Steps to Becoming a CNS and NP in Newfoundland and Labrador

1Get your Graduate Degree in Newfoundland & Labrador
2Take your Exam(s) in Newfoundland & Labrador
3Apply for your Registration in Newfoundland & Labrador
4Renewing your License in Newfoundland & Labrador

The Association of Registered Nurses of Newfoundland and Labrador (ARNNL) (phone: 709-753-6040, [email protected]) oversees the regulation and licensing of the following advanced nursing practice (ANP) roles:

Newfoundland & Labrador

  • 2011 average salary for general practitioners/family physicians in Newfoundland and Labrador: $175,428
  • 2010-2011, number of NPs licensed in Newfoundland and Labrador: 111
  • April 2010, ARNNL Continuing Competence Program (CCP) implemented
  • 2010-2011, 96.7% of RNs completed all components of CCP
  • Clinical Nurse Specialist (CNS)
  • Nurse Practitioner (NP)
    • Primary Health Care
    • Adult
    • Pediatric

In order to work toward a CNS or NP practice role in Newfoundland and Labrador, you must first obtain an RN registration:

  • If you were never registered in a Canadian jurisdiction and you are a graduate from outside of Canada, you must apply to ARNNL for registration with the IEN application package.
  • If you are a graduate of a nursing education program in Newfoundland and Labrador, you must complete the CRNE application form, which is provided by your nursing education program.
  • If you are an RN registered in Canada or a Canadian jurisdiction, you must apply for Registration for Canadian Registered Nurses.
  • If you were previously registered with ARNNL, you must contact the Registration Department (709-753-6040, [email protected]) for a Membership/Licensure Renewal Application form.

Step 1. Get Your Graduate Degree

Once you have obtained your RN registration, you must obtain a graduate degree in your advanced practice role. The minimum requirement for advanced practice nursing in Newfoundland and Labrador is a master’s degree in nursing. Graduate programs for advanced practice nursing are grounded in the theoretical foundation of nursing.

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Nurse Practitioner

The ARNNL approves all nurse practitioner programs offered in the province, and all programs must therefore meet the ARNNL Standards for Practice for Nurse Practitioners and the ARNNL competency requirements for entry-level nurse practitioners. Any nurse practitioner education program offered in other provinces or territories must be equivalent to the ARNNL-approved programs.

Within Newfoundland and Labrador is the ARNNL Approved Nurse Practitioner Education Program of Memorial University of Newfoundland School of Nursing Master of Nursing, Nurse Practitioner Specialist Program. This program offers three clinical options for nurse practitioners: adult acute care, mental health and psychiatric nursing, and neonatal. The program includes 35 credit hours in both graduate program courses and an integrated clinical practical experience. Some of the courses included in the NP master’s program include:

  • Research in Nursing: Quantitative Methods
  • Philosophical and Theoretical Foundations of Nursing
  • Nursing Informatics
  • Nursing Individuals and Families through Life Transitions
  • Nursing Therapeutics for Individuals and Families
  • Advanced Practice Issues and Role Development

Memorial University also offers a post-master’s nurse practitioner diploma that includes 14 credit hours in graduate program courses and integrated clinical practice experience. To be eligible for the post-master’s program, you must possess a master’s degree in nursing or an equivalent degree with a nursing focus, as well as two years of clinical nursing experience.

Clinical Nurse Specialist

Some of the areas of clinical expertise chosen by CNSs include:

  • Pediatrics
  • Adult nursing
  • Rehabilitation
  • Gerontology
  • Critical Care
  • Cardiology
  • Palliative Care
  • Oncology
  • Mental Health
  • Community and Home Care
  • Women’s Health
  • Gerontology
  • Cardiology

The Canadian Nurses Association, in their Clinical Nurse Specialist Position Statement, notes that the CNS Practice is within the current scope of the registered nursing practice, and is therefore regulated by nursing regulatory bodies responsible for regulating the activities of registered nurses.

