CNA Code of Ethics for Nurses

The Canadian Nurses Association (CNA)^[1] is a professional organization that represents the national and global interests of Canadian nurses. They represent registered nurses, nurse practitioners, licensed and registered practical nurses, registered psychiatric nurses, and retired nurses across all 13 provinces and territories. ^[2] The CNA developed the Code of Ethics for Registered Nurses as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.^[3]

CNA Registered Nurse Practice Framework

The CNA publishes The Framework for the Practice of Registered Nurses in Canada. This framework promotes a common understanding of RN practice among nurses, students and stakeholders (including other health professionals, employers, educators, policy-makers and the public). Given the large number of regulated and unregulated care providers in Canada, it is essential for policy-makers, decision-makers and employers to clearly understand RN competencies and contributions as well as to know when RN care is the most appropriate. ^[4] Each province and territory also has a regional governing body for nurses. These regional bodies are responsible for further outlining the scope of practice, practice standards, and professional standards for their registrants. The regulatory body in Ontario is the College of Nurses of Ontario (CNO). https://www.cno.org/

The CNA defines nursing as “the application of professional nursing knowledge, skills, and judgment for the purpose of: (a) promoting, maintaining, and restoring health; (b) preventing illness, injury, or disability; (c) caring for persons who are sick, injured, disabled, or dying; (d) assisting in pre-natal care, childbirth, and postnatal care; (e) health teaching and health counselling; (f) coordinating health care; or (g) engaging in administration, teaching, or research. ^[5] A registered nurse is an individual who is educationally prepared and licensed by a province or territory to practice as a registered nurse. 

Only nurses registered with CNO can practice nursing in Ontario and use the titles “nurse,” “Registered Nurse (RN),” “Registered Practical Nurse (RPN),” or “Nurse Practitioner (NP).” It is illegal for anyone to practice nursing or use any of these titles in Ontario without a valid certificate of registration issued by CNO.

CNA Entry-level Competencies

CNA entry-level competencies describe a competent level of behaviour in the professional role.^{[6] A total of 101 competencies are grouped thematically under nine roles. Integration of all nine roles enables the entry-level registered nurse to provide safe, competent, ethical, compassionate, and evidence-informed nursing care in any practice setting. Some concepts are relevant to multiple roles. The roles include:}

1. Clinician: provide safe, competent, ethical, compassionate, and evidence-informed care across the lifespan in response to client needs; integrate knowledge, skills, judgment and professional values from nursing and other diverse sources into their practice.
2. Professional: commit to the health and well-being of clients; uphold the profession’s practice standards and ethics and be accountable to the public and the profession; demonstrate accountability, accept responsibility, and seek assistance as necessary for decisions and actions within the legislated scope of practice.
3. Communicator: use a variety of strategies and relevant technologies to create and maintain professional relationships, share information, and foster therapeutic environments.
4. Collaborator: play an integral role in the health-care team partnership.
5. Coordinator: coordinate point-of-care health service delivery with clients, the health-care team, and other sectors to ensure continuous, safe care.
6. Leader: influence and inspire others to achieve optimal health outcomes for all.
7. Advocate: support clients to voice their needs to achieve optimal health outcomes and support clients who cannot advocate for themselves.
8. Educator: identify learning needs with clients and apply a broad range of educational strategies towards achieving optimal health outcomes.
9. Scholar: demonstrate a lifelong commitment to excellence in practice through critical inquiry, continuous learning, application of evidence to practice, and support of research activities.

CNA Practice Standards

Compared to the other designations of regulated nurses, the standards of practice for registered nurses vary across Canada with no national framework identified. The next section will focus on the professional and practice standards in Ontario as set out by CNO.

CNO Professional Practice Standards and Practice Guidelines

Professional Practice Standards “…outline the expectations for nurses that contribute to public protection. They inform nurses of their accountabilities and the public of what to expect of nurses. The standards apply to all nurses regardless of their role, job description or area of practice”.  Practice guidelines “…address specific practice-related issues, help nurses understand their responsibilities and how to make safe and ethical decisions in their practice”. CNO(2023) https://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/

• Code of Conduct
• Scope of Practice
• Confidentiality and Privacy – Personal Health Information
• Documentation
• Medication
• Nurse Practioner
• Therapeutic Nurse-Client Relationship

Nurses are guided by professional standards in all aspects of their roles, including medication administration.

There is a specific practice standard related to medication administration for nurses.

CNO Practice Standard for Medication

In Ontario, the CNO has developed a practice standard for medication administration for all nurses. This practice standard outlines nurses’ accountabilities for providing safe nursing care to clients when performing activities involving medication. The Medication Practice standard is to be used by all Ontario nurses for the administration of medications.

Controls on Practice

Controls on practice explains the bases for nurses’ scope of practice. Scope of practice refers to a range of activities that nurses’ have the legislated authority through the Nursing Act, 1991 and the Regulated Health Professions Act, 1991 (RHPA) to perform.

Employer policies and practice setting requirements set the context if the nurse can perform the activity, as well as the individual nurse’s competence, which also impact nurses’ decisions and accountability related to scope of practice. This standard outlines the expectations for all nurses when determining if they have the authority to perform a specific activity, if it is appropriate for them to perform and if they are competent to perform the activity safely (CNO, July 2023).

There are three key concepts that guide nurses’ scope of practice. All three of these concepts are required to provide quality, safe client care that is evidence-based.

Authority: When a nurse is legally entitled to perform an activity by the RHPA, the Nursing Act, 1991 and the regulations under those Acts, is permitted by setting-specific legislation and employer policies and the required authorizing mechanisms are in place.

Context: The broader environment in which nurses work, the health care setting and the available resources to support the nurse and client.

Competence: The knowledge, skill and judgment required to perform an activity safely and manage outcomes within a nurse’s role and practice setting.

(Above definitions retrieved from CNO Practice Standard: Scope of Practice 2023. With permission for educational purposes as permitted by the CNO.)

Image Description

Figure 2.2: CNO Scope of Practice three key concepts: Authority, Context, and Competence.

Media Attributions

• Figure 2.2:  Is copyrighted by College of Nurses of Ontario (2023). Reproduced for educational purposes as permitted by the CNO.