General Practice Guidance FAQs

Understanding Nursing Roles

What is the difference between LPNs, RPNs, and RNs and NPs?

In Alberta, there are different types of nurses:

Licensed Practical Nurses (LPN)
Registered Psychiatric Nurses (RPN)
Registered Nurses (RN)
Nurse Practitioners (NP)

While individuals in all the above categories may use the protected title "nurse" (under the authority of the Health Professions Act), there are differences between the various types of nurses.

1. Regulatory Body

Under the Health Professions Act, different regulatory bodies are authorized to govern and regulate each type of nurse. Each regulatory body has its own registration and education requirements. For more information, please contact the appropriate regulatory body:

The College of Licensed Practical Nurses of Alberta (CLPNA) for LPNs
The College of Registered Psychiatric Nurses of Alberta (CRPNA) for RPNs
The College of Registered Nurses of Alberta (CRNA) for RNs and NPs

Please visit the CRNA’s statement on how we operate for further details.

2. Education and Training

Each regulatory body sets the requirements for approved education:

LPNs are generally required to complete a diploma program, typically over 2 years.
RPNs are generally required to complete a diploma or degree program, typically over 2 to 4 years.
RNs are required to complete a degree program, usually over 4 years.
NPs start as RNs and then advance through specialized education and clinical training.

For more information on the difference between RNs and NPs, please Frequently Asked Questions: Registered Nurse (RN) vs Nurse Practitioner (NP). You may also visit Post-Secondary Education Requirement page to learn more about the education requirements for both RNs and NPs.

3. Scope of Practice

While there may be some overlap in the scopes of practice (SOP) among different types of nurses, the SOP for individuals will differ based on applicable legislation, restricted activities, standards and policies set by their regulatory bodies, employer requirements and individual competence.

For more information on the CRNA registrant’s scope of practice, please refer to our Scope of Practice resources:

Standards documents:

Understanding what specific interventions are within your scope of practice: Practice Guidance Frequently Asked Questions (FAQs)
Questions related to Restricted activities: Practice Guidance Frequently Asked Questions (FAQs)

Graduate Nurses and Restricted Activities

I am a graduate nurse (GN) scheduled to write the National Council Licensure Examination - Registered Nurse (NCLEX-RN) and simultaneously working as a GN. What am I permitted to do in the workplace?

You must have an active provisional permit from the CRNA to work as a GN. You cannot practise as a GN in Alberta either before the effective date or after the expiry date of your provisional permit — this includes orientation. You may not use the protected title of registered nurse (RN) in Alberta or “RN” until the CRNA has approved your RN permit application.

While GNs cannot call themselves RNs, they are bound to the same legislated practice statement for the profession of RNs.

There are specific supervisions standards for GNs as registrants on the Provisional Register. For more information, please refer to Standard 5 of the Supervision Standards (2022).

More information on new graduate registration can be found on College Connect.

How can I find out if a specific intervention is within my scope of practice?

Scope of practice refers to the interventions that registrants are authorized, educated and competent to perform. Registrants of the CRNA include registered nurses (RN), graduate nurses (GN), certified graduate nurses (CGN), nurse practitioners (NP), graduate nurse practitioners (GNP), and RN or NP courtesy registrants.

A registrant can use the regulatory framework to determine if they can perform a specific intervention. Details on the regulatory framework are within the Scope of Practice for Registered Nurses Standard (2022).

Further support to help you determine whether or not a specific intervention is within your scope of practice can be found in the Practice Guidance FAQs.

Can I still work as a graduate nurse (GN) if I have failed the National Council Licensure Examination – Registered Nurse (NCLEX-RN)?

If a GN fails their first attempt at the NCLEX-RN, the GN can continue to work as long as their provisional permit has not expired. If a GN fails the NCLEX-RN twice, their provisional permit will be cancelled by the CRNA, and they will not be able to register again until they have passed the exam.

How many times can I attempt the National Council Licensure Examination – Registered Nurse (NCLEX-RN)?

Graduates of an approved Canadian nursing program who have met the criteria to write the NCLEX-RN, must pass the exam within two years of graduation. These individuals can attempt the exam as many times as needed, however, they must wait 45 days after each failed attempt.

More information on the registration exam can be found here.

Working With Students

What is my responsibility as a registered nurse (RN) if I am asked to supervise a restricted activity performed by an undergraduate nurse?

An RN can only supervise a nursing student performing a restricted activity if the RN is authorized and competent to perform the restricted activity without being required to have supervision themselves, and consents to supervising the nursing student performing the restricted activity.

