Can an RPN do Botox in Ontario?

Yes. An RPN in Ontario can give Botox and other neuromodulator injections when an NP or physician has authorized it with an order. From 1 March 2027, that order has to be client-specific: the NP or physician assesses the client first, sets a plan of care, then writes the order for that one client.

That short answer hides most of what an RPN actually needs to know: where the authority comes from, what changes in March 2027, and what kind of training puts you in a position to say yes when a clinic asks if you can inject. This post covers all three, in plain terms, from the College of Nurses of Ontario's own documents.

It explains the rules as CNO has published them. It isn't legal advice. Your NP or physician, your employer and CNO have the final word.

What may an RPN do in aesthetics today?

Injecting a neuromodulator involves a controlled act: administering a substance by injection. Dermal filler involves a second one too, performing a procedure below the dermis. CNO's Aesthetic Services practice guideline says so plainly.

RNs and RPNs may perform these acts only with an authorizing mechanism from an authorized provider, such as an NP or physician, based on an assessment of the client. Today there are three of those mechanisms, and people use the words loosely:

• A direct order. It is client-specific. It covers a specific activity at a specific time for one client.
• A directive (often called a medical directive). A written order for an activity that can be carried out for many clients when set conditions are met.
• Delegation. A professional with the authority and competence for a controlled act temporarily transfers the authority to perform it for an individual client. Nurses can't pass on a controlled act that was delegated to them.

So the honest answer to "can an RPN do Botox" has always been "yes, on someone else's authority". Your licence and your competence let you perform the act. The order lets you perform it on this client.

What doesn't change with your designation: an RPN and an RN work under the same requirement here. If a clinic tells you RPNs can't inject, or that RNs can inject without an order, ask them to show you where CNO says so. Neither may inject on their own authority. NPs and physicians inject on theirs, and NPs can write orders for the nurses they work with.

What changes on 1 March 2027?

On 14 October 2026, CNO announced three new requirements for nurses providing aesthetic services. They take effect on 1 March 2027:

1. Client-specific orders, not directives, for treatments involving prescription drugs or controlled acts.
2. An initial assessment by the authorized provider, in person or virtually, with a plan of care set before the order is issued.
3. The onsite rule. When a nurse delegates to someone without authority, the nurse stays onsite for the whole procedure.

For most RPNs who inject, the first two are the ones that change the working day. If you work under a medical directive today, the standing instruction that covered "any client who meets these conditions" stops covering your aesthetic injections. Each client needs their own assessment, their own plan of care and their own order.

That has practical effects:

• Booking. Every new client needs an assessment by the NP or physician before you treat. That takes time in the calendar, so build it in now.
• Charting. When each treatment rests on one order for one client, your chart should show the order, the plan of care, what you did and the follow-up.
• New areas. When a client wants a new area treated, ask how the plan of care and the order get updated before you touch it.

CNO's guideline also says it is reviewing how directives and delegation are used in aesthetic practice, and that nurses must follow changes when they take effect. Check CNO's site before 1 March 2027, and again after.

We go through all of it, with the questions to take to your medical director, in 1 March 2027: what changes for Ontario nurse injectors.

What training does CNO expect?

CNO says entry-level nursing education doesn't fully cover aesthetics, so it expects extra training. It doesn't approve or endorse any training program, so there is no such thing as a "CNO approved Botox course". What it does is describe what good training looks like. The Aesthetic Services guideline describes it as three parts:

• Theory. What you need to know before you touch a client. CNO's list includes adverse reactions and managing outcomes.
• Supervised practice. Treating real clients while someone competent watches, corrects and signs off.
• Evaluation. Someone checking that you can actually do it, not just that you sat through it.

A certificate of completion records the training you finished. It does not give you the right to inject. That comes from your licence and the order.

For an RPN, that means two questions about any course: does it give me all three parts, and does it teach me to work the way the rules work from March 2027?

How should an RPN pick a course?

Start from what you already do. If you have never injected, pick a course that teaches the face first, with live models and supervised practice, and keeps the class small enough that a trainer can watch every injection.

Then ask these questions before you pay:

• Will I inject live models, or only practise on pads? Supervised practice means real clients.
• How many students are in the room? At The Aesthetic Method it is 3 at most.
• How is my work evaluated? Ask who signs off and what they check.
• Is the 2027 order model part of the course? Ask how models are assessed and ordered for.
• Are complications taught? Look for vascular compromise, the emergency kit and the first minutes.
• What support is there after the course? Ours is 12 months.
• What does it cost, with HST? A clear price before you book.

We wrote a longer list in how to choose a nurse injector course in Ontario.

How The Aesthetic Method trains RPNs

Every live model on our table goes through the same steps, so you learn the 2027 workflow before you need it:

1. Assess. An NP or physician assesses each model first.
2. Order. They set the plan of care and write an order for that one client. No order, no treatment.
3. Map. You mark the landmarks and the vessels in white pencil. Your trainer checks your map first.
4. Treat. You inject under supervision, in a class of 3 students at most.
5. Chart. You chart against the order, so the paperwork is the one you'll use after March.

If you're new to injecting, the RPN injector course page shows where to start. Most RPNs begin with Foundational Botox, two days on the upper face, or Foundational Botox & Dermal Filler, four days across the whole face. Tell us your licence and we'll tell you which one fits, and the next date for it.