Aesthetic Nursing - Frequently Asked Questions (2023)

Aesthetic care - Frequently asked questions

March 31, 2023

Please note that the content of the FAQ is currently under review. Contact us at 1-800-252-9392 or using the form below.

Modified Regulations and Standards

HeRegulation of Personal Servicesand thePersonal Service Standardsit entered into force on July 1, 2020 and establishes minimum health and safety requirements for the personnel services industry. All nurses performing cosmetic procedures and treatments should be aware of all requirements relevant to their practice, as outlined inRegulation and standards for personal services.

If you are the operator of a cosmetic care clinic and provide any of the services referred to in the Personal Services Regulations, you must notify the Regional Health Authority (RHA) by providing your name and contact details, address and location of the business and the types of personal services you offer. You must also notify the RHA before offering new personal services/activities. For more information, you should read the Regulations and Rules of Personal Services.

These FAQs were jointly developed by the Alberta College of Licensed Practical Nurses, the Alberta College of Registered Psychiatric Nurses and the Alberta College of Registered Nurses. Registrants from previous regulatory authorities should contact their respective organizations if they have any questions about this document or if they would like practical guidance on the subject.

Do cosmetic procedures fall within my nursing practice area?

The job of a registered nurse in Alberta is established within the legal framework and is further defined by the respective regulatory bodies. Performing procedures that are not within the purview of a caregiver can have significant professional and legal ramifications.

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The administration of neuromodulators such as Botox and dermal fillers are post-entry level skills and are not taught in entry level programs. Neuromodulators require custom ordering after initial evaluation by a licensed physician, e.g. B. a doctor, dentist, or nurse. Because cosmetic care procedures pose a potential risk to the patient, appropriate emergency support must be available.

The caregiver performing an aesthetic procedure has a skill set consisting of the following competencies:

  • a sensitive and respectful way of communicating, a positive, non-judgmental attitude, and caring behavior
  • thorough knowledge of the anatomy and physiology of the skin and underlying tissues
  • in-depth knowledge of the drugs and substances to be used
  • strong analytical skills and clinical competence in this field of activity
  • Provide honest and factual advice and advertising.

In Alberta, RPNs, RNs, and LPNs are licensed and trained to administer drugs and substances by injection. Orders from a licensed prescribing physician are required before a caregiver can administer drugs and/or Schedule 1 substances (eg, neuromodulators and dermal fillers). The nurse is responsible and responsible for making sure that she has the necessary training and experience to carry out the order.

In addition, the Alberta College of Licensed Practical Nurses requires that LPNs who provide cosmetic nursing procedures within their defined area of ​​practice must be directly or indirectly supervised by a physician or nurse. The doctor or nurse must be trained in dermatology, be on site, and available to assist if necessary when performing cosmetic procedures and treatments.

Is there a difference between aesthetic procedures and cosmetic procedures?

Yes. Many cosmetic procedures do not need to be performed by a licensed healthcare professional (eg, facials, waxing, piercing, tattooing, including semi-permanent makeup, etc.). These would not fall under the definition of nursing or health services, but are included in theRegulation of Personal Servicesunder thepublic health law. The person providing these personal services may not use the protected title of 'nurse' and these hours do not count as practice hours.

Do I need more training to offer cosmetic procedures?

Yes. Nurses must have the additional training to practice competently and ensure public safety. When admitted to practice, nurses do not have the skills or training to administer dermal fillers, plumpers, collagen stimulators, and neuromodulators (eg, Botox). Nurses must ensure that their education and training teach basic competencies, including best practices for infection prevention and control. On-the-job training may not provide the skills necessary to safely practice cosmetic nursing, as it requires specific training in the anatomy and physiology of the skin and underlying tissues, assessment, and knowledge of neuromodulators and fillers. dermal. Each nurse is responsible for ensuring that they have the necessary knowledge to practice safely, competently and ethically.

NOTE: CLPNA, CRNA and CRPNA do not endorse any particular training courseOffers that are currently related to the field of aesthetic care. It is the nurse's responsibility to ensure that any education and training she undertakes provides the basic skills to become competent to safely perform cosmetic procedures. RNs, LPNs, and RPNs are expected to acquire additional theoretical knowledge and supervised clinical practice related to procedures and treatments in the following areas (not including):

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  • Anatomy and physiology related to the treatment area
  • specific assessment of the dermatological patient
  • Medicines, pharmacology and technology for treatments
  • Treatment Complications and Appropriate Interventions

Documentation and record keeping: is it mandatory?

