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PR ACTICE STANDARD

Professional Standards, Revised 2002

Table of Contents

Introduction 3

Standards 4
Accountability 4

Continuing competence 5

Ethics 6

Knowledge 7

Knowledge application 8

Leadership 10

Relationships 11

Therapeutic nurse-client relationships 11

Professional relationships 12

References 13

VISION
Leading in regulatory excellence

MISSION
Regulating nursing in the public interest

Professional Standards, Revised 2002 Pub. No. 41006


ISBN 978-1-77116-121-3
Copyright © College of Nurses of Ontario, 2022.
Commercial or for-profit redistribution of this document in part or in whole is prohibited except with the written consent of CNO. This
document 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 June 1996 as Professional Standards


Reprinted January 2000, October 2000
Revised June 2002, Reprinted December 2002, January 2004, December 2005, May 2008. Updated June 2009. Aug 2013. May 2015 example removed p3 (ISBN 1-894557-33-6).
Updated August 2018 to clarify reporting requirements under applicable legislation p4.Updated July 2022 to replace Long-Term Care Homes Act, 2007 with Fixing Long-Term
Care Act, 2021.

Additional copies of this document may be obtained by contacting CNO’s Customer Service Centre at 416 928-0900
or toll-free in Ontario at 1 800 387-5526.
College of Nurses of Ontario
101 Davenport Rd. Toronto, ON M5R 3P1
www.cno.org
Ce fascicule existe en français sous le titre : Normes professionnelles (éd. révisée 2002), no 51006
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PR ACTICE STANDARD

Nursing standards are expectations that contribute Guiding principles


to public protection. They inform nurses of their The following principles guided the development of
accountabilities and the public of what to expect of Professional Standards:
nurses. Standards apply to all nurses regardless of their ■ in Ontario, nursing is one profession with two
role, job description or area of practice. categories — RN (which includes NPs) and RPN;
— College of Nurses of Ontario ■ the foundational knowledge base of RNs and
RPNs is different because of differences in basic
Introduction nursing education;
Professional Standards, Revised 2002 (Professional ■
all nurses are accountable for their own decisions
Standards) provides an overall framework for the and actions and for maintaining competence
practice of nursing and a link with other standards, throughout their career;
guidelines and competencies developed by the ■ clients2 are the central focus of the professional
College of Nurses of Ontario (CNO). It describes in services that nurses provide and as partners in the
broad terms the professional expectations of nurses1 decision-making process, clients ultimately make
and applies to all nurses, in every area of practice. their own decisions;
■ the goal of professional practice3 is to obtain
Professional Standards includes seven broad standard the best possible outcome for clients, with no
statements, a description of each statement and unnecessary exposure to risk of harm; and
indicators that illustrate how the standard may be ■ all nurses continually enhance their knowledge
demonstrated. To help nurses in different practice through education, experience and self-
areas apply the standards, there are indicators for all assessment. Nurses can become experts in an area
nurses and for those in administrative, educational of practice within their category.
and research positions. As well, three of the standards
(Knowledge, Knowledge application and Leadership) A standard is an authoritative statement that sets
have indicators for RNs and NPs. out the legal and professional basis of nursing
practice.
The indicators used in this document are not a
complete list, nor do they apply to all nurses at All standards of practice provide a guide to the
all times. As well, the seven standards are inter­ knowledge, skills, judgment and attitudes that are
related; an indicator used to illustrate one standard needed to practise safely. They describe what each
may also demonstrate the application of other nurse is accountable and responsible for in practice.
standards. How a nurse demonstrates a standard is Standards represent performance criteria for nurses
influenced by the nurse’s level of competence, role, and can interpret nursing’s scope of practice to the
practice setting and the situation. It is expected public and other health care professionals. Standards
that all nurses will meet the expectations of these can be used to stimulate peer feedback, encourage
professional standards and be able to articulate how research to validate practice and generate research
they demonstrate the standards in their practice. questions that lead to improvement in health care
delivery. Finally, standards aid in developing a
better understanding and respect for the various and
complementary roles that nurses have.

