This article is featured in the Fall 2018 issue of our allnurses Magazine...
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As A Conventional Nurse...
When I began my nursing career, becoming a nurse entrepreneur was not in my field of vision. I mean, I didn't even know that term existed. Like most of my colleagues, I began working with Med/Surg patients and personally, I had no further thought other than being thankful I passed the NCLEX and prayed I would never harm a patient by being so green.
I started and ended my clinical experience working Med/Surg and had a few years of critical care nursing in the middle. This is when nurses worked eight-hour swing shifts, which felt completely normal to me, having a father that worked forty years in the steel mills. Back then, you had to select your holidays and you could not have the same holidays the following year. And we weren't given any option to try to arrange for someone to take our shift.
You know it is funny, I loved providing nursing care for my patients, but my favorite part of caring for my patients was hearing their stories. I also believed in getting my patients involved in conversation since it had therapeutic effects of decreasing their anxiety and discomfort. My co-workers teased me about this, but it was good-natured teasing.
I loved the nurses I worked with. They were the ones to teach me the ins and outs of nursing, you know, nursing in the real world versus what we all learn in nursing school. We enjoyed each other, and socialized outside the hospital setting. Many nights after working 3-11 we would go to the Hilltop Lounge and have steak salads piled with french fries, (it's a Pittsburgh thing). Even the married nurses would join us for decompressing and laughing. We had nurse bowling leagues with the different units challenging each other. When you see someone outside of a work setting you have the opportunity to see different aspects of their personality, and I believed that's why we all pulled for one another more.
I don't know what is currently going on with the amount of friction in the workplace. Is it due to stress levels being so high because of increased patient loads? Is it due to keeping up with technology? Are twelve hours shifts hurting nurses or serving them? My colleagues were wonderful, and were the main reason I kept going to work when it became apparent to me that it was time to find something new. After several years, of swing shifts, working weekends and holidays, and missing so many family get-togethers I started looking for what else I could do.
Transition towards an unconventional path...
It was very interesting trying to find something different because I didn't know any nurses that weren't working in a traditional setting. I had recently moved to the Chicago area because the guy I was dating asked me to. He didn't want a long distance relationship. So, add finding an apartment and a new job. This was when you saw classified ads in the newspaper and went in personally to interview for a job. A major insurance company was looking for a Health Care Resource Specialist, so I thought, why not? I went in for the interview, met with the manager and left with starting a job in Case Management. I didn't realize at the time that this would be a pivotal moment in my nursing career.
I was only looking to work nine to five and have my weekends off. My new job included educating about a hundred claims processors on the medical aspects of reports they would be processing. I worked with beneficiaries to help them understand the short term and long term implications of their chronic conditions, and what resources were available to them. I also worked for the first time on a computer to input healthcare data and run reports for the manager. In trying something new, I found a passion that I never saw coming, case management and healthcare data analysis. I came to a realization that I have come to many times since: you don't know what you don't know and that in itself is the very reason to try new things. I didn't know I would enjoy being a health care data detective, analyzing reports and trending results. I didn't know I would love educating beneficiaries and claims processors about health and optimum outcomes.
This came even more into play in my next job with the Georgia Medical Care Foundation which was the state peer review organization for all the Medicare beneficiaries on their inpatient and outpatient health records. Due to willingly working crazy hours to catch up a backlog with the state, I was given my first role as a manager. Being a utilization review manager, I managed the staff doing pre-certifications, concurrent reviews and retrospective reviews. I was flat out horrible as a first-time manager and it's a wonder that I remained in management. I was extremely fortunate that our nursing director cared enough to inform me of the mistakes I was making and mentored me during this time.
Journey to today...
In this role, I also had the responsibility to recruit Georgia physicians to GMCF's peer review group. While I was recruiting Earl Kolb, MD, for one of our peer reviewers, he turned around and recruited me to help him implement software he was working on for Crawford & Company's corporate office in Atlanta.
