Steps to Becoming a Nurse Practitioner in Ontario

1Get your Graduate Degree in Ontario
2Fulfill Safe Nursing Practice Requirements in Ontario
3Pass the Necessary Examinations in Ontario
4Apply for Registration in Ontario
4Maintaining Your Registration in Ontario

The College of Nurses of Ontario holds the responsibility for registering nurse practitioners (NP) to work in the province. You may become certified to work in Adult Health Care, Pediatrics, or Primary Health Care.

Ontario Job Statistics

  • 2011 average salary for general practitioners / family physicians in Ontario: $164,394
  • NP Integration report indicates over 90% of NPs in Ontario refer patients to specialists
  • NP Integration report found that 75% of RN(EC)s work in primary healthcare NP positions
  • As of 2007, Ontario government had funded over 400 NP positions
  • June 2010, 26 clinics led by NPs introduced in communities with physician shortages

All NPs in Ontario must first register as registered nurses (RNs) in the province.

  • If you graduated from a nursing program outside of Ontario, or are an RN or RPN registered outside of Ontario, request an application package.
  • If you have graduated from an Ontario nursing program, follow these instructions to register as an RN in the province.
  • Were you educated internationally? If so, follow the instructions listed here to apply for RN registration in Ontario.

When you have achieved RN registration in Ontario, follow these steps to attain NP registration:

Step 1. Get Your Graduate Degree

You must complete an NP educational program that has been approved by the College of Nurses of Ontario Council before you may register in Ontario as an NP. These programs are at the graduate level and usually result in a master’s degree or post-master’s diploma/certificate. If you do not graduate from an approved program, you must be assessed by the College’s Registration Committee.

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Qualified Graduate Programs

The following NP programs are currently on the College’s approved list:

Adult Specialty Certificate:

Pediatric Specialty Certificate:

  • Dalhousie University
    • Master of Nursing, Nurse Practitioner, Neonatal Program
  • McGill University
    • Graduate Diploma in Nursing, Nurse Practitioner, Neonatology Program
  • McMaster University
    • Diploma Program, Advanced Neonatal Nursing
  • University of Alberta
    • Individual/Family Health Nursing, Acute Care Nurse Practitioner, Child Program
    • Individual/Family Health Nursing, Acute Care Nurse Practitioner, Neonatal Program
  • University of Toronto
    • Master of Nursing, Nurse Practitioner Field (Pediatric Stream)
    • Post-Master’s Nurse Practitioner Diploma (Pediatric Stream)

Primary Health Care Specialty Certificate:

If the NP program you graduate from is not Council-approved, the Registration Committee must assess your competencies. This process begins when you submit your application packet for registration as an NP in Ontario. The Committee will focus on your demonstration of knowledge of the NP Core Competencies as defined by the Canadian Nurses Association. Further information may be required from you as your application is evaluated, such as a resume, job description or a list of medical directives you have used.

Course Requirements

Because the College of Nurses of Ontario does not assess credentials, only competencies, course requirements for NP programs have not been specified. However, if you look at the NP core competencies, you can surmise that the following topics must be covered in any NP educational program. These competencies are common to all specialty certificates:

  • Professional responsibility
  • Professional role
  • Professional accountability
  • Health assessment and diagnosis
  • Therapeutic management (including pharmacology)
  • Health promotion and prevention of injury and illness

There are certain acts that Ontario NPs may perform that RNs in the province may not. These include:

  • Diagnosing
  • Prescribing medications/drugs
  • Administering medications/drugs that you have prescribed
  • Ordering the application of a form  of energy (like ultrasound)
  • Ordering laboratory tests and x-rays

Prescriptive Authority

Because NPs are authorized to prescribe medications limited to your scope of practice, you will take advanced pharmacology coursework in your NP program. This coursework will prepare you to take on this added responsibility.

