This report will focus on the mentoring of qualified nurses in aesthetic medicine. There are several obstacles when mentoring this group due to the financial implications involved and the lack of regulation and access to mentors for many nurses, who are usually self-employed within private healthcare.
Aesthetic medicine is a sub-specialism of plastic surgery that is only available in the private sector (Campion, 2012). Aesthetic medicine is a relatively young specialism when compared to cosmetic surgery (British Association of Aesthetic Plastic Surgery, 2019). There has been an increasing number of nurses choosing to specialise in aesthetic medicine (Di-Scala, 2017). As aesthetic medicine is classed as private healthcare, a large percentage of those nurses opt to be self-employed and will need to self-fund their training, mentorship and continuous professional development (Vilas, 2016).
Although it is not possible to discuss all aspects of mentoring within this report, it will focus on the key issues for this specialism. The common themes that will be discussed in this report are the lack of regulation for aesthetic medicine; the lack of support for nurses who specialise in aesthetic medicine; practical issues in mentoring; benefits of mentoring for aesthetic nurses; and the challenges for mentors within aesthetic medicine.
A systemic literature review was used to locate the best available literature on mentoring nurses in aesthetic medicine (Atkinson and Cipriani, 2018). The literature search showed minimal research specific to mentoring in aesthetic medicine. Aesthetic medicine often uses literature from other medical specialities for this reason. For this report, wider literature was reviewed and applied, focusing on mentoring nurses in general.
Lack of regulation in aesthetic medicine
It is important to understand the lack of regulation in aesthetic medicine in order to critically analyse and evaluate the role of the mentor within this specialism. Following Keogh's (2013) review of regulations in the aesthetic medicine sector, recommendations were published for improving safety by Health Education England (HEE) (2016). These recommendations state that clinicians will need to observe and then administer 10 of each treatment while under supervision. It was also advised that clinicians would be required to undertake examinations, including theory and practical, prior to achieving a qualification in medical aesthetics at Level 7 (HEE, 2016). Unfortunately, these recommendations are not mandatory and have still not been implemented.
The Joint Council for Cosmetic Practitioners (JCCP) was formed following the HEE recommendations. Clinicians and training providers were invited to join their voluntary registers to demonstrate that they met the standards set by HEE (2016). The JCCP (2018) states that the specialism of aesthetic medicine is poorly regulated, with no standard requirements for those administering treatments or those offering training in such procedures.
It has previously been identified that there was a global need for statutory regulation and governance in aesthetic medicine practice and training (Tan, 2007). This suggests that, for many years, there has been a clear need for better support for those who specialise in this sector.
Lack of support for nurses working in aesthetic medicine
According to the Nursing and Midwifery Council (NMC) (2018a), nurses must ‘prioritise people’, ‘practice effectively’, ‘preserve safety’ and ‘promote professionalism and trust’. Nurses who practise aesthetic medicine have mixed levels of competency and qualifications (Greveson, 2013). Greveson (2013) goes on to comment that many nurses in aesthetic medicine feel unprepared and isolated due to the current lack of educational standards and regulation. Soutter-Green (2013) stated that supervision and reflection in practice can enhance knowledge and skill; however, this can often be difficult for nurses to access and implement within aesthetic medicine. This is surprising as evidence-based practice and education are essential for all nurses in all specialisms and are part of the NMC code of conduct (2018b). Evidence-based education is a must for all nurses and is applicable to those specialising in aesthetic medicine (Harrison and Hotta, 2020).
» … it is essential to have a mutually agreed set of expectations for both the mentee and the mentor, as it makes the expectations of both mentor and mentee clear from the beginning, promoting a shared understanding «
Greveson (2013) acknowledges that nurses working in aesthetic medicine often work alone and can, therefore, feel isolated, and may need support and mentorship. Development is essential for nurses practising within the skilled specialism of aesthetic medicine (Jones et al, 2018). As Guinan (2019) advises, continuous professional development is pivotal to safe practice. All nurses must follow their regulatory body's code of conduct (NMC, 2018b). Nurses specialising in aesthetic medicine take full responsibility for their clinical practice and must be competent. Baker (2018) advises that nurses should embrace learning opportunities so that they can develop as specialist nurses in aesthetic medicine.
Defining mentoring in aesthetic medicine
As Clutterbuck (2014) comments, it is not easy to define mentoring. Modern mentoring is seen as when a more experienced person uses their knowledge to support and encourage learning and reflective practice in someone who is less experienced and knowledgeable, thus assisting with both their personal and career development (Roberts, 2000). This definition suits the views on mentoring in aesthetic medicine.
