Weighing your nursing options: Employee versus Entrepreneur?

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While most still think of nursing as being only the traditional bedside role, more and more nurses are discovering different ways to work in nursing that better align with the type of lifestyle they want to live. If you’ve known any nurses who are working independently and have started a business, you might be asking yourself… “Could I do that too?” Yet, a better question to ask would be, “Do I want to do that too?”

Specializes in Nurse Business Mentor, Healthcare Consultant. Has 23 years experience.

Contemplating Entrepreneurship as a Nurse

Weighing your nursing options: Employee versus Entrepreneur?

The second most common question asked when meeting anyone new, (just sneaking in behind, What’s your name?), comes the inevitable…What do you do?

I used to nearly corner the market on escalating the awkward factor right off the chart as I replied, “I’m a cancer nurse.”  

(Insert record screech here.)

Que the uncomfortable shifting of feet, hand in pocket, wincing of face followed by the long pause before someone sighs and comments how they could never do “that” (“that” usually implies “all that death stuff”).

Of course, most oncology nurses that I have worked with over the last two decades certainly never shared the outsider’s view of our specialty. But for many of us, we’ve recognized over the years that instead of trying to convince others of the passion we have to serve this population and how the reward of working far, far exceeds any potential negatives, we just smile and agree that it’s not for everyone.

Nowadays, I’m still screeching the record a bit when I reply to that question with, I’m a nurse entrepreneur.

A what?

I’m an entrepreneur. I work for myself…as a nurse.

So do you work with a hospital or something?”   

Well, I have worked with hospitals as a consultant, but no, I don’t just work with only one hospital. I work for myself.  

Huh. I didn’t know that was a thing.

And the most astounding thing to me is that most nurses also don’t know being a nurse entrepreneur is a thing either.

There are several contributing factors that are foundational to why this is true, but I’ll save that for another article.

If you are among the significant number of nurses who have not realized the best-kept secret of a specialty in nursing, consider this your official notice of yet another possibility open to you and your nursing career.

And like always, I’ll do my best to keep it real. First and foremost, I’m direct by nature. Secondly, I am a firm believer in viewing and talking about the good, bad, and ugly so that you have as much information as possible to consider so you can then make the best decision for you. I’m inclined to think that’s a result of the years working as a research nurse ensuring patients had the information needed to make an informed decision.

…but truthfully, if you asked anyone who knows me…they’d probably tell you I likely came out of the womb being direct.

So let’s get into it…

The Big Question

When considering this option, you’ll want to ask yourself the big question, “Is it the right specialty for me?” It is true that just like other specialties, you may not know until you’ve had a little taste of it.

However, if you find yourself wondering if business might be something you want to check into, I recommend spending a little time in self-reflection about how you’re wired, what you value most, and how you like to operate. This can be a great exercise to walk yourself through as you contemplate your next nursing move instead of just jumping into the deep end blindly.  

Employee Versus Entrepreneur Mindset

If you’re like most people, you want to be really good at what you do. As a nurse, you likely got into this profession because you have a servant’s heart that drives you to help others. 

So maybe you started out thinking this would be the perfect profession for you where you could literally make an impact every single day. And while that is true, if you’ve been a nurse for more than five minutes on the job, you’ve quickly realized that it’s just not that simple. There’s a whole lot of complicating factors that get in your way of helping people. 

  • Like billing.
  • Like the expired order that you need but must be renewed every ____hours and the doctor forgot to reorder it on rounds this morning. (Oops.)
  • Like coding & scanning charges so every single item you touch gets billed to someone.
  • Like not having the supply you need on the floor when you need it, so you have to wait...which means the patient has to wait.
  • Like policies that seem to have been written to have the exact opposite effect as intended.
  • Like being hounded by a time clock that makes sure you don’t clock out a minute too late, regardless of if you’re finished with your charting or you’re in the middle of replacing an IV that just blew and now you have no way to give their antibiotics due right now or hook up their pain pump. 

Can you relate?

It can be frustrating, can it not?

So here you are with all this experience that you know can help people and there clearly is no shortage of people who need help. Yet, no matter how many times you advocate for changes within the system, it seems like the gaps are still there.

In fact, you might find yourself increasingly feeling like the monsoon of frustration is raining down upon you. And that just may be when you start to think about doing nursing on your own terms. Maybe you’ll just start a business and say to heck with this broken system and fix the problem yourself.

Discovering If Entrepreneurship is Right For You

Maybe. But what drives many nurses to leave their place of work is the peak of frustration in their current job, not necessarily the desire to be an entrepreneur. 

