eddy

Providence has a very poor reputation in the KC area. They really need to learn how to staff the place. It's bad.

They've gone downhill big time over the last 9 months. I used to work there for my agency, but they decided to go exlusive with a new upstart agency that undercut pay. Since then, the place has been a joke to the career agency nurses in town. Some of the worst nurses go there because they are the only ones willing to work for such pathetic wages. I would avoid that place like the plague until they change their operations.

What I've told you may at first glance seem "wrong" to you, but if you take the time to do your research, you'll find it's quite the contrary. I can speak from experience with regard to giving business advice. People pay me lots of money to do it. These things you have issue with really have nothing to do with small vs. large business situations. They have to do with UNIVERSAL BEST PRACTICES. If you would consider sparing the time you spend debating these issues here with me and instead research them, you'd be doing yourself and countless others who come to this forum for advice a big favor. Harry, I'll continue to say this. It is not NEARLY as black and white as you make it out to be. While it is true that health professionals have a difficult time with pass-through liability when in the performance of their profession, there are many more sources of liability exposure that can effectively be protected against from transacting through a limited liability entity, and there is no question that a health professional benefits from these protections. Additionally, when specific to a nurse, pass through liability has been argued in court continously and has been ruled in favor and against countless times. It largely depends on the degree of discretion used by the nurse. Scope of practice and scope of care are also closely examined for a determination. Again, not a black and white issue. Transacting through a limited liability entity combined with solid general and professional liability policies is simply BEST PRACTICES for an agency owner with employees, and yes, even an IC like you. Oh boy. Harry, if you 1099 them, they are NOT employees. You can't even call them employees. They are contractors. This actually IS very black and white. Here, this might help. See http://www.irs.gov/businesses/small/article/0,,id=99921,00.html Keep in mind, the practice of simply calling a contractor an employee has caused them to actually revert to employees in several cases throughout the US. Of course that puts the company on the hook for all the payroll taxes, fair access to benefits (comperable to any you provide yourself through the company) plus you'll owe the IRS some painful penalties and interest. With regard to work comp, the risk is exactly the same in most states if the contractor does not carry their own WC policy. By state law (for most states) you actually become the default insurer if they don't have their own policy. No contractual agreement can trump that unfortunately, so make sure your IC's get their own policy. It usually costs about $700 a year or so for a nurse and they'll have to pay 25% up front as a deposit most of the time. You are correct that unemployment insurance risks can be pretty safely avoided by using contractors. The only way a contractor can typically secure unemployment benefits from your fund is by first proving they should have been classified as an employee to begin with (so don't call them employees!). Even then (if they won that round), they'd still have to go through the usual process to get UI benefits, which you have the ability to dispute, even appeal if needed. Why yes I do, and if you feel left out, see google for thousands of examples. Try starting out by searching for nurse lawsuit death. One example off the top of my head: All About Staffing currently has a wrongful death suit against them which involved the use of their own employees as well as contract nurses. You generally don't hear a ton about these because they usually settle prior to going to trial. Negligible at best. They would more likely be better off with a limited liability entity than worrying about making it a littler easier to do business from state to state. Correct. Incorrect. Trademarks and copyrights involve company naming and branding and are handled by the federal government. Entity creation is at the state level. Maybe that's what you are thinking. Wrong. The federal government has countless laws and regulations regarding "corporate actions", not to mention several federal agencies specifically involved with monitoring, auditing and investigating corporations with regard to federal compliance. Again, they are created at the state level (like you mention with your Delaware expample) and indeed they are regulated at the state level as well, but to say "primarily" at the state level would be misleading. Harry, you are free to have your own opinions, but when you provide information that is wrong, I'll continue to do my best job to correct it for the benefit of others seeking information and advice on this forum. I question whether you are worried more with trying to win a debate than you are about providing factual information to the users here on the forum. I'm fairly certain I'm qualified to address these questions and situations. In the accounting and consulting world, we hear from people that claim to "know better than you" all the time. They make us lots of money when we inevitably have to come in and clean up the messes they make because of their assumptions. I'd say you still have a great deal to learn, but you've definately got more business knowledge than the average nurse. However, a little knowledge can sometimes make people think they are qualified to make sweeping assumptions on incredibly complex issues. Be careful in that regard. I too know several agency owners. I've been very close friends with the owners of one for about 12 years. This particular agency has been an Inc 500 company the last 2 years in a row. That makes them one of (if not THE) fastest growing privately held nurse agency in the US. Quite an acomplishment. I showed this thread to one of the owners yesterday. I'm going to be honest with you Harry, we both got quite a chuckle out of it. Best of luck! -eddy

