New Zealand registered nurses are fortunate to have a scope of practice that is broad and enabling.

In fact the scope is often undervalued, misunderstood and probably underestimated in terms of the flexibility it offers the New Zealand nursing workforce.

This is particularly so for those nurses who are working, or considering working, in non-traditional settings in non-traditional ways, for example self-employed nurses.

In many countries, nurses who become self-employed can struggle to retain their regulatory equivalent of an annual practising certificate, even if they are delivering clinical practice. Not so in New Zealand. Despite this, self-employed nurses still make up only a tiny percentage of the total nursing workforce; however the number is slowly and steadily rising.

Self-employment in nursing is still relatively unusual, but there are examples from New Zealand, particularly from the 1980s onwards, where entrepreneurial nurses saw an opportunity to deliver a clinically based service and took it, in areas like occupational health and nurse-led primary care services.

Today, nurses are self-employed not only in clinical practice, but also increasingly in non-clinical ‘consultant’ roles working locally, regionally, nationally or even internationally. These nurses are often in management, quality, policy or professional advice roles, where nursing knowledge and experience is vital, alongside project management and leadership skills.

Resources for self-employment

The steady growth in self-employed nurses has been recognised by the College of Nurses Aotearoa which has created a suite of web-based resources to support nurses considering self-employment as a future career option.

Planning a new business can feel daunting, especially for registered nurses and nurse practitioners as – unlike midwifery, physiotherapy or general practice – the New Zealand nursing profession does not have a strong history of self-employment.

For nurses considering solo self-employment or becoming an employer – either as a clinical or non-clinical business – there are now links in the resource kit to support them at each stage, from set-up to self-care, as well as how to maintain an income and professional nursing registration. The resource has six sections containing helpful advice, direction, prompts and links.

  1. Planning: first steps

Nurses who successfully set up and run businesses usually have a niche, or a specific skill set on which they draw and which will attract clients. Nurses new to this environment need to be sure about their abilities and that they have the professional networks, skill set, infrastructure, capital and qualifications to be offering and charging for the service they plan to deliver. They also need to make decisions about how to position the business, to check the markets and to assess how to find work.

2. Set up: business structure, marketing and tools for business

Businesses come in many shapes and sizes, but there are some fundamental similarities. These include needing a memorable name, registering the company, filing an annual return and deciding on business structure, website and email hosting, as well as managing contracts.

3. Finance: Invoicing and tax

Finance, invoicing and tax considerations are often the steepest learning curve for people new to running a business. They are often experts in the actual work, but not many nurses have had previous experience in calculating GST, dealing with the IRD or sending monthly invoices.

4. Security: insurance, indemnity and privacy

Security and business insurance is not something nurses need to consider as employees, however if they become employers or solo self-employed then these become vital. If delivering a clinical service, nurses need to be sure they are meeting the principles of the Nursing Council’s Code of Conduct and keeping records according to the Privacy Act. Those delivering a clinical service also need to consider public liability insurance.
All nurses should have professional indemnity as this is financially vital if any complaints are made in relation to their practice. Self-employed nurses should also consider insurance for the business, in case they become unwell or unable to trade for any period of time.

5. Nursing regulatory requirements

Registered nurses who move into self-employment in non-clinical roles will often ask if they need to maintain an annual practising certificate (APC) from the Nursing Council of New Zealand:

  • Registered nurses undertaking any clinical practice, delivering clinical care must complete the clinical competencies.
  • Registered nurses who practise in direct client care AND management or education or policy or research must meet both sets of competencies.
  • If only in non-clinical practice then check for the correct registered nurse competencies – either management or education or policy or research.
  • The correct competencies and assessment forms are on the Nursing Council website.
  • Nurse Practitioners have one set of competencies¹⁵, also available on the Council’s website.

6. Self-care

Research shows that people running their own businesses often forget to look after themselves.

Examples range from never taking holidays and working longer and longer hours to feeling huge responsibility for sustaining an income.

Another vital component of nursing self-employment is keeping professionally connected. This can be through professional nursing organisations, such as the College of Nurses, or making time to attend conferences and nursing events.

Isolation can be a big factor for the self-employed; there is a need to connect with others in similar roles. How self-employed nurses achieve that connection can be varied, but it is important, especially if working from home, to remember to link back up to colleagues and support.

Conclusion

Self-employment can certainly be rewarding, but it doesn’t suit everyone and for most who take that pathway, it means learning a whole new set of skills.

So, before considering setting up any sort of business providing a nursing service – either clinical or non-clinical – it is important to do your homework and consider the niche into which you may fit.

  • Do you have the qualifications or experience?
  • Do you have somewhere to work?
  • Is there a market?
  • What is your risk?
  • Do you have the ability to manage a potentially precarious income and the day-to-day management of your own business, as well as offering a quality service?

If you need more information, check out the self-employment resources on the College of Nurses website www.nurse.org.nz.

The resource has links to the College’s professional supervisor’s page but for specific enquiries about setting up a business in nursing you can contact the College office on admin@nurse.org.nz.

Author: Liz Manning RN, MPhil, FCNA(NZ), is director and owner of Kynance Consulting, where she works as a self-employed nurse consultant and is currently undertaking a PhD research study on self-employed, non-clinical registered nurses in New Zealand.

References

  1. Nursing Council of New Zealand. (2007). Competencies for Registered Nurses. Retrieved from Wellington:
  2. International Council of Nurses. (2004). Guidelines on the Nurse Entre/Intrapreneur Providing Nursing Service. Retrieved from Geneva, Switzerland
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  8. Nursing Council of New Zealand. (2013). The New Zealand Nursing Workforce: A Profile of Nurse Practitioners, Registered Nurses and Enrolled Nurses 2012-2013. Retrieved from Wellington: http://www.nursingcouncil.org.nz/Publications/Reports-and-workforce-statistics
  9. Nursing Council of New Zealand. (2015). The New Zealand Nursing Workforce: A profile of Nurse Practitioners, Registered Nurses and Enrolled Nurses 2014-2015. Retrieved from Wellington: http://www.nursingcouncil.org.nz/Publications/Reports-and-workforce-statistics
  10. Hawken, L., & Tolladay, J. (1985). Short-term autonomous nursing in a small community. Palmerston North: Massey University.
  11. MacDonald, J. (1989). Two Independent Nursing Practices: An Evaluation of a Primary Health Care Initiative(T. Scotney Ed.). Wellington: Department of Health.
  12. Nevatt, E. A. (1989). Occupational Health Care: An Entrepreneurial Venture in New Zealand. Palmerston North: Nevatt, E A.
  13. Nursing Council of New Zealand. (2012). Code of Conduct. Retrieved from Wellington: http://www.nursingcouncil.org.nz/Nurses/Code-of-Conduct
  14. Privacy Act (1993)
  15. Nursing Council of New Zealand. (2017). Competencies for the nurse practitioner scope of practice. Retrieved from Wellington: http://www.nursingcouncil.org.nz/Nurses/Scopes-of-practice/Nurse-practitioner
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  17. Sankelo, M., & Åkerblad, L. (2009). Nurse entrepreneurs’ well-being at work and associated factors. Journal of Clinical Nursing, 18, 3190-3199. doi:10.1111/j.1365-2702.2008.02666x

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