Yes. Caregivers must document the care they provide in an accurate and timely, objective, complete, and confidential manner. All documentation and records must comply with the documentation and privacy requirements defined by your regulator, employer policies, and state laws. These documentation expectations are the same in all practice settings.

Documentation is not separate from maintenance and is not optional. It is an integral part of nursing practice and an important tool used by nurses to ensure quality patient care. Nurses document patient-centered holistic care, including relevant components of the care process:

  • Assessment
  • nursing diagnosis
  • The plan
  • implementation
  • Assessment

Documentation is evidence that care has been provided and is required

  • communication between health care providers;
  • Compliance with professional and legal requirements;
  • quality improvement; AND
  • Investigation.

Do I have to obtain a declaration of consent?

Yes. It is very important that the client understands the risks, benefits and expected results of the treatment. Prior to performing any aesthetic care procedure, the caregiver must obtain informed consent from the client for the specific procedure. The consent must be valid, current and not revoked or revoked at the time of the intervention or treatment. Performing any procedure on a client without informed consent is considered illegal and may result in a professional investigation and/or criminal charges, whether or not the client is aggrieved.

For consent to be "informed", the caregiver must explain the procedure, including alternative options and disclosure of risks and complications. Consent must be voluntary and cannot be coerced by the client through undue influence or deliberate misrepresentation. It is the caregiver's responsibility to provide the service

  • assess the client's ability to understand the nature of the proposed procedure, the risks and complications, and the right to opt out. The consent will only be considered valid if the client fully understands what he accepts;
  • ensure that the proposed procedure is only available to a minor (under the age of 18) if prior parental/guardian consent has also been obtained and the treatment has been mutually agreed between the parent/guardian and the minor;
  • Obtain consent ethically and document accordingly. Reinstate consent if there are changes to the client's initial plan of care or if the client has changed their mind; AND
  • Consent for the proposed procedure must be obtained each time the procedure is performed.

It is important for the nurse to mitigate the risk of complaints and legal action by ensuring that consent is informed and the client's outcome expectations are considered before performing any procedure.

What are my infection prevention and control (IP&C) responsibilities?

Nurses must ensure client safety, including prevention of health care-acquired infections. If you practice in a clinic or have an independent practice, it is important to use IP&C best practices and follow IP&C guidelines.

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The following routine practices are an important part of IP&C and must be applied at all times:

  • Hand sinks and hand sanitizer stations should be available.
  • Follow the four moments of hand hygiene.
  • Make sure that the appropriate personal protective equipment is used for the procedure being performed.
  • Surfaces and equipment must be cleaned, disinfected and/or sterilized accordingly.
  • Disposable products can only be used once.
  • All waste, whether general or biomedical, must be disposed of safely and properly.

Many IP&C resources are available to ensure patient and caregiver safety.

What do I need to know about civil liability and self-employment?

The Canadian Nurses Protective Society (CNPS) provides CRNA members with professional liability protection, as well as legal advice, risk management services and legal assistance. CNPS only offers liability protection if you are providing professional care services. If you work with other healthcare professionals, you should ensure that each healthcare professional has adequate liability coverage.

RNs or NPs who maintain an independent nursing practice independently, in association with other professionals, or through the employment of others are considered self-employed.

Who can prescribe neuromodulators and dermal fillers?

Medicines on Health Canada's prescription drug list can only be prescribed by licensed and regulated healthcare professionals. In Alberta, these health professionals include:

  • doctors;
  • nurse practitioner;
  • dentists; AND
  • Pharmacists licensed to prescribe by the Alberta College of Pharmacy.

Neuromodulators, such as botulinum toxin, are Schedule 1 drugs and can only be prescribed by a licensed prescribing physician, as described in the Government Organization Law and relevant regulations for each healthcare profession. Some dermal fillers are classified as Schedule 2 drugs and do not require a custom order unless required by employer policy.

Nurses must be satisfied that the physician prescribing the neuromodulator or dermal filler is licensed by their institution to practice that practice.

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What rules apply to prescribers?

