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Nursing Education Program Approval
Nursing Education Program Approval (program approval) is the College of Nurses of Ontario’s (CNO’s) new evaluation and monitoring process for approving all entry-level nursing education programs (Practical Nursing, Baccalaureate Nursing and Nurse Practitioner) in Ontario. This process is one way CNO meets its mandate of protecting the public.
Program approval ensures graduates are prepared to practise nursing safely, competently and ethically for the nursing category and/or class for which they want to register.
CNO’s registration regulation requires that all applicants have graduated from a program approved by CNO’s Council. Making sure this regulatory accountability is consistently and effectively applied to all nursing education programs is fundamental to protecting the public.
In 2017, CNO piloted the new nursing education program approval process. The following six pilot schools received approval status at the March, 2018 Council meeting:
| School | Nursing Program | CNO Program Category | Approval Status |
| George Brown College | Practical Nurse Diploma Program | Direct-entry full | Approved |
| Georgian College | Practical Nurse Diploma Program | Direct-entry full | Approved |
| Trent Fleming School of Nursing | Collaborative Bachelor of Nursing Program | Direct-entry full | Approved |
| Trent Fleming School of Nursing | Compressed Bachelor of Nursing Program | Second-level entry compressed | Approved |
| Trent Fleming School of Nursing | Post-RPN Bridging Pathway Bachelor of Nursing Program | Pre-health education entry specified | Approved |
| University of New Brunswick at Humber College | Collaborative Bachelor of Nursing Program – Regular 4 Year Pathway | Direct-entry Full | Approved |
| University of New Brunswick at Humber College | Collaborative Bachelor of Nursing Program – Second-entry Pathway | Second-level entry compressed | Approved |
| University of New Brunswick at Humber College | Collaborative Bachelor of Nursing Program – Bridge Pathway | Pre-health education entry specified | Approved |
| Queen’s University | Primary Health Care Nurse Practitioner Program | Pre-health education entry specified | Approved |
| University of Windsor | Primary Health Care Nurse Practitioner Program | Pre-health education entry specified | Approved |
The new program approval process will be applied to all nursing education programs starting with the Nurse Practitioner programs in December 2018, followed by the Baccalaureate Nursing (Registered Nurse) and Practical Nursing programs in 2019.
The objectives of program approval are to:
- fulfill CNO’s legislative duty to approve entry level-nursing education programs
- promote the safe practice of nursing by implementing a standardized nursing education approval process for all categories and classes of nursing education
- foster accountability of nursing education programs to provide and sustain relevant content that meet standardized criteria
- promote continuous evaluation and improvement of nursing education programs
- grant jurisdictional recognition to nursing education programs
- provide stakeholderswith a transparent account of program approval.
In 2014, CNO’s Council approved the Program Approval Framework, a new approach to evaluating all nursing education programs in Ontario. The same approval standards and process will be applied to Baccalaureate Nursing (RN) programs, Practical Nursing (PN) programs and Nurse Practitioner (NP) programs.
The new approval process will involve a comprehensive review of nursing education programs approximately every five years. Additionally, programs will be monitored each year based on a subset of measures, for example, nursing registration exam results. Programs must meet or exceed the approval requirements to be approved.
We list the approval status of all Ontario nursing education programs on our website. This information is updated annually.
Want more information? Please contact programapproval@cnomail.org
CNO’s Council approved the Program Approval Framework in 2014. CNO will evaluate all nursing education programs in Ontario with this new approach.
Each nursing education program is evaluated against three approval standards:
- Structure
- Curriculum
- Outcomes
Each of the three standards has indicators and evidence requirements used to evaluate a program’s performance of that standard.
CNO uses the following three processes to approve programs:
- Comprehensive review process
- Annual monitoring process
- CNO Council approval
At the centre of the framework is the program’s effectiveness in preparing graduates to practise in a safe, competent and ethical manner.
CNO engaged evaluation and measurement consultants to provide expert advice and guidance on the development of the program approval process. Their work focused on validating the indicators, developing the measurement tools and scoring methodology, and evaluating the new program approval process and tools. A pilot of the new program approval process helped in the evaluation of its development.
We also used the following five principles to guide the development process, and we will continue to use them to guide our program approval process and decisions.
Evaluation Principles
Regulatory-focused: The program approval standards and process are centred on CNO’s public-protection mandate.
Transparency: The program approval and decision-making processes are clear, open and forthright.
Objective: Decision-making is impartial and unbiased.
Evidence-informed: The program approval process is based on best practices and multiple sources of data and information.
Sustainability: The program approval process can be maintained by all stakeholders.
Program approval indicators
Each of the three standards has indicators used to evaluate a program’s performance for that standard. Each indicator was developed based on:
- a literature review
- a jurisdictional scan
- consultation with key stakeholders, such as nurse educators, clinical instructors, nursing leaders, students and front-line nurses
Each indicator was assessed for its ability to address the objectives of program approval, CNO’s public protection mandate and whether the indicators were specific, measurable, appropriate, relevant and time-bound.
