The Columbus Dispatch reports that the ruling in favor of nurses administering Botox injections was in response to a request from Dr. Fernando Colon, a board-certified plastic surgeon. The physician argued that nurses could indeed safely administer the subcutaneous medication under close supervision, and that this would allow plastic surgeons to see a greater number of patients in a more efficient manner.

One might wonder if this request for nurses to take over a procedure previously under the control of doctors was mostly about economics, not efficiency. Since most health insurance plans do not pay for elective cosmetic surgery, it would be sensible for doctors to want nurses to perform the injections, allowing the supervising physician to attend to other matters while billing patients the market value of the procedure. 

Prior to the Board of Nursing ruling, some Ohio nurses had already been administering Botox, since no regulation existed which actually prevented nurses from doing so.  Based upon the new ruling, all nurses planning to administer Botox injections must undergo a preceptorship with a supervising physician prior to being allowed to perform the procedure without direct supervision. 

While Botox has been purported to be safe and effective, some reports underscore the fact that off-label uses---like treating the leg spasms of children with cerebral palsy with significantly higher doses than that used for cosmetic treatments---may increase the danger of side effects like respiratory failure.

As nurses take on the responsibility of more complicated procedures previously under the purview of physicians, they are also assuming more risk. It would behoove all nurses undergoing training in Botox administration to determine if they have sufficient legal protection, and to discuss the potential ramifications of malpractice lawsuits with both their supervisiing physician and their state board of nursing. 

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NurseKeith is a nurse, consultant, writer, and blogger. Please feel free to visit his blog, Digital Doorway .  

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