Yes I am. I am also a CPA and professional business consultant with nearly 20 years of experience in corporate compliance, accounting and tax law. I have served as an executive for companies both small and large. I've also been a business owner for the greater portion of my life and have served on several boards for small and mid sized companies. I guess you could say nursing came later in life for me, but I still would like to consider myself fairly young, though the kids will be quick to disagree with me on that subject. Again Harry, you are incorrect or should I say you're right but on the wrong subject. It's not NEARLY as black and white as you make it out to be. Additionally, you are relating your own position as an IC versus the original poster's questions regarding EMPLOYING PEOPLE (though not initially). From your postings that I have observed, this doesn't seem to be something you do, nor do you seem to have any practical experience in regard to the subject (employing people). Specific to an IC (you), there can be times when there is no personal liability protection for a professional when during the performance of their professional duty they commit a crime, and that's a pretty simple concept for most people to understand (that's where the applicability of your statement ends). The point I have been trying to make is that without the protection of a limited liability business entity, you open yourself to personal liability based on what your EMPLOYEES do. Mostly right. However, again, you are talking about your own IC situation, NOT the business situation the original poster is inquiring about. It's merely YOUR situation as an IC. I have been providing input on what you need to do to protect yourself from your EMPLOYEES creating additional liability issues for you as an EMPLOYER. If you commit a CRIME as an owner or executive you are not allowed ANY limited liability protections, nor is the company. This has existed since corporate entities have been acknowledged in the US. However, nurses that you employ in the field are not considered to be corporate representatives, so they can not put your personal assets at risk, provided you are operating as a limited liability entity. Your CHEAPEST "insurance policy" is obtained by conducting business through a limited liability entity (granted it's not a real insurance policy but it's a protective shell which is better than insurance). Now, beyond that, OF COURSE insurance comes into play, but as a limited liability entity your insurance policies are in place to protect the companies assets (with caps), not personal assets. I'm going to assume that you are aware that professional and general liability insurance policies have "per occurance" and "per policy" caps. Any money you owe due to a lawsuit, or worse multiple lawsuits in the same year, should you exceed those caps, the additional balance becomes your company's responsibility (your insurance only has to pay up to their insured limits), and in the event someone takes your advice and conducts business as a sole prop, they are PERSONALLY responsible. This means their personal assets will be used to settle up the remainder of the bill. That could wipe them out. With a limited liability entity, pending the owner(s) acting lawfully and within the reporting and structural requirements of their chosen entity, they are safe from personal liability. Only the company entity's assets are exposed. According to your previous posts, you don't EMPLOY people. You don't have the same policy as we are talking about. If you do, you in fact have the WRONG policy for YOUR situation. I wouldn't consider the advice I've provided to be misplaced. The most recent poster wishes to start an agency that will ultimately employ others. She/he wishes to be the sole employee at first. This is NOT the same as your situation. She/he will need a rated policy from day one otherwise he/she will have to deal with tail coverage and other issues (and tail coverage will be near impossible to get in this situation if you are honest about your situation) because you'll have to transition from an IC/Individual policy to a business policy. To prevent liability issues the best this person can, they should pay themselves a reasonable salary (with appropriate withholdings taken out) and insure their limited liability company. The umbrella policy will cover the business entity and her/him as the current sole employee in the field. Again as long as he/she does not commit a crime he/she has no personal liability exposure. Any additional profits beyond the "reasonable salary" may be taken via distributions or dividends based on the entity they've chosen. Safe, simple, best practices. In a case where you represent yourself as someone or some business you are not it's fraud, but that's the most extremes of extremes. What I was really talking about is that should a hospital have concerns over the legalities of a business entity, they may (and often do) choose to put a hold on paying any current invoices until they conduct their own "investigation". We all know that hospitals can void a contract virtually at will due to the numerous angles they have in any given contract. The most simple thing they could assert is professional misconduct. I'm not sure I see a need to cite that. Seriously Harry... it is a legal REQUIREMENT, and you yourself state it's the case. So why the issue? Every state requires this, as does our federal government. A fact is a fact. A law is a law. Don't worry about what others do or you ASSUME them to do. Do what's right and lawful. The lawyers will worry about the rest. They always do. Go to google and type in: oig hospital vendor precluded You can also type in: oig hospital nurse precluded You'll find plenty of worthy citations there. Harry, just because you got "lucky" and they missed your issues doesn't mean they aren't LEGALLY REQUIRED to perform due diligence. I've consulted with what I consider to be some of the best regional hospital systems in the US. I can speak from EXPERIENCE rather than assumption. The reputable systems perform thorough due diligence in regard to vendors. Those that don't... I would be cautious of doing business with. Fast and free. OIG checks are simple indeed. While some MAY not do them, the greater amount in fact do. It's a federal requirement. It's a law. Those who don't are exposing themselves to serious legal and monetary risk. This in turn, as I've already said, exposes their vendors to risk (in terms of possibly not getting their money for services or products already delivered). It's also a legal requirement to run the OIG exclusion check on all employees. I believe you may be talking about a "certificate of insurance". If so, what you are talking about is possibly one of the biggest issues right now in terms of liability insurance fraud. Less reputable agencies have (for years) paid their down payment (typically 25%) to get their insurance certificate and then never pay the rest of their balance on their policy. Technically, they aren't covered, but no one is the wiser... until a lawsuit surfaces. Most recently, many hospitals have begun requiring NAMED certificates which are sent directly from the carrier. This is a good start to put an end to this unethical practice. Ironically, one of my recent assignments I took through my agency was held back a day because the certificate was delayed (due to a foul up by the carrier). While it was a minor issue for me, I'm honestly glad to see they were doing the right thing. It is where you TRANSACT, not where you have a physical presence. If you withhold taxes for that state and bill in that state you are creating a transaction and therefore must be registered with that state. Again, huge numbers of businesses do not obey this rule, but they are breaking state laws. With regard to sole props, I was stating simply that you must register as a business entity in your HOME STATE if you use a "dba" name (any trade name your business goes by besides your own personal name). States want people to be able to reasonably track down who they are actually doing business with. Unrelated but worth mentioning: Unfortunately, by using numerous corporate shells, businesses are able to make it pretty difficult to actually pin their identities and whereabouts. Fraud against a government entity is a crime. In the event you get caught, your insurance company will actually fight YOU to make sure they don't have to pay the fines or carry the expense of defending you because of your choices. In most cases they will have no responsibility to represent you in criminal cases. They will work hard to find a way to put the liability back on you. Sadly, you may have to hire an attorney to fight your own carrier's attorneys, and they are much better paid and way more equipped. There are definately aspects with regard to small and large business that differ. However, they all must play by the same rules (laws and regulations, SEC aside), and that's what we are talking about here. If it takes $5000 to do it right, then yes I'd advise them to spend the money. If they can do it right for less... well I'd advise them to do so. I started my first "real" business on $500 as a one person shop. I grew it to the point that I didn't wish at that time to carry the debt that was required to run it (huge inventory carrying costs). I sold it for a large sum of money. My next venture required about $100k. I grew that one into a $3 mil+ yearly revenue company. Sold it too (to a local competitor). Made out like a bandit. Later, I started a third business following years of working in executive level (CFO and COO) positions. I started an accounting, financial and business consulting firm. I sold that one too. That one provided me a hefty retirement fund (it also provided my employees a large sum of money too, due to my desire to reward them for THEIR part in making the company what it was). This allowed me to pursue a new interest without much worry, so I chose nursing because I was always interested in the medical industry but didn't want to go through the schooling required to be a doc. So, the point being, I conducted myself ethically and always in a legal manner, and as a result, I got everything I ever dreamed of.