1
In this document, nurse refers to a Registered Practical Nurse (RPN), Registered Nurse (RN) and Nurse Practitioner (NP).
2
A client is a person with whom the nurse is engaged in a therapeutic relationship. In most circumstances, the client is an individual but
the client may also include family members and/or substitute decision-makers. The client can also be a group (e.g., therapy), community
(e.g., public health) or population (e.g., children with diabetes).
3
In this document professional practice is defined as the care and/or services that nurses provide to clients. Care/services is the process of
working with clients to identify care needs, and to establish, implement and continually evaluate plans of care.

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Standards Nurses are responsible for their actions and


The seven standards are presented in alphabetical the consequences of those actions. They’re also
order. All standards have equal importance and are accountable for conducting themselves in ways that
interconnected. promote respect for the profession. Nurses are not
accountable for the decisions or actions of other care
Accountability providers when there was no way of knowing about
Each nurse is accountable to the public and those actions.
responsible for ensuring that her/his practice and
conduct meets legislative requirements and the
standards of the profession.

Indicators In addition, a nurse in an administrator role


demonstrates the standard by:
A nurse demonstrates the standard by: ■ ensuring that mechanisms allow for staffing
■identifying her/himself and explaining her/his role to decisions that are in the best interest of clients and
clients; professional practice;
■providing, facilitating, advocating and promoting ■
ensuring the appropriate use, education and
the best possible care for clients; supervision of staff;
■advocating on behalf of clients; ■ advocating for a quality practice setting that
■seeking assistance appropriately and in a timely supports nurses’ ability to provide safe, effective
manner; and ethical care; and
■sharing nursing knowledge and expertise with ■
creating an environment that encourages ongoing
others to meet client needs; learning.
■ensuring practice is consistent with CNO’s standards
of practice and guidelines as well as legislation; A nurse in an educator role demonstrates
■taking action in situations in which client safety the standard by:
and well-being are compromised; ■
ensuring the appropriate supervision of students;
■maintaining competence and refraining from ■
communicating the level of preparation of
performing activities that she/he is not competent in; the student and the objectives of the learning
■taking responsibility for errors when they occur and experience;
taking appropriate action to maintain client safety; ■ using standards of practice and evidence-based
■reporting to the appropriate authority any health care knowledge to educate students; and
team member or colleague whose actions ■
ensuring that nurses receive the appropriate
or behaviours toward clients are unsafe or education, support and supervision when
unprofessional, or indicate abuse4, in accordance with acquiring new knowledge and skills.
applicable legislation, including (but not limited to):
◗ the Fixing Long-Term Care Act, 2021; A nurse in a researcher role demonstrates
◗ the Child, Youth and Family Services Act, 2017; the standard by:
◗ the Public Hospitals Act, and ■
ensuring the safety and well-being of the client
■reporting sexual abuse of a client by a regulated above all other objectives, including the search for
health professional to the appropriate regulatory knowledge.
college, as legislated in the Regulated Health
Professions Act, 1991.

4
Abuse means the misuse of the power imbalance intrinsic in the nurse-client relationship. It can also mean the nurse betraying the
client’s trust, or violating the respect or professional intimacy inherent in the relationship, when the nurse knew, or ought to have
known, the action could cause, or could be reasonably expected to cause, physical, emotional or spiritual harm to the client. Abuse
may be verbal, emotional, physical, sexual, financial or take the form of neglect. For a detailed explanation, read Appendix A in the
Therapeutic Nurse-Client Relationship practice standard at cno.org/standards.

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Continuing Competence that the nurse is able to perform in a changing health


Each nurse maintains and continually improves care environment. Continuing competence also
her/his competence by participating in the College contributes to quality nursing practice and increases
of Nurses of Ontario’s Quality Assurance (QA) the public’s confidence in the nursing profession.
Program.
Participation in CNO’s QA Program helps nurses
Competence is the nurse’s ability to use her/his engage in activities that promote or foster lifelong
knowledge, skill, judgment, attitudes, values and learning. The program helps nurses maintain and
beliefs to perform in a given role, situation and improve their competence and is a professional
practice setting. Continuing competence ensures requirement.

