Catie Harris, PhD, MBA, AGACNP, FNP, ANP, and a nurse entrepreneur, knew she loved nursing, but she also knew the crazy schedules weren’t giving her the balance she needed and wanted in her life. Rather than leave nursing, Harris took another look at how she could continue in an industry she loved, but with more control over her schedule, projects, and even her salary.
With her knowledge from a nursing career and a business degree and a lot of innovation, NursePreneurs was born. Harris is determined to help other nurses find a nursing path that suits their needs best.
For National Nurses Week, Harris recently answered a few questions from Minority Nurse about the importance of finding your best path.
Many people, nurses included, overlook the essential business skills nurses bring to the industry. How can nurses determine if an entrepreneurial path is a good match for them?
Nurses are trained in nursing school to be entrepreneurial. In fact, I relied more heavily on the nursing process to teach me how to run my business than anything I learned from getting my MBA. That might sound surprising, but the MBA teaches you how to operate within a business, not start one from the ground up. Whereas the nursing process teaches you how to assess a population, diagnose a problem, plan for a desired outcome, intervene with the solution and evaluate the response. These are the essential business skills needed to be an entrepreneur. Even though every nurse learns this entrepreneurial design in the nursing process, not every nurse wants to become an entrepreneur. There are certain qualities that simply stand out in entrepreneurs such as:
Adaptability – business is inherently risky and unpredictable. A business rarely becomes successful from the first unaltered idea. When the idea is floated to an audience, the market decides what it wants and the entrepreneur either adapts the business or risks failing. An entrepreneur must be flexible enough to adapt to whatever evolution the business needs to go through to evolve and sustain itself. Change is inevitable and an entrepreneur has to be willing to accept it frequently.
Resilience – there will be many failed attempts at starting and scaling a business. An entrepreneur must see every attempt as an experience and not a failure. No entrepreneur would ever be successful if they focused on all the things that go wrong. Entrepreneurs must see every obstacle as a challenge to overcome and not a dead-end.
Persistence – Entrepreneurs have to be persistent. A “no”, simply means your audience doesn’t understand what you are offering and the message needs to be adjusted. You have to be ok with getting candid answers to the solution your provide. Entrepreneurialism is not for people who attach all their self-worth into a solution or suffer from perfectionism.
Excellence – Entrepreneurs love to over deliver and provide massive value. They are consumed by learning, growing and sharing their knowledge. The entrepreneurial path is for people who want the freedom to pioneer their own way and decide how to focus their attention and energies. This is definitely not the space for anyone who needs to follow an agenda.
In what ways can an entrepreneurial nurse make an impact on healthcare policies and industry practices and, of course, patients?
All nurses can make a huge impact on healthcare policies, industry practices and patients. Being at the bedside, nurses know more than anyone what patients need, want and desire. Nurses are the number 1 trusted profession, and because of that ranking, patients trust us with incredibly sensitive information. Patients tell us their fears and frustrations about their disease and health conditions. Nurses are in a unique position to use that information to create businesses that serve the patients in a way that benefits them.
Nurses are also keenly aware of how hospital policies and industry standards impact the services provided to patients. For instance, one of my students is working on a business model that helps cancer treatment centers to educate their staff on how to communicate with patients. There are many questions and concerns that patients have that never get addressed out of embarrassment, worry that they are taking up too much time or being burdensome or because they simply don’t understand what is going on. This type of business has strong potential to alter how cancer education is delivered in the healthcare system.
What can nurses do to gain business skills and education that will help augment their nursing skills?
Nurses can gain business skills and education through books and online education. There are many groups out there who are helping nurses to gain the knowledge they need to support their business models. Investing in seminars, conferences and networking events is also hugely beneficial. Finally, nothing will fast track business success more than finding a mentor who has done what it is that you want to do and start working with that person as early on as possible.
How did you discover this path for your own nursing career?
I have had the entrepreneurial itch for decades! I also suffered from “bad employee syndrome”, meaning I always wanted to pioneer my job in directions that weren’t exactly in line with what my employer had in mind for me. I didn’t like being reigned in and having a defined job. I wanted to explore what was possible and continue growing and learning. The only “job” that truly allows this type of occupational freedom is the one you can create for yourself. I might not have started my business if I found a job with occupational freedom that paid well, but it didn’t exist for me, so I created it.
