Aesthetics services can carry the same risks for clients as other necessary health care procedures, including adverse events such as infection, pain, and in rare cases, death. As more nurses provide aesthetic services involving prescription drugs and controlled acts in non-traditional health care settings, often with limited support, CNO has a responsibility to help ensure clients continue to receive safe, ethical and quality care.  

The proposed changes are informed by extensive consultations with nurses, the public, Canadian health regulators and other health system partners.

Not necessarily.  A direct order by an authorized provider based on their assessment of the specific client can support a defined course of care or treatment plan if it is clear, complete and appropriate for the specific client. The authorized provider conducts the assessment that informs the direct order, including assessing the client’s individual needs and any risks, in-person or virtually as appropriate. 

If the nurse implementing the order identifies a change in the client's condition, treatment needs, treatment goals or any other factor that could affect whether the order remains appropriate, the nurse consults with the authorized provider. The authorized provider may need to reassess the client and provide an updated order before care can continue.  

Even if nothing has changed for the client, the authorized provider must reassess the client and provide a new order once the current order reaches the end of its specified duration. 

Example: An NP assesses a client and provides a direct order for a specific neuromodulator treatment plan for a pre-determined time period, including the medication, dose, frequency and treatment areas, based on the client's assessment and goals. The client returns for a follow-up treatment. The RN/RPN completes their own assessment and determines that there have been no changes in the client's health status, contraindications, treatment goals or response to previous treatments. The RN/RPN determines that the original direct order remains clear, complete and appropriate for the client. Because the direct order remains clear, complete and appropriate, the RN/RPN may provide the treatment according to the established plan of care without requiring a new assessment or order from the NP. If the RN/RPN identifies a change, such as a new medical condition, a change in medications, unexpected side effects or a request to modify the treatment plan, they should consult with the NP to determine whether reassessment and an updated order are required before proceeding. Once the order reaches the end of its specified duration, the NP must reassess the client and provide a new direct order before treatment can continue.

If approved by Council, the onsite requirement applies when nurses (RPNs, RNs or NPs) are delegating a controlled act to another individual (for example, a UCP or regulated health professional without authority). RNs/RPNs performing controlled acts that they have legislated authority to perform and a client-specific order to administer, do not need the authorizing provider to be on-site unless the authorizing provider or nurse considers it necessary (for example, during training). 

If approved by Council, the onsite requirement applies when a nurse delegates the performance of an aesthetic procedure involving a controlled act to someone who does not have the authority to perform the act, such as a UCP or a regulated health professional who does not have authority. The nurse must be onsite for the entirety of the procedure that the nurse delegated.

Delegation is the temporary transfer of authority to perform a controlled act by a regulated health professional who is authorized and competent to perform it to an individual, whether unregulated or regulated, who is not authorized to perform it. For example, this may include a nurse delegating a controlled act to a UCP, such as an aesthetician or international medical graduate, when all delegation requirements are met.

Delegation must be done in compliance with all requirements of applicable regulations and practice standards. 

A nurse who is delegating a controlled act remains accountable for the client’s overall care. The nurse is delegating the act and not the overall care.

Nurses are expected to advocate for policies that are in the client’s best interest and support client safety. Nurses should also ensure employers are aware of CNO standards and guidelines, to which nurses are accountable. 

If there is a discrepancy between an employer policy and CNO standards, the nurse remains accountable for practicing in compliance with CNO standards.