What is the nursing effect on Nurse Entrepreneurs? Is there one? Consider these facts: Nurses make up 80% of the health care workforce and are on the frontlines (Wilson, Whitaker & Whitford, 2012).
There are an estimated 3.1 million nurses in the U.S. (U.S. Bureau of Labor, 2014) and approximately 220,000 nurse practitioners (AANP, 2016). Yet there are very few nurse entrepreneurs.
Wilson, Whitaker & Whitford (2012) quote less than 0.2% of nurses in the U.S. are entrepreneurs. Based on those statistics, the number of nurse entrepreneurs equals about 6 thousand nurses.
I’m not sure how many of NPs are in that mix, but I’m going to guess the percent of NP Entrepreneurs is also fairly low. I find it hard to digest these numbers, they seem way too small, but I haven’t found anything to the contrary either in the literature or anecdotally.
Why are there so few nurse entrepreneurs out there? The Institute of Medicine (IOM) called for nurses to practice to the fullest extent of their licenses, however there remains the unspoken nugget here, which is nurses are not considered equal partners on healthcare teams.
Hence, nurses remain underutilized and undervalued.
We can’t blame the rest of the healthcare community for undervaluing ourselves. I think our own collective mindset must encourage this behavior. How is it that we make up 80% of the healthcare workforce yet have so few ideas to contribute?
Yes, it’s true that we didn’t get any business training in school and yes our roots are in patient servitude and being handmaidens to physicians. But it’s no longer 1850.
The role of the nurse and more recently the nurse practitioner has evolved and is expanding and our mindset needs to evolve with it. Nurses and Nurse Practitioners are essential members of the healthcare team. But we seem to have this inferiority complex about our overall value and worth.
Let alone thinking we can monetize our expertise.
The Nursing Drive
Part of this issue I think has to do with our drive to do so much. This is one of our most positive attributes and biggest failings. What do I mean by that?
Every really awesome nurse that I have ever known has been a doer. She is strong, competent, invaluable and willing to take it all on.
Nothing is too advanced or too menial for a great nurse. I imagine this is how the nurse practitioner role came up as well. I’ve never met Loretta Ford, but I imagine that she was one of those awesome nurses who kept taking on increasing responsibility until she pioneered a new role!
I’m sure there is more to it but essentially there was more to do, so she did it. That is what nurses do.
We pioneer roads, we treat all the patients, we service the homeless and forgotten. Nurse practitioners are more likely to see Medicaid patients, work in rural areas or start free clinics.
Not because it’s a cash cow, but because it needs to be done. We aren’t afraid of anything. Except . . . valuing ourselves.
Nurses are constantly doing more, expanding their scope of practice and asking for more. Yet we do it all for free or under the radar. We give away all our talent, expertise and know-how and everyone gobbles up our ideas and takes credit for them. I’ve done it time and time again.
How many times have I built programs and started new initiatives on my days off and just literally handed over all my work to someone else to take credit for it–quite a few times, I am now embarrassed to say!
How many times have you gone above and beyond, not just to do something for your unit, your physician, or your facility, but you created something out of your expertise and just handed over your entire project?
I have a friend who is the director of a stroke program, who was asked by an industry rep to do him a “favor” and speak to a potential client. Of course, she agreed, and spent 3 hours telling the CMO of a huge hospital system everything she knew about setting up a stroke program, which is a ton! In return, she got a big “thank-you.” It’s stories like this one that get me increasingly agitated.
First, we need to stop doing these “huge favors” for everyone in the healthcare industry. Next time someone asks you to do a “huge favor”, you tell them you would be happy to and you will send over your contract for consulting fees at a MINIMUM of $125/hour.
If that person says thanks but no thanks, guess what I just saved you a bunch of time. On the other hand, you will be amazed at how easily most people will agree to those terms.
Another friend of mine has started up a couple of nurse practitioner programs. He was approached by a faculty member from an outside school to see if he could design a program for her since he had so much experience. He agreed and told her he would send over a contract.
The other faculty member was appalled that he would charge her to do her this favor.
Second, we need to stop doing these “huge favors” for each other. It’s one thing for my friend to give valuable advice over coffee for free.
But it’s a whole other ballpark to expect him to sit down with your school and lay out how to set up a program. We need to value and respect each other’s time and expertise.
My friend didn’t get to do the huge favor of building a nurse practitioner program for this other school, but I see that as a big win!
As nurses, we need to respect each other’s time and we need to demand respect from the healthcare community for our own time.
Nurses are afraid to value themselves and it is a big deal. Does the idea of telling someone your time is valued at $125/ hour make you squirm and feel really uncomfortable?
Well, guess what that is a pretty standard rate. Anything lower and you should just do it for free. You need to value your expertise at a numerical rate, this not only helps you with identifying yourself as an expert, it helps the rest of the healthcare community to do the same.
