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11 - The Role Aesthetics Medicine Plays in Healthcare: Virtually Shadowing an ARNP Injector in Cosmetic Medicine | Heather Stancil, ARNP

• Ashley Love • Season 1 • Episode 11

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Unlock the secrets of a fulfilling career transition with Heather Stansel, an advanced registered nurse practitioner who shares her remarkable journey from pediatrics to aesthetics. For anyone considering a career in nursing or contemplating a shift in specialties, Heather's story offers valuable insights and practical advice. Hear firsthand how a simple high school aptitude test set her on a path that would eventually redefine her professional pursuits.

Discover the intricacies of moving from one medical specialty to another, as Heather recounts her experiences and the challenges she faced during her transition. Her move into aesthetics wasn't just about mastering Botox and fillers; it was a deep dive into communication and confidence, skills she honed in pediatrics that seamlessly translated into the world of aesthetics. Explore how her ability to soothe anxious parents became a transformative tool in building trust with her aesthetics clients, offering a unique perspective on patient care.

Addressing social media's impact on self-worth, Heather delves into the essential conversations medical professionals must have with patients seeking aesthetic treatments. Join us as we explore the collaborative spirit within the aesthetics industry, where diverse opinions and teamwork lead to enhanced patient outcomes. Be inspired by the rewarding nature of helping individuals overcome insecurities and gain confidence, and learn how you can connect with Heather and other professionals for more insights. Don't miss out on this enlightening episode and join our community on social media for future updates and discussions.

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Ashley :

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face and what drives them in their careers. It's access you want and stories you need, whether you're a pre-health student or simply curious about the healthcare field. I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations, so make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped, and follow us on Instagram and Facebook at Shadow Me Next, where we will review highlights from this conversation and where I'll give you sneak previews of our upcoming guests.

Ashley :

Today, I have the pleasure of chatting with Heather Stansel, an advanced registered nurse practitioner who's made a great transition into the world of aesthetics. Heather shares her journey from her early days in nursing to how she combines art and medicine to help patients look and feel their best. We'll explore the flexibility of a career in nursing, the realities of aesthetics training and how she builds confidence and trust with her patients. Heather also shares her vision for the future of aesthetics and advice for anyone considering a career in aesthetics medicine. Stick around until the end, where Heather describes how she manages patient expectations and discusses the importance of self-worth in cosmetic medicine.

Ashley :

Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. Hey, heather, thank you so much for joining me today on Shadow Me Next. How are you doing? I'm good. How are you? I'm really good. Thank you for being here with us. I know your time is valuable and you have a lot to offer, and I think you have a lot of really great things to share today that are important for not just students, not just pre-health students, but important for just the regular person too. I think these are questions that have come up in conversation, and these are questions that we really wish we had a medical professional that we could ask.

Heather:

Of course, Any questions you have, I'll be sure to answer.

Ashley :

Thank you, Heather. So tell us how your journey in medicine started. Did you always know that you wanted to go into medicine? How did that look?

Heather:

I think it wasn't something I always knew, I want to say my senior year in high school, when we had to sit down and take those aptitude tests, what kind of matches these careers to your personality and what your future would look like. And I think that's really the first time nursing became a thing for me. And then, of course, like a lot of nurses, when you're out in the hospital world it gets a little physical and you think, oh, I can't do this forever. And then you decide to become an NP, and I think that's how it was for me. It wasn't always an NP dream of mine, it just kind of came naturally over time.

Ashley :

Is that a pretty common thing that you found working in nursing to where you know? Maybe it didn't turn out the way you wanted it to, or perhaps your life goals have shifted a little bit? Have you found that a lot of your colleagues end up becoming nurse practitioners?

Heather:

Yes, I do. When I decided I wanted to be a nurse, I wanted to do pediatrics and that was always my job that I dreamed of. And I think a lot of people kind of start off with that idea and once you try it out you're like, oh, maybe that's a little different than I thought it would be and let me try something new. And that's the great thing about nursing is that you can kind of venture out a little bit and see what works better for you with that period in your life yeah, no, that's true's true.

Ashley :

And I think that that's where training, generally speaking, is so important. And from the beginning I've talked to people who thought they wanted to become a doctor initially, and that's a very reasonable dream. And then either they shadow a doctor or they start researching about the schooling that's required and they shift. Or perhaps they start in nursing and then they realize that's required and they shift. Or you know, perhaps they start in nursing and then they realize that's not what they want to do and they shift. Or maybe they're in school to become a nurse practitioner and they're looking at pediatrics and they realize, hey, pediatrics is a lot of talking to parents and really not so much hands-on with kids, and then they shift, you know.

