Aesthetic Nursing: A Career in Enhancing Beauty

If you’re interested in the exciting field of Aesthetic Nursing - It’s understandable. It‘s a growing field that can be challenging, rewarding, and lucrative! In fact, Aesthetics is one of the fastest growing nursing specialities in Canada with great job prospects.

The Regulated Health Professionals role in Aesthetics is increasing in scope and complexity. Having the interest and education will facilitate both entry into the specialty but what precisely is Aesthetic Nursing and what is the exact career path?

Aesthetic, Esthetic, or Cosmetic?

You may have already been exposed to several terms within the world of Aesthetic or Cosmetic Nursing and be curious to know what the terms mean. Let’s try to clear things up. Generally, ‘Aesthetic’ is used more frequently in British English whereas ‘Esthetic’ used more in American English. As Canadians, we commonly use the terms interchangeably or we let autocorrect make the choice. 

The difference between “Aesthetic’ and ‘Cosmetic’ is subtle and again the terms often used interchangeably. For example, you’ll see both ‘Aesthetic’ or ‘Cosmetic Nurse’ in job postings. If you want to get right down to semantics, ‘cosmetic’ refers to imparting or improving beauty, particularly of the complexion. ‘Aesthetic’ is a slightly broader term referring to beauty, artistic appeal, and appearance. 

From some sources, you’ll find reference to ‘estheticians’ as those that provide skincare through exfoliation, massage, aromatherapy, and facials and work at beauty salons, resorts and fitness centres; whereas ‘aestheticians’ may be more medically focused and often work in clinics. Not all Aesthetic procedures require a nurse or regulated health professional (e.g facials, waxing, piercings, and tattoos). 

Again, you’ll find some variability of terminology within the industry. Most commonly, you’ll see ‘Aesthetic Nurse’ or ‘Cosmetic Nurse’ in job postings and staff listings. It’s best to look more at the context, job description and information from your regulatory body requirements to inform the distinction.

What does an Aesthetic Nurse do?

Perhaps the words ‘Aesthetic Nurse’ conjures up an image of a nurse injecting botox into a patient eager to have years instantly fade away. The truth is, aesthetic nurses do much, much more. Aesthetic nurses utilize their skills in health assessment, health promotion, and perform many surgical and non-surgical treatments to enhance how patients and clients look and feel.

Generally, Aesthetic Nurses work in private clinics often in collaboration with other nurses or nurse practitioners, physicians, cosmetologists and estheticians. 

Aesthetic Nurses use a robust set of knowledge and skills including:

• Knowledge of anatomy and physiology of the skin and underlying tissue
• Understanding of the medications and substances to be used
• Strong analytical skills and clinical competence in this practice area
• Provision of honest and factual counselling and advertising
• Taking and assessing a patient's medical history
• Checking a patient's vital signs
• Educating patients on procedures and treatments, to include what to expect and aftercare
• Preparing the procedure area and equipment
• Maintaining a clean/sterile environment
• Monitoring patients during a procedure
• Assessing healing and identifying adverse responses to treatment

Aesthetic Nursing is characterized by minimally invasive techniques and services that utilize injectables, lasers, and other procedures that require little or no surgery or general anesthesia. Nurses are essential members of the beautification team and are often involved in monitoring patient’s response to treatments as well as education, follow up, and after care.

Nurses bring professionalism and trustworthiness to the specialty. In some ways, the Aesthetic Nurse role is similar to a plastic surgery nurse, though the aesthetic nurse is typically more involved with non-invasive, in-clinic cosmetic treatments rather than surgical procedures that may include:

Injections

• Botox
• Collagen/other fillers
• Sclerotherapy

Skin treatments

• Microdermabrasion
• Tattoo removal
• Chemical peels
• Photo facials
• Light therapy

Laser treatments

• Hair removal
• Skin rejuvenation laser treatments

Perhaps you’re wondering, ‘I chose nursing to care for the injured and ill, isn’t that what nursing is all about?’ Caring for the ill and injured is a commendable and satisfying aspect of the profession; however, the nursing profession is growing in scope, variety, and complexity and we now have many marketable skills in several non-traditional sectors.

Nurses across Canada enjoy rewarding careers in insurance, cannabinoids, holistic and natural health, consulting, and cosmetics - just to name a few. Cosmetic procedures may be explicitly for enhanced beautification but can also help those suffering from body image disturbances, depression, and anxiety.

Looking for a new nursing job? New jobs get posted daily on our nursing job board - you search by keyword or location and sign up for daily alerts. 

What are neuromodulators and dermal fillers and who can prescribe them?

Dermal fillers are small injections of gel, typically made up of hyaluronic acid, that fill in wrinkles and add volume to soft tissue. You can have dermal fillers in different parts of your face: around the eye, cheeks, mouth and jawline, as well as lip fillers administered directly into the lip tissue.