Licensed prescribers must adhere to standards of practice developed by their regulatory body. Standards of practice for doctors and nurses require that they personally evaluate a client before writing a prescription. Doctors and nurses may prescribe neuromodulators and other drugs from Health Canada's Prescription Drug List only after a client assessment has been completed. Physicians can only write a prescription for "practical use" if they personally care for the patients for whom they write an injection prescription. An office use medication (eg, a multi-dose vial) may be used for more than one patient visiting a clinic.

What should be taken into account when acquiring and storing medicines and substances?

Medicines and substances for administration by injection (prescription or not) must be obtained through legal channels (ie, through a pharmacy or pharmaceutical company). Medications and substances obtained by other means may not be the correct substances, may be past their expiration date, or may have been improperly stored, altering composition, safety, and potency. Pharmaceutical companies may have restrictions on who can get drugs and substances. A nurse should not use another health professional for acquisition purposes only. Caregivers should follow manufacturer's recommendations for storage and handling as outlined in standards, best practice guidelines, and manufacturer's recommendations.



Competency Profile for Licensed Practical Nurses
Approved practical professional nursing code.


Considerations for the provision of cosmetic services
Consent for treatment: the role of the caregiver
Professional Liability Protection
Quality Documentation: Your Best Defense


medical prescription practice
Practice Standards: Informed Consent
Practice Standards: Telemedicine


Documentation standards
Hand Hygiene Guidelines
Guidelines for the safety of injections of drugs and vaccines
Nursing Prescription Standards
Restricted Activity Standards


independent practice
Licensed Psychiatric Nurse Code of Conduct

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Proposed Standards of Practice and Guidelines for RNs, RPNs, and NPs to Administer Cosmetic Injections

alberta government

Prevencion and control of infections
Regulation of Personal Services
state certified nursing professional code

Government of Canada

Prescription Drug List


How do I become an aesthetic nurse after passing Nclex? ›

Here's a list of steps on how to become an aesthetic nurse:
  1. Enroll in an undergraduate degree program. Employers require any RN to have an undergraduate education. ...
  2. Take the NCLEX-RN exam. ...
  3. Apply for licensure. ...
  4. Obtain a position as an RN. ...
  5. Earn your aesthetic nurse specialist certification.
23 hours ago

What are the 6 C's of nursing interview questions? ›

Interviewee: Before your interview, you must ensure you understand the six Cs of nursing, which are: care, compassion, competence, communication, courage and commitment.

Is aesthetic nursing hard? ›

If you do not like school or taking tests, becoming an aesthetic nurse can be difficult. You must receive a Bachelor's degree, at minimum, and complete a licensing exam to start practicing. But if these requirements sound okay to you, you may not find the process very difficult at all.

What makes a good aesthetic nurse? ›

The role of an aesthetic nurse practitioner is highly interactive and requires great interpersonal skills to deal with daily tasks without extreme stress. Effectively communicating, resolving disputes, and ideal performance are all interpersonal skills that are vital to have in an aesthetics profession.

What is the highest salary for an aesthetic nurse? ›

Aesthetic nurses in California earn an average of $127,597 per year (or $61.35 per hour).
Aesthetic nurse salary range in California.
Annual SalaryHourly Wage
90th Percentile$170,425$81
75th Percentile$160,454$77
25th Percentile$101,831$48
3 more rows

Can a new grad be an aesthetic nurse? ›

Overall, aesthetic nursing is an excellent option for newly graduated or veteran registered nurses who are interested in exploring one of the quickest growing specialties in the medical field.

What is a 5 question for nursing interview? ›

NHS Band 5 interview questions
  • Why do you want to work with the NHS? ...
  • How might you deal with emotionally taxing situations in this role? ...
  • What is your priority when looking after patients? ...
  • Detail a time when you've had to work under pressure. ...
  • What is your proudest achievement in your nursing career to date?
Jan 17, 2023

What is the most important C in nursing? ›

Care is the first C; Care is defined as the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something. The primary duty of the nurse is to care for the patient. Amongst all the C's this is the most important.