Indicators In addition, a nurse in an administrator role


demonstrates the standard by:
A nurse demonstrates the standard by: ■ supporting nurses to become reflective

■assuming responsibility for her/his own


practitioners;

professional development and for sharing



encouraging nurses to engage in ongoing learning;
knowledge with others;

seeking opportunities for nurses to participate in
■investing time, effort and other resources to continual learning activities;
improve knowledge, skills and judgment; ■ seeking opportunities to incorporate reflective
■engaging in a learning process to enhance her/his practice into agency professional development
practice; systems; and
participating in the College’s QA Program.
■ ■
advocating for a quality practice setting.
Participation includes:
◗ performing a self-assessment; A nurse in an educator role demonstrates
◗ seeking peer input; the standard by:
◗ developing a learning plan; ■
supporting students and nurses in becoming

◗ implementing the plan; and reflective practitioners;

◗ evaluating the outcomes of the plan; ■


developing, implementing and facilitating learning
■keeping records of participation in QA Program activities that help nurses enhance their practice;
activities; and
■providing colleagues with feedback that ■ supporting nurses in engaging in ongoing
encourages professional growth; learning.

participating in Practice Assessment when
selected; A nurse in a researcher role demonstrates
■advocating for quality practice improvements in the standard by:
the workplace; and ■ encouraging the evaluation of practice through
working together to create quality practice settings
■ research; and
that promote continuing competence. ■
communicating best-practice research findings to
others.

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Ethics privacy and confidentiality,5 respecting the sanctity


Each nurse understands, upholds and promotes and quality of life, maintaining commitments,
the values and beliefs described in CNO’s Ethics respecting truthfulness and ensuring fairness in
practice standard. the use of resources. It also includes acting with
integrity, honesty and professionalism in all dealings
Ethical nursing care means promoting the values of with the client and other health care team members.
client well-being, respecting client choice, assuring

Indicators and manage ethical issues; and


■ facilitating/advocating for nursing input on ethics
A nurse demonstrates the standard by: committees.
■identifying ethical issues and communicating
them to the health care team; A nurse in an educator role demonstrates

identifying options to resolve ethical issues; the standard by:
■evaluating the effectiveness of the actions taken to ■ encouraging and supporting critical thinking and
resolve ethical issues; and dialogue about ethical issues; and
■identifying personal values and ensuring they do ■ assisting nurses and students in identifying
not conflict with professional practice. resources to improve recognition and resolution of
ethical issues.
In addition, a nurse in an administrator role
demonstrates the standard by: A nurse in a researcher role demonstrates
■ creating environments that promote and support the standard by:6
safe, effective and ethical practice; ■ ensuring that the client has all the information

valuing the time that’s taken to resolve ethical necessary to make informed decisions;
issues; ■
advocating for nursing involvement on ethical
■ advocating for resources and establishing review boards;
mechanisms to assist nurses in recognizing and ■ participating in the ethical review of research; and
resolving ethical issues; ■ ensuring ethical guidelines are followed to protect

supporting nurses in developing skills to recognize research participants.

5
For more information, refer to the Freedom of Information Protection of Privacy Act.

6
Canadian Nurses Association. (1994). Ethical Guidelines for Nurses in Research Involving Human Participants.

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Knowledge clinical practice, decision-making, critical thinking,


Each nurse possesses, through basic education and research and leadership. RNs and NPs study for a
continuing learning, knowledge relevant to her/ longer period of time to achieve a greater breadth
his professional practice. and depth of knowledge in clinical practice, decision-
making, critical thinking, research utilization,
RNs, RPNs and NPs study from the same body leadership, health care delivery systems and resource
of nursing knowledge. RPNs study for a shorter management. All nurses add to their basic education
period of time than RNs and NPs. They have a and foundational knowledge by pursuing ongoing
more focused or basic foundation of knowledge in learning throughout their careers.