I entered into the corporate world where I remained for over ten years and began my transition into entrepreneurship. Crawford had an amazing training department. What I learned served me well throughout the remainder of my career. The training was a week long, and besides learning the structure of the company, we learned time management and goal setting. It was a very exciting time and when I first starting working with programmers. It was still a ways to go before hiring my own programmer group in the future, but the path was opened with the role of product manager. Basically, the software was a medical bill auditing program that accurately priced claims to the workers' compensation fee schedules. The software edited out about 20% of medical bills that appeared to be fraudulent, and those bills were reviewed by nurses to ensure accurate payment. Crawford's claims processors would no longer have to flip through volumes of paper-based documents. This is a great example of intrapreneurship: creating a completely new revenue stream within a corporation. I worked with nurses showing them how to use the software in four offices around the country which were producing a revenue of several million dollars. Segway a couple of years later and it dawned on me that I could earn a six-figure income going out on my own. When I informed the VP of the health care division of my plans to resign and to start my own business, he asked me to hold off for a couple of weeks.
He was good at securing funding and asked that I join him in creating a new entity, General Care Review. We provided medical bill review services to the Property and Casualty industry. In three years we had over 14 offices around the country, a couple of hundred employees, and 24 million dollars in revenue. This was an exciting time and I found out the next new thing, I loved growing businesses. We ended up merging with General Rehabilitation Services into Genex where I was the VP of medical bill review operations. After five years and now part of a very large organization, I started to feel it was not the right fit for me. And by this point, I wasn't afraid of trying something new.
I was being heavily recruited at the time by major executive recruiters. One of the offers I received was from a programmer that I had worked with in the past that co-owned a software company in California. He really wanted me to come out there and run their company, and position it for a future acquisition.
So many times during my career, I have been asked: "How does a nurse end up being the president of a multi-million dollar software company?" "How does a nurse end up in boardrooms across the country with Fortune 500 clients?" Very clearly, it was an evolution, not a leap for me. I was a nurse that had a solid foundation in nursing. I was able to synthesize my healthcare background with IT knowledge (programmers) to impart useful information for decision-making. I have a knack for problem-solving and ability to define and manage the processes, programs and projects. I used two nursing constructs in every business setting; the nursing process and Maslow's Hierarchy of Needs. The nursing process for getting the right things done, and Maslow's for getting the right things done in the right order.
After substantially growing the company's revenue and succeeding in its being acquired, I decided to resign. Not long afterwards in 2001, I was recently married and the world experienced September 11th. Reflecting on what was really important, I knew being around family was what I valued most and I asked my husband if he would be willing to move across the country so I could be near my extended family. He was a Californian and I knew it was a big ask, but we had another reason soon afterwards which was being pregnant with our daughter. I knew that while I had a great deal of autonomy in executive roles in the corporate setting, I still never was my own boss. So we began discussing starting our own business.
I always loved taking care of the elderly patients, and I remembered how much I enjoyed hearing their stories. We knew this was a market that needed services, so we became franchise owners of a Comfort Keepers in the Youngstown Ohio area near my family. For several years we grew our business, a business that allowed us the freedom of being with our daughter and working around our lifestyle. We sold that business in 2010 and when our daughter was ready to start school we moved back west.
In 2011, writing a book had always been on my bucket list. I had three questions mounted on the wall of my office: What could I write that would serve others, who could I serve, and how could I reach more of them? As I mulled this over, I thought to myself "I'm just a nurse that did really well in business" and it dawned on me that I could help nurses by writing about the strategies that I learned that made me successful in business. This grew stronger when I started to research the statistics about the high level of burnout in nursing with more and more nurses feeling unappreciated, overworked, and overwhelmed.
Why the NNBA...