What is the hardest type of nurse to be? ›

Most Stressful Nursing Positions
  • Intensive Care Unit (ICU) nurses. ICU is an extremely high-pressure environment and these nurses work with patients who have significant injuries and disease with added morbidity risks. ...
  • Emergency Department nurses. ...
  • Neonatal ICU. ...
  • OR nursing. ...
  • Oncology Nursing. ...
  • Psychiatric Nursing.
Jan 27, 2021

What is the hardest nursing class to take? ›

Hardest Nursing School Classes
  • Pathophysiology. In this course, students learn how different anatomical systems work and how diseases or injuries affect these systems. ...
  • Pharmacology. ...
  • Medical Surgical 1 (also known as Adult Health 1) ...
  • Evidence-Based Practice.

What is the hardest nursing profession? ›

The most stressful nursing jobs include ICU nurse, ER nurse, and NICU nurse. In these roles, nurses work in an intense environment with high stakes.

What are the 4 ways of knowing in nursing aesthetic? ›

The four ways of knowing are empirics—the science of nursing, esthetics—the art of nursing, the component of personal knowledge in nursing, and ethics—the component of moral knowledge in nursing.

What are the three qualities of aesthetics? ›

Aesthetics is a core design principle that defines a design's pleasing qualities. In visual terms, aesthetics includes factors such as balance, color, movement, pattern, scale, shape and visual weight.

What are some facts about aesthetic nurses? ›

Unlike a plastic surgery nurse, an aesthetic nurse is typically involved in in-office, non-invasive cosmetic procedures rather than surgical procedures. Other responsibilities of a cosmetic nurse include: Consulting with patients, interviewing, scheduling and conducting medical screening prior to providing services.

Where do aesthetic nurses make most money? ›

Where Do Aesthetic Nurse Practitioners Get Paid The Most?
  1. Alaska. Alaska is the state with the highest average salary for Aesthetic Nurse Practitioners. ...
  2. 2. California. Aesthetic NPs in California make $105,815 per year on average. ...
  3. D.C. ...
  4. New Jersey. ...
  5. Massachusetts.
Apr 18, 2022

Which RN specialty pays the most? ›

The Certified Registered Nurse Anesthetist consistently ranks as the highest-paid nursing career. That is because Nurse Anesthetists are highly skilled Registered Nurses who work closely with medical staff during medical procedures that require anesthesia.

Who are the highest to lowest paid nurses? ›

Highest Paid Nursing Jobs:
  • Certified Registered Nurse Anesthetist – $202,000.
  • Nursing Administrator – $120,000.
  • Neonatal Intensive Care Nurse – $120,000.
  • General Nurse Practitioner – $118,000.
  • Critical Care Nurse – $118,000.
  • Certified Nurse Midwife – $114,000.
  • Informatics Nurse – $102,000.
  • Clinical Nurse Specialist – $95,000.
Dec 5, 2022

What type of nurse is an aesthetic nurse? ›

An aesthetics nurse (also known as a cosmetic nurse) is a registered nurse (RN) who has specialized training in cosmetic procedures.

How do I start an aesthetic nurse? ›

These are the steps you'll need to take to get there.
  1. Step One: complete a nursing degree and get NMC registration. ...
  2. Step Two: get post-qualification nursing experience. ...
  3. Step Three: find an entry-level position in aesthetics, or undertake training. ...
  4. Aesthetic Nurse Injector/Independent Prescriber: ...
  5. Aesthetic Clinic Nurse:

What are your 5 weaknesses? ›

Here are some weaknesses that you might select from for your response:
  • Self-critical.
  • Insecure.
  • Disorganized.
  • Prone to procrastination.
  • Uncomfortable with public speaking.
  • Uncomfortable with delegating tasks.
  • Risk-averse.
  • Competitive.
Feb 15, 2023

What is the hardest part of nursing interview question? ›

The hardest part about answering why you want to be a nurse is that you need to be honest, without sounding trite. “I just want to help people” is a phrase that has been heard far too often in nurse job interviews.

What are three don'ts for an interview? ›

Don't do these things:
  • Don't be late.
  • Don't ask about other applicants.
  • Don't request salary information.
  • Don't smoke.
  • Don't chew gum/eat life savers, etc.
  • Don't slouch.
  • Don't criticize previous employers, professors, etc.
  • Don't dress inappropriately. (You must dress to fit in.)

