Who Can and Should Be Allowed to Inject?
Who should be allowed to inject botulinum toxins and dermal fillers? I live and own a clinic in Louisiana, and the state's Board of Nursing recently issued a statement about this. The board stated that certain nurse practitioner specialties are allowed to inject both botulinum toxins and dermal fillers, if they have been trained to do so and if they are practicing collaboratively with a physician who provides aesthetic services. However, RNs are allowed to inject only toxins -- if they have received training and only if a physician or nurse practitioner is present in office. The board's opinion excludes RNs from injecting dermal fillers.
Interestingly, the board that regulates licensed practical nursing in Louisiana allows LPNs to inject toxins under the same circumstances as RNs, with the exception that a physician must be present. Their statement was released in 2010.
The Board of Nursing statement raises a couple of issues. What about RNs who began injecting fillers prior to the publication of this opinion? What about RNs who have been injecting without a physician or nurse practitioner present but who operate under written protocol or standing orders? The statement additionally limits nurse practitioner practice owners who have RN employees, now requiring their presence at all times.
What about estheticians injecting botulinum toxin? This occurs in my medical community. To my knowledge, the Board of Cosmetology in Louisiana has not issued a statement deeming it to be within the scope of practice for estheticians to perform injections. One of the first questions estheticians ask when I hire them is, "When are you going to teach me how to inject Botox?" My response, "As far I can determine, it is not within your scope according to your board."
I'd like to hear your thoughts on who you think should be allowed to inject and under what circumstances.