We have involved the nursing education community in the development of the Program Approval process through various forums, including:
- teleconference presentations to the academic community
- the Nurse Educator Subject Matter Expert Working Group, which was established in September 2016 and has provided feedback during the development process
- the Academic Reference Group, which was established in September 2016 and provides an opportunity for discussion and collaboration
- various focus groups and consultation sessions in February, March and April 2017.
- piloting the new program approval process at six schools of nursing starting in the fall of 2017.
HIGHLIGHTS: DECEMBER 2016 TO AUGUST 2017
December 2016
We hired evaluation consultants to provide expert advice and guidance on the development of the Program Approval process.
January 2017
We asked for volunteers to participate in focus groups to help validate the indicators and finalize the assessment tools and process; over 200 people responded. We selected 40 participants based on the criteria established by the evaluation consultants to make sure we had representatives from all parts of the nursing community. Focus group participants included educators from Practical Nursing, Registered Nursing and Nurse Practitioner programs, nursing leaders, front-line nurses from across the health care sector, clinical faculty, preceptors and students.
February/March 2017
We held six focus groups with the volunteers. With their help the indicators were finalized and work commenced to develop the assessment tools and scoring guide.
March 2017
We sent a survey to all nursing education programs. The purpose of the survey was to collect information that will help in the planning of Program Approval.
April 2017
Volunteers, including nurse educators and representatives from five nurse regulatory colleges from other provinces, participated in consultation sessions. The results helped inform the development of the final Program Approval assessment tools and scoring guide.
May 2017
We asked for schools to volunteer in a pilot of the new Program Approval process and assessment tools. Twelve schools volunteered to participate. Based on selection criteria established by the evaluation consultants, the following schools were selected for the pilot:
- George Brown College (Practical Nurse Program)
- Georgian College (Practical Nurse Program)
- Trent Fleming School of Nursing (Baccalaureate Nurse Program)
- University of New Brunswick at Humber (Baccalaureate Nurse Program)
- University of Windsor (Nurse Practitioner Program)
- Queen’s University (Nurse Practitioner Program)
We began a formal request for proposal (RFP) process to identify a third-party to administer Program Approval for us. The third-party will be responsible for coordinating Program Approval logistics with the schools, collecting data, reviewing documentation, conducting interviews and completing reports for each of the programs.
June 2017
We had an orientation session for the six selected schools where we explained the pilot and the new Program Approval process and requirements.
July - August 2017
We finalized and translated the new Nursing Education Program Approval guidebook to share with the schools in the fall of 2017.
September 2017
The College selected the Canadian Association of Schools of Nursing (CASN) as the third-party vendor to administer the new Nursing Education Program Approval process on behalf of CNO.
October 2017
Teleconference calls were held with schools to review the new Program Approval process. The Preliminary Program Approval Guide was distributed to all schools.
September – December 2017
The pilot Program Approval process was conducted. Schools submitted their evidence to support the requirements and participated in interviews conducted by the assessors. We worked with evaluation consultants during the pilot to assess the validity of the tools and to gather feedback from stakeholders.
March 2018
The results from the pilot program approval process are completed and will inform the final program approval process. The approval recommendations for the six schools in the pilot was brought forward at the March 2018 Council meeting for a decision. All school received approval status.
CNO conducted a pilot of the new program approval process between September 2017 and January 2018. Twelve schools volunteered to participate. Schools were selected to represent the range of nursing categories and classes, types of programs and delivery models and different locations in Ontario. Based on this criteria, the following six schools were selected for the pilot:
- George Brown College (Practical Nurse)
- Georgian College (Practical Nurse)
- Trent University (Registered Nurse)
- University of New Brunswick at Humber (Registered Nurse)
- University of Windsor (Nurse Practitioner)
- Queen’s University (Nurse Practitioner)
The purpose of the pilot was to:
- validate the new program approval assessment tools and process
- obtain feedback from the schools and the program assessors, including input on their experience, their ability to obtain and assess the required evidence and the time and resource requirements.
Our teleconferences share information on the progress and status of the program approval framework project. Download the slides from each teleconference:
Nurse Program Approval Process: Education Sector Update – October 2017
Timing
When will the new process be used to approve nursing programs?
We will start approving Nurse Practitioner (NP) programs using the new approval process in December 2018. Baccalaureate (RN) programs will follow in January 2019, and Practical Nurse (PN) programs in September 2019.
How often are nursing programs approved?
We approve nursing programs on an annual basis using a monitoring review, with a comprehensive review conducted every seven years.
Program Approval Processes
What is the difference between the comprehensive review process and the monitoring review process?
The comprehensive review is a rigorous evaluation of a program’s ability to prepare graduates to be competent and safe in their nursing practice, and is conducted every seven years. The monitoring review involves an annual evaluation of a sub-set of indicators. Council will use the two processes to determine a program’s approval status.
Will a school that offers both an NP and BScN credential need to complete the approval process for each program?
