Medical spas and aesthetic clinics provide nurses with the opportunity to focus on wellness and to expand their role by providing services such as dermal filler injections. While this work can be rewarding, the pleasant environment and working with typically healthy patients may lead nurses to mistakenly believe that their risk of legal liability is low, especially when compared to traditional settings such as hospitals.
In reality, aesthetic nurses face significant liability risks. According to a 2026 report from NSO and CNA, the percentage of closed claims in the specialty of aesthetics doubled from 2020 to 2025 (2.2% vs. 2.5%). In addition, the average total incurred claim increased by 25.9%, from $104,132 to $131,148. To mitigate the risk of legal action, aesthetic nurses need to understand the importance of practicing within their licensure and be aware of potential liability areas specific to the setting. They can then take proactive steps to protect themselves.
The foundation: scope of practice
A core concept of avoiding liability in aesthetic clinics and med spas is to stay within the scope of practice for the state in which the nurse is licensed. Nurse practice acts define the activities nurses can engage in. These permitted activities can vary by state, so it is essential to understand specifics. For example, depending on the state, a nurse may be able to perform dry needling independently, with supervision in some cases, or not at all.
Nurses risk legal action when they practice outside their scope of practice. A common issue in the med spa setting is when a nurse unintentionally provides medical advice. It is also important to remember that even when the clinic is supervised by a physician or an advanced practice registered nurse, nurses employed by the clinic remain liable for their actions. Clearly defined roles, including delegation protocols that align with the scope of practice and best practices, are key.
Liability risk areas
Aesthetic nurses face risks in the following areas.
Patient selection. Nurses frequently screen patients for procedures. Failing to identify potential issues can result in inappropriate procedures being performed, leading to adverse effects. Screening is particularly critical in the case of intravenous and injectable therapies. For instance, a nurse may neglect to ask about a patient’s allergies. If the patient is allergic to hyaluronic acid, an ingredient in the dermal filler being used, they could suffer a serious allergic reaction.
Informed consent. Informed consent is more than a signature on a form. If nurses fail to reinforce information such as treatment risks, alternatives, and realistic potential outcomes related to the service, the patient can claim that they were not fully informed or did not understand the information.
Patient monitoring. Inadequate patient monitoring during and after the procedure can cause the nurse to miss early signs of complications. In addition, even when concerning signs are detected, the nurse may neglect to notify the physician or transfer the patient to a higher-level facility for care, creating legal liability. Failure to escalate care as needed is a particularly common cause of aesthetic-related claims. Other areas of concern include insufficient follow-up instructions for patients and, depending on the procedure, failing to contact patients the next day to check for adverse events.
| Documentation: a key defense tool |
Thorough, timely documentation is an aesthetic nurse’s primary tool for reducing liability risk. Documentation starts with patient consent and ends only after the final follow-up.
In addition to filing the completed consent form, record your discussion with the patient about their understanding of the treatment and its potential risks. Document all actions taken before, during, and after the procedure. This includes assessments, product lot numbers, dosages, injection sites, changes in the patient’s condition (and who was notified of the changes), and patients’ understanding of post-procedure instructions.
It is advisable to follow up with patients the next day. Also, document any post-procedure communications with patients, including texts and emails.
Most importantly, document any escalation of concerns regarding potential adverse effects experienced by the patient. Include details such as who was notified, the date and time, what actions were taken, and follow-up assessments and care.
Refer to the article for the entire list.
Source: Rollings-Mazza P, Williams T. Beware the dangers of cognitive bias. CorrectCare. 2023;37(2):12-13. |
Medications. Liability risks in this area include prescribing without authority, outdated standing orders, and improperly managing compounded medications (e.g., incorrect labeling, the ability to compound medicines is not within the state’s nurse practice act, or medicine is incorrectly compounded). Nurses may also incorrectly divide a medication or not provide sufficient education to patients.
Documentation. Inadequate documentation can significantly impact legal action against a nurse. Even if the nurse acted appropriately and is not at fault for the adverse outcome, a lack of supporting documentation limits the ability to mount an effective defense.
Delegation and supervision. Improper delegation and supervision of unlicensed personnel can significantly increase an aesthetic nurse’s liability risk. For example, a nurse may assign a task to an employee who is either not qualified to perform it or is not permitted to perform it under regulatory and legal guidelines.
