Journey from NICU Nurse to Aesthetic Nurse Practitioner: Racquel Frisella

These examples are intended to provide information and inspiration for your journey and are not a recommendation or endorsement. 

You could say board-certified nurse practitioner and aesthetic specialist Racquel Frisella was born for her career.

“I am a caretaker at heart, so I've always had a natural draw to medicine,” says Frisella, who specializes in injectables, lasers, body contouring, and skin care at a plastic surgery practice in St. Louis, Missouri. In high school, she took anatomy classes and even shadowed a neighbor who worked as a neonatal nurse, which Frisella went on to become in 2009.

But she’s also had a lifelong passion for aesthetic treatments, even from a young age. For Frisella, Medical Aesthetics is the perfect blend of her two passions. “It gives me the opportunity to take care of people and to combine it with my artistic skills,” she explains.

See how Frisella’s experience transitioning from NICU nurse to board-certified nurse practitioner and aesthetic specialist may help you take that leap into a career in Medical Aesthetics. Here are her best tips based on her journey.

Know which type of practice is the best fit for your nursing skills.

It's true that in most states (always check your state guidelines for more information), once you're a registered nurse (RN), you are also automatically a nurse who can inject. But the setting—a hospital vs an aesthetics practice—plays a large role in shaping what you do and how you do it. In both settings, you're following and adhering to core nursing skills—assessing, evaluating, and treating—as well as being actively involved in patient care and always putting safety first, according to Frisella. She appreciates how working in an OR (Operating Room) taught her to think on her toes in an emergency. “If I'm doing an injection and have an adverse event, I know what to do,” she says.

The biggest difference between being an NICU nurse and an aesthetic nurse is that you’re providing a concierge service. “Aesthetic treatments are rarely covered by insurance and patients are spending money to see you, so there is definitely a certain expectation and level of service that you have to provide,” Frisella says. “You also want to cultivate loyal customers, whom you treat throughout all of life’s milestones and who may recommend you to their friends and family. Unlike in a hospital where you might treat a patient that you'll never see again, in private practice you have to be willing to go the extra mile to make personal connections,” she notes.

Invest in the right schooling and training.

The first step on Frisella’s career path was a bachelor's degree in nursing from the University of Missouri. She then worked as a neonatal nurse at Barnes-Jewish Hospital for about three years, during which time she began taking certification courses to learn more about neurotoxins and fillers. After handing her resume and cover letter to every reputable practice in town, she got her first aesthetics job at a med spa, working part time while continuing as a NICU nurse. “That's where I started getting my on-the-job training,” Frisella mentions.

She also received product training from pharmaceutical reps and took hands-on courses. A few years after juggling the two jobs, Frisella dove into aesthetics full time, going to work for the plastic surgery practice where she still works to this day. She also went back to the Goldfarb School of Nursing at Barnes-Jewish College for an additional two and a half years to earn a master's degree and become a nurse practitioner.

Take steps to stand out when seeking to land your first job in aesthetics.

It’s tricky to get experience in aesthetics when you can’t get hired without experience, “so you’ll want to put all these things on your resume to show that you’ve invested time, money, and energy into learning more about the field,” Frisella notes. She shares 5 tips:

1. Master anatomy. “Whether it's from books, Google™, or whatever, study muscle anatomy, facial anatomy, muscles, vessels, nerves—really work on educating yourself on all of those things,” Frisella advises.
2. Seek training. Next, she says to “take as many virtual and hands-on training courses as you can.”
3. Shadow another injector. “Offer to be almost like a medical assistant for someone for free,” she says. To find a shadowing opportunity, reach out to local injectors to see if you can come observe. “Shadowing will give you some real insight into what this field is all about,” Frisella explains. “Everyone thinks it’s so glamorous and fun. And it is fun, but it's really hard work, too.”
4. Start networking. “You have to network to find your ‘in’ somewhere,” she says. So even if it’s only part time, not the hours you want, or not your ideal practice, it can still get your foot in the door so you can work your way up to that job you have always wanted.
5. Get on social media, particularly Instagram®. “You can learn so much about this field by following key opinion leaders and injectors across the country,” Frisella notes.

