning plan, see Self-Assessment: A Guide to Developing Your Learning Plan.

4. What changes to nursing practice have not yet been proclaimed?

The following amendments have not been proclaimed:

• permitting RNs and RPNs to dispense drugs
• removing the restrictions on the diagnostic tests that NPs can order (i.e., eliminate the diagnostic test list)
• permitting NPs to perform point of care laboratory tests
• permitting NPs to apply specified forms of energy (e.g., defibrillation)
• permitting NPs to order additional forms of energy (e.g., Magnetic Resonance Imaging)
• permitting NPs to order CT scans
• permitting NPs, RNs, and RPNs to perform psychotherapy as a controlled act
• requiring nurses who are registered with the College, and practising nursing in Ontario, to have professional liability coverage.

Both the College and the Ministry of Health and Long-Term Care continue to work together to develop the regulatory amendments needed to proclaim these remaining provisions in Bill 179 that affect nursing practice.
The College will continue to advise members and stakeholders through its website, its Quality Practice newsletter, and The Standard when the outstanding regulatory amendments are approved and take effect.