Joint statement from the Australian College of Nursing and the Australasian College of Cosmetic Surgery, 15th May 2018
There is increasing demand for a large variety of cosmetic services in Australia.(1) In this rapidly expanding sector, nurses must pursue and provide safe and legal practice in the delivery of all cosmetic procedures.
‘National Law’ – applies to ALL nurses working in the area of cosmetic procedures
This national regulatory framework applies to ALL enrolled nurses (ENs), registered nurses (RNs) and nurse practitioners (NPs) working in the area of cosmetic procedures at ALL times.
There are no circumstances or practice settings within which nurses are exempt from complying with the National Law and the professional standards set by the Nursing and Midwifery Board of Australia (NMBA).
Nurses working in the area of cosmetic procedures are obliged to have knowledge of and comply with:
Nurses: Know your responsibilities and service requirements
Cosmetic procedures can pose varying levels of risk to consumers. Any EN, RN or NP providing cosmetic procedures are reminded of their obligations to comply in full with the requirements and expectations of the profession REGARDLESS of their practice setting (Note: This includes running a registered business from your own home you must have a public health inspection) and/or service arrangements. This includes, but it is not limited to, working within scope of practice at all times. While nursing is nationally regulated, nursing scope of practice is governed by national as well as state and territory legislation and is heavily influenced by jurisdictional service arrangements and organisational context, policies and models of care.
Depending on jurisdictional requirements, examples of cosmetic procedures that nurses may deliver include, but are not limited to:
The provision of skin care advice and referral
ENs, RNs and NPs delivering these and/or other cosmetic procedures are obliged to comply with relevant clinical policies, standards, and guidelines in their state or territory, included but not limited to: clinical governance, infection prevention and control, quality use of medicines and emergency procedures.
Spotlight on Injecting
When cosmetic procedures involve injecting, in addition to other key requirements and considerations, NURSES and NURSE PRACTITIONERS MUST:
Spotlight on Scheduled Medicines
When working with Scheduled medicines, in addition to other key requirements and considerations, NURSES and NURSE PRACTITIONERS MUST:
Spotlight on ethical practice:
Example Snapshot - NSW:
In NSW nurses working in the area of cosmetic procedures may be required to know that:
Both botulinum toxin and hyaluronic acid and its polymers (dermal filler) are restricted substances listed in Schedule 4 of the NSW Poisons List.
There is no provision under Section 11 of the New South Wales Poisons and Therapeutic Goods Act 1966 (the Act) for a wholesaler to supply a registered nurse or other unauthorised persons with restricted substances. The Act and the Poisons and Therapeutic Goods Regulation 2008 (the Regulation) allows for a medical practitioner to be supplied by wholesale with restricted substances.
Section 10 (4) of the Act allows for the supply of a restricted substance by a medical practitioner in the lawful practice of his or her profession. Supply is interpreted to also include administration to a patient.
The re-supply by some medical practitioners of restricted substances to registered nurses for therapeutic use in circumstances where the registered nurse is not under the direct supervision of the medical practitioner, prima facie is considered to be wholesaling, contrary to Section 9 of the Act.
Regarding controlled substance administration:
There is no provision under the New South Wales Poisons and Therapeutic Goods Act 1966 (the Act) for a registered nurse to administer restricted substances, outside of a hospital or designated institution (and then only when authorised on the prescription of a medical practitioner), or unless the nurse is a patient carer (and then only when authorised on the prescription of a medical practitioner).
The form of a prescription is mandated in Clause 35 of the Poisons and Therapeutic Goods Regulation 2008.
Regarding Standing Orders:
Although Standing Orders are an accepted protocol for authorising the administration of restricted substances within hospitals, in accord with Section 10(4)(c) of the Act and Clause 58 of the Regulation, subject to strict conditions specified in the Ministry of Health’s Policy Directive for the Handling of Medications in NSW Public Health Facilities (PD2013-043), there is no equivalent provision in the legislation for the use of Standing Orders in beauty clinics or salons by registered nurses.
Administration of Medications
Nurses and midwives must practise in accord with legislation, with standards and guidelines provided by the Nursing and Midwifery Board of Australia, policy directives of the NSW Health Department where these policies are applicable, and policies of individual employers.
The storage, supply etc, of medications is governed by legislation. The relevant legislation is the Poisons and Therapeutic Goods Act 1966 and the Poisons and Therapeutic Goods Regulation 2002. Implementation of this legislation is delegated to the NSW Health Department’s Pharmaceutical Services Branch which issues directives and guidelines to assist health personnel in complying with the requirements of legislation.
Some specific documents that may be relevant and applicable to ENs, RNs and NPs, depending on their practice settings are shown below.
-Medication Handling in New South Wales Public Hospitals
-The Administration of Medication by Endorsed Enrolled Nurses
Private Hospitals and Day Procedure Centres:
-Guide to the Poisons and Therapeutic Goods Legislation in Private Hospitals and Day Procedure Centres – TG115
-Nursing Homes - ‘Guide to Handling of Medications in NSW’ Information Bulletin 2003/10
Community-Based Health Services & Residential Facilities:
-Community-Based Health Services and Residential Facilities - Guidelines for the Handling of Medication
There is no provision for “prescriptions” or “standing orders” for restricted substances to be prepared by an unauthorised person and then signed by a medical practitioner. Clause 32 of the Regulation is specific, allowing a medical practitioner to issue a prescription for a restricted substance. There is no allowance for another person to “issue” a prescription or part of a prescription, to be signed by a medical practitioner.