Title: Cosmetic and Dermatologic Procedures
(Formally Advisory Ruling (AR) 0101: Medical Aesthetic Procedures – Date issued: September 13, 2000; Date Revised – January 9, 2001, March 2001, May 2002, 2006 and AR 0001: Non-Ablative and Non-Laser Sources Device Use – Date issued May 10, 2000: Date Revised January 10, 2002, March 8, 2006.  AR 0101 and AR 0001 rescinded November 13, 2013)

Advisory Ruling Number: 1301

Authority: The Massachusetts Board of Registration in Nursing issues this Advisory Ruling on Nursing Practice pursuant to Massachusetts General Laws (MGL) Chapter 30A, section 8 and MGL c. 112, s 80B.

Date Issued: November 13, 2013

Date Revised:

Scope of Practice: Registered Nurses and Licensed Practical Nurses

Purpose: The purpose of this Advisory Ruling is to guide the practice of the Registered Nurse and Licensed Practical Nurse (nurse) who may perform cutaneous procedures that utilize non-ablative laser and non-laser light sources and/or who may perform aesthetic procedures that utilize chemical solutions, micro-particles, soft tissue augmentation, or injections of solutions/medications or soft tissue fillers as part of their nursing practice

The nurse’s practice must be in compliance with M.G.L. c. 112, s. 80B; 244 CMR 3.02: Responsibilities and Functions - Registered Nurse; 244 CMR 3.04: Responsibilities and Functions – Practical Nurse; 244 CMR 9.03(5): Adherence to Standards of Nursing; 244 CMR 9.03(8): Identification Badge; 244 CMR 9.03(9): Responsibility and Accountability; 244 CMR 9.03(10): Acts within Scope of Practice; 244 CMR 9.03(11): Performance of Techniques and Procedures; 244 CMR 9.03(12): Competency; 244 CMR 9.03(14): Asepsis and Infection Control; 244 CMR 9.03(44): Documentation; and 244 CMR 9.03(46): Role of Nurse in Management Role.

Advisory: The nurse licensed by the Massachusetts Board of Registration in Nursing (Board) is expected to engage in the practice of nursing in accordance with accepted standards of practice. The nurse must only assume those duties and responsibilities within the scope of practice for which necessary knowledge, skills, and abilities have been acquired and maintained. The nurse may perform cosmetic and dermatologic procedures as part of an overall comprehensive plan of care to treat various dermatological conditions or as part of a health maintenance/health promotion regime. The procedures are non-diagnostic in nature and do not involve the removal of tissue.

It is the Board’s current position that it is within the scope of practice for the licensed nurse to provide cutaneous procedures that utilize non-ablative laser and non-laser light sources and/or aesthetic procedures in settings that comply with M.G.L. c. 111, § 51 and subsequent declarations of agencies that provide setting oversight, including, but not limited to the Department of Public Health and the Board of Registration of Cosmetology. Provision of ablative procedures by laser are limited to Board authorized advanced practice nurses.

For the purpose of this Advisory Ruling, procedures include, but are not limited to:

  • Non-ablative, non-vaporizing laser or light-based devices used for hair removal, photorejuvenation, acne, spider veins, vascular and pigmented lesions, and tattoo removal;
  • Microdermabrasion;
  • Chemical peels;
  • Administration of absorbable fillers;
  • Administration of Botulinum exotoxins; and
  • Sclerotherapy

Competence Acquisition
The nurse must acquire education that includes a supervised practicum resulting in a competency evaluation commensurate with the procedure.  Components of the education include, as appropriate to the specific procedure, but are not limited to:

  • Anatomy and physiology;
  • Pathophysiology of the integumentary system and supporting structures;
  • Cosmological and dermatologic conditions;
  • Wound healing principles;
  • Safe use of product/device/equipment ;
  • Side effects and management;
  • Management of emergencies; and
  • Patient and environmental safety.

When the procedure includes the use of non-ablative, non-vaporizing laser or light-based devices, the nurse must have evidence of successful completion of a Laser Physics and Safety course that includes relative content from the Occupational Safety and Health Administration (OSHA) and American National Standards for the Safe Use and Handling of Lasers in Health Care Facilities (ANSI) that includes both a didactic portion and a practicum.

Practice
Although the patient assessment must be performed and documented by a registered nurse or duly authorized prescriber, the performance of the procedure is pursuant to the orders of a duly authorized prescriber. The nurse must verify the orders from a duly authorized prescriber that include the patient’s name, valid order date, medication or substance name, dosage, route, anatomical site for administration, specific administration directions and prescriber signature. It is not within the scope of practice for Licensed Practical Nurses and Registered Nurses who are not authorized to practice as an advanced practice nurse to independently select the medication/solution, dosage, or device setting to be used when performing cosmetic and dermatologic procedures.

It is the Board’s position that nurses whose practice includes cosmetic and dermatologic procedures may not practice in an organization that does not have policies and procedures that include:

  • A requirement for informed consent;
  • A requirement for a comprehensive, documented evaluation;
  • Recommendations for self care;
  • Follow-up recommendations;
  • Situations that require referral;
  • Management of side effects; and
  • Provisions for emergent care.

Documentation
Documentation criteria must include:

  • Review and verification of informed consent that clearly informs the patient of the operator’s qualifications, licensure, and expected outcomes of the procedure;
  • Assessment data inclusive of past medical, surgical, allergy and medication histories;
  • Skin typing/classification;
  • Sun exposure history;
  • Current cosmetic/dermatologic product usage;
  • Exclusion from treatment criteria;
  • Identification of and evaluation of test site as indicated;
  • Specifics of procedure performed and patient response to procedure; and
  • Directions for referral back to or consultation with the duly authorized prescriber of procedure.

The nurse must document and provide the patient with written pre and post procedure education which includes, but is not limited to, self-care instructions and follow-up recommendations inclusive of continued and emergent care needs.

Advance Practice Registered Nurse
In addition to the procedures above, a Board authorized advanced practice registered nurse with appropriate competence acquisition, is authorized to perform ablative or vaporizing laser cosmetic and dermatologic procedures.

References

  • Dermatology Nurse Association (undated, The Nurse’s Role in the Use of Laser, Light, and Energy Emitting Devices and The Nurse’s role in the Provision of Cosmetic Services, accessed 7/31/13)
  • Massachusetts Report of the Medical Spa Task Force Established by Chapter 81 of the Acts of 2006, published January 12, 2009
  • American Society for Dermatologic Surgery Association (undated, Laser Hair Removal and Cosmetic Dermatology, accessed 8/1/13)
  • Food and Drug Administration (10/12/2012, Cosmetic Devices, accessed 7/31/13)
  • Occupational Safety and Health Administration (undated, eTools, Use of Medical Lasers, accessed 11/5/13)
  • American National Standards for the Safe Use and Handling of Lasers in Health Care Facilities (December 5, 2011, Laser Institute of America, American National Standards Institute, Inc. accessed 11/5/13)
  • Massachusetts Department of Public Health Medical Spa Services Advisory, undated, accessed 3/28/13.
  • Massachusetts Board of Registration of Cosmetology
  • Massachusetts Office of Consumer Affairs and Business Regulation (Consumer Advisory: Botox® 11/4/2010 accessed 11/5/13 at http://www.mass.gov/eohhs/docs/borim/physicians/publications/advisory-botox.doc)

This information is provided by the Division of Health Professions Licensure within the Department of Public Health.