Specialization for NPs

In Ontario, NPs must be certified to work with a specialized population. The three certifications available are Adult Health Care, Pediatrics, and Primary Health Care. Courses that you take in your NP program will be tailored to your intended clientele.

Step 2. Fulfill Safe Nursing Practice Requirements

One of the requirements to become registered as a NP in Ontario is to demonstrate safe nursing practice. This entails proving that you have been practicing nursing safely for at least two years of the past five years. At least one of those years must have consisted of you practicing in an advanced practice nursing role.

Your advanced practice nursing experience must include demonstration of the following advanced practice clinical competencies:

  • Health assessment and diagnosis
  • Health care management
  • Therapeutic intervention
  • Health promotion
  • Prevention of injury, illness and complications

Additionally, you must be able to provide an employer reference attesting to your fulfillment of the safe nursing practice hours requirement. This reference must include numeration of hours practiced, the safety of your practice, your role, a copy of your job description, and must meet the advanced practice competencies above.

Fulfill Other Requirements


You must demonstrate that you are fluent in spoken and written English or French before you may register as an NP in Ontario. If you are a registered RN or RPN in Canada, you are considered to be exempt from this requirement (as you have already proven fluency).


All NPs in Ontario must also be Canadian citizens, or permanent residents of Canada authorized under the Immigration and Refugee Protection Act to practice nursing. Copies of one of the following documentations of citizenship must be provided at the time of application:

  • Canadian birth certificate
  • Landed immigrant papers
  • Current permanent resident card
  • Current Citizenship card
  • Current Canadian passport
  • Current certificate of Indian status
  • Current work permit authorizing you to practice nursing

Original jurisdiction registration

If you completed your nursing program outside of Ontario, you must also have been registered to practice nursing in the jurisdiction in which you completed your nursing  education. You must not have been refused registration in another jurisdiction.

Suitability to practice/Criminal history check

As part of your registration application to become an Ontario NP, you must sign a Declaration of Registration Requirements that declares your good character and suitability to practice. The following conditions may disqualify you from registering as an NP in Ontario:

  • Conviction for a criminal offense
  • Conviction for an offense under the Controlled Drugs and Substances Act or Food and Drugs Act
  • Having a mental or physical condition that could affect your nursing practice. These include, but are not limited to:
    • Bipolar disorder
    • Depression
    • Anxiety
    • Attention deficit disorder
    • Panic attacks
    • Anorexia
    • Schizophrenia
    • Other medical conditions diagnosed by a health care provider
    • Having been or currently being the subject of professional misconduct, incapacity or incompetency hearings in Ontario or any jurisdiction
    • Having been refused nursing licensure or registration in Ontario or any jurisdiction

If you are or have been a Canadian resident you must undergo a Canadian Police Information Center Criminal Records Check (CPIC Check). More information on this process will be given to you when you apply for NP registration.

Step 3. Pass the Necessary Examinations

Before you may register as an NP in Ontario, you must pass an examination approved by the College of Nurses of Ontario Council. When you file your application for NP registration, information on applying for the necessary examination will be provided as well.

You may choose to register to practice in more than one specialty, which will entail passing more than one examination. However, you must meet the registration requirements for that specialty, including graduating from an approved program for that specialty.

These exams are Council-approved and listed by specialty certificate you will receive when you pass:

Primary Health Care Specialty Certificate

  • Canadian Nurses Association Canadian Nurse Practitioner Examination (CNPE)
    • Offered in May and October (deadlines to apply, respectively, are March and August)
    • Examination centers in Ontario:
      • London
      • Sudbury
      • Ottawa
      • Toronto
      • Thunder Bay
    • Preparation materials available from CNA
  • American Nurses Credentialing Center Family Nurse Practitioner Examination

Adult Specialty Certificate

  • American Nurses Credentialing Center Adult Nurse Practitioner Examination
    • Offered in May and October (deadlines to apply, respectively, are March and August
    • Examination centers in Ontario:
      • London
      • Toronto
      • Ottawa
      • Hamilton
    • Preparation materials available from ANCC

