NPs and medical direction: you're the special case.

Nurse Practitioners sit on both sides of the medical-direction question. As authorized prescribers, NPs can generally run their own injectable practice without a separate Medical Director — and in many practice models, an NP can be the Medical Director for other injectors. Here's how both directions work, and where physician support still earns its keep.

Running your own practice as an NP

NPs in Ontario hold broad prescribing authority. Within your scope and competence, you can generally assess clients, prescribe cosmetic injectables such as botulinum toxin, and administer them — no external signature required. The operative phrase is within your scope and competence: the CNO expects the knowledge, skill, and judgment for each specific therapy you offer, and aesthetics training is on you to obtain and document.

Where NPs still choose to bring in physician support:

• Complication backup. A collaborating physician with deep complication experience (e.g., dermatology) can be invaluable for the rare bad day — and reassuring for everything in between.
• Services at the edge of your comfort zone. New device categories, advanced filler work, or treatments you're still building competence in.
• Insurer or supplier expectations. Some products, suppliers, or insurance arrangements come with their own requirements — read yours carefully.

Employing RN or RPN injectors? You're the oversight now

The moment your practice includes RN or RPN injectors, someone has to provide what a Medical Director provides — and as an authorized prescriber, that someone can often be you. That means the full kit: current directives or orders covering your staff's treatments, chart review with real feedback, complication protocols, and genuine availability. Our Ontario guide describes what good oversight includes; it applies to NP-led oversight exactly as it does to physician-led.

Becoming a Medical Director for other practices

Ontario's injector population is growing faster than its pool of aesthetics-comfortable prescribers, and in many practice models NPs can fill that gap — providing orders, directives, and oversight to RN-led practices. If you have aesthetics experience and capacity, it's meaningful clinical work on a schedule you control, with fees you set directly with each practice.

Common NP questions

Do I need a Medical Director at all?

Often no — within your scope and competence you're an authorized prescriber. Many NPs still establish collaboration for complications or specific services. It's a fit question, not a paperwork question.

Can I prescribe botulinum toxin?

NPs have broad prescribing authority in Ontario and can generally prescribe botulinum toxin within their scope and competence. Confirm current CNO expectations for the specific therapies you offer.

Can I be the Medical Director for someone else's med spa?

In many practice models, yes — NPs can often provide the oversight an aesthetic nursing practice needs. Some practices prefer or require physician involvement depending on their services. If you're open to this work, register with the network.

Where do RNs and RPNs fit?

See the companion pages: RN injector requirements and RPN injector requirements.

General information for Ontario healthcare professionals — not medical, legal, regulatory, or compliance advice. Botox® is a registered trademark of its owner; Plus One MD is not affiliated with or endorsed by any drug manufacturer, the CNO, or the CPSO. Confirm current requirements with the CNO and qualified advisors. Related reading: the complete Ontario Medical Director guide.