What makes your role as a nurse entrepreneur so rewarding?
I love seeing the impact of my students on their clients. When they have success, I celebrate it as if it were my very own. When you see how your work helps others to help others, it’s incredibly rewarding. My goal is to help 1000 nurses to start up their businesses in the next 2 years. Imagine the impact of 1000 nurses in business helping others to achieve healthier lifestyles, improved outcomes and live happier lives. Pursuing my passion, living my purpose and using my talents is what makes being a nurse entrepreneur so rewarding.
Have you always dreamed of starting your own business? You don’t have to give up your nursing career or job in order to be a business owner. In fact, many people work full time and run side businesses or “side hustles” to earn extra income, grow their savings or pay off student loan debt.
Nurses have a wealth of skills and knowledge that naturally lend to entrepreneurship. Here are two businesses that nurses can start with little to no start-up costs and maximum flexibility.
Freelance Health Writer
Are you a good writer? Your writing skills combined with your health knowledge would make you the perfect health writer for websites and/or magazines. You set your own hours and have the flexibility to take on as much or as little work as you like. To land assignments, you’ll need to learn how to develop article ideas and pitch those ideas to editors. Pay varies by publication. For more information on getting started, check out Starting Your Career as a Freelance Writer by Moira Allen.
Teacher/Public Speaker
If you love sharing health knowledge and teaching people about diseases or healthy living, teaching/public speaking may be a great side hustle for you. You can offer your services to community health organizations, hospitals or colleges/university continuing education programs. Pick your topic and contact the education department to see how to get started.
Those are just two of the many side businesses that nurses can start to boost their earning potential. Your side business doesn’t have to be related to your career as a nurse. If you enjoy making jewelry, you could sell your creations. If you enjoy cooking, you could offer personal chef services on your off days. The possibilities are truly endless.
Photo credit: Stuart Miles / FreeDigitalPhotos.net
When Christina Rojas-Fletes, MSN, RN, ANP-C, began preparing to take her first job as a nurse several years ago, she encountered an unexpected problem. She found that nurses’ scrubs sold in retail and uniform stores were bland, baggy and poorly made.
“There wasn’t a lot of fashionable attire out there for nursing uniforms,” recalls Rojas-Fletes, a cardiology nurse at Cedars-Sinai Medical Center in Los Angeles who also works as a nurse practitioner at a long-term care facility. So she decided to design her own scrubs and asked her 80-year-old grandmother, Elma Rivera–a lifelong seamstress–to sew them for her.
“I would give her the idea and she would make them for me,” says Rojas-Fletes, a native of Delano, Calif., a farming community halfway between Fresno and Sacramento. “I would wear them to work and people started to notice them and ask me where I bought them.”
By 2004, the growing demand from her co-workers had spawned a business, Amelia’s Scrubs, named for her now two-year-old daughter. It took a year and a half, between $30,000 and $40,000 of Rojas-Fletes’ own money, plus assistance from friends and other Latina businesswomen to get the start-up business up and running.
Amelia’s Scrubs sells what Rojas-Fletes describes as “boutique-style” limited edition scrubs with designer prints and bright colors. The jackets, tops and pants are made of cotton rather than the usual polyester fabric. Features like asymmetrical necklines, zippers, larger pockets and drawstring ties that create definition around the waist give them a more stylish and form-fitting look. The company’s slogan is “Beautiful scrubs for beautiful women.”
“I think a lot of [other scrubs] try to appeal to a variety of tastes and body shapes. When you try to produce for all those body shapes, you lose a lot,” explains Rojas-Fletes, whose scrubs sell for $25 to $32 a set compared to $15 to $20 a set for most other scrubs.
Rave Reviews
“We are going to change the way you see yourself in scrubs,” the company’s Web site proclaims. And according to Rojas-Fletes, it’s a change that many nurses have been waiting for.
“One client told me that just looking at [these scrubs] invokes a certain type of feeling,” she relates. “It’s more of a positive feeling. [The designs] get reactions from the patients that the nurses really like.”
Her first customers were friends and colleagues at Cedars-Sinai. One co-worker, Sara Goldberg, BSN, RN, says it’s obvious Rojas-Fletes put a lot of thought into creating her designs.