Ashley :

So I think the flexibility of medicine early is a really interesting topic and I'm really glad you brought that up. It's not set in stone initially, but it can be set in stone later. So have you? Right now you are working as an aesthetics nurse practitioner. Have you always worked in that field as a nurse practitioner, or has that changed? Is there flexibility there too?

Heather:

No, I have not always done aesthetic. I actually did pediatrics for probably close to five years. So yeah, I do think you can make a career change, but it probably does kind of have to be earlier in your career. You don't want to stick to one thing and do it for 30 years and then have to start over. It's going to be kind of hard to get into if that's where none of your experience is from.

Ashley :

It's true I've had a couple of friends in life that have done exactly that for one reason or the other. A lot of times it's because their current place of practice has either closed or significantly changed leadership and they've shifted fields, not just specialties. So a PA, for example, that I worked with she started off in emergency medicine, urgent care, and she had done that for almost 20, 30 years and then the urgent care shifted. They had new management coming in and it was just not a comfortable, safe environment for her anymore and so she started working in dermatology and she said you know, ash, working in the urgent care, I saw a lot of dermatology. I saw a lot of things in urgent care rashes and cysts and abscesses, things like that rashes and cysts and abscesses, things like that. But she said it's like a whole new world actually being in this specialty and specializing and it's a lot.

Ashley :

But I think in school and I'd love to talk to you about your scholastic experience but I think in school we learn how to be flexible and we learn how to shift and learn new things. We learn how to learn is the easiest way to say it. And she said you know, after 30 years being out of school. I still remember that. Tell me about what your schooling looks like and how you kind of arrived at where you are.

Heather:

I became an RN, I just did associates two years and started working in the hospital, and then a lot of nursing programs are online, so I was able to get my bachelor's degree online. In order to get into a nurse practitioner program at least back when I did it you had to have at least two years working in that field before a program would accept you. So once that happened, it was an additional two years to get my master's, so six years total.

Ashley :

But there was a little break in there to kind of get some experience in before you could get into a practice program it seems like so much schooling, but and I'm sure it was so much schooling, which is nice though that you can kind of offload doing other things and I'm sure financially it was really nice to be able to have that job while you were in school, kind of continuing to bring in money as money was also going out, kind of a revolving door of finances. Did you have any experiences, either while you were in nursing school or getting your nurse practitioner degree, that you stopped and you said I definitely don't want to do that part of nursing?

Heather:

Yeah. So for me the whole pulmonary part of nursing was very confusing to me, like the blood gases out just kind of went over my head a lot of the time. So I knew I could never be a nurse anesthetist. I know a lot of people went that route and are doing great, but for me that just didn't click very well, like cool didn't love my GYN internship, I think maybe I just wasn't at a very great place where I was learning a lot, but for me that was a specialty that didn't quite, you know, get me very excited for whatever reason. So yeah, there were a few instances like that for sure.

Ashley :

Thanks for sharing that. You bring up two really interesting points. So when I talk to people about their experiences in school and if they had any fields or patients, even where they knew it was a hard stop, a lot of times they talk about those exact two things that you just mentioned. It's education related and it's places related, right? So for example, for me, on the last episode, I was talking to Hector Bird and I told him I said, hector, I failed my endocrine test in PA school. I did. I missed it by two questions, so it's hardly bombing, but I did fail it. And I said, because of that, I knew I was absolutely not interested in endocrine. And God bless the people that work in endocrinology because in my head they are geniuses. I just do not get it. And much like you said, the blood gases, it's just, there are certain concepts of medicine that we have an understanding of, but you can bet I am going to send any of my patients with any of these problems off to a specialist for that. Send any of my patients with any of these problems off to a specialist for that. So that's one reason education. You know, it's just, the concepts are just not clicking for you.

Ashley :

And then the other one which to me it's it's a little bit more upsetting are the experiences on rotation right? So places, I agree with you. My OBGYN rotation was rough and I went and worked as an OBGYN PA for a number of years after my OBGYN rotation, but it was just hard. I think it was because of the place and, like you said, I think yours was because of the place, whether it's the support from your supervising physicians or the leaders on the medical team that you're working with, or perhaps the amount that they let you do, or perhaps the amount that they let you do, or maybe the things that they force you to do, which is never any fun the patients, the procedures. I think being on rotation sometimes can make or break. But I just want to encourage whoever's thinking about medicine that your experience at one place is not necessarily your experience at the next. So keep that in mind when it comes to places. Now, education do you love blood gases? I still hate endocrinology. I can't really speak to that.

