Services Nurses and Others Can Perform Under Physician Delegation in Texas Med Spas

Operating a med spa in Texas requires a solid understanding of the rules governing delegation and supervision of medical tasks. Nurses, physician assistants (PAs), and nurse practitioners (NPs) can play essential roles in delivering aesthetic services, but their scope of practice is tightly regulated, especially in a non-traditional medical setting like a med spa. Here is a breakdown of what services each of these professionals can legally do under physician delegation and under what conditions in Texas.

Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs)

Permitted Services Under Delegation:

• Administering injectables (e.g., Botox, dermal fillers) only under appropriate delegation and supervision

• Performing laser hair removal if certified by TDLR and under physician supervision

• Operating medical-grade devices (e.g., IPL, RF) with written protocols in place

• Providing pre- and post-treatment patient care

• Assisting in aesthetic procedures (e.g., microneedling, PRP therapy)

Delegation Requirements:

• Must work under a physician’s delegation through a written protocol.

• Supervision can be on-site or off-site, but the physician must be available for consultation.

• Physicians cannot delegate the diagnosis or creation of a treatment plan to an RN or LVN.

Important Limits:

• LVNs may have more restrictions than RNs and should not be the primary person responsible for administering or evaluating medical treatments.

• Neither RNs nor LVNs may perform independent medical assessments or make treatment decisions.

Physician Assistants (PAs)

Permitted Services Under Delegation:

• Conduct patient evaluations, including history and physical exams

• Diagnose and develop treatment plans

• Prescribe medications (including Schedule II-V, with physician authorization)

• Perform injectables and laser treatments

• Supervise RNs and medical assistants for delegated tasks

Delegation Requirements:

• Must have a delegation agreement with a supervising physician

• The physician must review and co-sign charts, depending on the number of locations and patients.

• Supervision may be off-site, but the physician must be available by phone and must periodically review the PA’s work.

Limitations:

• PAs must operate within the scope defined in the delegation agreement.

Nurse Practitioners (NPs/APRNs)

Permitted Services Under Delegation:

• Perform exams and diagnose conditions

• Prescribe medications under a prescriptive authority agreement

• Administer and supervise cosmetic medical procedures

• Create and oversee treatment plans for aesthetic services

Delegation Requirements:

• Must have a collaborative agreement with a supervising physician (often called a “delegating physician”).

• The agreement must include a prescriptive authority agreement if the NP is prescribing.

• The physician must perform monthly chart reviews and regular meetings with the NP.

Scope of Practice:

• NPs can practice more independently than RNs or LVNs, especially if the collaborative agreement is comprehensive.

• However, Texas does not allow NPs full practice authority. They must still work under a delegating physician.

Key Compliance Tips for Med Spas

• Always maintain written protocols or delegation agreements for every type of provider.

• The supervising physician must conduct periodic chart reviews, especially when off-site.

• Ensure staff training, certifications (e.g., laser hair removal technician license), and continuing education are up to date.

• Document all patient assessments, treatments, and communications carefully to comply with Texas Medical Board rules.

Conclusion on Services Nurses and Others Can Perform Under Physician Delegation in Texas Med Spas

Understanding physician delegation in a med spa setting is essential to avoid regulatory violations and protect patient safety. While RNs, PAs, and NPs can provide many services, they must operate within a tightly controlled legal framework. Written protocols, proper supervision, and well-documented delegation agreements are non-negotiable elements of a compliant Texas med spa.

Feel free to reach out if you need more specific information or further clarification.

Weitz Morgan is a leading law firm in Texas in providing comprehensive advice and guidance to med spas. With a deep understanding of the unique challenges and complexities faced by this rapidly growing industry, our team of experienced attorneys is dedicated to helping med spas navigate the legal landscape successfully.

We recognize that med spas operate at the intersection of healthcare and beauty, which necessitates a multifaceted approach to representation. Our firm offers a range of services, including a flat-fee med spa formation package and an outside general counsel subscription, tailored to meet the specific needs of med spas, ensuring compliance, mitigating risks, protecting licenses, and fostering a legally sound business environment.