January 2025: Pulse on Policy: Joint Committee Recap

As many of you are aware, a request for APRNs to inject Botox for aesthetic procedures was presented at the November Joint Committee meeting. The Alabama Board of Nursing (ABN) submitted a two-part request: first, to add Botox injections to the standard protocol for nurse practitioners, and second, to allow the injection of Botox to be a delegated task for nurses. The Alabama Board of Medical Examiners (BME) requested to delay any decision until the January Joint Committee meeting to allow for further discussion among their members regarding the delegation of Botox administration to nurses.

During this time, a subcommittee comprised plastic surgeons, dermatologists, CRNPs, and PAs specializing in Botox administration was formed. This subcommittee collaboratively drafted a protocol that both nurse practitioners and physician assistants could utilize. Several CRNPs who are members of NPAA played an active role in developing this protocol. Once a consensus was reached among all providers involved, the Botox for Aesthetics protocol was presented to the PA Liaison Committee on January 14, 2025. Recommendations from the PA committee were documented with the intent of bringing the feedback back to the subcommittee in February for further refinement. The intention was to bring the Botox for aesthetics protocol to the Joint Committee the following day for consideration. 

However, at the January Joint Committee meeting, the original request from November—to add Botox to the standard formulary and allow its delegation to nurses—was not received favorably as anticipated by NPAA. Despite this, I want our membership to know that the Botox for Aesthetics protocol developed by the subcommittee is one that members of NPAA have actively contributed to and support. We strongly believe in the importance of this protocol and will continue advocating for its approval by the Joint Committee.

In addition to the Botox protocol, three other protocols—Fluoroscopy, Tunneling, and Dermatology—were also developed through collaboration among nurse practitioners, physician assistants, and physicians. These protocols had previously been reviewed and approved by the PA Liaison Committee, granting PAs these privileges. Unfortunately, at the recent Joint Committee meeting a nursing representative requested these protocols to be tabled without discussion, denying an opportunity for consideration and a vote. NPAA has reviewed and contributed to the development of these protocols, and we firmly believe that NPs should have the same opportunities to provide these services as PAs.

Another issue of great concern for NPAA members is the “no” vote cast by the two nursing* representatives regarding the request for an exemption to Rule 610-X-5-.09, “Requirements for Collaborative Practice by Physicians and Certified Registered Nurse Practitioners.” This exemption specifically sought to allow a CRNP with 30 years of experience to fulfill the 10% physician onsite requirement. The Alabama Board of Nursing has long expressed its support for full practice authority for nurse practitioners, yet this “no” vote seems to contradict that stance and runs counter to the ABN’s stated commitment to advancing the autonomy and professional growth of CRNPs.

We will continue to work on advancing these protocols and advocating for fair and equitable practice privileges for NPs in Alabama. Your involvement and support are crucial as we move forward in these efforts. We appreciate your dedication to our profession and will keep you informed of any updates regarding these important issues.

*Original reported as 3 "no" votes, was 2 no and 1 abstain