“It is nice to see a nurse creating scrubs, since nurses know what nurses want,” Goldberg comments. “It’s boring to wear the same old thing to work every day. Wearing Amelia’s Scrubs makes me enjoy wearing scrubs.”
Rojas-Fletes believes traditional scrubs sometimes detract from the professional atmosphere that’s appropriate to the field of nursing. After all, it’s a field populated with highly educated and skilled professionals.
“Sometimes when you go to work and [you feel like you’re wearing] pajamas, you feel kind of frumpy,” she contends. “You don’t feel as vibrant as people who get to wear professional-looking work clothes.”
Another customer, Jennifer Betts, MSN, RN, FNP, believes Amelia’s Scrubs target a younger group of nurses, because the patterns are more “funky.” The one improvement she’d like to see in the line is the availability of smaller sizes, since most designers don’t make scrubs for smaller women.
“Extra-small is really needed,” she says. “That’s one of the only reasons why I have not purchased a lot [of Amelia’s Scrubs].”
Growing the Business
Today Amelia’s Scrubs are manufactured in the Los Angeles Fashion District, which is the center of the apparel industry on the West Coast. Buyers, retailers, wholesalers, designers and manufacturers generate more than $7 billion in annual revenues there, according to the Los Angeles Chamber of Commerce.
Rojas-Fletes turned to the Fashion District for help because her grandmother, although a veteran seamstress, wasn’t set up to mass-produce clothing. And the budding nurse-entrepreneur didn’t have any fashion industry experience at that point. Fortunately, a friend who had attended design school came to her assistance. The friend shared her knowledge of design and how it’s applied in the real world and she encouraged Rojas-Fletes to go into business.
“She kind of gave me the structure and [taught me] how it all works behind the scenes,” says Rojas-Fletes, adding that she then spent eight months researching the design and fashion industries. “I ended up finding a designer who helped me put all my ideas on paper. Then I met some people through her who actually made the patterns.”
The next step was to find someone to make samples to show someone else who would, in turn, be able to mass-produce her line. Rojas-Fletes says it took 18 months to go from her ideas to the finished product. “Throughout that time, I was going to business classes,” she adds. Eventually she had amassed a portfolio of “a couple of hundred” copies of 11 sets of scrubs.
She also received a lot of help from members of the Latina Business Association. These women had a variety of experience in starting, running or working for small businesses like hers. She met an attorney, accountant and Web designer through the association, and they helped her set up a corporation, establish a bookkeeping system and create a site for selling her scrubs online.
Commercial Potential
Rojas-Fletes draws her designs freehand and then uses a computer program to translate her ideas into a blueprint. The manufacturer uses the computer renderings to create pieces that, when sewn together, create the final product. Amelia’s Scrubs markets its products via Yahoo!, Google, nursing magazines, flyers and nursing conventions.
Rojas-Fletes says most of her nursing colleagues own 10 to 20 sets of scrubs. She believes her line, although a bit more expensive, is a better deal for nurses in the long run because the fabric is more durable than that used to make other brands.
“Usually most of the cheap [scrubs] will last for about a year or less, because of the shrinkage factor,” she explains. “Plus with all the multiple washes, the fabric becomes thin and worn and you end up getting lots of holes in the material.” She estimates her scrubs will last roughly twice as long.
So what’s ahead for Christina Rojas-Fletes and Amelia’s Scrubs? The next step in the development of her business, she says, is to create a line designed to be sold at wholesale-to-retail outlets across the country. As she puts it, “The next [line] is going to be a little more commercial. It’s going to appeal more to wholesalers at a more reasonable price.”
While she obviously enjoys this new entrepreneurial direction her life has taken, she still enjoys nursing, too. She says she can envision a day when her business, which currently takes up approximately 20 hours a week of her time, will take on full-time status. But even when that happens, she doesn’t plan to abandon nursing entirely.
“I think I would still do nursing in some form,” says Rojas-Fletes, who earned a BSN degree from Loma Linda University in 1997 and an acute care nurse practitioner master’s degree from California State University, Los Angeles in 2000.
And she’ll no doubt continue to be one of the best-dressed nurses around.
“If I had a daughter or a son who wanted to be a nurse, I would tell them: ‘Do what you love to do,’” says Rose Leidl, RN, BSN. “’Earn a degree first and then follow your heart.’”
