Carolyn Buppert, NP, JD


January 18, 2006


I am an ANCC-certified APN practicing in a state where I can practice independently, and I am providing anti-aging/cosmetic services in a medical spa. Will this ultimately jeopardize my credentialing as a "family" nurse practitioner?

Response from the Expert


Carolyn Buppert, NP, JD 
Attorney, Private Practice, Annapolis, Maryland

The American Nurses Credentialing Center (ANCC) Web site says:


Applicants for certification renewal must complete 1000 hours of practice during the 5-year certification period. Nursing practice includes nursing administration, education, client care, and research related to the area of specialty certification.... Practice must be in the area of specialty certification. Advanced practice nurses (nurse practitioners and clinical nurse specialists) must function at the advanced practice level in order for the practice hours to qualify. Practice occurs in a variety of settings, and may be for compensation or volunteer. However, care of family members, significant others, or friends do not apply.[1]

The legal questions are: (1) whether anti-aging treatments and cosmetic services are advanced nursing practice; and (2) whether these activities are practiced within your area of specialty certification.

To answer the questions, we need to know exactly what services you are providing. Are you prescribing and administering prescription medications, or only prescribing, or only administering the medications?

The prescribing function is always going to be within the practice of medicine and advanced practice.

Administration of anti-aging medications and performing of procedures are more complicated categorizations. Some cosmetic treatments may be performed only by cosmetologists and are not within the scope of practice of medicine or nursing. Other cosmetic treatments are medical procedures subject to regulation by the state medical and/or nursing boards.

First, determine what, if anything, your state Board of Nursing and Board of Medicine say about the procedures you are performing. Some Boards of Nursing have determined that some cosmetic treatments are within nursing practice. For example, some Boards are issuing policies addressing Botox administration, laser treatments, various forms of dermabrasion, injection of collagen, and peels. The Boards may view Botox injections differently from collagen injections.

Some Medical Boards have determined that the administration of Botox is the practice of medicine, and only physicians may perform that procedure. The manufacturer of Botox apparently has its own opinion (ie, it limits membership in its Physicians' Network to physicians who specialize in facial aesthetic treatments, including dermatologists, maxillofacial surgeons, ophthalmologists, otolaryngologists, and plastic surgeons).

Whether medical spa treatments fall within the spectrum of procedures that make up the practice of a family nurse practitioner is a question you may need to answer for yourself at this point. The ANCC's application for recertification asks only whether you have completed 1000 hours of practice in your specialty. It does not ask you to describe your practice. The ANCC does not make a determination whether you are practicing within your specialty.

The ANCC Web site describes an FNP as follows:


The Family Nurse Practitioner (FNP) is a registered nurse with a graduate degree in nursing who provides individuals of all ages and families a full range of health care services at an advanced level. This practice includes independent and interdependent decision making and the FNP is directly accountable for clinical judgments. Graduate preparation expands the FNP's role to include participation in and use of research development and implementation of health policy, leadership, education, case management, and consultation.[2]

While an FNP may provide a full range of healthcare services to individuals of all ages, there is no requirement that an FNP actually provides care for all age groups or provide the full range of healthcare services. Therefore, until the ANCC gets more specific in defining the practice of a family nurse practitioner, or until the ANCC develops a certification in dermatology or medical cosmetology, if you believe your practice is within the realm of family practice, you probably are safe in applying for recertification. But there are no guarantees. The ANCC may make new policies at any time.

Questions you didn't ask, but which I believe there is a need to answer for NPs who may not have done the research on the opportunities in medical spa services are: Is providing anti-aging or medical spa treatments within my scope of practice under state law? Am I going to jeopardize my nursing license or subject myself to criminal prosecution? Am I going to lose my malpractice insurance coverage if I am sued?

Unless an NP has the legal authority to perform the treatments he or she is performing, the NP can be accused of practicing medicine without the legal authority to do so. That can mean loss of nursing license, fines, and even jail time. And if an NP is practicing outside his or her scope of practice, an insurer may refuse to defend the NP, if the NP is sued. So, before undertaking medical spa services, research your state law to determine whether you have the legal authority to perform these services. Follow the state's requirements. And be honest on your malpractice insurance application about what you are doing.

Related Resources

Boards of Nursing in the United States: State-by-State Web Links


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.