Published: October 28, 2026.
The College of Nurses of Ontario (CNO) has approved important changes to its Scope of Practice and Medication practice standards. These changes will take effect on March 1, 2027, and will affect nurses across Ontario, including Registered Nurses (RNs), Registered Practical Nurses (RPNs), and nurses working in aesthetic services.
The changes aim to strengthen client safety, clarify nurses’ professional responsibilities, and promote consistent nursing practice across different healthcare settings.
For nurses working in hospitals, long-term care homes, community healthcare, medical spas, and aesthetic clinics, understanding these updates is an important part of professional development.
In this article, BrandedNurses.com explains the key changes, what they mean for nursing practice, and how nurses can prepare for the new requirements.
Important: This article is an educational summary based on information published by the College of Nurses of Ontario. Always consult the official CNO standards for the complete requirements.
What Has CNO Announced for 2027?
On September 24, 2026, CNO Council approved updates to two important nursing practice standards:
- Scope of Practice
- Medication
According to CNO’s October 14, 2026, announcement, the updated standards will come into effect on March 1, 2027.
The changes include new expectations for nurses working in aesthetic services, as well as clearer requirements regarding client-specific orders, client assessments, and delegation.
CNO considered feedback from nurses, members of the public, and healthcare system partners before approving the changes.
The goal is to support safe, competent, and accountable nursing care throughout Ontario.
Official source: Aesthetic Services
1. New Requirements for Nurses Working in Aesthetic Services
Aesthetic nursing is an evolving area of practice in Canada. Some nurses provide cosmetic treatments in medical spas, aesthetic clinics, and other non-traditional healthcare environments.
These services may include procedures involving prescription medications or controlled acts.
Examples can include:
- Neuromodulator injections
- Dermal fillers
- Certain microneedling procedures
- Platelet-rich plasma (PRP) treatments
- Other aesthetic procedures involving controlled acts
The exact requirements depend on the procedure, applicable legislation, and the nurse’s authority and competence.
CNO has announced two important changes for nurses providing aesthetic services.
A. Nurses must remain onsite when delegating certain procedures
Starting March 1, 2027, nurses providing aesthetic services must remain onsite for the entire procedure when they delegate a procedure involving a controlled act to a person who does not otherwise have the legal authority to perform it or requires delegation to perform it.
For example, consider a nurse who delegates an injection-related controlled act to an unregulated care provider (UCP).
Under the new requirements, the nurse must remain onsite throughout the procedure.
This requirement is intended to strengthen client safety and clarify the nurse’s responsibilities when another person performs a delegated procedure.
What should nurses do?
Nurses working in aesthetic clinics should review their current delegation arrangements, staff roles, workplace policies, and procedures before the implementation date.
They should also confirm that any delegated activity is appropriate and that the person accepting delegation has the necessary knowledge, skill, and judgment to perform it safely.
B. Client-specific orders will be required instead of directives for certain treatments
Another significant change concerns the use of orders and directives.
Effective March 1, 2027, nurses providing aesthetic services must use client-specific orders rather than directives for treatments involving prescription drugs or controlled acts.
A client-specific order is based on the assessment of an individual client and specifies the care or treatment authorized for that person.
A directive, by contrast, provides instructions for carrying out an activity for a defined group of clients who meet specified conditions.
The updated requirements mean aesthetic practices will need to review how they authorize treatments involving prescription medications and controlled acts.
Practical example:
An aesthetic clinic should review whether its existing process for authorizing injectable treatments meets the new client-specific order requirements. The clinic should establish appropriate processes for client assessment, orders, documentation, and follow-up.
The details of the order and the assessment requirements must follow applicable CNO standards and other relevant legislation.
2. Client Assessment Before a Client-Specific Order
The updated standards also clarify expectations that affect nurses across all practice settings.
Authorized providers are expected to assess a client before issuing a client-specific order.
Depending on the circumstances, an assessment may be conducted in person or virtually when appropriate.
This is important because treatment decisions must be based on the individual client’s needs, health status, risks, and treatment goals.
For nurses, this reinforces the importance of ensuring that an order is appropriate before carrying it out.
Nurses should not assume that an order remains suitable in every situation simply because it was appropriate during a previous visit.
If a client’s condition, medications, treatment needs, or other relevant circumstances change, the nurse must consider whether the existing order remains appropriate and consult the authorized provider when necessary.
For aesthetic nursing, this may be particularly relevant when clients return for follow-up treatments.
3. Clearer Rules for Delegation
Delegation is an important part of nursing practice in many healthcare environments.
A nurse may delegate certain activities when the applicable requirements are met. However, delegation does not remove the nurse’s professional responsibilities.
Under CNO’s announced changes, delegation requirements will be clarified for nurses across practice settings.
Nurses should understand the following principles:
- They must determine whether delegation is appropriate in the circumstances.
- They must ensure that the person accepting delegation has the necessary knowledge, skill, and judgment to perform the activity safely.
- They remain accountable for their own decisions about delegation.
- They must continue to meet their responsibilities for the client’s ongoing care.
- They must follow applicable CNO standards, legislation, and organizational requirements.
Delegation should never be treated as simply assigning a task to another person.
The nurse must consider the client’s condition, the nature of the activity, the risks involved, and the competence of the person accepting the delegation.
For nurses working in long-term care, community care, hospitals, and aesthetic clinics, reviewing delegation practices before March 2027 is a sensible step.
4. What Is Not Changing for RNs and RPNs?
Although the updated standards introduce important clarifications, several fundamental nursing responsibilities remain the same.
Nurses must continue to assess clients
Nurses must continue to use their professional knowledge, skill, and judgment when assessing clients and making decisions about care.
