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Under the skin of cosmetic nursing

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More than ever before patients are choosing to have aesthetic treatments. Emma Vere-Jones talks to nurses in the field about the ethical dilemmas of working in this unregulated area

NURSES are not meant to be judgmental about patients but it seems that some in the profession take a different view when it comes to cosmetic medicine.

More patients are choosing to undergo aesthetic treatments than ever before. Last year, in the UK alone, more than 700,000 cosmetic procedures were carried out, of which around three-quarters were non-invasive. According to research company Mintel, that figure is increasing every year.

‘There’s always been a stigma around it because cosmetic aesthetic work is not deemed as necessary as having something corrective or reparative. People have this image of ladies who don’t have much to do, popping in for botox and lip augmentation and then going to Harvey Nics for lunch,’ says Sharron Brown, a clinical nurse specialist in aesthetics, who splits her time between Chelsea and Westminster NHS Foundation Trust and private practice.

Not surprisingly, such judgement is condemned by those in the specialty. Clinical nurse specialist in aesthetic medicine Suzanne Armstrong (pictured), who runs her own private practice, says: ‘My belief is that no matter what area you work in, you must endeavour to make sure your patients get the very best possible care. It’s not a nurse’s position to judge that someone gets the best possible care in one scenario but not in another.’

Nurses can also be quite judgmental of colleagues working in aesthetics. ‘Aesthetic nurses are not seen to have a vocation in the way that nurses on a critical care unit are,’ admits Ms Brown.

But Ms Armstrong has noticed an interesting trend. ‘It’s interesting that I now have quite a few doctors and nurses as patients,’ she says. ‘There are increasing numbers of professionals as patients.’

Undoubtedly, the reputation of the specialty has not been helped by what is perceived to be the work’s lucrative nature.

A quick scan of job advertisements for cosmetic nurses reveals why the practice has a bad reputation. All too often they read something like: ‘cosmetic nurse – sales experience preferred’ or ‘cosmetic nurse – base salary plus excellent commission’.

A link between earnings and practice gives rise to concern and causes some nurses to question the ethics of those in the industry.

It is a worry shared by many who work in the specialty. ‘I do have massive concerns about people going into this area purely for commercial reasons. I think there are far too many people who don’t have a background in an appropriate specialty,’ Ms Armstrong admits. ‘I’d be loath to see someone with an unrelated background doing a course in dermal fillers to make a few extra bucks to pay for the school fees or golf club fees.‘

It is not only financial gain that makes people feel uneasy. They also question whether it is ethical to carry out procedures that many would deem unnecessary.

Nurses in the specialty argue that there is undoubtedly a ‘need’ among patients.
It was patient need that drove Ms Brown into aesthetics in the first place. She set up the country’s first NHS clinic providing the filler poly-L-lactic acid to treat HIV lipoatrophy, after research she undertook revealed a desperate need among patients.

‘Some patients were very, very distressed,’ she recalls. ‘There were people who just didn’t go out. There was one guy who was so distressed about his face that he was allowing his dog to defecate in his house rather than go outside to walk the dog.’

Anne Prout is the first nurse at Lancashire Teaching Hospitals NHS Foundation Trust to become a surgical care practitioner in the aesthetics department. She carries out a range of work, including nipple tattooing for mastectomy patients and removal of basal cell carcinomas. She is training to undertake simple skin grafts on her own.

Ms Prout’s unit undertakes work for private patients outside NHS hours. Staff can earn extra money and the trust ploughs its share back into the cosmetic unit. ‘One reason why our unit is in profit and hasn’t had the financial problems at some trusts is because of the private work we do,’ she points out.

However, there are times, nurses admit, when patients are not suitable for treatment.
‘I think there is an ethical decision to be made with every patient,’ says Liz Bardolph, a nurse practitioner in aesthetic medicine who runs her own business. ‘Patients’ expectations can be very high and much can be done at the consultation to make sure they are realistic and achievable. Programmes such as Ten Years Younger have increased patients’ expectations.

They want an instant result and often this is not possible.’
Ms Armstrong, who is also an RMN, agrees. ‘I undertake a psychological medical history as well as a physical one to make sure people are not having treatment for the wrong reasons, for example if they have unrealistic expectations or are body dysmorphic,’ she explains.

Ensuring standards, as with all professions, lies in education and regulation. ‘There are a lot of people working in this business for purely commercial gain,’ says Ms Armstrong. ‘If you don’t ensure they meet the proper clinical standards and benchmarks patients will be put at risk.’

There were no cosmetic courses certified by a higher education institution until last month, when Greenwich University and the RCN launched England’s first postgraduate diploma in aesthetic medicine.

‘I think the diploma at Greenwich University is a great leap forward, given that previously education was provided by companies that make the products,’ says Ms Armstrong.
‘Often such training was structured to become a commercial opportunity and a way of getting people on board in terms of purchasing the product rather than giving people an objective analysis.’

Odile Brennan, a registered nurse who has been practising in the specialty since 1990, agrees. ‘Often the training was more about your business than about how to deal with the body-dysmorphic patient,’ she says.

Regulation remains troublesome. For many years the government turned a blind eye and the industry remained unregulated. Then a spate of shocking headlines about malpractice forced the Department of Health into action. In 2004 it commissioned an expert working party to make recommendations to improve standards but today many have still not been carried out.

The Healthcare Commission took on responsibility for licensing organisations and individuals offering both surgical and non-surgical practices. But many practices – such as the widely reported ‘botox parties’ in hotels or homes – continue unabated.

‘We have been striving for years for regulation,’ says Ms Brennan. ‘We should have to prove that we’re good at doing this – it is the only way to keep standards high. By not regulating the industry, the government is saying it’s only cosmetic, it’s not important. I think they underestimated the scale of it.’

With an aging population, pressure to look youthful and a reduction in the stigma around cosmetic procedures, the growth of the profession only looks set to increase. Cosmetics is very much here to stay.

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