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Board of Nursing Issues Declaratory Statement Regarding Botox Injections by RNs

The Scope of Practice for a Registered Nurse isn’t always clear. The Florida Nurse Practice Act (Florida Statute Ch. § 464) and the Rules of the Florida Board of Nursing (Florida Administrative Codes, Title 64B9) exist to establish regulations, authority, and guidance regarding the practice of nursing. The issue of whether a registered nurse can legally administer Botox has been clearly addressed under Florida law. Previous rulings set a precedent when a nurse was disciplined for performing Botox injections on a client without a physician’s direct orders (Department of Health v. Trisha Lorraine White, R.N. Case Number 2016-13884). However, this ruling seemed to leave more questions than answers. The ruling did not clearly state whether a nurse is allowed to perform Botox injections if acting pursuant to a physician’s orders. In White, the court held 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 a nursing license. Without clarification, this matter left unanswered questions for nurses, med spas, and clinics who could potentially benefit from having nurses perform Botox procedures.

Per the Board of Nursing, if a specific act is questionable, a declaratory statement may be requested to provide clarity. The Board of Nursing defines a declaratory statement as a means for resolving a controversy or answering questions or doubts concerning the applicability of statutory provisions, rules, or orders over which the board, or department when there is no board. On September 26, 2022, Jessica James, a registered nurse (R.N.) from Pensacola, Florida requested a declaratory statement on clarification for the task delegation of Botox Cosmetic. The case referenced Florida Statute § 464.003, specifically quoting, “The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.” Jessica James’ request went on to identify some prerequisites in her case for Botox task delegation eligibility by stating that the physician would first examine the patient and write an order detailing the specific muscles to be injected as well as the units per injection site before delegating the task to a registered nurse.

The Board of Nursing concluded that it is within the scope of practice for this particular case to allow the task delegation of administering of Botox. It should be noted that the Board of Nursing mentioned the “Petitioner’s specific and particular education, training, and experience” when making this decision. In this particular case, Jessica James, stated that she had experience in this field because she had observed aesthetic injections for 4 years and had completed Method Aesthetics Academy Level I training. This finding opens the door to the possibility for other qualified nurses to administer Botox under the supervision of a physician with the appropriate trainings and education. At the very least, this finding displays more progressive thought than previous rulings and statements that disallowed nurses to partake and assist in Botox injections. While this matter remains open ended and subject to specific conditions, it most definitely provides some transparency for those concerned.

 

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

All information and references made to laws, rules, 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.

Do Doctors and Nurses Have to Self-Report to the Florida Department of Health if Arrested?

In our society, Medical Professionals have always been held to a higher-than-average standard. Doctors, nurses, and physicians must abide by several professional rules of conduct that not many other employees have to keep in mind. This in turn also means that your personal life is up for scrutiny as well. Ethical standards and moral values are usually private assumptions but for those who have chosen the medical field, those normally private matters can have a deep affect your employment status. Any serious off-duty conduct issue must be reported, reviewed, and taken care of on a case-by-case basis.

Florida Requirements for Self-Reporting

In Florida, doctors are required to report all criminal activities committed after they receive their medical license even though it is not in relation to employment and occurs after regular working hours. Any report or complaint filed towards a medical professional will be investigated by the Florida Department of Health. Being placed under arrest can trigger disciplinary action from the state licensing boards. Medical disciplinary actions require a much lower burden of proof than federal cases. It is possible to be penalized, face Medicare/Medicaid exclusion, and potentially have your license revoked based on the severity of the crime and investigation. It is entirely possible that a physician can face the loss of their medical license even if an investigation does not result in criminal prosecution and a conviction at a trial.

Complaints Against Medical Professionals

The most common criminal concerns leading to the harshest disciplinary actions towards a medical professional involve healthcare fraud, solicitation, moral turpitude, dishonesty, or deceit in any jurisdiction in the state. According to the Florida Department of Health’s website, they do not carry out complaints regarding the fees charged for individual procedures, missed, or cancelled appointments, unfair customer service, rudeness or disrespect, bedside manner, professionalism or personality conflicts again medical professionals.

Complaints against medical professionals can lead the Board of Medicine to issue citations based on the type of and severity of the complaint. It is completely free to file complaints against medical professionals. The only potential fees may be for requesting copies of medical records if deemed necessary. Complaints remain confidential until the panel determines reasonable cause, and a violation is issued.

How to Report

According to the Florida Board of medicine, all criminal activities after receiving your medical license must be timely reported. The Board provides various options for reporting including email, online service portal, or via regular mail. If a complaint is issued via sending an email or letter, the correspondence must include the date of the offense, the activity that happened, and the county and state of jurisdiction. The complaint cannot reach processing without the proper information.

The Florida Department of Health’s Medical Quality Assurance (MQA) launched a user-friendly online portal. The portal was developed in collaboration with the Agency for Health Care Administration (AHCA) to allow for easy reporting of any complaints again medical providers from fraud to unlicensed activity and violations. The portal offers education on the different federal agencies for complaints as well.

