How to get started in Aesthetics - My story and advice

First, my aesthetic nursing history:

2009- I graduated from nursing school with a two-year associate's degree- I had goals to get my bachelor's degree, but life happened fast. I still built a successful career in aesthetics with a two-year ADN. I worked in Home Health right out of nursing school. I wanted to be an emergency room nurse, but when I graduated, most hospitals put their new grad programs on hold due to the economic downturn of 2009.

Many of my classmates could not find hospital jobs right out of school. I got my first job as a home health nurse just weeks after learning I was expecting my first child. I loved HH's flexibility and independence, but it was not for me! Shortly after getting my nursing license, I went to a medspa for a facial and saw a nurse working there. I started asking more questions about what she did, which sparked my interest immediately. I had never heard of RNs working at spas. I applied at that same spa, didn’t get hired, and applied elsewhere for a year with no luck. Finally, a year later, I applied again at that same spa with new ownership and got hired without experience. They hired me, and I started seeing patients within the first week of getting hired.

2012-First medspa job.I started with laser hair removal, Intense Pulse Light, Thermage Skin Tightening, and B12 shots. It was a high-volume medspa with a ton of laser. The training was minimal, and I was thrown into the position where they pressured me to start seeing patients immediately. I was naive to the harm I could have caused to patients with little training. Patients were coming in burned and botched, and it scared the hell out of me. The biggest lesson there was you have to be an advocate for yourself and your license. The management didn’t provide much training, so I bought textbooks and started reading and educating myself as much as possible. There was a NP that would let me shadow her at another location.

A few months into that position, I took a loan and went to the National Laser Institute in Scottsdale, AZ, for their two-day Botox and Filler Course. I was impressed with the number of models I could train on and felt confident to start injecting patients the next day. I was thrilled to have landed that position, but that medspa had a ton of drama between the owners. There were a lot of scheduling mistakes, and sometimes, we would be without a receptionist due to those mistakes and flaky front desk staff. There was no Dr on site, we had to take pictures of the patients for good-faith exams, NOT OK! (An Advanced Practitioner needs to medically clear the patient before treatment.) Legally, good faith exams are required to be done face-to-face or via telemedicine depending on the state (See below for more on good faith exams)

I heard about other aesthetic nurses getting caught undercover with the California Board of Nursing due to improper good-faith exams. Once I heard that, I started looking for other jobs at a dermatology or plastic surgery office where the dr was on-site.

2013-2015-I took a small break from aesthetics when I moved to a different city, I temporarily went back to home health while I was looking for work at a dermatology or plastic surgery office

2015- Was hired at a dermatology office part time while working home health part time but the Dr was not busy enough to provide a schedule for me.

2017-I was hired as a full time Cosmetic RN at a Dermatology office with a high focus on aesthetics, where I stayed for about four years. I finally quit home health for good. It was an extensive practice with five advanced practitioners, 50 staff members, in a 10,000-square-foot building. They paid for all my training, would always have trainers come in for the staff, and would pay for us to attend the Vegas Cosmetic Surgery and Aesthetic Dermatology Conference every year. At this office, I performed injectables, lasers, and skin tightening. I assisted in the OR with skin cancer surgeries, lipoma removals, and cysts. I also performed laser treatments for vitiligo and psoriasis patients. It was a great experience; however, I was getting burnt out due to the high volume and poor management. The office had high turnover. They would pressure me into seeing patients every 15 minutes, and some advanced practitioners refused to do good faith exams for me (there are a lot of Drs out there that don’t think RNs should be injecting, and some states don’t allow RNs to inject.) Which turned it into a high-anxiety and toxic work environment. I left during the pandemic. .

2021- Present. I work three days a week in an established office seeing patients for mostly injectables, but I also perform laser treatments, and microneedling. I also have a per diem job with Lumenis Lasers, training other clinicians on their newly purchased devices. I spend the other two days doing Lumenis training, consulting for medspas, mentoring other aesthetic nurses, and building online courses, which are in the works. I currently have a microneedling online course and beginner neurotoxin online course available on my website. .I am co-founder of skinofcoloraesthetics.net, an online training platform helping to educate aesthetic clinicians on treating skin of color and ethnic skin types.

Here is my advice to get started in aesthetic nursing:

EXPERIENCE and SIGNING CONTRACTS- Most places want you to have experience; some hire without, but usually, they have you sign a contract because training a new aesthetic nurse is costly. It’s not abnormal to see those contracts. Non-competes are invalid in California. (A non-compete states you can’t work within so many miles after you leave for a designated amount of time) Most non-competes won’t hold up in court but check with your state. Have a labor attorney review your contract before signing. A hands on training course can cost anywhere between 2K-5K. I spend about 10K-15K A YEAR on trainings, conferences, articles and I'm over a decade in. There are always new advancements in aesthetics and it's important to keep up to date with the latest.

I think a lot of new aesthetic nurses get some sticker shock when they realize how expensive it is to get trained. This is a whole different situation than hospitals.

CERTIFICATION- Most hands-on courses will give you a “certificate of completion” and a lot of nurses call themselves “ceritifed injector” after completion, but the only aesthetic certification is the CANS- Certified Aesthetic Nurse Specialist Certification by the Plastic Surgical Nursing Board. Learn more at ispan.org. The CANS certification requires 2 years of experience, a passing grade on the exam and more. In 2022, I passed my CANS exam. There are only approximately 500 CANS nurses in the US. More information on how to become a CANS certified nurse on my YouTube: https://youtu.be/AyeApbbneyg?si=fzdw6HypjaOdMu48

WHERE TO APPLY- Apply to as many places as possible. Use Jobsnob.net to look for open positions. Check Indeed, LinkedIn, Titan Aesthetic Recruiting and follow up with jobs if you don't hear anything after applying. . Look for places with good reviews that your friends and family go to and that have a good reputation.