Other fillers and enhancers may include:

Synthetic fillers 

Products containing lab-made substances not found naturally in the skin.

Collagen fillers 

Products made with purified collagen extracted from animal sources or made with synthetic collagen.

Autologous fillers 

Fat from one’s own body that is surgically removed, treated, and injected into the desired treatment area.

Collagen Stimulators

Collagen Stimulators are products that can help to restore volume to crepey skin and also provide a subtle lift by stimulating the underlying dermal tissues to resume collagen production.

Lipolysis 

Lipolysis (aka lipotherapy) is the use of an injectable solution to reduce fat deposits and cellulite. 

Neuromodulators 

Neuromodulators are wrinkle-relaxing injections, typically of botulinum toxin (Botox).

Medication listed on Health Canada’s prescription drug list can only be prescribed by authorized regulated health professionals:

• physicians
• nurse practitioners (in some jurisdictions)
• dentists
• pharmacists (in some jurisdictions)

What is the salary of an Aesthetic Nurse and Job Prospects?

Aesthetic Nursing salaries vary but are often above the average nursing salary in most provinces. This is often a result of opportunities that exist in private industry settings like commission or incentive based compensation packages.

It’s not uncommon for Aesthetic Nursing salaries to range from $80,000 to over $100,000 annually, again, based on your experience and specific designation. Also, depending on your interests and specific skill set, you may choose to explore entrepreneurial opportunities within the industry.

Demand for plastic surgery and cosmetic procedures continues to grow, and services are becoming more affordable and commonplace. As a result, the demand for medical professionals in cosmetic nursing is increasing as well. Thus, the future looks bright for those interested in a career as an Aesthetic Nurse!

What Licensure and Education is required?

In Canada, you'll find Licensed Practical Nurses (LPNs), Registered Practical Nurses (RPNs), Registered Nurses (RNS), and Nurse Practitioners (NPs) working in Aesthetics; however, many skills required are post entry-level competencies and include:

• Anatomy and physiology related to the treatment area
• Specific assessment of the dermatology patient
• Medications, pharmacology, and technique for treatments
• Complications of treatment and appropriate interventions

Many provinces and jurisdictions have guidance documents related to the practice of Aesthetic Nursing and have unique regulations. You’ll want to familiarize yourself with these resources.

In New Brunswick, for example, NPs are not authorized to diagnose, order tests, nor prescribe medication considered to be within the practice of cosmetic medicine; whereas, in many other provinces these functions are considered within scope of the NP. 

Regardless of your designation, if you are new to the practice, you’ll require additional skills. In some circumstances, these skills can be acquired ‘on the job’ and under the direction of a seasoned Aesthetic Nurse or Physician.

In other circumstances; however, you’ll need to obtain additional education to facilitate entry into the field and landing a job. Giving that it's a growing industry, there are many emerging programs to choose from. Depending on your location, desired skills, and costs, ensure your chosen program is right for you.

Some Canadian Courses include:

Advanced Medical Aesthetics Certificate | Ontario

Canadian Association of Medical Aesthetics: Medical Aesthetics Courses

Botox Training Canada - Medical Aesthetics Training, Botox Courses

Medical Esthetics for Nurses: Cosmetic Injectables

As you continue to develop your passion for the work and industry, you may choose to pursue certification. While not currently required to practice, certification does demonstrate dedication, pride and credibility to your craft.

Currently, there is no Canadian specific certification; however, the Plastic Surgical Nursing Certification Board (PSNCB) offers a certification process for Canadian Nurses to earn the Certified Aesthetic Nurse Specialist credential.

Requirements for certification include:

• Active RN license
• Have accrued at least 1,000 hours in core competency specialties in the last 2 years
• Have a minimum of 2 years of nursing experience within the designated 4 core competencies with a board-certified physician within a core specialty (Plastic/Aesthetic Surgery, Ophthalmology, Dermatology, or Facial Plastic Surgery)
• Must have a supervising physician endorse the applicant's application

What are some regulatory and legislative factors I should consider?

Given the relatively new practice area of Aesthetic Nursing, there are inconsistencies across Canada related to regulation and legislation. Again, consult your regulatory body to ensure you are fully aware of implications to your practice .

Since this is a relatively novel way to deliver nursing services, nurses should understand the unique liability risks when providing cosmetic services. Some considerations may include:

• In some jurisdictions, injections and other fillers may only be provided by the nurse when the patient has been initially assessed by a physician or other authorized prescriber and when there is a client-specific order.
  
  
• A few regulatory bodies have prepared guidelines to inform RNs of their roles and responsibilities in relation to cosmetic services. In some jurisdictions, RNs require additional education and experience to have the necessary competency for performing cosmetic procedures.
  
  
• In some jurisdictions, a physician or other authorized prescriber must be present on site for the initial cosmetic injection, but subsequent injections can be administered by the nurse. 
  