How important is expertise?
I have spent a great deal of time, money and energy in the last 5 years researching and building businesses.
In the majority of the mastermind circles, I am in, the biggest concern and threat to businesses that people want to start up is that they have no expertise in anything.
While I’m listening to these conversations, in my mind I’m thinking, that is NOT my problem at all. If anything I’m overqualified for just about every role I’ve ever had. I have more schooling behind me than most doctors or any other profession for that matter.
If there is one thing I am super confident about, it’s my expertise and not because I have umpteen degrees.
But because I have 18 years of experience with patients. I’m not alone, most nurses are experts in their areas of specialty. However, I think they fail to recognize it.
Maybe, we as a profession forget to validate each other in this area. You may not know the molecular structure of the medication you are about to give, but who cares? You can relate and emphasize with patients and earn their trust. This is an amazing skill that is 100% transferable to business.
I think you can take just about any profession/hobby/skill/market+nursing and create the most valuable and amazing hybrid product. As you know nurses are one of the most trusted professions in the U.S. So look, people trust us, they like us and we are experts. Not having business skills to start a business is a really lame excuse not to do it.
So lame, that I cannot for the life of me believe that lack of business skills is the reason more nurses are not entrepreneurs. Guess what, most entrepreneurs don’t have business skills.
I have an MBA and I can tell you it has not helped me one bit in the entrepreneurial space. It’s something I’ve had to learn new as well. In fact, most people learn business skills on the fly.
This is also why most businesses fail–because there is a structure you do need to follow, but it’s not rocket science and it’s certainly not nursing!
It’s my theory that our long past of being handmaidens has crossed over into our collective mindset. We don’t believe that we can be entrepreneurs because we are only servants of the people and of physicians.
Well, guess what, the business part of entrepreneurialism is the easy part. There are very specific and structured steps to starting up a business. The hard part is transitioning your mindset from a subservient role to that of an entrepreneurial leader.
Nurses and Nurse Practitioners are experts and have an incredible amount of knowledge to share. I think it’s our duty to share this expertise, but NOT for free.
If you don’t place a value on something no one else will either. Here is an example. Imagine I offered you course A for $600 or course B for free. Which one would you assume has more value? Naturally, you would think course A is better.
Now try this analogy. A physician speaks to the CMO of a large hospital system for 1 hour about a stroke program at the rate of $350/hr or the nursing director of the stroke program talks to a CMO for 3 hours for free.
Whose time do you think was valued more, regardless of who provided better information. Now is the physician’s time more valued because of his/her stature as a physician or because s/he charged a rate or maybe a combination of both?
Imagine the nursing director charged $250/hr and the physician met the CMO for free. Money and value change your perspective.
As nurses, we have not been taught how to value our services. We are accustomed to taking orders, so we don’t always recognize that we in fact develop expertise in areas that are valuable to others, whether it’s other nurses, the industry, or patients.
But we absolutely can and should place a value on our services and the potential that we have to offer. We really just need to educate ourselves. Nurses always have ideas on how to improve processes, workflows, and just about everything.
The BIG Idea
I know you have a million ideas of how you can improve things in your facility, for your peers or for your patients. You just need to believe that YOU can make the difference and YOU can offer up the solution. Until nurses do it, no great changes will occur in my opinion.
If you are interested in discovering if your ideas can be formulated into a business concept you can easily and very inexpensively Google it to see if it has the potential to be profitable.
The ironic thing is that I see nurses Googling about business, so I know there is an intense interest for nurses to pursue their own business.
The top 3 searches associated with NPs are a business plan, the legal structure of a business and business ideas. Yet there are less 0.2% of nurses who are Entrepreneurs. We need to change this!
You could potentially turn any expertise into a consulting or online training program.
NPs can run their own clinics, or any nurse can become a speaker, author, consultant. Work with a special group of patients and you love working out?
What about an online training program for patients with degenerative spine disease or after a stroke?
You can easily create any niche based on your expertise and your passion or hobbies that you love.
I think that nursing has had an inferiority complex for so long that it undervalues what nurses do.
This, in turn, has led us to not think of ourselves as experts. Since we are not “experts” and we have no business training we can’t start a business.
I’m here to tell you that is CRAP! Nurses are experts. Business is straightforward and follows a relatively predictable and sequential path to success that requires hard work, perseverance and a willingness to take a risk–this is the epitome of nursing!
My mission is to flood the market place with nursing expertise through entrepreneurialism one nurse at a time.
I believe that we are truly the x-factor that will execute change in the healthcare arena. Nursing is an amazing profession and I’m really excited to see our profession move forward!
Wilson, Whitaker, and Whitford (2012). Rising to the challenge of health care reform with entrepreneurial and intrapreneurial nursing initiatives. OJIN. DOI: 10.3912/OJIN.Vol17No02Man05