NP Collaborative Relationships

All NPs establish collaborative relationship with interdisciplinary team members, such as physicians, pharmacists and other healthcare professionals. The NP can practice both autonomously and collaboratively, and may initiate consultation with physicians and other members of the team regarding an opinion, recommendation or concurrence for the care of clients.

NPs must consult with a physician when the physician’s expertise is required to diagnose or manage a health condition. In addition, the NP must consult with a physician when a diagnosis or treatment is beyond the scope of the NP; during an emergency or urgent situation; and on an annual basis regarding reassessment of a client with a chronic condition.

NP Pharmacological Therapy

Nurse Practitioners may manage and monitor the care of patients through current pharmacological therapy within their scope of practice. The NP may:

  • Prescribe over-the-counter medication
  • Advise the patient about prescription and non-prescription drugs
  • Document medications on the client’s permanent health record
  • Dispense specific medications in small quantities when a pharmacist is not available

Step 2.  Take the Appropriate Nurse Practitioner Exam (NP Only)

Upon completion of your nurse practitioner graduate education, you are then eligible to take one of the following national examinations:

Family/All Ages Nurse Practitioner

The Canadian Nurses Practitioner Examination: Family/All Ages (CNPE:F/AA) through the Canadian Nurses Association (CAN) and its examination company, Assessment Strategies Inc., is a national, entry-level exam used for NPs who specialize in family/all ages/primary health care. The CNPE:F/AA Exam is used in all jurisdictions except British Columbia, Alberta, and Quebec and is offered twice a year (you can check the CNA website for test dates).

Before you can take the CNPE:F/AA exam, you must secure authority to take the exam by the ARNNL nursing regulatory authority. The exam consists of 190 to 200 multiple-choice questions and can be taken over a four-hour period. There are 42 competencies that comprise the exam’s content. You may purchase a prep guide from the CNA bookstore by calling 1-800-385-5881 for this exam.

The 42 competencies of the CNPE:F/AA exam are part of the four categories of the framework of the primary healthcare nurse practitioner, which include:

  • Professional Role, Responsibility and Accountability
  • Health Assessment and Diagnosis
  • Therapeutic Management
  • Health Promotion and Prevention of Illness and Injury

All applicants must contact the ARNNL (709-753-6040) for an application form for the CNPE:F/AA exam. Upon completion of the examination, the ARNNL will inform you of the results of your examination within 4 to 8 weeks.

Pediatric/Adult Nurse Practitioner

The American Nurses Credentialing Center (ANCC) offers a Pediatric Nurse Practitioner Exam (PNPBC) and an Adult Nurse Practitioner Exam (ANP-BC). To be eligible for these exams, you must:

  • Hold an active RN license
  • Hold a master’s degree or higher from a PNP program that has been accredited by the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE)
  • Provide evidence of at least 500 supervised clinical hours in the PNP program
  • Provide evidence that the graduate program contained three separate courses in: advanced physical/health assessment; advanced pharmacology; and advanced pathophysiology
  • Provide evidence that the graduate program contained content in health promotion and disease prevention, and differential diagnosis and disease management

To apply for the Pediatric Nurse Practitioner or the Adult Nurse Practitioner exam through the ANCC, send the completed application, along with the following fee (in a personal check or money order, made payable to “ANCC”):

  • $270 ANA Member Fee (requires proof of membership)
  • $340 Discount Fee (requires proof of membership to the American College of Nurse Practitioners)
  • $395 Non-Member
  • $125 Additional Fee for International Testing Privileges

to the American Nurses Credentialing Center, P.O. Box 8785, Silver Spring, MD 20907-8785.

Canadian Nurse Practitioner Exam

As of January 1, 2007, all applicants for NP registration in primary healthcare who have not established registration as an NP in another Canadian jurisdiction must pass the Canadian Nurse Practitioner Exam (CNPE).

