Self-Employment Choices by Nursing Specialties
Self Employment Choices by Nursing Specialties
This is an excerpt from Self-Employed RN: How to Become a Self-Employed RN by Patricia Ann Bemis, RN CEN, president National Nurses in Business Association, Inc. It is published by National Nurses in Business Association, Inc.
Choices: Nurses tend to look at their skills in categories of specialty. The following choices are either built on existing areas of specialty skills or new areas of practice for nurses. They are presented alphabetically.
Ambulatory Care Nursing
Ambulatory care nurses treat patients of all ages with acute and chronic illnesses and injuries on an outpatient basis.
Care includes:
- triage
- patient education
- pain management
- case management
- discharge planning to restore, maintain, and promote the patients’ physical well being
Telehealth Nursing Practice (TNP) is a subspecialty.
The Telehealth Nursing Practice Standards define Telehealth Nursing Practice as nursing practice using the nursing process to provide care for individual patients or defined patient populations over the phone or other electronic communication media.
Nursing practice methods include employment and self-employment as an independent contractor or consultant with healthcare facilities and clinics.
Small business opportunities include:
- operating a placement agency or staffing agency;
- providing the services of nurses and other personnel to the ambulatory care facility.
Cardiac Rehabilitation Nursing
Cardiac rehabilitation nurses treat older adults with coronary artery disease who are making lifestyle changes to prevent worsening of the disease after surgical intervention.
Care includes:
- heart monitoring during physical workouts;
- teaching lifestyle changes;
- dietary changes to low-fat and low-cholesterol foods;
- weight reduction;
- incorporating exercise into his or her daily lifestyle;
- smoking cessation.
Nursing practice methods include employment and self-employment as an independent contractor to patients or consultant with healthcare facilities and clinics.
Small business opportunities include:
- staffing agency to staff cardiac rehab units in healthcare facilities;
- seminars and courses for the public on life-style changes and smoking cessation;
- fixed or mobile cardiac rehab facilities owned and operated by nurses providing cardiac rehabilitation to urban and rural areas;
- fitness centers owned and operated by nurses that include cardiac rehabilitation;
- products, such as multimedia audio and video presentations and books teaching lifestyle changes, weight reduction, exercise, and wellness.
Case Management
Case management nurses work with patients of all ages and diagnoses. However, most specialize in areas of HIV/AIDS, rehabilitation, and geriatrics. The goal is to maximize health and minimize cost by utilizing the proper treatment at the proper time while maintaining continuity and quality care. The nurse coordinates the care provided by the physician and other healthcare workers.
Case management nurses are knowledgeable in both the clinical and financial aspects of healthcare.
Nursing practice methods include employment and self-employment as an independent contractor to patients and their families, with healthcare facilities as well as the health maintenance organizations, and the insurance industry. The services of consultants are needed in healthcare facilities and in the insurance industry as large corporations downsize and terminate in-house positions.
Business opportunities include:
- medical underwriting;
- designing and writing patient pathways;
- owner operator of agency providing managed care nurses to healthcare facilities, managed care organizations, and insurance companies.
Education and Training
Nurse educators are responsible for educating student nurses and providing continuing education and training for practicing nurses. The level of education required depends on the educational setting.
Nurse educators are often clinical specialists with advance degrees. However, more and more practicing nurses want continuing education from nurses who have current experience at the bedside. Current practice experience can be more important than advanced degrees to some nurses looking for continuing education.
Nursing practice methods include employment and self-employment as an independent contractor or consultant to schools of nursing and healthcare facilities to provide education to staff members.
Business opportunities include:
- companies that design and sell multimedia educational products including books and seminars;
- CPR, ACLS, PALS instruction and certification, and certification review classes;
- review classes for certification in all nursing specialties offering certification.
Emergency Medical Services Pre-hospital
The emergency medical pre-hospital nurse works with patients of all ages and diagnoses who need emergency, pre-hospital treatment at the scene and/or moves high-risk patients from facility to facility for specialty services by air or surface transport.
Nursing practice methods include employment and self-employment as an independent contractor with pre-hospital, emergency medical services; healthcare facilities providing emergency and high-risk transport services; and with cruises, camps, and resorts.
Business opportunities include:
- owner operator of air and surface ambulance transport services;
- teaching institutes that teach emergency medical technicians, paramedics, and 911 dispatchers;
- classes for certification in ACLS, CPR, and PALS;
- companies to provide medical personnel on ships and classes to certify the ship’s personnel in life support;
- companies to train and certify individuals in life support and automated external defibrillators for other companies;
- staffing agencies that provide nurses on cruises.