You might be thinking, “Big deal. Out is out, right?” Well, not necessarily. What has become readily apparent after working with more and more nurses on their entrepreneurial journey, is that a chunk of them don’t really want to become a nursepreneur.

Wait. What?

Yep. I know. It’s news to them too. But, it’s progressively apparent as they continue to try to force a square peg into a round hole.

Or they simply bounce from idea to more vague idea to more clear idea...but “just not the right idea” for them. They course hop. They go back to get yet one more certification, because then they’ll be ready.

Nope. They won’t. And it’s perfectly OK. Because at the heart of the matter, they don’t really want to be an entrepreneur. They simply want to be in control of their schedule or maybe, they just want to work remotely as a nurse. All those options are available to nurses, just recognize it does not require that you start your own business. 

Flexibility is one of my favorite things about nursing and the number one factor I just cannot in good conscience recommend anyone leave the field. It’s equivalent to encouraging someone to go to the land of less opportunity.

Why would we do that to our friends, colleagues, or even strangers?

I bring this up because quite frankly, entrepreneurship is not for everyone. And that’s OK. Regardless of your path, you just need to find a nursing position that aligns with what you want and how you want to work.

A Quick Barometer

Before investing in a program, mentor, or sinking thousands of dollars into your big idea for a product or course, ask some qualifiers and see if you notice any guideposts pointing in that direction.

➡ Do you prefer to have a structure laid out for you, so you know and understand your role, scope, job duties, and have the resources needed to do your job?  

➡ Does the idea of a promotion excite you and give you something to work towards?

➡ Do you want the security of a stable guaranteed paycheck and income for the year?

➡ Imagine your dream job…get the visual solidified in your mind…now imagine someone offered to hire you for it. Would you take the job? 

While this is just a quick spot check, it can be a helpful barometer when getting started. If you answered yes to any of the above questions, there are some strong indicators that being an employee aligns more closely with your preferences than life as an entrepreneur. 

The Different Roads of Entrepreneurship

Entrepreneurs are literally creating something from nothing. They create the structure from scratch. And while it sounds very freeing to “craft your own career” and create whatever business you want, with freedom comes great responsibility.

No one is giving you the answers. You are creating it all … from scratch. So, if you love structure, you will likely hate the lack of it during the starting out phase as a nurse creating your own business. 

You’ll also be responsible for not only your role, but all the roles in the beginning. Most entrepreneurs start out as a team of one in the initial phase. How long the beginning phase lasts depends on your investment of time, energy, and resources and often, mentorship. As you can imagine, working with someone who has done what you want to do already and is successful can exponentially impact your learning curve in a positive way.

I think this is partially why business-in-a-box models are so popular. It’s easier to work with someone who has already developed the blueprint mapping out all the logistical pieces that must be considered and knows how to address them. People buy into franchises for the same reason. You’re taking out a lot of the guesswork operationally by getting the blueprint playbook from someone who has already figured it out, but to get that playbook you must pay for it.

Additionally, you’ll need to learn how to market yourself, so you stand out among your competition because when you’re in the business-in-a-box model, there are certainly more competitors. Most importantly you will still need to confirm what is or is not within your scope of practice based on your state regulations, but often they’ve worked with nurses across the country, so they are familiar with the nuances in different states. Just keep in mind, at the end of the day your license is your responsibility, so act accordingly.

For me personally, those business-in-a-box franchise-like models didn’t feel aligned. I wanted to use my years of experience in my specialty, passion for serving that population, and truly focus on solving some of the gaps that I have seen for far too long in practice. I needed and wanted something custom-designed, which is why I set out on the path I did.

There’s no wrong answer, here. To each their own. What is critically important is that you spend at least a little bit of time recognizing what your drivers are for starting a business and then making sure it aligns with your inherent strengths, highest values, and the type of life you want to live. Design with intention, as I always say.  

Growth as an Employee Versus as an Entrepreneur

Regardless of which model you choose; you’ll inevitably grow beyond your individual capacity. When you decide to hire someone to start taking things off your plate so you can stay in your zone of genius, you’ll be the one writing the job description, determining the pay scale, doing the training, interviewing, hiring and performance evaluation. And yes, sometimes the firing, which causes you to start over and do it all again. Most don’t talk about the behind-the-scenes, true reality, and necessities of running a business.

Employees aim for promotions within the company and can see the milestones required for each rung of the fixed ladder that is leading to where they want to go. The structure and path are clear and easy to understand. In contrast, entrepreneurs aren’t interested in others designating their milestones, nor incremental advances that eventually tap out sooner than later. They aim to promote their company and their cause and meet the business goals that they defined.

