It takes a hefty dose of moxie and a business plan
What do Seattle Sutton and Wild Iris in have in common, other than intriguing names? Both are companies started by nurses, people like you and me. Nurse entrepreneurs as a group are largely unknown, yet there are hundreds of them. They form a “sort of secret society,” says Pat Bemis, RN, CEN, head of the National Nurses in Business Association. It isn’t that obscurity is the goal. But many people — can I include the majority of nurses? — think that entrepreneurship is incompatible with nursing. We care for others, even for free, if necessary. It’s not just about the money, right? So how could you thrive in business with that attitude?
Fortunately, not everyone thinks that way. Bemis, for one, didn’t. She knew she understood emergency room nursing. She also understood that while many nurses had plenty of knowledge, it didn’t get communicated effectively to new practitioners. Enter her first book, now in its fourth edition, Emergency Nursing Bible. (Look for it as a prop in the Columbia Pictures movie The Brothers Solomon.) You don’t, of course, just write a book and, presto, it sells. Medical publishers liked her work, but they wouldn’t offer sufficient compensation. So Bemis decided to self-publish and reap all the rewards, not just a percentage. That takes moxie and skill, two traits she exudes.
Several books later, she has helped many nurses think through how they might take an idea and go into business for themselves. Through her website, books, CDs and seminars, she offers advice for nurse entrepreneurs, whether they are beginning with just a kernel of an idea or are already involved in a full-fledged enterprise.
Sometimes it’s not a consuming idea that motivates. The desire for flexibility can also drive the entrepreneurial spirit. Ann Johnson, RN, is the co-founder of Wild Iris Medical Education with physical therapist friend Lauren Robertson. Their company offers online CEUs for nurses, occupational and physical therapists and “first responders” like EMTs and paramedics. I asked Johnson, “Why Wild Iris?” She explained that the wild iris is a flower that grows among the redwoods in Northern California, a place that she calls home.
Several years ago, when a home health job ended suddenly, Johnson realized she didn’t want to commute to a hospital, work a 12-hour shift and commute home again. She wanted to stay in the woods! Now owning a company makes that possible. It is a lifestyle that even includes volunteer fire fighting. Gone are the commuting and the 16-hour days. Her online courses show that Johnson understands how nurses approach continuing education: convenience, affordability and professional credibility. With virtually no marketing except word of mouth, the company’s email now reaches 67,000 practitioners, all former users of the Wild Iris site.
LeaRae Keyes, RN, BSN, PHN, CDMS, CCM, also values flexibility, and she has found it as an independent case manager and life care planner. Clients who serve patients suffering a catastrophic accident or illness can count on her nursing expertise to coordinate care and assess future needs. Even covering a four-state area, she reports, “I can take a day off in the middle of the week if I want to.” Her business, classified as an S corporation (limited liability) now earns her at least as much as, and usually more, than she made working for someone else. It was risky, but she has what she wants, “including getting paid what you are worth.” She too has a website that offers networking possibilities, audio-visual downloads and coaching to nurses interested in self-employment. Her free “tip of the week” is sent directly to subscribers’ email.
Big “E” and LITTLE “e”
Nurse entrepreneurs generally fit into a few distinct categories. The largest by far is the nurse legal consultant group, followed by case managers. Education is popular, especially with the increased demand for competency testing, and so is forensic nursing. Any medical evidence used in a court case must be collected by medical personnel, so it’s easy to see that a nurse who, for instance, qualifies as a Sexual Assault Nurse Examiner could keep busy in almost any location.
Some nurses offer a product rather than their services, and Seattle Sutton, RN, BSN, sells a quite successful one. Seattle Sutton Healthy Eating provides precooked meals to anyone wanting to follow sound nutritional guidelines. Large enough to offer franchise and distributor opportunities, Seattle Sutton meals are available everywhere but Alaska and Hawaii. As a mother of five who worked in her physician husband’s office, she realized that many people simply don’t eat right. She saw firsthand the consequences of unhealthy diets, and she did something about it.
