Any guide on the legal requirements for starting a nurse staffing agency?

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This might be a hail marry pass.

Anyone here been through it? Asking about CA specifically.

2 hours ago, NedRN said:

S corp, sole proprietor, and LLCs that do not chose regular taxation are all taxed the same.

You are generally best off filing for a business entity in your home state. You can make your own business decisions, but it gets complicated when you start to worry about registering as a foreign corp in other states. State laws vary, but generally require you to have a physical presence in the state. Does sending an employee (or an independent contractor) to work in a state count as a physical presence the way an office would? I don't know, and don't want to know. Running a small business is largely about staying below the regulatory radar. Larger business do need to start worrying about such things as corp registration and local employee laws because they have more to lose.

I've never come close to having an issue in 15 years of working in a number of states. I've avoided a few states with regulatory issues, either bad BONs (NY/NJ/TX) or those who require agency registration (WA/RI) - MA also appears to require such registration, but as that was an important state (high bill rates and personal fun) for me, I pursued an answer and was told it didn't apply to me as too small and out of state. I had a friend who started a real agency who ended up having to register with one CA agency (don't remember which one, perhaps WC) but didn't have to deal with the other agencies (you might think CA would information share, but apparently not) or even register his corp there. The only regulatory issue I've ever had was maintaining my CA license and having CA once send me a tax bill even though I hadn't worked there that year. They just assumed! A simple letter took care of that.

There are any number of interesting regulatory and tax questions I don't know the answer to. But I do know if I hired a lawyer to deal with them, I could not make money as a single (usually) worker business. If I wanted to become a larger agency, then yes, I would have to have a different strategy.

Beautiful info! Thanks!

Ahh! Decisions decisions ?

A few more questions Ned.

1. You said you had a friend who started a real agency who ended up having to register with one CA agency.

I'm confused. Do you mean "...having to register with one CA "hosptial"?

What do you mean having to register with an agency? Why would an agency register with another agency?

2. So if I were to pick a state where I am not a resident in order to file my entity, it would automatically be a foreign entity in that state. And this is the case with all the states. Correct?

3. What are the regularory issues (that you know of), besides having to register your entity in the state where you are sending nurses (including yourself)?

4. How do you know before hand whether you'd have to register in the state before working with a hospital or staffing it through a vendor?

5. There would be two owners (50/50) for my entity. So if it's an LLC, it would be an LLC with partnership election. Any disadvantages to this choice as opposed to a corporation with S election?

6. Considering there is a partner, is an LCC with S election a feasible option? If yes, would it be the better choice, in your opinion?

Thanks again Ned!

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Register with a state agency such as workers comp.

A foreign corp is one that is not domiciled in a work state. Your domiciled state is the state you formed your business entity in. It is easiest to do so in your home state. Theoretically if you formed a business out of state, you would now have to register as a foreign corp to work in your home state and pay some minimum level of taxes to both states. And presumptively you do have a physical presence in your home state (home right?) so the legal authority of your home state is much more clear.

As I said, I don't even know all the regulatory questions and don't really care about the answers.

I've never "registered" in any state, nor have been required to specifically by a hospital or vendor manager. It is the responsibility of any business working in the state to follow the laws, not that of the hospital or VM.

Can't help with partnership questions. But you may well need a lawyer to help with agreement language and taxation issues. I'd advise against anything that will require a lawyer. Nothing with them is simple and will end up costing a lot.

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11 minutes ago, NedRN said:
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And presumptively you do have a physical presence in your home state (home right?)

Not really. I'm not rooted anywhere. But I do have a home state (or tax home), for tax purposes only.

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I've never "registered" in any state, nor have been required to specifically by a hospital or vendor manager. It is the responsibility of any business working in the state to follow the laws, not that of the hospital or VM.

So what do you do? Pick a state, bid for a job on medifis, and if they accept and you have a nurse, you just send them to that state? No consequences?

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Hi NedRN, I went to your blog to find your post on starting a healthcare staffing agency and I do not see it. Can you please help? I’m trying to gain as much information as possible.

thank you,

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Search for my screen name on Google plus "FAQ".

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Thanks, is it included in your travel nurse blog pg?

I found it, Thanks

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Just to suggest that queries along these lines, starting a business, might be better off in the Entrepreneurs forum: https://allnurses.com/entrepreneurs-innovators-hub-c220/

I have responded many times there on business issues including a number of threads on starting an agency. I think of this forum topic as primarily about helping travelers with agencies and other travel issues.

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Hi NedRN,

The post was very informative. Does the information apply if I want to start my own agency instead of being an independent contractor? I read over post that being joint commission certified isn’t a requirement, is this true for an agency? Also, would you know as a healthcare agency would I need policies and procedure?

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Agency = independent contractor. Covered in the FAQs.

Agencies don't need to be JC certified, but it possible some hospitals require it. I always keep a set of the requirements and state I'm compliant. That would include having a policy manual (I do) but if you are not certified, you cannot be audited. I constantly am asked the certification question when signing up with a vendor manager, but none have required it.

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