Ontario proposes ending standing medical directives for nurse aesthetic injectors

The College of Nurses of Ontario is considering regulatory changes that would eliminate standing medical directives for nurses administering neuromodulators and dermal fillers, a shift that would require a physician or nurse practitioner to issue a patient-specific direct order for every single treatment visit. Under this proposal, clinic owners would no longer be able to rely on blanket medical directives. Instead, an authorizing prescriber must consult with the patient at every appointment, including routine touch-ups.

This proposed change follows the publication of "Aesthetic Services" in July 2026, which was the CNO's first dedicated practice guideline for nurses in this space. If the CNO decides to adopt these changes during its expected vote in September 2026, Ontario will align with several other provinces that have already moved away from standing orders. For context, the Alberta College of Pharmacy prohibited standing directives effective February 1, 2025. British Columbia adopted similar individual-order standards into its College of Nurses and Midwives bylaws in April 2026, and Quebec's four professional orders began a joint regulatory initiative in November 2025 that is expected to conclude in 2026.

For a business, this change will reshape daily operations and margins. If your clinic relies on nurse injectors supervised by an off-site medical director who only conducts initial consultations, you will need to restructure your clinical workflow. To prepare, begin auditing your current booking capacity and evaluating how to integrate real-time prescriber assessments into every patient visit.

Source: Fasken, https://www.fasken.com/en/knowledge/resources/2026/09/01-ontario-proposed-regulatory-change-shaping-medical-aesthetic-clinics/