Nursing Notes Live looks at nurse entrepreneurs. Our panel discussion is joined by Patricia Bemis, President of the National Nurses In Business Association, LeaRae Keyes, Executive Director of the Nurse Entrepreneur Network and Victoria Powell, founder and current President of VP Medical Consulting. I spoke with them about nurses in business and entrepreneurial positions.
MP3 Audio Podcast
LeaRae, tell us a little bit about what you did when you decided to move out and work on your own and how that developed.
LeaRae: I have to backtrack a little bit more to probably the early ‘80s when I decided to go into sales because I wanted to be paid more for what I produced than a straight salary. Within six months of getting into sales, I won the national sales award for that company by applying the nursing process to sales which is basically assess, diagnose, plan, implement and evaluate. I found that by applying that process to sales, I was able to quickly soar above the other people who were in sales. I later became a marketing director for a rehabilitation company and I have a staff for which I was responsible. I became a full-time case manager in 1989 and then decided to start my own case management company in 1998. After several Intrapreneurships – an intrapreneurship is starting a division or a company within a company. I did that at least three times: trying a work comp rehabilitation model and applying a work comp case management model to catastrophic case management in healthcare; and then applying a case management model and starting a telephonic case management company. I can
Jamie: LeaRae, I like what you said about applying a nursing process, your critical thinking aspect of nursing to something that’s not nursing-centered or not patient-focused but really focusing on business. It’s very interesting that you found a way to apply that in other aspects of your life.
LeaRae: Yes. I think a lot of nurses don’t realize that they already have a lot of the skills and tools they need to go into business.
Victoria: I agree with LeaRae. I think the biggest thing that nurses are missing is not the critical thinking to get started in business but just the marketing and sales and asking for the business. That’s where nurses fall short.
Jamie: I think it’s not uncommon. We’re not very good at tooting our own horns. We’re all about everyone else, right? That’s why we became nurses. We’re caring people. It’s hard to be the person who goes out and says, “Look what I’m doing. I can offer you something.” That’s not really something that we focus on in nursing very often.
Victoria: We’re educators. We like to share and we like to teach and that comes pretty naturally to most of us. But we don’t toot our own horns and I think we should do that more often.
Jamie: Pat, tell me a little bit about how you got into being a nurse entrepreneur initially and then taking that nursing education focus that we have and offering some assistance and putting together this opportunity to help other nurses.
Patricia: Thanks. You know, it’s kind of interesting you talked about nursing skills. I think that it comes naturally to us to initiate that nursing process. I think that’s part of the talent that we have, that we bring with us and bring into nursing. I think it is part of us before we are educated as a nurse. As far as my experience, I was an emergency nurse and I did know how to toot our horn. Emergency nurses, we usually get right out there. But I was dissatisfied with the way nursing was practiced in the emergency departments nationwide and saw that I could help solve that problem by introducing complaint-based emergency nursing rather than as it had been typically taught by body systems which in emergency department we dealt with the complaints, not the whole body system. It was a new approach. I did write a – ultimately wrote a book on the subject, currently in its fifth edition, 600 pages, very proud of it. It’s been very good to me over the years. That was back in 1998 and as LeaRae’s noted, I had no idea how to sell it or how to market it. I did have publishers that offered to do that for me but, of course, they offered to do that for me and take a high price for doing that. I became a member of the National Nurses in Business association. It had been in 1985. I became part of it in 1999 or 1990, I think it was. They mentored me and helped me start a small press publishing company to publish that book. When I started the publishing company, I suddenly realized that I had no knowledge of how to start a business. In fact, probably had some negative knowledge, all that caring and all of that. It’s not about money and it is about money. You’re right, a lot of that I had to rethink because it was so difficult for me and because I had such difficulty finding the information on how to start a business. When I was asked in 1998 to take over as president, the National Nurses in Business Association, I accepted willingly. I wanted to do that and to teach other nurses how to become business. Not only have I kept my own writing and personal consulting business going but I have taught other nurses how to start their own business. There’s just room for so many of us out there. I always appreciate what LeaRae does. We need probably even more information on nurse entrepreneurship. I know there’s a lot of the colleges are teaching nurse entrepreneurship now. In fact, they’ve used one of my books on how to become a self-employed RN as a textbook. A lot of my time is taken up writing online programs, writing books, and writing materials and mentoring nurses.
Jamie: Mentoring is so much an important part of nursing education anyway. When nurses move into new units, whether they’ve been nurses for a long time or brand new nurses, having that mentor on the unit, having that person to guide you through the policies and procedures of a new organization or as a new student, you’re really learning the hands on aspects of nursing that are just so much more than what you get in your clinical process. Mentoring is an important. I’m interested to hear you say that mentoring is just as an important a part in the nurse entrepreneurial setting as well.
