Summary: The Dermatology Nurses' Association recognizes that laser, light and energy emitting devices (LLED) and are standard equipment in private practice and academic settings. The role of nurses in the delivery of LLED and the need for understanding and complying with international, national, regional and local safety standards and guidelines has resulted in the development and implementation of this position statement. Nurses fulfill many important roles in the uses of laser and other emerging technologies. These roles and function change based on the type of procedure, the setting where the treatment occurs and the educational level of the nurse.

Standards require the appointment of a designated Laser Safety Officer in dermatology practices. Nurses who serve in the role of Laser Safety Officer, must meet all requirements identified in the ANSI Z136.3 standards to include Documentation, establishing and enforcing compliance with policies and procedures, maintaining education and certification records of staff, verifying physician credentialing as required by the facility, risk management, hazard analysis, periodic audit, OSHA compliance, and providing advice to management on all aspects of LLED use.

The position of the Dermatology Nurses' Association is:

• Nurses who deliver LLED must work within the stated scope of practice as defined by their State Board of Nursing, and State Medical Board. This could be but is not limited to the Nursing Practice Act and the State Board's Rules and Regulations.
• As defined by their licensure, educational preparation and certification/competency, Advanced Practice Nurses (APN), Registered Nurses (RN), Licensed Practical Nurses (LPN/LVN) and non-nurses are by nature different based on these integral factors and should function within their individual limitations.
• In most cases, it is considered a delegated function and the APN, RN and LPN/LVN are expected to comply with their state Nursing Practice Act and the Board's Rules and Regulations.
• Nurses, who are responsible for supervising other personnel delivering LLED, must ensure that they are compliant with all national, state, professional, regional, local, and facility requirements.
• Appropriate, medical and nursing support should be readily available in the event of side effects occur which require interventions that are outside of the Scope of Practice of the Nurse performing the procedure.
• Nurses must comply with national safety standards, institutional policies and procedures, and professional recommended practices.
• Nurses must document appropriate education, competency and certification that represent a core of knowledge and skill needed to perform safe and effective care of patients receiving LLED. LLED education includes, but is not limited to: biophysics and tissue interactions, clinical applications, patient care and management, patient safety, safety of the treatment environment, and ANSI Z136.3 standards.
• Nurses have worked in collaboration with medical staff in the development of written policies/procedures /practice guidelines and these are available for nursing staff practicing in the facility and the guidelines are reviewed annually as applicable.
• Nurses are expected to engage in ongoing professional development activities designed to maintain and increase their levels of knowledge and skill associated with the use of LLED.
• Nurses engaging in LLED procedures should have knowledge of anatomy, physiology, pathophysiology regarding the integumentary system as well as systems specific to the procedure being performed.

References

American National Standard for Safe Use of Lasers in Health Care Facilities (ANSI Z 136.3 2005)
American Academy of Dermatology Position Statement P-61.400, 2005
American Society for Dermatologic Surgery Position Statement, 2004
ASLMS Policy for Non-Physicians Laser Use, 2002
IEC International Electrotechnical Commission 60825 TR8
AORN Recommended Practices
Kentucky State Board of Nursing, Advisory Opinion Statement on Cosmetic Dermatological Procedures by Nurses Approved: February 2008
Texas Board of Nursing Position Statement on the Performance of Laser Therapy by RN's or LVNs Board Action 09/1993 Last reviewed 01/2010
Oregon State Board of Nursing, Policy Guideline: Nursing Scope of Practice for Cosmetic and Dermatologic Procedures Adopted: February 15, 2007