Misconduct. Engaging in professional misconduct can prompt legal action or action against a nurse’s license. Marketing materials are of particular concern in the med spa and aesthetic clinic settings. Nurses are not to promote misleading claims about the provided services. They also have a duty to report unsafe practices, so they can be held liable if they fail to speak up.
Reducing liability
Aesthetic nurses can take several steps to reduce their risk of liability.
Adhere to the scope of practice. Practice within the state’s scope of practice and stay informed about any changes in scope, as well as legal and regulatory developments, that may arise in this expanding field. One resource is a website maintained by the American Med Spa Association (
https://www.americanmedspa.org/legal-updates/).
Understand others’ scope of practice and ensure that roles and responsibilities are clearly defined. For instance, it should be clear what each member of the staff is responsible for. Know that requirements related to physician or advanced practice registered nurse oversight can vary. Ensure that the environment where you are practicing adheres to legal and regulatory requirements in this area.
Conduct quality assessments. Before the procedure, ask patients about allergies, medical history, and medications (including over-the-counter medications and vitamin and herbal supplements). Although the clinician providing the service is responsible for obtaining informed consent, ensure that patients understand the procedure, including risks, before asking them to sign the consent form. In addition, monitor patients closely during and after the procedure and report any concerns promptly. This includes alerting providers of any problems found on follow-up phone calls or texts.
Follow standards and best practices. Adhere to best practices and standards such as those from the American Nurses Association. Pay particular attention to medications. For example, handle compounded medications appropriately, and do not divide medications improperly. Do not perform procedures you have not received sufficient training in.
Adhere to protocols and standard operating procedures. Ensure standing orders are current (reviewed at least annually) and appropriate. There should be a procedure for managing emergencies, including criteria for when patients need to be transported to another facility and how transport should occur. Ensure the clinic has the necessary emergency equipment and follow infection prevention guidelines (e.g., proper care of sharps). Periodically check emergency equipment and general equipment, such as lasers, for functionality and follow the manufacturer’s instructions for use and care.
Delegate appropriately. Delegate only in alignment with others’ scope of practice and abilities. Do not give responsibilities to those who are not qualified to assume them by skill or law. For example, nurses cannot delegate patient assessments to non-licensed personnel.
Provide patient education. Provide education both verbally and in writing or digitally in the patient’s preferred language. Ensure patients understand the material before leaving the facility.
Continue your education. Before embarking on a career in aesthetic nursing, obtain the necessary skills. For example, states usually allow registered nurses to inject Botox under direct or indirect physician supervision. Still, before doing so the first time, you would want to learn more about injection components, facial anatomy, and possible adverse effects.
Periodically assess your current competencies, particularly those related to managing adverse events, such as anaphylaxis and laser burns, that rarely occur. Complete continuing education programs to gain or upgrade your skills. One resource is the International Society of Plastic and Aesthetic Nurses, which holds an annual meeting and may be helpful for networking with others in the field.
Consider obtaining certification, particularly for specialized treatments such as lasers. Examples of certifications include certified aesthetic nurse specialist and certified plastic surgery nurse. Keep records of education and certifications.
Follow ethical and professional guidelines. Represent yourself accurately to avoid patient confusion. Wear a name badge with your credentials. Do not “oversell” potential outcomes of procedures. In addition, protect patient privacy.
Maintain professional liability insurance. Your coverage should include both legal action and action that a board of nursing might take against your license. Review your policy annually to ensure you have sufficient coverage, and if you become aware of pending legal or board action, notify your insurance provider immediately.
A network of protection
Aesthetic nurses may falsely believe that their risk of legal liability is low. However, claims in this specialty have been rising, making it imperative that nurses engage in preventative action. Implementing strategies such as practicing within scope, following standards and guidelines, completing through assessments, reviewing competencies, engaging in continuing education, and documenting fully (sidebar), nurses can help reduce their risk. Many of these actions also serve to keep patients safe and help nurses meet their ultimate goal: quality patient care.
Lynn Pierce, FNP-C RN, Risk Management Consultant, NSO
This article does not constitute legal advice.
References
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