Thank you Pat for emailing me this link.
What are the standards in your state related to Botox administration?
Do you see this as a victory for the expansion of the nursing scope of practice, an assumption of more legal risks, a case of employers asking nurses to "do more" but not increasing salary, or something else?
Crystal Ford gets Botox injections to deal with wrinkles. "I tell everyone I'm growing old gracefully, just cheating along the way," she said.
And thanks to a ruling by the Ohio Board of Nursing, the wrinkle-smoothing toxin is likely to help some Ohio medical practices improve their own lines -- their bottom lines.
Last week, Allergan Inc., the pharmaceutical company that makes Botox, said its second-quarter profit rose 6.9 percent, well above analysts' estimates, largely because of robust sales of the facial treatment overseas. Overall, Botox sales jumped 13 percent, to $315.5 million.
A survey by the American Society for Dermatologic Surgery suggests that the use of Botox and dermal fillers is up in the United States, too, in spite of -- or perhaps because of -- the sagging economy and rising unemployment. In a news release detailing the findings, the organization speculated that "baby boomers may be looking to put their best face forward on the interview circuit."
In Ohio, Botox sales could get an additional boost from the recent determination that nurses can give Botox injections, provided that they first undergo special training.
The financial advantage is obvious: By assigning the duty to nurses, medical practices that offer Botox can treat -- and bill -- more patients. And because health-insurance plans typically don't cover elective cosmetic procedures, practices can deal directly with patients and charge, for the most part, whatever the market will bear.
In 2006, the most recent year for which data are available, physicians across the country charged an average of $492 for a Botox injection, according to the American Society of Plastic Surgeons.
Because Botox is a poison, some states explicitly forbid anyone other than a licensed physician to administer the drug.
Before the nursing board ruled on the matter last month, however, Ohio's nurses were operating in uncharted territory. Some were giving Botox shots -- and even determining doses. Others thought the procedure was beyond the scope of practice for nurses and therefore could be performed only by a physician.
"There was no specific prohibition," said Lisa Emrich, manager of the board's nursing practice, education and administrative unit. "It was becoming evident that physicians wanted nurses to do this, and there were no specific guidelines."
The board's decision came in response to a request by Dr. Fernando Colon, a board-certified plastic surgeon and associate medical director of the Skin Center Medical Spa in Gahanna.
Colon argued that allowing nurses to do the procedure would enable him and his colleagues to serve patients more effectively and efficiently.
"A well-trained nurse can continue to repeat this treatment, while I'm at the office doing other things," he said. "In a well-supervised environment, I think it is safe for a nurse to administer these Botox injections."
Colon's request, submitted last year, sparked months of discussion, much of it focusing on potential complications.
"What happens in a bad outcome?" board member Eric Yoon, a nurse practitioner from Springboro, asked at one hearing. "Just call 911?"
Ultimately, the board agreed with Colon but said nurses first must complete a "preceptorship," a period of practical experience and training supervised by a physician, Emrich said.
The board also determined that Botox can't be administered in homes, beauty salons or shopping malls, she said.
Still, some Ohio physicians aren't happy with the decision.
Dr. Michael Sullivan, a board-certified plastic surgeon in Columbus and former director of facial, plastic and reconstructive surgery at the Ohio State University Medical Center, had testified that Botox injections should be left to experienced plastic surgeons or dermatologists.
In unqualified hands, Sullivan said, the drug can cause a number of problems, including muscle weakness, drooping and bruising.
"We're going to hear of more and more complications and potentially deaths, because more and more physicians want to get out of insurance medicine and look at Botox and fillers and some of these quick procedures as a way to create a lucrative practice," he said.
In February, the U.S. Food and Drug Administration reported that Botox had been linked "to adverse reactions, including respiratory failure and death, following treatment of a variety of conditions using a wide range of doses." The most serious side effects stemmed from the "off-label" use of Botox to treat limb spasms in children with cerebral palsy, the agency said.
Last month, more than a dozen people filed a lawsuit against Allergan in California, where the company is headquartered. The plaintiffs contend that Botox injured them or killed their relatives and that Allergan failed to warn them of potential dangers.
Allergan said Botox has been used safely by millions of people.
There have been changes in the Kentucky Nurse Practice Act effective July 15, 2008 that are significant for Kentucky licensed nurses.