Heather:

I think we made the right choice there. But yeah, definitely can be different in different areas like, can be different in different areas, absolutely.

Ashley :

So let's talk about aesthetics. You were working in pediatrics and at some point you decided, hey, you know I'm ready for a little bit of a career shift, were you afraid?

Heather:

yes, it for me. I made the switch. It was during the pandemic, I had just had a baby, so there were a lot of big changes going on around me. Anyway, I think I just kind of didn't want to go back to the craziness after I was on maternity leave and I had you know, I had lasers done before.

Heather:

And I always thought like this just seems like such a fun environment to work in. So I think that's kind of just what pushed me to finally take the class and see if it was a fit for me and I haven't looked back.

Ashley :

Mobility, and you know we talk about being able to shift around careers. Like it's. You know you wake up on the right side of the bed instead of the left side of the bed, and it's not. You know. We've already talked about this a little bit. What kind of preparation, what kind of course did you have to take, if any, to shift from pediatrics to aesthetics?

Heather:

Well, there's a few different ones out there. At the time I don't think there were a lot being offered, but you know, there's courses like a basic intro to Botox or basic intro to filler, and then they get a little bit more advanced. So you kind of started I started with just a basic Botox and filler course, did a little practice and then took some more of the advanced courses and got a job and that's kind of how you get your experience and you got to do it wherever you can what?

Ashley :

in your opinion, was there something that stands out as the biggest learning curve with? With stepping into aesthetics?

Heather:

I think it's a field where you know people are nervous, they're very concerned about their look. So it was kind of different in that aspect of how I presented myself. Like you definitely have to be able to communicate well and show your confidence, to kind of calm them down and trust you, and that was different than what I was used to in working in PEDS.

Ashley :

Different, but I bet you, I bet you there were certain elements that were very much the same. And I'm thinking about a parent comes in with their sick child and you know that the child is not life or death sick and the parent thinks that they are right. The child has 104 temperature and their cough sounds like it's from the depths of hell and but the kid is sitting there playing, looking at you, smiling and laughing, and the parent thinks that it's the end of the world. And yet you know, because of your practice, this child's fine, this child's playing and smiling, and so you kind of have to take what you see clinically and and boil it down for the parent, who is very scared and concerned, and I'm sure that a lot of those skills translated over. It's just a different topic, right, and it's a different type of fear You're right, that's very true.

Ashley :

So what does your schedule look like? What does a day working in aesthetics? What does that look like?

Heather:

It's typically the majority of people getting Botox. I do have a few 15-minute follow-up appointments where somebody has had treatment a couple weeks before and we're just you know, checking up to see how they're doing, taking some after photos, and then probably two to four people a day getting filler, which is an hour-long appointment because they have to numb for it. It doesn't start a little bit longer, but I would say majority are those 30-minute people getting talked.

Ashley :

Are most of them geared up, ready to go excited about it, or do you have a lot of patients that come in and they are scared right?

Heather:

Yeah, especially if they haven't done it before. I do kind of have to, you know, do some amping up of them if they don't really know what to expect, or even if they're just new to me or they've never had filler in their lips before and they're scared. It's going to look crazy. Those people are nervous, but the majority of people are very excited to be there and ready to go.

Ashley :

Absolutely. So what does kind of like a Botox appointment look like? Do you talk to the patient about what they expect every single time, or do you have some patients that walk in and you know what they want and they know what they want, and so you just get after it?

Heather:

Yeah, you get regular for sure. If I know them, we kind of catch up and do our little girl talk, but if not, typically start with taking some before photos, asking them to explain to me where the areas on their face they want me to try to work with I do some marking. Let them know about how many units of Botox I think they need. Then we draw it up and make our injections. It typically takes about two weeks to kick in. You want to avoid exercise for the first 24 hours and like flat for four hours. So there's a few little instructions I have to give people who aren't regular. You know that people are getting it for a while. You don't have to give that education every time, but for somebody new you definitely want to kind of warn them of the things not to do.

Ashley :

Which is really good medical practice. Patient education is a huge element and there is patient education in aesthetics. I think that's a really big deal huge element. And there is patient education and aesthetics. I think that's a really big deal. And I think a lot of times, the patient education and aesthetics is they really have to listen to it. And I think a lot of times, you know, patients will walk away with their educational pamphlets and they'll say, okay, well, you know, out the door, I'll leave it in my car under my seat.

