Nurse entrepreneurs strike out on their own to find rich rewards, challenges.

by Bree LeMaire, MS, RN

It was Saturday and Karon White Gibson, RN, and Joy Smith Catterson, RN, were making visits to several patients in their new home care business. They were also on their way to a wedding, so they were dressed more sophisticated than usual for a home visit. They went to the designated address for the visit where the family welcomed them and offered them a cup of tea. Then they sat and chatted a bit with the family, as they were new in the home care business and wanted to establish a rapport with their patient. The family introduced them to their daughter and her husband.

Following tea and the introductions, White asked, “Where’s the patient?”

“Well, there was no patient because we were at the wrong house,” White said. That was when White and Catterson learned that people like to have nurses visit them, even when they’re not expected.

Nurses traverse many roads when starting their own business with differing motivating factors and approaches that precede their transition. These nurses came up against things they were never taught in nursing school, but with the diversity of their education, knowledge and a

Motivating factors

The impetus to start a business varies. The reasons are both internal and external. “I always wanted my own career,” said Gibson, co-author of Nurses: On Our Own with Catterson. “I saw the need for my skin peels, when laser treatments were in vogue”, said Jane Nolan, RN, who now has her own practice as an aesthetician.

“We don’t need Danielle Steele with a cap on,” and “Nurses should pass bedpans not pens,” was the response given to Carolyn Zagury, Ph.D., RN, who wrote Nurse Entrepreneur: Building the Bridge of Opportunity. That is when she decided to go into the publishing business and now enjoys the challenges of running a small publishing business and concentrating on writing from nurses.

Cindy Duggan, RN, and Bobbie Richards, MA, RN, co-owners of Angel Home Care and Angel Health Care in Oakland, Calif., worked together for 25 years in local hospitals. They survived three mergers and some painful downsizing before they started to look at other choices. Home care seemed to be the place to go. They started a business where they provided Medicare-certified, skilled home visits, which they sold. Then they moved into Angel Home Care where they provided unskilled custodial aides. Recently, they started a third business, Angel Health Care, an executive recruitment and search firm. It grew out of an increasing need for recruitment and the shortage of health care workers. All of their endeavors came from visions that their businesses were needed, which evolved from their previous cumulated experience.

Doris Davis, RN, who manages her own clinical research consulting company, said that after nearly seven years of working “on the inside” (within three different corporations), she had hit a glass ceiling. She liked many things about her work as a clinical research associate and she noted the shift in biotech companies to “outsourcing” of their work.

The time was right in June 1990 to “break out of the corporate life” and she took the risk. Davis said that this type of business is not for everyone because of the long hours and continual discipline. There were times when she had to remind herself to keep that same discipline she’d learned in nursing school. In the beginning, she wrote down on a small card the reasons why she chose her independent consulting life and kept the card for those times when the business seemed overwhelming. Then she would glance at her card and say, “This is why I’m doing what I do.”

Nolan, an aesthetician at The Cutting Edge, a full-service salon in San Francisco, loved her work in dermatology, but wanted to be on her own. She had learned how to do “peels” or dermabrasions from the physician who originated them. Later, she saw laser treatments becoming the preferred method, but she wanted to continue with her own “peels.” That was when she obtained her aesthetician’s license and opened a small private practice. Most recently she added permanent makeup to her services.

Gibson, who started her home care business career with Catterson, now produces TV health shows. She hosts one on traditional and alternative medicine. She said she always wanted to have a career with independence and was always looking for new opportunities. Now, she works only because she wants to and occasionally does consulting work.

Finding their niche

Nurses know how to do an assessment from all angles using the nursing process. They can walk into a patient’s room and see what needs attention. It’s almost an automatic response for some. All of these entrepreneurs were alert to fields they might draw on. They found their niche and moved into it.

Richards and Duggan decided to use the nursing process and adapt it to their business needs. Looking at their strengths and weaknesses, they saw that Richards had management skills and Duggan had financial skills. They complemented one another, but they needed a marketing person. Then they brought in Barbara Smith, MS, RN, who began “nurketing,” a merged concept that integrates nursing and marketing as a business application.