PAY-Most hospital nurses will have to take a pay cut at first. Most places start inexperienced RNs (in California) at $30-$35/hr, depending on the area. It takes a while to perfect the skills (2-3 years), gain clientele, and then start making hospital money. I hear hospital nurses giving up on aesthetics because the money and the benefits are not there- then they return to the hospital. It will be a long-term investment. (I left a six-figure full-time job with great benefits at a large Home Health Company for a Dermatology office for $32/hr plus commission) I only received seven sick/ vacation days total for the year.

DOING IT AS “A SIDE GIG”- I take my career very seriously, and I think it's devaluing what we do when someone says they want to do this as a side gig to make extra money. If you're doing it as a side gig, you are relying on the hospital to continue to provide your income. However, Aesthetics will eventually pay just as much as hospitals, but you have to invest your time and money. You will have to spend money on training programs unless you can find a practice to train you from scratch. If you only do it as a side gig, it will take you longer to gain clientele, perfect your skills, and get your books complete with repeat and loyal clients. I know a lot of nurses do this, but this is just my opinion.

OPENING UP YOUR OWN PLACE- a significant number of nurses and physician associates find it difficult to find work in aesthetics without experience, so many of them open up their own practice. This route is very challenging and extremely hard to do. If you want to open up your own practice, bring in an experienced aesthetic clinician (RN, NP, or PA) instead of going to training programs and investing in the training on your own. You will need to get your own training, but to be completely independent is very difficult. You need a collaborator and others to learn from. Find an aesthetic clinician that might be willing to train you and that you can collaborate with. I mentor nurses that are on their own, their medical directors are not on site and they don't have the in person support. If interested in learning how to start my mentorship program please email me. Info@nursemarisa.com

Trying to start a practice on your own with no aesthetic experience leads to your clientele not returning, botching patients, and gaining a bad reputation.

BENEFITS - great benefits are few and far between. Most private practices and medspas don’t offer significant benefits unless they can afford to and want to do so. My experience has been that private practice does not provide the same benefits as hospitals.

COMMISSION- office dependent and becoming less of the norm because of “fee-splitting.” Check with your state laws

GOOD FAITH EXAMS- Most medspas and private practices have registered nurses performing injectables and laser treatments depending the state. Some states allow LVNs and estheticians to perform laser treatments. However, registered nurses cannot diagnose or prescribe, so they need an advanced practitioner to do a medical clearance before treatment (NP, PA, DO, MD). This medical clearance is called a good faith exam in which the advanced practitioner thoroughly examines the patient's medical history, contraindications, and precautions to ensure the patient is a good candidate for the treatment. At this time of the good faith exam, the patient is diagnosed, and a treatment plan is set. That treatment plan is then given to the registered nurse as orders. This good faith exam should be done once yearly. There are third-party companies that are doing good-faith exams via telemedicine.

A note about third-party good faith exams, while it's a great way to keep costs down, it should only be used if the usual advanced practitioner is unavailable for some reason.

MY TWO CENTS ABOUT MOST MEDSPAS/PRIVATE PRACTICE- doctors and nurses do not go to school to learn how to run a business, so many of them are poorly run and have high turnover. The ideal practice would have a business manager, separate from the owner, that runs the daily operations and keeps things in order. For example, the practice where I work now has an aesthetic practice manager that keeps things running smoothly.

WHAT TO LOOK FOR IN A TRAINING COURSE FOR INJECTABLES-

- Research the trainer and make sure they have years of experience in aesthetics, not just medicine

-Ask how many models you will be training on HANDS ON! not just observing (ideally you want training with 4-5 models in a 6 hr botox training or 3-4 for filler training)

-Ask if there's any follow-up or help after training is over

-For filler make sure they will teach you how to dissolve and how to administer hyaluronidase (the dissolving agent)

-Ask if complications will be discussed and how to treat them (this wasn't discussed at ANY of the training I went to)

***I offer private injectable training, where we do 100% hands-on training t the entire time. The didactic is sent prior so the whole training is dedicated to you getting your hands dirty. We don't learn by watching or observing. I want you to be comfortable once the training has been completed. I go over complication protocols and send the documents to you afterwards. For filler trainings I will have a model that needs filler dissolved so we can practice hyaluronidase.

QUESTIONS TO ASK WHEN INTERVIEWING

-Is the DR or advanced practitioner on site? Who does the good faith exams?

-How many patients will I see a day?

-Do you pay for training?

-Do you require a working contract with penalties if not completed?

-Do you offer benefits and 401k?

-Who runs the daily operations and administration?

ASK TO SHADOW FOR A DAY- Before accepting the position, ask if you can do a working interview where you can see the daily operations to see if it’s a good working environment.

CHECK THE DRS/OWNERS MEDICAL LICENSE ON YOUR STATE BOARD WEBSITE - all records are public documents. Make sure they have a license in good standing.

TAKE WHAT YOU CAN GET- it's hard to find open positions, and they may offer either low pay or work you may not want to do. However, if you were offered a job and want to get started in Aesthetics, you must take what you can get. It will be a stepping stone to the next position.

GOOD LUCK WITH YOUR ADVENTURE!!

CONTACT ME FOR MORE INFORMATION AT INFO@NURSEMARISA.COM