Emergency Nursing
The emergency nurse cares for patients of all ages and diagnoses who need emergency care in an acute care facility in an emergency department or trauma unit. Care provided includes critical and non-critical care. Emergency nurses are able to respond quickly and appropriately to stabilize patients and make critical decisions independently.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities, teaching institutions that train emergency medical service personnel, cruise lines, camps, and resorts.
Business opportunities include:
- training and certification for ACLS, CPR, and PALS;
- teaching and mentoring emergency medical technicians and paramedics;
- writing and teaching continuing education for emergency nurses;
- multimedia educational presentations;
- writing core curriculum;
- writing continuing education;
- emergency management consulting;
- sales and after-the-sale programs for automatic external defibrillators (AED);
- presenting seminars for emergency nurses to teach the knowledge base needed to become certified.
Forensic Nursing
Forensic nurses work with law enforcement agencies, victims of crime, and perpetrators of crime. Specialties include death investigators, nurse coroners, domestic violence and sexual assault nurse examiners, correctional nurses, and nurse investigators. The sexual nurse examiners collect clinical evidence, investigate, and determine the circumstances of the trauma. Correctional nurses work with the perpetrators of the crimes.
Nursing practice methods include employment and self-employment as an independent contractor with law enforcement agencies, correctional facilities, coroner’s office, medical examiner’s office, and insurance companies.
Business opportunities include:
- owner operator of private autopsy facilities;
- deputy coroner;
- private investigation services;
- agency providing correction nurses to prison facilities;
- agency providing nurse examiners to law enforcement.
Genetic Nursing
Genetic nurses care for people’s genetic health including screening for early detection, risk identification, and treatment. They care for patients of all ages with acute or chronic genetic illnesses. Care includes advocacy, teaching, counseling, case management, and research.
Nursing practice methods include employment and self-employment as an independent contractor and consultant with healthcare, university, and research facilities.
Business opportunities include:
- political lobbying;
- data collection and analysis companies;
- grant writing.
Holistic Nursing
Holistic nurses treat patients of all ages with acute or chronic illnesses or injuries on an outpatient basis. Care includes treating the whole person not just the disease. Holistic practitioners include massage therapists, acupuncturists, and general holistic nurses. These nurses focus on wellness from a spiritual and natural perspective.
Nursing practice methods include employment and self-employment as an independent contractor with holistic clinics, spas, pain management centers, health clubs, and holistic resorts.
Business opportunities include:
- owner/operator of holistic bed and breakfast resorts, fitness clubs, health clubs;
- independent practice;
- multimedia presentations;
- products teaching holistic treatment modalities to the public;
- seminar-production business.
Infection Control Nursing
Infection control nurses identify, track, and control infections in healthcare facilities, develop methods of prevention in healthcare facilities, implement immunization programs, and develop biological terrorist response protocols. No patient care is involved.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities.
Business opportunities include:
- pre- and post-regulatory survey consultations;
- consultations on nosocomial infection eradication and prevention;
- policy and procedure writing for healthcare facilities;
- guideline and mandate writing for regulatory organizations and governmental agencies.
Informatics Nursing
Nurse informaticists work with computerized data and the hardware required for collecting data. Nursing informatics is a combination of nursing and computer science and includes no patient care.
Data analysis is used throughout healthcare specifically to reduce risk and improve quality of care. The goal of informatics is to improve efficiency, reduce risk, and improve patient care.
Specialization includes:
- data analysis;
- systems management;
- software design;
- training;
- systems installation;
- sales;
- market planning.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities, computer hardware and software companies, educational institutions, regulatory agencies, and pharmaceutical and research companies, as well as medical libraries.
Business opportunities include:
- documentation system design;
- systems management;
- education and training;
- data analysis firms;
- software and hardware design, manufacture, and sales.
Intravenous Nursing
Intravenous nurses treat patients of all ages with acute or chronic illnesses or injuries who require intravenous therapy. Care includes accessing the intravenous site, providing medications, blood, fluids, and nutrition including initiating, monitoring, and terminating therapy.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities, clinics, and home care agencies.
Business opportunities include:
- owning and operating clinics for intravenous therapy;
- staffing agencies for acute and long-term facilities with intravenous nurses on a need-for-service basis;
- insertion of intravenous lines for other nurses to manage fluids and medication;
- education of practicing nurses on intravenous insertion techniques and management of intravenous fluids, medications, and nutrition.
Legal Field – Non-lawyer Professionals
The legal field uses physicians and other healthcare professionals to determine the healthcare issues in a law case. The medical records are reviewed, analyzed, client interviewed, and a document is written to meet the needs of the case.
