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Hi all,

Wondering if anyone has any standard work documents or can provide how they are utilizing RNs during Mohs procedures in dermatology?

• Do you allow nurses to help with subcutaneous lidocaine injections?  Topical lidocaine?
• Do you use any Nurse Practitioners or APPs to help first assist in any capacity or do Physicians do the whole procedure start to finish?

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Geneva Alexander
UCSD Health
San Diego CA
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Hello Geneva, 

I work very closely with multiple MOHS programs in my region and am working with our Chief of Dermatology to start one at our VA. For you questions:

1) Yes, pending your hospital requirements RNs can help with the subq injections (required a class and check offs) and topical lidocaine application.
2) NP/APPs are used when residents are not available to help with first assisting and closing as needed. 

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Shalah Shannon, BSN, RN, AMB-BC
RN Case Manager
NWI Omaha VA
Omaha, NE
402-930-7616
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I worked as an RN with a Mohs Surgeon from 2015-2019 and was trained for subcutaneous lidocaine injections as well as topical lidocaine prior to other procedures. We did not use topical lidocaine during Mohs at all. My surgeon also trained two of us RNs to be first assist with him. We prepped the patient, the surgical trays, the paperwork, would dress wounds between layers and at completion as well as cut suture during closures. Each nurse would be responsible for half the patients so we could go back and forth with him. It worked really well for our office. 

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Becky Bishop BSN RN
Monument Health
Belle Fourche SD
(605) 939-9868
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