New CNA Study Reveals Soaring Liability Risks for Medispas and Their Nursing Staff

A new national study by CNA and the Nurses Service Organization (NSO)* has revealed a sharp increase in professional liability claims against nurses working in medical spas (medispas) and aesthetic settings. The 2025 Nurse Professional Liability Claim Report (5th Edition) paints a concerning picture: aesthetic nursing claims have doubled since 2020, and the average cost of settlements has jumped nearly 26%.

These findings signal a growing crisis for both medispas and the nurses who power them — one driven by rapid industry growth, evolving state regulations, and a widening gap in compliance and clinical oversight.

Rising Claim Costs and Growing Exposure

According to the report, aesthetic and cosmetic nursing accounted for 4.5% of all closed claims, up from 2.2% in 2020, with average payouts increasing from $104,132 to $131,148.
The trend mirrors similar surges in other outpatient and elective care environments, such as home health and urgent care, where autonomy is high but oversight can be inconsistent.

CNA attributes the escalation to factors such as:

• Nurses performing procedures beyond their legal scope of practice
• Insufficient medical supervision in privately owned medispas
• Delayed escalation of complications
• Text or social media communication with patients instead of formal documentation channels

Real-World Consequences

The report cites cases where aesthetic treatments led to catastrophic outcomes and costly settlements. In one example, a nurse injector performed dermal filler injections that resulted in tissue necrosis. Instead of immediately contacting her supervising physician, she continued to advise the patient via text message. The delay led to permanent disfigurement — and a settlement exceeding $875,000.

Such cases underscore how well-intentioned nurses can face devastating legal and financial consequences when clear protocols and documentation are lacking.

Practical Steps to Reduce Risk

Homewood Insurance Group urges medispas and aesthetic nurses to take proactive steps to protect both their patients and their professional reputations:

For Nurses:

• Stay within your scope of practice. Know your state’s supervision and procedural limits.
• Never perform treatments without a written order or physician protocol.
• Document every step, including consent, lot numbers, dosages, and post-procedure communication.
• Avoid texting or messaging clinical advice; use approved communication systems only.
• Invest in continuing education and keep certificates for every new aesthetic technique.
• Carry personal professional liability insurance that includes license defense coverage for cosmetic procedures.

For Medispa Owners and Operators:

• Ensure proper medical oversight — your medical director must be actively involved in patient care protocols.
• Create and enforce written clinical policies for assessment, escalation, and emergency management.
• Conduct regular compliance audits and chart reviews.
• Confirm your insurance covers aesthetic and elective procedures — many general business policies exclude them.

The Insurance Impact

As liability severity increases, insurers are tightening underwriting standards and raising premiums for aesthetic practices. Policies now scrutinize:

• Staff training and certification records
• Supervision ratios
• Documentation and consent procedures
• Use of approved injectables and devices

For nurses, the rise in claims means that carrying individual malpractice coverage — rather than relying on an employer’s policy — is more critical than ever.

Conclusion

The CNA report* offers a timely reminder that the glamour of aesthetic medicine comes with genuine medical and legal risks. With better protocols, supervision, and personal coverage, both nurses and medispas can continue to thrive in this fast-growing field — safely and sustainably.

*Source: CNA & Nurses Service Organization (NSO) – Nurse Professional Liability Claim Report, 5th Edition, 2025.