Patricia: It is, very definitely. I get calls all the time from nurses that are taking their masters and are working in an entrepreneurship program and what they’re missing is their good common sense that’s only available from a nurse that has experienced it, the real world.
Victoria: That’s a good point, Pat.
LeaRae: I also loved what you said about it is about the money. Often I come across nurses who one of their frequent questions is, “What should I charge?” They don’t know how to go about pricing their product. If anything they want to way underprice it. They don’t take into consideration overhead, they’re just so used to giving information and education away that they forget that it is about the money and it is about supporting yourself.
Patricia: Two little points about that. Number one, I finally developed an actual formula so you can figure out how much your services or work. Taking into consideration that overhead, the time spent on non-billable hours, which is kind of interesting because when they see that then they recognize there is much more to it than just an hourly wage like they work at their hospital. When I, one time, did a conference for the National Nurses In Business Association, it was going to be in Santa Monica and I decided to apply for continuing education through the California Board of Nurses. You have to send a lot of documentation. I sent a brochure and on one part of the brochure it said that operating your own business, the goal was to create wealth for yourself. When they saw that, they actually called me on the telephone to tell me that nursing is not about money and therefore and they would not approve the conference.
Jamie: I think there’s a misconception because, well, LeaRae and Pat and Victoria, we all know it’s about the money as entrepreneurs because I do what I do and act as a nurse journalist creating high-quality content with what I do as an entrepreneur. I’m doing it because I’m passionate about the topic. I want to share good information. I want to interview thought-leaders. I want to make sure others know the things people like you know. I do that because I’m passionate about it and I believe in it. But if I don’t make money doing it, I can’t continue to do it.
Jamie: It’s about the money but it’s about being a good nurse in what you’re doing even if it’s a business for yourself, you still got to be able to turn a profit. If hospitals didn’t charge what they needed to charge, they couldn’t keep the doors open and their communities would no longer be served.
Patricia: If a nurse at a hospital did not receive her check at the end of a week or two weeks, then it would be about money. But they usually don’t have to think about that. That’s the only reason the Board of Nurses – I had to take off that from the brochure and we finally got everything all ironed out. That’s sort of a knee-jerk reaction that it’s not about money.
Victoria: Well, if it wasn’t about money, there would not be as many marketers out there trying to encourage nurses to go into business for themselves by sharing, “You can make $100.00 an hour, $150.00 an hour,” those marketing pieces would not be successful if it wasn’t about the money.
Patricia: Right. And the nurses need the money or they would not survive.
Jamie: Victoria, we didn’t get the chance to find out about you but tell us a little bit briefly how you got started as a nurse entrepreneur.
Victoria: Well, a little bit background on me. While I was in nursing school, I developed a latex allergy and this was in the early ‘90s when it was not nearly as common. There weren’t as many – in fact, there were rarely any latex-free items. My hospital stint was kind of short because it was making me quite miserable. I worked in outpatient clinics. I did management. I obviously did some outpatient nursing and then also sold some medical equipment. It was actually while I was in sales that I was encouraged to go to work for a national case management company which I did. I found that I really enjoyed the work. But my husband was also in business at the same time as an airbrush artist and I was running marketing in business aspects of his business for him. His business was getting more and more busy and I wanted to do more and more. Then I found that very rewarding to work with the customers and really see the fruits of our labor because we were working for ourselves and for more – every hour that we invested in that business, we were investing in ourselves and our future. I really went to decrease my hours with this case management company and worked more for him so that I can keep the benefits intact. With so many nurses, we talked about our vacation, our 401K and retirement benefits and so forth. We found those as so important and they become tethers to keep maintain us in the environment that we’re used to. My husband, on the other hand, has always worked for himself and those things were incidental to him. I describe him as somebody who would fly by the seat of his pants. I always felt like I had to be the one that had those benefits because he did not have them without my tether to the hospital or to the clinic. He’s just encouraged me and said, “Look, you know, if it all fails and you can’t do it on your own, then you can always go back to the hospital,” and that was really my fall back plan. I gave myself only three months and I think that is too short of time. Anybody that’s going to do this on their own, they do not need to only give themselves three months but that was my goal. I actually got some education in legal nurse consulting work and decided that if case management business on its own do not work out, I could always add to those services by adding to some legal nurse consulting services to make ends meet. Forty-five days after I officially started my business, I started having many coming in and I never looked back. I had to continue to increase education because I think education is a lifelong process. In attending different educational courses, I expanded into new areas and the business has continued to expand. I highly encourage others to do the same. If they’re passionate about something and, just like we said earlier, want to find out how to make money doing it.
