The Wild Wild Texas: Long Gone are the Days of Monopoly

This post is in response to HB 3749 and and HB 3889 being proposed which would limit the role of the APRNs and PAs (NPs and PAs) in the Aesthetic Industry in Texas.  From what I understand, this bill proposition is purportedly in response to a deadly incident that occurred related to an I.V. given by an unlicensed person in North Texas.  My first reaction upon hearing about the incident: how incredibly sad.  My second thought: why on earth would an unlicensed person be giving an I.V. in a spa like setting?  Where was the doctor?  Where was the NP or PA?   

Taking away the initial involvement by highly trained, extensively educated, certified, and insured professionals is not the solution.  Apparently, the bill is generalized to include tighter stipulations on cosmetic procedures such as neurotoxin and dermal filler injections.  As a well-established Adult-Gerontological Nurse Practitioner with a thriving aesthetic practice for the past ten years, I find the introduction of this bill highly offensive.  This bill targets a specific area of nursing and medicine that happens to be lucrative, in high demand, cash pay, and incredibly specialized.  It eliminates decision making by top degreed individuals.

A similar bill is also being tossed around that allows physicians to partner with unlicensed people.  How incredibly embarrassing for our profession and state. Aesthetics is not a skill that can be properly delegated to a person who has not passed state boards, who has not been through skills labs, checkoffs, and clinical.  This is not something that can be carelessly picked up by a person who does not carry malpractice insurance, and who did not take an oath before God, family, and state to do no harm.  It takes years of experience, an incredible amount of monetary investment, years of relationship building, excellent credit, sound reputation, unique artistic talent, people skills, documentation skills, and the patience and dedication to building and perfecting protocols, policies, and procedures, research, and in my case, even a trademark.  Intellectual property is highly valued and held dear.  It also takes a genuine interest in helping others look and feel well and beautiful.  I’ve been told countless times that they chose me over a plastic surgeon because I get what they want and have the skills to safely deliver.  We value our high standard and the ability to work as a team with our collaborative physicians and RNs.  The practice of aesthetics to most NPs and PAs is not just a side gig.  Practicing safe aesthetics is what we eat, sleep, and breathe. It is not just bread and butter for my family (which is important as well) but it is a way of life for so many of us.  When I train new RNs I always explain that if they always put the client's best interest at heart, the prosperity will follow.  Under our care, what’s best for the client always prevails.  We will only offer the safest and most effective procedures and never ever upsell.  Good clinicians do not have to upsell.  I am very thankful that with my mobility in the profession that I can control what I do and don’t offer.  The new bill would take away my autonomy, which was the sole purpose of pursing an Advanced Practice Registered Nursing degree many years ago.  Our application of applied science is in our own right and should not be for sale or traded.  

I am proud to be offering a legacy of evidence-based outcomes, favoring more organic procedures.  I am determined to improve the overall practice of aesthetics by advocating for less invasive, safer alternatives to surgery, dangerous devices, and overuse of drugs.  Client education is very big in our practice.  People count on our professional opinion regarding new treatments, beauty gadgets, skin care, and the countless gimmicky devices that are approved by the FDA.  We have large audiences who count on us to give advice for their cosmetic wants and needs.  These are people who have prominent positions in our community and surrounding areas.  Doctors, nurses, judges, police officers, teachers, choose us because they trust us. If professional involvement in the care of our clients is jeopardized by what I believe is a small group of self- motivated individuals, there will be countless people negatively affected.  Not only the clients, but also the support staff and entities.  The fallout of something like this will be negatively felt throughout all our communities.  It will be talked about, blogged about, covered on the news, and petitions will be started for years to come.  There will be lasting damages to companies that have spent years and a minor fortune to build.  All seems like a very large punishment for something we had nothing to do with in a faraway place.  If this bill starts to pick up ground, we will be reaching out for letters, petitions, and various other forms of vocal support. Please educate those around us what they are trying to do to long-standing, safe and successful NP and PA practice in Aesthetics under the guise of patient safety. I would be interested to get demographics on the population pushing for something like this, vs the population being affected. I think we will find some interesting results.

Thank you and god bless.

Dana Koenning, MSN, APRN, AGNP-C

BoBeauty