Legal Limitations of Aesthetic Nursing

As with all aspects of nursing, state laws vary according to scope of practice.

Recently, I asked Melanie Balestra, a nurse practitioner and attorney who has a great deal of experience in the field of aesthetic nursing, to give me a rundown of how state laws vary in respect to aesthetic nursing.

Because I want all nurses to understand their limitations, I am sharing her information with you that she provided to me regarding the legal implications of aesthetics and nursing.

Legal Implications

Before starting your own aesthetic business, it is extremely important to know the laws governing aesthetics including nurse practitioner regulation and entity regulation including but not limited to limited liability companies and corporations.

Aesthetic injectables have to ordered by a qualified provider in every state. There are several certifying organization for aesthetics.

Every RN, NP, or PA needs to be able to provide proof of training and experience in aesthetics.

Independent Practice States Nurse Practitioners

The states that have independent practice for nurse practitioners without restrictions include Alaska, Arizona, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Iowa, Maine, Minnesota, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Vermont, Washington, and Wyoming. Nurse Practitioners can open their own aesthetic practices and hire and supervise RNs to perform procedures in these states.

Reduced Practice States Nurse Practitioners

  • Alabama NPs are regulated by the Board of Nursing and Medical Board and require NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Delaware NPs are regulated by the Board of Nursing and require NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Illinois NPs not practicing in certain hospital settings are required by law to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Indiana law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Kansas law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice.
  • Kentucky requires NPs to maintain a regulated collaborative agreement with a physician as a condition of prescribing scheduled mediations.
  • Louisiana law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Maryland law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Mississippi law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Nebraska law requires maintain a regulated integrated practice agreement with a physician for at least one element of NP practice as well as national certification.
  • New Jersey requires NPs to maintain a regulated joint protocol agreement with a physician for at least one element of NP practice as well as completing CE requirements for national certification.
  • New York requires NPs to maintain either written collaborative agreements and written protocols or a regulated collaborative relationship with a physician, or a hospital, licensed under article 28 of the PHL that provides such services through licensed physicians qualified to collaborate in the specialty involved and having privileges at such institution as well as national certification.
  • Ohio law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.
  • Pennsylvania law requires NPs to maintain a regulated collaborative agreement with two physicians for at least one element of NP practice as well as national certification.
  • South Dakota law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification regulated by the Board of Registered Nursing and Board of Medical and Osteopathic Examiners as well as national certification.
  • Utah requires NPs to maintain a regulated relationship with a physician in order to prescribe Schedule II and III controlled substances as well as national certification.
  • West Virginia law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP as well as national certification.
  • Wisconsin law requires NPs to maintain a regulated collaborative agreement with a physician for at least one element of NP practice as well as national certification.

A physician would always have to be involved in a practice in these states.

Restricted Practice States

  • California requires NP supervision by physicians for at least one element of NP practice. Written protocols signed by the physician, NP and administrative person must be in place and national certification is not required.
  • Florida requires NPs to function under protocols with physicians for at least one element of practice and is regulated through the Board of Nursing and Board of Medicine with national certification required.
  • Georgia requires physician delegation for at least one element of NP practice with national certification required.
  • Massachusetts requires physician supervision for at least one element of NP practice as well as national certification.
  • Michigan law requires physician delegation for at least one element of NP practice as well as national certification.
  • Missouri requires a regulated physician relationship for at least one element of NP practice as well as national cortication.
  • North Carolina requires NP physician supervision for at least one element of NP practice and is regulated by the Board of Nursing and the Medical Board with national certification.
  • Oklahoma requires NP physician supervision for at least one element of NP practice as well as national certification.
  • South Carolina requires physician delegation and supervision for at least one element of NP practice as well as national certification.
  • Tennessee requires physician supervision for at least one element of NP practice as well as national certification.
  • Texas requires NPs to have physician delegation and supervision for at least one element of NP practice as well as national certification.
  • Virginia requires a NP to a physician led and managed care team and is regulated by the Board of Nursing and Board of Medicine with requirement of a national certification. A physician would always be required to be part of the practice in these states.

States vary as to who can start a practice with or employ a physician. It is commonly called the corporate practice of medicine.

RNs cannot practice aesthetics independently in any state. Either a NP or MD must be involved.

A NP in an independent state can form an independent entity allowed in the state, usually a corporation or limited liability company.

However, before starting an aesthetic business, the NP or RN must seek legal assistance to determine what type of entity, if any, can be formed independently or with a physician. Ask the attorney his/her experience in setting up medical aesthetic spas.