Indicators A nurse in an administrator role


demonstrates the standard by:
A nurse demonstrates the standard by: understanding how a practice environment

■providing a theoretical and/or evidence-based can foster professional growth and improve
rationale for all decisions; professional practice;
being informed and objective about the various

facilitating nurses to continually seek new

nursing roles and their relationship to one another; knowledge;


■being informed about nursing and its relationships ■knowing how to access resources to enable nurses
in the health care delivery system; to provide the best possible care;

understanding the legislation and standards ■
critically evaluating research related to outcomes
relevant to nursing and the practice area; and advocating for its application in practice;
understanding the knowledge required to meet the
■ ■
using relevant leadership and management
needs of complex clients; principles; and
■having knowledge of how bio-psychosocial needs ■understanding and promoting nursing as

and cultural background relate to health care needs; as knowledge-based and research-informed


knowing where/how to access learning resources, profession.

when necessary;
seeking and reviewing research in nursing, the

A nurse in an educator role demonstrates
health sciences and related disciplines; the standard by:
■using research to inform practice/professional ■ identifying and evaluating information sources
service; and that are useful for professional practice;

being aware of how practice environments affect ■
promoting an environment that facilitates

professional practice. questioning and learning; and

■ possessing/developing knowledge of teaching-


In addition, an RN or NP demonstrates the learning theories and practices.
standard by:

contributing to the generation of new professional A nurse in a researcher role demonstrates
knowledge through research; the standard by:
■ seeking and critiquing philosophical, theoretical ■ identifying research methods useful to the nursing
and research-based literature in nursing, health profession;
care services, etc.; and ■ identifying resources to answer research questions;

using philosophy, theory and research to inform and
practice. ■
sharing knowledge gained through research.

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Knowledge Application knowledge to practice using nursing frameworks,


Each nurse continually improves the application theories and/or processes. They employ knowledge
of professional knowledge. in the performance of clinical skills because the
technical and cognitive aspects of care are closely
The quality of professional nursing practice reflects related and cannot be separated.
nurses’ application of knowledge. Nurses apply

Indicators by analyzing all influences;


■ identifying a full range of options based on a

A nurse demonstrates the standard by: depth and breadth of knowledge;

■ensuring that practice is based in theory and


■ creating comprehensive and creative plans of care
evidence and meets all relevant standards/
that reflect the complexity of client needs;
guidelines;

meeting client needs regardless of complexity and
■assessing/describing the client situation using a predictability;
theory, framework or evidence-based tool; ■ analyzing and interpreting unusual client

identifying/recognizing abnormal or unexpected



responses; and

client responses and taking action appropriately; ■


evaluating theoretical and research-based


recognizing limits of practice and consulting approaches for application to practice.

appropriately;
■planning approaches to providing care/service A nurse in an administrator role
with the client; demonstrates the standard by:
creating plans of care that address client needs,
■ creating practice environments that support

preferences, wishes and hopes; quality nursing practice;



using best-practice guidelines to address client ■
establishing and maintaining communication
concerns and needs; systems to support quality service and research;
■managing multiple nursing interventions ■supporting and contributing to practice
simultaneously; environments that encourage learning, and the
evaluating/describing the outcomes of specific

application of nursing knowledge and research;
interventions and modifying the plan/approach; and

identifying and addressing practice-related issues; ■
articulating an evidence base for all decisions and
and measuring the impact on practice.
■integrating research findings into professional
service and practice. A nurse in an educator role demonstrates
the standard by:
In addition, an RN or NP demonstrates the ■
planning and implementing creative learning

standard by: opportunities for students/nurses;

■ analyzing and applying a wide range of ■ critically analyzing and evaluating nursing practice
information using a variety of frameworks or and education; and
theories that result in a global approach and ■
creating an environment where learning is

creative solutions; encouraged.


