Independent Nurses providing medical care?

rachel h, BSN, RN · Apr 28, 2003

This may be a dumb question, but how can a nurse be an independent care provider as so much of what we do depends on physician orders (IVF, meds, certain procedures, etc.)? Do you collaborate with a physician, which would then mean you're not truly independent or is there another way?

I'm very curious about how this is done, as the idea of being an independent contractor is very appealing to me. I understand how it can be done as, say, a legal nurse consultant or someone who is not doing direct patient care, but I don't understand how it works when you're providing direct patient care.

Thanks for any input!

5150dx · Apr 28, 2003

Hello,

I checked at the website for the CA BON and read the information about which are considered independent nursing procedures (those relating to comort, hygeine, etc.) compared to those which require a doctor's order (foley cath, etc.). I followed up with a phone call to BON, was transferred to a nurse education consultant who confirmed this for me. Have fun researching!

Kristi

5150dx · Apr 28, 2003

Hello,

I checked at the website for the CA BON and read the information about which are considered independent nursing procedures (those relating to comort, hygeine, etc.) compared to those which require a doctor's order (foley cath, etc.). I followed up with a phone call to BON, was transferred to a nurse education consultant who confirmed this for me. Have fun researching!

Kristi

5150dx · Apr 28, 2003

5150dx · Apr 28, 2003

JNJ · May 7, 2003

Rachel:

In many states, the Medicaid program uses the term "independent nurse provider" (INP) to designate a nurse who is self-employed. I am an INP for Medi-Cal in CA.

INP means that I provide nursing care independent of employee status with a healthcare organization.

I obtain an order signed by my patients' physician(s) which legitimizes the administration of medications, treatments, and other procedures by an RN. I practice nursing within the CA Nurse Practice Act by maintaining MD orders on my activities.

I think the terminology "independent" may have come from the IRS which uses the term "independent contractor" (IC) along with their rules and regs. for self-employed people of any profession.

The National Association of Independent Nurses (NAIN) at independentrn.com defines "independent" as self-employed.

I hope this clarifies the independent RN situation for you.

renerian, BSN, RN · May 7, 2003

I have had alot of professionals tell me lately in Ohio they cannot find cases as independent providers and have to go back to agency work. Let us know what you find out.

renerian

JNJ · May 10, 2003

Renerian:

I'm sorry the professionals you talk with have had difficulty finding work in Ohio. Perhaps they are simply nursing professionals and lack the skills and knowledge to successfully become independent.

Indie nursing takes marketing and moxie and tenacity and humor and thinking out of the box and research savvy and . . . get the point.

You may want to direct them to the National Assoc. of Ind. Nurses independentrn.com where access to the forum requires membership, but oh how we share the above qualities and most of us are/are getting there with a little support from our friends.

Power to us all. JNJ

nightingale, RN · May 10, 2003

The National Nurses in Business Association (NNBA) also can direct and educate nurses on Entrepreneurship. No membership is required to view their website and look at what they offer in books, seminars, and sapport through the President, Pat Bemis and it's members. I am a member of NNBA.

I do remember another Group of Nurses (forgive my lapse in remembering their name) that provides direct coaching and classes.

There are probably others I am not familar with. It has been a while since I have run a new search of sapportive associations for Independent Nurses.

I have noticed a trend towards independent practice nationally via articles and agencies who will allow subcontracting of nurses as Vendors.