According to Connor and Pokora, (2017a), the mentor is usually more qualified and experienced than the mentee, and the focus is on the career and personal development of the mentee. There is some common ground between mentoring and coaching, which can be applied to aesthetic medicine. Both mentoring and coaching require well-developed interpersonal skills and focus on the personal growth and development of the mentee/coachee (Zeus and Skiffington, 2000). The common ground between mentoring and coaching is further reinforced by the nine key principles of effective practice for coaching and mentoring (Connor and Pokora, 2017a).
Nurses specialising in aesthetic medicine can face barriers that can impact on their ability to commit to mentorship. Such barriers can include finances (if paying for the mentorship), access to mentors and time constraints (especially if self-employed) (Davey et al, 2020).
Practical issues in mentoring nurses in aesthetic medicine
There are practical issues that need to be considered when mentoring in aesthetic medicine. Thomson (2014) stresses the importance of contracting for mentorship. It could be argued that this is even more applicable within aesthetic medicine, as mentoring is often a paid-for service. Therefore, it is essential to have a mutually agreed set of expectations for both the mentee and the mentor, as it makes the expectations of both mentor and mentee clear from the beginning, promoting a shared understanding (Barker, 2006).
Contracts for mentoring nurses in aesthetic medicine usually include the points made by Hawkins and Shohet (2012). This involves an agenda being set by the mentor after a telephone discussion with the mentee. Third parties are not often involved in setting goals for mentoring due to most nurses in aesthetic medicine being self-employed. On the rare occasion that a third party is involved, the mentor needs to be mindful of the potential issues that can arise, such as confidentiality.
The mentor needs to be aware of the mentee's areas of concern/lack of experience and tailors the day to cover these areas. Good practice would be to send an agenda to the mentee prior to the mentoring day to ensure the mentee is happy with the aims for the day. It is important that both mentor and mentee understand who will lead the direction of the session (Huskins et al, 2011). In the area of aesthetic medicine, mentees are usually keen to be directed and advised by the mentor, with time to reflect on practice.
Paid-for mentoring will usually take a more formal approach to the mentor/mentee relationship. Written agreements may include terms and conditions, such as cancellation fees for missed sessions (Geraci and Thigpen, 2017). Thomson, (2014) refers to third parties such as the employing organisation as ‘sponsors’. A sponsor may not have the same agenda as the mentee and may even brief the mentor about the specific aims of the mentoring relationship. If the sponsor is seeking feedback from the mentoring, there are issues surrounding confidentiality and this can place the mentor in a difficult position. This has the potential to put a strain on the mentor/mentee relationship. Thomas (2014) also points out that it could be argued that it is the organisation that is the client, not the mentee. The mentor needs to remain professional, ethical and transparent so that the expectations of all parties can be met.
The benefits of mentoring for nurses in aesthetic medicine
Mentoring is a two-way process, and the mentee needs to be prepared to be involved (Hudson, 2016). It is not just the mentee who benefits from mentoring. Roberts (2000) identified that there were multiple benefits from mentoring to both individuals and organisations where applicable in aesthetic medicine. Some of these benefits included improved performance, staff retention, increased confidence in mentees, personal growth of the mentee and more awareness of their role within the organisation. Not all of these are applicable to aesthetic medicine, as mentees will usually have their own businesses, rather than working for an organisation, but it will encourage reflective practice for the mentee.
Mentoring can benefit the mentor on several levels, including personal, work-related and academic development (Miller, 2002). Helping mentees to develop professionally can leave the mentor feeling positive, which increases their feeling of self-worth. Emotional intelligence can be developed through mentor training and the mentoring relationship with mentees (Miller, 2002). In regard to work-related benefits, the mentor will gain skills such as honesty, motivation and reliability, which are all attractive attributes to an employer. A mentoring role reinforces a mentor's knowledge and skillset. As mentoring within aesthetic medicine is provided externally, there is usually a charge for it. Therefore, there will be a financial gain for the mentor. There is very little research available regarding paid-for mentoring. However, Franks (2016) suggests that aesthetic nurses seeking mentorship need to focus on the quality of the mentoring, rather than the cost.
