In 2019, Danielle Maltby had hit a wall after 12 years as a night shift pediatric neonatal intensive care nurse. 

“I had hit that moment. I honestly couldn’t put another child in a body bag,” she said. “I needed to get out of the field or at least take a break from the hospital setting.”

She tried to break into the aesthetics field as a nurse injector, but hit a different wall — she couldn’t find a place to get in-depth training. One must be a registered nurse to administer injections such as Botox while supervised by a medical director. Nurse practitioners and physician assistants can do it without that oversight. Maltby went to training to learn injectables for three hours, practicing on three people. Technically, she could have started administering Botox and fillers, but didn’t feel comfortable without more intensive training. 

“I found one clinic that was willing to train and that was out of tons,” she said. “Everyone wants someone with experience. How do you get experience unless someone trains you? Or they weren’t hiring RNs; they wanted a nurse practitioner. So it was really difficult.” 

Even before the pandemic, Maltby heard from hundreds of nurses through social media who wanted to make a change to aesthetics in favor of better hours, more pay and less of an emotional toll. According to data from September 2021, nearly four in 10 nurses say they are planning to leave patient care. There is not a universal training requirement for nurses performing injections, and aesthetic industry professionals described to the Post a lack of a clear route from nursing school to aesthetics, despite interest from medical professionals seeking to enter the field. 

Dr. Sarah Allen, founder and CEO of Skin Clique, made a route for herself and the more than 250 nurse practitioners and physician assistants she employs, including five in the Nashville area. Allen said she didn’t have to recruit because nurses were eager to join her practice. Skin Clique employees receive up to six months of training in a program Allen designed, so they can ultimately work independently to perform at-home Botox, dermal fillers and chemical peels, among other aesthetic services. She too went to a short educational course on injectables and was left feeling underprepared. 

“I tell people a lot of times that aesthetics is like the new tech,” Allen said. “Tech grew so fast that nobody could keep up with the regulation. Aesthetics is getting to be very similar.”

The company entered a strategic partnership with Nashville-based investment company Graham Healthcare Capital earlier this year. Allen has her own story of nurse burnout as a former nursing home medical director. She was heartbroken to lose 70 patients from her facility during the COVID-19 pandemic, and she opted to leave that job in October 2020. 

“I have found this part of medicine to be so joyful, lighthearted, but also really makes an impact on your patients and in their lives,” Allen said. “I tell people I won’t stop until everybody who wants that opportunity has it.”

Despite a high interest in leaving the field overall, Mark Phillips, chief nursing officer at Ascension Saint Thomas, said nurses he works with are feeling more positive in recent months.

“While it is certainly true that some nurses are choosing to leave the profession or change how or where they work, many of the nurses I speak to seem [more] optimistic about their careers and the future than they did at earlier stages of the pandemic,” he said.   

McKinsey research shows the aesthetics injectables market has historically grown by more than 10 percent each year, and the sector is projected to grow 12 to 14 percent each year for the next five years, globally. Additionally, the consulting firm estimates that the market penetration is only around 5 percent. 

The state of Tennessee started requiring all medical spas, or “medspas,” that offer cosmetic medical services to be registered in 2016. There are 77 licensed in Davidson County, including 20 added in the last year. 

After maintaining a practice in Memphis since 2015, Skin Body is getting in on the Nashville market, spending more than $1 million on new equipment for its West End office that opened earlier this month. The company offers Botox, cool sculpting, fillers, microneedling, nonsurgical facelifts and skin care treatments. 

“The pandemic did nothing but increase our business,” said Skin Body owner Tomi Beckemeyer. “I felt a little guilty actually, but people seeing themselves on Zoom — that’s a real thing. They started picking themselves apart.”

The company employs five nurses in Memphis and two more in Nashville – all who formerly worked in hospitals or doctor’s offices. 

“I was one of the first aestheticians in Memphis to go to work for a physician so I learned directly with nurses and physicians,” Beckemeyer said. “I’m all about rigorous training. They have to be very well trained to be able to operate these devices. My girls are, they’re very well trained and they get great results.”

Maltby credits her ability to switch fields to luck and personal connections, though not every nurse has the same opportunity to find a way to the growing and less stressful sector. 

“You get to help people feel better in their skin,” Maltby said. “Then you also get this artistic, creative side that so many nurses bring to their practice. Typically, you’re not working holidays, you’re not working weekends. You have a pretty nice nine-to-five job and you can go home and eat dinner at a normal time, you can go to bed at a normal time and live like a normal human.”