CO Independent Contractors (IC), Business Owners, Consultants

deleteaccount · May 13, 2009

This is a great post, but how did you get started? Do you carry your own Liability Insurance? How do you market yourself? Are you working on a w-2 or a 1099? How did you base your fee structure? Are you doing "agency-type" contracts with SNFs or hospitals? I'm a 12yr RN and really would love to start my own business...your input would be great!

innovativemurse · May 13, 2009

I basically fell into becoming independent. I had moved back to Colorado after working at Hopkins and thought that I would just pick up a few shifts per diem with hospitals or through an agency.

It's a long story, but the short of it is that a previous colleague of mine started a company serving people with developmental disabilities and needed a nurse to oversee the medical aspect of his business. This is basically how I got my start. I was pondering starting a business and his need for a nurse fast tracked my desire.

I now do all sorts of consulting: Health care consultant for daycares, case management/skilled nursing for the DD population, private duty (mostly temporary couple of weeks to a month), health/wellness coaching...to name a few. I have seen HH jobs out there looking for per diem nurses and many of these agencies will certainly pay you more and send a 1099. There are also families who can't take care of a loved with post-op, but sometimes insurance isn't willing to pay for HH. You could do a few jobs here and there for a few weeks at a time helping patients who let's say had a CABG. The wife/husband has to go back to work, but they need a little assistance. (this is where it might be nice to know a CNA as you can work together) You could "extend" the teaching that was done at the hospital and monitor progress. I have met so many people who LOVE having a "nurse on call." Basically someone to just ask advice and answer questions (not diagnose of course).

I am strictly 1099. Doing a mix of w-2 and 1099 is doable, but I prefer to oversee my own tax liabilities both as an individual and a business. (Quickbooks helps tremendously). My fee is somewhat based on market rates, but I'm trying to get the "market" to pay up a bit more. That way I am helping current employees of hospitals and other organizations, but again that's another story.

So, if I know what the market rate is (sometimes you have to dig), then I typically add 40% to my hourly rate, but it does depend on what I'm doing. Believe me, if I am paying my overhead ( I run lean and have lots of technology to streamline my job), then 40% is not that big of a deal. I actually use this for some non-profits and most of them don't really think twice about it.

Sometimes I may just charge a fee for service. Let's say I'm health coaching for an individual and I may charge $150.00 (this is kind of arbitrary and really depends on the situation). So, for that fee the individual may get some face-face time, email, chat, phone services (f/u basically) and I base this on how much support and education this person may need. Again, some of these coaching scenarios are variable because if someone has an increased need, I can cut them a break on the fee as I will be spending more time with them.

All in all a drop in the bucket compared to long term issues that can arise from needing to drop a few pounds or help steer those lipids in another direction without the sole use of meds. I can go on about this topic.

I carry Liability Insurance (you can use NSO, or go to proliability) as an IC. Very similiar to the insurance you would carry while working at hospital (please carry your own even if the hospital says, "we've got you covered.") Small price to pay to protect your A$$ets. The premium is a little more than the $100/yr, but YMMV based on how much you are working on your own.

My advice is to gently work your way into becoming an IC. Learn about running a business, know some of the basics about tax law (boring, but necessary), talk it up with your friends and colleagues. Bounce ideas off of people who care about your well-being. You can bounce them here, and even though I don't know you personally, your success as an IC is important to me (that means all of you reading this).

Hit me up for more info here or PM. I think I'll take the rest of the day off and hang out with my kiddos. I LOVE MY JOB!

innovativemurse · May 13, 2009

Forgot to mention. You can work as an IC in a hospital. I'm still trying to find an old listing, but I believe it was PSL that was hiring IC's at one time (not that long ago).

This was my next step, but I keep getting more work doing non-hospital consulting and haven't had time or really the bandwidth to spread out that far, but I will be working on this. In this economy hospitals could benefit greatly to have a per diem (on call person) to fill in some gaps (I know most facilities have a float pool), and there is really little commitment on their part. Of course makes it a little tricky for you when you need to work and aren't sure when you might get that call.

That's why it might be best to register with a few hospitals if this is going to be your only means of work. Businesses and people need you, they just don't know you're out there yet.

deleteaccount · May 14, 2009

Thanks for all you insight! Luckily I've been on the financial/business side of healthcare for about 4yrs and am ready to strike out on my own. I think I've found a little niche in the Denver/Boulder area and just trying to work the courage up to do it. Is good to know others out there have been able to. I keep thinking...there has to be something better in nursing! Will search your posts to see what other pearls of wisdom you may have dropped!

innovativemurse · May 14, 2009

Sounds great. If you ever need to bounce an idea just let me know. I find myself marketing/selling other nurses' services because there is plenty that is outside of my realm or expertise.

I love letting others know that there are more of us out there.

Keep me posted.

hope3456, ASN, RN · May 17, 2009

There would probably be more independant contractor nurses if it we didn't need to depend upon our employers for our (and families) health insurance. Hopefully obama changes this soon.

innovativemurse · May 17, 2009

Hope,

You make a very valid point and this is certainly a concern for anyone who wants to become a small business owner or independent consultant-in any industry.

There are definitely ways around these issues as many IC's have had to make some type of arrangement, especially if they leave their job that was offering a health plan. I won't go into too much detail, but Colorado does have a fairly decent plan for those that are self-employed. Basically, you have to decide what type of plan you would need.

Would you establish a HSA to put in pre-tax dollars for routine visits, Rx., etc. and then have a cheap hospital plan for emergencies? Or if you have a family (kids that see the PCP often), then you may have to opt for some type of HMO/PPO, which the premiums are more expensive, but the coverage is very similar to an employer plan (these are all tax deductible). If you have a spouse or partner that works, this of course is another option-having them cover you.

There are also ways to create a "group" plan as well. Many IC's (in various industries) create a group or some type of "umbrella organization" so that they can all come together and receive group benefits; most importantly at group rates. The promises by this administration would certainly help individuals and small businesses if we could get some type of significant tax break if we are footing the bill.

Here is an example of what I'm talking about on the "group" aspect of things:

http://www.freelancersunion.org/

This organization is based in NY. I actually belong to it (free to sign up), and one benefit I get from them is a discount on my cell phone bill. If I could create enough buzz and get some interest from other nurses here in the state, then this is something that could be created for IC's. Heck this could encompass all independent consultants in any business.

Think about this too; businesses get a discount on their insurance premiums if they have a wellness program. Who better to run a wellness program? Nurses! You could essentially run your own wellness program within the "organization" and receive further discounts.

Thanks for the post. I appreciate the input.