How to get into Aesthetic Nursing

By: Ali Wagstaff, NP

One of the most frequent questions I get asked by friends, colleagues and random people on the internet is how to become an aesthetic injector.

This path is different depending on your medical title: RN, PA, NP or Physician and I have other articles that answer general med spa questions, like who can inject and even how to open a medical spa.

This article will focus specifically on nursing, for Registered Nurses (RNs) and Nurse Practitioners (NPs) that want to get into aesthetics.

Becoming a RN Injector

First off, know your state guidelines because in certain states, such as Florida, RNs cannot inject at all. Only providers (NP, PA and Physicians can).

In other states, such as here in Colorado, RNs can inject with a Physician Medical Director overseeing them or in some cases a Nurse Practitioner Medical Director. 

In general it’s very competitive to get a job in this field. I get at least one email or DM every few days from nurses looking for a job or asking how to get into aesthetics. 

I usually ask what experience they have and 9/10 times they have none and have done nothing to try to get any. Maybe they have applied for a few jobs but that is it. 

I usually tell them to take some classes so they have something to put on their resume. Show that they’re interested and willing to put in the work. Also consider offering to intern at a place if you really want to work there! Showing that initiative will go a long ways. 

It’s a huge investment training a nurse in this specialty and half the people want training so they can go start their own thing. If I am going to invest in someone they need to show they are willing to invest in themselves first and want to be part of a great team long-term. 

Becoming a NP injector

If you’re a NP looking for a job as an injector then I would follow all of the same advice above. Take some initiative and get some training. Not only do you want to do trainings to make sure you like this specialty but also to have something on your resume when you apply.

If you are a NP and want to open your own practice, still get the experience. The laws are vague for NPs in independent practice and you have to be able to prove you had adequate education and training in whatever specialty you are going into.

You also have to have prescriptive authority in your focus area in order to be independent. So in CO you must have 3 years of work experience as a RN or NP and then complete the 1000 (may be 750 hrs now) of supervised prescribing before you can apply for prescriptive authority. 

So for perspective I am a dual certified NP with prescriptive authority for AG-ACNP and FNP and I’m a fellow in aesthetic medicine. My fellowship was an additional 160 hours of aesthetic specific training on top of the hundreds of hours of experience and training I already had.

People often ask me if they can practice independently if they are a CRNA, acute care only NP, or other specialty. I don’t know as I am not a lawyer and I’m not on the state board of nursing. Unfortunately if you call the CO state board 1/2 will tell you you can’t practice and the other half say you can with adequate training and experience and must call yourself a “Nurse Medical Director”. Apparently the Nurse Practice Act was written to be vague in order to not limit our scope of practice but some people use it to try to limit our scope. 

But if you’re a FNP or AGNP and in any position to advocate for NP independent practice in aesthetics for your state, here are just a few arguments for it:

  •  NPs are holistic practitioners and aesthetics is part of caring for a whole person and falls under the primary care focus. It’s just another system like cardiac, pulmonary, or mental health. Anti-aging medicine is hugely important for holistic care and quality of life for many patients. 
  • There is no aesthetics training for Physicians in residency. So NPs sit in the same classes as Physicians to learn aesthetic injectables and laser. My fellowship was about 75% Physicians in fact. So why should they supervise us if we do the same training?
  • In relation to the above, I recently reached out to a medical director agency after hearing NPs were being told in CO that they had to have a medical director. The agency told me it would be a minimum of $750/month and honestly it would be an ER physician that knew less than I did about aesthetics. How would that be beneficial or safer for clients?
  • If NPs have independent practice in the state but the state does not allow independent practice only in aesthetics then there could be legal ramifications against the state. They cannot support/endorse Physician owned practices in this one specialty of medicine only (per lawyers, not my language)
  • Lastly, many of us have prescribed and supervised much more dangerous drugs. For instance I worked in ICU and often prescribed opioids, sedatives, vasoactive drugs, and other dangerous meds. Botox and fillers are not even controlled substances and the prescription and administration of them fall under our prescriptive authority. If they didn’t, then pharmaceutical companies would not allow us to order them. 
With all of that being said, don’t try to go out on your own in any specialty without getting adequate education and training. And if you have a great physician mentor or colleague there’s nothing wrong with teaming up! This is simply to say that it doesn’t make any sense (in my opinion) to be required to have a physician medical director just to have a physician on staff. Especially when most physicians have less training than the aesthetic NP they would be supervising. 

Getting off my soap box… but long story short, you need to research your specific situation and scope, get lots of education and training and consider legal consults before practicing independently in aesthetics.