See below for email, website and address:

MQAOnlineService@FLHealth.Gov
www.mqa-vo.doh.state.fl.us./datamart/voservicesportal
Florida Department of Health

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 All information and references made to laws, rules, 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.

Understanding the Intervention Project for Nurses Monitoring Contract

If you are a nurse (i.e. LPN, RN, APRN, etc) and have decided to participate in the Intervention Project for Nurses (“IPN”) you will first have to undergo an evaluation, which will include an interview with an IPN approved doctor and a toxicology test. After this evaluation has been completed, IPN may suggest no monitoring or require that you enter into a monitoring contract.

Typically, you have roughly two weeks to sign the monitoring contract. Prior to signing the contract, you should thoroughly review the IPN Participant Manual so that you understand the requirements for participation. The last thing you want is to comply with the monitoring contract only to have your contract extended or have your case referred to the Board of Nursing because you failed to adhere to the Participant Manual’s requirements.

You will also receive a contract packet, which will include: (1) Progress Evaluation for Therapy Form; (2) Work Performance Evaluation Form; (3) Notice of Address/Employer Change; (4) IPN Medication Management Evaluation Form and (5) Medication Report. Depending on your situation you many not be required to complete all of these forms.

Requirements

Contract lengths typically vary from 2 – 5 years and you are required to keep your contact information updated throughout the term of the contract. IPN will review your participation after one year of active monitoring. If you comply with the terms of the contract they will grant you early completion and suspend your contract. For example, if you are have a 2 year contract term and you pass all of your toxicology testing and other requirements under the contract IPN may suspend the second year of your contract so that you can return to practice without any further obligations under the contract.

During the contract period you will be required to undergo random toxicology testing. This is an abstinence contract which means that you are prohibited from using mood altering, controlled or addictive substances including alcohol or alcohol-based products or THC/cannabis products (i.e. CBD, Hemp, etc.). This is true even if you are not participating in the IPN program for any of these specific products.

Periodically, you will need to check in with the Affinity eHealth/Spectrum Compliance App for your toxicology testing notification Monday through Friday. Again, to ensure the accuracy of your testing, you must adhere to the recommendations in the Random Toxicology Testing section of your Participation Manual.

You are required to complete and submit a quarterly self-report online via the Spectrum Compliance App. Quarterly reports are due in January, April, July and October. The App will have a complete list of reports due each quarter some of which can be downloaded from the available reports page by clicking on the PDF link.

Employment Expectations

Prior to accepting a position (paid or volunteer) and/or beginning nursing school clinicals, you are required to inform your immediate supervisor you are an IPN participant. Your position must include direct supervision by another licensed healthcare professional who is: (1) aware of your IPN participation; (2) working on the premises or same unit with periodic observation; (3) readily available to provide assistance and intervention; (4) willing to complete required employer report each quarter.

RNs must be supervised by another RN or APRN and LPNs must be supervised by RNs. LPNs may only be supervised by LPNs in nursing home facilities. You must immediately notify and/or obtain approval from IPN prior to starting or making any changes in any health care related position (i.e. resignation/termination, new employment, supervisor change, etc.) You are also required to work in nursing a minimum of twelve (12), eight (8) hour shifts per quarter while employed, to meet completion criteria.

Unless you have special approval from IPN you may not: (1) be self-employed or work for multiple employers; (2) work for more than 40 hours per week and/or more than 84 hours bi-weekly, if not working 12-hour shifts; (3) work for an agency, home hospice, home health, or float outside the areas supervised by your manager.

Current Status

Your Contract will also state your employment status. Depending on the severity of your condition you may be approved for employment in a supervised nursing position. You are required to provide your immediate supervisor with a copy of the Monitoring Contract and provide your supervisor’s email address to IPN for completion of your quarterly reports. You also need to provide IPN with the contact information for your current place of employment as well as the name of your immediate supervisor. If you fail to relay this information to IPN you may face immediate termination from the IPN program.

Review for Early Completing

As stated above, you may have your contract reviewed for early completion. However, it is contingent upon: (1) compliance with all terms of the Monitoring Contract; (2) negative toxicology tests; (3) minimum of six (6) consecutive months of negative toxicology tests preceding the contract completion date; (4) satisfactory work performance in a clinical nursing position for a minimum of one year; (5) if applicable, recommendation for completion form your Support Group Facilitator, employment supervisor, and treatment provider; and (6) if applicable, work successfully for six (6) months in a clinical nursing capacity subsequent to controlled substance restriction being lifted. For Board of Nursing participants, a readiness-to-complete evaluation is mandatory.

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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, 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.

Jamaal Jones Wins Against Florida Board of Nursing

On June 6th, Jamaal R. Jones represented a client during a Board of Nursing hearing at the Streamsong Resort. The Board wanted to permanently revoke the client’s nursing license, pay over $15k in fines, etc. stemming from very serious allegations. Mr. Jones was able to secure a settlement of only 6 months of probation without an admission of guilt! Great result and a grateful client!

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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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services please contact me using the contact information listed above.

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.

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