An emergency nurse turned injector on the habits she kept from the hospital, the ones she had to learn as an owner, and why a two-person team changes how care gets delivered.
The assessment comes before the plan. A consultation room before the first appointment of the day.
I spent my clinical years in the emergency department of a teaching hospital before I opened my own practice. People sometimes assume aesthetics is a clean break from that. It isn’t. Most of what I do all day is nursing, and most of the habits I rely on came from that department.
The practice is a nurse-led med spa in Knoxville with two offices, in Bearden and Farragut. It started as one room in Bearden in March 2024. There are no investors. The full-time team is two people, me and my husband, who runs operations and marketing, along with a physician medical director who oversees the practice. I’m the only injector, and I work in the offices every day. That size shapes everything below.
The assessment comes before the plan
In the ER I didn’t read faces. I read the chief complaint, looked at the vital signs, assessed the patient, and asked where it hurt and what the pain felt like. That order matters. You don’t treat what you haven’t assessed.
A consultation at my practice follows the same order. I look at facial anatomy, we talk through what’s bothering the person, and then I make a recommendation that fits their goals. Most people come in because they noticed something in the mirror while doing their makeup or washing their face. They aren’t in crisis. They just want the line gone. The assessment still comes first.
For neurotoxin, that means checking muscle strength and anatomy in the chair rather than treating from a unit count someone found online. A number from a label or a study is background information. It’s not a treatment plan for the face in front of me. The same rule holds at the Botox-focused practice in Knoxville I run from the same rooms.
The laser portion of my practice works the same way. I also run a laser clinic at the same two offices, and people come in about unwanted hair, or brown spots on the backs of their hands, or redness that won’t settle down. We look at the skin and at what the person wants changed first, then set the treatment and how many sessions it will take.
Checking twice is slower, and it’s the job
Emergency nursing taught me to stay calm and to act quickly. It also taught me to check, and then check again. Repeat vitals. Rhythm checks during a code. Going back to the patient instead of trusting the last reading. Nobody in that department gets credit for being fast and wrong.
In aesthetics, checking twice looks less dramatic. It means going over medical history before anything is injected. It means reading the product’s own label with the patient instead of summarizing it from memory. Botox Cosmetic carries a boxed warning about toxin effects spreading beyond the treatment area, and anyone who has trouble breathing, swallowing, or speaking after treatment needs immediate medical attention. I’d rather say that out loud in every consult than assume someone read the paperwork.
Repeat vitals and a second look are hospital habits that fit a small practice just as well.
It also means I don’t call a result on injection day. Tox takes about two weeks to kick in, so there’s nothing honest to say about the outcome until then. I tell people that before they leave.
The weight-loss side runs the same way. I also run a medical weight-loss clinic in Knoxville from these offices, and no GLP-1 program starts there without a consultation that goes through medical history first. Only candidates are started. Patients begin at a low dose, and we adjust as we go, with monitoring and side effect management built into the program. The word in “medically supervised” that matters is the second one.
A two-person team can’t lose a patient in a handoff
Here is the part that is different from the hospital. In the ER, I stayed calm partly because the hospital was around me. Owning a practice feels different. It’s all on me. Some days that is uncomfortable. It is also clarifying.
When the nurse who assesses you is the nurse who treats you, nothing gets lost between rooms. There’s no report to give at shift change and no receiving nurse who may or may not pick up the phone. I remember what you told me at the consult because I was the one in the chair across from you.
The practice is growing, slowly. I balance the two offices myself, so I’m hiring a second provider to keep the rooms booked when I’m across town. I’m also hiring a licensed medical aesthetician. That posting asks for a Tennessee esthetician license in good standing plus a medical aesthetics certification or documented experience in a medical setting. An esthetician license alone doesn’t qualify. In a two-person practice, every hire changes the standard of care, so the bar is set before the interview.
Some of the hospital’s rules came with me unchanged. Staff complete HIPAA training and sign a confidentiality agreement before their first shift. Patient photos are taken only with written consent. The practice has a physician medical director. None of that is unusual for a hospital. It is less common than it should be in a small aesthetics office, and I think a nursing background is why it felt non-negotiable to me.
What the consult actually sounds like
The honest version of my consults is this. Many women come in wanting facelift results for very little money, and I bring the plan back down to earth. That conversation is easier for a nurse to have, because it’s the same conversation we have about blood pressure or a wound that isn’t healing. What it can do, what it can’t, and what I’d do first.
I believe in preventative treatment and in accentuating the features someone already has rather than altering them. Wanting to look your best isn’t vanity. Vanity is putting too much focus on appearance, and the excess in this industry is the person who injects far too much filler trying to become someone else. Done well, this work complements your natural beauty.
I’m working toward my Doctor of Nursing Practice while running the practice. The ER gave me the assessment, the calm, and the habit of checking twice. Ownership gave me the accountability. A nurse-owned practice does the same things a good hospital unit does. It just does them with fewer people, so there is nowhere for a shortcut to hide.
