Why I Built the Alliance of Cosmetic Nurse Practitioners
Every day, nurse practitioners enter the aesthetic industry hoping to escape burnout, only to recreate the exact conditions that drove them away from bedside nursing in the first place. They spend thousands on Botox certification courses, apply for jobs that require two years of experience they don't have, and are ultimately told to "just start your own business", as if entrepreneurship is simpler than employment. Within two to three years, most of these NPs are either burned out again or bankrupt, abandoning aesthetics entirely. This cycle is the predictable result of three systemic gaps in cosmetic nursing education: nursing schools ignore skin of color dermatology, dermatology training programs exclude business fundamentals, and aesthetic courses dismiss the value of advanced nursing practice. Most cosmetic NPs are entering a field without the comprehensive education, mentorship, or community support required to build sustainable, ethical, profitable practices. The Alliance of Cosmetic Nurse Practitioners was founded to disrupt this pattern. We address all three gaps simultaneously, providing graduate-level clinical education with an emphasis on skin of color, evidence-based business strategy, and a professional network designed to keep nurse practitioners in business. This is the story of why I built the Alliance, what I learned watching nurse practitioners struggle in isolation, and how we're creating a new model that transforms cosmetic NPs from overwhelmed solo practitioners into confident founders building businesses that generate wealth, serve their communities, and honor the clinical expertise they worked so hard to earn.
I scroll through social media for nurses every day. Not because I'm looking for content ideas. Because I need to see what's really happening out there.
This morning, I saw this post:
"I'm an RN with 20+ years of experience. The emotional toll is too heavy. I need positive direction."
And right below it:
"Newbie here! 13 years in L&D. Just graduated NP in 2024. Taking the leap into aesthetics."
I see these posts every single day. Burned-out nurses looking for an escape. New NPs hoping aesthetics is the answer. Experienced providers trying to figure out how to make it work.
And here's what breaks my heart: I know exactly what's going to happen next.
They're going to spend $2,000 on a Botox training course. They're going to get certified. They're going to apply for aesthetic NP jobs. And they're going to hear the same thing over and over:
"We need someone with at least two years of experience."
So then what? They're told to start their own business. Just like that. As if starting a business is simpler than getting hired. So they do. They launch. They become solo injectors. They work nights and weekends. They handle the marketing, the scheduling, the inventory, the bookkeeping, the patient care, all of it. Alone. And within two to three years? They're burned out again. Or worse, bankrupt. And they abandon the industry entirely.
This cycle is completely avoidable.
But it requires something most cosmetic NP training programs don't provide: comprehensive education that addresses clinical excellence, business acumen, and the unique needs of treating skin of color.
That's why I built the Alliance of Cosmetic Nurse Practitioners™.
The Three Gaps No One Is Addressing
I was like you. I wanted to build a business helping to solve patients' problems. But the more I learned, the more I realized there were massive gaps in our education and training.
Gap #1: Nursing school ignores skin of color.
We learn about "normal" skin. We learn about melanoma detection on pale skin. We learn textbook presentations that don't account for the fact that conditions present differently on Black and brown skin. When I started studying dermatology, I had to teach myself how to recognize, diagnose, and treat conditions in patients who looked like me. If you can relate, I invite you to download our list of Essential Dermatology Textbooks for Skin of Color from the Mahogany Dermatology Nursing Bookstore.
Gap #2: Dermatology training doesn't include entrepreneurship.
You can learn every injection technique in the world, but if you don't understand pricing strategy, client retention, marketing, financial planning, or systems that scale, you're not building a business. You're creating a high-paying job that only works if you show up.
Gap #3: Cosmetic training doesn't care about your nursing experience.
You come into aesthetics with years of clinical expertise, assessment skills, patient education, critical thinking, evidence-based practice, and it's treated like it doesn't matter. You're told to just learn the injections. Your advanced practice training is ignored. Your nursing judgment is undervalued. You take a huge pay cut just to get your foot in the door. Nursing school ignores skin of color. Dermatology training doesn't focus on business or entrepreneurship. Cosmetic training ignores advanced nursing practice.
We've experienced all three gaps. That's why I built a methodology that addresses all three.
The Pattern I Kept Seeing
As I started mentoring NP entrepreneurs and watching the aesthetic nursing industry evolve, I saw the same patterns repeat:
Cosmetic NPs are getting sold an escape from burnout, only to create a new job for themselves.
Having to pay to play, spending thousands on courses, certifications, and memberships, and still not receiving the visibility and credibility they deserved.
Being told the same advice over and over: "Take a Botox course. Start your own business."
