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.

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 article, “Scope of Practice: What’s In and What’s Out?”.

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.

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.

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.

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:

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

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.

"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 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.

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 may access the Self-Employed Practice Checklists by logging into College Connect, selecting “Manage Your Practice” and then “Self-Employed Practice”.

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:

1. For information on the use of the title “registered nurse” or "RN" for self-employment, review the Use of Title Standards and Advertising Standards.
2. Consider reaching out to the Canadian Nurses Protective Society (CNPS) for independent practice guidance and legal advice when starting your own business.
3. Refer to the Complementary and Alternative Health Care and Natural Health Products Standards for additional information regarding the standards of practice.
4. 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.
5. Consider reviewing Scope of Practice and Scope of Practice: What’s In and What’s Out?.

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.

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.

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.

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.