A ruling in the Victorian Civil and Administrative Tribunal has confirmed that – contrary to AHPRA’s official position – registered nurses working in cosmetics can qualify as nurse practitioners.
The outcome of a recent Victorian tribunal hearing could set off a domino effect that will see a sharp rise in nurse practitioners working in cosmetic medicine, despite no formal training protocol.
This will have particular ramifications for nurse-led cosmetic clinics in Queensland, which cannot order or hold stock of S4 cosmetic injectable medicines unless there is a registered doctor or nurse practitioner on site.
The state of play
Nurse practitioners have hitherto been about as easy to find as hen’s teeth.
As of last year, there were just 3194 endorsed nurse practitioners registered across the entire country.
It’s roughly the same as the estimated number of nurses who work in cosmetics – but there isn’t much overlap between the two.
That’s by design.
In 2022, the Australian Nursing and Midwifery Board adopted a position statement which indicated that registered nurses intending to become nurse practitioners while working in the area of cosmetic medical procedures were “unlikely to meet the requirements for endorsement”.
This, it said, was because the board considered that doing most cosmetic medical procedures (e.g., cosmetic injectables) does not count as working at an advanced practice level.
As a consequence, most registered nurses working in the cosmetics space have been precluded from endorsement as a nurse practitioner.
“What was happening was people would do their qualification, which is a formal qualification through a university or the like, complete [the mandatory] 5000 hours [of practice] and make an application for registration,” lawyer and former AHPRA investigator David Gardner told The Medical Republic.
“And then the board would say, ‘No, you’ve been mostly working in cosmetics. And our position statement says that means it’s not endorsed’.
“There wasn’t a lot more detail given – it wasn’t, ‘We’ve done an assessment, and we think 3200 hours of your advanced practice are fine and 1800 are not’.
“It was just, ‘You work with cosmetics, and therefore no’.”
The case
Enter Victorian nurse Nektaria “Nicky” Tzimas, who has been working in non-surgical cosmetic medicine since 2008.
In July 2022, the Victorian branch of the nursing and midwifery board knocked back her application to become a nurse practitioner.
She appealed the decision in the Victorian Civil and Administrative Tribunal.
In a ruling released earlier this month, the VCAT came down in favour of Ms Tzimas.
Crucially, it found that because the board’s position statement was just that – rather than a ministerially-approved registration standard – it was inappropriate to treat it as an inflexible policy position.
“… Section 95 [of the Health Practitioner Regulation National Law (Victoria)] establishes two pre-requisites for a nurse to qualify to practice as a nurse practitioner, being an approved qualification and compliance with the Registration Standard,” the VCAT decision read.
“The definition of advanced nursing practice in the Registration Standard recognises that a nurse can practice at an advanced level ‘within a generalist or specialist context’.
“… While it is appropriate for the Board to provide guidance to the nursing profession that the routine practice of cosmetic medical procedures is ‘unlikely’ to meet the requirements of advanced nursing practice, we consider it goes too far in stating that practice in that area ‘is not working at the advanced practice level’ (emphasis added).”
The tribunal ordered the nursing and midwifery board to set aside its refusal to endorse Ms Tzimas and substitute it with a decision that she is, in fact, endorsed as a nurse practitioner.
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What it means
Prior to 2025, Queensland’s Medicines and Poisons Act 2019 was commonly interpreted as allowing medical cosmetic clinics completely run by registered nurses to hold stock of prescription-only cosmetic injectables so long as a nurse practitioner or doctor – who could be working via telehealth – made the order and wrote the prescription.
It has since been clarified that only prescribers can buy S4 cosmetic injectables to hold as stock at a clinic if they are physically working there and can exercise exclusive custody.
The rule change has meant that clinics which were already set up to be run entirely by nurses, potentially with a doctor prescribing via telehealth, have had to either hire a doctor to work onsite or have started to send patients to external pharmacies to have their Botox or filler dispensed.
It’s driven up prices, alongside concern that patients will turn toward the burgeoning cosmetics black market.
While Queensland is the most prominent example, this could happen in other states too.
Opening up a pathway for the nurses already working in cosmetic medicine to be endorsed as nurse practitioners would go some way toward solving the issues many nurse-led clinics currently face in states like Queensland.
“In general, nurse practitioners have greater rights to prescribe and also possess drugs,” Mr Gardner said.
“Because that’s one of the issues with some of these cosmetic clinics, is that the doctor prescribes this, but then the nurse actually allowed to possesses [those injectables] in the particular circumstances of the clinic.
“I think, if practitioners are able to demonstrate that they’re practising the advanced level and get endorsed, it does open up the ability for them to be operating these kind of clinics.”
While the Tzimas case doesn’t automatically make all nurses working in medical aesthetics eligible to become nurse prescribers, the decision is likely to stop the board from rejecting those applications ad nauseum.
“This is a monumental achievement in terms of acknowledging that, actually, you can work across different areas, and working as a cosmetic nurse is not making you less of a registered nurse than somebody who’s working in another area,” Cosmetic Nurses Association president Sheri-lee Knoop told TMR.
“What it doesn’t automatically do is allow room for advanced practice in cosmetic nursing. So you’re not going to be able to apply as a nurse that works full time in a cosmetic nursing space, at this stage, for advanced practice in cosmetic nursing.
“And the reason for that is there is no recognised education pathway in cosmetic nursing. There’s no recognised pathway that you can take as an avenue to cosmetic nursing.”
This is changing, she said, with Monash University having opened a postgraduate course in cosmetic medicine for nurses and doctors last year.
“Now it makes sense to start putting together a nursing framework for cosmetic nursing, and that will give younger nurses, registered nurses entering the area of cosmetic nursing, a distinctive pathway for their education,” Ms Knoop said.
At the heart of the issue for practitioners like Ms Knoop is that cosmetics, as a field, exists somewhere between medicine, wellness and big business. It has not traditionally been taken seriously.
“It’s a hybrid area of medicine where people are not sick, they’re not unhappy, they’re not debilitated, and so we’re dealing with happy, healthy people,” she said.
“There’s a fine line between what is business and marketable, and what is medicine.”