A conversation with a faculty member of the approved nursing program regarding the type of supervision (direct, indirect or indirect remote) required is necessary as each restricted activity and skill may warrant a different level of supervision based on the program expectations and the student’s competency level. Following the supervision of the restricted activity, the registrant must address and manage any competence issues that are observed during the nursing student’s performance. Collaboration with the faculty member will also be necessary to address any competency-related concerns.

What responsibilities must a nursing faculty member who is responsible for nursing students consider when it comes to the supervision of students?

There are many things to consider when assigning a student to perform a restricted activity. The CRNA outlines expectations that nursing faculty members need to critically think about when making these decisions.

Decide the type of supervision required in collaboration with the registrant providing supervision at the point of care based on the:

assessment of client health-care needs,
current competencies of the nursing student,
nursing care required,
course requirements,
restricted activity to be performed,
practice setting, and
level of risk in the student performing the restricted activity.

What are my responsibilities when an undergraduate nursing student is in my practice setting and is assigned to one of my patients?

The CRNA describes mentorship as "the provision of guidance by a more experienced or more knowledgeable person in a certain area of expertise to a less experienced or less knowledgeable person" (CRNA, p. 12).

The registrant, and not the nursing student, bears the responsibility by ensuring all aspects of patient care are complete, communicating with health care providers and members of the patient’s family. The nursing student is not solely responsible for the care of the patient, even though they may have a high level of competency. Students are still learning and growing in their skills and critical thinking, and they require continued mentorship, guidance, collaboration, consultation and oversight by a registrant in the practice setting.

Who is responsible for the care of the patient when working with a nursing student?

"The primary responsibility for the assignment and care of the person remains that of the primary nurse to whom the person has been assigned" (CNA, 2017, p. 41).

What should I consider when asked to supervise a nursing student?

What is the student's skill and competence level with the restricted activity?
Am I authorized and competent to perform the restricted activity unsupervised?
What is my expectation for communication with the student?
How will I know when care activities are completed?
If I observe unsafe care or minimal competency related to a skill, how will that be addressed?
Do I feel comfortable providing feedback following the supervision of the skill?

For more information:

Practice Standards for Registrants
Supervision Standards
CNA Code of Ethics: Ethical Considerations in Relationships with Nursing Students
Entry-Level Competencies for Registered Nurses
Restricted Activities Standards
Coordination of Client Care Guidelines
Interprofessional Collaboration Guidelines

Ethical Considerations in Relationships with Nursing Students

Nurses in all roles share the responsibility of supporting nursing students in providing safe, competent, compassionate and ethical care. Several statements in the Code include specific references to student nurses and their relationships with others in providing nursing care:

Nurses treat each other, colleagues, students and other health-care providers in a respectful manner, recognizing the power differentials among formal leaders, colleagues and students. They work with others to honour dignity and resolve differences in a constructive way. (D13) Nurses share their knowledge and provide feedback, mentorship and guidance for the professional development of nursing students, novice nurses, other nurses and other health-care providers. (G9)

On the basis of these statements in the Code, the following guidelines are suggested:

All teacher-nursing student interactions are to be in keeping with ethical nursing practice. • All nurses and nursing students treat each other with respect and honesty.
All nurses endeavour to provide nursing students with appropriate guidance for the development of nursing competence.
The primary responsibility for the assignment and care of the person remains that of the primary nurse to whom the person has been assigned.
Persons receiving care are informed of the nursing student’s status as a learner. Ideally, the preceptor would advise persons in care about the nursing student’s status and seek permission for that student to provide care. When the preceptor is not able to speak to all of the nursing student’s assigned persons, the student informs the person and requests permission to provide care. The person’s right to refuse care or assistance provided by a nursing student is to be treated with respect.
Nursing faculty, preceptors and nursing students “place the safety and well-being of the [persons in care] above all other objectives, including fulfilling educational obligations” (CNO, 2017c, p. 3).
Nursing faculty and their administrators honour the ethical imperative on the well-being of the persons in care, which supersedes the responsibility of providing the student with learning opportunities.
Nursing students are expected to meet the standards of care for their level of learning. They advise their faculty clinical instructor and their clinical unit nurse supervisors if they do not believe they are able to meet this expectation. If nursing students experience difficulties with disrespectful actions from a nurse(s) in practice that they are not able to overcome through conversation with the nurse(s) involved, they discuss these incidents with their faculty clinical instructor and, failing helpful outcomes from that discussion within an appropriate period, they enlist the assistance of the appropriate nursing education administrator in their nursing program.