retiredusaf · Sep 11, 2003

I too am an "Independent Nurse". I got tired of all the OR call, politics, and lack of quality of life (because of all the call... 2 weeks a month of beeper AFTER the regular work day.) We also had a new DON. Before she came, it had been approved that 2 of us not on call could leave early when everything was done, still be paid, and HAVE A LIFE! IF we were slow during the day, and 4 of us did not always need to be there till the clock struck 3pm,we could take care of personal things that needed to be done, like a car repair, going to Walmart, seeing a ball game our child was playing in a nearby town, etc. Being able to do these thing ONCE IN AWHILE helped morale so much that we did not mind the 15 days a month we could not even swim, cut the grass, take a shower without wife listening for phone, etc. You need to know that the closest mall is 2 hours away, and Walmart is an hour. Well a new DON put a stop to it all! So as a Dept. we offered to take a $5000 a year pay cut EACH to be able to continue what we'd been doing. Well, the cut in pay was looked at in some ridiculous way as a PAY increase over our hourly rate (less than $20. hr I might add with 20 yrs as a nurse and a BSN!) They did not add in all the Call pay we earned during the year. (1.25 an hour.) Her other concern was ,"What will the other nurses think?" "It won't be fair to them!" That was the stupidest thing we ever heard! That is comparing apples to oranges! Other nurses in this town are OFF when they are not working. They are not called back in. They did not pull call. Well, within 3 months..... 3 out of 4 of us OR nurses quit, and we had over 50 yrs experience between us!!!! Do you think they asked us how they could keep us? NO! Was there an EXIT interview? No.

That was over 2 yrs ago. Do you think they have REPLACED us with nurses? No, they did replace one of us with an OR tech, but she too is gone. They have hired TRAVELERS and are continuing to do so!! Think of all the money they have spent......all because we asked for some "time" to go home early if we were not on call, and IF the work was done ,yet make enuf money to support our family and call this time "comp" time. .. and take advantage of the daylight hours, knowing the next night we had call and that weekend too. THAT IS WHEN I became independant!!!

I started a business for tax purposes, incorporated and am president of the company. I can advertise myself as indep. or as an agency depending on what the hospital wants to work with!! Some hospitals will not touch an indep. nurse, they want to go thru an agency. Others are tired of the high price of agencies and want to negotiate a lower price with an indep. contracted nurse, and in either case I bring in over $50 an hour and $8 hr for call. And this is LOW sompared to what agencies charge in other places. I have worked in WY., close to home, am home on weekends and the hospital gives me an apt. free!! ( Since our towns are so far apart, I have to travel. Other indep. nurses can continue to live at home, and contract with a hospital for a designated period of time.) I can depreciate my truck, I pay workman's comp, I have all the liability insur to protect me, I pay my own payroll taxes too, and I can deduct my medical and life insur. as a business expense. I follow all the State rules for a corp. in WY.

I plan to travel with my motor home in the next 2 years and finish seeing the US. Yes, it is hard not being in my home, but because I am treated so well and paid what I am worth, and pull less call, I really like it. My attitude is: "I am part of the solution, not the problem".

Indep. nurses are not employees of the hospital... and the IRS has guidelines for indep contractors. Think of yourself as a construction worker with your own business. You make up a contract that you will complete this job by the safety standards, codes, etc. and you will be on the job for X amount of time and for X amount of money. You are trained and do your work for the sake of the project being the best it can be. You state the terms you will work under, and they sign your contract (written by a lawyer).you submit an invoice weekly, monthly, and they pay you. You pay your own taxes and your benefits yourself. You pay your own training, drug screenings, etc. You are not an employee of that firm. That is the philosophy to take as an indep. contractor/ nurse.

I hope this helps clarify what we do. Please think outside of the box, and help nursing be what it should be. Be happy with your job, either stick together for better benefits and conditions, or branch out like we did. By the way, out of the 3 that left, 2 of us are doing this! My friend works 6 months of the yr, takes the rest of the yr off!

Cmyst · Sep 12, 2003

Congrats on your success, Retiredusaf :)

The Workman's comp bit confuses me, though. I thought that workman's comp was to cover *employees*, and that to cover oneself it would be disability insurance? Is it because you have incorporated that you get WC on yourself?

I'm a sole proprietor, working right now per diem and trying to find a contract. I have my own health insurance and disability. By purchasing the insurance that I feel is best for me, I have kept the cost reasonable while keeping myself insured and am making much better money now than working for the same employer in a benefitted position.

However, due to the tax breaks that Retiredusaf already enumerated, working IC would be the best option and it is one that nurses have the ability and licensing to pursue.