The University of North Texas Health Science Center is honored to host Dr. Ernest Grant, President of the American Nurses Association to offer the preamble for their free Nurses Month Webinar, presented by HSC nurse leaders and faculty. Join HSC nurse leaders and faculty, Dr. Stephan Davis, and Dr. Kayla Fair, on Thursday, May 28th at 12:00 pm (CST) for a free Nurses Month Webinar on “Become the Future of Nursing Leadership: Educational and Professional Pathways to Leading Change and Advancing Health.”
In this session, participants will learn about:
- The Changing Healthcare Landscape
- Increasing Educational Standards for Nurse Leaders
- Competencies for Nursing Leadership in Public Health and Health Administration
- Pathways to Advanced Credentials
- Integration of Personal Mission, Vision, Values and Strengths to Career Strategy
Date: May 28th, 2020
Time: 12:00pm (CST)
Location: Zoom Webinar
At the end of the Nurses Month Webinar, participants will be able to:
- Delineate various educational and professional pathways to developing their leadership capacity
- Create a leadership development plan based on their personal passions and professional goals
This continuing professional development activity was approved by the Georgia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
1 Free CNE Credit Available!
For more information on this free Nurses Month Webinar, please contact:
In many states, Nurse Practitioners (NPs) can open their own practices. But just because you can doesn’t mean you should. Here’s how to decide and, if you choose to, the types of actions you’ll need to take.
When Scharmaine Lawson, FNP-BC, FAANP, FAAN, had been a nurse for 15 years, she had worked in many different specialties. One of her favorites was home care. In fact, it was her passion.
“I wanted to help my community, and a physician approached me about starting my own clinic/housecall service. It was a ‘right time/right place’ moment,” she recalls.
Lawson ended up founding a VIP housecall practice, Advanced Clinical Consultants in Louisiana, which has been successful for the last 15 years. She also penned Amazon’s number one house call book, Housecalls 101: The Only Book You’ll Need to Start Your Housecall Practice. Finally, she’s designed a course called Housecalls 101, in which she teaches other clinicians how to start and maintain a successful home visit program. Since 2008, Lawson says she has trained more than 600 nurses on how to do this themselves.
“When the opportunity presented itself, it was a natural fit in an environment I felt comfortable operating in,” says Lawson. “Plus, I saw the community need and felt I could best be a servant leader. At the end of the day, the ability to serve is my superpower. It’s an honor that I don’t take lightly.”
Should You Open a Practice?
As Lawson says—and as do our other sources—first, you need to find your passion. You also need to decide if this is something you really can do. “Opening your own practice takes guts, time, and dedication. If you’re missing any of those, it’s not worth it,” says Graig Straus, DNP(c), APRN, CEN, FF-NREMT, founder and owner of Rockland Urgent Care Family Health NP in New York. “I always knew that I wanted to be my own boss, make my own rules, and care for my patients on my own terms. Having that desire really drove me to the point of wanting to open my own business.”
While fulfilling, opening and running your own business isn’t easy. “Nurse practitioners should only open their own practices if they want all the things that go along with owning any business: bookkeeping, marketing, networking, hiring/firing, social media, etc.,” says Bradley A. Bigford, MSN, APRN, NP-C, CCHP, founder and owner of Table Rock Mobile Medicine, PLLC in Idaho. “If they like working 9-5 jobs, owning their own businesses likely isn’t for them. They have to put in long days and nights, weekends, and holidays.”
If you’re up to the task, the next step is to determine what kind of impact you want to have on your community and profession, while making sure that what you want to do matches up with a need in the area you want to serve. “It was a simple decision for me,” says Maurice D. Graham, DNP(c), MSN, APRN, FNP-BC, CEO of Graham Medical Group, a concierge medical practice in Maryland. “As an African American male, [I know that] we are often undertreated for health care issues, accompanied with the fact that African American men do not seek routine screenings and prevention.”