The Uncertainty Game

I’ve spoken with numerous nurses who voice their concerns about making the leap to invest in a course or program or mentor as they were starting out. This typically is rooted in fear. Fear of failure. Fear of judgement if they really move forward with their idea and put it out in the world. (Because saying you want to do this big thing from the seat in your office at home is a whole lot different than actually doing it.) Fear of investing in a business until it’s making money. Fear of making the right decision about transitioning to business in the first place.

For most nurses starting out and this holds true for all entrepreneurs in general, there’s typically no shortage of these types of fear-based feelings. So, if you’re already on the path in your business and the brief mention of the above felt like it hit a bullseye in the pit of your stomach, rest assured, you are 100 percent normal.

And it’s not just in the initial part when I’ve seen these feelings stop nurses in their tracks. I’ve seen numerous nurses finish a course or training and instead of plowing through to the next step, they pause for one reason or another.

Whether a step back or a move laterally to something adjacent that now seems necessary (often more training or another certification), they find a way to move any which way but forward.

As you can probably guess, all of that is a smokescreen and not addressing the root of the underlying issue. Think of it like when a patient comes to you looking for help with a symptom. As you ask questions that start to allude to the underlying issue, they quickly try to focus solely on this one gnawing symptom that just won’t go away.

As nurses, we know only palliating what’s on the surface will be brief at best to alleviate the symptoms, unless we address the underlying root cause.

Being willing to work through fear, as well as numerous limiting beliefs, and your comfort level with uncertainty are some additional guideposts that you should pay attention to. To put it simply, if uncertainty makes you come completely undone…entrepreneurship is likely not the right fit.

If you are wired to want the safe bet and find yourself worrying about whether your paycheck will be the same as always, you likely align more with the employee mindset. Because the idea of knowing within a close ballpark what your paycheck will be every week in perpetuity is a negative in most entrepreneurs’ minds. It feels like a ceiling that they don’t want to be enclosed under. In fact, being a business owner allows them to remove restrictions on their revenue. Still, for most entrepreneurs money is not the end game. Time is the end game. Entrepreneurs focus on designing and growing their businesses so they can have the time freedom they want down the road. They are literally willing and ready to work for months without profits because they’re in it for the long game. 

Employees want to know all the things they will need to do their job. Entrepreneurs recognize the pursuit is a constant work in progress and focus on improving as they go. Because they know perfection is an illusion, there’s no point wasting time aiming for it. Instead, they aim for best possible right now, understanding the next iteration will be better after they adjust because of what they’ve learned from experience and feedback. By accepting and embracing it’s impossible to know all the things, they operate from knowing they will learn fastest by doing.

One mantra I have found incredibly helpful from one of my mentors is

🔷 70% perfect is perfection….100% perfect is failure.

How many times have you chased perfection? How many tweaks until you finally think it will be good enough to put out there? Of course, you can continue to chase the leprechaun but recognize that while doing so…you could be helping people right now. People who need you right now, with exactly your current level of expertise. Aim for excellence and start helping people as soon as you can. Your next iteration will be infinitely better when being adjusted because of feedback versus your tiny incremental tweaks stemmed from guessing.

Where is the Barometer Pointing You?

As you can see, even before you dip your toe in the entrepreneurial pool, there are several guideposts that will give you indications if being in a nurse in business may be the right specialty for you. Take the time to do some self-reflection and it will save you time, energy, and resources. My hope is that this article may have helped you discover which direction, employee or entrepreneur feels more in natural agreement with you.

Keep in mind, there are no wrong answers, just discovery and awareness. The world of nursing possibilities remains at your fingertips, whether that is as an employee or an entrepreneur. Decide what is most important to you and how you want to work, then seek the role that aligns with those preferences. There’s plenty of work that needs to be done in healthcare which means there is plenty of opportunity for all of us to make our contribution as a nurse, no matter what that looks like.

After more than 2 decades as a nurse, Jill has seen her share of change in healthcare. After witnessing the gaps continue to widen within the healthcare system, she transitioned specialties to become a nurse in business and work on closing gaps outside the system. Her consulting company originally focused on oncology, where she took her idea and partnered with a startup company out of Israel to bring it to fruition. As Jill’s network expanded to more entrepreneurs, she met more nurses interested in “doing nursing” differently. She has been working as a Nurse Business Strategist & Mentor for other nurses teaching them how to wrap a business model around their nursing skills to help close gaps in the healthcare system. Jill firmly believes that nurses are the key to putting the heart and healing back into healthcare.

