Carla Pierson, DNP, RN, is the Co-founder and Chief of Business Operations at Smiley Aesthetics, a medical aesthetics company that provides clinical services, training, and business support to aesthetic providers. With over a decade of experience in nursing leadership and healthcare operations, she combines critical care, hospital administration, and business strategy. Before launching the company with her twin sister, Carla held leadership roles at major healthcare companies.

In this episode…

Building a business often looks straightforward from the outside: identify a need, create a solution, and grow. Yet behind that simplicity are decisions that carry weight, especially when stability, identity, and risk are all intertwined. How do entrepreneurs know when to leap and when to hold steady?

Seasoned healthcare operator Carla Pierson didn't set out to become an entrepreneur overnight. After years of managing large-scale hospital operations, she partnered with her twin sister to explore a small, scrappy idea — bringing aesthetic services directly to clients. What began as a side hustle quickly gained traction, forcing her to confront a defining moment: leave a secure career or fully commit to something uncertain. As the business scaled, Carla leaned on structure, discipline, and her clinical background to build systems that empowered others, all while navigating the complexities of partnership, growth, and opportunity. Her advice to others: focus is everything, and splitting your energy limits your ceiling, but committing fully can unlock exponential growth.

In this episode of The Decision, Robert Hartline and Eric Jackson sit down with Carla Pierson, DNP, RN, Co-founder and Chief of Business Operations at Smiley Aesthetics, to discuss transitioning to entrepreneurship. Carla talks about her transition from healthcare leadership, building a scalable platform model, and the decision to walk away from a potential sale.