Self-employed Practice

What do I need to know about self-employed practice?

All registrants are responsible for understanding the Practice Standards for Registrants and applying them to their practice. The Practice Standards for Registrants always apply to all registrants regardless of their domain of practice, role or setting. The standards outline the minimum expectations for registrants whose practice will be measured by the CRNA, the public, clients, employers, colleagues and themselves.

The self-employed practice checklists include resources and information for any registrant engaged in or wanting to engage in self-employed practice. Registrants can read more about self-employed practice here.

Self-employed Assessment Checklist: Am I Practising Registered Nursing?

Identify the requirements for registered nurse (RN) or nurse practitioner (NP) practice
Review specific requirements for NP practice in addition to RN practice

Self-assessment Checklist for Self-employed RN or NP Practice

Determine if your practice is within the scope of practice of an RN or NP practice based on the definition of Schedule 24 of the Health Professions Act
Identify and analyze some of the potential self-employed practice risks
Access resources that may help mitigate these risks

Additional resources:

For information on the use of the title “registered nurse” or "RN" for self-employment, review the Use of Title Standards and Advertising Standards.
Consider reaching out to the Canadian Nurses Protective Society (CNPS) for independent practice guidance and legal advice when starting your own business.
Refer to the Complementary and Alternative Health Care and Natural Health Products Standards for additional information regarding the standards of practice.
Refer to the Medication Management Standards for information regarding prescription of IV vitamins, preparation, storage, dosages, most responsible providers (MRPs) and administering Schedule 1, 2 medications.
Consider reviewing Scope of Practice and Practice Guidance FAQs.

Incorporating Restricted Activities into Practice

How can a registered nurse (RN) determine if an activity or intervention is within their scope of practice?

To answer this question, it is important to first understand what scope of practice means. Scope of practice encompasses all the interventions that RNs are authorized, educated and competent to perform. It is set out in provincial legislation and regulations and is complemented by the CRNA standards, guidelines, other regulatory documents and the Canadian Nurses Association Code of Ethics for Registered Nurses (2017).

To help determine if an intervention is within the scope of practice of RNs, one needs to determine if the intervention is a restricted activity authorized within the Health Professions Restricted Activity Regulation (2023) as this legislation authorizes the restricted activities that the CRNA registrants may perform. It is important to understand that not all nursing interventions fall under restricted activities. Many interventions, such as assisting clients with activities of daily living or client teaching and coaching, do not necessarily involve restricted activities.

Does the CRNA have a list of interventions that registrants can perform?

Maintaining such a list is not feasible due to the dynamic nature of the profession. Registered nursing practice, health care needs and the context in which care is provided, are all consistently evolving, and it would be impossible to keep a list of interventions registrants can perform. While a scope of practice that is defined narrowly by a list of activities, interventions or tasks may provide greater clarity, it leaves fewer opportunities for the practice to evolve and respond to health care priorities. Lankshear & Martin (2019) suggest that focusing on client health care needs, rather than a series of tasks, emphasizes professional practice and the evolving knowledge that registered nurses (RN) bring to the health care team.

What are restricted activities? Does the term "restricted" mean I cannot perform them?

Restricted activities are high-risk activities performed as part of providing a health service that requires specific competencies and skills to be carried out safely by authorized persons and are, therefore, restricted to those authorized persons. Restricted activities are listed in the Health Professions Act (2000) and the Health Professions Restricted Activity Regulation (2023). The restricted activities authorized for CRNA registrants are outlined in section 60 of the Health Professions Restricted Activity Regulation.

Although legislation may authorize a registered nurse (RN) to perform a specific restricted activity, it doesn’t mean that an individual RN can automatically, or should perform that activity. An RN must only perform those restricted activities that they are competent to perform and are appropriate to the area of practice.

How does an individual RN know if they can perform a restricted activity?

The CRNA document Incorporating a Restricted Activity into Practice: Guidelines (2022) provides a decision-making framework to assist registrants when assessing whether they can incorporate a restricted activity into their practice. The decision-making framework can also assist employers and other stakeholders in making decisions about interpreting the registered nurse (RN) scope of practice to allow for additions to the individual RN’s scope of practice. Based on knowledge application and critical thinking, the decision-making framework structures the factors that must be considered around three key guidelines: assessment, competence and practice setting support. Here is an example: You are working on a mental health unit and notice that a client has a small laceration on their leg, which may require sutures. Some questions that you can ask to determine if you should engage in suturing include:

Assessment

Does the Health Professions Restricted Activity Regulation allow you to perform the restricted activity?
Does the restricted activity meet the needs of the client and not the convenience of health care professionals?
Are you the most appropriate health care provider to perform the restricted activity at any given time?