Nurses entered this role in the mid-1970s in cases that involved Workers’ Compensation and rehabilitation. At that time, the plan of the insurance companies and defense was to decrease the disability and therefore, decrease the financial settlement. Legal nurse consulting (described below) is but one of the areas of practice.
The registered nurse is now an active player of these healthcare professionals (social workers, physical therapists, occupational therapists, vocational rehabilitation councilors.)
Nursing practice methods include employment with law firms and insurance companies and self-employment as an independent contractor with legal firms and insurance companies.
All these nurses must know the current rules, regulations, and services available to their clients. Specialties include:
- Life care planners formulate a care plan for the life of the patient using financial codes to determine future money needed to care for the claimant’s disability.
- Rehabilitation nurses work towards getting the client as well as possible and ultimately reduce the amount of money needed to care for the client’s healthcare needs related to the disability.
- Workers’ Compensation nurses work towards getting the client back to work and managing his healthcare to decrease the disability and increase the client’s function.
- Elder care managers work with the elderly to see they are provided with services that keep them active as long as possible. These nurses often work for elder trust attorneys and for families who do not live near the patient.
- Case managers work towards getting the clients to the appropriate services within their network.
- Nurse paralegals work with an attorney and offer legal services as well as working with healthcare issues.
- Medicare Set-Aside consultants write a plan that is a financial document forecasting the medical needs of the client throughout life. Economists take the medical needs and project them into the future. These plans are used to determine settlement amounts and to set-aside funds to use after age 65. Medicare requires that funds be set-aside for future care under certain circumstances.
- Forensic nurses collect and preserve evidence from the records, crime scene investigation, and interviews.
Business and self-employment opportunities include:
- consulting service;
- staffing service providing these consultants to law firms and insurance companies.
Legal Nurse Consulting
The American Association of Legal Nurse Consultants states, “The primary role of the legal nurse consultant is to evaluate, analyze, and render informed opinions on the delivery of health care and the resulting outcomes.”
The association lists the services that a legal nurse consultant provides to include:
- identifying standards of care, causation, and damage issues;
- conducting client interviews;
- conducting research and summarizing medical literature;
- applying multidisciplinary standards of care and regulatory requirements;
- preparing chronologies of medical events and comparing and correlating them to the allegations;
- educating attorneys regarding medical facts and issues relevant to the case;
- identifying and determining damages and related costs of services, including collaborating with economists in preparing a cost analysis for damages;
- assisting with depositions and trials, including developing and preparing exhibits;
- organizing medical records and other medically related litigation materials;
- locating and procuring demonstrative evidence;
- collaborating with attorneys in preparing or analyzing complaints, answers, and motions for summary judgment, interrogatories, deposition and trial outlines, queries for direct and cross examination, document production requests, trial briefs, demand letters, and status reports
- identifying and retaining expert witnesses;
- acting as a liaison among attorneys, physicians, and clients;
- providing initial case screening for merit
Areas of practice include:
- personal injury;
- product liability;
- medical negligence;
- toxic torts;
- workers’ compensation;
- risk management;
- medical licensure investigation;
- fraud and abuse;
- compliance;
- criminal law;
- elder law;
- other applicable cases.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities in risk management, with insurance companies and plaintiff and defense legal firms.
Business opportunities include:
- owner operator of an agency providing legal nurse consultants to attorneys on a need-for-service basis;
- writing continuing education for legal nurse consultants;
- writing text books;
- institutes to teach legal nurse consulting;
- seminars for legal nurse consultants.
Labor & Delivery
Obstetrical nurses care for mothers and babies at the time of delivery and teach mothers to care for and feed their infants. Breastfeeding is learned and not instinctual for today’s woman. New mothers need proper evaluation and education.
Business opportunities include:
- breast pump rentals, sales, and service;
- home visits and education for mothers and families;
- lactation consulting services.
International Board Certified Lactation Consultants (IBCLCs) are healthcare providers working towards assisting families in making informed choices regarding their infant feeding practices. The clinical practice of the IBCLC lactation consultant focuses on providing lactation care and clinical management.
This is accomplished through collaboration with other members of the health care team and the client. IBCLC lactation consultants are responsible for decisions and actions undertaken as a part of their professional role in the management of lactation or breastfeeding issues, including:
- assessment, planning, intervention, and evaluation of care in a variety of situations;
- prevention of problems;
- complete, accurate, and timely documentation of care;
- communication and collaboration with other health care professionals including:
- assessment information
- suggested interventions
- instructions provided
Nephrology Nursing
Nephrology nurses care for patients of all ages with renal dysfunction. They focus on the physical and psychological aspects of kidney dysfunction while implementing treatment modalities including hemodialysis, peritoneal dialysis, and care of the kidney transplant patient.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities, renal dialysis centers and clinics, and home health agencies.
