If you are an RN or RPN injecting in Ontario, you need a client-specific order for every client by March 1, 2027. From that date, CNO's updated standards say nurses providing aesthetic services use client-specific orders instead of directives, so an arrangement built on a directive has to change before then.
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 Directive or order?What changes for you
Two things. For aesthetic services involving prescription drugs or controlled acts, the authority you inject under is a client-specific order, not a directive. And if you delegate an aesthetic procedure to someone who has no authority to perform it, such as an aesthetician, you must be onsite for the entire procedure. The full summary is in the CNO changes on March 1, 2027.
Check your current arrangement
Ask your Medical Director, or yourself, these questions now:
- What do I inject under today? A directive covering many clients, or an order written for each client?
- Who assesses each client before the first order? CNO expects the authorized provider to complete an initial assessment, in person or virtual, and set a plan of care with follow-up.
- How long does each order last, and how does reassessment get booked when it ends?
- How quickly can I reach the prescriber when something changes or goes wrong? CNO's guideline expects the authorized provider to be available for prompt consultation.
- Do I delegate anything to an aesthetician? If so, plan to be onsite for every delegated procedure.
What a normal follow-up visit looks like
CNO's own example: an NP assesses a client and writes a client-specific order for a neuromodulator treatment plan for a set period, with the medication, dose, frequency and treatment areas. When the client returns, the RN or RPN does their own assessment. If nothing has changed, and the order is still clear, complete and appropriate, the nurse can treat under it. If something has changed, such as a new condition, new medication, unexpected side effects or a different treatment request, the nurse consults the NP first. When the order reaches its end date, the NP reassesses the client.
The risk of leaving it late
Every Ontario injector working under a directive needs a new arrangement for the same date, and setting up assessments, records and consent takes time. If your current director cannot or will not work this way, you want to know in the autumn, not in February. And from March 1, 2027, nurses remain accountable to CNO's standards even where an employer policy says otherwise.
What to do this month
- Ask your director the questions above, in writing.
- Read directive or client-specific order so you know what to ask for.
- If the answers are not good enough, ask us for an introduction.
Have the right order in place before March 1, 2027.
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Questions injectors ask about March 2027
Can I keep injecting under my medical directive after March 1, 2027?
Not for aesthetic services involving prescription drugs or controlled acts. CNO's summary says nurses providing aesthetic services will use client-specific orders instead of directives from that date.
Does my Medical Director have to see every client in person?
No. CNO says the authorized provider's initial assessment can be in person or virtual, as appropriate, and the provider decides whether a virtual assessment is appropriate.
Do I need a new order for every appointment?
Not necessarily. A client-specific order can cover a defined course of care. You assess the client at each visit, consult the prescriber if anything changes, and the prescriber reassesses when the order ends.
Does my director have to be in the room when I inject?
No, not when you are performing a controlled act you are authorized to perform under a client-specific order, unless you or the director consider it necessary, for example during training.
What if my clinic's policy still uses directives?
CNO says nurses remain accountable for practising in line with CNO standards where an employer policy conflicts, and should advocate for policies that support client safety.
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.