CHAPTER THREE: ENTREPRENEURSHIPEntrepreneuring is such a vast and viable area for nurses that it deserves its own separate chapter from the other alternative careers. Nurses are so multidimensional, flexible, creative, and organized that developing and operating a business is a natural fit for many. Kelly reports that there are an estimated 20,000 nurses operating their own businesses (1991). Nurses who have been in the work force for at least a few years can identify patient needs and understand how health care systems operate. They often see the voids in the system which prevent patients from receiving appropriate care, or those black holes which can keep an operation from running smoothly. Nurses also have many and varied professional contacts. Combine all this with a creative idea to solve a problem or fit a particular niche, and you’ve got some valuable components to starting a small business. Entrepreneurship is not for everyone. It takes more than just a good idea and wanting to be your own boss. Successful entrepreneurs share certain personal characteristics. Vogel (1988) describes these characteristics as follows:
In view of the above listed characteristics, it is important to assess personal strengths and limitations in comparison with those attributed to successful entrepreneurs. Entrepreneurial characteristics can be developed, therefore it is crucial to identify which areas need attention. There are ways of acquiring the much needed skills and personal resources for a successful business venture. The following characteristics need to be assessed in order to develop an understanding of one’s entrepreneurial personality:
The following worksheets are from Entrepreneuring: a Nurses’ Guide to Starting a Small Business, (Vogel 1988). These will help you to assess your own entrepreneurial characteristics. After each category is an interpretation of the score as well as suggested methods for acquiring or enhancing certain traits. Assessment 3-1 The entrepreneurial Orientation Inventory Click here for Assessment 3-1. Internal/external ratios above 3.0 indicate a high level of entrepreneurial internality; the chances are high that such individuals will initiate entrepreneurial activities. Rations below 1.0 indicate that the respondent has a more external (less entrepreneurial) locus-of-control orientation. There is a need for this type of person to become more internal in order to be able to initiate and sustain entrepreneurial activities. Ratios above 1.0 indicate possible entrepreneurs. The higher the ratio above 1.0, the more internal the respondent is. Reprinted from Rao (1985). Used with permission. Assessment 3-2 Critical Event Click here for Assessment 3-2. Assessment 3-3 Personal Characteristics Click here for Assessment 3-3. Skills can be developed in several ways. Workshops, credit courses and independent reading are three useful strategies. Collaboration with someone who has the skills you lack is also helpful. Consultation with a peer group or a mentor as you begin your new career can provide the support and feedback you need to grow. Assessment 3-4 Interpersonal Skills Click here for Assessment 3-4. Assessment 3-5 Business and Management Skills Click here for Assessment 3-5. Your business and management skills can be developed by means of the techniques listed in the previous assessments. As alternatives, three other strategies may be tried.
Assessment 3-6 Nursing Expertise Click here for Assessment 3-6. Exercise 3-1 Entrepreneurial Personality Profile. Click here for Exercise 3-1. After assessing whether you have what it takes to be a successful entrepreneur, you must develop a business idea by finding the right niche. If you are considering your own business, chances are you have been mulling over an idea for some time. You may have a personal interest in something, or a particular talent that you have developed through your nursing experience. You may have seen the gaps in health care and feel driven to provide a service badly needed. If so, it is time to go the step further and develop that nagging idea into a marketable business plan where you can apply your unique talents and begin to reap the personal satisfaction that goes along with having found a “fit”. The most important guideline in business is to provide the right service to the right market (Vogel 1988). You must assess and interpret your client’s needs accurately, match them with you special skills and interests, then develop and market a service that addresses the needs. Finding the right niche, or market, involves the following:
Nurses have more opportunities than perhaps any other profession or vocation to apply their education, experience, contacts and special skills in a unique business arena. Nurses command the immediate respect and trust of the public. They have the education and professionalism to interact appropriately with professionals even outside health care, such as attorneys or CEO’s of major corporations. The ideas are limited only by your imagination. Benzel, in his guide for home based businesses in health care using a personal computer, has highlighted three specific business ideas which offer moderate to high income potential and will remain a solid opportunity into the next decade and beyond (Benzel 1993). Individuals who work full time in these areas were found to earn from $30,000 to $60,000 per year. These businesses are in electronic medical billing, medical claims assistance professional and medical transcription. ELECTRONIC MEDICAL BILLINGA medical billing service submits or processes claims on behalf of doctors and other allied health professionals to commercial insurance companies and government agencies such as Medicare and Medicaid. Filing claims is a tedious and time-consuming process. Each insurance company has their own rules and regulations with complex paperwork that needs to be submitted. Medicare and Medicaid have their own complicated procedures as well. In 1990, the