What do I think about nurses injecting?

I’ve worked with some excellent Cosmetic Nurses, and I’ve come across some not-so-excellent ones. The same can be said about Cosmetic Physicians (doctors) – some are naturally astute and some seem to struggle to produce great results. I believe that Cosmetic Medicine is firstly a science, which can be studied by many, but secondarily an Art which requires somewhat of an innate grasp of aesthetics and the psychology of feeling good about one’s physical appearance.

What I think about nurse injectors is that it is not the injector that is the problem, it is the system surrounding them that is the problem.

You see, injectable procedures range from simple and superficial, to long lasting and highly invasive of the facial tissues. All of the medicines used in antiwrinkle and dermal filler treatments are called S4 medications, which means that they must be purchased, possessed and prescribed by a doctor. Ideally and ethically, a doctor should be directly supervising the manner in which they are given. If you think of a hospital environment, the nurse pages the ward doctor who comes to see the patient, review their notes and then select the medication and dose and time at which it is given.

Now, enter the system of Remote Prescribing. This came about to enable people living in remote communites to receive S4 medications in an emergency setting from a nurse directly. I used to work in Alice Springs where we had community nurses who would phone the doctor in charge at the emergency department (my old job) and we would discuss the patient, review any results and carefully select the medications they would receive. If needed, we would fly a doctor to them. This legal principle of Remote Prescribing somehow made it’s way into the Cosmetic Medicine industry where in my view, it doesn’t belong. What happens is that a nurse phones a doctor who they most often have never met or worked with. In fact that doctor may be in a different state and may not ever have worked in Cosmetic Medicine before. The doctor reviews the patient remotely and prescribes the antiwrinkle, dermal filler, local anaesthetic or other medications to be used. I find this very bizarre and many patients tell me they think it is odd when a doctor is ‘facetimed’ during their consultation. The nurse goes on to administer the medication hopefully in a safe and effective manner. But, what if something does go wrong? Thankfully our industry is prone to usually minor side effects only. But certainly in the years I have been practising, I have managed blocked arteries, infections, allergies or most commonly – have had to manage an intercurrent medical condition that the patient suffers which can affect their treatment. Without a doctor, these things are not properly done. A medical practitioner is the professional best placed to manage a medical emergency, which can and does occur in the setting of Cosmetic Medicine. When I have previously managed significant complications, I’ve been able to recall my training as an Emergency Medicine doctor. I remembered managing heart attacks which is kind of like managing an artery blocked with dermal filler, I’ve remembered managing strokes or Bells palsy which helps me to safely diagnose when a patient has had a facial droop which may or may not be from antiwrinkle injections. In fact, I’ve seen two patients being told that antiwrinkle caused their facial droop when actually they have had a Bells palsy and needed a brain MRI. I’ve had phone calls from a concerned nurse working in regional areas who had a patient with an infected filler that developed an absess and needed plastic surgery. She was stuck, alone and could not prescribe antibiotics to help the patient. She needed to phone around scrambling to find a doctor to help them. When I properly discussed her case, I thought it was probably an allergic type response anyway and conceded that she just didn’t have the skills to diagnose and treat like a doctor does.

So what I think is that, this is not a turf war. This should be viewed in the domain of patient safety and professionalism. Doctors diagnose and manage medical issues, they oversee medication prescription and administration. Therefore, the current system of satellite nurses phoning a doctor and then proceeding with a cosmetic procedure has the potential to be very unsafe. My recent concern relates to the fact that our hospitals are lacking staff and the government is making nursing degrees free of charge. There is a high number of young people seeking a nursing degree, not to become a nurse, but to pursue the highly commercial profession of being a cosmetic nurse. To go straight from university into injecting, which in my opinion does not constitute someone who should call themselves a qualified health practitioner. A medical doctor has done six years of university, years of clinical work managing the sickest of individuals. They understand anatomy and physiology to a much greater degree. Moreover, many doctors now will undertake a fellowship in Cosmetic Medicine which means they have been assessed at the highest level. Nurses most commonly take a short course and then learn on the job. Rarely are questions asked about any other experience in health care.

My advice to patients would be – whoever your cosmetic medical practitioner may be, ensure they have the right qualifications, experience and track record.  If it’s a nurse, ask who supervises them and how closely they are affiliated with a supervising medical practitioner. What will they do if something were to go wrong? And ask if they have had any experience as a clinical Nurse or if they have simply done the degree and gone straight into injecting.

To conclude it must be said, there are some excellent cosmetic nurses out there, and I hope they involve themselves in increasing the standards for the systems in which they operate. At the end of the day, the most important thing is safety for our patients, but also professional integrity and ethos and I really don’t think the current model of facetiming as a bastardisation of a law designed for rural Australia, can be considered safe or appropriate.