Ask yourself tough, but important, questions. Melanie Balestra, JD, NP, MN, of the Law Offices of Melanie Balestra, is a lawyer and an NP and has been working with other NPs in a legal capacity to help them set up their own practices for more than 25 years. She says you should ask yourself some of the following questions:
- What are the goals of opening your own practice?
- Where will it be located?
- What will be the focus of it?
- Will you take insurances or be cash based?
- Will you need support help?
- Will you be taking out a loan? If so, where will you apply for one?
- Will you be able to function in the red for at least a year?
“The biggest challenge is that it does not happen overnight,” says Balestra. “The NP needs patience and be able to evaluate what might not be going right in the practice. This is why location is important. Collections can be a nightmare, so it’s important to have a good billing and collection service. The biggest mistake is expecting overnight success, and then when it does not happen, giving up.”
What to Do First
The first thing you need to do if you plan to open your own practice is to develop a business plan, says Balestra. “If you are in a state that requires a supervising physician, make sure you have him/her on board. When this is done, hire an attorney who has experience with setting up NP businesses and understands the laws of your state. Hire an accountant to work with the lawyer on setting up the best entity for you legally and tax wise,” she explains. Have several office spaces in mind and make sure they are zoned for medical practices. If you need a loan to start business, it may be a personal loan but a note can be written so that the business pays back the loan.”
Do your research. “Nobody should just open a practice for the sake of opening one without any research into their idea or doing market analysis,” says Lawson. “This is a disaster waiting to happen.”
Bigford stresses that you also need to talk with your family. “It takes a buy-in from everyone because of the significant work it takes from everyone involved and their loved ones to pick up their slack,” he says.
As for how long it will take—for our sources, it took anywhere from four months to two years before they opened their practices.
Straus says that after you incorporate, you should also get a group NPI number—this is different from the personal one you would have gotten when you initially began practicing. “This establishes your company as an organization capable of being recognized by CMS,” he says. He then went and spoke with his local Industrial Development Agency to determine what tax breaks and industry connections he could get. “This will help to reduce costs and potentially hasten any permits needed to build a practice. These are quasi-governmental agencies who have the ability to lessen the tax burden placed on you in the initial stages of opening a business. The goal of these agencies is to promote sustainable businesses and help support local communities.”
You’ll also need insurance—for yourself and your business. “Insurance is a necessity prior to your business opening,” says Emily Keller Rockwell, RN, MSN, CRNP, owner and founder of The Montchanin Center for Facial Aesthetics in Delaware. “Without question, have a detailed meeting with your insurance agent, discussing your business in detail—making sure they understand all aspects of your business and will provide the adequate coverage and limits to protect you and your business.” A few kinds of insurance to discuss, she says, are property, liability, errors and omissions coverage, umbrella, and disability, among others.
Some of our sources didn’t hire staff—at least for the first year. “Staffing depends on the volume of business being generated,” says Graham. “My first year, I didn’t hire anyone. I did all my administration duties and cared for my patients. My goal was to keep my overhead as low as possible without lowering the level of care given to my patients. This worked out well for me.”
Rockwell also waited a year to hire an assistant. Now she has three and a full-time publicist. “I am able to do speaking engagements, conduct trainings, and attend training events to further my professional knowledge,” she says.
If your type of practice requires that you have staff from the beginning, Balestra says to know what you’re looking for in attitude, skill level, and personality.
Bigford says that “Hiring non-revenue generating staff should be kept at a minimum.” When you hire anyone, he suggests that you find people who have a good work ethic. “Someone personable, easy going, and friendly is important,” says Straus.
Once you’ve determined your business, you may need to find a place. (Obviously, if you choose to have a house call business, you don’t need a brick-and-mortar office.)
“Think about the services you want to offer and the space you need to do it in,” says Straus. His urgent care facility needed a lot more resources than a primary care office. “I specifically met with architects who specialize in medical offices to help determine the size and capabilities of the space, based on my needs.”