But no one tells you that you need two-plus years of experience to get hired. No one teaches you what it actually takes to build and exit a business. No one prepares you for the financial reality of solo practice. And here's the thing that really got me: there were some really great NPs doing excellent work in isolation, and some struggling NPs making the same avoidable mistakes, and everyone was operating in silos. I thought: What if everyone was in one stadium, like the Olympics? What if instead of scattered scrimmage games, we had one place where cosmetic NPs could come together, share knowledge, set standards, and keep each other in business?
What if I was the lady who built the stadium?
Why Structure Matters
I strongly believe the quality of our practice is a direct reflection of the quality of our education. As practicing clinicians, we all recognize our constraints when it comes to doing it all. There are so many gaps to fill in NP education, and there's only 24 hours in a day.
So I made a choice: I chose to build a medical education business and partner with clinical advisors who have demonstrated a level of excellence in their practice and business. Together, we provide comprehensive education with an emphasis on skin of color, business acumen, and digital fluency.
That's why the Alliance is structured the way it is:
We specialize in didactic education, business strategy, and research. Our clinical advisors provide the clinical expertise in areas like PRP, advanced injection techniques, laser treatments, and other specialized services. We're not trying to replace your clinical training. We're building the infrastructure around it so you can practice with confidence, scale with integrity, and build wealth without burnout.
We aim to leverage our collective numbers to increase awareness, respect, compensation, opportunities for funding and investment, discounts on education, and most importantly, to keep each other in business.
Because here's the truth: far too many NPs in cosmetics go bankrupt or burn out in the first two to three years. I believe that is completely avoidable. But it's very difficult to do without proper education, mentorship, or community. I know we all work too hard not to enjoy the fruits of our labor.
What Changes When You Join The Alliance
When you join the Alliance, here's what shifts in your life:
You stop waking up anxious about whether you're doing this right. You have protocols for skin of color, pricing strategies that work, and systems that scale.
You stop feeling like an imposter. You're surrounded by nurses at every stage, some just starting like you, some already scaling to multiple locations, and everyone validates your journey and celebrates your wins.
You stop sacrificing time with your family. You learn how to build a business that serves you instead of consuming you.
You stop being invisible. Your credibility increases because you're part of a recognized network. Your visibility grows because we leverage each other's platforms to amplify our collective voice.
You stop working in silos and suffering in silence. You finally experience what it feels like to be seen, heard, and cared for the way you care for everyone else.
This isn't about getting more content. This is about transformation. Helping you go from where you are to where you want to be.
From invisible to influential.
From overwhelmed to in control.
From working harder to building smarter.
From isolation to community.
What We're Building Together
The Alliance offers ongoing coaching and mentorship either before or after you start clinical training or practice. Whether you want to build a business on the side or start an empire, we're here for you at every stage.
We provide:
Weekly workshops covering clinical protocols, business strategy, and financial literacy
Access to clinical advisors who have demonstrated excellence in their practice and business
Community support from NPs at every stage of their aesthetic journey
Research initiatives that advance the field of dermatology nursing for skin of color
Intensive training opportunities throughout the year (this year, we're focused on alopecia)
Business resources including templates, pricing guides, marketing strategies, and financial planning tools
A place where your nursing experience is valued and amplified
One month of membership costs less than one injectable training course, where you're left to figure it out on your own afterward. The difference? You don't have to figure it out alone.
Building Founders, Not Followers
I didn't build the Alliance to create more employees. I built it to create founders.
NPs who understand that aesthetic care is health care.
NPs who can treat skin of color with clinical excellence because they've been trained properly.
NPs who know how to price their services, manage their finances, and build businesses that generate wealth, not just income.
NPs who lead movements, not just medspas.
We're not here to help you fit in. We're here to help you stand out. You don't need to have it all figured out. You just need to be ready to stop doing this alone.
Join the Alliance so we can help you live the life you worked so hard for.
Need 1:1 strategic guidance? Apply for Mahogany Dermatology Nursing Consulting.
Want to talk first? Email me to book a complimentary mentorship session.
Let's build something that lasts.
About the Author
Dr. Kimberly Madison, DNP, AGPCNP-BC, WCC, is a Board-Certified, Doctorally-prepared Nurse Practitioner, educator, and author dedicated to advancing dermatology nursing education and research with an emphasis on skin of color. As the founder of Mahogany Dermatology Nursing | Education | Research™and the Alliance of Cosmetic Nurse Practitioners™, she expands access to dermatology research, business acumen, and innovation while also leading professional groups and mentoring clinicians. Through her engaging and informative social media content and peer-reviewed research, Dr. Madison empowers nurses and healthcare professionals to excel in dermatology and improve patient care
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