The choice to form a limited liability entity depends on many factors, and indeed some small business owners are perfectly fine operating as sole props rather than a more "formal" entity. Forming a limited liability entity is a fairly simple thing to do and costs very little, and the benefits associated with it make it a no brainer for many businesses. It is especially wise to do in this HIGH liability and HIGH risk industry. Why expose your personal assets when a couple hundred dollars can provide your shelter from that? Correct, the moment you engage in a business activity with a profit motive you become a business entity by default. However, a sole proprietor has ZERO personal protection from liability, and that is the most important point here. In regard to insurance, independent contractor insurances and the type of insurances a true agency that employs other people requires are completely different. Don't be fooled into thinking that just because you have IC coverage, you have a company policy. You don't. You must be rated to get coverage when you employ other nurses. You also will be subject to occasional audits as the insurer bases the amount you owe on either your payroll or your total revenue... and of course the amount of coverage you purchase. The difference in cost is SUBSTANTIAL. Just because it's "worked" for you so far doesn't mean it will continue. If/when the hospital discovers this shortcoming, the business person could lose their contract with the hospital, and they may end up with issues collecting money on work that has already been performed as the hospital tries to sort through how to deal with the situation. This could cause a serious interruption in the business, the person's income and their ability to pay their other staff. Again, to save a few hundred bucks, why would a person expose themselves to such silly risks? Also, Harry, since you are now incorporated you are legally required to put a corporate abrevation (or spell out corporation or limited liability company, etc.) at the end of your business name on official documents including contracts. Hospitals are REQUIRED to perform this due diligence on EVERY single vendor. If they aren't doing so, they expose themselves to serious risks. Namely, they could lose their government reimbursement monies. Without this, almost every single hospital would have to close shop. If they aren't performing their due diligence, they are putting YOU as a vendor at risk. Hospitals and many other business receiving ANY federal money must verify all vendors against the Attorney General OIG list. The people and companies on the list are primarily people who have committed some sort of fraud against the government or owe them a bunch of money for something. The OIG look up is just ONE of many verifications both at the federal and state levels they are legally required to do on each and every single vendor they use. They also have to do this on every single employee in the hospital's organization. The amount of verification they must perform on vendors is far less than what they must perform for employees, but they share most of the verifications in common, meaning they are already QUITE well equipped for performing proper DD on vendors. This is incorrect information Harry (not entirely but mostly). All business entities (even sole proprietors if they use a fictitious name, meaning anything other than the actual name of the business owner) are REQUIRED to register as a business entity. If you are an out of state company, you must also register as a foreign entity in any state your transact in. If you can't afford the small filing fee and the 2 minutes it takes to fill out your annual report, there are far worse problems that need to be addressed. You may consider them expensive and incredibly expensive, but it's the law. Also, in your case Harry, by not filing your foriegn corp status with the state (as you say you don't), you are are potentially at risk of losing the veil of limited liability protection of your corp. In the event you are sued in that state, they could potentially go after all your personal assets, not to mention that at that point you've just been discovered to have commited a crime in that state and have THAT to deal with. I'm not sure where you read this in my post. I never said that, and I honestly don't think I implied it either. With that said, having owned several of my own businesses that posted millions in revenue every year (though not in the nurse agency industry), I can speak from solid experience when I say it's not terribly complicated to deal with the additional requirements of corporate compliance, and I would never want to operate without its protection. It's true, it's a little more work, but worth it. In closing, folks, It's ALWAYS best to conduct business based on BEST PRACTICES and within the law. Just because someone says they "get away" with something or "fly under the radar" doesn't make it safe, legal, ethical or wise.