How do I stand out in a nursing interview? ›

Nursing Interview Tips
  1. Know where you're going. Healthcare facilities are often big and confusing. ...
  2. Dress professionally. Professional attire tells interviewers you take them and the job seriously.
  3. Rehearse your nursing interview questions. Don't just prep answers. ...
  4. Pamper yourself. ...
  5. Listen and take notes.
Mar 21, 2023

What is your weakness as a nurse? ›

Examples of common nursing weaknesses our experts say they hear include: Paying too much attention to detail. Wanting to do everything at once. Spending too long on paperwork.

What are the 4 P's of nursing? ›

It's structured around four themes – prioritise people, practise effectively, preserve safety and promote professionalism and trust.

What are the 4 A's in nursing? ›

As a systematic process for change, this article offers the AACN's Model to Rise Above Moral Distress, describing four A's: ask, affirm, assess, and act. To help critical care nurses working to address moral distress, the article identifies 11 action steps they can take to develop an ethical practice environment.

Why are ABCs priority in nursing? ›

A part of Maslow's hierarchy of needs is airway, breathing, and circulation (ABC),which are physiological elements that are needed for the body to survive and help determine one's level of health. Observing ABCs is a rapid assessment of life-threatening conditions in order of priority.

Which nurses have the highest burnout? ›

Critical care nurses suffer the highest rates of burnout.

This is mainly due to the nature of the job, as critical care nurses work specialize in the emergency department (ED) and intensive care unit (ICU). As such, their work environment is constantly fast-paced, meticulous, and demanding.

Is it common to fail nursing class? ›

Many nursing schools require a minimum grade of roughly 80% to actually pass, as well. By the time you realize you aren't doing well enough to be successful in the course, the choices can be pretty limited. Failure happens all the time. It happens every day...

How many nursing students fail? ›

Most students pass their nursing program, so you can too. How many nursing students fail? According to the National League of Nursing, the dropout rate for nursing programs in the United States is around 20%.

What is the hardest nursing semester? ›

Without question, the most difficult semester for me was the last semester of my junior year in nursing school. I attended a 4-year BSN program, and that particular semester included three classes that were very content-heavy, as well as the corresponding clinical hours for those classes.

What is the most relaxed nursing specialty? ›

Institutional Nurses

These nurses administer more basic care and typically don't have to work long hours and overnight shifts, so this field of nursing tends to be low-stress. Even with less excitement, these nurses find fulfillment in providing basic and family care to those in need.

Where do the smartest nurses work? ›

Case in point, within all general areas of nursing, the Medical ICU, Trauma ICU, Peds ICU, Neonatal ICU, are perceived to require the highest skill set of nurses.

What is the best floor to work on as a nurse? ›

The best floor for a new grad nurse is the medical-surgical floor (med-surg). In med-surg, new nurses will deal with a wide range of patients, diseases, and illnesses. They'll broaden their knowledge and learn valuable time management skills.

What is the aesthetic theory of nursing? ›

Aesthetic knowing in nursing is a way of knowing realities that are not empirically observable – the deep meanings in a situation. As nurses grasp these meanings, they can draw on their inner, creative resources to respond to the situation in ways that move the situation from what is, to what is possible.

What is aesthetic pattern of knowing in nursing? ›

Aesthetic knowing or the art of nursing is achieved through empathy, dynamic adaptation and understanding of the components as a whole as well as the recognition of specific cases rather than holism (1).

What is the aesthetic value of nursing? ›

The aesthetic principle of nursing is respect for life, dignity, and rights of the patient. Aesthetical responsibilities of nurses in the process of working with the patient are a certain set of actions for the unconditional implementation.

What is the golden rule of aesthetics? ›

The golden ratio formula

If we measure the length and width of the face and then divide the length by the width, the ideal result – as defined by the Golden Ratio – is roughly 1.62. This number is known as Phi, after the Greek sculptor Phidias, who used this proportion in his work.

What are the 5 basic forms used in aesthetic? ›

There are five basic forms- Step, Stream, Taper, Shear and Sculpture. There is a relationship between functional requirement and appearance of the product. In many cases, functional requirements result in shapes which are aesthetically pleasing.

What are 3 questions about aesthetics? ›

Questions in Aesthetics
  • What is an aesthetic issue?
  • Why think about art? ...
  • What makes art different from nonart?
  • Should we recognize a difference between fine art, commercial art, and craftwork?
  • What do the arts have in common?
  • Why does art matter?
  • Are art and beauty essentially related?
  • What is a symbol?

