As the popularity of Med Spas and aesthetic procedures continues to grow, questions about who can legally perform these treatments have become increasingly important. Botox and dermal fillers are two of the most sought-after treatments, but in Florida, the rules around who can administer them are not always clear.
Recently, the Florida Board of Nursing addressed this issue after a declaratory statement filed by Diana Lange, RN. Their ruling provides valuable insight into the scope of practice for registered nurses when it comes to administering Botox and fillers.
Background of the Case
The question of whether an RN can administer Botox and fillers was brought before the Florida Board of Nursing on October 5, 2023. Diana Lange, a registered nurse with extensive training in aesthetic procedures, filed a petition seeking clarification on her ability to perform these tasks under the delegation of a licensed physician. Per her filings, Lange works at ZRoc Dermatology, a medical practice owned and operated by Dr. Matthew Zarraga, a dermatologist.
In her petition, Lange outlined her professional experience, including over 300 private and group injectable trainings she attended or organized sponsored by Galderma (a major pharmaceutical company specializing in dermatological treatments). She also worked directly with dermatologists, nurse practitioners, and other medical professionals, with significant hands-on experience in the administration of neurotoxins and dermal fillers.
Diana requested that the Board clarify if she could be delegated the task of administering Botox Cosmetic and dermal fillers, as long as Dr. Zarraga had examined the patient, prescribed the treatments, and provided direct supervision during the procedure. The petition was filed with the Department of Health on August 7, 2023, and was officially addressed in a public meeting on October 5, 2023, in Orlando.
The Board’s Decision and Key Findings
After reviewing Lange’s petition and relevant statutes, the Florida Board of Nursing determined that under the specific circumstances of her case, she could administer Botox and dermal fillers under the supervision of a physician. The Board issued its Final Order on October 18, 2023, confirming that it is within Lange’s scope of practice as an RN to perform these procedures, under specific guidelines.
The Board’s ruling emphasized several key points:
- Education and Training: Lange’s extensive background in aesthetic procedures was crucial to the Board’s decision. Her participation in over 300 training sessions and her hands-on experience of Botox and dermal filler administration were seen as vital qualifications.
- Physician Supervision: Botox and dermal fillers could only be administered by an RN when delegated by a licensed physician. The physician must first examine the patient and issue a written order detailing the treatment plan. This includes specifying the muscles to be injected, the number of units per injection site, and other necessary medical information.
- Delegation Under Florida Law: The Board’s ruling was grounded in Section 464.003(19) of the Florida Statutes, which defines the “practice of professional nursing.” According to this statute, registered nurses are allowed to administer medications and treatments that are prescribed or authorized by a duly licensed practitioner. Botox and dermal fillers, classified as medical treatments, fall within this scope.
- Direct Supervision: The administration of injectables must occur under the direct supervision of a physician, ensuring that the RN operates under the immediate oversight of an authorized medical professional.
- Informed Consent: The Board stressed the need for proper informed consent from the patient. This consent must be signed by both the patient and the supervising physician before the procedure can take place.
Legal Framework Behind the Decision
The Board’s ruling was guided by two primary statutes: Section 464.003(19), which defines the scope of practice for registered nurses, and Section 120.565, which governs the issuance of declaratory statements. Under Section 120.565, any person who is “substantially affected” by the application of a statute or rule can petition for a declaratory statement from the agency governing that statute. This allows for greater clarity on how specific rules apply to unique circumstances.
In this case, Lange’s petition fell within the Board’s jurisdiction, and the Board determined that her request was in compliance with the law. By allowing an RN to administer Botox and fillers under a physician’s supervision, the Board reaffirmed that registered nurses play a key role in medical aesthetics, as long as they operate within the bounds of Florida law.
Implications for Registered Nurses in Florida
This ruling has significant implications for registered nurses working in medical aesthetics in Florida. It confirms that RNs can perform certain cosmetic procedures, including Botox and filler injections, under strict conditions and after applying to the board in a similar manner to Ms. Lange.
The key factors that determine whether an RN can administer these treatments are:
- Supervision: RNs can only administer Botox and fillers when delegated by a licensed physician who provides direct supervision throughout the process.
- Written Orders: Before any injections are administered, the physician must examine the patient and provide a clear written order that details the treatment plan. This ensures that the RN is following a specific medical directive tailored to the patient’s needs.
- Training and Experience: The RN must possess the necessary education and training to safely perform the procedure. As seen in Lange’s case, her years of experience and extensive training were critical in the Board’s decision.
- Informed Consent: Proper informed consent must be obtained from the patient, outlining the procedure’s risks, benefits, and alternatives. This consent must also be signed by the physician.
Can RNs Inject Botox and Fillers in Florida?
In conclusion, yes, registered nurses can inject Botox and dermal fillers in Florida, but only under specific conditions and after getting a specific ruling from the board. The Board of Nursing’s recent ruling provides clarity on the matter, making it clear that these procedures must be supervised by a licensed physician who has examined the patient and provided a written order.
Registered nurses with the appropriate training and experience, like Diana Lange, can perform these tasks, but they must adhere to the legal requirements set forth by the Board. This decision opens doors for more registered nurses in Florida to engage in the growing field of medical aesthetics, offering cosmetic treatments such as Botox and fillers while ensuring that patient safety and medical oversight remain a top priority.
If you are an RN or healthcare provider considering whether to incorporate these procedures into your practice, it’s important to ensure that you completely understand and comply with your state’s regulations. Consulting with legal professionals and medical boards can help you stay on the right side of the law while expanding your aesthetic practice. Here at Lengea, we can help. With years of experience reviewing regulatory guidelines and frameworks, we can advise you on the right way to structure your practice. We offer complimentary 15-minute consultations to go over your needs and determine the best plan for you.