Nurses in Business: The Time Is Now.

More and more nurses are beginning businesses for many reasons: wound care, family therapy, in-home respite services, and acute/chronic patient management. Owning a business can be a fulfilling and flexible way to build a career, or it can be a professional nightmare. According to the US Department of Labor Statistics, half of all small businesses will fail within 5 years, and only a third survive 10 years or more. For nurses who want to start their own businesses, taking the time to plan a strategy of business design, implementation, and ownership can contribute to long-term success. Use your head. The first key investment is the timeneeded to create a solid business plan,which should begin asmuch as a year before the doors of a new company are ready to open. Think carefully about realistic short-, mid-, and longterm goals. The bottom line for any business is revenue generation, and this entails more complexity in the world of healthcare. For example, howmanypatientswill need to be seendaily to create the cash flowneeded to sustain daily operations, while building capital for other projects? Lending agencies will likely want to review this business plan as they work with potential borrowers to design the best financial strategies for new companies. In the beginning, an attorney, preferablywith a specialty in business law, will be needed to assist with creating the articles of incorporation for the company and obtaining tax identification numbers and to offer expertise on the intricacies of state and local business permits and licensing. To prepare the physical site of the business, the negotiation of building leases or purchases, repair and/or renovations contracts that may be necessary, and follow-up inspections to ensure that local building codes are met is needed. For many health-related businesses, having a location near the local hospital maximizes visibility for those patients whomay be unattached to providers and in need of care. An attractive building,with easy-to-access entrances, bright lighting, and lots of parking,may be especially appealing to patient populations such as older adults or familieswith small children. Manage the bottom line. The cycle of revenue generation is vitally important to a business; in healthcare, this begins with providers’ ability to produce cash flow. To bill third-party reimbursers, healthcare providersmust be credentialed with each insurer. The process of credentialing can be lengthy, taking 3 to 6 months or more with some reimbursers. Once the physical and mailing addresses of the business are established, the process of credentialing can begin. Retaining a billing agency that can comprehensively manage the credentialing process simultaneously for multiple insurers is a strategy that has been suggested by practice owners as a method to both initiate and maintain cash flow from day 1 of operations (C. Landrum, personal communication, October 8, 2015). Creating financial policies for the business, with review by legal counsel, is also needed before the business opens so that key steps in the revenue cycle can be established before clients are seen. These policies also need to be supported by the practicemanagement systems. Building payment fee schedules into billing systems can eliminate errors as patient volume grows. In the 21st century, efficient management of a healthcare practice necessitates the use of electronic health records (EHRs) for management of patient visits, scheduling, and billing. Many (EHR) systems contain all 3 of these functionalities. It is important that you take the time to investigate these systems and how you will integrate them into your daily work flow. Consider goals for productivity, ease of system use, adherence to clinical guidelines, and how the system will Author Affiliations: College of Nursing, University of Alabama, Huntsville. The author reports no conflicts of interest. Correspondence: SusanAlexander, DNP,ANP-BC, ADM-BC, 301 Sparkman Dr, Huntsville, AL 35899 (susan.alexander@uah.edu). DOI: 10.1097/NUR.0000000000000185