This philosophy has certainly worked well for Leidl. She followed her heart from an island in the Philippines to the Los Angeles metro area, where she now runs her own consulting business, Managed Healthcare Unlimited, Inc. (MHU).
Although Leidl never expected that she would one day be in business for herself when she first immigrated to the U.S. in 1985, she did come here in hopes of living the traditional “American dream.” At that time, the nation was in the midst of a critical nursing shortage and hospitals were aggressively importing nurses from the Philippines and other countries to fill their staffing gaps.
“The main reason why I took up nursing was that I wanted to come to the United States,” Leidl remembers. “I’d never thought of being a nurse, but when I saw that it was a good way to find work in the U.S., I thought, why not? As it turned out, I enjoyed every minute [of my nursing career]. I think being a nurse was part of my destiny.
“It’s an emotionally rewarding profession,” she continues. “The best part is getting a letter from a patient saying, ‘You made my hospital stay a little bit more comfortable.’ I’ve kept all the letters I’ve received from my patients because they remind me that nursing is a noble profession.”
Having earned her BSN at Manila’s venerable University of Santo Tomás in 1980, the young Filipino nurse passed the rigorous examinations required of foreign-trained nurses and in 1985 started work at a community hospital in Boonton, New Jersey. A year later Leidl moved across the country to Los Angeles, where she worked at Charter Community Hospital. There she met her future husband, a physician at the facility.
Being Her Own Boss
By 1995, Leidl was working for Blue Shield of California and had gained valuable experience in the health insurance and managed health care industries. That same year, with some financial assistance from her husband, she took the plunge and launched MHU.
Making the transition from working for an employer to becoming the self-employed owner of a start-up company was not difficult for her. “My father instilled in my mind that even if you are an employee, you still work for yourself,” Leidl recalls. “I look at the employer as my client. Even when I was working for other people in large HMOs and in hospitals as an ICU nurse, I might have been part of the organization, but as far as I was concerned, I was working for myself, because my reputation follows me.”
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What motivated Leidl to strike out on her own? “My going into business was never driven by money,” she emphasizes. “I think it’s a common misconception that entrepreneurship is driven by the idea of making more money. In my case the motivation was that I was very good at one particular aspect of managed care: utilization management. I thought: I could have my own business, enjoy the work that I do, and if and when the business becomes successful, then perhaps I could be remunerated fairly. So first comes the desire to create from scratch something that you love to do. And then, if the consequence of that is money, that’s fine, too.”
When Leidl first started her business, she was still working full time for Blue Shield. “I was lucky because I had a job that allowed me to work from home,” the nurse entrepreneur recalls. “As long as I finished my work, the rest of the time was mine. I started MHU from my guest room. When the business outgrew that, I rented a 175-square-foot office with a couple of $33 tables and a file cabinet, one mile away from home.”
From Boom to Bust–and Back
Leidl’s original idea when she started MHU was to provide managed health care services for self-insured companies. By 1996, however, most of the firm’s business was coming from subcontracting assignments for one of the “big five” consulting firms and for the Health Care Financing Administration (HCFA), now known as the Centers for Medicare & Medicaid Services (CMS).
By the end of 1997, things were looking promising for Leidl’s venture. But then she hit a run of bad luck. MHU lost two large accounts and her business partner defected to found a competing firm.
“There was a time from 1998 through 2000 when MHU had hardly any business,” Leidl recounts. But she refused to give up. She went back to her nursing roots, supporting herself with temporary work at a local HMO while she struggled to keep her business alive.
“I didn’t have any qualms about temping myself out [as a nurse],” she says. “I would call my voice mail and check whether there were any calls for me to return. There’s always a temp job [available] for a nurse.”
This setback taught Leidl an important lesson about the realities of entrepreneurship. “I would never start a business without something to fall back on,” she advises. “It would be one thing to be independently wealthy. But I never was independently wealthy, nor am I now.” Finally, in July 2000, MHU landed a major contract with the Department of Managed Health Care of California to develop a protocol for surveying HMOs’ compliance with California regulations. The protocol has become the heart of a reborn and thriving MHU.
