I am thinking of taking a part-time job in a medical spa, injecting Botox and other fillers. What are the risks?
Registered Nurses and Nurse Practitioners need to meet certain criteria when providing cosmetic procedures. For instance, nurses who provide cosmetic services are required to work within their scope of practice, as defined by their respective regulatory bodies. Performing procedures that are not within a nurse’s scope of practice can result in significant professional and legal consequences, including disciplinary action and negligence claims. A nurse’s scope of practice may be further limited by the employer’s policies and failure to adhere to these policies may result in disciplinary action at the employer level.
The roles and responsibilities of RNs and NPs involved in cosmetic procedures vary by jurisdiction. In some jurisdictions, RNs can only administer Botox and other fillers if the patient has been initially assessed by a physician or other authorized prescriber and there is a client-specific order. RNs may also require additional education and experience to ensure competency. In other jurisdictions, a physician must be present on site for the initial injection, but subsequent injections can be administered via directive with a physician readily available.
Regulatory bodies across Canada have taken varying positions on NPs prescribing Botox and other cosmetic injections. For example, in Ontario, NPs may prescribe and administer Botox and other neuromodulators1. In New-Brunswick and British Columbia, NPs are also permitted to provide medical aesthetic services, although additional educational is required2,3. It is important to thoroughly review the standards of practice and guidelines in your practising jurisdiction to ensure compliance with what is permitted.
In order to assist nurses in navigating these issues, some regulatory bodies have prepared guidelines to inform nurses of their roles and responsibilities with respect to cosmetic procedures. Nurses who are unclear as to whether any aspects of their practice fall within the permissible scope should consult their regulatory bodies.
As with any other treatment, nurses performing cosmetic procedures will be held to the standard of a reasonable nurse. It may be prudent to receive additional education and experience to demonstrate competence when carrying out cosmetic procedures. Despite any legislative requirements, nurses may also want to consider what resources are available to them both onsite and remotely such as a physician, clinical director, trusted and experienced colleagues to help guide their practice and if adverse or unexpected events arise.
Finally, not all cosmetic services are nursing services. While you may have professional liability protection in place with respect to the nursing practice, if the services you are engaged in are not considered nursing, then you may be unprotected and require additional protection.
Nurses who are considering opening a clinic or operating their own independent nursing practice in affiliation with a clinic to provide cosmetic procedures, may wish to retain their own personal lawyer and/or accountant to determine the best business structure for their business. This is a complicated issue that involves a number of specific legal questions. Nurses who are CNPS beneficiaries may contact the CNPS for advice with respect to professional liability issues associated with commencing an independent practice.
Nurses who are working in collaboration with other health care professionals to provide cosmetic procedures will want to ensure that each health care professional individually has adequate personal professional liability protection.
CNPS beneficiaries can contact the CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
Published May 2015, reviewed in July 2021
1. CNO, Can nurses in independent practice administer Botox? July 2019, online: https://www.cno.org/en/learn-about-standards-guidelines/magazines-newsletters/the-standard/july-2019/nurses-independent-practice-administer-Botox/
2. Nurses Association of New Brunswick, Fact Sheet: Medical Aesthetics, June 2021, online: https://www.nanb.nb.ca/wp-content/uploads/2022/10/NANB-FactSheet-MedicalAesthetics-June21-E-1.pdf
3. BCCNM, Scope of Practice for Nurse Practitioners, July 2022, online: https://www.bccnm.ca/Documents/standards_practice/np/NP_ScopeofPractice.pdf
THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.