Examination dates and application deadlines can be found on the ARNNL website. Examination fees for the CNPE are $1,448.66. Newfoundland and Labrador Writing Centers for the CNPE can also be found on the ARNNL website.

Applicants may also request to complete the CNPE in another province, provided the province is offering the exam and has space to accommodate the applicant. Requests to take the exam in another province must be forwarded to Registration before the application submission deadline.

Step 3.  Apply for Registration with ARNNL (NP Only)

Before employment can commence, the ARNNL requires initial registration as a nurse practitioner.

The application for NP registration consists of three sections:

  • Section 1: Both “A” and “B” are to be completed by the applicant.
  • Section 2: Section 2 must be sent to the school of nursing where you completed your nurse practitioner education program.
  • Section 3:  Section 3 must be sent to the jurisdiction where you are currently registered as an NP. If you are a new graduate, forward Section 3 to the licensing body where you are completing (or have completed) your nursing education program.

Requirements for Registration

If you were never registered as an NP in a Canadian jurisdiction and you graduated from outside of Canada, you must request an application for registration for international graduates. Otherwise, you may complete the Application for Initial Registration Nurse Practitioner.

All applicants must meet the following requirements for initial registration:

  • Must be registered as an RN with the ARNNL and possess a valid practicing license issued by the ARNNL
  • Must be a graduate of an approved NP program (if you graduated from a program outside of Newfoundland, your program be equivalent to Newfoundland-approved NP programs)

Complete the application and send it, along with a $536.50 processing fee (made payable in a check or money order to: Association of Registered Nurses of Newfoundland & Labrador) to: Association of Registered Nurses of Newfoundland and Labrador, 55 Military Road, St. John’s, Newfoundland, A1C 2C5.

Interim License

If you are a graduate from another Canadian school and you are awaiting the results of a written nurse registration examination, you may apply for an interim license, provided you can show proof of the completion of a nurse practitioner education program and of having applied or written the nurse registration examination. Interim licenses are only granted to RNs who possess a valid practicing license from the ARNNL. An interim license is issued for a period of 4 months for a fee of $152.55 in the following blocks:

  • April 1 – July 31
  • August 1 – November 30
  • December 1 – March 31

Step 4. Renewing NP Your License

All nursing licenses are renewed every year, and all members who held practicing licenses in the previous year must declare that they have met all requirements prior to March 31st.

To renew your NP license through the ARNNL’s Online Renewal System, you must provide proof that you have done one of the following:

  • Completed an NP educational program within the previous 36 months; OR
  • Practiced for a minimum of 1800 hours during the previous 36 months

To access the online renewal system, you must enter your ARNNL registration number and password. If you received an Application for Licensure/Membership from the ARNNL in the mail, enter the password found on this form. If you have an email address on file with the ARNNL, you may also enter it to retrieve your password.

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The renewal fee for NP licensure is $536.50, and an additional late fee of $56.50 applies if you fail to renew your NP license before March 31st.

Advanced Practice Nursing Associations in Newfoundland and Labrador

There are a number of professional organizations that support advanced practice nursing in Newfoundland and Labrador:

Newfoundland and Labrador Nurse Practitioner Salary

In 2005, a total of 5,835 nurse practitioners were employed in Newfoundland and Labrador. The average salary among them was $47,536, which had increased nearly 11% from the year 2000 when the average was $42,377. There was a more significant change in the median salary level between 2000 and 2005, as it went from $45,928 to $54,803, which represented an increase of roughly 16%.

Occupational Classification
Number of Professionals
Average Income
Nurse Supervisors and RNs
Registered Nurses
General Practitioners and Family Physicians

Employment and salary data included in these tables was produced by Census Canada in 2006 and originally published by Statistics Canada in 2008. To provide comprehensive information for comparative purposes, the data includes all Statistics Canada Occupational Classifications in which advanced practice nurses were identified.

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