• Cheryl Muise, R.N.

So you want to become a Canadian Aesthetic Nurse?


By Cheryl Muise, R.N.

I graduated nursing in 1980 – so yes I’m currently in my 39th year!  So when I thought about doing a small part time job outside of my current field, which is long-term, care- I decided to check out medical aesthetics.  

I sort of stumbled on this field as a patient when I went for injections from time to time.  After having several conversations with these nurses, I thought it would be a great idea to earn some extra ‘retirement’ cash and a nice change.  A change is as good as a rest, right? I figured once I retired from my full-time work, I’d have a small clientele of ladies that would help augment my less than bountiful retirement savings.

In my long career as a nurse- I have always loved mentoring new nurses.  So I’d like to share some of the things I needed to consider when embarking on this avenue of nursing.  I personally faced all these questions, twists and turns and spent hours in researching what to do.

Nurses are taught how to give injections, subcutaneous, intramuscular, intradermal as part of their general nursing course but doing aesthetic injections is an added skill with course costs generally around the $5,000 mark.  This is not small potatoes so you really want to make sure the investment will prove to be sound for you and your own circumstances.

Before undertaking this kind of expense- the nurse generally has to have a clear business plan as to where they will provide these services to their patients. Will you seek employment in a physician office, spa or start your own clinic? Many nurses provide their services in several locations as independent contracted professionals.  Some work as an employee of the spa or doctor’s office. There are not a lot of ads for aesthetic nurses and generally they are looking for someone with a couple of years experience already.

In my following blogs I want to explore some important aspects of what should be in your business plan- what you need to consider and research before embarking on this fun and what could be, a very lucrative career.   I personally only do botulinum injections. I did start out with dermal fillers but never really got over my nervousness with them. (Maybe this old gal can’t learn too many new tricks?) I suppose if I worked in a plastic surgeon’s office rather than independent spas, I would have gained more confidence?  Hard to say…

Botulinum is a drug and in Canada a nurse in the general class cannot prescribe so the number one consideration will be how will you be getting the order to provide the treatment?  This is the first hurdle and concern that I had when considering my business plan. I had been nursing for over 35 years when I took the course and I was in good standing to practice nursing in Ontario.  I did not want to do anything to jeopardise that.

No matter where you work, nurses are responsible to their licensing body and must follow their standards religiously and these standards differ from province to province.  No matter the province, though, the nurse must have the knowledge and skill to perform the procedure and must know what to do in case of an adverse event.

In Canada the nurse must have an order from an appropriate health professional and who this is differs a bit from province to province:

In my home province of Ontario, the College of Nurses of Ontario states that RPNs and RNs can do these injections with a direct order or medical directive.

In several provinces such as Alberta, Ontario and Nova Scotia nurse practitioners can order botulinum toxin and can act as medical directors for aesthetic nurses.  

While in BC, nurses must provide the treatment under the guidance of a physician and the nurse can administer subsequent treatments if the physician is readily available.  BTW what does readily mean?  In New Brunswick the physician must be onsite when the patient gets their first injection.  A nurse practicing in provinces with these limitations will also be limited in their own options for practice.

In my own experience I wanted options.  I wanted to provide treatments in my own clinic room and I was also open to provide these services in different spas.  I had a full time day job so for me I wanted to provide these services part-time in the evening or weekend. The biggest and most difficult part of setting up my business was finding a physician or nurse practitioner that could be available for consults.  Some spas already have a medical director that provides these services and some spas expect the nurse to provide everything needed to do the service.

Availability is a huge a barrier.  When can the medical director provide the consult?  Some medical directors are only available certain days of the week such as Wednesday afternoons.  Well that sort of arrangement wouldn’t fit in with my full time job. Some clinics then will do all their consults during that window of time and then the patients had to book to come back for the actual treatment.  Many patients don’t like making two trips in order to get their treatment. I know when I first started getting aesthetic treatments as a patient, I found it difficult to find a clinic where I could get my consult after working hours and then quite annoyed to learn I had to turn around and find a time when I could come back for the actual injections.  That was very frustrating. Everyone has such busy lives- in my experience as an injector, when my new patients come in they generally know what they want and they want it right then and there. Keep in mind this is a lucrative business and because it is- it is highly competitive. Patients will shop.

Cost is another big factor- what fee will you be paying your medical director?  This also varies. Some charge by the unit such as 1.00 per unit. My first medical director charged $100 per 100-unit bottle.  

This fee was charged upfront when I purchased my product- even if the product was wasted or used for personal use. My second medical director charged 10% for first patient consult and then 5% after that.  There are certainly many other arrangements out there.

I personally found working with nurse practitioners that were experienced in aesthetic injections the best solution for me.  Our first appointment was done electronically over a service such as Webex or Facetime. I generally found them flexible in hours and as a new injector their guidance in dosing was invaluable.  

So how does one recruit a medical director?  

You may already have professional relationships with doctors and NPs that could offer these services.  You may meet someone taking the training with you and many training centres often have a list of medical professionals that have expressed interest to act as a medical director and can facilitate the introduction.  I followed up on the introduction before I paid for and took the course. Whatever avenue you pursue, you cannot move forward without meeting this need.

Another serious consideration is to think of is what will happen if your medical director gives notice that they need to resign?  You will not be able to conduct business so you need a backup plan. I personally know nurses that were renting clinical rooms in spas, they had a roster of patients, rent to pay, large investment in medical supplies, fillers and botulinum toxin stock- all with expiry dates.  When they got the short notice of their medical director’s resignation- it caused palpitations and dread.  Depending on the size of your business expenses having more than one medical director maybe the way to avoid s

uch a potential business disaster.   

If all of this seems to daunting then consider working in an established clinic or doctor’s office as that might be just the right place for you!


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