California HMOs are subject to more than a thousand pages of standards and regulations. MHU interprets these, assesses the HMO’s compliance, prepares reports, evaluates corrective action plans and monitors progress.
“This is the most wonderful job!” Leidl exclaims. “I thought nursing was a great job. I worked in one of the busiest heart units and I enjoyed that very much, especially when I saw my patients go home after successful heart surgery.” But she finds her consulting work with the HMOs even more rewarding, “because I am making a big difference not just for individual patients but population-wide. I love what we do. To me, it’s a privilege.”
What exactly does the work entail? “As regulatory consultants, we go into an HMO and look at its quality assurance program,” Leidl explains. “If we feel that they are not ensuring access and availability of health care services, then we effect the changes that should be made so that our health care service system will be better. Especially, we look at services to disadvantaged populations, such as the elderly and mental health patients.”
Branching Out in New Directions
Today, Managed Healthcare Unlimited has carved out a successful market niche as a consulting firm specializing in state and federal regulatory compliance surveys. This success has spurred Leidl to recently launch another new start-up venture: The nurse who immigrated to America in response to the nursing shortage of the 1980s is starting a business that will recruit nurses from foreign countries to help reduce today’s nursing shortage.
In the course of exploring potential business opportunities, Leidl has studied the current nursing shortage in depth. “Because of the aging population, I definitely think the U.S. will need more nurses for the next 10 years at least,” she states. “California has just passed a law that says you can have only five patients per nurse. It sounds great but it’s not realistic. We don’t have enough nurses to have five patients per nurse.”
While the nursing profession continues to work on encouraging more young people and career changers to enter the field, Leidl believes the short-term solution is to “identify more sources internationally to get nurses from, because we have to.” She points to U.S. recruiters as far afield as Korea and South Africa. “They are recruiting nurses in South Africa, which is a country that has its own nursing shortage,” she says. “Unfortunately, the lure of a better life [in America] is very strong.”
Leidl also has some advice about what must be done to create a more permanent solution to the RN staffing problem. “One of the reasons we don’t have enough native-born Americans going into nursing is that we have not made the nursing profession attractive enough for people to go into,” she argues. “It’s not easy to be a nurse. You have to be intelligent.
“A smart young person wants to go into business,” Leidl continues. “Why? Because they like the lifestyle. They like the pay that goes with it. If you compare the pay of nurses, even in high-paying nursing jobs, with what these very intelligent young people get working for corporate moguls, it’s not comparable. The salary range for nurses should be comparable to our counterparts in the business world.”
Although Rose Leidl is far from being a “corporate mogul,” this business-savvy nurse has carved out an empowering career for herself by following her heart–and also throwing in plenty of hard work, persistence and, above all, passion.
“You can enjoy what you’re doing only if you believe in it,” she insists. “The main thing is, you’ve got to listen to your heart. I used to worry about tomorrow. I don’t anymore. I worry only about doing my best every day. Tomorrow will take care of itself.”
Imagine getting paid to work in the field you love while also enjoying opportunities to travel around the country. That, in a nutshell, is what the field of travel nursing is all about. With no end to the national nursing shortage yet in sight, RNs have unlimited opportunities to work in health care facilities throughout the United States as travel nurses, accepting short-term assignments and making valuable contributions by filling critical staffing gaps.
For minority nurses, travel nursing offers an exciting chance to add variety to their careers and serve diverse patient populations while traveling to a variety of locales. Trilby Barnes, RNC, president and CEO of Medi-Lend Nursing Services, Inc., one of the country’s few minority-owned travel nursing agencies, says there is a growing demand for travel nurses of color in many parts of the nation.
“[Ethnic minority nurses] have [cultural] insights other nurses might not have,” explains Barnes, who is African American. “They are able to relate better to patients who share their same background, which helps put these patients at ease.
“Travel nurses [of color] can dispel myths about minorities and help the nursing profession to become more culturally sensitive,” she continues. “Our [firm’s] nurses receive exceptional on-the-job education by working in different states and facilities and learning a broad spectrum of treatment modalities.”
For nurses suffering from wanderlust, or who are seeking a change of scenery, travel nursing does indeed provide many personal and professional opportunities. The field also offers excellent perks, including bonuses of up to $6,000, company-paid housing, and excellent salaries and health insurance plans.