Graham had one large room that included his own personal desk as well as all the equipment he needed to conduct assessments and provide routine care to his patients.
Rockwell says that when designing your space, keep your clients’ need in mind. “Design a warm, comfortable waiting area to keep patients relaxed,” she says.
All our sources say that you must have a website. Even if it doesn’t bring clients in directly, they will want to look at it to get information about you and the kinds of services you offer.
Don’t discount word of mouth. This can be one of your best marketing tools.
Social media is your friend. Learn how to use it. If you don’t know how, hire someone who does.
When using social media, decide which is best for you. For Rockwell, Instagram has brought her the most clients. Bigford says to go where your core consumers are. His are on Facebook and Instagram. “Post every single day. Go to Facebook groups. Facebook and Instagram ads work really well for me to build trust,” he says.
Straus suggests having “coming soon” ads before you actually open to build up curiosity. “Ads in local papers that cater to your community could be beneficial,” he says. He adds that advertising in church newsletters, school calendars, and through the police athletic leagues—any organization that involves your community—can be beneficial to your business.
Our sources also stress getting patients/clients to give you reviews on Yelp, Google, and Facebook. High ratings attract new consumers.
Before you start your own business, there’s still more to know. “Get experience elsewhere first,” says Bigford. “If you’re trying to learn to be an NP and start your own business, you’re going to struggle at both.” He also suggests that you get traction with patients. It took Bigford about a year to get a steady stream of patients and referrals. “If you have a high overhead in the beginning, you can go out of business before you even see your first patient,” he cautions.
Be sure that you know how to properly manage your time. That was Rockwell’s biggest challenge. “I wanted to see and help every patient who inquired,” she recalls. “I quickly found out that I needed to manage my work time and personal time equally. As with anything in life, you need to reboot or you will burn out. Schedule yourself into your schedule!”
Look for a mentor. “NPs should look for a mentor or someone who has already established a clinic, and pick their brain. That’s what I did,” says Graham.
Have enough money to get you through. “In jobs that rely on insurance, payments are delayed. You do not simply offer a service and get paid the exact moment of exchange. A claim has to be made, filed, and processed. Then payment is issued per contracts,” says Straus. “A solid 4-6 months of cash on hand to cover expenses is needed while you establish your practice, build clientele, and await the beginning of insurance reimbursements.”
Despite all the hard work and sacrifice needed to run your own practice, our sources wouldn’t have it any other way.
Lawson’s biggest reward in having her own practice? “Complete autonomy,” she says. “It is the biggest entrepreneurial superpower.”
Disclaimer: This story is meant to give general advice. For specific individual advice on starting your own business, be sure to consult a lawyer, an accountant, and other professionals.
Oncology Nurses Month is honored throughout the month of May and celebrates the broad options of this nursing path.
Nurses who pursue this career specialty and who work with patients who have cancer are open to many career opportunities. They are often on the cutting edge of technology and working with new treatments that change evidence-based practice with each successful development.
“With over 34,000 clinical trials occurring to test new drugs, combination therapies, and supportive strategies for patients, novel cancer therapies and care strategies are constantly emerging and being integrated into practice which provides exciting new treatment options for cancer patients,” says Erin Dickman, Oncology Clinical Specialist with the Oncology Nursing Society (ONS).
“An oncology nurse can be in the role of a staff nurse, nurse practitioner, clinical trials nurse, clinical nurse specialist, or administrator just to name a few,” she says. Because of this, oncology nurses can work in various healthcare settings and treat patients of all ages. And oncology nurses are constantly learning from their patients, their professional development, and each other. Oncology nurses should keep asking questions and working through the evidence-based practice process to ensure that all practices are evidence-based to ensure the best outcomes for your patients, she says.
