Q: I AM INTERESTED IN starting private-pay home health nursing, ie, case management or lab draws. Where is the best place to find out what I need
to do legally to get started to do this appropriately? I am a current home health/hospice nurse, and I am worried about conflict-of-interest
issues. Thanks.
Michelle Schiel, RN
Via e-mail
A: What you can do in your state is addressed in your nurse practice act. Get a copy online. Print it out and read it carefully
to be sure you are practicing within the law.
You cannot do the same things you are doing for the home health company. You are working under a physician's order. You will
be able to do only the tasks that do not require a physician's order. Most labs require a physician's order. That may not
be true in your state for screening tests such as glucose. Unfortunately, all states are different.Regards,
Pat
Q: WHAT RESOURCES DO YOU HAVE for RN self-employment or working from home? As I approach the end of my career, I want to be able to apply my knowledge in
a consultant capacity or work from home to assist a company with case management. Any resources or suggestions you have would
be appreciated. I will check out the NNBA Web site, too.
Kathleen Conn, RN, MSN
Durham, NC
A: The National Nurses in Business Association Inc. Web site ( http://www.nnba.net/) does have a lot of free information regarding RN self-employment.
Starting an RN business is basically the same regardless of the services offered. Don't be taken in by the marketing ploys
that state you need to be certified to practice as a consultant of any kind. You DO NOT need to be certified to practice in
any area of nursing. You already know the nursing and easily can convert that knowledge to any consulting field. I recommend
you start by reading the textbook or handbook in the area you are considering BEFORE spending a lot of money on a course.
Care management (not case management) has a bright future. Look over the care management Web site. See details at http://www.caremanager.org/index.cfm.
Regards,
Pat
Q: FROM MY UNDERSTANDING, hospitals will not hire me as an independent contractor if I own the agency (one-person). What is the best way for an independent
contractor nurse to get hired for a facility?
Laura Mitchell, RN
A: To work for a facility as an independent contractor, you have to do a job that meets the IRS criteria of an independent contractor.
Most nurses that meet the criteria are consultants who come into the facility to do a certain job, then leave.
I don't give legal advice, but I will try to help you understand the problem. A healthcare facility does not hire independent
contractors as staff nurses because that position is designated as employee worker status by IRS criteria. If the facility
did hire independent contractors as staff nurses and the IRS designated the workers as employees (as it would), the facility
would have to change all the contractors over to employees and pay back taxes and penalties. If you owned your own agency,
you still could not work for your agency as an independent contractor.
The IRS has two worker statuses. One is employee, and the other is independent contractor. You must meet certain criteria
to be an independent contractor. The difference is how you pay your federal taxes. You can read more about it at http://www.irs.gov/businesses/small/article/0,,id=99921,00.html?portlet=2.
The information found on the Internet and elsewhere that a staff nurse can work for a facility as an independent contractor
simply is not true. Unfortunately, some agencies take advantage of nurses and hire them as independent contractors.
Regards,
Pat
PATRICIA ANN BEMIS, RN, CEN, is president of the National Nurses in Business Association Inc. ( http://www.nnba.net/) and the author of several books.
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