Home based RN business

Nurses Entrepreneurs

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As someone currently working in Home Health and increasingly frustrated with regulations that prevent me from giving care that patients deserve, I'm interested in what kind of business an RN could manage independently.

Ideally, what I'd love to do is this:

Go to client's homes.

If they need help with managing meds, then I'd help with that. (Setting up pill boxes, reminders, compliance, looking for interactions and adverse effects, etc)

Educate on chronic illnesses, health promotion, and illness prevention

Can y'all help point me to resources to find out the legality of this? I've looked at my state's nursing act, but it's so hard to translate that into what I can do on my own.

I wouldn't be interested, at least at first, in billing insurance companies. I'd really only want to do private pay. But then it seems that SOMEONE would be regulating me. If it's not Medicare/Medicaid/CMS, who is it?

Thanks for direction. I've been trying to do web searches and am just not using the right words to find stuff. This forum has been inspirational! And I'm probably looking at the wrong threads, but the most relevant replies I'm seeing to what I want are several years old. :(

Thanks again and sorry for being wordy,

-Davina.

Wondering how all of you have come out on this idea, as I see it's been a couple of years since this thread began. I, too am a Registered Nurse and have a desire to start my own home-based business. I guess a good place to start would be the IL Dept. of Professional Regulation to see exactly what is allowed/appropriate for our state. I'm just aching to work from home. My husband and I both drive (we have to drive separate due to our work hours) like 80 miles round trip, each day. That's 160 miles/day total for our family! I'm not wanting to start an assisted living or anything like that. More like med. mgmt services, maybe nail trimming, etc. I saw someone mentioned LLC in an earlier post. Must be having a brain cramp, as I can't think of what that stands for.

Limited Liability Company. We can start any business in any type of entity that we wish to, just like any other person. The challenge is leveraging our education and experience.

I've formed my own travel nurse agency to cut out the middleman. While a nice pay raise, I'm not on the road to becoming wealthy as I do not want to become a real agency.

Hello nedRn... also I want to start a business like yours... but my question is, how do you know how much to charge for services? The pricing and everything and you said that you dont want to be an agency but what happen if you suddenly decide to do it. What changes will need to be make?

Basically I need ideas for the marketing research. .. cause an agency paid to you like 40 an hour... so how much this agency charge for an hour! ? Please help help help, I'm so exiting to do all this

Thanks in advance

There are lots of methods you can use to help determine bill rates. The easiest is to ask the facility what they would like to pay. That is usually the starting point for negotiation but of course you want research the market. Typical bill rates are around 60 but the range is 48 to 90. Around 65 for my selected contracts. 80 is the best I have done but I have a high needs specialty and it was a difficult place to fill needs. I also am only negotiating for me so I do better than I would if I was seeking to place several travelers at the same hospital.

Nothing much would need to change in my agency to expand. I'd need better internal systems to help with organization and would probably shop other insurance providers. A better website.

Wow... nedRN thank you so much for your help... I'm planning to start just like you but definitely I will love to ad some five or seven staff in a near future. .. your words are very helpful to me. Thank you! I wish the best for you.

I have another question nedRN and what do you think that it have to be charge in home services...?

No idea, sorry. I would think it would be less than for acute care RN though and would certainly depend on your area. Entry employee pay for nurses varies by a factor of three, and experienced RNs by a factor of two. So there is a wide range depending on your local area.

Ok.. thanks a lot!

NedRN,

I'm also looking to become my own agency RN. I'm hoping to do this long enough to establish funds for my overall goal, and keep myself busy and "employeed".

My overall objective is home health agency, what I've spent the last 7 years doing. The Medicare site survey takes up to two years in my state, and I still need to submit the $25,000 Application for a necessity of need (not a guarantee of certification, just the app!).

My question is, where do I go to review local markets and find out what local temporary agency RN's charge facilities? I worked agencies for years prior to 2008, and since then worked in home health. But I never dealt with the business aspect of the registry or staffing agency, so I don't know what to charge a SNF or hospital hourly for an RN.

Thank you!

Tina

I know very little about local staffing. That seems very ambitious to me as you need a critical mass of local RNs willing and available to work for you to land hospital contracts. That is not necessary for travel which is what I do.

Determining optimal bill rates is trivial in comparison. Generally HR or staffing has no problem telling you their average bill rate and that is your starting point for negotiation.

For local you have a number of variables. You are competing with other local agencies for nurses. You have to pay them competitive wages to attract them, especially if you are not racing to the bottom for quality staff. You also have to have a competitive bill rate if facilities are going to use you over other agencies. Presumably you will have a low margin to help but I assume you need phone coverage around the clock to receive staffing needs and then try to find an available nurse to fill.

Ambitious to be sure and I don't know how you can start slow. You should talk to facilities and see if you can build a viable business model that fills an unmet need.

NedRN

I am also considering starting my own staffing agency. At first it will be just me contracting myself out and then hopefully grow to accommodate other RNs that I worked with in the past. It would be no more than maybe 10 other RNs total for the foreseeable future. I worked as a supervisor for a local LTACH before I moved to CVICU and still stay in touch with the CEO of that hospital, therefore pretty much have the "in" for the two local hospitals.

I'd like to hear your suggestions on opening a local agency, since you contracted yourself out for a while now. I know the competition is fierce, where there are numerous other well established agencies to go around, but the need is still there. A number of agency RNs that I have worked with in the past are interested to jump ship and come work for me if that meant more money.

I would be particularly interested to hear about how you went about dealing with hired help. In one of your previous posts you mentioned that in the past you hired a traveler. Did you hire them as an employee or a contractor? Did you issue them a W-2 or a 1099? Did you end up paying for their FICA/SS/Medicare taxes?

Thank you for you time.

I've only ever paid 1099. You will find that some facilities will specifically require contract language not allowing subcontracting. Part of the reason for that is they don't want a daisy chain of agencies with diluted responsibility but the larger issue is workers comp. If one of your workers is injured on the job, and you have no coverage and you have protected your personal assets, the worker's lawyer will of course try to get his client reclassified as the facility's client covered by their WC and this is often successful. Hospitals that don't require it probably don't understand the issues but I am not an expert either.

That said, there is a tradition with per diem agencies that they pay 1099. So you might be fine with that and it is certainly a lower cost way to go. My WC rate is 1.5% of payroll, no small amount really. Plus no unemployment or FICA. You can pay your workers more, but many are not willing to be paid 1099 even so with the hassles of filing estimated taxes quarterly.

This year, I decided that I wanted to offer WC as the right thing to do considering the incidence of injury in healthcare and the age of the nurses I work with. Unable to get it other than for myself. Technical issues but I read that WC is a huge hassle to obtain in many states.

You can try both of course. Start 1099 and see how your business goes and then go W-4. It is even possible to have a mix of employees, but if audited, you will have a tougher fight.

Anyway, you are well positioned to get your agency going, tax issues aside. You should create profiles and gather necessary documents from those nurses who want to join you (even if you won't use them immediately). Having those profiles in hand, those nurses presumably having already worked for facilities of interest, will help you tremendously in getting your foot in the door persuading staffing to give you a contract.

A possible problem for you are "do not compete" clauses in the contracts of agencies you and others have worked for, not allowing working for a competitor for some period of time such as 6 or 12 months. These clauses are virtually never upheld for ordinary workers (think CEOs and key employees or those with proprietary information), but just the threat of litigation may stop facilities or employees from working with you. I have no idea if these are common in the per diem world but they are almost universal in travel.

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