Leading the Way

Illustration by George Abe

The career path of most nurses after graduation is like a well-marked highway. This way to a large hospital unit. That way to a small private clinic. Turn here for pediatrics. Straight ahead for more education. But a few nurses choose to veer off onto a career path that’s more like a dense jungle trail, one that requires a hacking machete to make any progress. This is the path to owning your own business. There is no straight line from nurse to business owner, but thousands of nurses choose to do it every year.Here are the stories of three Vanderbilt graduates who became their own boss, and their advice for others who may want to follow their lead.

1. Get experience.

Jason Boylan’s goal was to get a nursing education and real-world experience in order to open his practice in downtown Nashville earlier this year. Photo by John Russell.

“As a provider you have to know when to hold ‘em and when to fold ‘em,” Boylan said, “meaning there are many things nurse practitioners can treat competently, but we also need to understand when a specialist or internist may be appropriate. It’s important to have good mentoring from other nurse practitioners and physicians as a new grad and beyond. Even with several years of experience I still will often lean on colleagues for clinical direction.”

After graduating in 2003, Boylan spent five years practicing in an internal medicine/pediatric clinic and in emergency medicine.

“I made the most of my time in school and early in my career. I picked everyone’s brain and learned the different core competency procedures,” he said. “Then I decided I was polished enough and ready to go out on my own.”

Today Boylan has a thriving clinic in downtown Nashville called 3rd and Church Health Care and a house call business called Nashville House Calls. 3rd and Church is a walk-in clinic for urgent care, chiropractic care, and some primary care.

“It is the only urgent care offered in downtown Nashville, and it is built to get patients treated quickly and efficiently without compromising care and patient satisfaction,” Boylan said.

The clinic sees about 300 patients per month, including guests staying at downtown hotels. About 80 percent of his business is clinic visits, and 20 percent is house calls to patients living close to downtown Nashville.

Within a few years of graduating nursing school, Boylan had drafted a business plan for an urgent care clinic following templates he found online, and he reviews that plan every three to six months.

“It’s important to have a guide to go back to as the business and economics morph. If you don’t have a plan, how can you give the best care to patients?” Boylan said his years of experience gave him a good sense of medicine and sharp assessment skills, but he still “paid a lot of stupid tax” while learning to run a business.

“Lean on those who have already learned. You don’t have to reinvent the wheel,” he said. “Where are you getting the best bang for your buck in marketing and advertising? How can you keep your overhead low but also keep everyone happy? Look at your business from the big picture and every angle.”

Because Boylan learned so much from others, he is especially willing to share the knowledge he has gained.

“Part of the mandate of being a business owner is sharing your knowledge and experience with others, especially other nurses.”

3rd and Church currently has just a few employees and Boylan still manages the books himself, but the clinic and house calls are quickly outgrowing that. He knows he wants to expand house calls but isn’t quite sure where the road leads next.

2. Start low and go slow, but go.

Carol Whitten’s success didn’t happen overnight. She took methodical steps in her transition from employee to successful business owner. Photo by Susan Urmy.

Carol Whitten, P.M.H.A.P.N., didn’t careen wildly off the typical nursing career path and jump right into her own endeavor. She followed her No. 1 piece of advice: “Start low and go slow, but go.”

She continued to work her day job while building her business, and then when her client base was established, she switched to only working weekends. Soon she had enough demand to quit her regular job and focus on her business full-time.

Whitten owns Psych-Services, a company that visits patients in long-term care facilities to manage psychiatric medications, most frequently for depression and dementia.

“We keep the nursing homes in compliance with federal and state regulations related to psychiatric medication administration, known as O.B.R.A. guidelines,” Whitten explained. “The whole company is composed of psychiatric nurse practitioners, and we visit our patients as frequently as is necessitated by their medication and attempt to keep patients on the lowest possible dose. We weigh risk versus benefit and monitor for side effects. We’re on call 24/7/365 for whatever may come up.”

Whitten’s eight employees work autonomously, receiving their referrals by e-mail and covering nearly 4,000 clients in 50 care facilities. About 1,000 of those patients are seen in the greater Nashville area, and the rest are in rural areas.

“We cover as far as Waverly and Waynesboro to the west, and as far as McMinnville to the east, Cookeville and Sparta. We get so far out our cell phones hardly work,” Whitten said.

Whitten has built this widespread client base purely through positive word of mouth. She has never spent money on marketing or want ads for nurses, and she hasn’t even needed to establish a website. “The best advertising is quality care.”

Psych-Services provides the personal attention that many patients in long-term care facilities need regarding psychiatric service in medically underserved areas.

