RI Bill Challenges Health Department Guidelines on Nurses Performing Cosmetic Procedures

• Rhode Island Rep. Jacquelyn Baginski introduced the Medical Aesthetic Practices Safety Act, which she says would allow nurses to continue performing cosmetic procedures in the state. 
• The measure is in response to the state health department’s new guidance on who can offer services and perform procedures at medical spas and IV therapy businesses. 
• The state’s dermatology society has come out against the bill, while medspa and IV therapy employees believe the restrictions would cause businesses to close. 

Changes to one state’s health department guidelines prompted legislation that would ensure nurses can keep performing cosmetic procedures. 

Rep. Jacquelyn Baginski introduced House Bill 5351, known as the Medical Aesthetic Practices Safety Act, which mandates that cosmetic medical procedures “be performed by a physician, PA, APRN, or delegated to a qualified non-physician, non-PA or non-APRN under the supervision of a physician, physician assistant, or advanced practice registered nurse.” 

Last summer, the Rhode Island Department of Health announced several changes in response to the “proliferation of two new healthcare business types,” medical spas and IV therapy. RNs, according to the guidelines, would be operating beyond their scope of practice “if they are diagnosing, prescribing, compounding, and/or treating the patient with IV hydration or therapy.” 

Cosmetic Procedures Guidelines

The RIDOH stated that services from medical spas and IV therapy businesses are “advertised as being of minimal risk” and viewed as spa treatments rather than medical procedures. 

Patients, according to RIDOH, must be assessed by a licensed practitioner (physician, physician assistant, or certified nurse practitioner) before undergoing any service or procedure at a medspa or IV therapy business. The health department also put the following parameters on who can provide services: 

• Physicians licensed to practice allopathic or osteopathic medicine. 
• Licensed physician assistants with proper “academic and practical training.” 
• Certified nurse practitioners in family practice or adult gerontology. 
• Dentists licensed to practice in the state. 

The RIDOH also stated that it discovered many medspas and IV therapy businesses have been “operating without proper healthcare facility licensure,” performing procedures beyond their scope of practice, and not “adhering to the proper standard of care.” 

A 2020 study from Dermatologic Surgery found that patients who saw non-physicians for cosmetic procedures “experienced more burns and discoloration compared to physicians.” The non-physicians, according to the authors, are being visited “outside a traditional medical office.” 

Cosmetic Procedures Legislation

Sarah Beatrice, a nurse practitioner who spoke to 12 News, said without RNs and NPs, many of the state’s medical spas would close. 

“It’s a lot of revenue that’s going to be lost, not only by our state, but our patients are not going to be able to make their choices of who they want to see as a provider,” she said. “They’re going to follow us. Now you’re going to deal with unemployment that’s really going to affect our state too.” 

Baginski told 12 News the guidelines suggest “nurses should not be participating” in cosmetic procedures. 

“The legislation I’ve submitted would ensure that nurses who have been doing these things can continue doing so in the future,” she said. 

The health department argued that standards of care for cosmetic procedures “should not be less stringent or handled differently than a non-cosmetic procedure,” according to a letter submitted to the House Committee on Health and Human Services. 

The Rhode Island Dermatology Society has come out against the bill, according to 12 News. 

“Unfortunately, Bill H5351 leaves much open to interpretation, including what is considered the practice of surgery by the American Medical Association and should only be performed by physicians (whose scope of practice includes such training),” they said in a statement. “This would include several lasers such as resurfacing or ablative lasers. These cosmetic procedures are medical procedures and should be given the same level of appreciation and regulation.”

The Bottom Line

Last summer, the Rhode Island Department of Health updated guidelines for owning and operating medical spas and IV therapy businesses, along with who is allowed to administer cosmetic procedures. RNs were excluded from the list of appropriate providers, prompting one representative to introduce legislation that would allow them to continue providing these services.  

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