anticipating and preparing for possible outcomes

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

A nurse in a researcher role demonstrates ■ communicating research findings to decision-


the standard by: makers and others;
■ supporting and evaluating practice through
■ supporting and contributing to environments that
research;
encourage the application of research findings to

facilitating the involvement of others in the
professional practice;
research process;
■ securing resources to explore nursing research; and
■ ensuring that high standards are used in the ■ fostering an atmosphere of inquiry.
research process;

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Leadership one’s behaviour affects others), respect, trust,


Each nurse demonstrates her/his leadership by integrity, shared vision, learning, participation, good
providing, facilitating and promoting the best communication techniques and the ability to be a
possible care/service to the public. change facilitator.7 The leadership expectation is
not limited to nurses in formal leadership positions.
Leadership requires self-knowledge (understanding All nurses, regardless of their position, have
one’s beliefs and values and being aware of how opportunities for leadership.

Indicators ■
guiding/coaching nursing projects;
■ providing feedback and support to staff about
A nurse demonstrates the standard by: nursing issues at an individual and organizational
■role-modelling professional values, beliefs and level;
attributes; ■
creating opportunities for nurses to assume various

collaborating with clients and the health care team leadership roles;
to provide professional practice that respects the ■ involving nursing staff in decisions that affect

rights of clients; their practice; and

■advocating for clients, the workplace and the ■ coordinating and supervising the development of
profession; client programs and services.
providing direction to, collaborating with, and

sharing knowledge and expertise with novices, A nurse in an educator role demonstrates
students and unregulated care providers; the standard by:
acting as a role model and mentor to less-
■ ■ role-modelling the development of expertise and
experienced nurses and students; leadership qualities;

participating in nursing associations, committees ■
enabling others to develop expertise and

and interest groups; confidence in their abilities; and

■providing leadership through formal and informal ■ providing professional and educational advice to
roles (e.g., team leader, charge nurse); committees and teams.
■taking action to resolve conflict; and

developing innovative solutions to practice issues. A nurse in a researcher role demonstrates
the standard by:
In addition, an RN or NP demonstrates the ■
communicating research findings to nurses and
standard by: other team members;
■ coordinating care for complex clients and ■ promoting nursing research;
demonstrating leadership when collaborating with ■ educating staff about the research process;
care providers. ■
promoting nursing through research that improves
or validates professional practice; and
A nurse in an administrator role ■ advocating for nursing representation on research
demonstrates the standard by: 8 review committees.
■identifying goals that reflect CNO’s mission

and values and facilitate the advancement of

professional practice;

7
Murdoch-Perra, B. (2001). Leadership: The keys to quality outcomes. Journal of Nursing Care Quality, 15(2), pp. 68–73.
8
Ferguson-Paré, M. (1998). Nursing leadership and autonomous professional practice of registered nurses. Canadian Journal of Nursing
Administration, 11(2), pp. 7–3

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Relationships Therapeutic Nurse-Client Relationships


Each nurse establishes and maintains respectful, The client’s needs are the focus of the relationship,
collaborative, therapeutic and professional which is based on trust, respect, intimacy and the
relationships. appropriate use of power.9 Nurses demonstrate
empathy and caring in all relationships with
Relationships include therapeutic nurse-client clients, families and significant others. It is the
relationships and professional relationships with responsibility of the nurse to establish and maintain
colleagues, health care team members and employers. the therapeutic relationship.

Indicators In addition, a nurse in an administrator role


demonstrates the standard by:
A nurse demonstrates the standard by: ■ fostering an environment in which clients and

practising according to CNO’s Therapeutic Nurse-


■ nurses are safe from abuse;

Client Relationship, Revised 2006 practice standard; ■


supporting the therapeutic nurse-client


demonstrating respect and empathy for, and
relationship;

interest in clients;
■ promoting a philosophy of client-centred care and
■maintaining boundaries between professional
collaborative relationships; and
therapeutic relationships and non-professional
■ advocating for systems of care that acknowledge
personal relationships;
and support nurses in developing and maintaining

ensuring clients’ needs remain the focus of nurse- therapeutic relationships.
client relationships;
ensuring that her/his personal needs are met