“Someone who is screaming out all the time or assaultive is at risk to be sedated or isolated. Patients on the proper medications are less likely to fall, their mood, sleep, and appetite are better, and they just do better overall,” Whitten said.

“The nursing homes we cover are calm and quiet. Everyone is awake, not sedated. We’re preserving the dignity of a person with progressive dementia.”

Whitten cruised the clinical nursing career path for 23 years as a medical/surgical nurse and a psychiatric nurse. (Her very first ER patient was dead on arrival, shot by McNairy County Sheriff Buford Pusser during his “Walking Tall” famed time in office.)

With the feeling that she had done all she could do with her associate’s degree, Whitten applied to VUSN and was awarded a scholarship for Clinical Specialist in psychiatric/mental health nursing. But it didn’t come without personal sacrifice.

“I was 42 when I went to Vanderbilt. I worked a full 40 hours on the weekends, went to school full time, raised five children and had a sick and dying mother in the nursing home and a traveling husband.”

Whitten graduated in 1990, and worked for Parthenon Pavilion as a nurse manager, but was beginning to feel “restless.” Previous colleagues in medicine and nursing practiced psychiatric care in nursing homes, and the opportunity was obvious.

“You don’t have to be a futurist or demographer to see where the population is going. The geriatric need only increases as the years pass.”

In 2001 Whitten slowly built the company in response to the federal regulations passed regarding psychiatric medication management.

Though she said she had no worries about starting a business in her 50s, Whitten is already training her replacements – her daughter Heather has two master’s degrees and a bachelor’s degree in business administration and facilitates business operations. Her son Jason is an intensive care nurse.

Whitten said the most crucial part of owning a nursing business is to know the requirements and regulations – “minding your Ps and Qs,” as she puts it. She jokes that she has never had a sleepless night before a regulation survey.

“People ask me how I can be so calm, but they give you the rules ahead of time! You just have to know them and follow them always.”

3. Identify the need.

Elizabeth Rudolph has parlayed her experience in the worlds of health care and law into a thriving legal nursing consulting business. Photo by Joe Howell.

Elizabeth Gardner Rudolph, M.S.N., R.N., J.D., found a path that accommodates both her compassionate side and her analytical brain and fills a huge need.

After working her way up through the ranks of nursing (from riding her bike to volunteer at a nursing home as a teen, all the way to teaching Pediatric Nursing at VUSN), Rudolph returned to Vanderbilt for a law degree. She married and moved to Memphis and began representing nurses and other health care providers sued for a malpractice at a large firm there.

After many years representing defendants, Rudolph began litigating for the plaintiff. With experience from both angles, she began to see a need for nurse expert witnesses – nurses who could review and interpret medical records and testify in medical-legal cases. At the same time, Rudolph began publicly speaking on liability issues.

“Nurses would come up after my presentation and ask some question about the talk, but then get down to their real question – they wanted to know how to be a legal nurse consultant,” she said.

Rudolph knew from her time in court that there was a great need for legal nurse consultants, and now she had confirmation that nurses were interested as well.

So in 2006, Rudolph opened the Jurex Center for Legal Nurse Consulting, a business that certifies nurses as expert witnesses and legal nurse consultants. Jurex links lawyers and nurses.

“Attorneys need nurses with medical expertise as well as training in legal issues, and nurses need to know how the legal system works and how to market themselves to lawyers,” she said.

Rudolph says the primary appeal of the certification is flexibility. Nurses can be trained in two days through their choice of course – online, video, audio or at four live presentations around the country each fall and spring.

“I didn’t think it was necessary or fair for nurses to take weeks to get certified. A nurse can do this on his or her own schedule,” she said. “Once certified, they can do this in their spare time or make it a full-time business.”

After the course, nurses take a certification test, and if qualified, receive the Professional Legal Nurse Consultant (P.L.N.C.) certification. Jurex also offers continuing education hours accredited by the American Nurses Credentialing Center. Rudolph said Professional Legal Nurse Consultants could expect as much as $150 an hour to review medical records and $200 an hour to testify.

“Nurses have so much knowledge to impart. This is a chance to be a patient advocate or to defend nurses who have been sued,” she said.

Nurses have been certified by Jurex in places as far away as Honolulu and Miami and all states in between.

As president of Jurex, Rudolph works with independent contractors to manage aspects of the business such as graphic design and administrative support. One of the keys to her success is good customer service, she says.

“I always try to be timely with responses. When a nurse e-mails or calls, he or she expects a response right away, and they deserve it.”

For nurses who may be teetering on the edge of making the leap to starting their own business, Rudolph says there is no time to waste.

“The time is now to start a business, whatever it may be. There is no time like the present. Small steps lead to next steps.”