Unconventional Nurse: Going from Burnout to Bliss, outlined ten steps for nurses to re-invent and advance their careers. Prior to the book being published, we created our website that began with my blog. After the book was published, I added coaching services for nurses because I had been coaching managers, executives, and nurses for many years. I had never heard of the National Nurses in Business Association (NNBA) at the time and I came across it while researching what was out there to help nurses that wanted to start their own business. I discovered that the NNBA started in 1985 and is the forerunner of the nurse entrepreneurship movement. Pat Bemis, the former president of the NNBA asked if I would like to speak at the 2013 annual conference. As a result of that first speaking opportunity, Pat and I remained in contact. In every conversation with Pat, she was always knowledgeable and resourceful. I helped make a few suggestions for growing the NNBA and was taken by surprise a few months later when Pat told me she thought I was the person that should take the helm.
Keeping up with the changes in nursing...
Since 2014, we have run the NNBA which is dedicated to encouraging nurse entrepreneurs and intrapreneurs to start, grow, and manage their own business, finding nurse opportunities locally and nationally, and providing the educational and networking arena for nurses in business. We continue to see membership and participation in our annual educational conference grow. Not only is it an honor to work with such amazing and creative nurses from around the country, but I am continually inspired by the variety of ways nurses are using their knowledge and experience in business.
Nurses are creating services, products, and programs to serve needs in the healthcare marketplace. In fact, in our shark tank competition, we have several nurses that have created products to serve a niche in elder care, oncology, nursing, and education. Nurses have tremendous subject matter expertise and can learn ways to monetize that valuable asset. We have nurses that are nationally acclaimed speakers, authors, and bloggers. In 1985 the NNBA started as a grassroots organization, a handful of nurses that wanted to provide information for business minded nurses and a forum for them to connect and share information. NNBA's impact and influence have not only resulted in thousands of nurses starting and expanding their business, we are also seeing more nursing colleges and universities adding entrepreneurship programs. Nurse entrepreneurship is rising, mainly because it allows nurses the freedom, flexibility, and financial control to fully express their potential.
When I've spoken on why nurses need a plan B, it is because of the volatility in the healthcare marketplace. Keeping current with legislative, technologic and socio-economic changes can be daunting. For example, patient care is moving out of the acute care setting and into population health settings. Many rural hospitals have closed. Metro hospitals continue to be acquired forming large corporations and many jobs are being consolidated resulting in positions being eliminated. Mega disruptors are entering the healthcare space, such as Amazon and Berkshire Hathaway. So, nurses can protect the longevity of their careers by creating additional income streams for increased financial security.
Tips for nurses that are thinking of stepping out and following their dreams...
Some nurses dip a toe in the water and others jump right in. As you can see, I didn't jump into entrepreneurship. It became a path that was gradually illuminated through having new experiences in different work settings. It was trying career alternatives before going all in. Jim Rohn, widely regarded as one of the most influential thinkers of our time, and mentor to Tony Robbins said, "Formal education will make you a living; self-education will make you a fortune". With that in mind here are some tips if you are thinking of stepping out.
Try new things, you don't know what you don't know.
Find, mentors, coaches, and role models to decrease your learning curve and not re-invent the wheel.
Learn time management and goal setting to become more productive.
Improve communication skills such as writing, speaking, and presenting. Look for opportunities right where you are now to sharpen these skills.
Take the time for yourself to clarify what it is you really desire for your life and work.
Contribute to your nursing community; all nurses voices are needed to improve the delivery of healthcare and the lives of individuals locally, nationally and globally.
I remain a case management consultant for corporate clients, write for various publications and courses, speak, and am interviewed on empowerment of nurses through entrepreneurship. I have the distinct pleasure to serve my nursing colleagues as the president of the NNBA. Every day I am grateful for my nursing education and the tremendous array of opportunities it has provided.
Since 1985, the NNBA had helped thousands of nurses launch successful businesses. Each fall, the NNBA has an annual educational conference on nurse entrepreneurship & career alternatives. Try something new and join us next month in Las Vegas, Nevada. Learn more at nursesbusiness.com.