July 2019
You Asked Us

Can nurses in independent practice administer Botox?

To obtain the authority required to administer botulinum toxin (Botox), RNs and RPNs need to work in a practice setting or collaborate with at least one prescriber, such as an NP or physician.

This is because administering Botox requires performing two controlled acts: administering a substance by injection and performing a prescribed procedure below the dermis. RNs and RPNs can only perform a controlled act if they first obtain the proper authorization, such as a direct order or a directive, from an NP or physician.

Who can administer Botox, and when?

RNs and RPNs can administer Botox only when all of the below criteria are met:

  • You obtain an appropriate order from an NP or physician

  • You determine that the order is clear, complete and appropriate

  • You reflect on your practice and determine that you have the knowledge, skill and judgment to proceed, and to manage any adverse outcomes

  • You properly consider your patient. Complete an assessment and determine if this medication is appropriate for them. Then, verify that they consent to the procedure.

  • You properly consider the environment. You can only perform a procedure if you are in a practice setting where health services of that nature are routinely performed. Then, assess whether you have the resources to monitor and intervene if needed.

Because administering Botox is a cosmetic procedure, it may seem to be a low-risk activity. This is not true. Administering Botox requires nurses to perform controlled acts, and controlled acts can cause harm if performed by those who do not have the knowledge, skill and judgment to perform them.

The Medication and Decisions About Procedures and Authority practice standards both contain decision trees that can help you decide whether you should administer a medication and perform a procedure. Both tools can help you make a decision that is best for your patient.

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