Ashley :

But that's why it's so important to discuss these things with them face-to-face and kind of explain why we're talking about the things we're talking about. It's huge. It's not just in primary care or dermatology, it's in aesthetics too, and I think that's a really important element of it. Heather, how do you manage patient expectations? I think this is one of the most tricky questions I've ever wanted to ask an aesthetics provider is when you have a patient come in and they've seen all the TikToks and all the videos of people with this, that and the other done and they sit down and they start explaining these things to you and you realize that this is not going to be what's best for this person? How do you manage those expectations when they have unrealistic goals?

Heather:

yes, and that happens a lot, as you can imagine. Honestly, you have to be able to communicate really well. Yeah, to listen to what they're telling me, because my idea of what they're saying may be a little bit different than the way they think they're communicating it. So this is so important to have clear communication with the patient on what they're expecting or telling them. Honestly, I don't think you'd be a good candidate for this. A lot of that TikTok and social media stuff just really is inaccurate as well?

Ashley :

do you have conversations about self-worth in aesthetics at all?

Heather:

yeah, yeah. I think as a woman, we're just so hard on ourselves and it's almost kind of sad to see a lot of times when there is a flaw that somebody is focusing on and we are able to fix it for them, it's almost instant how their eyes will find something else to focus on that they won't fix next. So yeah it is a lot of trying to build these women up and make them feel good about themselves. It's really easy to pick ourselves apart.

Ashley :

We see that in dermatology too, and you know, at our dermatology practice we do not do any aesthetics, which I'm grateful that I have people like you that I can send these patients to, that know exactly what you're doing and have had all the practice I have seen. And I'd be interested to know if the age of your clientele has started to decrease. Very, very young people, mostly girls, but not always A lot of boys too coming in wanting X removed or Y quote, unquote fixed I really try hard not to use that term. None of us need anything fixed, right and a lot of them will have that conversation about self-worth and about what specifically is upsetting them about that feature of their body, and a lot of times I will send them over to the aesthetics professionals like you and have you guys also speak to them about this.

Ashley :

And I'm just so grateful to know that the conversation for self-worth and you probably experienced this in your pediatrics clinic but that conversation of self-worth and you probably experienced this in your pediatrics clinic but that conversation of self-worth they're not going to just hear it one time from their mom or their dad or their grandma. I hope that especially children, but also adults and older adults, hear this conversation over and over amongst all of their medical providers. I agree, heather. Tell me a story about when you had a patient come in and you were able to effectively communicate with them and determine the area that they wanted some treatment on, and tell me about how good it felt when they were so happy and thrilled with the final outcome. How did it feel? Is it just like ultimately so satisfying?

Heather:

Oh, absolutely, because you know those are times when you do feel like you're really making a difference, when you know somebody had this insecurity and you were able to get rid of it for them and you just see their face light up. So it's, like you know, a very rewarding job in that sense.

Ashley :

Absolutely. I want to pivot a little bit real quick and ask you about teamwork and aesthetics. Do you work in a practice where there are other providers doing different things or perhaps other providers doing the same things? What does that look like at your clinic?

Heather:

Yeah, so it's a little bit of both. I work at Dermalase Medical School in Ocala and, as of right now, there's three of us that are injecting and then we have two other girls that are estheticians, so they're doing the facials and the microneedling. Three nurse practitioners are doing the Botox and fillers, which is nice because it's very helpful to have other people to bounce ideas off of. I think in anything in red and black. It's kind of nice to have my first job in aesthetics. I was working on my own, so that was a little tough for me to really learn new techniques or be confident to try something new when I was on my own, versus when you're with other people. You can kind of be a little more confident to try this technique or something that they do that works for them, and it's a really nice environment to work in.

Ashley :

Yeah, I think it's. You know, we're all capable. We're all totally capable of working on our own as PAs. We have to have a supervising physician, but a lot of times, you know, the supervising physician isn't peering over your shoulder the whole time you're doing the exam. But you absolutely nailed it when you said that it is just so much better working in a team as opposed to working by yourself or bouncing off ideas or, you know, getting their opinion on something that perhaps they might disagree with you on.

Ashley :

I cannot tell you the number of times I have spoken to a colleague of mine specifically because I knew that colleague was going to have a different opinion. And it's so valuable to me because I think like I think, and sometimes I can try to see the opposite side of things. But a lot of times it's so helpful to have a trusted colleague say you know well, yes, you could inject filler in this part of her face, but if this is her concern, then why don't you consider injecting here instead? It's going to feel strange, but I think you're going to achieve a better result, something like that you know. So I think that collaboration people always think that it's collaboration because we agree and collaboration because we have a similar view. But so much of it is collaboration because I don't agree with them and I want to hear what they have to say. It's so great working as a member of a team, so tell me about what the estheticians do.

