Private Duty Nursing vs. Agency Nursing

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As an agency nurse, I'm still working for a middleman that takes more than half my pay because they connect me with clients that need my services. I've worked in various facilities that gave me the toughest assignments while the agency made more than twice my pay by literally sleeping. (I worked midnights!)

Who doesn't love one-on-one nursing? You can't do this working for hospitals or facilities. Our time is spent away from our patients charting properly to avoid being sued.

I work at a sub-acute rehab facility for the largest Catholic Healthcare Organization in Illinois. Besides passing out meds, doing some treatments for 15 plus patient for the majority of my 8 hour shift, I chart and do clerical work mainly to protect a license I've worked hard to earn. All the while I feel this Corporation is taking advantage of me, and they treat me and my nursing coworkers as unprofessional by always threatening 'write-ups.'

And in today's economy, they stress in no uncertain terms how we should be lucky we have jobs. In fact, they take advantage of that and squeeze more out of us for their greedy gain.

And where is nursing management in all this? Aren't they supposed to be our advocate? Instead, the majority of them are clawing their way up the corporate ladder only to be stressed out to make a few extras dollars just to become a higher up pawn in Corporate America's game/gain.

These Corporate giants, even though part of a non-for-profit organization, with their large salaries are laughing all the way to their vacations villas mostly on our hard work!

How would hospitals and facilities function without nurses?

I feel nurses are second only to patients.

Nurses are SO underpaid and unappreciated!

At one point I wasn't familiar with Private Duty Care because the nursing program prepared me to work closely with patients in a professional setting, they did not prepare me for that special kind of one-on-one care. That's when I realized private duty means you should be working with one patient as opposed to fifty and working for an agency doesn't always get you private duty.

However, as a Private Duty Care Provider, minus the Agency, I can be my own boss, work close to home and choose my own schedule. I realize my license must be current and I need a clear understanding of my state's professional practice act.

Having is optional but very much encouraged and not that expensive when compared to what I'm handing over to the agency every single hour I work. Besides, even though nurses are covered by an agency, hospital or facilities' malpractice insurance, if it came down to us or them in the courtroom, who do you think they're going to protect?

In addition, I know it is my responsibility to pay state and federal income taxes. But wouldn't it be worth it not have to share my hard earned wages with an Agency just by doing a little initial homework upfront?

So, I thought about taking an ad out in the local classifieds as a private duty nurse only to discover this was much too expensive, and I had to question how many people were looking for a private duty nurse via the classifieds.

I soon found that many nurses are asking the same question.

How can we affordably go about getting a private duty job without handing over the majority of our wages with an agency?

Specializes in Pediatrics, Emergency, Trauma.
Properly set up, none of those agency 1099 employees are "thrown out" by the IRS. Some of these agencies have been operating for decades. We all know why withholding taxes were instituted in that there is a human tendency to cheat otherwise and tax collections suffer. And of course the IRS favors employee status and withholding. But there is no reason to preach fear.

There are millions of such Americans whose pay is not subject to withholding, from restaurant staff, to every kind of contractor such as HVAC and carpenters, to physicians and lawyers. And yes, nurses, including this one. I did not hire a lawyer or an accountant to clarify IC status, help me incorporate, or do my tax returns. I'd bet quite a bit that most small one person businesses don't either - IC is not so obscure that you need to spend thousands of dollars in consults, there are literally millions of ICs.

Thank you Ned; I have been a IC for about 7 years in some capacity; 5 years solely an IC. I paid my taxes at the end of the year-no issues with the IRS at ALL.

Specializes in Pediatrics, Emergency, Trauma.
I'm hardly spreading fear. I'm throwing out things for people to consider. The not being paid thing has happened to me, myself, three times- this is where I got my information. As far as other occupations I wouldn't know, the topic here is about nurses that want to go it alone. Not only does it 'not' cost thousands of dollars in consults to talk to a professional for guidance, to avoid these pitfalls- it's never good advice for anyone starting a business to believe they know all there is to know. Spending a little money on professional advice will always more than pay for itself, in one way or another.

On other note, I know several IC nurses (and caregivers) that report (and pay taxes) on only a fraction of what they really earn. They think they are somehow coming out ahead, even while risking civil and even criminal penalties once they get caught. They also can't seem to undertstand that by not claiming all of their income, and paying taxes, they are shortchanging their own SS retirement accounts, and the benefits they will ultimately be entitled to. As far as recouping pay if an agency doesn't pay you- yes, some states have a process to allow a claim to be made with the state labor department, or other agency. Good luck with that.

