Medical Examiner

Nurses Are Quitting the ER to Do Botox

They got into health care work to help people—some say cosmetic injections is the best way for them to do it.

An up-close photo of a woman's lips. A syringe is going into the lower lip.
Photo by Sam Moghadam Khamseh on Unsplash

Janet Gedjeyan’s first job after nursing school was as a bedside nurse in the heart and lung transplant division at a Los Angeles hospital. “I loved it,” the 29-year-old Californian tells me. Well, she loved some of it: “About a year in, I started realizing that patient care was a fraction of what my job entailed,” she explains. Gedjeyan spent much of her days dealing with physicians, social workers, and hospital administrators—not the sick people who needed her support. It was less McDreamy, more McPaperwork.

Advertisement

As Gedjeyan was seeking alternatives to a career in the hospital, her mother was undergoing plastic surgery. “I went with her to her follow-up appointment and the nurse just happened to mention she was ‘doing’ Botox,’ ” Gedjeyansays. In California, Gedjeyan learned, registered nurses like herself are legally allowed to inject cosmetic neuromodulators like Botox and dermal fillers like Juvederm, so long as they do so “under the direction” of a physician. “They called it ‘cosmetic nursing,’ ‘aesthetic nursing,’ ” Gedjeyan says. She knew it was her golden ticket.

Advertisement
Advertisement
Advertisement

Today, Gedjeyan has a gig doing Botox, filler, threads and more at a “self-care bar” in Southern California—as well as 23,000 followers on Instagram, where she goes by “Nurse Janet” and posts photos of her handiwork and tips for getting into the booming field of medical aesthetics.

Advertisement
Advertisement

In the past year, 1,300 new med spas have opened, according to the American Med Spa Association, an industry organization. Their average annual revenue comes in just shy of $2 million a year. Clients are mostly women between the ages of 35 and 54 who may not want or “need” full-blown plastic surgery but aren’t satisfied with at-home anti-aging serums, either. These client-patients want to have their faces “balanced” with dermal fillers, their arm hair lasered into oblivion, their tummy fat frozen away, their bodies pumped full of “beauty bag” IV treatments with “prime nutrients for glowing beauty inside and out,” and so much more. While it’s still too soon to say, investors are hoping this all proves recession-proof. Who doesn’t want to look beautiful, even in this economy? “I think people will invest in making themselves look and feel better,” says Terri Ross, a med spa business consultant.

Advertisement
Advertisement

The medical aesthetic industry’s growth comes at a time when more traditional health care settings feel inhospitable for medical professionals, and nurses in particular. Even before the pandemic, female nurses died by suicide at twice the rate of their non-nurse peers. Burnout and depression are common, yet resources for those in distress are scarce. The pandemic has only amplified the problem. Roughly 34 percent of nurses say they want to leave their current job by the end of the year, according to a survey from Incredible Health. The result is a staffing shortage that shows little sign of abating, as nursing schools struggle to expand enrollment to meet demand. Young nurses are “picking up on [the fact] that working in a hospital, it’s a lot of burnout from a young age,” Gedjeyan says. Her line of work offers an appealing alternative.

Advertisement
Advertisement
Advertisement
Advertisement

Call it the aesthetic brain drain: While some students are enrolling with the express goal of working in beauty, based on my conversations with those in the field it seems the majority of aesthetic nurses are fleeing from emergency medicine, bedside nursing, and related work.

For these nurses, aesthetics offers something other fields can’t. “I saw a lot of autonomy in it and I saw a lot of growth in it,” Gedjeyan says. The average full-time salary for an RN in medical aesthetics is about $80,000 a year, on par with RNs in other fields. But aesthetics is seen as more flexible than other nursing roles. “You have some really big deal injectors doing tons and tons of injections, working their butts off, and earning their money,” says Caroline Barnes, an RN who transitioned from emergency medicine to aesthetic nursing in 2017. But you also have parents who want a three- or four-day workweek and extra time with their kids.

Advertisement
Advertisement
Advertisement

Gedjeyan’s career has so far run the gamut. In her first year as a bedside nurse, she made $74,000. Her first year as an aesthetic nurse, she made $104,000 (though she was now responsible for covering her own health insurance, retirement plan, and related expenses). While her current employer doesn’t allow her to disclose her salary, Gedjeyan says she is doing just fine—while working three eight-hour days per week. “I just knew that if I did well, the money would take care of itself, and the money sure enough did,” she says.

For the nurses I spoke to, aesthetics also offers a sense of autonomy—a key factor in preventing and healing from burnout. For artistic individuals, injecting can feel like a creative outlet. “A lot of people think aesthetics is looking fake or even looking very plasticy, but I think with our training now, aesthetics is just meant to enhance your natural beauty,” says Sabrina Pham, an eyelash tech-turned-RN. For entrepreneurial people, medical aesthetics offers a chance to promote their work through social media, build up a client list, and even open up their own med spa.

Advertisement
Advertisement

There can be potential conflicts of interest for those trying to be both medical practitioners and salespeople. “You’re a clinician first, but you also have to have in the back of your mind, what are some of the things I can do to retain this patient?” says Mimi Martins, a former family medicine physician and owner of Estar MedSpa in Maryland. But the field also presents an opportunity for connection: “A lot of my relationships are so meaningful,” Pham says of the industry, “and a lot of my patients are my friends, too.”

Advertisement

Aesthetic nurses know not everyone sees their work as noble. “If I told any of my nursing professors, ‘I’m going into aesthetics,’ they would have found a way to fail me on the spot,” Gedjeyan says. And making the leap from saintly bedside nursing to the wild world of beauty isn’t always easy. While a nursing degree is a prerequisite for working as an RN in a med spa, aesthetics aren’t taught in school. Instead, nurses who want to work in a med spa must pursue additional training, typically out of pocket, from private educators who teach the fundamentals of anatomy, injecting technique, and more. “Every nurse injector is different,” Pham says. “I think of it as going to a hair stylist or nail technician; everyone has their own sense of style.” On-the-job training is also essential, Barnes told me. Before moving full-time into medical aesthetics, she developed her skills by working part-time in the ER and part-time in a med spa setting.

Advertisement

The idea of pulling nurses away from other fields and into aesthetics may sound concerning. But the nurses I spoke to wouldn’t have it any other way. If you’re the person on the receiving end of these needles, they want you to be sure that you’re in good hands. The benefits of having a nurse do your injections (or hair lasers, or IV bags) versus an unregulated operator, or even a cosmetic surgeon who spends all day in the operating room, is that these treatments are an aesthetics nurse’s singular focus. “There’s a very large value to be said of, this is all that I do, all the day long,” Barnes says. Knowing what she knows, “I don’t think I’d ever let a doctor touch my face, to be perfectly honest.”

Advertisement
Advertisement
Advertisement
Advertisement
Advertisement

But these nurses say you shouldn’t let the spa-like atmosphere fool you: They really are dealing with the workings of the human body. Their clients can experience allergic reactions and brow ptosis (which causes their eyelids to droop) in response to Botox, vascular occlusion (when the blood can no longer pass through the vessel) as a response to fillers, and burns from improper laser hair removal technique. A skilled aesthetic nurse should be able to avoid many of these complications in the first place, and correct a situation that’s threatening to go awry. As George Baxter-Holder, an aesthetic nurse with Skin Spirit, puts it: “The most important part of medical aesthetics is the fact that it’s medical.”

Advertisement