For example, see KRS 314.091
See this press release issued by the Kentucky Office of Attorney General last month.
http://migration.kentucky.gov/Newsroom/ag/stacyharrisonindicted.htm
Cut and Paste below:
Office of the Attorney General
Attorney General Conway Announces Indictment of Kentucky Nurse for Neglect
| Press Release Date: | Monday, July 07, 2008 |
| Contact Information: | Allison Gardner Martin Communications Director 502-696-5651 (office) |
Stacy Harrison, a 48-year-old Licensed Practical Nurse from Jeffersonville, Ind. was indicted on Wednesday, July 2. According to the indictment, Harrison, while employed with Hurstbourne Care on March 8 and March 9, failed to respond to multiple requests to check on an elderly resident who was in the facility for rehabilitative therapy. The indictment further alleges that Harrison did not attempt to revive the resident after the patient appeared to have stopped breathing. The resident eventually died. Harrison faces up to 10 years in prison if convicted.
A criminal summons has been issued for Stacy Harrison, who is licensed as a nurse in both Kentucky and Indiana.
The indictment was sought by Attorney General Conway’s Office of Medicaid Fraud and Abuse Control. Citizens are urged to report suspected fraud or elder abuse by calling the Attorney General’s tip line at 1-877-ABUSE TIP (1-877-228-7384).
See http://www.kbn.ky.gov/renewal
Renewal is online in Kentucky or you can pay an additional fee for a paper application.
There is a criminal activity question on the renewal application.
See page 20 of the Summer 2008 KBNursing Connection at http://kbn.ky.gov/NR/rdonlyres/BA3B72F4-0A01-4B2D-A010-EE9C31A80260/0/con_s08.pdf.
As always, do not wait until the last minute to renew your nursing license.
See http://www.kentucky-nurses.org/news2.htm.
Here is the cut and paste:
KNA And Its Union Separate
On July 8, 2008 the National Labor Relations Board granted petitions (Amendment of Certification Petitions) filed by the KNA to permit the KNA Collective Bargaining Division to become its own independent union, separate from the KNA. Effective immediately upon the signing and approval of those petitions on July 8th, the KNA Collective Bargaining Division became the Southern United Nurses (SUN).
SUN is a newly formed and independent union that is not affiliated with the KNA. As a result of this transition, SUN is the collective bargaining agent for the new union and the KNA no longer services a union.
The effects of these developments on the KNA are expected to be positive, despite the initial loss of just over five hundred members. While KNA membership numbers will drop, the financial impact will be positive. During the last couple of years, the KNA’s expenses related to servicing the union exceeded the income provided by the union. In addition, union-related costs were unpredictable and often sizeable. The transition out of the union business will allow the KNA to stabilize its operating budget and more accurately project expenses and income in the future. KNA expects the departure of the union to better position the KNA for growth and investment in new and progressive membership services and benefits.
KNA will actively encourage the members that have moved to SUN to join the KNA as individuals, even though they are no longer members through their union. In addition, the KNA looks forward to embracing its future with a renewed energy and fresh perspective that will be channeled into an upcoming Membership Recruitment and Retention campaign to promote the benefits and value of the KNA to RNs throughout Kentucky.
The fall will be here in no time and you know that means for nurses: conferences, seminars,in-services, and conventions.
How many have you attended this year?
I am attending the Kentucky Law Update next month presented by the Kentucky Bar Association for CLE. I need the credits for my Ohio, Kentucky and Indiana law license.
I am attending more webinars and teleconferences related to my law practice. I have attended three webinars offered by Lorman Education this summer and I will register for several more this year.
I will attend a program on chemical dependency offered by the Indiana State Nurses Association in Indianapolis in October. I will also attend the Ohio Attorney General Administrative Law Seminar this winter if its offered again.
I don't have to renew my Ohio RN license until 2009 so I don't really have to worry about CNE this year.
If you read this website then you know in my opinion, ---- rolls down hill in any healthcare facility and its usually the nurses who take the brunt and blame for an incident, occurrence, etc.
See this article on the Cincinnati Enquirer website about an illegal immigrant who was shot and ran over during an alleged robbery attempt. This guy was was shot and is now a parapalegic. He was awaiting trial and because the Sheriff's Office could not provide for his care at the local jail, the resident was being cared for at the Residence of Greystone, a nursing home with the Carrington System.
In all fairness, I must say that I have found that the Carrington System to be one of the few facilities in my opinion that work with nurses as far as workplace issues. Most facilities love the fact that nurses are at-will employed and use this to its advantage. But that's another post....
The resident was released and discharged from custody and its a big stink here in Cincinnati.
Do you think this is common?
Do you think this is more likely to occur in a hospital, nursing home, home care, clinic, out-patient setting, school of nursing, or another setting?
Is practicing nursing without a license a crime in your state? Felony or misdemeanor?