Safe in our Hands

By: Michelle Irving
Created on 16th February 2010

In recent years, the world of medical aesthetics has become a minefield, with everyone from beauty therapists to vets trying to get in on the act. Local clinic director, Michelle Irving, RGN, NIP talks about the history of aesthetic nursing and why she feels it is important to adhere to the set standards in the industry

Medical aesthetics is the term used to describe the use of medical procedures and treatments to enhance and alter appearance, and encompasses everything from Botox® injections to cosmetic surgery.

Having worked as an aesthetic nurse since 1989, I have seen the industry undergo a lot of changes, some positive - the introduction of new, more effective products, treatments and techniques - others, sadly, less so. As consumer demand for cosmetic procedures has grown, the industry has become more lucrative, and more and more practitioners want their piece of the pie.

Unfortunately, competition in the marketplace does not always equal a better deal for the consumer, and I am particularly concerned about the number of practitioners who are offering cosmetic services without the depth of specialised knowledge necessary to give patients the best care and results. Whilst there are some great training courses available, a one day course is no substitute for years of experience.

Having served for six years as one of the steering committee members of the Royal College of Nursing Forum for nurses in Aesthetic Medicine, which
produced the world's first written standards for the undertaking of non-surgical cosmetic treatments, I am passionate about the importance of raising standards and ensuring a constantly improving patient experience.

When it comes to medical aesthetics, there is a worrying trend for practitioners to view patients as 'clients'. I believe that where medical procedures are involved, a patient should always be treated as a patient, with all the care and professionalism that implies. Anti-ageing procedures should not be a matter of popping in for a quick injection, but should involve a proper consultation, assessment, diagnosis and specialist counselling.

I find it helpful to draw up an individualised, long-term treatment plan which takes account of the wishes of the patient and the indications for treatment, the consideration of different products and treatment modalities, costs, religious beliefs, as well as medical and emotional health issues. The nurse must ensure that she has gained valid consent prior to treatment taking place, and feel confident that the patient has a good understanding of everything that has been discussed.

Sometimes patients aren't emotionally prepared to undergo a procedure, or their expectations are unrealistic. It is crucial that patient welfare be prioritised above financial gain. A successful aesthetic practice should be backed up and supported by the use of policies, procedures and protocols, and constantly
reviewed and updated to mirror both the needs of the patient and the constantly changing legal situations. Reliable conscientious ancillary staff are
equally important to the ultimate patient experience.

One issue which has been in the press a lot lately is the question of remote prescribing - where a nurse who is not registered as an Independent Nurse Prescriber and therefore cannot prescribe Botox®, pays a doctor to prescribe it remotely, without the doctor seeing or speaking to the patient in question.

With the publication of the latest NMC Standards, the situation has now become crystal clear. Patients should be in no doubt that remote prescribing is not ethical for doctors, dentists and nurses alike, and anyone indulging in this is actually in breach of their code of conduct and risks losing their licence to practice. These rules are put in place to protect patients from what is in fact a
highly dangerous practice.

For nurses who do not hold an independent prescribing qualification, we at the Cheshire Image Clinic have set up a unique programme to allow these nurses to continue to practice non-surgical aesthetics without risking their license.

Cheshire Image Practical Support Services (CHIPSS) was launched in March 2008 and provides mentorship and career development for aesthetic nurses, within a recognised professional framework, supported by safe, legal and
ethical practice.

Consisting of six registered Independent Nurse Prescribers, the CHIPSS team provide face to face consultations with other nurses' patients and then safely
prescribe the required product, allowing the nurse to continue practicing and offering a safe environment to the patient.The patient has the right to expect the utmost care and consideration for any treatment which should be administered by a nurse, doctor or dentist.

The most important advice I can offer someone who is looking for cosmetic treatments is this: if you are in any doubt as to a practitioner's qualifications
or expertise, always ask them to provide evidence that they are registered to prescribe and administer aesthetic treatments safely and well. If they cannot
do so, do not be afraid to walk away.

Cosmetic surgery is the only branch of medicine which is completely unregulated but now IHAS has been asked by the government to produce a quality mark system for nurses, doctors and dentists who can prove competency and high standards in the provision of cosmetic injectables.

This quality mark will surely give credence to those professionals who are embracing the principles of regulation although it may be a slow process for the public to realise that in this field, you get what you pay for in terms of
expertise.