Regulation - LGIC

Initiation of Psychotherapy by Registered Nurses and Registered Practical Nurses

Regulation Number(s):
Ontario Regulation 275/94
Instrument Type:
Regulation - LGIC
Bill or Act:
Nursing Act, 1991
Summary of Proposal:
College Introduction

In Ontario, the regulation of health professions is based on a self-governance model. There are 26 health regulatory colleges governing 28 health professions under the Regulated Health Professions Act, 1991 (RHPA) and their respective health profession Acts.

Under the RHPA and the Nursing Act, 1991, the College of Nurses of Ontario (CNO) is responsible for governing the profession of nurses in Ontario. Under these Acts, the CNO has the authority to make regulations on a variety of subject matters, including regulations regarding the performance of controlled acts authorized to the profession. The proposed regulation amendments are subject to prior review by the Minister of Health and the approval of the Lieutenant Governor in Council (LGIC).


As a core component of the RHPA, there are specified controlled acts which include procedures or services that are considered to represent the most significant, invasive and potentially harmful health care services. Under the RHPA, these activities may only be performed by individuals authorized by their health profession specific Act or through another identified mechanisms in the legislation. All other individuals are prohibited from performing these activities unless they are being performed under certain, limited circumstances (i.e. in an emergency).

The controlled act of psychotherapy was proclaimed on December 30, 2017, adding it to the list of controlled acts in the RHPA. At the same time, a two-year transitional period, ending December 31, 2019, was established to allow providers and organizations to undertake the necessary work to prepare for the coming in to force of the controlled act of psychotherapy.

Beginning December 31, 2019, only physicians, nurses, occupational therapists, psychologists, psychotherapists and social workers and social service workers who are authorized by their respective regulatory college will be able to perform the controlled act of psychotherapy.

CNO is proposing amendments to Ontario Regulation 275/94 (General) made under the Nursing Act, 1991. The amendments would allow Registered Nurses (RNs) and Registered Practical Nurses (RPNs) to independently initiate the controlled act of psychotherapy without an order from a physician or nurse practitioner after December 31, 2019, if they meet the conditions of the regulation.

These conditions include, but are not limited to, the RN or RPN having the knowledge, skill and judgement to safely perform the controlled act and that the RN or RPN has determined the individual's condition warrants performance of the controlled act. Additionally, RNs and RPNs are responsible for adhering to the standards of the profession in all aspects of their practice, this expectation will continue to apply to RNs and RPNs performing the controlled act of psychotherapy.

The proposed amendments are intended to ensure that patients receiving psychotherapeutic services from RNs and RPNs have continued access to care.

Should you wish to provide feedback on this proposal, you may provide it by email to
Analysis of Regulatory Impact:
The proposed amendments are not expected to have any new incremental costs to Ontario businesses. The proposed regulatory amendments are consistent with existing mechanisms for independent initiation of procedures by RNs and RPNs and do not create any new regulatory compliance costs.
Further Information:
Proposal Number:
Posting Date:
October 4, 2019
Comments Due Date:
November 17, 2019
Contact Address:
Health Workforce Regulatory Oversight Branch
Strategic Policy, Planning and French Language Services Division
438 University Avenue, 10th Floor
Toronto ON M5G 2K8