Jamie: It’s interesting when you talk about some of the things that you do as – you’ve expanded your business. It’s gone in directions you hadn’t originally anticipated when you started. I know that I’ve seen that happened for me as well. People have come to me and say, “Well, you’re involved in something that’s sort of associated perhaps you’d be able to do this for us as well.” I’ve had to be able to be flexible enough to do that. Part of it is that, I think, because nurses are required to be adaptable and innovative in the ways that they come up with solutions for their patients, I think that’s no different. Those skills also apply very well to a business setting.
Victoria: And to so many different aspects. That’s really what happened with me is when I worked for the national case management firm, one of the things that we did was we had an account that was all-office people. They needed someone who had an ergonomic assessment certificate. Well, normally that would have been a vocational rehab counselor but we did not have any of those in our state so they sent me for the training because I was the most senior personnel. Well, it was all about ergonomics and a topic I really had not been interested in. In my role as a case manager, I had manufacturing companies who were having repetitive injuries in certain areas and suddenly this ergonomic certificate that I got became very valuable in creating ergonomic programs. The next thing you know the safety manager says, “We’re wanting to start doing some safety education once a month, would you be interested in coming as a speaker to help us with our safety conference?” It just expands and expands and expands. You recognize a need. You say, “Yes, that’s right on track with the kind of step I already do.” The next thing you know you’re adding on another service.
Patricia: I had a similar experience of developing a new service that I hadn’t even considered. I was calling an insurance company that had internal case managers that did telephonic. I was trying to sell them onsite case management. And during that – they were all was interested in the idea of onsite. They thought they were doing just the fine job with telephonic. They said, “What we really need is somebody’s [objective] from the outside to come in and do an evaluation of how our nurses are doing. We don’t have the objectivity that we would like.” I developed a quality assurance tool, a 100-point quality insurance tool, and went in one day a week for six months and reviewed charts and scored those charts on the quality assurance scale. That is something I would never have thought of if this customer hadn’t said, “This is what we really need.”
Victoria: That’s a great point.
Jamie: That is a good point and I think that brings up something that a lot of people in business no matter what – whether you’re nurses or not nurses – is you need to ask your prospective customers what they really need from you. That is something that we so often don’t do is say, “Here I have the service I want to provide you. Is it something you really need?” The services, the products – I interviewed Sharon Rogone, who is the Get-to-Know nurse this month. She created a business called “Small Beginnings” that create specific products for care of NICU patients. She took a passion for a type of patient care and came up with solutions that really she started using when she was working in the NICU and other nurses were saying, “Can you make me one of those to leave on the shift for next time so I have it too? Can you show me how you put that together?” She developed that into a business. It’s not just services but also products. Nurses, when you’re working with patients and you come up with that finagled way, I call that “MacGyvering” stuff. You put something together using commonly available tools to create something new then maybe you come up with a new product that needs to be developed for the market place.
Patricia: I agree with that. In fact, we have brought in an adviser with that group who can help somebody bring their product to market. He has written a book on the subject but also he is a very successful entrepreneur in his own right, developing a product that’s used by nurses. Nurses think of themselves, in the beginning most of them is providing clinical nursing services and then in providing some other adjunct service. You’re right, it seems to be the last thing that they think about is developing a product but these products are often developed from the services that we provide – our books, our DVDs, LeaRae’s wonderful website, all those things.
LeaRae: Pat, I think you and I know a nurse who developed a special surgical scissors.
Patricia: Oh, yes. Something that we also knew we need. I guess we didn’t know we need it but she came up with the idea and once we saw her, it’s been certainly – we knew we do need this. There are lots of products out there that are available to nurses. LeaRae, I’d like to say a little bit about you and your business if you don’t mind. LeaRae does an exceptional job with her website. Her website is extremely unique. It offers all kinds of services. Could you tell us a little bit more about it?
LeaRae: Well, the website is a membership website and members can go there and look up all kinds of information on sales and marketing, downloadable marketing charts, unique ways to present their ideas to customers and get their foot in the door and just lots of resources. Thank you for mentioning that, Pat.
Patricia: You’re welcome.
LeaRae: And Pat has an excellent yearly conference that is talked about within the nurse entrepreneur community on a regular basis.
Jamie: Yes, I was looking at that. It looks like just a tremendous resource for nurses that are either existing entrepreneurs or even thinking about developing something to get their feet wet and get an idea of what’s out there. If only for the opportunity to network with other nurse entrepreneurs, the same way that you network with other nurses in your specialty to gain ideas, to improve patient care. The same thing is true for networking in business and finding out some of the challenges others have overcome.