Oncology nurses know that each patient will respond differently to cancer therapies, so they need to have the critical thinking, clinical experience, and expertise to respond to each patient’s individual needs. “They administer drugs within a treatment plan and the supportive medications that help to prevent and manage side effects,” Dickman says, “and they create individualized care plans for each patient that identify needs and risks of the patient, come up with a plan of interventions to achieve positive health care outcomes.”
Nurses in this field are an integral part of the care team and will work and communicate with various providers, family members, caregivers, and support services. As a result of working so closely with patients, nurses, says Dickman, are advocates for them and may be the driving force in getting access to additional care or specialty consults.
The COVID-19 crisis presents challenges for oncology nurses. “Nurses have had to flex, innovate, and adapt in the midst of the COVID-19 pandemic,” says Dickman. “Treatment protocols have been offered in different locations and some appointments are even switching to telehealth visits. Oncology nurses have especially been challenged in helping patients differentiate between COVID-19 symptoms and those associated with the disease process and treatment through additional remote monitoring and screening they have been providing to their patients.” They are also determining how treatment plans will need to change to protect patients’ health and are navigating the loss of support systems during visitor restrictions. “The oncology nurse has stepped up to be the hand holder and person to reassure the patient of their strength,” says Dickman.
Even as they are using their technical nursing skills, oncology nurses are also finely tuned to how their patients are responding to their condition and their treatment. “Sometimes overlooked, is the role that nurses play on the psychosocial and emotional well-being of patients and the role nurses play as advocates for their patients,” says Dickman. And nurses must trust their intuition. “When you think something may be wrong with your patient and they may require some intervention — either physically or psychosocially, they usually do,” she says.
If oncology nursing sounds like a career path you’d like to pursue, Dickman recommends talking with oncology nurses and even finding a mentor who can help you find the best subspecialty for your interests and skills. She also suggests talking with current and former cancer patients to find out about how nurses impacted their care.
Nursing students can choose to pursue many avenues to boost their knowledge of the field. “Other options are to find a shadowing opportunity, volunteer or become a nursing assistant on an oncology unit, seek out internships or externships, or build your knowledge base in oncology by taking select oncology focused classes,” she says. “There is also free student membership to ONS so you can stay up to date with what is happening in cancer care.”
A cancer diagnosis not only affects the patient’s physical and emotional health, but it also transforms a family and is a life-defining moment. “There are many ups and downs to cancer treatment, but having the opportunity to walk with patients throughout the journey is a gift,” says Dickman. “There is no greater reward than knowing you have helped a patient and family through a very difficult time, shared their joy, and helped them cope with sadness.”
When Neuroscience Nurses Week arrives every May, nurses in this specialty champion the vast choices they have within this career path.
For Ebonye Green, MNSc, APRN and director-at-large for the American Association of Neuroscience Nurses (AANN), becoming a neuroscience nurse was hardly something she planned. “I have my bachelor’s in chemistry, and I was going to go to pharmacy school or med school,” she says. She actually ended up going to pharmacy school and was two years into the program when an off-chance comment by a patient she saw every month changed everything. “He said, ‘This isn’t for you. You should do something else.’”
Green took a chance. She shadowed people at a university hospital while still working with outpatient pharmacy patients. “One night, I was pulled into the neuro ICU,” she says. Other nurses said she was going to hate it because the patients can be unpredictable. The talk made her nervous to go in, but the result was transformative. “I loved it,” she says.
When fall semester came around, Greene didn’t go back to pharmacy school, instead enrolling in nursing school. “That was totally out of character for me to quit something,” she says. “My parents were surprised because I am a planner. I am a Type A, which actually fits in really well with neuroscience nursing.” But she had everything worked out from finding funding to moving credits around. “People thought I was crazy,” she says. And while she says she really didn’t know what to expect, she had a gut feeling that she was on a path that suited her. “It felt right,” she says. “I didn’t feel like I was going to work. I have never felt that way. I always learn something new every day. It’s eye-opening. It’s exciting.”
