Health Assessment: Related Legislation

Any health assessment you perform must fall within your nursing scope of practice and be informed by the appropriate nursing College or association practice standards. In Ontario, the College of Nurses of Ontario (CNO) is the legal governing body for nurses, so as a nurse, you must perform health assessment within the CNO legislated scope of practice, the practice standards, and also based on your individual level of competence (i.e., knowledge and expert practice to perform an action).

It is important to be aware of controlled acts, which are activities that are considered harmful if performed by someone who is unqualified as per the Regulated Health Professions Act (RHPA) (CNO, 2020a). As per the RHPA, a controlled act must only be performed with an order or when permitted by specific regulations and you must be competent to perform the skill/procedure (CNO, 2020a). For example, it is within your scope of practice to perform health assessments that move “below the dermis or mucous membrane” or involve putting your finger/hands or an instrument beyond “the external ear canal,” regions where the nasal passages narrow, the larynx, urethra, labia majora, anal verge, or “into an artificial opening in the body” as long as there is an order from a physician AND you are competent to perform this skill/procedure (CNO, 2020a).

Keep in mind that many controlled acts are related to interventions (e.g., treatment procedures) that you perform as a nurse, and some controlled acts relate to assessment techniques (e.g., performing an invasive technique).

When you perform an assessment, it is important to inform the client what you are assessing and typically share some of the findings that are within your scope of practice (e.g., I noticed inflammation around your ear drum). However, you are not permitted to communicate a diagnosis about what is causing the inflammation around the ear drum. Communicating a diagnosis is not permitted because this is considered a controlled act and outside of the registered nursing specific controlled acts (CNO, 2020b). Communicating a diagnosis is done by certain regulated health professionals such as a physician or nurse practitioner. However, you may be expected to communicate a diagnosis if you are delegated to do so by a physician or nurse practitioner and you have the knowledge to do so.

In performing any health assessment, you are also required to adhere to the CNO practice standards. These various standards will provide you information about therapeutic relationships, informed consent, permission to touch, documentation, privacy and confidentiality and other important topics. Many of the CNO practice standards are informed by health laws and nurses are legally obligated to practice in accordance with these practice standards.

Common practice standards that apply to health assessment include: 

• Code of Conduct (2026). Highlighting six specific principles, this standard describes nurses’ responsibilities (CNO, 2026). In addition, “the code also describes what nurses must do to maintain professionalism, competence and ethical behaviour to deliver safe client care” (CNO, 2026).
• Professional Boundaries and Nurse-Client Relationships (2025). This standard highlights the vital importance of a therapeutic nurse-client relationship (CNO, 2025). As per CNO, the following three principles are described in this standard: 
  • How to “establish and maintain a therapeutic nurse-client relationship” (e.g., respect, trust, culturally-inclusive care, protecting client’s privacy, respecting their health needs and preferences, communication).
• Confidentiality and Privacy — Personal Health Information (CNO, 2025). As per CNO, this standard focuses on the ethical and legal responsibilities and on building trust by maintaining “the confidentiality and privacy of client health information.” This standard highlights what personal health information is and when disclosure is permitted. Since client’s have the right and expect that their information will be kept confidential, it is important for you to think about the consequences of inappropriate access to client information. Inappropriate access is considered professional misconduct, but it can also negatively affect there therapeutic nurse-client relationship and adversely affect client safety and quality of care. Most important, clients need to know that they can trust you and that their information (patient data) will be kept private. 
• Documentation (CNO, 2025). This standard highlights how document “is an essential component of safe nursing practice” (CNO, 2025). Overall, nurses (as well as you) need to understand that accurate, clear, timely and complete nursing documentation promotes client safety, continuity of care, effective decision-making and interprofessional care, and prevents the potential for miscommunication and errors (CNO, 2025). In the standard, CNO outlines the three following principles:
  • Communication (e.g., use of approved documentation methods, accurate and complete documentation that is clear and relevant). 
  • Documentation requirements (e.g., timely, legible, permanent, entries with date and time, signature, designated title)
  • Information security).
  • Information security (e.g., maintain privacy and confidentiality, unique log-in credentials for electronic systems, 

In addition, health assessment and decision-making should be based on evidence informed practice such as best practice guidelines. The Registered Nurses Association of Ontario (RNAO) has a series of best practice guidelines. Many of these guidelines will inform your decision-making and support client health outcomes. Examples of best practice guidelines include topics surrounding anti-Black racism, assessment and management of leg ulcers, assessment and care of adults at risk for suicidal ideation, and pain assessment and management.

References

College of Nurses of Ontario (2020a). Legislation and regulation: An introduction to the Nursing Act, 1991.  https://www.cno.org/globalassets/docs/prac/41064_fsnursingact.pdf

College of Nurses of Ontario (2020b). Legislation and regulation RHPA: Scope of practice, controlled acts model.  https://www.cno.org/globalassets/docs/policy/41052_rhpascope.pdf