Like Ned stated, when done CORRECTLY, these issues don't occur; I know a few IC peers that pay to the IRS quarterly, some, including myself, pay at the end of the year; both parties did it correctly, and in the clear.

If done right, even by an agency, you can't "shortchange" your earnings, especially with a 1099 form; you still have to report losses (or breaking even) by the end of the year-that's not a "fraction" of income; if one doesn't have any income left at the end of the year, and a portion went to business expenses-food, gas, supplies, for example, and then have mortgage, student loans, etc; then you are still eligible for those "credits"-that doesn't change. :no:

And really, you don't need thousands of dollars to do it "right"- a simple phone call or a trip to the IRS website clears up ANY confusion-when I decided to be an IC, that was the FIRST place I visited; 5 years (and counting) no issues.

Assuming if you work for an agency, that that agency is ethical and plays by the rules. Plent of them are fly-by-night.

Your claiming that you can't shortchange your earnings (even if 'done right') based on a 1099 is awfully naive, LadyFree28. Also, a 'simple' trip to the IRS webite is an oxymoron.

It's simply bad policy to suggest to any nurse wanting to work indepedently that no professional guidance is warranted.

Hey Sam, you are giving uniformed advice to two nurses with 100 percent more experience with working as an IC than you have, and on my side, I have experience on the employer side as well, issuing 1099s to subcontract IC travelers through my corporation. Getting a 1099 for a few days work does not count as IC experience, especially since you say you didn't get paid (three times - more fool you). Perhaps per diem work is casual, but on the travel side, we have contracts that can be enforced. If you had such a contract, you could have easily filed in small claims court (no lawyer required) and collected. If the business was nurse-owned, you would have had a sledgehammer available to collect - fear of being reported to the BON for fraud.

Employees have more protections than do ICs, so it behooves an IC to have good contracts. I'm not sure why you belittle the substantial help that most state boards of labor provides.

You have already thrown out so many red herrings and misinformation it would be difficult to correct it all. But let me give you a quick soundbite or two.

ICs that misreport profits - so? Employees are also known to fiddle with tax returns as well. Both are illegal, and no one here is suggesting breaking the law.

No one suggested that one shouldn't seek professional advice, just that it is costly. I know you have never done it, but starting a small business is a learning experience. If you don't do it, but rather seek professional advice in lieu of before starting, I can promise you that it will be amazingly expensive. I did talk to several lawyers and accountants before starting about fees and services, and just having a lawyer write a contract for an industry he knows nothing about would be several thousand dollars. Trying to shortcut a bit and still have "expert" advice, I asked about reviewing a contract I would write. Two hours minimum at 300 to 500 dollars an hour. I happened to have that much money, but most wage slaves cannot afford that for a business they don't even know is going to ever pay back those start up expenses. So I did my own research, and probably like most small business owners, I know far more about the risks of my particular business. I've even sued a hospital for breach of contract and won, even better, collected.

I learned by reviewing actual agency-facility contracts and using them as a basis for my own. I learned about IC from reading IRS publications and certain books I purchased. Elsewhere I have posted links to books and web resources but I can't do that here. Two Nolo books that are really helpful were "Working for yourself" and "Hiring Independent Contractors". Both have in depth information and case studies on what is a legal IC actually is if you want to find out more for yourself.

If you have the tiniest bit of self discipline, money saved from FICA can be invested and over a working career, you will have much more retirement income that can ever be gained from Social Security. Millions and millions more in fact. Social Security is a safety net for the masses, not how to retire well. I'm not a Republican, but George Bush and many others had a reasonable thought to privatize SS. It can't work, as most workers do not have the discipline to save, but for those who do, and can avoid FICA (as can most small business owners to some extent), they end up far better off. I'm in that category, and I max out my corporate contribution to my 401 every year (no FICA).

Being an employee is for suckers, and the IRS treats employees like suckers. Small businesses get many more tax breaks than employees. Large businesses have a license to steal.

Specializes in Pediatrics, Emergency, Trauma.
Assuming if you work for an agency that that agency is ethical and plays by the rules. Plent of them are fly-by-night. [/quote']

And you have the expertise to know they are fly-by-night...how many? Probably not that much in the big scheme of things...

Your claiming that you can't shortchange your earnings (even if 'done right') based on a 1099 is awfully naive, LadyFree28. Also, a 'simple' trip to the IRS webite is an oxymoron. It's simply bad policy to suggest to any nurse wanting to work indepedently that no professional guidance is warranted.

As someone who has been doing this for quite some time, against someone with virtually NO experience, you are misinformed on "shortchanging" earnings versus eligible credits.

