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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. In particular, 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.
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 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. In Nova Scotia, NPs are able to prescribe Botox and other fillers with additional education and experience and with the approval of the CRNNS NP Committee. At this time, British Columbia and New Brunswick have stated that prescribing Botox and cosmetic fillers are outside of the scope of practice for NPs.
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 with their regulatory bodies.
As with any other treatment, nurses performing cosmetic procedures will be held to the standard of a reasonable and prudent nurse. Nurses may require additional education and experience to demonstrate competence when carrying out cosmetic procedures. Where necessary, nurses should ensure they are following a physician’s order to carry out a given procedure.
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 to determine the best business structure for their business. This is a complicated issue that involves a number of specific legal issues. Nurses who are CNPS beneficiaries may contact 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 CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.
NOTE: As of June 2019, there is no longer a requirement for Nova Scotia nurse practitioners to obtain approval from their nursing regulator (the Nova Scotia College of Nursing) prior to changing client types (including cosmetic clients) that fall within the client populations for which they were educated and passed an appropriate entry to practice examination.
Published May 2015
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.