How is agency set up? - page 2

How many nurses are needed to actually run an agency??? Are there many RNS? Is there a need for middle manager RNs??? What would they be doing anyway?? Who does the scheduling, etc?... Read More

  1. by   suzanne4
    Quote from adeoyin
    I AM THINKING OF SETTING UP A NURSING AGENCY AS AN ENTERPRENEUR. CAN SOMEONE PUT ME THROUGH THE WHOLE PROCESS PLEASE. JUST THE HIGHLIGHTS ON HOW TO START. ANYONE WITH IDEA OF BOOKS OR WEBSITE THAT I CAN CONSULT?

    SINCERELY
    ADEOYIN
    Which country are you trying to do this in? Our laws vary greatly from those in your country, I am sure. Corporations over here also have different rulings for foreign owners. My suggestion would be to sit down with an attorney and go from there.
  2. by   NedRN
    Quote from eddy
    The most important these days is health insurance. As a very small company or a company of ONE (independent contractor) you will find it very difficult and almost impossible to find health insurance that is within financial grasp. Obviously, if you have a spouse that works somewhere and can put you on their insurance this isn't a huge issue. However, if you must provide your own, seriously think about the costs.
    I come from the background of a travel nurse and I agree health insurance is an issue. One way to solve it is every 18 months do a regular agency assignment and the Cobra the insurance. That is good for a two year cycle.

    Quote from eddy
    Also, you do not get any other "benefits" associated with being an "employee" of a larger company such as paid vacation, group retirement plans, liability umbrella insurance, work comp insurance, disability, scholarship reimbursements, and all the other stuff.

    Of course, you will also pay BOTH portions of your taxes. Your employer covers half, but as your own "employer" you pay the whole thing.

    These factors can, and often do, eliminate the percieved
    "better pay" of being an IC.
    Well, if you charge the same as the agency you used to work for, consider that they have provided all of the same benefits as well as a profit margin of 25% or higher for themselves. I have a hard time seeing how you could come out with less (except for the issue of group health). Not a question of perception. And if you incorporate, you are on a dead level footing with large companies on the deductibility of benefits.

    Quote from eddy
    Alas, it is generally the norm that IC's get lower bill rates than agencies do.
    I don't know where this is coming from. At all the hospitals I have done direct contracts, I know I have the highest bill rates, often $5 an hour better than the other agencies. And part of that comes because I control the negotiation and am able to do things like offer a flat rate regardless of hours. I do have the whole country to get contracts from so I suppose if you are talking about ICs in other fields in a local market, I can see how it is possible to let others take advantage of you because you are not with an "established" company. Haven't seen it work that way in nursing.


    Quote from eddy
    I'm not saying it is a bad thing to do. Not at all. I applaud the entrepreneurial spirit (I'm still a part time independent accountant)! All I am saying is that the perception some people have that agencies are ripping nurses off or causing you to make less as a nurse is simply not true.
    Well, they may not be ripping you off (they have to make a living), but the truth is that they are making a living off of you and you can take that margin.

    Quote from eddy
    The idea that hospitals are increasingly seeking IC's for staff shortages is also NOT true. Hospitals are ACTUALLY increasingly seeking "master vendor" contracts with large nationwide agencies that manage all of their agency staffing (as well as many other processes, systems and supplies in hospitals). As stated prior, All About Staffing (AAS), a subsidiary of HCA is one of the big ones. Like it or not, they aren't going away and will only grow bigger and grab more market share as time goes on. Hospitals are simply not interested in managing hundreds or even thousands of single IC contracts every year. It's a paperwork nightmare, a legal department fiasco, a staffing department impossibility and an accounts payable disaster!
    Certainly no one is seeking ICs for staff shortages. Nor are they seeking prime vendors - they are SOLD on the idea of prime vendors by salespeople. And right now, there are as many hospitals backing away from prime vendors as signing up with them. It is tough to beat market forces and when you try, you have difficulty meeting your needs. The same is true with hospital associations.

    Quote from eddy
    With all of this said, should you choose to go the IC route, I bid you best of luck. There are some out there doing well at it, but fewer than you think.... the rest that say it's great merely want to sell you something.
    I have nothing to sell so you may be being over cynical. It is probably true that the number of nurses doing direct hospital contracts are few. And they don't do it as "ICs", they do it through an agency front they set up. Do realize, probably the majority of agencies out there were started by a nurse or other healthcare practitioner doing just that.

    And then there are hundreds of nurses who realize the benefits of being independence by subcontracting through other agencies. Yes, they are not getting the full bill rate, but typically they are getting more than an employee would and being able to take full advantage of your own benefits is something no agency can give an employee.
    Last edit by brian on Jun 9, '05 : Reason: removed solicitation

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