  
• Regulatory bodies have taken differing positions on nurse practitioners (NPs) providing cosmetic procedures as part of their practice. In Nova Scotia, NPs are able to prescribe Botox and other fillers with additional education and experience. By contrast, the regulatory bodies in British Columbia and New Brunswick have stated that cosmetic procedures are not part of primary health care and therefore should not be ordered or performed as part of NP practice.
  
  
• Nurses performing cosmetic services should be aware that some cosmetic services may not be considered to be nursing activities, particularly esthetic services that do not need to be performed by a regulated health professional (e.g. microdermabrasion). Therefore, they are encouraged to contact their regulatory body to confirm that their activities fall within the definition of nursing practice in order to correctly refer to themselves as nurses to clients and patients, and that these activities qualify toward the required number of practice hours for maintaining licensure.

Informed Consent Considerations

• Before providing any cosmetic service to a client, the health-care professional proposing the intervention must obtain valid consent. In order for consent to be considered valid, it must be voluntary. The client must have had the capacity to consent and must have been properly informed. For consent to be informed, the client must be provided with sufficient information about the nature of the procedure, its anticipated outcome and any material risks.
  
  
• Given the subjective nature of cosmetic outcomes, those who deliver these types of services are more at risk of being subject to complaints and civil actions from their clients or patients. In order to minimize this risk, it is prudent for nurses who perform cosmetic procedures to manage their clients’ expectations about the anticipated results of the procedure.
  
  
• Consent discussions with the client should always be documented by the health-care professionals involved in providing the cosmetic service.

Record-keeping Requirements

As with nurses in other practice areas, nurses providing cosmetic services have legal and professional obligations to document their encounters with clients. All regulatory bodies have established documentation standards, which are equally applicable to cosmetic services when the nurse is acting in a professional nursing capacity. In some jurisdictions, client records must also be retained for a specified period.

Proper and thorough documentation is also likely to be a nurse’s best defence in a legal proceeding related to cosmetic services. Records can be used later to reconstruct events, refresh memory, and provide detailed evidence of the care, all of which may minimize legal risk.

It’s important to store all records in a secure manner. Nurses in independent practice providing cosmetic procedures will often be considered the custodian of their clients’ records and subject to the legal requirements imposed by the relevant privacy legislation.

Independent Practice

Nurses who are considering opening a clinic or operating their own independent nursing practice to provide cosmetic procedures face unique challenges because they are also responsible for business management. Nurses in independent practice should consult with their own lawyer: 

1. To determine the best business structure for the delivery of their services and

2. to discuss other business-related matters, such as appropriate billing of clients, compensation practices, taxation issues, advertising requirements, compliance with privacy legislation, etc.

Liability Protection

The Canadian Nurses Protective Society (CNPS)’s professional liability protection is structured to protect individual eligible nurses from claims for professional liability arising from the provision of professional nursing services. Performing procedures that are not considered professional nursing services may limit the ability of an otherwise eligible nurse from relying upon CNPS professional liability protection. This is yet another reason for nurses providing cosmetic services to consult with their relevant regulatory body to ensure that their activities fall within the definition of nursing practice.

Nurses who are considering opening a clinic or operating their own independent nursing practice to provide cosmetic procedures may also need to consider liability protection for their business entity. CNPS protection does not extend to a business entity.

Business insurance options are available to CNPS beneficiaries.  To learn more, visit “Operating a Business or Independent Practice?” or contact CNPS at 1-800-267-3390.

Nurses who partner with a spa or a clinic to deliver cosmetic nursing services are encouraged to inquire about whether they will be covered under the spa or the clinic’s insurance policies and, if so, the amount of coverage. Alternatively, CNPS beneficiaries may also purchase business liability insurance from the commercial insurance market.

It's prudent for nurses who are working in collaboration with other health-care professionals to provide cosmetic procedures to confirm that each health-care professional has adequate individual professional liability protection.

Conclusion 

The role and career path of the Aesthetic nurse is exciting, challenging, and rewarding; however, the practice and industry is relatively new.

To ensure you and your client remain protected, ensure you are fully informed of your college standards and that you choose the training program that best meets your needs. You and your client will see remarkable results!

Please note that sections of this article reference the Canadian Nurses Protective Society (CNPS) article, “Considerations for Providing Cosmetic Services,” published in May 2016. Due to constant regulatory changes and the evolving nature of this topic, the information presented here is only accurate until the publication date.
 

Author Bio: 

Ro Rath is a Nova Scotian Nurse who has worked primarily in Primary Care including private for-profit, non-profit, and governmental organizations.  Currently, Ro utilizes his nursing skills to inform health related content for various audiences and publications. He lives in a small coastal village with his spouse, daughter and Basset Hound. Ro can be reached at rorathwriting@gmail.com