On Monday, March 1, 2027, the College of Nurses of Ontario's updated Scope of Practice and Medication standards take effect. For aesthetic services involving prescription drugs or controlled acts, nurses will use client-specific orders instead of directives, and a nurse who delegates an aesthetic procedure to someone without the authority to perform it must be onsite for the whole procedure.
Source: the College of Nurses of Ontario, Aesthetic Services: practice standards changes coming into effect on March 1, 2027. CNO Council approved the changes on September 24, 2026. The updated standards are not published yet, and CNO says it will update its Aesthetic Services guideline to match. This is general information, not legal or regulatory advice: confirm your own obligations with CNO.
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Get matched, free I am an NP or physicianWhat changes on March 1, 2027
CNO Council approved updates to two practice standards on September 24, 2026. Some changes apply to every nurse in Ontario; two apply specifically to nurses providing aesthetic services.
| Who | What CNO says changes |
|---|---|
| All nurses | Authorized providers complete an initial client assessment, in person or virtual, and establish a plan of care with follow-up before issuing a client-specific order. |
| All nurses | Clearer delegation requirements. |
| Nurses in aesthetic services | Use client-specific orders instead of directives for aesthetic services involving prescription drugs or controlled acts. |
| Nurses in aesthetic services | Be onsite for the entirety of a procedure the nurse delegated to someone without the authority to perform it, such as an unregulated care provider. |
CNO set a future date, it says, to give nurses and organizations time to review their practices and make the adjustments. It is also planning a webinar for nurses who provide aesthetic services and those who want to start.
Why it matters for injectables
Injecting a neuromodulator or a dermal filler involves controlled acts, so an RN or RPN needs an authorizing mechanism from an authorized provider such as a Nurse Practitioner or a physician. Until now, that mechanism could be a directive covering many clients. From March 1, 2027, for aesthetic services, it is a client-specific order, based on the authorized provider's own assessment of that client. An arrangement where a director signs one document and is never involved with individual clients does not meet that.
What does not change
Nurses still assess their clients and need the knowledge, skill and judgment to provide safe care. A client does not necessarily need a new order before every treatment: CNO says a client-specific order can support a defined course of care if it remains clear, complete and appropriate, with the nurse checking at each visit and consulting the authorized provider when anything changes. The assessment can be virtual where the authorized provider judges that appropriate.
The onsite rule for delegated procedures
The onsite requirement applies only when a nurse delegates an aesthetic procedure involving a controlled act to someone who does not have the authority to perform it, for example an aesthetician or an international medical graduate, in CNO's own examples. The nurse must be onsite for the entire procedure. An RN or RPN performing a controlled act they are authorized to perform, under a client-specific order, does not need the authorizing provider onsite unless either of them considers it necessary, for example during training.
Read the part that applies to you
| You are | Read next |
|---|---|
| An RN or RPN who injects | What to have in place before March 1, 2027, then directive or client-specific order |
| A Nurse Practitioner who directs injectors, or wants to | What changes for NP Medical Directors, then assessing clients virtually |
| A practice owner who delegates to aestheticians | The onsite rule for delegated procedures below |
Why sort it out before March, not on March 1
Every practice in Ontario that relies on a directive for injectables has to change how orders work by the same date. Finding a prescriber who will assess each client, agreeing how assessments are booked, and updating your records and consent process all take time, and every other practice in Ontario is working to the same date. Starting now means you are not choosing in a hurry.
Get your new arrangement in place before March 1, 2027.
Tell us where you practise and what you offer. We introduce you to a Medical Director who assesses each client and writes client-specific orders. Free for injectors.
Get matched, free For NPs and physiciansQuestions about the March 2027 changes
When do the CNO aesthetic changes take effect?
Monday, March 1, 2027. CNO Council approved updates to the Scope of Practice and Medication standards on September 24, 2026.
Can nurses in Ontario still use a medical directive for Botox or fillers after March 1, 2027?
No, according to CNO's summary of the changes: nurses providing aesthetic services will use client-specific orders instead of directives for services involving prescription drugs or controlled acts.
Does every Botox treatment need a new order?
Not necessarily. CNO says a client-specific order can support a defined course of care if it stays clear, complete and appropriate. The nurse checks at each visit and consults the authorized provider if anything changes, and the provider reassesses when the order expires.
Can the assessment be virtual?
Yes. CNO says the initial assessment may be in person or virtual, as appropriate, and the authorized provider decides whether virtual assessment is appropriate.
Does the Medical Director have to be onsite?
Not for an RN or RPN performing a controlled act they are authorized to perform under a client-specific order. The onsite rule applies when a nurse delegates an aesthetic procedure to someone without the authority to perform it, such as an aesthetician.
General information about the College of Nurses of Ontario changes to the Scope of Practice and Medication standards that take effect on March 1, 2027, based on CNO's published summary and FAQs as read in October 2026. The updated standards had not been published when this was written. Not legal, regulatory or compliance advice. Plus One MD is not affiliated with or endorsed by CNO. Confirm your own obligations with CNO and your liability protection provider.