Green says making connections with other neuroscience nurses early in her career helped her gain her footing and gave her a sounding board. She talked to other nurses through AANN, and they gave her career-boosting tips. She was told how important it was to gain additional certification in her specialty or sub-specialty. They also let her know about neuroscience journals and about how conferences for neuroscience nurses were a great way to find other like-minded professionals.
Green understands why the nurses so long ago thought she might not like neuroscience nursing—it’s not a field that will appeal to everyone. “Things are happening with your patients and you can’t see it,” she says. There’s no cast to show a broken bone healing and no pacemaker to check on, she says. “It’s in the brain and you don’t see the moving parts,” she says. “You have to rely on your exam and what you know about the patient.”
But those very things are what keep Green motivated. “For me, it’s all about education,” she says. “It’s about wanting to know more to take better care of my patients.” It’s easier today to find the information she needs, but when Green first started, not many people were using the internet the way they do today. “You couldn’t Google something on a phone,” she says. “I was opening textbooks and showing my patients.”
Calling neuro recovery “a marathon, not a sprint,” Green says the education piece of recovery is vital. She works with patients, families, and caregivers who often just have to come to terms with a long, uncertain recovery. Finding out what can help patients calms everyone’s fears a bit, she says. Like pieces of a puzzle, as Green sorts out the reasons someone is under her care, she can help formulate the best path back to having the best life possible.
Nursing students who think neuroscience nursing is appealing should also realize the specialty, like a nursing career, is broad. “You can create your own avenue,” says Green. If you want to work with stroke patients, you could find yourself working with them from the time they hit the door in the emergency department or in rehab after they have had initial treatments. You could even find a place in the OR as a neuroscience nurse. “While you are on different rotations, decide what you want to do,” says Green.
Green particularly likes being able to follow her patients through their recovery. “We are in this together,” she says. “This is a very challenging and extremely rewarding field.”
One year ago, I would have taken any opportunity to write, advise, or lecture on the inequalities of being a black nurse in health care. I could’ve complied a novel of complaints, stories, examples, and tears from the countless nurses that have described horrific scenarios of discrimination and bias feelings of being undervalued and overlooked for coveted leadership roles. Today, my paradigm has shifted and my perception of reality has moved from fractured to healed. How did this happen? Am I drunk on the liquor of white America, am I not “woke”? Have I forsaken my people and joined the other side? No. I’m still very much an advocate for equality in health care.
Here’s where I’m at: there are many individuals who subscribe to a methodical and intentional belittling of those who do not look like them and they come in every shade, even black. I may have heard a metaphorical gasp, but the truth is we focus so much of our attention on those individuals, working to receive their approval, waiting for a nod, anticipating some sort of compassionate act to help us succeed. Here’s the truth. They are not enlightened and they don’t care and until they plan to become self-aware their behaviors actions will never change. They are disconnected from the pillars of nursing compassion, empathy, human connection, and healing. Create a path to success using your knowledge and passion. Channel your energy and focus on yourself.
I have countless stories of inequality, being undervalued, and overlooked, feeling inadequate, not good enough, not included. Many of my colleagues have the same stories, we have collected so many stories that we could build a library of hate, but why? Why waste energy on what’s unimportant? Why not channel that energy and create something new, innovative, and intentionally inclusive? Achieve the highest degrees or certifications possible, build a nurse framework that cannot be torn down, that cannot be destroyed, that lasts lifetimes. Not just something for the moment.
Here’s a truth: my move to corporate America opened my eyes to a reality. Nobody, I mean nobody eats for free. It’s time for Black America to open its eyes to the truth and learn the transparency of human behaviors. What you fear is created in your mind, so change the narrative. Move your mind to a positive paradigm and see the opportunities in every task that you are asked to complete, instead of complaining why not focus on self-awareness and success. Yes. It’s OK to be selfish. Don’t just complete an objective. Execute it. Put all your hurt and pain in your work and watch how your outcome changes. Change how you eat, what you eat, include exercise, meditation, and whatever it takes to move you to a healed space. We have over 400 years of shackles to break, take pride in breaking your own chains and contribute to the evolution of history. Don’t just read the news; become the news.