Yes, a school that offers more than one entry-level nursing education program will be required to undergo an approval evaluation for each category and/or class of nursing.
Will a school that offers different program streams to prepare students for registration need to complete a separate review for each program? For example, a 4-year direct-entry program and a 2-year compressed program?
Yes, a school that offers more than one entry-level nursing education program stream will be required to undergo an approval evaluation for each program.
How are programs approved for university-college collaborative programs?
For Baccalaureate nursing programs offered through a collaboration between a university and college(s), the approval is given to the university which confers the nursing credential. However, the university and college(s) would work collaboratively to prepare the approval submission for the program.
How are programs that are offered at multiple campuses approved?
Programs with multiple campuses that offer the same program will receive one approval decision.
Will bridging programs be approved by the program approval process?
Yes, bridging programs will be approved by this process. A bridging program provides the education needed for Registered Practical Nurses (RPNs) to graduate with a BScN and become eligible to write the RN registration exam.
Will post-graduate programs be approved by the program approval process?
No, post-graduate programs will not be approved. Only entry-level nursing programs are required to be approved.
The Ontario Council of Universities in Nursing (COUPN) has developed a curriculum that is shared amongst a nine-school Nurse Practitioner (NP) consortium. How will approval work for those schools?
Where a curriculum has been standardized, such as the NP consortium, it will be evaluated only once. However, curriculum is only one component of the program approval process. Another nine indicators will be assessed individually for each school in the consortium, and the approval will be applied to each individual school.
Registration exams
How will the registration exam results be used?
First time pass rates for the entry-level registration exams is one of the three outcome indicators used to approve nursing programs. This indicator will have a score that is calculated based on the first time pass rates, which will contribute to the overall score for the program.
With the advent of unlimited writes for the RN-NCLEX, will schools still be evaluated based on the first-time writes of graduates? If so, what is the rationale?
Yes, programs will still be evaluated on the results of first-time writes for the registration exam for each category and/or class. First-time writes are a more reliable indication of how well a program prepares its graduates for competent and safe nursing practice.
French
Will the evaluation be available in French and English?
Yes, materials required by the schools to complete the program approval process will be available in both French and English. The CASN team that is supporting the administration of the process is bilingual and can respond to schools in French or English as requested.
Cost
Will nursing schools have to pay for the evaluation?
Yes, nursing programs will have to pay for the evaluation. Once we have completed the pilot project, we will have a better idea of the cost of the process.
Academic Advisory Group
Who is on the Academic Reference Group?
You can find the members’ names on the website's Academic Reference Group section.
Role of the Canadian Association of Schools of Nursing in Program Approval
CNO has selected the Canadian Association of Schools of Nursing (CASN) to administer the new Nursing Education Program Approval process on behalf of CNO.
How and why was CASN selected?
In the spring of 2017, CNO issued a Request for Proposal (RFP) for a vendor to administer the new program approval process.
CASN was the successful candidate, based on its proposal, its ability to deliver the necessary services in the required timeframes, and its established and strong relationship with the academic community.
What is CASN’s role in program approval?
CASN will coordinate program logistics with schools, collect data, review documentation, conduct interviews and complete assessment reports for each of the programs. Using the reports, CNO will then make program approval recommendations to Council. Using the reports, Council will decide which programs are approved.
What is the difference between CNO program approval and CASN program accreditation?
CNO’s program approval is mandatory for all nursing education programs; CASN’s program accreditation process is voluntary.
CNO’s mandatory program approval process focuses on ensuring schools are preparing nursing students to practise competently, safely and ethically once they graduate and become registered nurses with CNO. All nursing education programs must have CNO approval because this process is one way we meet our mandate of protecting the public.
CASN’s program accreditation process is voluntary. Based on its own quality criteria and standards, it is recognized worldwide as an important, objective method to assess professional education programs, and ensures programs are benchmarked against the same standards.
The College currently accepts accreditation by CASN as program approval for Baccalaureate nursing programs (RN). Will this continue?
No, not after 2019. All Baccalaureate nursing programs (RN) will be reviewed and approved using the new CNO program approval process starting in January 2019. At that time, CASN accreditation and CNO program approval will be two separate processes.
Baccalaureate nursing programs can choose to continue to participate in CASN accreditation for the purposes of quality improvement.
If a Baccalaureate nursing program was just approved through the CASN accreditation process, does it have to be reapproved with the new CNO approval process?
CNO will develop a transition plan and schedule for all nursing programs, taking into consideration a program’s current approval status. We will work with educators in developing this plan.
Programs that were recently approved through the CASN accreditation process will be placed at the end of the schedule for their full review. However, programs will have an annual program approval requirement.
The time and resource commitment to complete both program approval and accreditation is significant for schools. Will there be opportunities to streamline these processes and eliminate duplication?
CNO program approval and CASN accreditation are two distinct processes that serve different functions. However, they do overlap in some areas, and we will work with CASN to identify opportunities for efficiencies.