The best way to learn about agencies is to work in the office of one. Forget the how to books. Once you are working "in" the industry, meaning in the office not as an agency nurse, you'll have a chance to decide if it's right for you. You may find you don't like it, and that means you just saved yourself a great deal of time and expense. To the contrary, you may find you really enjoy it, and now you've learned more than any book can teach you and are more confident that it's a reasonable venture to undertake. The best mechanics don't always make good shop owners. The best pilots don't necessarily make good airline execs. The best cooks don't always make the best restaurant owners. I think you get the point. My stance on most of those how to guides and books is that if the people writing them could have really "made it" in the agency business they wouldn't be trying to sell you information packets. Ask yourself, why would a successful person tell you how to potentially compete with them for a few hundred bucks? If it's so easy to get rich owning a nurse agency, why are they bothering selling a lousy book? They should be too busy raking in their millions to waste their time peddling a book. I like to fish. I love to brag about a great catch and show all the pictures, but I NEVER tell people where I caught them. If I did that, the next time I visit one of my favorite spots I may be competing with a bunch of other fishermen. Granted, they may not know what kind of lure or bait to use, but just the noise and the space they occupy could scare off the fish or make it difficult for ME to fish where I want to. Everyone has the same opportunity to find their own fish, but I'm not going to tell them how and where to catch MINE! :rotfl: Likewise, a successful business person likes to brag about their accomplishments and enjoys the fruits (money) of their labor, but they aren't going to tell you how to get that for yourself lest you take THEIRS! :rotfl:

