Injectable treatments like toxins and fillers are central in the medical aesthetic industry, and licensed practical nurses (LPNs) can be valuable pieces of the medical spa puzzle. They typically provide excellent care to patients and can be relied upon to perform a number of non-medical tasks throughout the practice. In many medical aesthetic practices, LPNs even perform injections of fillers and Botox.

Unfortunately for those practices, though, this may create more problems than it solves, since in most states injecting patients falls outside an LPN's scope of practice. (AmSpa members: check your state's medical aesthetic legal summary to see who can inject in your practice.)

Before going any further, it's helpful to understand what an LPN's qualifications are. An LPN typically has undergone two years of training at a nursing school, and he or she has passed the National Council Licensure Examination-Practical Nurse (NCLEX-PN), which is administered by the National Council of State Boards of Nursing. In terms of the hierarchy of nursing, an LPN comes in below registered nurses (RNs) and nurse practitioners (NPs). An RN has earned a degree in nursing and passed the more rigorous NCLEX-Registered Nurse exam, while a nurse practitioner has done all this, earned an advanced degree in nursing, and passed a national board certification exam.

Of these levels of nursing, only a nurse practitioner is allowed to perform medical procedures in most states and, unfortunately for those who use LPNs to administer injections, most states recognize injections to be medical procedures. Therefore, LPNs should not be performing injections. AmSpa recommends that if your medical aesthetic practice is using LPNs to administer injections, it should stop doing so immediately. If a patient happens to suffer a bad outcome and raises a case with a state medical board, the practice, the supervising physician, and the LPN could be cited for practicing medicine without a license. This could result in severe financial penalties and possibly even create issues with the physician's medical license.

There is a bit of a grey area here, however. If a physician can prove that an LPN has developed expertise in administering injections, a medical board may see fit to permit the LPN to continue performing these procedures. However, it is nearly impossible for a physician to prove that an LPN demonstrates unusually advanced injection skills, and there is no widely recognized certification specifically designed for injections, so physicians probably should not plan to use this defense if they are caught using an LPN to administer injectables. Physicians and practices should also be wary of LPNs who profess to have an expertise in this area.

It may seem like a good idea to use LPNs to perform injections of fillers and Botox, since doing so conceivably frees up more highly paid nurse practitioners and physicians to perform more lucrative procedures. However, doing so may very well place your practice in peril. Consult an experienced health care attorney to learn about the minutiae of the matter in your state, and stay tuned to AmSpa for any further developments in the matter. LPNs are valuable members of medical aesthetic teams; however, as with all medical spa employees, they must stay within their scope of practice in order for businesses to remain compliant.

(Author's note: The American Med Spa Association (AmSpa) works with the national law firm of ByrdAdatto that focuses on medical aesthetic legalities and AmSpa members receive an annual complimentary legal consultation. Become an AmSpa member today!)