“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.

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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.”


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.”

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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.

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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.”

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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.”

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