You negotiate the rate. It's just part of the "sales" process.

Put simply: Don't factor. It will bleed you dry, and you'll likely never catch up with your revolving debt. If you don't have the seed money needed to employ people or at least a solid line of credit from a bank, you really should not even attempt to employ your first person.

To add to your list of restricted states, off the top of my head: - Kentucky has a licensing requirement specific to nurse staffing. - Illinois requires a physical office in the state. - Florida has a medical staffing license requirement of some sort. To address incorporating: If you are going to staff ANYONE but yourself, it is incredibly foolish not to form some sort of limited liability entity. Should that be a corp, an LLC or whatever it SHOULD be something. Without the limited liability of an official entity you expose ALL of your personal assets (your home, your cars, your personal bank account, everything). It absolutely will not be "easier to staff nationwide without incorporating". Hospitals have large legal departments that will disagree with your statement. The issue at hand is simple. If you are not a true business entity with appropriate general and professional liability insurance and work comp insurance, you'll get nowhere... unless you get lucky by complete accident, in which case you're probably providing services to a hospital that has terrible risk management and in turn exposes YOU to increased risk.

Very first post, and it's an endorsement (or at least a strong defending) of the company. I smell a shill. Anyone else?

They actually do both. I'd suggest contacting your local VA's purchasing office and simply asking them who they use for staffing help.

Nurseynightnight - I'm going to say this for your sake and any others with this belief. There is no other way I can put this except... THAT IS THE WORST ADVICE SOMEONE COULD EVER GIVE YOU. Your instructor had no business saying that. He/She's not a qualified person to make such a bold and potentially life altering suggestion. That's terrible they said that, and I feel sorry for those who took the advice. A malpractice attorney will tell you quite simply that they will name as broad a list of potential defendants as possible. Going solely for the "big fish" is almost never the case. The larger the list, the better their chances of a favorable result for their client. In part, this is due to the fact that the various defense lawyers will be somewhat pitted against each other. Often in their attempts to prove the "innocense" of their client they help the opposition by opening more holes in the various defenses. It can get downright nasty. The company you work for will have THEIR insurance, and the lawyers that work for their insurance company will focus on protecting the insurance company and their client (your employer, the policy holder). Sometimes that can be at your expense as they try to correctly or incorrectly shed their liability in the case. Quite literally, your employer's lawyers could be working AGAINST you. This happens more than you'd think. NOT having liability insurance guarantees only one thing. That if you ARE sued, you'll be paying for your defense out of your own pocket. It will be EXTREMELY costly just to consult with your attorney, and if/when you must be represented at trial, costs will go through the roof. You will likely lose most or all of what you have just in your defense, and if you have anything left over and end up with a judgment against you.... well, that'll be gone too as well as most of what you try to earn in the future. Your Liability insurance company will hire GOOD lawyers. They don't want to pay a claim any more than you do, so they find the best men and women for the job. They will also be paying them for you. If you have to hire your own, you likely won't be able to afford the same level of attorney. Your mediocre attorney will be facing some of the best in the industry, and you will have increased the probability of a judgment against you. Lastly, when you are likely to be found to have some fault in the case (we are human and we ALL can and do make mistakes), in the discovery stage your attorney will work to settle rather than go to court. The amount of coverage you have will be discussed between the lawyers and almost without fail the settlement amount will be negotiated DOWN from your max coverage amount or worst case at your max coverage. Ultimately, you walk away without losing anything but time and maybe a few hairs. If you DON'T have coverage, they will try to take everything you own and whatever future earnings they can grab as well. The amount will likely be less $$$ than with insurance, but the cost to you will be enormously worse (everything you own, future earnings, stress galore and lots of time). People without coverage often irrationally choose not to settle because they can't afford to and hope to fight in trial to protect themselves. They end up broke for the rest of their lives. It's a whole different kind of process when you go it alone (without coverage). Liability/Malpractice insurance is somewhat like a tax. That stinks, but it's a pretty cheap tax, and the risks of not paying that tax are infinitely worse than bucking up the hundred or so bucks a year. PLEASE. Protect yourself and get covered.