Victoria: Jamie, one of the unique things about the NNBA conference, I get to speak there quite often. One of the things that is most amazing to me is that, these are nurses who are not necessarily going into nursing-type businesses. They’re using their nursing process critical thinking for – yes, a lot of them go into a nursing-type related businesses and create services just like we’ve been talking here today but many of them attend this conference and they maybe still employed by the hospital but they’re looking at businesses that have no bearing on nursing whatsoever. That’s been one of the things that really have surprised me. People are passionate about different things. They have different hobbies and talents. They use that combination of that non-medical, non-nursing-related interest with their nursing critical thinking model and the networking available at these conferences to start a new business.
Patricia: Yes, it’s always been a challenge to make the conference applicable to newbies, to people that are just beginning to think about this and then to people like LeaRae, for example, who has exceptional knowledge in marketing and sales and has her own business. That’s always been a challenge. I think this year we have done exceptionally well bringing all those topics to be. It is our goal to provide the business information that you need to develop your business, any business. That’s our goal and I’m glad we’ve been able to accomplish this, providing business information that the nurses don’t get in their usual nursing education.
Victoria: I think actually that’s one of the reasons that I do speak with Pat so often is one of the things that I’m interested in outside of my own business is just technology. I’m a computer geek. I love gadgets. I have a mobile office. Anything that I can do to maintain my own business practices around the clock is something that I personally am interested in. Because of my interest in that area and then also with social media marketing efforts, I’m an early adopter. I’ve done Twitter and Facebook, and Google+ and so on and so forth. Because of my interests in those areas, not necessarily in respect to my own personal business but just my personal life, the way I manage my own life, that’s something that a lot of nurses aren’t doing and they can use those for business. That’s one of the topics that I often am asked about to speak not only with Pat but with some other places as well.
Patricia: There’s something Victoria commented on earlier, she talked about being in case management and then also taking training in legal nurse consulting kind of as a backup. I find that many nurses in the nurse entrepreneur network have basically put several what I will consider like part-time jobs together to create a full-time job.
Victoria: Oh, absolutely.
Patricia: The nurse entrepreneur doesn’t have to do just one thing. As a matter of fact, their life is probably more interesting if they do multiple things. I don’t want nurses to forget that they can put a number of things together to create that full-time employment.
LeaRae: Yes. I’ve been lucky enough to have the University of Florida contact me to write and present some professional development for nurses. That’s what I’ve been trying to do is putting all these courses together that you can develop a business and not just do one thing. We’re doing legal nurse consulting, forensic nursing, risk management, case managers. All those things now are out there on a university level to teach the nurses how to do the principles and practices behind presenting the service.
Victoria: Well, and it’s about thinking outside the box. I’ve even done presentations on this. Okay, we’ll take legal nurse consulting, for example. There’s a big marketing effort for nurses to get involved in legal nurse consulting but nurses who are interested in that tend to think that it is either being an expert witness on the stand or reviewing cases behind the scenes. They don’t understand that there is such a wide variety of [tops] of legal nurse consultants. Even my own education, I went to education training on legal nurse consulting and I started asking about, “How do I sit for the LNCC?” which is the American Board of Nursing subspecialty recognized by the American Board of Nursing. I was told, “Oh, don’t worry about it. It will take you years before you have enough hours under your belt to be able to sit for that exam.” Well, I didn’t like that answer. So I went and got the test materials myself and looked and found out that my years of case management experience, because of the fact that we’re dealing with the laws of the state that you’re in for the work comp and you’re dealing with attorneys particularly on the defense side, that you were qualified. That did count as legal nurse consulting experience. That’s when a light bolt came on for me. Now, one of Pat’s, the course that she’s involved in with the University of Florida, the forensic nursing, for example, goes in to everything from SANE nursing, legal nurse consultants to crime scene investigators, and the people who were doing the toxicology screens for blood alcohol levels and so on and on and on and on. These nurses just have to get out of the mindset that it’s just this one thing that you’re going to do and really look at the big picture.
Jamie: Well, we need to wrap up. Like we said at the beginning of the call, I think we can all probably sit here and talk about this all afternoon, but it’s something that we need to put an end to it at least at this point. I just would like to ask for a quick piece of advice that you might leave with someone who’s a nurse thinking about doing something branching out on their own, starting their own business as a nurse either in healthcare, associated with healthcare, or perhaps even outside of healthcare. Victoria, why don’t you go first?
Victoria: Well, anyone that’s interested in being any type of nurse entrepreneur needs to do one very, very important thing and that is to spend some time working on their own business development every day. It’s really easy to work your regular job, twelve-hour shift, eight-hour shift, whatever, come home and take care of your home environment and only get to the business stuff every now and then, but if you work on it a little every day, you’ll be closer to your goal before you know it. (30:30)
– End of Discussion –