government required that all doctors file claims to Medicare on behalf of patients, thus increasing the burden. Some medical practices will offer to file claims to private insurance companies as well. The process is so time-consuming, burdensome and confusing that many health care professionals simply abandoned collecting a certain percentage of their claims, which cost up to millions of dollars each year (Benzel 1993). There is an estimated six billion or more insurance claims filed each year, with Medicare alone responsible for 500 million claims per year. There is tremendous opportunity here for someone well versed in medicine, insurance terminology and who owns a personal computer (PC). In the last decade, new software has brought about electronic claims processing (ECP), which allows claims to be transmitted via personal computer. This allows for fewer errors in billing processes and expedites the reimbursement to health care providers. Insurance companies also see the value of ECP. It saves thousands of dollars in overhead and salaries for claims processors and examiners. Medicare has encouraged all providers to switch from paper to electronic claims filing. It is felt that ECP will save $8 billion in health costs each year (Benzel 1993). The need in the health care community for such a service is tremendous. Rather than keep an office staff busy full-time on filing insurance claims, many physicians reap far greater benefits by contracting out this tedious, yet necessary work. This is a highly profitable business opportunity for someone who enjoys working independently at a computer, is numbers and detail-oriented, finds accounting interesting, can be preserving regarding payment of claims and can work well with doctors and medical office personnel. This type of work is highly computer oriented. CLAIMS ASSISTANCE PROFESSIONALThis business also has to do with filing medical claims to insurance companies, but in behalf of the consumer rather than the physician. Many individuals simply do not know how or do not want to be bothered with filing insurance claims. Insurance claim forms can be confusing and burdensome to patients, particularly for certain groups, such as the elderly or handicapped. A consumer may be dealing with a particularly difficult claim, perhaps one that has been denied. To insure payment, the patient may want the help of an expert in the field. This is where a Claims Assistance Professional (CAP) can be of assistance. The CAP tries to maximize the coverage and reimbursement each person can obtain out of their insurance carrier (Benzel 1993). They must have a good understanding of insurance policies and regulations and be able to decipher insurance jargon. This business is not heavily computer-oriented, as insurance companies do not allow electronic submissions from someone processing one claim at a time. The old paper method of submission would be required. However, the CAP must be detail-oriented, have good math skills, as well as the ability to communicate and negotiate with tenacity in the patient’s behalf. MEDICAL TRANSCRIPTIONThere is a serious shortage of transcriptionists in the United States (Benzel 1993). This type of work does require some training and often a few years of experience before venturing out on one’s own. Medical transcriptionists must have a good command of English grammar, must be familiar with medical terminology and must be able to decipher the often unclear dictations of physicians, as well as type 60 to 90 words per minute. Transcriptions must generally be submitted back to the physician or hospital within one to three days, so there is quite a bit of pressure with this business, particularly if one has many clients. It is not necessary to have a PC, but a word processor is imperative. Doctors must prepare documentation for patient records, insurance companies, police department, employers, lawyers or worker’s compensation boards. Anyone who has ever worked closely with a physician knows the endless volume of paperwork required of them. This is an ominous task, and one that takes time away from their clinical duties. As with insurance claims processing, this can also be a burdensome and overwhelming task for office personnel. Again, the opportunities are limitless and quite valuable to the medical community. For information: Members are medical transcriptionists, supervisors, teachers and students of medical transcription plus owners and managers of medical transcription services and other health personnel. The organization provides information and continuing education, holds an annual meeting, and publishes a quarterly journal, bimonthly newsletter and Style Guide for Medical Transcription. Below are more suggestions for potential business ideas. No doubt, if this chapter peaks your interest at all, you already have a few ideas of your own.
There are many resources available that guide one through the process of starting a small business. Form developing the idea, to legal considerations, to initial start-up costs, the entrepreneur can find books, classes and workshops on how to start a small business. Local colleges and adult education are good resources for learning opportunities. Nurses are fortunate in that they can find a well-paying part-time job while developing and growing a business. You can also test your idea or product on the professional contacts you already have, without having to put out a large investment. Finding other nurses who are operating similar businesses and networking with them is a good way to learn and evaluate what it will take to get started and potential problems. The National Nurses in Business Association, mentioned in chapter two under “Sales”, is an excellent resource and opportunity to network. The Appendix lists many organizations which might match your particular business idea, such as The Association of Nurses Practicing Independently and Nurse Consultants’ Association (see Specialty Nurses Organizations). |