Competence

Do you have the knowledge, skill and judgment to perform the restricted activity safely and competently? If not, how can you attain that competence?
Are you able to maintain your competence?

Practice Setting Support

Is the restricted activity within your role?
Are you supported by your employer and practice setting to perform the restricted activity?
Do you have access to the equipment and resources required to perform the restricted activity?

Upon meeting the expectations outlined in the Restricted Activities Standards (2022), performance of the restricted activity of suturing requires:

Education beyond foundational knowledge of this restricted activity being incorporated into your practice;
Development of practice setting support to facilitate the practice as well as identify parameters and limitations; and
Quality assurance mechanisms to evaluate and support safe, competent practice.

Where can I find further information about restricted activities?

CRNA

References

Health Professions Act, RSA 2000, cH-7
Health Professions Restricted Activity Regulation, Alta. Reg. 22/2023
Lankshear, S. & Martin, D. (2019). Getting comfortable with “it depends”: Embracing the impermanence of scope of practice. Nursing Leadership, 32(1), 30-41. https://doi.org/10.12927/cjnl.2019.25850
College of Registered Nurses of Alberta. (2022). Restricted activities standards.
College of Registered Nurses of Alberta. (2022). Incorporating a restricted activity into practice guidelines.

Referrals

I have a patient who wants a referral to a health professional such as physiotherapy, what is my role as a registered nurse?

The role of a registered nurse in this scenario includes but is not limited to providing comprehensive education to the client on what to expect, when applicable, and referring their questions to the most responsible practitioner (MRP) or other interdisciplinary team members as described in Interprofessional Collaboration Guidelines (2023) and Coordination of Client Care Guidelines (2023), when appropriate. Registrants are responsible for ensuring competence in knowing the services offered by the specialist or agency and how they will help support the client.

Questions to consider:

Is this referral within my scope of practice?
Is there a policy or procedure at my practice setting regarding registered nurses making referrals?
Do I have the competency in knowing the services offered by the specialist of agency that the client is requesting the referral for?

Can I obtain a referral-only Practitioner ID?

Registered nurses (RNs) are authorized to refer patients to other practitioners within their scope of practice. However, the College of Registered Nurses of Alberta (CRNA) only issues letters for Alberta Health Practitioner IDs to RNs who are authorized to prescribe Schedule 1 drugs and order diagnostic tests. Currently, Alberta Health Services does not issue Practitioner IDs for any other purpose.

Where can I find further information about referrals?

Registered Nurse (RN) Prescribing Schedule 1 Drugs and Ordering Diagnostic Tests

What is RN Prescribing?

RN prescribing enables registered nurses to prescribe Schedule 1 drugs (excluding controlled substances) and order diagnostic tests. This authority is designed to address client needs within specific clinical practice areas in collaboration with other healthcare professionals.

Following the completion of the RN Prescribing education, what are the next steps?

To apply for authorization, an RN must first successfully complete an approved nursing program for prescribing and ordering diagnostic tests.

The next steps after completing the education program include:

Submitting confirmation of program completion from Athabasca University.
Being registered as an RN with no conditions or restrictions on the practice permit.
Providing a satisfactory employer reference and the required supporting document.
Confirming the presence of an established clinical support tool in the relevant clinical practice area before being authorized to prescribe Schedule 1 drugs and order diagnostic tests within that area.

What is the intention for RN Prescribing?

RN prescribing (excluding controlled drugs and substances) and ordering diagnostic tests are intended to address specific, employer-identified needs for access to medications. While ordering diagnostic tests is part of the authorization, the primary purpose is to assess the effectiveness, therapeutic levels, and/or potential adverse responses to medications.

RN prescribing is authorized within specific parameters that consider factors such as the patient’s medical condition and its complexity, the practice setting, the patient population, the choice of medication, and the ability to order screening or diagnostic tests. These parameters are outlined in regulations, standards of practice, practice directions, and other clinical support documents, including clinical or decision support tools, protocols, guidelines, and explanatory guides.

What can an RN Prescriber do and not do? Are there any other important considerations?

Registered Nurses (RNs) can order tests to:

Support prescribing decisions
Monitor medication efficacy and safety
Screen clients for specific conditions
Clearly identified in the clinical support tool

Registered Nurses (RNs) cannot:

Prescribe controlled drugs and substances
Order tests involving ionizing or non-ionizing radiation, such as those used in nuclear medicine, radiation therapy, lithotripsy, magnetic resonance imaging (MRI), or tests requiring radiopharmaceuticals or imaging contrast.

