The College of Nurses of Ontario (CNO) is currently consulting on proposed changes to the way Registered Nurses provide medical aesthetic services in Ontario.

One of the most significant proposed changes would move away from the use of medical directives or standing treatment plans and toward client specific orders for patients receiving aesthetic treatments. In practical terms, this could mean that a physician or Nurse Practitioner would need to assess a patient and issue an individualized order before every single treatment can proceed, including situations involving long-term patients receiving routine maintenance treatments or when treatment plans change.

The CNO has stated that these proposed changes are intended to strengthen public protection. We support that objective. However, many Registered Nurses, Nurse Practitioners, physicians, educators, and patients are concerned that these changes may not improve patient safety while creating significant unintended consequences for both healthcare professionals and the public.

For more than two decades, Registered Nurses have safely provided medical aesthetic treatments in collaboration with physicians and Nurse Practitioners through established treatment plans, collaborative practice models, and comprehensive nursing assessments. Nurses remain individually accountable for every patient assessment, informed consent, clinical decision, treatment performed, documentation, complication management, and follow-up care.

If implemented as proposed, many healthcare professionals believe these changes could substantially reduce nursing autonomy and fundamentally change how aesthetic medicine is delivered in Ontario. Experienced nurses who have safely managed long-standing patients may no longer be able to independently carry out routine maintenance treatments without obtaining additional practitioner orders, even when the patient's condition is stable and the treatment falls within an established plan of care.

The potential impact extends far beyond the nursing profession.

Patients may experience fewer appointment options, longer wait times, reduced access to experienced regulated providers, interruptions in continuity of care, and increased costs associated with additional practitioner assessments. Physicians and Nurse Practitioners—already in critically short supply across Ontario—could be required to spend valuable clinical time issuing individualized orders for routine aesthetic treatments rather than providing primary healthcare to patients with urgent medical needs.

There is also concern that reducing access to regulated healthcare professionals may unintentionally drive some patients toward unregulated providers operating outside Ontario's healthcare system. If this occurs, patients may receive treatment from individuals who are not accountable to a professional regulatory body and who may lack standardized education, emergency preparedness, and appropriate complication management protocols. This could undermine the very public protection these proposed changes seek to achieve.

In practice, this proposal would create significant barriers to accessing timely care. Returning patients receiving ongoing treatment plans would require a new order before every appointment, increasing administrative burden, delaying care, reducing appointment availability, and diverting Nurse Practitioner and physician time away from assessment and treatment. Ultimately, this could decrease access to qualified providers without clear evidence that it improves patient safety.

Nurses have made tremendous progress toward independent, accountable practice. Nurses who possess the education, clinical judgment, competency, and experience to safely perform aesthetic procedures should not be required to take a step backwards in their practice without evidence demonstrating that this additional requirement provides greater protection to the public.

This petition is not opposed to regulation.
We strongly support higher standards for aesthetic medicine, including mandatory education, competency-based certification, advanced anatomy training, continuing professional development, quality assurance, emergency preparedness, ethical practice standards, and clear accountability for all healthcare professionals providing aesthetic services.

What we are asking is that any significant changes to nursing practice be based on clear evidence. Before introducing new regulatory requirements that fundamentally alter how thousands of experienced Registered Nurses practice, we believe there should be transparent evidence demonstrating that the current collaborative model has resulted in measurable patient harm and that the proposed changes will improve patient outcomes.

Ontario has spent decades expanding the role of nurses and Nurse Practitioners to improve access to healthcare and allow them to practise to the full extent of their education, competence, and clinical judgment. We believe any future regulatory framework should continue to protect the public while preserving access to safe, regulated care and recognizing the professionalism, expertise, and accountability of Ontario nurses.
We respectfully call upon the College of Nurses of Ontario to work collaboratively with Registered Nurses, Nurse Practitioners, physicians, educators, professional organizations, and patients to develop an evidence-based regulatory framework that strengthens patient safety without unnecessarily restricting access to care or reversing decades of progress in collaborative healthcare.

If you believe healthcare regulation should be evidence-based, that patients deserve continued access to safe, regulated aesthetic care, and that highly trained nurses should be supported to practise safely within their competence, we invite you to add your voice by signing this petition.