The popularity of social media cannot be understated. Currently, over two billion people use various social media platforms, including 81% of Americans. Social media is not just something we do when we are bored. It allows us to connect with old friends, share stories and recipes, and talk with our colleagues.
But using social media isn’t always ideal. In general, using Facebook or watching YouTube videos at work is considered unprofessional, and you must always be careful of what you post. This is especially important for medical professionals. Nurses have one of the noblest professions, as they help people heal from an unending variety of ailments. However, nurses must also follow a different set of rules, and failing to do so could jeopardize their careers.
Let’s look at the benefits and downsides of social media at work for nurses.
A Different Set of Rules
Everyone should be cautious of the messages and pictures they share on social media, especially if it involves someone else. This is especially true for nurses because they not only have to follow the standards of public decency like everyone else, but they also must also follow the requirements set forth by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In essence, HIPAA says that a health professional cannot share the medical or personal data of a patient with anyone without the patient’s consent.
So that means that a nurse can never post a picture of a patient or any identifying information about a patient, including their name, initials, contact information, or anything in between. Medical professionals should be extra cautious because they could post patient information without even realizing it. For instance, you might post a picture of your workplace, then years later, post a photo of a patient that you became friends with at the same place. Even though you didn’t intend to cause a stir, someone could connect the dots and realize where that person got their patient care.
The punishments for sharing patient data and violating HIPAA guidelines are understandably harsh. Potential consequences could run the gamut from fines and mandatory training all the way to termination from your employer and civil lawsuits. For all of these reasons, nurses should always think twice before they press the post button.
Social Media Nursing Don’ts
The best way to stay safe is to avoid talking about patients at all costs. Even if you had an incredible day helping a patient and you are rightfully proud of a job well done, you should avoid posting about the individual, their ailments, duration of stay, and other details. You should also avoid connecting with a patient via social media. Stay safe by keeping a private profile.
You can never be too careful when it comes to posting anywhere inside the hospital or clinic where you work. Even if you are making a video of you and your coworkers lounging in the break room, you never know when a patient can be seen out a window or a confidential file can be seen on a nearby table. Check your surroundings before posting any pictures at work.
While you should never post anything about your patients, you also don’t want to post anything negative about your employer. To ensure that you stay within compliance, you should probably never mention them by name. But even if you don’t, you do not want to share a post where you insult your job or the management. Just like at any other job, talking negatively about your place of business could put a sour taste in the mouths of management, and you could find yourself out of a job.
Social Media Nursing Dos
It is important to remember that social media is not all bad. In fact, when used correctly, medical professionals can use social media to share important messages about health and wellness. At a minimum, medical professionals across a network of hospitals could create their own group on Facebook where they can share new solutions and treatment ideas with one another.
While you cannot post about medical conditions specific to an individual, you can use social media to spread the message about how people can take care of themselves and stay healthy. For instance, a nurse could start a blog about how to stay safe during the COVID-19 pandemic or post to a private page of people who suffer from a particular ailment, like a diabetes support page. Medical professionals could even set up a “Ask Me Anything” forum as they do on Reddit, where you can answer health questions from the audience.
For nurses who want to take public outreach to the next level, post videos with helpful information to sites like YouTube or Snapchat, where you can film fun and brief 10-second videos that stay online for only 24 hours. If uploading videos is something you are interested in, take a look at some of the experts who already have quite the following. One such voice is Crosby Steen, the “Nomad Nurse” who gives advice to traveling RNs. There is also Nurse Liz, who combines nursing with family life.
Social media certainly has its pros and cons, especially when used at work. As a nurse, sharing information online can be risky, but if used properly, it can also help those looking for answers.