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Scope of practice questions are tricky. In many cases, the law does not outline specifically what types of procedures APRNs are allowed to perform nor does it expressly prohibit nurse practitioners from offering certain services. Rather, NPs tend to be regulated by a very general set of practice guidelines. In many states, however, cosmetic procedures like administering dermal fillers (ex. Juvederm, Restylane) are treated differently.

Nurse practitioners are allowed to administer dermal fillers in the overwhelming majority (if not all) states. The conditions under which these services are rendered, however, differ by state. If you’re looking to add fillers to the list of services you provide there are two steps you need to take to make sure you’re complying with guidelines. 

Step 1: Identify State-Specific Cosmetic/Aesthetic Procedure Regulations 

Many states expressly permit or prohibit certain types of health professionals from performing cosmetic procedures like Botox, dermal fillers or laser treatments. So, you’ll need to do some digging as far as what’s allowable and how these services can be rendered.

In Louisiana, for example, cosmetic treatments including fillers may be administered by APRNs but only those certified in certain specialties. Acute Care NPs, Neonatal NPs and Psychiatric NPs, for example, are only allowed to provide cosmetic services at the level of and with the independence granted to RNs in the state. NPs certified in these specialties are not treated like other APRNs when it comes to providing cosmetic procedures.

It’s also important to note that physician supervision or collaboration laws typically still apply if you’re rendering cosmetic services in your state. There may even be additional supervision/collaboration guidelines related to cosmetic procedures as opposed to other areas of practice.

Overall, you’ll want to understand the following about the regulations surrounding the administration of cosmetic procedures (including fillers) before you start offering these services as a nurse practitioner. Note that not all states give specifics about each item on this list.

1. Are there any specialty restrictions for APRNs related to cosmetic procedures?

2. Is physician supervision/collaboration required? To what extent?

3. Must this supervising or collaborating physician also be trained to administer fillers?

4. Does my state expressly allow or prohibit nurse practitioners to administer dermal fillers?

5. What other conditions must also be met for this type of patient visit? (ex. a physical exam, a medical history)

6. Do I need to meet any specific training requirements to administer fillers?

7. Can I supervise other professionals administering these services (ex. RNs)? If so, under what conditions?

Step 2: Understand General State Scope of Practice Regulations 

Your state may or may not get specific when it comes to answering each of the above questions and that’s okay. Regardless of the lengths your state goes to as far as regulating the cosmetic services industry, you will also need to abide by the general scope of practice regulations for your state. To practice within your scope as a nurse practitioner, two primary conditions must be met:

1. Practice in compliance with state regulations – State scope of practice regulations usually discuss the extent of physician supervision/collaboration required for nurse practitioners as it relates to both patient care and prescribing. Again, these regulations are typically general in nature and don’t expressly permit or prohibit specific activities.

2. NP is trained to perform the services rendered – While you may not have learned how to administer dermal fillers in your NP program, its likely you’re still allowed to do so in practice. But, have you been trained appropriately to do so? Do you have the knowledge to administer fillers safely and effectively? Education and/or training in a practice area is required to comply with scope of practice guidelines.

Do you administer fillers as part of your nurse practitioner practice? How restrictive are the laws related to cosmetic procedures in your state? 

 

You Might Also Like: 3 Dermatology Certifications for Nurse Practitioners 

 

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