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3 Comment(s)

nuangel1, BSN, RN

Specializes in CT ,ICU,CCU,Tele,ED,Hospice. Has 34 years experience.

Very informative article.I have been a nurse in multiple specialties over last 35 years.I am at a point where I need to make some decisions about my future place in nursing .I want to retire at 63.Thats in 6 years .But I cant physically continue in my current nursing position indefinetly.As I have some health issues after years of nursing .I have thought about consulting in my current specialty Hospice,becoming a LNC or working in computer infomatics .The last 2 ,I would need to get training for.I would even consider telephone triage or casemanagement remotely.I just don't know what my next steps should be?

Edited by nuangel1
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Jill Weberding MPH, BSN, RN

Specializes in Nurse Business Mentor, Healthcare Consultant. Has 23 years experience.

Thanks so much for reading the article and taking the time to comment. With 35 years in nursing, you certainly have a wealth of experience you can draw from. One of the things I love most about entrepreneurship as a nurse is I certainly feel it will extend my career. Many nurses are facing the same dilemma that you are currently pondering, What's next? 

 

Because you can design your own business, you can match it to how you want (or maybe need) to work. Of the first three listed, computer informatics can be a bit harder to get started in --unless you already have experience (which you might). Generally, nurses break into the field at their current job being on EMR role-out teams & often have the opportunity to get training from their specific vendor so they can teach staff. There are degrees in informatics, but having a degree does not give you experience on the job which is what most want with informatics. It seems with the many options you have and the timeframe you have mentioned above...I would favor others over informatics. I have nurse colleagues in my network who are LNCs and they are growing rapidly because there's so much demand.

 

If you choose to do the LNC route...you’re exactly right, a good mentor is a must. Be sure to check out the program thoroughly...how much hands-on mentoring is included or is it just a "watch recorded lessons" and figure it out. With some businesses like LNC--you absolutely want to learn the pitfalls to avoid when writing briefs and how to network/market yourself to get lawyers and firms to partner with you. So I would take into consideration...length of the program, amount of coaching/mentoring, any personal review of your drafts, teaching of marketing, community with other LNC students, opportunities to network or receive recommendations from mentor, and social proof from previous students (are they successful? How long did it take to get first clients? What kind of revenue are they generating for the hours they're working)?


You want a success roadmap...and you'll find that not all LNC programs have them. Some are just "promises" without the proof to back it up. That being said...quality programs are an investment...which has a great ROI for this type of business. Generally, when done right you are tracking 6-figures within your first year if not 6 months. If the program can’t give you the above...that should be a red-flag. If you have further questions, happy to connect you to LNC nurses in my network so you can speak to them directly and find out if this is the type of work you would enjoy. In general, it’s 100% remote so that coupled with the security of the typical income can be motivation enough if you aren’t driven by a “passion” for a specific specialty.

 

Hospice consulting is often on the quality and credentialing side, although some positions can be sales related (increasing/growing referral network). For quality & credentialing you must be familiar with state and federal regulations, detail oriented, excellent problem solving skills, clinical knowledge of OASIS, ICD-10 coding, and related clinical best practices, and obviously strong verbal and written communication skills. Some consulting positions require traveling/onsite management, while others can be conducting 100% remotely. 

 

Telephone triage and case management can easily be done as a contractor so these are great options if you’re on the fence about if you truly want to be a business owner or not. Currently, right now there are a plethora of job opportunities right now for both of these roles. If you have experience in case management...you can easily find yourself "in demand" which will give you even more opportunities to choose from. 

 

Getting clear about how you want to work, how many hours you want to work, and income you want to make will get you started in the right direction. What’s most important to you? The logistics (hours, remote, income)? Or what you’re working on (purpose-driven, passionate about a speciality or solving a specific problem in healthcare? 

 

Happy to connect you with nursing colleagues in the area you think you might want to pursue so you can explore further and get a better feel for what’s right for you. 

nuangel1, BSN, RN

Specializes in CT ,ICU,CCU,Tele,ED,Hospice. Has 34 years experience.

Thank you so much for responding.I really appreciate it.I would like to do work from home.less traveling .And for health reason less physical position.I would like hospice trage,home case management,I do know and use ice 10 codes and know Medicare CMS.I want a job I can use my 35 years of experience.I have thought about working for insurance company.I recently have been looking into getting my license in finance and healthcare insurance.I would very much like to connect with one of your colleagues please.