And it is a simple trip to the IRS; the information is available; Ned has provided great information above as well. It doesn't cost "thousands" that you implied, and there are too many sources to get the information; when in doubt, one can be a subcontractor, and STILL be eligible for credits-again, it's not "shortchanging" income, an most contractors and subcontractors know this, especially the ones who do it right.

Nice try, but again, off the mark.

[quote=AreaNurse;7720020

I soon found that many nurses are asking the same question.

How can we affordably go about getting a private duty job without handing over the majority of our wages with an agency?

By asking other nurses (even Sam, despite claims in here that Sam has virtually no experience, in what nobody has said, because nobody knows who Sam is) what type of work they do, what their scope is, how they locate work, what they get paid, pitfalls they may have encountered, the best and worst parts about what they do, the type of business entity they operate under (whether they are the employee or the employer), licenses or permits they hold, or even if having is really 'an option'?

And by taking note of the bits and pieces of experience posted in AN, or elsewhere, so that when you consult a certified tax man, or accountant, or lawyer (or nurse/lawyer, even BETTER), or insurance professional, or all of them you arrive armed with enough questions that you will maximize the time and money you spend with those folks.

NedRN,

I would very much love to be doing what you do...have you considered mentoring?

I happened to stumble onto this thread and am so happy I did. I have been wanting to be an Entrepreneur for a long time now. My parents are entrepreneurs in the hostelry department. I moved to Spain to seek an opportunity like that but I have run out of time and money since I cannot practice working as an RN in Spain without going through the bureaucratic nightmare Europe is notorious for. And yet, here I find myself with renewed enthusiasm with the thought of going back to the States and trying a different route in the nursing field I never knew existed.

I have worked as a traveling RN and for an Agency ( run by an RN) and, of course for the Hospitals. But the burn-out is one of the reasons why I ventured completely away from nursing...but this thread, it's given me a new focus :)

If you would not consider mentoring, other than the books, where would you suggest I continue to look into? How do you build a network as an IC when I don't have any first clients to offer services? By the way, my challenge is that I have been a NICU nurse most of my career...how do I branch out?

Any suggestions would be greatly appreciated!!

LadyFree28,

I would like to ask you the same thing I asked NedRN, (so I will copy my message)

I would very much love to be doing what you and NedRN are doing...have you considered mentoring?

I happened to stumble onto this thread and am so happy I did. I have been wanting to be an Entrepreneur for a long time now. My parents are entrepreneurs in the hostelry department. I moved to Spain to seek an opportunity like that but I have run out of time and money since I cannot practice working as an RN in Spain without going through the bureaucratic nightmare Europe is notorious for. And yet, here I find myself with renewed enthusiasm with the thought of going back to the States and trying a different route in the nursing field I never knew existed.

I have worked as a traveling RN and for an Agency ( run by an RN) and, of course for the Hospitals. But the burn-out is one of the reasons why I ventured completely away from nursing...but this thread, it's given me a new focus :)

If you would not consider mentoring, other than the books, where would you suggest I continue to look into? How do you build a network as an IC when I don't have any first clients to offer services? By the way, my challenge is that I have been a NICU nurse most of my career...how do I branch out?

Any suggestions would be greatly appreciated!!

Without reading this entire thread again, I don't really know if if I do what you think. I'm a travel nurse, and I started my own agency to cut out the middleman. I have a good description of just how I did that online, Google my posting name plus "independent nurses" and read the FAQ thread.

Thank you NedRN, I will do that. I have been a traveling nurse, but it never occurred to me to start my own agency to cut out the middle man...thanks again for the response, I will look it up !

Funny, it is the first thing I thought of! However, I just assumed that a hospital would not wish to do business with a dink agency. I'm naturally snoopy and curious and year eight of travel I had a casual acquaintance at an assignment hospital with someone who worked in the staffing office and she blew my mind when she said she would take on a vendor just to get one traveler she needed. After extensive research, I was off and running.

It certainly makes sense that a hospital would only want vendors with excellent products who can supply needed quantity. However, when presented with a profile (mine) that meets their needs, they prove most willing. Hospitals don't truly care about agency brands anymore than travelers do. They will have their favorite agencies that they work well with and provide quality travelers, but if your agency has the best qualified traveler, then you are in. Since I'm just supplying myself, I don't care about repeat business, and the number of travelers I have is proprietary (no agency will tell you) but no hospital has ever asked.

Of course the entire system would completely break if every nurse became an independent contractor. But managing a business is not up the alley of most employees, it takes a certain entrepreneurial bent. The professional and financial rewards are great for the very small numbers of those of us who do it though.

Specializes in geriatrics.

This is not true. It sounds like you are saying lpns are not nurses. As a lpn , I can work independently.

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