A nurse in an educator role demonstrates
outside of therapeutic nurse-client relationships; the standard by:
■developing collaborative partnerships with clients ■
role-modelling therapeutic nurse-client

and families that respect their needs, wishes, relationships; and

knowledge, experience, values and beliefs; ■


identifying and supporting education related to
■recognizing the potential for client abuse; professional and therapeutic relationships.
■preventing abuse when possible; and
■taking action to stop abuse and reporting it A nurse in a researcher role demonstrates
appropriately. the standard by:

communicating knowledge of evidence-based,
best-practice guidelines related to caring and
therapeutic relationships.

9
Refer to CNO’s Therapeutic Nurse-Client Relationship, Revised 2006 practice standard.

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Professional Relationships
Professional relationships are based on trust and
respect, and result in improved client care.

Indicators at risk of harm from colleagues; and


■ valuing and acknowledging nursing expertise and
A nurse demonstrates the standard by: contributions to the health care of clients.
■role-modelling positive collegial relationships;

using a wide range of communication and
A nurse in an educator role demonstrates
interpersonal skills to effectively establish and
the standard by:
maintain collegial relationships;
■ facilitating the development of conflict-resolution
■demonstrating knowledge of and respect for each skills; and
other’s roles, knowledge, expertise and unique ■ supporting nurses in developing skills to address
contribution to the health care team; any unethical, unprofessional or unsafe behaviour

sharing knowledge with others to promote the of colleagues.
best possible outcomes for clients;
■developing networks to share knowledge of best A nurse in a researcher role demonstrates
practices; and the standard by:
demonstrating effective conflict-resolution skills.
■ ■ communicating knowledge of the research process
and relevant studies to other nurses and team
In addition, a nurse in an administrator role members; and
demonstrates the standard by: ■ supporting nurses in participating in research
■ promoting a work environment in which trust studies.
and respect among all health care disciplines is
expected;

ensuring systems are in place to effectively reduce
and manage conflict between team members;
■ supporting nurses to take action when clients are

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

References
Association of Registered Nurses of Newfoundland.
(1999). Guidelines regarding shared scope of practice
with licensed practical nurses.

Canadian Nurses Association. (1994). Ethical


guidelines for nurses in research involving human
participants. Ottawa: Author.

College of Nurses of Ontario. (1999). Entry to


practice competencies for Ontario registered nurses.
Toronto: Author.

College of Nurses of Ontario. (2000). Ethics.


Toronto: Author.

College of Nurses of Ontario. (2002). Professional


Standards. Toronto: Author.

College of Nurses of Ontario. (1999). Therapeutic


Nurse-Client Relationship, Revised 2006. Toronto:
Author.

Ferguson-Pare, M. (1998). Nursing leadership


and autonomous professional practice of
registered nurses. Canadian Journal of Nursing
Administration, 11(2), pp. 7–30.

Lamond, D. & Thompson, C. (2000). Intuition


and analysis in decision making and choice.
Journal of Nursing Scholarship, 33(2),
pp. 411–414.

Murdoch-Perra, B. (2001). Leadership: The key to


quality outcomes. Journal of Nursing Care Quality,
15(2), pp. 68–73.

Royle, J., Dicenso, A., Boblin-Cummings, B., Blythe,


J. & Mallette, C. (2000). RN and RPN decision
making across settings. Canadian Journal of
Nursing Leadership, 13(4), pp. 11–18.

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


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PR ACTICE STANDARD

Notes:

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


15
PR ACTICE STANDARD

Notes:

College of Nurses of Ontario Practice Standard: Professional Standards, Revised 2002


101 Davenport Rd.
Toronto, ON
M5R 3P1
www.cno.org
Tel.: 416 928-0900
Toll-free in Canada: 1 800 387-5526
Fax: 416 928-6507
E-mail: cno@cnomail.org

JULY 2022
41006
2022-51

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