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Ask Maddy: Nurses working in cosmetic medical and surgical procedures

Ask Maddy: Nurses working in cosmetic medical and surgical procedures

Madeleine Harradence, Assistant Secretary of ANMF (Vic Branch)

Nurses are increasingly working in the cosmetic medical and surgical settings (including in laser therapy). ANMF (Vic Branch) strongly encourage members working in this setting to seek guidance and representation with respect to their industrial rights. Further, the ANMF professional team recommends members refamiliarise themselves with their professional obligations and seek advice and support for professional concerns as soon as they arise.

What is my scope of practice when working in this setting?

Individual scope of practice will vary between practitioners, based on:

  • Foundational education (the education that led to registration as an enrolled nurse or registered nurse, or for endorsement as a nurse practitioner)
  • the health needs of the people receiving the treatment
  • the level of competence and confidence of the individual practitioners
  • the policy requirements of the service provider/employer
  • relevant legislation (such as drugs and poisons legislation)
  • Nursing and Midwifery Board of Australia’s (NMBA) registration standards, standards for practice, codes, guidelines, and position statements (such as the Position statement on nurses and cosmetic medical procedures).

Members are encouraged to review the relevant NMBA documents (linked above and below), to collaborate with their colleagues, to discuss scope of practice with their employer, and to seek advice from the ANMF professional team. If you are ever unsure about the procedure or nursing activities you are being asked to assist with or to undertake, seek advice.

Nursing and Midwifery Board of Australia – Professional standards (

Nursing and Midwifery Board of Australia – Frameworks (

Source: Nursing and Midwifery Board of Australia fact sheet – scope of practice and capabilities

Do I have individual Professional Indemnity Insurance (PII) coverage as an ANMF member when working as in cosmetic medical and surgical procedures?

It is a requirement of the Health Practitioner Regulation National Law (the National law that governs and regulates health practitioners in Australia) that appropriate professional indemnity insurance arrangements are in place when practising the profession.

When practising, there are two categories of PII arrangements: your employer’s PII arrangements (third party), and your own PII arrangements (individual coverage as an ANMF member).

Exclusions on ANMF PII cover (individual coverage) apply with respect to cosmetic injectables (however titled) (for example, Botox/Dysport/dermal filler injectables) and laser therapy.

Members are strongly encouraged to seek written confirmation and detail on the PII arrangements in place with your employer to ensure your practice with that employer is covered in its entirety.

For nurse members working independently as sole practitioners in this field, you will likely have to source a separate PII policy to cover your practise in the event there is a claim made against you, and to ensure you meet registration requirements and the PII Standard.

For further information on PII please refer to:

Professional Indemnity Insurance – make sure you are covered

ANMF Vic Branch Professional indemnity and public liability insurance

Nursing and Midwifery Board of Australia – Fact sheet: Professional indemnity insurance arrangements (

Are midwives able to work in the area of cosmetic medical procedures (such as administering cosmetic injectables)?

The Nursing and Midwifery Board of Australia states that ‘it is not within a midwife’s therapeutic model of care to work in the area of cosmetic medical procedures’ (Position statement on nurses and cosmetic medical procedures).

I’m not sure my employer has appropriate governance, training and policies in place. What should I do?

‘Nurses are responsible for making professional judgements about when an activity is within their scope of practice and, when it is not, for initiating consultation and collaboration with, or referral to, other members of the healthcare team’ (Nursing and Midwifery Board of Australia Decision-making framework for nursing and midwifery).

When making decisions on your individual scope of practice there needs to be consideration of the health status of the person, the lawfulness of the activity (example, drugs and poisons legislation), and compliance with evidence, professional standards, regulatory standards, policies and guidelines.

Importantly and in addition to this, there also needs to be review of the context of practice and the health service provider/employer’s policies and protocols, as well as the organisational support when performing all nursing activities. Organisational support includes safe levels of staffing, as well as appropriate skill mix.

If you have not been provided appropriate training, and there aren’t systems in place to maintain competence with respect to certain nursing activities, then raise this as a matter of urgency with your employer. Members are encouraged to keep written record of when they raise concern with their employer, to follow up if these concerns haven’t been addressed, to confirm who their nursing reporting line is on each shift, and to see how escalation is reflected in written policies and protocols of the workplace.

If the employer does not have policies and protocols in place then it is difficult to make an appropriate assessment as to whether a nursing activity can be safely undertaken. Similarly, if there aren’t appropriate systems of work or reporting lines then you should raise this with your employer and seek advice from your colleagues and your union.

My contract says I am obliged to pay back training fees to my employer if I resign within a certain timeframe. Can they put this in my contract?

Employers may try to include terms in a contract of employment whereby payment of training fees or repayment of a training loan is included. The contract may require that the member repay the training fees paid by the employer if they do not complete a minimum period of employment, or other such arrangements. For example, some employers may also insist on ‘restraint of trade’ clauses in which they will try and prohibit you from operating or working for a cosmetic business in a geographic area for a specified period after your employment ends.

Such clauses can only be valid if they are reasonable in all of the circumstances. It is best not to include such clauses at all in a contract. However, where the employer insists on such a clause as a precondition for employment, you should first seek advice to ensure that the clause is clear and limited in scope.

A training cost recovery clause should specify the maximum or exact amount of the training costs that can be recovered, and the training should be itemised. Such costs should reflect the actual training provided, and not be a potential punishment hanging over your head if you leave. For example, the amount of $20,000 would be totally unreasonable for a one-week or two-week course and some additional mentoring, whereas $1500 may be proportionate and appropriate.

Members are advised to carefully review any proposed contract of employment before agreeing to the terms contained within. An employment contract is a legally binding contract so you should not sign anything you have not fully considered. If you are unclear about a specific term in the contract then check this with your prospective employer and please reach out to the ANMF Member Assistance Team for help.

You are not required to return a contract of employment on the spot. In fact, you should be encouraged to take the time to carefully review the contract. Please keep copies of all position descriptions and your contract of employment as these documents set the framework for your employment, and can inform your scope of practice in that setting.