Heather:

That's a little bit different perhaps from what you're doing as an injector. So they're doing chemical peels, they're doing microneedling facials. It's nice because they are experts when it comes to like skin care. A lot of times I do bounce ideas off of them if somebody is having like a big rosacea problem or something that's not specific to my field, but they know more, so about the better products we can use on that type of patient, or just kind of give them advice on what they can do better for their skin.

Ashley :

Very cool. I love hearing about who people work with and the elements of the team and what differentiates us from them, and it's very interesting. I love hearing about that. Thank you for sharing, heather. This is a tough question. Are there any misconceptions that people have about aesthetic medicine that you wish you could just speak to and give them reassurance on?

Heather:

Well, I think it. You know, obviously there are a lot of people in the world that take aesthetics a little too far and maybe give us a little bad advertising. I would say, and I think there's just so many people that don't even realize you can do a little bit and have nobody notice, but it can definitely look very natural if that's the look you're going for. So that's kind of what I wish more people would consider instead of you know thinking that it's all giving us a bad rap in that way.

Ashley :

Now, heather and I did not discuss a quality question, but this brings up a really great question that I have received a few times on interview myself. The interviewer will see that I've had a history in dermatology, for example, as a medical assistant, and they will say so. Obviously, since you've worked in dermatology up until PA school, you must want to be a cosmetic dermatologist and I would encourage you to really explore your answer to that question. Yes, of course, I was interested in dermatology. That is what I wanted to do, but I was so excited about PA school and I was so excited about all of the different things I was going to learn. The fact that that interviewer pigeonholed me was something I was really able to discuss and elaborate on in my own interview.

Ashley :

Keep in mind that these quality questions are meant to help you develop your own cache of questions to prepare for for your own interviews, and there are so many more resources on shadowmenextcom, such as mock interviews and personal statement review, to help you answer your own quality questions. I think that's great. You know, you're absolutely right, and in every field, in every arena in life, there are people that take it too far. You know, good things in moderation. That's what I'm telling my four-year-old all the time. Granted. We're not talking about Botox. We're talking about M&Ms and chocolate chip cookies, but good things in moderation.

Ashley :

It's wonderful to treat ourselves sometimes and we can have fantastic outcomes because of it, and I think that I think it's very important, obviously in moderation, just like everything else. Exercise good things in moderation. I spoke to a physical therapist a couple episodes ago and I think she would totally agree with us. You know she sees plenty of people who have come in and they have exercise-induced injuries because they didn't, you know, pertain to this theory that it is exercise is fantastic for your body, but you can't overdo it. You shouldn't overdo it, because then you're going to run into some trouble. You're going to run into some problems. Where do you see the aesthetics field going in the next five to 10 years? What do you propose? Do you think it's just going to continue to remain the same? Do you think there's going to be new things out there that are exciting for people to try? Do you think we're going to pull back on it really hard? What are you seeing trending?

Heather:

I mean they're always coming out with new and exciting things, so I think it's going to keep progressing. Obviously, we can only go so far. We're not plastic surgeons. I think it probably will reach a point at some point, but I think it'll be a long time from now, because they're just all the time coming out with new products that can do these cool and amazing things so that you can avoid plastic surgery if possible.

Ashley :

Yeah, absolutely. That's exciting. Heather, what advice would you give to other nurses or nurse practitioners or even just other members of the healthcare network that might be interested in transitioning into aesthetics? What would you recommend?

Heather:

I'd say do it, take the course, see how you feel about it, if it's something for you or not. And obviously I think with anything in medicine you're gonna not be super confident right off the bat. You kind of do have to get some experience in before you feel like you really know what you're doing. So just kind of stay the course and get the practice in where you can.

Ashley :

I think that's a great piece of advice and really good recommendation. Take the leap, see how you feel, see if you like it as with all things, you never really know until you're in there doing it. But I think, as long as you really research what you are walking into and you talk to the appropriate people and you shadow if you can, it's a great field and I love how it combines art and medicine and you really get to make huge impacts in people's lives. So thank you and Heather, thank you so much for joining us today on shadow me next. It has been absolutely fantastic talking with you. It's been really great. Thank you so very much for listening to this episode of shadow me next. If you liked this episode or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday, as always. If you have any questions, let me know on Facebook or Instagram access. You want stories you need. You're always invited to shadow me next.

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