Pediatrics Specialty Certificate

  • American Nurses Credentialing Center Pediatric Nurse Practitioner Examination
    • Offered in May and October (deadlines to apply, respectively, are March and August)
    • Examination centers in Ontario:
      • London
      • Toronto
      • Ottawa
      • Hamilton
    • Preparation materials available from ANCC
  • National Certification Corporation: Neonatal Nurse Practitioner Certification
    • Exam not offered in Ontario
    • Contact NCC to schedule exam dates/locations
  • Pediatric Nursing Certification Board: Pediatric Nurse Practitioner Primary Care Certification Examination
    • Exam not offered in Ontario
    • Contact the College of Nurses of Ontario at 416-928-0900 for more information
  • Ordre des infirmières et infirmiers du Québec’s Certification Examination for Nurse Practitioners Specializing in Neonatology
    • Contact the College of Nurses of Ontario at 416-928-0900 for more information

Step 4. Apply for Registration

Once you are ready to apply for NP registration and to take the NP examination, you can apply online by following this link.

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When you receive the package, there will be two classes of forms. A Forms must be completed by you and submitted to the College of Nurses of Ontario (CNO). B Forms must be sent to a third party and then submitted directly by them to CNO.

A-Forms include:

  • A-1E Application for a Certification of Registration for an NP Specialty Certificate
  • A-3E Summary of Registration and Declaration of Registration Standing-you must declare all jurisdictions in which you are registered as an RN and/or NP, or other provinces in which you have applied for registration but not yet received it
  • A-4E Summary of Nursing Employment-list all NP employers, address, dates of employment, and specialty
  • A-6E Authorization to Release Information
  • A-7E Summary of Nursing Education

B-Forms include:

  • B-1E/B-2E Verification of registration- mail to all registration boards of provinces and countries in which you have registered as an RN or NP, they must return the verification to CNO directly
  • B-3E Verification of Course Completion and Transcript –mail to your NP institution and ask for an official transcript and the form to be returned to CNO
  • B-4E Verification of Employment and Reference- send to your most recent employer, and they must return it to CNO


You must also submit the proper fees, as follows:

  • To apply for registration:
    • Assessment – Canadian: $50
    • Assessment – U.S./International: $200
  • To apply to write the exam:
    • Exam fee (CNPE): $1100
    • (other exam fees will be disclosed to you by CNO)
  • To register with CNO:
    • Registration fee: $163.55
    • Specialty certificate: $46.73

All materials must be mailed to College of Nurses of Ontario, 101 Davenport Rd, Toronto, ON, Canada M5R 3P1.

Step 5. Maintaining Your Registration

Every year, you must complete the CNO’s Quality Assurance Program to maintain your NP registration. Three components are involved:

  1. Self-assessment
  2. Practice assessment
    • Submit your learning plan to CNO
    • Participate in specified assessments
  3. Peer assessment
    • The CNO will assign you a peer assessor to
      • Review your learning plan
      • Make recommendations to the QA committee
    • The QA committee will make a final determination if you have fulfilled QA requirements or need to participate in remedial activities

You will renew your registration and begin the QA process through your CNO Online Account.

Advanced Practice Registered Nurse Associations in Ontario

You might want to join one of the following professional organizations for advanced practice nurses in Ontario:

Ontario Nurse Practitioner Salary

According to information provided by Statistics Canada, during 2010, the average hourly wage of nurse practitioners in the Toronto and Ottawa areas of Ontario was $36.22, which was about $75,337 per year. The top ten percent in the Ottawa area averaged $42.00 per hour, which represented an average annual salary of $87,360. The highest paid nurse practitioners in Ontario were found in the Hamilton, Niagara Peninsula, and Brantford areas where they earned $88,275 per year on average.

Occupational Classification
Number of Professionals
Average Income
Nurse Supervisors and RNs
Head Nurses and Supervisors
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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