Im an R.N in Florida and I want to open a med spa, I will be doing injections but no lasers. Does my medical director have to be onsite?

Yes, your MD needs to be physically on-site. In Florida, that's known as "direct supervision". Ideally, he/she should evaluate each patient, order the treatment, and then that injection can be delegated to a suitably trained RN.

What if your a nurse practioner? Also, if you own a med spa and your plastic surgeon/medical director uses it as a second office, can you just schedule injections on the days he is there?

If you are a NP or a PA, the situation is different. Provided you are working under the appropriate protocol / arrangement with a supervising physician, you could be much more independent with your scheduling & practice.

Alternatively, just schedule the injections on those days when your MD is on site, as you suggested.

SoCalRN:
I'm not so sure who "owns" the box is the problem. For example you could have taken out an "equipment loan" from a bank and be responsible for the payments yet have a working relationship/ arrangement with an MD (hopefully a core MD) working in his office. Ergo, you "own" the box.

I believe you are missing the point here. Lasers and pulsed light devices are PRESCRIPTION DEVICES. Federal law restricts the sale of these devices to health care professonals-- and then I believe defers to the medical boards of the various states in order to determine exactly who can legally purchase and/or operate the device. With sales being made every day over the Internet these laws are- of course- being violated all the time. The next step is to obtain professional liability insurance to protect yourself from possible lawsuits, etc. Most of the reputable insurance companies will want some assurance that the device is being operated legally.

A PA (or NP too I believe) does NOT need an MD/DO to be on-site when injecting fillers or botox or performing laser services, at least in Florida. Everything we do is on behalf of our supervising physician, and our practice law says the MD/DO only need be available by some means of telecommunication (i.e. - phone, email, etc).

For Texas RNs: Laser Hair Removal by RNs is regulated by both the nursing AND medical boards. The Texas BNE has its own rules AND then they tell you to also abide by the Texas Medical Boards. The Medical Board differentiates betw 'ablative' and 'non-ablative.' Currently, LHR is considered 'non-ablative.' Basically, any NP or PA may do LHR under 'supervision' of an MD and the MD does NOT have to be physically present in the clinic. The MD generally just signs off the records by the NP or PA. If you are 'only' an RN, the MD has to be physically present 'in the building' and immediately available. Notice I mention 'in the building.' This has been translated by MDs that the RN can do LHR on the 2d floor of a clinic if the MD is on the 23d floor seeing his internal med patients. And yes, there is an MD in TX who is fighting the medical board as the medical board is attempting to regulate the use of lasers to those who are under the DIRECT supervision of the MD. This particular MD uses medical assistants (9months of Medical Assistant School) to do all of the laser hair removal (with kickass Candela's and Cynosures Alex and nd-Yags). The MD is 600 miles away. The only one supervising these Med Assts is a RN and in fact,the RN 'oversees' three other clinics in the area so it is way obvious that this RN cannot even supervise the laser procedures being done by the medical assistants. Each of these clinics see about 30-40 'clients' per day and MA's are paid 9.50 per hour. What a sweet deal for the MD, heh? So, there is always a way to get over the system as evidenced by this MD and the conflicting regulations by the nursing and medical boards.

What about in the starte of wisconsin? An RN or Aesthetician? For example, can an aesthetician preform thermage with only an RN on site?

If you check the Wisconsin statutes - usually the law or regs which define the practice of medicine, etc., it is probably stated-- as it is in most states-- that the operation of a laser (usually any light-based device also) is considered "the practice of medicine". Most states then discuss whether or not the doctor can delegate, abd if so to whom, etc. If delegation to nurses, P.A.'s, etc. is permitted, you then need to research the laws and regulations concerning their conduct, Just finding the correct law in your state is rather difficult. Minnesota law is very puzzling in this regard. Throughout the U.S. many people are currently flying under the radar. It only becomes a problem when someone files a complaint and the authorities call you to the carpet. Oftentimes the insurance companies will also require compliance in order to provide professional liability coverage.

What about in the state of Maryland, what are the laws regulating injectables and use of laser for R.N.'s