In my opinion, word of mouth is by far the best way to find a quality agency. The amount an agency advertises says very little. They may have tons of openings, they may have trouble holding on to their people, they may have a huge coporate purse or they may have a poor reputation among the agency community so need "fresh meat". The point is that advertising means very little. Sources of "Word of mouth": 1.) Area facilities. Ask them who they use and prefer to call first for help. 2.) Area agency nurses. Who do they work for and why?

For me, it goes something like this. My 5 reasons for (and against) working agency: 1.) If you want flexibility in work schedules, agency is a plus. I like to go on a lot of vacations throughout the year. Sometimes, I may be gone for up to 20 days. A staff job really wouldn't work around MY schedule. 2.) If you are able to budget and save, agency may be good for you. I make 40-60% more than those I work side by side with (not including occassional overtime that makes it even more percentage wise). However, there is always a risk that I might not get the hours I want in a given week (sometimes even when I came off of a prior week with all the overtime I could take). I am prepared though. I have a budget. I live as if I made "staff pay". This allows me to save a lot of money. I keep a certain amount of liquid cash in my money market account that earns about 4.5-5%. Much better than a savings account though not quite as good a return as other investments, but since I have access to it whenever I need it, it's a good trade off. This is my rainy day cash. I invest the rest of my money in various things... a work-based 401k, stocks, CD's and so forth. Because I have followed this model for about a decade now, I could retire any time I wanted to. I work now because I enjoy it and because I continue to build a fantastic retirement for myself. I couldn't get the same results from a staff job. 3.) If you are flexible in "where and when", agency may be good for you. When I am not on vacation, I make myself available always. Of course, there are times when I have some other things planned, and I can't work. However, if for some reason things get a little slow, I make it clear to my staffers that I am available, and if they call based on my availability I TAKE THE SHIFT! A lot of agency nurses fail to understand the importance of honoring your availability that you report to the staffers. If you cry wolf too many times, they'll quit calling, and for good reason... They can't depend on you. 4.) If you approach agency work like you are self-employed, agency can work for you. Ultimately, you are responsible for your success in the agency world. Always leave a good impression with the facilities you go to. Make it known that you are excited to return and that you're available for more upcoming shifts. Don't be pushy just enthusiastic. You want to be REQUESTED when they have openings. I have worked with many nurses that I would consider more skilled than me, but due to my enthusiasm and willingness to go over and beyond, I am requested over them. You have to market yourself, and this is how you do it. Also, work on developing solid relationships with your staffers. Be honest with them. It's truly a "you pat my back I'll pat yours" kind of relationship. Make sure you're patting. 5.) If you like variety and can handle jumping into an often very heavy workload when staff may be quite short, overworked and grumpy, agency may be for you. Not everyone likes this situation. You may be at hospital A today, hospital B tomorrow and hospital C the next day. Can you handle working that way? Some like it, some don't. For me, it's great, but it is defenitely not everyone's cup of tea. Hope that helps.

Hah! It all depends on which method pays more of course. :wink2: