Alex Dinovich, Nurse Practitioner and Medical Director at Bradford Skin Clinic and Medical Spa, acts as medical director for Registered Nurses and Registered Practical Nurses injecting in Vaughan, Woodbridge, Maple, Kleinburg and Thornhill. Bradford is about thirty five minutes north on Highway 400, which makes an in person working relationship practical rather than theoretical.
Written and reviewed by Alex Dinovich, NP, Nurse Practitioner and Medical Director at Bradford Skin Clinic & Medical Spa.
College of Nurses of Ontario registration 13564840, verifiable on the
public Find a Nurse register.
Last reviewed .
At a glance
The short version.
InvestmentQuoted per arrangement. Scope, number of nurses and case review volume all move the figure
What the arrangement includes
Included in the arrangement
Directives authored for your practiceWritten to the interventions you genuinely perform, at the sites you genuinely work.
Direct orders where a named client is the better routeRather than stretching a directive to cover somebody it was not written for.
Prescribing for neuromodulatorsWhere that applies to what you do.
Case review, including in person where it helpsThirty five minutes up the 400 is close enough that a difficult case can be looked at properly.
An agreed complications planWhat you manage, what you escalate, and to where.
Revision as your practice growsA second injector or a new intervention is a change to the documents, not an afterthought.
Not included: training. Directorship gives you authority, not technique.
Who you would be working with
A person, not a signature.
Directorship is a professional relationship rather than a
location. You are choosing the person who authors your mechanism, reviews it as
your practice changes, and picks up when a client does not fit it.
Alex Dinovich is Nurse Practitioner and Medical Director here. She is registered with the College
of Nurses of Ontario as 13564840, verifiable on the
public register.
What a directive gives you
Authority to perform the controlled act it names.
A written mechanism you can show.
A named provider accountable for authoring it.
What it does not cover
Anything the directive does not say.
Competence, which comes from training and practice.
Your own accountability to the College for your own decisions.
A directive covers what it says it covers.
Accountability under an authorizing mechanism is specific and bounded.
You remain accountable to the College of Nurses of Ontario for your own practice.
Alex Dinovich, NP. The authorising provider, not a name on a certificate.
Thirty five minutes, one highway
Vaughan is the closest large city to us, and the drive is the simplest in the Greater Toronto Area: Highway 400 north from Vaughan Metropolitan Centre to Exit 64, then east into Bradford. In the morning you are going against the commuter flow, which is why it holds at about thirty five minutes rather than stretching the way a southbound run does.
Woodbridge and Maple are much the same. From Kleinburg, Highway 27 north is an alternative that avoids the 400 entirely. If you commute by train, Maple and Rutherford are on the Barrie line and so is Bradford, four and five stops north.
That matters less than it sounds for the legal side, and more than it sounds for the working side. Directorship is a documents and conversation arrangement, and most of it happens remotely wherever both parties live. What proximity changes is the realistic option of being in the same room when it is worth being in the same room.
When being in the same room is worth it
Three situations come up often enough to plan for.
Establishing competence at the start. A director has to be satisfied that you are competent for the interventions a directive covers. That is a conversation, a review of your training and experience, and sometimes watching you work. The last part is harder to arrange at a distance and easy to arrange at thirty five minutes.
A case that a photograph does not settle. Most case review is a phone call with a few images. Occasionally it is not: an asymmetry you cannot capture, a lump that needs palpating, a client who should be looked at by somebody with prescribing authority. Being an easy drive apart means the honest answer can be “bring them up” instead of “send me a better photo”.
Adding an intervention. When your practice extends into something new, the competence question reopens. Doing that properly is easier in person.
None of this is a requirement, and plenty of our arrangements run entirely remotely. It is an option Vaughan has that Thunder Bay does not.
What the arrangement covers
The same as anywhere in Ontario, because the regulator is the same: directives authored for your practice, direct orders where a named client is the better route, prescribing for neuromodulators where that applies, case review with a real route to reach the authorizing provider, an agreed plan for complications, and revision when your practice or the College’s expectations change.
What it does not cover is also the same. It does not make you competent at something you have not been trained to do, it does not transfer your accountability to the College of Nurses of Ontario, and it is bounded by what the documents actually say. Medical directives and delegation explains the difference between a directive, a direct order and delegation, which is worth reading before any conversation about fees.
Vaughan clinics and the second injector problem
Vaughan has a lot of clinics with more than one injector, and the most common weakness we see in existing arrangements is a mechanism written for the first nurse and then quietly extended to the second.
Competence is individual. An RPN two years out of a foundation course and an RN with six years of injecting are not interchangeable under the same document, even when they work side by side and inject the same product. A directive that treats them as interchangeable protects neither of them.
If you are the second injector in that situation, ask to see the document and ask whether your own competence was assessed. If you are the clinic owner, assume that each additional nurse is a piece of work rather than a line item.
Before you commit to anybody
Check the registration number on the College of Nurses of Ontario register. Ask whether the documents are authored or templated. Ask who revises them, and how fast, when guidance changes. Ask how you reach the authorizing provider, and what a realistic response time looks like. Ask what happens to your booked clients if the arrangement ends.
Alex Dinovich, FNP-PHC, Nurse Practitioner and Medical Director, College of Nurses of Ontario registration 13564840. She assesses, diagnoses, prescribes, issues direct orders and authors directives in her own right, and she injects daily in this clinic.
Tell us what you inject, where, for whom, and what you are competent to manage. We will tell you what the directives need to cover and what the arrangement costs.
Call 647-333-6805. Bradford Skin Clinic and Medical Spa, 444 Holland Street West, Unit 2, Bradford, Ontario.
Asked by nurses
Asked and answered.
How far is Bradford from Vaughan?
About thirty five minutes from Vaughan Metropolitan Centre, straight up Highway 400 to Exit 64. From Woodbridge or Maple it is much the same, and from Kleinburg you can come up Highway 27. It is the easiest run of any part of the Greater Toronto Area, because it is one highway the whole way and you are travelling against the commuter flow in the morning.
Does being close actually matter for directorship?
Less than people think, and not nothing. The documents, the prescribing and most case review happen by phone, video and email no matter where either of us is. What proximity buys is the option of looking at something in person when a photograph is not enough, and the ease of a first meeting in a real clinic rather than on a video call.
I am on the Barrie GO line. Is that useful?
It can be. Maple and Rutherford stations are on the same line as Bradford, so if you would rather not drive you can be here without a car. Check the northbound timetable, because midday service is thinner than the commuter peaks.
Can you cover two nurses at the same clinic?
Yes, and that is common in Vaughan. Each nurse is an individual whose competence has to be established and reconfirmed, so a second nurse is not free, but it is not double either. What you should not accept anywhere is a per nurse fee that simply adds a name to an existing document without looking at that nurse's competence.
My clinic owner says they will arrange the director. Is that fine?
It is common, and you still need to see the documents. The mechanism authorizes you, personally, to initiate a controlled act, and you are accountable to the College of Nurses of Ontario for working within it. Read what you are being covered by, check the author's registration, and make sure you can reach them yourself rather than through your employer.
What happens if I move clinics inside Vaughan?
Tell us before you move, not after. A directive names the circumstances in which it applies, and a different clinic is a different circumstance: different equipment, different storage, sometimes a different scope of work. It is usually a straightforward revision, but it has to actually be made.
Sources
Where this comes from.
Everything on this page is drawn from the regulator, not from a
competitor's marketing. Read the originals rather than taking our word for any of it.
General information about Ontario regulatory requirements. Not
legal or regulatory advice. Nurses remain accountable to the College of Nurses of Ontario
for their own practice decisions.
Talk to us
Ask before you commit to anything.
Leave four details and Alex will come back to you directly. If what
you need is not something we do, we will say so and point you at whoever does.
Written and reviewed by Alex Dinovich, NP, Nurse Practitioner and Medical Director at Bradford Skin Clinic & Medical Spa.
College of Nurses of Ontario registration 13564840, verifiable on the
public Find a Nurse register.
Last reviewed . 
