Yes, RN's can administer Botox to patients as a cosmetic medical procedure under the supervision of a physician.

Non-invasive cosmetic surgery is a rapidly growing field for nurses with many regulations, requirements and considerations. Each state's Board of Nursing provides Standards of Practice to address considerations for Botox injections. Cosmetic medical procedures are those that are intended to revise or change the appearance, color, texture, structure or position of normal body features with the intention to achieve a desirable appearance as perceived by the patient.

Botox, Dysport and Xeomin are all forms of purified neurotoxin botulinum toxin A, which means they do not have actual risk of botulism when used properly. For cosmetic purposes, Botox works by blocking the nerves that cause muscles to contract, which softens the appearance of wrinkles.

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Other uses for Botox include severe underarm sweating, cervical dystonia (a neurological disorder causing severe neck and should muscle contraction), blepharospasm (uncontrolled blinking), strabismus, chronic migraine and overactive bladder. In these cases, toxin is used to weaken or paralyze certain nerves.

The desired effects of Botox usually lasts three to twelve months. The most common side effects of Botox injections include pain, swelling or bruising at the injection site. Some people experience flu-like symptoms of nausea and headache. Facial injections may cause eyelid drooping, which is usually temporary.

Nurses who are considering this role must first seek education and certification from a validated institution such as the American Association of Aesthetic Medicine and Surgery (AAAMS). Courses range from a simple weekend course to two weeks where medical professionals can gain certification in injecting Botox and other cosmetic medical procedures. Course instruction should include anatomy and physiology of the face, key facial muscles and the pharmacology and side effects of neurotoxins.

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Once an RN has completed certification and is proven to have the knowledge, skill, and ability, Botox injections must be performed under the supervision of a physician. Supervision can be indirect where the physician is readily available if there are any untoward effects requiring an increase in medical attention. Ideally, physicians should evaluate a patient and order the appropriate amount of Botox prior to the nurse administering the toxin.

Nurses should always consult their local state Board of Nursing and State Medical Board for the defined scope of practice for each area.

Amanda Bucceri Androus, RN, BSN
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