Business opportunities include:
- ownership and management of fixed and mobile dialysis units;
- staffing agencies providing nephrology nurses to dialysis units and healthcare facilities;
- nursing continuing education seminars and certification review courses;
- public wellness programs and support groups.
Parish Nursing
The parish nurse treats patients of all ages with acute or chronic illnesses or injuries on an outpatient basis. Parish nursing brings together healthcare, community, and the church.
Services and personnel provided include:
- education;
- healthcare counseling;
- bereavement counseling;
- program design and presentation;
- resource nurse and liaison between healthcare and religions that limit healthcare options.
Nursing practice methods include full and part-time volunteering, employment, and self-employment opportunities as an independent contractor with religious organizations and congregations.
Business opportunities include nonprofit organizations providing nursing services to missionary outposts.
Pediatric Nursing
Pediatric nurses treat children and their families in a variety of settings. The patient age group is from newborn to adolescence. The patients are seen in healthcare inpatient and outpatient facilities, clinics, and home care.
Care and services include all aspects of physical and psychosocial nursing care.
- patient and family education
- case management
- discharge planning to restore, maintain or promote the physical and psychological health of children and adolescents
Nursing practice methods include employment and self-employment as an independent contractor with hospitals, clinics, daycare centers, camps, and home care agencies.
Small business opportunities include:
- staffing companies providing pediatric nurses to healthcare facilities and home health agencies.
Pharmaceutical and Medical Sales
Nurse salespersons sell and promote pharmaceutical and medical products and services. Selling often involves exhibiting at trade shows, travel to facilities purchasing the products, and educating and training the customer after the sale.
Nursing practice methods include employment and self-employment as an independent contractor with pharmaceutical and medical products companies as well as direct marketing firms.
Business opportunities include:
- invention of a medical service or product;
- design of a medical service or product;
- manufacture of a medical service or product
- sales of a medical service or product;
- Federal Drug Administration documentation writing.
Recruiter
The nurse recruiter brings nurses to the employment arena for healthcare facilities by direct contact, trade shows, and even travel to foreign countries for nurse recruitment. No patient contact is involved.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities and recruiting on commission.
Business opportunities include:
- nurse and healthcare personnel brokerages;
- recruiting companies;
- placement companies that recruit from foreign countries.
Rehabilitation Nursing
The rehabilitation nurse cares for patients with temporary or permanent disabilities. Care includes triage, patient education, pain management, case management, and discharge planning to restore, maintain, or promote return to maximum function.
Nursing practice methods include employment and self-employment as an independent contractor with healthcare facilities, rehabilitation centers, and long-term and acute skilled care facilities.
Business opportunities include:
- staffing agencies specializing in rehabilitation nurses for rehabilitation centers;
- owner-operator inpatient assisted care and skilled nursing facilities;
- owner-operator daycare centers;
- home care agencies.
Research Nursing
Research nurses work with all aspects of pharmaceutical, nursing, and medical research. Patient care can be involved when working with clinical research centers that monitor patients.
Nursing practice methods include employment and self-employment as an independent contractor with pharmaceutical companies, research centers and universities, clinics, and healthcare facilities.
Business opportunities include:
- grant writing;
- data analysis.
Senior Health Services
Registered nurses are well qualified to provide a wide variety of services to older adults. Nursing practice methods include employment or self-employment as an independent contractor.
Business opportunities are diverse and may include:
- foot care services;
- medication management counseling and supervision;
- home safety assessments and supply recommendations;
- private duty and case management.
Travel Nursing
The travel nurse cares for patients of all ages and diagnoses and supplements staffing of healthcare facilities. A travel nurse often specializes and only works in his or her area of expertise. Care provided by a travel nurse includes all aspects of patient care in a variety of specialty areas.
Nursing practice methods include employment and with healthcare facilities and temporary staffing agencies. Most often the travel nurse works as an employee for a staffing agency.
Small business opportunities include staffing agencies providing travel nurses to healthcare facilities
This is an excerpt from Self-Employed RN: Choices, Business Aspects, & Marketing Strategies by Patricia Ann Bemis, RN CEN, president National Nurses in Business Association, Inc. It is published by National Nurses in Business Association, Inc.
Copyright © National Nurses in Business Association, Inc.
