Starting An Agency - page 3

I'm exploring the possibility of starting an agency. I've worked agency for several years in an urban area with many hospitals (and agencies). I have a pretty good feel for what hospitals are paying... Read More

  1. by   RNPATL
    I think there are several points about starting an agency business that have not been explored on this thread as much as perhaps it should be. Namely, competition. I have also wanted to start an agency and think that in most areas there is a need. The nursing shortage has made agencies a popular alternative for staffing. However, even agencies are feeling the crunch with the shortage.

    When I was doing my due-diligence and market analysis for my business, I realized I had a number of HCA hospitals in my market region. They have cornered the market in relationship to agencies. For cities and towns that have several HCA facilities in their backyard, you would have to negotiate with their staffing company (All About Staffing) in order to even get some small percentage of market share. They cost cap what they pay agencies that they sub-contract with. And, if you don't sub-contract with them for business, and you have several HCA hospitals in your area, this could spell poor revenue and poor utilization of your business. My one friend was charging $47.00 per hour for an RN and was staffing several HCA hospitals in our area (there were actually 4 of these HCA hospitals within a 20 minute drive of each other). HCA made this policy decision that they would NOT use "outside" agencies for their hospitals and if the agency wanted the business, they would sign with All About Staffing. My friend had to do this and her RN rate went from $47.00 per hour (remember ... this is billable) to $30.00 per hour billable. This impacted the rates she was able to pay her nurses (went from $35.00 per hour to $22.00 per hour). Naturally, she ended up losing some of her RNs. She finally decided to bite the bullett and reduce her overall business revenue and end her contracts with All About Staffing.

    If, however, you have reviewed your competition and feel that you could develop decent market share, then starting a nursing agency is a great business to have. I have several friends that have been successful in other demographics with nursing agencies. Some of them have even branched off to home health and I have one friend that even wrote and was awarded a CON for a Medicare home care agency. Of course, I have no interest in a Medicare Home Health company, but the sky is really endless with this type of business if you do your homework, develop a reasonable and logical business plan and grow your business slowly.

    I commend all those who want to start a business like this and hope that those of you who are starting and are successful, will come back to this thread and let us all know how you are doing with it.
  2. by   WyomingRN
    Both me and my husband are independent contractors. Technically speaking, all agencies are independent contractors. My husband is a construction contractor. I took his 14 years of experience and applied it to nursing and am now a nursing contractor. Like my husband, sometimes I am the only employee of the business. Like my husband, sometimes I hire a few employees when the need arises.

    As a nursing contractor, I work out of my home; as do many independent contractors including my husband. I started off as the only employee and had very little expense. One month, I paid for my yellow page advertising; the next month I paid for insurance for the LLC so that I could hire employees when the need arose. Cost can be spread out as you earn money. My entire start-up expense is paid in full and within my first two months, I recouped the entire cost working no more than 12 days. We printed up our own advertising flyers right here on the computer as we needed them. We designed and printed my business cards right here on the computer. They both look very professional and cost us a fraction of having others do it (and if want to change something, I'm not stuck with hundreds of cards). I now have a contract with two facilities and am negotiating with another.

    Of course you do have the option of borrowing tons of money, renting a fancy office, buying a new computer instead of making due, ordering 500 business cards all at one time, and hiring a professional marketing agent, etc. You can run your start-up costs up as high as you like.

    As to the question of what to charge, we know that there is no one answer. In preparing to go independent, I simply started asking the DON's and staffing personal at various facilities "how bad is agency zyz ripping you off?" I was surprised at the information they were willing to divulge. The love to moan and complain about how bad the facility was being ripped off. The cheapest rate we have found is $65 for an RN for our area. Every facility we have talked to in the last year has made it a point to tell us about all the extras that agencies add above the basic rate for things like a nurse working as "charge", shift differential, housing costs and travel expenses. In our area, the agencies pass everything on to the facility. So there is room to negotiate and maneuver.

    Check out the information on these threads also:
    Independent Nurses providing medical care?
    PRN vs Independent Contract
    Independent Contracting and Protecting Your License
    RN Independent Contractor

    This information helps you out.
  3. by   Guardian Angels
    We have a staffing agency and home health care. We are doing very well. We have been in business for a year and a half. I am pleased with the response.

    We staff 9 facilities at this time.
    Last edit by Guardian Angels on Mar 11, '04
  4. by   relysh717
    Quote from Guardian Angels
    We have a staffing agency and home health care. We are doing very well. We have been in business for a year and a half. I am pleased with the response.
    Hi, My name is Sheryl Pastores, an LVN my first time to join this forum aand I am currently doing some research in how to start a nursing registry. Do you have some helpful advise that you can give me? Thanks.