Special Circumstances: RNs may prescribe and administer epinephrine for anaphylaxis without prior authorization if:

It is included in the clinical support tool (CST)
The RN has the required education, skills, and employer support

Other Considerations:

Stable Client Health Needs: Prescribing is only allowed for clients with predictable conditions and outcomes.
The RN must personally assess the client before prescribing or ordering diagnostic tests.
Prescribed drugs and diagnostic tests must be listed in the CST specific to the RN's clinical practice area.

Can an RN only order Diagnostic Tests as an RN prescriber?

An RN prescriber cannot only order diagnostic tests at this time. Diagnostic test results support safe and appropriate prescribing decisions. The specific diagnostic tests that will be used to determine the medications to be prescribed must be clearly identified in the clinical support tool.

Diagnostic tests might be ordered to:

ensure the medication and dose ordered are congruent with expected therapeutic responses;
monitor the response of the client to the medication therapy to ensure optimal outcomes;
monitor for adverse drug reactions to ensure client safety; and
screen clients for certain conditions

Why are self-employed RNs unable to prescribe?

Self-employed RNs are not authorized to prescribe, as RN prescribing is intended to occur only within an employer-employee relationship. This structure ensures proper employer support and oversight of RN prescribing activities. Self-employed RNs may not have an employee-employer relationship and should call the CRNA before considering applying for RN prescribing.

Key reasons for this restriction include:

Employer Support: RN prescribing can only occur in clinical practice areas where the employer has demonstrated and implemented support. This support is essential for maintaining the safety and standards of prescribing practices.
Oversight and Accountability: An employer ensures proper oversight and accountability, helping RNs adhere to best practices and regulatory standards.

Can Registered Nurses prescribe controlled drugs and substances?

Registered Nurses (RNs) are not authorized to prescribe controlled drugs and substances. RN prescribers have specific prescribing limitations and cannot prescribe controlled substances. For further guidance on prescribing practices, RNs should refer to the CRNA’s Standards of Practice for Registered Nurse Prescribing, along with relevant federal and provincial legislation, including the Controlled Drugs and Substances Act (CDSA).

What are clinical support tools (CST)?

RNs seeking prescription authorization must provide the CRNA with the established CST specific to the clinical practice area. The CST must clearly guide prescribing decisions and any ordering of diagnostic tests. Although the CRNA reviews the clinical support tools submitted, we are not the subject matter experts and do not review from an accuracy lens. Our oversight is more to ensure that the foundational pieces are in place and that the nurse is well-supported.

What elements are required in the clinical support tools?

Please refer to Appendix A in the requirements and standards document for the relevant standards and competencies. There is no specific template for the clinical support tool. It is expected that both the RN and employer, as subject matter experts within the practice setting, will develop the necessary tools to meet the needs of the RN prescriber in that context.

Clinical support documents typically outline indications and contraindications for planned treatments, specify appropriate pharmacological interventions (including medication, dosage, frequency, etc.), identify potential complications and required follow-up, and provide guidance on when to consult a physician or Nurse Practitioner.

Are there any other elements that should be taken into consideration when developing a clinical support tool?

Other considerations may include:

When ordering diagnostic tests, the CST must align with the College of Physicians and Surgeons of Alberta’s Standards of Practice: Continuity of Care
There must be clear responsibility identified in the CST for the follow-up of diagnostic tests
CRNA requires the CST to outline the relationship between the RN role and any other healthcare professional involved to ensure the seamless provision and continuity of client care.
It is recommended that the clinical support tool should be developed, reviewed, and revised by an interprofessional team of subject matter experts with both content expertise and practice experience in the relevant clinical practice area.
The clinical support tool must be evidence-based and informed by best practices.
The clinical support tool must align with the expectations outlined in the standards for developing a clinical support tool.
Best practices indicate that the clinical support tool should be reviewed at least every three years

Can I obtain a referral-only Practitioner ID?

Can my prescribing authorization from one jurisdiction be transferred to the CRNA?

Unfortunately, your prescribing authorization does not automatically transfer from another jurisdiction to Alberta. Each province has its own specific requirements and education for advanced scope authorizations, so you would need to meet the CRNA’s criteria in order to obtain prescribing authorization there.

I have questions about RN Prescribing, who can I contact?

For questions about RN Prescribing please complete the form below. An RN consultant will reach out to address your questions and provide guidance.

Practice Guidance