Consider seeking out a reputable practice provider vs going it alone.

You may be happy to hear that once you’re a nurse, you can move into cardiology, oncology, urology, aesthetics, or another medical specialty—and there's no further certification required. The downside is that you don’t get any specific preparation for your choice of specialty in nursing school.

“The bulk of your training is going to come from on-the-job experience,” Frisella explains, “and that's why it's really important to align yourself for your first job with a reputable practice provider like a surgeon, a dermatologist, or a medical director; someone who can take you under their wing and give you mentorship and training.”

You won’t get that if you try to go solo right off the bat. “You really do need somebody to guide you and show you,” Frisella says. “Just like at the hospital, in the NICU, they don't just set you loose on premature babies right away. I worked under a nurse for three or four months before I saw my own babies, and it’s the same thing in aesthetics. You want to work alongside somebody first and really learn what you're doing, and then you can branch out on your own.”

Go beyond standard on-the-job training.

“You have to be a self-starter in this field,” Frisella says. So, on top of the experience of your first job and product training from pharmaceutical reps, go the extra mile to learn more—ideally through third-party training from top injectors. “I think that's one of the best resources,” she says.

Identify the top injectors in your area and reach out to them, checking their website or Instagram® to see if they offer hands-on, one-on-one training, or a training program. “There’s a lot of good information out there,” Frisella adds. “Just make sure the provider is credible.”

To vet providers, check websites like provider websites, reviews, and Instagram®. Check out the provider’s experience, how long they’ve been injecting, and their before-and-afters, as well as their patient reviews. “Just as you would if you were looking for a reputable provider, look at their work: look at the quality, look at their training, look at their education, and put some feelers out,” Frisella explains. “Word of mouth is huge.”

Be prepared to refer patients to other practitioners.

Even if you perform a wide range of services, some people will need things you can’t provide. “If I see a patient who isn't a candidate for filler or neurotoxin, but rather something surgical, I have the most amazing surgeon that I can send them to right across the hall,” says Frisella, noting that the practice also has aestheticians and laser specialists. “We can take care of patients from every angle, and that’s one thing that's really nice about working for a plastic surgeon or in a bigger practice, rather than being independent.”

If you are an independent injector, make those connections within your community. “So, if you come across a complication or someone who just needs a different treatment, you can cross-refer—whether it’s to a laser specialist, a good plastic surgeon, or a dermatologist,” Frisella says. “Heaven forbid, but if there’s a vascular occlusion, I have a great ocular plastic here that I would refer to should that happen. Just because they're not in your practice doesn't mean you can't have those relationships.”

Conduct your patient consultations very thoughtfully.

For Frisella, the consultation is huge. “That’s where you're making the personal connection,” she says. And it starts with listening. “You want to sit down, take the time, and have the patient tell you why they're there,” she explains. “If they're one of those people who's just like, ‘I want everything,’ get them to focus; ask, ‘what's your number one priority?’”

Next is education. “Education is the biggest part of my consultation—I teach patients about why they're seeing whatever the issue is and walk them through the anatomy part of it,” Frisella explains. Then, she suggests treatment options and explains what they involve. “If it's a filler, I start with the basics: I explain what filler is, how it works, what kind of filler I want to use,” she says. “Then I go over all of the pre- and post-treatment instructions, and what they can expect before, during, and after.”

Start the consultation even before your patient walks in the door.

Integral to Frisella’s business success is pre-screening her patients before they come in by reviewing photos they’ve sent to her Patient Coordinator. Reviewing patient photos before their first appointment helps Frisella achieve two things: 1) she helps to set the expectations of the patient ahead of time, 2) she may refer her patient to a more suitable provider for the procedure, for example her plastic surgeon.

Frisella will also send patients a lot of information in advance to help shape their expectations. “My patients get injected the same day, most of the time,” she adds. “I talk about their treatment, and we do the treatment. Then they're off, and I see them back for a follow-up.” The pre-screening helps Frisella move through her “long waiting list of patients” more efficiently.