Travel nurses take temporary assignments at facilities within their home state or in other states where their skills are in demand. The National Association of Traveling Nurses (NATN) estimates there are approximately 255,000 travelers working throughout the U.S., particularly in areas hit hardest by the nursing shortage, such as Arizona, California, Florida and Hawaii.
Expand Your Horizons
Barnes recently celebrated the 10th anniversary of Medi-Lend, an agency she founded in 1994 with just one employee besides herself. Today her multi-million dollar company, which is based in New Orleans with branch offices in Texas and California, has over 2,000 nurses in its registry. In 2004 she received the National Black Nurses Association’s Nurse Entrepreneur of the Year award.
Even though travel nursing offers many undeniable rewards, minority nurses appear to be even more underrepresented in this field than they are in traditional full-time hospital jobs. Barnes hopes minority nurse-owned agencies such as hers can encourage more nurses of color to consider travel nursing as a career option.
“There are a lot of misconceptions about the travel nursing industry,” she says. “Many nurses believe you need to commit for several years and travel constantly. But the reality is, you can sign on for a summer and travel with your family. Our assignments range anywhere from two weeks to three years.”
Barnes describes the ideal travel nurse as someone with agency experience who is flexible, likes the challenge of working in many different hospitals and wants to learn the business side of nursing. Experience in a specialty field, such as critical care or neonatal, is desirable but not mandatory.
“A lot of our nurses view this as a working vacation,” Barnes adds. “[By gaining exposure to different types of hospitals in different parts of the country], they are able to learn more about the nursing field and benefit from opportunities they might never have working as a full-time staff nurse.”
While Barnes would like to see more minority nurses enter the field of travel nursing, she knows that the lack of diversity among traveling RNs is part of a much bigger picture: the overall underrepresentation of minorities in all areas of health care. In September 2004 the Sullivan Commission on Diversity in the Healthcare Workforce reported that despite the nation’s growing diversity, the number of minorities entering the health care field is stagnant. Together, African Americans, Hispanics and American Indians make up more than 25% of the U.S. population, but only 9% of the nation’s nurses, 6% of doctors and 5% of dentists.
Barnes believes that travel nursing can increase the visibility of minority nurses around the country, which helps provide more role models to encourage young people of color to consider nursing careers. “Travel nurses can address these [health care workforce] disparities by working in geographic areas where there are many patients of color,” she says. “I think it’s hard for many people to envision going into a health care career if they have never seen a doctor or a nurse of their same ethnicity.”
A Unique Perspective
Although there are only a handful of travel nursing agencies that are owned and operated by nurses of color, these firms occupy an important niche in the marketplace: They are uniquely attuned to the needs and concerns of minority nurses, as well as their special strengths. For example, these agencies can help nurses of color determine where in the country their skills might best be utilized to help diverse populations. They are also sensitive to issues such as a nurse’s reluctance to be sent on an assignment where he or she would be the only person of color at the facility.
Rick Martinez, BSN, RN, president of MedTrust, LLC, a health care staffing agency based in San Antonio, Texas, started his company four years ago with himself and his wife Lisa serving as the first two travel nurses. Today MedTrust is a rapidly growing firm that specializes in providing travel, per diem and permanent health care staff to acute and sub-acute care facilities throughout the country.
“When I graduated from nursing school in 1995, nurses had the option of either working in a doctor’s office or in a hospital,” says Martinez. “Travel nursing provides nurses with a new and exciting career option.”
Some of MedTrust’s nurses travel full time; others take on occasional free-lance assignments. “One of the biggest motivators for travel nurses is that they can care for patients without getting involved in hospital politics,” Martinez points out. Since travel nurses typically work three 12-hour shifts, four days a week, they also have a significant amount of free time to tour the different locales in which they are working.
While his agency employs many minority nurses, Martinez says he would love to see more nurses of color enter the travel field. “The personal and financial benefits for travel nurses are huge,” he emphasizes. “This field allows nurses to take their career to a whole new level.”
Based on his own experience as a minority nurse, Martinez believes nurses of color can find satisfaction working with minority-owned agencies that take each nurse’s skills and ethnicity under consideration. “I’m not going to send nurses to a job or an area where they would feel uncomfortable working,” he says. “We want our nurses to work where their cultural diversity will be seen as an asset.”
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