Practicing Outside Scope of Nursing License

   In a July 3, 2025 decision, the Utah Supreme Court declined to disturb an order of the Department of Commerce that directed Anderson to cease and desist from the practice of medicine and found her to be practicing outside the scope of her Advanced Practice Registered Nurse (APRN) license.

Anderson has been licensed as an APRN since 2012. She began working to provide body contouring services for breast and buttock augmentation with local anesthesia as an independent contractor. In 2022, the Division of Professional Licensing (DOPL) filed a notice of agency action alleging that she had engaged in the practice of medicine without a license and outside the scope of her APRN license. The Board of Nursing held a hearing that resulted in a recommended order to DOPL that concluded that Anderson did not engage in the unlawful practice of medicine, nor did she exceed the scope of her APRN license. The Board’s recommendation reasoned that the APRN scope of practice overlapped with the scope of practice of a physician as identified in the Utah Osteopathic Medical Practice Act, the Utah Medical Practice Act. The Board also noted that the Nurse Practice Act in fact provided broad authority to an APRN to “correct, treat, prescribe controlled substances within limits and administer local anesthesia” and included tumescent liposuction and fat grafting.

DOPL reviewed the record and met with members of the Nursing Board and rejected the recommendations of the Board. DOPL pointed to the legislature and noted that the issue was settled more than a decade ago by providing “exclusive authority to perform non-exempt ablative cosmetic medical procedures to medical and osteopathic doctors.” As a result, DOPL determined that Anderson did unlawfully engage in the practice of medicine and practiced beyond the scope of her license. She was fined and ordered to cease and desist. Upon review, based upon Anderson’s request, the Department of Commerce reduced the fine but affirmed the remainder of the order.

Anderson next filed for judicial review by the Court of Appeals, which certified the case to this Court. Anderson alleged that the Department erred in its determination that the Medical or Osteopathic Practice Acts prohibit an APRN from performing ablative cosmetic medical procedures. In its analysis, this Court turned to the Umbrella Act that states, “it is unlawful conduct to practice or engage in any profession requiring licensure under” the law without the required license or an exemption. See §58-67-301(1). Further, the Cosmetic Medical Procedures bill was enacted by the legislature in 2012, addressing the way that cosmetic medical procedures are regulated and adding “cosmetic medical procedures” to the definition of the practice of medicine. See Utah Code § 58-67-102(19)(a)(i).

This Court looked to the key question of whether APRNs have “the authority to operate or perform a surgical procedure,” which would be an exception under the practice of medicine. The Nurse Practice Act does not include the terms “operate” or “perform a surgical procedure,” while many other practice acts provide for these specific authorizations, including the practice of dentistry, medicine, and podiatry.

Thus, as the legislature did not define those terms, this Court cannot conclude that the legislation was intended to provide vague authorization and not specific limitations when many practice acts allow for specific authorization, including physicians, osteopathic physicians, dentists, and podiatrists, all of whom fall within the category of persons statutorily authorized to independently perform ablative cosmetic medical procedures. On the other hand, APRNs do not have express authority to operate or perform surgical procedures and must qualify for an exception to show their scope of practice includes the authority to operate or perform surgery – which it does not.

Upheld Order.