Here’s the official flow: when patients reach out, their first touchpoint is usually with Frisella, who sends them to her Patient Coordinator. They collect very specific photos—in a certain lighting, in certain positions; then they review and assess the photos, make recommendations, and offer ballpark pricing. “That really helps too, because a lot of people just have no idea of the cost,” Frisella says. “Maybe they thought the treatment they wanted would cost one thing and they find out it is going to be exponentially more expensive, so they might choose not to come in at all, which helps you make the most of your time in the office.”

To further your career, consider pursuing an advanced degree.

I have RN injector friends all over the country who are at the top of their game,” Frisella says. “But if it's something that you want to do, there are perks in your career to getting an advanced practice degree.”

Further degrees include an advanced practice nurse (APRN) or a nurse practitioner (NP). Another route is physician associate (PA). Any of these may earn you higher pay, for starters. “It also opens the door for you to do more things and have a little more autonomy,” Frisella says, such as prescribing. “I can prescribe medications, and I can do some of the treatments that a doctor would do,” Frisella says. She adds that an advanced degree may be required for performing certain services, such as heavy-duty lasering.

When Frisella became a nurse practitioner, she was able to choose one of several pathways: family nurse practitioner, adult nurse practitioner, or pediatric nurse practitioner. She chose adult nurse practitioner because she already knew she’d be working in aesthetics. Once she graduated from nurse practitioner school, she still needed to get board-certified from one of several certifying bodies—do a little research to find the one that fits you best. Then prepare to renew it every five years, or as the board and state guidelines require.

Choose your medical director wisely.

Most states require a medical director for practices that perform injections. (Check with your State Board of Nursing to make sure you’re following the protocol for your state.) But not just anyone will do. The medical director is a physician who oversees your practice and helps in the event of complications or legal matters. “Your medical director is basically the backbone of the practice, so this should be a very experienced person,” Frisella says, adding that this is where people can go wrong. “It's not a good idea to pick an MD for a medical director who has no knowledge of or experience in aesthetics.” Ideally, your medical director should be a board-certified plastic surgeon or dermatologist, or someone very experienced in aesthetics, who can truly help you in the case of an emergency complication or a liability situation.

Take advantage of the newer tools and resources.

Frisella laments that she didn’t have the support that’s more readily available now. “I wish I had had something like Spark,” she says, noting that it’s a source for trusted information that can be a guiding tool.

“There are great books out now, and there are third-party trainings you can do. You can also hop on Instagram® and get lost there for hours looking at some of the really awesome nurse injectors who use their platform as educators,” she says. “You can just sit there and learn and learn and learn.”

Learning from other experts in the field is Frisella’s favorite way to pick up new pearls of wisdom. “If I see that a doctor whom I respect is demonstrating a new technique, that is something I want to know more about,” she notes.

Professional societies are also a good place to get information, read articles, and hear about conferences and events. “Those events are a great place to meet people, network, and learn,” Frisella says.

Invest in the future of the industry by sharing your expertise.

Frisella remembers that, while shadowing in nursing school, there were two types of practitioners: ones who would take you under their wing, and ones who seemed annoyed that you were chasing after them. “That was the worst feeling ever, and I vowed back then that I wouldn't be like that,” she says. “I vowed to be the nicest, most helpful educator once I knew what I was doing. And I have kept that in my heart.”

Frisella knows firsthand how instrumental mentors can be. “The plastic surgeon I work for has been a huge mentor for me throughout my career,” she says. “I've learned so much just from watching how he interacts with patients. And I hope to do that for someone else.”

Consider starting a blog to address common questions.

Frisella started a blog a few years ago to showcase her work and offer information. “The main reason I started it was for education, to give my patients good insight into what these treatments are, and what they're coming in for,” she says.

It also makes her job easier. “When you start to have people reaching out asking, ‘What's this? What's that? What do I need?’ It’s impossible to answer every single question every time,” she says. The blog has articles that answer all those questions, so patients have easy access to that information.

If you want it, work hard to make it happen.

If you’re looking to enter the Medical Aesthetics industry and if this is your passion, Frisella encourages you to persevere. “If you see this as your dream job, you just have to go for it and do everything you can to make it happen,” she says. “I know for some people it can seem overwhelming or like it's never going to happen, but if you want it badly enough, do the hard work to make it happen."