They must recognize situations in which a treatment or activity may not be safe or appropriate.
Nurses remain accountable for their practice
A nurse remains accountable for their own actions, decisions, and professional responsibilities.
Delegating a task does not mean that the nurse can ignore whether it is being performed safely or whether the client’s care needs are being met.
RNs and RPNs do not need delegation for controlled acts they are already authorized to perform
CNO has clarified that RNs and RPNs do not require delegation to perform controlled acts that they are already legally authorized to perform.
However, having the authority to perform a controlled act does not automatically mean that a nurse may perform every procedure in every circumstance.
The nurse must still meet the applicable requirements concerning competence, orders, client assessment, and safe practice.
Nurses should consult CNO’s Scope of Practice and Medication standards to understand how these requirements apply to their specific roles.
5. How Will These Changes Affect Aesthetic Nurses?
The changes are particularly relevant to nurses who currently work in aesthetic services or plan to enter this area of practice.
Aesthetic nursing can involve prescription medications, controlled acts, client-specific treatment decisions, and procedures performed outside traditional hospital settings.
Nurses and clinic operators should consider reviewing the following areas before March 1, 2027:
Client assessment procedures: Confirm how clients are assessed before treatments and how changes in their health status are addressed.
Orders and treatment plans: Review existing processes to ensure treatments involving prescription drugs or controlled acts use appropriate client-specific orders.
Delegation arrangements: Identify any procedures delegated to unregulated care providers or other individuals who do not independently have authority to perform them.
Onsite requirements: Review staffing and supervision arrangements for procedures that nurses delegate.
Documentation: Ensure records clearly reflect relevant assessments, orders, treatment decisions, and follow-up.
Staff education: Make sure nurses and relevant team members understand the new expectations.
These are preparation steps, not a substitute for reviewing the complete standards. The appropriate action will depend on each clinic’s services, staffing, and practice arrangements.
For additional guidance, visit CNO’s official Aesthetic Services information page.
6. How Can Nurses Prepare for March 1, 2027?
Nurses do not need to wait until the implementation date to begin reviewing their practice.
The following checklist can help nurses prepare.
- Read CNO’s announcement about the updated Scope of Practice and Medication standards.
- Review the official standards and related practice guidance.
- Identify any workplace policies that may need to be updated.
- Review how client assessments and orders are obtained and documented.
- Check whether any activities are delegated and whether those arrangements meet the applicable requirements.
- Discuss the changes with your manager, clinical lead, or employer where appropriate.
- Follow CNO announcements for additional guidance and educational opportunities.
CNO has indicated that it plans to provide a webinar to help nurses understand the new requirements. Nurses should monitor CNO’s website and official communication channels for details.
Taking these steps early can help nurses and employers identify changes that may be needed before the new standards take effect.
Frequently Asked Questions (FAQs)
When will the new CNO Scope of Practice and Medication standards take effect?
The changes approved by CNO Council are scheduled to take effect on March 1, 2027.
Do the changes apply only to aesthetic nurses?
No. Some changes apply to nurses across practice settings, including clearer expectations concerning client assessment before issuing client-specific orders and delegation requirements. Additional requirements specifically affect nurses providing aesthetic services.
What is changing for aesthetic nurses?
From March 1, 2027, nurses providing aesthetic services will be expected to use client-specific orders instead of directives for treatments involving prescription drugs or controlled acts. They must also remain onsite for the entire procedure when delegating a procedure involving a controlled act to someone who does not otherwise have authority to perform it or requires delegation.
Can an RN or RPN perform injections without delegation?
RNs and RPNs do not need delegation to perform controlled acts they are already legally authorized to perform. However, they must meet all other applicable requirements, including those relating to competence, orders, and safe client care.
Does a client need a new order for every aesthetic appointment?
Not necessarily. CNO’s aesthetic services guidance explains that an appropriate client-specific order may support a defined course of care or treatment plan for a specified period. Whether an existing order remains appropriate depends on the circumstances, the client’s condition, the treatment plan, and the applicable requirements. A new assessment and order may be necessary if relevant circumstances change or the existing order reaches the end of its specified duration.
What should nurses do if their workplace policies conflict with CNO standards?
Nurses remain accountable for practising in accordance with applicable CNO standards and requirements. They should raise concerns with the appropriate workplace leadership and seek guidance from CNO when needed.
Where can nurses get help understanding the changes?
Nurses can review CNO’s official standards, Aesthetic Services resources, frequently asked questions, and Practice Support resources. They should also monitor CNO announcements for information about its planned educational webinar.
Final Thoughts
The upcoming CNO Scope of Practice and Medication standards changes are an important development for nursing practice in Ontario.
The March 1, 2027, implementation date gives nurses and employers time to review their current processes and prepare for the updated expectations.
For aesthetic nurses, particular attention should be given to client-specific orders and onsite requirements when delegating certain procedures. Across nursing settings, assessment, professional judgment, safe delegation, and accountability remain essential.
Staying informed about regulatory updates is an important part of maintaining safe and professional nursing practice.
At BrandedNurses.com, our goal is to help nurses and internationally educated healthcare professionals understand Canadian nursing pathways, professional responsibilities, and career developments through accessible educational content.
Bookmark this page and check CNO’s official website for further updates.
Disclaimer
This article is for general educational and informational purposes only. It is not legal advice, clinical advice, or an official CNO publication. BrandedNurses.com is an independent educational website and is not affiliated with or endorsed by the College of Nurses of Ontario. For authoritative guidance, consult CNO’s current standards, guidelines, and official announcements.