    Sheryl
  5. by   Guardian Angels
    Are you starting a registry and what kind if so? Or Are you researching a Nursing Agency?
  6. by   relysh717
    Quote from Guardian Angels
    Are you starting a registry and what kind if so? Or Are you researching a Nursing Agency?
    We are starting a recruitment agency that specializes on medical staffing - particularly nurses. I do have an agency in the Philippines that we will bring in the US under working visa, and at the same time, we would like to start recruiting nurses locally that we can market to the hospitals. Therefore, I am at a loss and wants answers to the following questions:

    1) Do I need a special permit or business license to operate this?
    2) Do I need to be accredited to some kind of orgs. such as jcaho, calif board of nursing, etc??

    I appreciate your help.
  7. by   suzanne4
    I think you need to start in your research from the very beginning. There is no such thing as a "working" visa for a nurse anymore, at least not this year and probably not for the year 2005. Requirements will be the same, as far as Visa Screen certification and English requirements, the complete set. The only way for a nurse to come over to the US to work now is with a green card. Yes, they are getting fast-tracked compared to other jobs, but you are looking at about one year plus at the earliest to get everything done for each nurse.

    If you have any other questions you can PM me or send me an e-mail directly to suzanne@RNSpecifics.com

    Hope that this helps you.
    p.s. Unless you are planning on placing the nurse in one of five states, they must also complete the CGFNS exam. Deadline for all paperwork to be received in PA is one month form now for the July exam. Next exam date is November, and the scores aren't sent out until 8 weeks later. So you must take this into account also.
    Last edit by suzanne4 on Mar 12, '04
  8. by   suzanne4
    First you need to incorporate your business. You must also take into account the expense of bringing each nurse to the US, such as fees for immigration, immigration lawyers, plane tickets, etc. Are you planning on having them come over to the US earlier to take the NCLEX exam? If so, they need a separate visa for that, and round-trip plane ticket, etc. You will not got paid one penny from hospitals until the nurse is actually able to start work, so all of these funds will be coming from either your pocket, or your company's pocket. If your company is sponsoring the nurse and not the hospital, you will need all different types of paperwork on file with immigration, etc. Setting up a business to recruit from overseas is a highly specialized field, if it is done right and legally. Make sure you have enough funds to cover you through all of this. Simple example, if a company wants to recruit in Thailand they must place a $125,000.00 bond with the Ministry of Labor here and each of their staff needs to have a license also. So you need to look into these things also for the countries that you are dealing with.

    Good luck.
  9. by   carmenjo
    Hello to all. I am also wanting to start an agency in the DFW, Tx area. I'm currently working through the loan process (working capital) and would greatly appreciate any helpful information giiven.


    Thanks
  10. by   suzanne4
    Are you incorporated as of yet? Don't forget all of the insurance that goes along with it. For the business as well as you. Have you been in contact with any hospitals in your area? Have you actually ever worked agency?

    These questions need to be answered before I can give you any more advice. Feel free to PM me if you would like.
  11. by   Ylove113
    Hi, Kallie I am a RN in North Carolina and I am trying to get started on opening a personal care service agency. I am not familiar with writing policies and procedures. Can you help me or tell me where I can get help with writing the policies and procedures to get licensure.
    Quote from Kallie
    I can relate to your concerns regarding starting an agency. I live in a rural area. I have had my certifications for my personal care agency for two years. My agency is incorporated. I purchased an office space. I have been ready to take patients for two years. I have tried to get assistance through the Small Business Administration, however, you have to be wealthy to qualify for one of their loan programs. "If I was wealthy, I wouldn't need SBA's assistance!" But, in the mean time I continue to work as an RN. I hope to someday locate the capital that I need to use for my business. If anyone has capital, and would like to invest, feel free to contact me. The personal care agency is funded through Medicaid.
  12. by   suzanne4
    Ylove113: First thing, before doing anything else, you need to decide if you will take Medicare patients. If you do want to, they have a complete set of regulations that you must file, as well as the documentation needed, etc. Are you planning on being the only provider, or are you planning on hiring other nurses, etc? If so, you need to look into the regulations for your state. Some states have quite specific rules on what can be done and not done. I would worry about all of these things first, before even thinking about writing policies and procedures. That is the final thing that you need to deal with.

    Good luck......................
  13. by   Ylove113
    Hi Suzanne4, No I am not going to do Medicare patients, just Medicaid. I am going to be the only RN, but will have some Nursing assistants and PCA's and an Office Manager.
    Quote from suzanne4
    Ylove113: First thing, before doing anything else, you need to decide if you will take Medicare patients. If you do want to, they have a complete set of regulations that you must file, as well as the documentation needed, etc. Are you planning on being the only provider, or are you planning on hiring other nurses, etc? If so, you need to look into the regulations for your state. Some states have quite specific rules on what can be done and not done. I would worry about all of these things first, before even thinking about writing policies and procedures. That is the final thing that you need to deal with.

    Good luck......................

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Starting An Agency