2017-03-06T19:42:28+00:00 By |Insights|13 Comments

About the Author:

Haley Wood, offers her cosmetic patients a unique combination of experience, knowledge and personal attention. With almost a decade of experience in the field of Aesthetic Nursing, her areas of expertise include non-surgical facial rejuvenation with her distinctive injection technique.

13 Comments

  1. Cathy Coco February 1, 2017 at 5:53 pm - Reply

    I am an RN in Missouri. I have been practicing medical massage therapy for 30 years with extensive training. I work with chronic and acute pain patients by referral from physicians. I have been trying to branch into aesthetic nursing however am having no luck at all. There are expensive schools that range from basic laser hair removal to injectables. Would training advance me in the market or hurt me due to practices having their own modalities. How does an RN branch into this field.

    • Haley Wood March 28, 2017 at 1:33 pm - Reply

      Hi Cathy,

      Every state varies in the scope of practice RN’s have in cosmetic injectables. I would suggest calling your state board to fully understand your scope. More than likely, you will need a medical director in order to inject. But, first, call your state board to ensure you are taking the proper steps!

  2. Ashley February 8, 2017 at 3:58 pm - Reply

    Thank you for this information! I am hoping to open a practice in San Antonio TX, I see this will take some work.

    • Haley Wood March 28, 2017 at 1:32 pm - Reply

      You are welcome!! Best of luck to you!

  3. Tracy Malkin March 17, 2017 at 7:54 am - Reply

    In Connecticut, I read in this article below that an APRN can have her own practice. I thought it was limited to clinical DNPs only. Your thoughts?

    http://c-hit.org/2014/11/30/ct-joins-states-requiring-more-medical-in-med-spa-staffing/

    • Haley Wood March 28, 2017 at 1:31 pm - Reply

      Hi Tracy,

      I tell ya, every state is so different. That’s why it is so important to check prior to spending money on injectable education. I would suggest calling the state board in Connecticut to fully understand your scope! Good luck!

  4. Ginger April 10, 2017 at 8:11 pm - Reply

    In South Carolina I am an RN finishing my NP in August. Would like to get certified to do asthetics. (Botox, fillers, laser hair removal) I have a practicing Dentist that would over see.
    1. Does she also have to take the course.
    2. Can she act only in the oversee role?
    3. There are so many different places to get certified, how do you choose? Thank you.

    • Haley Wood April 30, 2017 at 2:15 pm - Reply

      Hi Ginger,
      Congratulations on finishing your NP! I would call the Board of Nursing in SC and ask what the requirements are involving cosmetic procedures. They should be able to guide you on who can serve as your supervising physician as well as give you any information on certifications required to practice aesthetics, if they are required. Dentists in Mississippi just received the ability to inject in their state. They only need “adequate” training but again, each state is very different so be sure to call your board of nursing and board of dentistry.

    • Karen Gaches May 3, 2017 at 10:21 pm - Reply

      Ginger, I am an RN with 9.5 years experience in dermatology and I am taking training classes now for aesthetics. If you are looking for RN’s, I would certainly be interested. I live in Charleston, SC.

  5. Kristina Herndon April 22, 2017 at 8:22 pm - Reply

    Hi Haley,
    I am currently a LPN, but I am looking to further my education to a RN and looking at the options of a Medical Spa in the state of Colorado. Can you point me in the direction of how to start this process? I am looking at ensuring I get the proper education and begin the proper business plan for my ultimate career goals.

    Thank you
    Kristina

    • Haley Wood April 30, 2017 at 2:27 pm - Reply

      Hi Kristina,
      At this point, there really isn’t anything you can do to focus your training on aesthetics right now. As you go through your RN clinicals, you will have to rotate through all the different areas, not just the ones you are interested in pursuing.
      Once you have your RN degree, I would suggest finding a job in derm or plastics. Good luck!

  6. Lexie Bardell April 28, 2017 at 1:35 pm - Reply

    As far as finding a supervising physician; can only MD’s supervise or can NP supervise an RN in a medical setting as well? I have also seen Dentists doing medical aesthetics. Could a dentist supervise an RN if said RN were to practice injectables in a medical setting?

    • Haley Wood April 30, 2017 at 2:46 pm - Reply

      Hi Lexie,
      Who can be your medical director depends solely on your state’s requirements. In Kentucky several years ago, a NP could be a medical supervisor but I am not sure that is still the case. I would suggest calling your state board to understand the requirements.

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