You are so right! I e-mailed Pat Bemis, RN, CEO, of the NNBA and received back from her a very warm welcome. To paraphrase her, she told me that a "nurse is a nurse". The NNBA welcomes ALL nurses into their membership community and so I will not hesitate one more second--I'm sending in my fee for membership.
This becomes a very important topic for discussion and it needs to be discussed here because any nurse who is experiencing the burning desire for personal and professional freedom has got to first cement the understanding into the heart that she/he has absolute permission to do so...
By law, in this country, I am given the perrogitive as a citizen, to form any business and maintain that business using acceptable guidelines which are recognized by the State I live in. (Although those guidelines are not requirements written in stone). When I set up my legal business name with my County Clerk, I was also setting up an 'IMPLIED' agreement with my State and with the Federal Government. My business successes directly contribute to the welfare of both of these entities through the business taxes which I pay and the service which I perform. Because any return I get goes back into my business, I, in essence am impacting government function and public welfare.
Now, as a nurse, the business I have developed, by myself, deals directly with community health. While what I do may not seem like such a big deal on the outside, I know that cost savings in terms of prevention is a big deal on the inside of things. Independent nurses, in my estimation, offer the greater degree of preventive care and teaching to communities at large and, with great success.
Why? Because we have the wonderful freedom to set up and maintain our practices in an autonomous manner. We are not bound by the stiff rules and regulations which restrict nurses from practicing in a manner which is both satisfying and productive. We are not, for the most part, bound by insurance regulations which decide how often a nurse will visit, or how the nurse will develop her plan of care. While we follow the protocols of good nursing practice, keep within our scope of practice as dictated by our respective BON, we still can enjoy a great measure of freedom in the delivery of our speciality to those who require it.
The Independent Nurse offers a tremendous SUPPLY of product, (expertise), in direct relationship to the DEMAND, for that product. Let me tell you- it doesn't take an Einstein to figure out that, in a very short time the demands of an ever increasing aging public will be for the kind of care which is best delivered by the Independent Nurse. This is my generation that is aging--and believe me, my generation will not put up much longer with the kind of shafting we are now seeing in regard to health care delivery- including the "nursing shortage" within the hospital and Home Health Care Agency settings--(which, by the way, I do not foresee improving anytime in the near future).
The RN who makes a firm decision to go out on her own is going to need help at some point. I predict that the need for Independent Private Duty Nurses will skyrocket, that health insurers will see this as cost containing and provide adequate reimbusement- (sadly, along with new rules and regs), and I predict that the subcontracting of LPNs will increase, also, as time goes on, and RNs find they need help. I also believe that, like with med students, business classes will be offered to the nursing student as part of the curriculum.
My Nurse Practice Act tells me that I may not do what I do without RN 'supervision', although I interpret that as, 'ought not'. It is for that reason that I PAY an RN a retainer each month to satisfy this requirement. Christine is very good at foot care but she's a Hospice Nurse at heart. So, she works full time Hospice and about once a year goes with me to a clinic and checks off the appropriate boxes on the OBSERVANCE FORM, (which I developed, by the way). If I ever decide to EMPLOY or SUBCONTRACT an LPN, Christine will be her 'supervisor'...because that's what I pay her to do on a retainer basis. To quell any misconception, Christine SUBCONTRACTS her expertise and her title to my business and receives a fee for her service.
For any LPN who wants to go into her own business, I heartily recommend you put an RN on retainer, if possible, regardless if your State BON and the type of nursing you are doing requires it; and for RNs who go into business, I heartily recommend that you consider the LPN, (who, as we have already agreed, is a nurse), as a subcontracting agent to your business when you are ready.
Like any good enterprise, I do review things, usually once a year, adding or deleting. A captian who does not perform routine inspections on his boat will go down with his ship. When Christine and I get together, I give her an update and copies of changes. But, don't misunderstand me..it is MY business...I call the shots and ultimately decide what or what not will be done.
I cannot count the number of RNs who are instrumental in the ongoing success of my business. These are nurses who know me from past work experience, and nurses who don't know me from Adam. They send referrals to me on a regular basis. They provide me with off-the-cuff suggestions, answer questions I have about new treatments, meds, wound care products, etc., provide me with much needed emotional support and when some of us get together for our 'impromptu parties', the glow can be seen all the way South to Florida!
In my opinion there is no substitute for the RN/LPN-LVN unit in any care setting. Together we represent a knowledge and expertise base which is incomparable. Health care facilities are going to fall and fail precisely because this uniteing of two nursing specialities has gone by the way-side, for the most part. I think that the coming together of these two nursing professions will prove invaluable in the area of Nurse Entrepreneurs.
We are trailblazers--so let's go blaze a trail for others!!