“If there are 300 people in an audience, that’s 600 eyeballs looking at you,” research consultant Davis said. “I loved talking to individuals, but talking in front of large groups was not my cup of tea. Assessing the criteria, I did not worry about content, but presentations to large groups were difficult. I solved my problems by inviting a colleague who was an accomplished speaker and friend to co-present with me at a professional meeting. I knew that if I froze or faltered, she could quickly pick up the theme and take over. That was my debut and it was fantastic. Now that I’ve found out I can do it, it gets addicting. Now I’m on a roll,” Davis said.

Davis also said she still schedules routing assessments. There were a number of “white-knuckle days” in the beginning, but she had set goals and initiated a built-in assessment plan. She’d ask herself each day where there were lessons to be learned and where she had done well. After the first six months, she began to see the results of good planning and “giving it her all” and has had steady success since.

Publisher Zagury also teaches classes to nurses on starting their own business and, she said, there is difficulty in translating nursing expertise into business. Nursing education doesn’t foster nurses to become business people. The traditional picture of the nurse is as a caregiver.

Yet, home care executive turned TV producer Gibson said that nurses are tremendously diversified in their education, as there is no end to things a nurse knows. There is a complete spectrum of different patients with their varying personalities. She points to nurses working under stress, short staffing and putting out fires—and that these situations are adaptable for managing a business. “If anyone can run a business, it’s a nurse,” Gibson said.

Obstacles and misconceptions

All of these nurse entrepreneurs have had misunderstandings as well as obstacles to overcome as they worked in their own businesses.

Richards and Duggan of Angel Health Care said they ran into an obstacle with new computer programs. When they worked in the hospital, there was a mainframe with a built-in program and all the instructions for use built into the system. They could just punch a few keys and check a medication or order a lab test. There’s a world of difference between a mainframe and a business PC. Their challenge was to first find someone who could help them and then devise programs that would fulfill their needs. They talked of exploring many dead ends, but now they have a program that is designed for their wants at every step of the way.

“I always considered that a clinical research contract would mean real work,” Davis said. “Early on, I had a signed contract for an extensive job and they kept promising me that it would be forthcoming. It took nine months for me to realize that a contract didn’t mean work.”

Aesthetician Nolan said that she always thought that having one’s own business would be a full-time occupation, but she found that her commitment didn’t have to include an eight-hour workday.

In the beginning it was hard, Nolan said. “The first year was strong on experience and weak on money, but I now set my own hours and I can work when I want. I have plenty of time to lead an outside life, attend dermatology conferences and even help out at my old job,” she said.

Gibson always thought it would get easier as time went on, but that wasn’t the case. “One can never rest on one’s laurels,” she said. She deals with HMOs and insurance providers and the glitches of putting on a television production. She is continually astounded at the many challenges she faces.

The reality is that we are all still nurses, Zagury said. It’s a matter of thinking outside the box. Nurses who leave need not leave their expertise behind. There are beautician nurses working with special populations and real estate nurses who focus on housing for the older populations in Florida. All of today’s new entrepreneurs have to gain information and experience through many avenues, including the nursing process, to broaden their horizons. Today’s market offers endless possibilities.

Overcoming obstacles

These are some barriers to nurses starting their own businesses, according to Carolyn Zagury, Ph.D., RN, author of  N urse Entrepreneur: Building the Bridge of Opportunity :

• Lack of business knowledge. Nurses need to assess their strengths and weaknesses and know what they have to work with.
• Lack of support, both financial and from customers. Potential customers need to know that a nurse may be their best resource in some cases. The type of business dictates the start-up monies needed.
• Lack of confidence. Nurses can translate the knowledge learned into their special expertise.

Getting started

These tips on starting your own business come from Doris Davis, RN, who manages her own clinical research consulting company:

• Network. Assess your network—do you have one?
• Finances. Get them in order.
• Talk to supportive friends and colleagues. Get “how-to” tips as well as potential contacts from them. Keep your distance from people who don’t seem to support your decision to start a business.
• Set up with an accountant to “learn the ropes” of deductible/non-deductible expenses. Set up a tracking system.
• Find a lawyer who can review your contracts and teach you what to look for in a contract.
• Read all you can, talk to as many people as you can.
• Always thank someone who has given you a potential lead even if it doesn’t turn into a contract.
• Remember, your client is always evaluating you. Be professional.
• Define your workspace and your work time and try to balance with relaxation time.
• When it gets touchy, remind yourself why you “want it” and just keep going.

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