Not every business is large. And not all nurses remain in distinctly medical enterprises. Tanya Yamada, RN, is an entrepreneur with a small “e.” She is employed full time as a case manager, but she spends a good deal of her free time selling novelty soap and packaging. Although she shows her work at invitation-only boutiques as a relaxing hobby, she has learned to follow sound business practices. She has a resale license, works hard on the presentation and development of her products and follows market trends. When she is introducing a new item, she makes only enough to test. If it sells, wonderful. If not, the product is discontinued. Uncompensated work and red ink don’t interest her.
What does it take to set off on your own and be successful? Maybe not what you think. Certainly not more academic degrees. Several entrepreneurs I spoke with are graduates of two-year associate programs. The rest of their expertise comes through combining certification programs and personal study — books, magazines, one-day business courses and the like.
Another learning habit they share is the willingness to seek outside expertise. For instance, Bemis gives credit to Dan Poynter, whom she calls “the international guru of self-publishing.” And Johnson is quick to credit her partner with a sense of autonomy and self-worth that helped herunderstand the value of nursing knowledge.
So where to begin? “You have a much higher rate of success if you start in an area in which you have experience,” Keyes says. So you don’t need to leave nursing or even stray too far from what you know. Perhaps most critical at the start is a clear evaluation of what your business will be. Keyes calls it “informational interviewing,” talking to people already in the field. Who are your intended customers? Is there a real need for what you will offer? She gives the example of someone who wants to start a staffing agency but fails to realize that the highest hurdle will be finding out how to win hospital contracts.
So you need assessment, one area in which nurses excel. Planning based on assessment is another strength. Will you target a local base, or do you intend to offer nationally accredited courses? What follows from that? Keyes describes two other traits that nurses bring to business: the desire to serve and the ability to multitask, shifting quickly when needed.
What kind of money does it take? According to Bemis, think in terms of about $8,000 to cover computers, business cards and phone lines. Of course, setting up a staffing agency would be more expensive, because salaries are an immediate issue. But a forensic nurse working from home might not need so much. The usual route for raising startup cash? Using retirement funds, home equity loans or savings. There is neither government funding nor, in most cases, private money.
A business plan, even a simple one, is essential. Bemis suggests early incorporation to maximize tax benefits, and each step of the way there’s help available from other nurses, organizations and websites. It is important to understand that ordinary business sources might not understand an entity set up to offer nursing services or products.
What about risk? Yes, there is some; there always is, if you are self-employed. Keyes says it took about a year and a half until she had enough reserves to feel secure. Nurses, for the most part, don’t fail, according to Bemis. What we offer can’t be done as well by others, and what we offer is worth good money. Understanding these “basics” is an aspect of entrepreneurship that can elude some.
But the times, they may be changing. Who would have thought that a prestigious nursing school would teach nurses how to market, how to sell and how to become entrepreneurs? It’s happening right now at the University of Rochester School of Nursing. The Center for Nursing Entrepreneurship (CNE) was launched in 2004 and includes Health Checkpoint, a nurse-managed business that provides wellness care and disease management, and Entrepreneur Nurse, which provides nurses with information, forums and resources to help start a business or reinvent their current role. The CNE also sponsors the Idea Generation Center, and in 2006 its first spin-off began, the National Forensic Nursing Institute.
So if independence is what you want, if greater pay is what you deserve, or if you believe in a product or service, think about becoming a nurse entrepreneur. Use your nursing skills and knowledge as a platform to start your own business and gain the flexibility you dream about. There’s plenty of help from fellow nurses who want others to succeed.
Want to Know More?
Center for Nursing Entrepreneurship
National Nurses inâ€ˆBusiness Association
Nurse Entrepreneur Network
Elizabeth Hanink, RN, PHN, BSN, is a freelance writer with extensive hospital and community-based nursing experience.