Is being an aesthetic nurse hard? ›

If you do not like school or taking tests, becoming an aesthetic nurse can be difficult. You must receive a Bachelor's degree, at minimum, and complete a licensing exam to start practicing. But if these requirements sound okay to you, you may not find the process very difficult at all.

Can you work as a nurse after passing Nclex? ›

After you graduate and find out you passed NCLEX-RN, you are free to begin work as a registered nurse. While you can apply for jobs and go to work without any other training, some new nurses enjoy the benefits of a Nurse Residency Program.

Can I become a nurse by just passing Nclex? ›

To become an RN, one must pass the NCLEX-RN. As mentioned, prospective candidates can sit for this exam with either an ADN or BSN. To become a practical or vocational nurse, nursing school or an undergraduate degree is not required.

What is the difference between cosmetic nurse and aesthetic nurse? ›

Cosmetic nurses assist plastic surgeons and dermatologists in providing treatments for patients seeking to improve self-confidence. They can also perform many treatments themselves. An aesthetics nurse can perform or assist with many procedures, such as: Collagen replacement therapy.

What happens if a graduate nurse fails the NCLEX? ›

You can retake the exam as soon as 45 days after your first attempt and take it up to eight times in a year. Also, the majority of states have no time limit on when you need to pass the NCLEX after graduation. The remainder give you a few years to pass the exam.

How many times can you fail the RN NCLEX? ›

If they fail, they'll need to wait 45 days before retesting. After failing three times, though, they'll need to complete a board-approved remediation program before the next retake. test-takers have six attempts to pass in total.

What is the success rate for the NCLEX-RN? ›

Find out the reasons and what you can do as a student or nurse educator. For first-time test-takers, the pass rate fell to 79.9% and for all test-takers to 63.4%.

What disqualifies you from taking the NCLEX? ›

Immediate disqualifiers are as follows: Major misdemeanor conviction for crimes involving weapons, violence, embezzlement, dishonesty, misappropriation, fraud or sex crimes. Any felony conviction. More than one drunk driving or related conviction in the past three years.

Is NCLEX easier than nursing school? ›

Unlike nursing school exams, which test for knowledge, the NCLEX tests your ability to apply and analyze situations using the nursing knowledge you gained in school. Logic and critical thinking, rather than rote memorization, are emphasized in this test—making it much more difficult and comprehensive.

How many times do nurses have to take the NCLEX? ›

California: Every 45 days as many times as you want. Florida: 3 attempts then you have to go back to school. Pennsylvania: Unlimited attempts. Ohio: Unlimited attempts.

What is level 7 aesthetics? ›

The Level 7 diploma is a JCCP approved and VTCT certified clinical aesthetics diploma in injectable treatments for medical professionals considering a career in aesthetic medicine as well as those already practicing but looking to obtain formal recognition for their knowledge and skills.

How much training does an aesthetic nurse need? ›

The general timeline for becoming an aesthetic nurse is approximately 4-7 years, depending on the type of degree you obtain and the time it takes to pass the NCLEX-RN.

Where do aesthetic nurses make the most money? ›

Where Do Aesthetic Nurse Practitioners Get Paid The Most?
  1. Alaska. Alaska is the state with the highest average salary for Aesthetic Nurse Practitioners. ...
  2. 2. California. Aesthetic NPs in California make $105,815 per year on average. ...
  3. D.C. ...
  4. New Jersey. ...
  5. Massachusetts.
Apr 18, 2022

Can you be an aesthetic injector without being a nurse? ›

The qualifications that you need to become an injector (also a laser operator in California) is to hold a license as a: Registered Nurse, Physicians Assistant, Nurse Practitioner or Physician.

What does an aesthetic nurse do on a resume? ›

An aesthetic nurse is a licensed nurse with specialised training in cosmetic and aesthetic treatments. They're equipped with critical skills to serve patients who need a wide range of cosmetic therapies, including exfoliation, tattoo removal, hair removal, photo facials, dermal fillers and neurotoxin Botox injections.

Is dermatology nurse the same as an aesthetic nurse? ›

Often, Cosmetic Nurses perform duties similar to that of a Dermatology Nurse, in that both careers deal directly with skin and appearance-related issues. However, the job responsibilities of a Cosmetic Nursing career usually differ in scope based on the areas of specialization and additional certification requirements.


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