Can a Registered Nurse Administer Botox?

**UPDATE: AS OF 09/13/2023**

A Declaratory Statement has been issued by the Florida Board of Nursing allowing for a nurse with the appropriate level of education, training, and experience to administer Botox under the supervision of a physician. A declaratory statement is not the appropriate means for determining the conduct of another person or for obtaining a policy statement of general applicability. The issuance of this Declaratory Statement does not mean that all registered nurses can administer Botox, rather that determination must be made on a case-by-case basis. See article here.

Those who run med spas, dental or dermatology practices are concerned about whether a registered nurse on staff can administer Botox without their direct supervision. Allowing them to do so would free up the physician’s schedule so that he can perform other procedures that his personnel is not permitted to do.

According to the Florida Board of Medicine, there are no laws and rules that address who can and cannot administer Botox injections in the state of Florida.

However, a 2017 Board of Nursing case[1] involved a Florida licensed Registered Nurse who was alleged to have violated Florida Statutes 456 and/or 464. In March 2016, the nurse administered Botox to multiple patients on multiple occasions. The Board of Nursing found that the nurse did not perform the Botox injections pursuant to a valid physician’s order. The Board of Nursing held that performing Botox injections without a physician’s order is beyond the scope permitted by law. Further, the nurse had reason to know that she was not competent to perform the Botox injections.

The Board referenced Florida Statute 464.018(1)(h) in its decision by stating that unprofessional conduct as defined by the board is grounds for disciplinary action. The Board also referred to Florida Administrative Code Rule 64B9-8.005(13), which provides that unprofessional conduct includes practicing beyond the scope of the licensee’s license, educational preparation or nursing experience. (emphasis added). Finally, the Board stated that the nurse engaged in unprofessional conduct by practicing beyond the scope of her license, educational preparation and/or nursing experience by performing Botox injections without a valid physician’s order.

In Florida, practicing medicine without a license is considered a 2nd degree misdemeanor. Additionally, the nurse could have had the following actions taken against her:

1. license suspended or permanently revoked;
2. restriction of practice;
3. imposition of an administrative fine;
4. issuance of reprimand;
5. probation;
6. refund of fees billed or collected;
7. remedial education; and/or
8. any other relief that he Board deemed appropriate.

Two things should be taken away from the decision in this case. First, just because there isn’t a specific law on the books regarding Botox injections doesn’t make it legal for a registered nurse to administer it to patients. Second, I thought that it was interesting that the Board stated that the nurse was not performing the Botox injections pursuant to a physician’s order. Many would view this sentence as specifically allowing a nurse to administer Botox injections only in situations where the nurse is doing so pursuant to a physician’s orders (not an NP, PA, ARNP). I don’t believe that to be true because the Board went on to state that even pursuant to a physician’s orders a registered nurse does not possess the requisite educational preparation to perform the procedure and that doing so would be practicing beyond the scope of her nursing license.

[1] Department of Health v. Trisha Lorraine White, R.N. Case Number 2016-13884

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All of the information and references made to laws, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.