The challenges for mentors within aesthetic medicine
Aesthetic medicine training remains unregulated. It is thought that many of those who offer mentorship to nurses in this specialism do not have formal training or postgraduate study in mentoring. Connor and Pokora (2017b) comment that anyone can refer to themselves as a mentor, but most would prefer to undertake some sort of training before taking on the role.
The issue here is how unqualified mentors reflect on their practice and develop their skills to be effective in this role. Another concern is whether these mentors are self-aware and able to design a mentoring scheme (Clutterbuck and Megginson, 2004). Connor and Pokora (2017b) recommend a checklist, and mentors in aesthetic medicine can use this to evaluate their training and development needs. Examining their own experience, reflective practice, training, accreditation and professional networking can help aesthetic medicine mentors to identify gaps in their development.
» In comparison to other specialist areas of medicine, which are predominantly based in the NHS, there is a need for clearer recommendations and guidance on mentoring for aesthetic medicine «
Clutterbuck (2014) suggests that line managers should not be directly involved in mentoring, as the mentee may be reluctant to be open and honest, and the line manager may feel conflicted. This will be more of an issue in the NHS, but it rarely applies in aesthetic medicine, where the nurse receiving mentorship sources a mentor themselves.
Mentoring can be specific to the individual and their reasons for the mentorship. These factors will often influence the direction the mentoring relationship takes. Mentorship in aesthetic medicine often takes a more formal approach (Garvey et al, 2018). Some of the dimensions (Garvey et al, 2018) are pre-determined and tailored to suit the needs of the mentee and the subjects they wish to cover (for example, a specific injection technique).
Mentorship has been highlighted in nursing literature for nearly 40 years (Andrews and Wallis, 1999). There were eight domains of competency outlined by the NMC. These ensure that mentors were at the appropriate standard. The eight domains included ‘establishing relationships, facilitating learning, creating a suitable learning environment, evidence-based practice, assessment and accountability, leadership and the evaluation of learning’ (NMC, 2018c). The term mentoring has now been removed, and the NMC set new standards regarding the supervision and assessment of students (NMC, 2018c). This has created new roles, with a practice supervisor and a practice assessor supervising and assessing students on placement. An academic assessor is a university-based member of the academic team. While this is used in the NHS, it is also implemented in aesthetic medicine for nurses who are undertaking their V300 non-medical prescriber qualification. Nurses working in aesthetic medicine are now finding it difficult to find suitable practice assessors and practice supervisors who fit the university criteria for carrying out such roles.
Nurses do seek mentorship and guidance from more senior nurses within aesthetic medicine (Soutter-Green, 2013). The British Association of Cosmetic Nurses (BACN) is the largest professional organisation for aesthetic medicine nurses (Bennett, 2017). Their competencies are available to members, and there is a clear career pathway for practitioners, specialists and expert nurses (Baker, 2018). These competencies align to the NMC code of conduct and promote best practice using an evidence-based approach (BACN, 2015).
Garvey et al (2018) discuss the five types of power. Many mentors in aesthetic medicine are regarded as experts in the field, and even if they do not view themselves as ‘powerful’, mentees may feel in awe of them. Mentees may feel that the relationship is unequal because of this. Mentors need to be mindful of this and ensure that they are acting in the best interest of the mentee and not misusing their power.
Conclusion and recommendations
The main area of weakness for mentoring nurses in this specialism is the lack of regulation. Mentoring and coaching culture needs to be embraced. In organisations such as the NHS, leaders can act as ‘champions’ for mentoring (Law, 2014). So, who can champion mentoring in aesthetic medicine when most nurses are self-employed and do not belong to an organisation workplace? Davies (2012) argues that the Royal College of Nursing needs to support nurses specialising in aesthetic medicine in terms of training and education. The BACN encourages members to seek mentorship and offers its own shadowing programme. In comparison to other specialist areas of medicine, which are predominantly based in the NHS, there is a need for clearer recommendations and guidance on mentoring for aesthetic medicine. Those taking on the role of mentor need to develop the skills that are essential to be effective in this role and attend training on this.
There is a need for professionalism in mentoring (Garvey et al, 2018). Networking is not always used well by nurses within the aesthetic medicine sector, and the BACN arranges networking for members through its regional meetings. Nurses often work alone in aesthetic medicine, and the same can be said for those in the role of mentors. Networking enables the mentor to keep updated on clinical practice and meet other mentors in aesthetic medicine. Implementing the six aspects of development would help aesthetic medicine mentors to be more effective mentors (Connor and Pokora, 2017b).