Tightening regulations and skimpy medical insurance reimbursements are prompting nurses in the United States to quit their jobs to launch or work in a range of profitable health-care-related businesses.
"There are opportunities for nurses to utilize their health-care knowledge in a variety of arenas," said registered nurse Eleanor Walsh, who develops in-house computer systems and software for National Medical Enterprises in Santa Monica, Calif.
Ms. Walsh said many nurses, frustrated with life inside the hospital or clinic, realize that their skills can be easily transferred to the business or legal worlds.
Nurses are writing software programs, running cardiovascular monitoring and rehabilitation centers, and designing health-care facilities. They also serve as legal consultants on complex malpractice or personal-injury lawsuits.
Debra Karam, a registered nurse with a degree in health services administration, founded Medical Review Nurse Consultants in Phoenix about six years ago.
"I was dissatisfied with nursing," said Ms. Karam. "I felt the hospital administration put more emphasis on cost containment than health care." The final straw was when the hospital administrator presented an all-expenses-paid ski trip to the physician who admitted the most patients, while the nurses received Christmas turkeys.
Ms. Karam's career as a nurse consultant began inadvertently when an attorney asked her to review a malpractice suit against a doctor accused of performing unnecessary hysterectomies.
"At the time, I was making $18 an hour at the hospital," she recalled. "When the attorney offered me $40 an hour, I almost fell off my chair."
Ms. Karam, whose basic rate is now $65, recently hired a part-time associate to keep up with the work. She also calls in a medical illustrator to help prepare evidence for settlement hearings and trials.
"My job requires an intense amount of concentration," she said. "I'm frequently reviewing voluminous files on people who have seen 10 doctors and been hospitalized five times."
Ms. Karam, who recently moved her business out of her home, leases space from a personal-injury law firm that hires her to assist with its cases.
There are more than 700 nurse consultants in the United States, according to Tracy Wilky, president-elect of the Phoenix-based American Association of Legal Nurse Consultants. California has the most members with 156, followed by Texas with 97, Arizona with 61, Florida with 46 and Georgia with 39.
"The most important thing is to find a field you are interested in and emphasize that area," said Ms. Wilky, who works for Vocational Diagnostics, a rehabilitation company with 15 employees. She also said nurses should have at least five years of hospital experience before establishing themselves as consultants.
Susan Pollack combined her nursing skills with a degree in environmental design to open Ventura, Calif.-based Perennial Designs. She works with Gwen Mitnick, a former medical office manager, and Diane Coletti, a former designer for a television studio, to design and renovate health-care facilities.
"While I was in nursing, my surroundings always bothered me," Ms. Pollack said.
"Hospitals in general have poor space planning. Nurses are walking around way too much and wasting too much time."
Her watershed moment came while visiting a brand-new nursing wing that was mistakenly designed without any provision for oxygen supplies in patient rooms. The red-faced architect had to break down the walls to add the vital oxygen systems.