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December 3, 2019

Practice Expectation Spotlight

Practice Expectation Spotlight: Neuromodulators

Examining the scope of RN practice in relation to administering neuromodulators

Image of a younger White woman receiving a neuromodulator (e.g. Botox) injection above her right eyebrow

Avery Ryvar RN has seen various job postings for RNs to work independently administering neuromodulators. This seems like quite an exciting opportunity because of the specific skills required to inject neuromodulators into facial muscles. She spoke with a local business owner who is considering creating a position for an RN to inject neuromodulators. She questions whether it is in her individual scope of practice to independently inject neuromodulators into facial muscles.

Avery must take into consideration a few factors in relation to independent RN neuromodulator injection.

She must determine whether a neuromodulator injection would be in her individual scope of practice. Then she needs to determine if the position would permit her to work within the Scope of practice for RNs while meeting the Practice Expectations for RNs.

Reserved Act 9: Administering a drug or vaccine

Reserved act 9 includes the injection of neuromodulators. CRNM regulations outline RN scope of practice under the RHPA’s reserved act model. An RN may perform a reserved act only if the:

  1. Reserved act is listed in the regulations for RNs;
  2. Reserved act is both safe and appropriate to be provided to the client.
  3. RN is competent to perform that reserved act; and
  4. RN works within their workplace’s practice setting policies, as long as the policy is consistent with the RHPA, College regulations, bylaws, practice directions and Code of Ethics.

Avery would need a prescriber to provide a client-specific order for each client. She is also expected to take appropriate action if the order for medication administration does not appear evidenced-informed or in consideration of the client needs.

It is necessary to note that Avery must have the competence to administer the neuromodulator into facial muscles so they will relax and smooth out the appearance of the skin. While CRNM does not approve or recommend what professional development or education opportunities she should seek out, it is expected that she gain and maintain the competency specific to neuromodulator administration before she administers these medications.

If she is satisfied that she will meet the above requirements, she will then need to assess if she can practice according to the practice expectations for RNs.

More specifically, she needs to consider her expectations re:

  • Collaborative care: Will she work collaboratively and cooperatively with clients, families and other health-care providers in providing for the health care of the client and communicate effectively and appropriately with them? This includes giving her full name and designation of membership class to the client, their representative and any other person involved in the client’s health care.
  • Practice environment: Will the practice environment support her to apply procedures that safeguard the hygiene and sanitation of the practice environment and the hygiene and sanitation of the equipment used in that nursing care?
  • Client records: What system will be used to document the nursing care provided in a record specific to each client and as soon as possible after the care is provided?

Finally, if she is thinking about this as a self-employed practice, there are additional responsibilities. Those responsibilities will be considered in a future practice expectations spotlight.