What is the name of your company?
What exactly does your company do?
Deliver Happiness! No one wants to live in a nursing home, so we give people the option of staying happy at home as they age.
Why did you start this company?
Being a staff nurse job in any facility these days is tough; I loved the tempo, but wanted to be able to spend quality 1:1 time with clients in order to educate and focus. Nurse Next Door’s whole core purpose is Making Lives Better, and that’s what I get really excited about.
What was the process like? Help us understand what it is like for a nurse to start their own business
Every situation is so different depending on job experience, business you’re going into, whether or not you’re dealing with private pay or insurance (ie Medicare, Medicaid), and amount of capital, among other things.
The process started in November of 2012 for me and we were open by June of 2013. By 2015, we were an annualized million dollar company, and we had started with nothing. The hour commitment was the hardest part; to grow, you need more people. But to have the money to hire more people, you need to grow! So the only solution at our beginning was for me to work more since our capital was limited. That was really tough. We held off on having kids so I could remain dedicated to the best client care. My husband and family continue to be extraordinarily supportive; otherwise there is no way I could have balanced work and family.
As a nurse, the hardest thing for me was the transition into the “business” world where I had to worry about numbers, bottom line, and margins. Most nurses and aides get into this business to take care of people, but as a business owner, you have to care about much more than just the service you’re offering. If you’re altruistic, like most nurses, it can be really difficult to make a tough decision that may limit the client care you provide. We have big hearts and want to take care of everything for everyone! Finding that balance continues to be a struggle today.
Another difficult thing for me was and is the disappointment when I have a caregiver or nurse who isn’t as dedicated to the business and clients as I am. We’re in the business of caring for people, so it’s frustrating and sad and maddening when someone chooses to call out short notice, or is insubordinate, or doesn’t help a client in the way the care plan is laid out etc. That’s not the kind of business I ever want to run, and that’s never the way I’d expect myself or staff to act. Not having complete control over the customer service experience is tough.
What has the hardest thing been in starting your business?
People! I’m a process person, so getting processes created and in place wasn’t the hard part. The hard part is making sure that I’m growing as a leader, accountable to myself and my team, and learning to be a people manager. I can care for client’s all day long, but managing a large team of per diem staff is truly a challenge. Just being a manager in itself requires a commitment to understanding what makes people tick and great people management is truly a make or break in our industry.
Something else I would mention; the money doesn’t always just come. I had to go without a salary for some time, which is why having family that is on board makes such a difference. Go into any business prepared to not take money out right away, unless it really works with your business plan.
What has been the most rewarding thing about starting your business?
I always thought it would be the client care. Turns out, it’s being able to make a difference for my employees. Giving them jobs that can be flexible, adapt for a family, and where they’re treated fairly and with respect is a big deal. The look on someone’s face when they’re appreciated, or when you ask how vacation went, or you help them with getting Christmas gifts for their kids is really rewarding. And I LOVE coaching people, finding that little thing that makes them great. Or helping them work towards life goals. Life is way bigger than just here and now.
What would you say are the five most important resources for a nurse who wants to start their own business?
- Small Business Technology and Development Center – a business plan and strategic plan is a must!
- Office of Licensing for your State – if it’s a healthcare business, understanding the guidelines front and back before you open is critical; it helps drive process and staffing decisions and ensures you’re in compliance. It’s never worth cutting corners.
- Chamber of Commerce in your State – for any business, a strong Chamber of Commerce connection can help propel you as a city-wide/state-wide brand before you have the power to show people who you are. The key with Chambers is that you have to actually be involved; you can’t just have a membership and expect it to work for you.
- National Associations – For whatever industry you go into, getting connected to the national trade association is extremely helpful. A great business knows what is going on in it’s industry when it comes to changing guidelines and legislation. It also gives you a hand up over competition!
- A Great Accountant – An entrepreneurial accountant makes a world of difference. Between all the taxation laws, understanding margins and costs, and maintain clean books, having this person up front is invaluable.
Do you have any success stories to share?
Absolutely! We have so many. I see success as any time we have accomplished our core purpose, which is Making Lives Better. So we get to do this a lot. A few little scenarios:
The Veteran who lives alone and has no family. He was hospitalized multiple times in a year related to hypothyroidism due to non-compliance with medications. After bringing us on, we’ve been able to connect with him and keep him out of the hospital for the last 25 months with no readmissions. We also have gotten him to start with hygiene care, walks, and getting to appointments. On Christmas, one of our nurses brought in two movies for him. And we conducted an interview with the use of StoryCorps so he could tell us about his life.
Another one is a gentleman who wants to stay at home until he passes away. We’ve been able to keep him there with the use of CNA’s and nurses and a completely customized care plan.
In June of 2015, we did a fishing trip for two of our clients who hadn’t been fishing in years (one had never been at all). What a great time and a feeling of satisfaction to see those smiles and those relaxed shoulders as we sat outside catching fish.
Do you have any unfortunate stories?
Liability will always be a difficult part of what we do. It’s difficult for any industry, but when it comes to dealing with people and their loved ones, emotions come into play as well, so liability as a nurse needs to remain a constant consideration.
Another thing to consider is safety; you can’t discriminate, but safety also needs to be a priority for any nurse and her/his staff. We had a client with an ankle bracelet, which we discovered only after agreeing to care for the client. The reasons for the ankle bracelet were unknown, which made it very difficult for me. On one hand, I’ve never personally had a safety issue with anyone that had an ankle bracelet. On the other hand, I was sending in young staff to be one-on-one with this person. We ended up having to get a lawyer involved to determine how to best protect ourselves.
Having a great lawyer on standby, or at least one knowledgeable with healthcare law in your local area is a really good idea so that if an issue does arise, you have a go to person.
What do you want other nurses to take away from this interview?
Healthcare can be tough. I’ve had to adapt to this quote by Maya Angelou “If you don’t like something, change it. If you can’t change it, change your attitude”. Many things over the last few years have made me realize that I can have the best intentions, the best ideas and the best staff, but ultimately can’t change some things. We can’t change people’s basic emotions, we can’t change a lot of circumstances, and we can’t change the law (without a lot of help!)
Take time for personal development. Business leaders, not just ones in your industry, are great. If you don’t know where to start, look up John Spence. People development for your staff is important too, if you have staff. Investing in people is timely, and it’s costly, but since we’re people taking care of people, there’s also no replacement for it.
About Tiffany Rubin, RN BSN
Tiffany has been in healthcare for over 11 years, starting as a CNA before becoming an RN in 2008 and starting her own company in 2013. She currently works as CEO of Nurse Next Door Delaware.