Nurses know nothing about medication, why can they administer botox? Or are they doing it illegally?

Question

Why can nurses inject botox and fillers? The nurses in my hospital barely know what acetaminophen is. How is that possible that a doctor of pharmacy who studied drugs for 6 or 7 full years and know every single side effect etc, cannot , but nurses that know abslutely nothing about the medications they give, can?

Richard Baxter, MD · Answer

Under  physician's direction, nurses can infuse chemotherapy drugs and perform complex and potentially lifesaving procedures if properly trained. Botox injection does require extensive training and experience in order to get consistently good results, but nurse injectors often have more hands on experience than the doctor who supervises them. If your nurse doesn't know what acetaminophen is, that's another issue.

Nelson Lee Novick, MD · Answer

Unfortunately, the field of nonsurgical facial rejuvenation has become glutted of late with an abundance of nonspecialist physicians and providers, including nurses, dentists, podiatrists, family physicians, gynecologists, breast surgeons, general surgeons and even I recently heard from one of my patients, neurosurgeons. Since you have to live with your face all the time, the question then becomes one of do you want to trust your face to someone who is fitting in an occasional nonsurgical facial rejuvenation procedure (such as Botox or fillers) in between filling teeth, paring toenails, treating high blood pressure and diabetes or doing pelvic exams, etc.? Or would you prefer to be treated by someone specifically and intensively trained in these procedures and who performs them multiple times each day and not just once in a blue moon as an add-on between his/her regular work? So, while these providers are not doing anything illegal, it would seem obvious that it might be in one's own best bet to make sure to seek treatment by a board certified aesthetic physician, and as part of vetting him/her make sure to ask to see his/her before and after photos before agreeing to proceed.

Farhad Rafizadeh, MD · Answer

To be fair I have to disagree with your statement that nurses don’t know about medications, but the knowledge of medication alone doesn’t qualify them to be injectors. Botox and other injectables require a detailed and precise knowledge of the anatomy of the face. In certain states nurses are allowed to be injectors under the physicians supervision. Ideally these injections should be done by plastic surgeons who have see the facial muscles, nerves and blood vessels during surgery and not just in the books. This is why I would not delegate this job and do all my injections myself.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Nurses must be under the supervision of a practicing physician to administer Botox but I do share your concerns. I am the only person that administers injections in my practice and my person opinion is that Botox should only be given by board certified plastic surgeons, dermatologists, and facial plastic surgeons (ENT).  Hope this helps.

Kenneth D. Steinsapir, MD · Answer

In my office, I do not permit this.  In my office, I personally perform all of the services I offer.  There is no way that a nurse has the knowledge, skill, or experience to deliver an expert service.  However that statement is often also true of the physicians who is supposed to be supervising the nurse.  I recommend looking for caring, ethical cosmetic surgeons who don't employ physician extenders.  You will pay more for the best care but this is your face we are talking about.

Robert M. Tornambe, MD · Answer

As I understand it, RN’s must be under supervision of an MD to perform injectibles in NY. I always preferred to do all injectibles myself, as I believe that my experience, expertise and aesthetic barometer is better.  My personal preference, however.  Hey podiatrists and dentists are doing it as well, go figure!

Elisabeth Dancey, BM, BCAM · Answer

It's different in the UK. Nurses need to follow a prescribing course and then they are known as "prescribing nurses". Once they have mastered this - and it;s a tough course - they may train and then finally administer botox.
It is your decision who you choose to treat you. If you choose a doctor then you know that they have had 6 - 7 years of training. They will also have recourse to their knowledge and experience in the unlikely event of something going wrong.

Melvin Elson, MD · Answer

Nurses can inject under the supervision of a physician and nurse practitioners can inject independently. some of them are very highly trained and i know a number who are excellent. one of my colleagues suggested you see a board certiified aesthetic physician but there is no such thing despite the claim. I refer you to my latest book SkinScam available on Amazon

Nicholas Gentry, MD · Answer

I perform all Botox injections in my office myself. I have a better knowledge of the anatomy than most nurses

Marek Kacki, MD · Answer

Every stat has different laws regarding injections. Otherwise it all depends on a doctor running the practice. But, it all is really a gray zone. What does it mean that a nurse is supervised by a physician? Nothing, really. The meaning of the word supervision comes from Latin and means over-looking. Looking is the key. It would mean what it says if the supervising doctor was in the same room monitoring injections done by a nurse. That is not the case so whether you call it RN injecting or RN injecting under doctor's supervision, it is all the same - a RN is injecting. You are very unfair to the nurses. To become an RN means an official college courses and years of education and not a weekend course. RN knows medications as much as it is needed to administer them safely. Why a Doctor of Pharmacy can not inject Botox although she/he may know more about Botox than some doctors? For two reasons: first, it is the law. The second, Doctors of Pharmacy as great as they are doing what they do, they do not know Anatomy and they would have a hard time to decide whether a given patient is a good candidate,  perhaps has contraindication for Botox and, above all, Doctor of Pharmacy, regardless of the experience would not feel comfortable if patient would have a severe, life threatening reaction or unrelated acute problem such as a syncope or seizure. So, everyone has her/his place in medicine, as much as in life. Demeaning someone or one's profession does not make any argument stronger.

Nurses know nothing about medication, why can they administer botox? Or are they doing it illegally?

Answers (17)

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