An RN first assistant's guide to private practice - registered nurse

AORN Journal,  April, 2003  by Sheila Hughes

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When starting a business, RNFAs should consider the following questions. How they answer these questions will affect various facets of their business.

* Will services provided be reimbursed by third-party payers?

* Is there potential to contract for fee for services with the surgeon or facility?

* What is the age majority and socioeconomic status of the patient population in the area?

* On what specialty is the practice going to focus?

* Does the specialty generate income?

* What other sources of income are available during the start-up and payment period?

* How much will the initial investment be, and what financial resources are available?

* How much time can be dedicated to administrative responsibilities?

An important part of developing a small business as an RNFA is membership in professional nursing organizations, namely ANA and AORN. American Nurses Association membership offers many benefits, including group rates for health and dental insurance and discounts for many products and services. (15) An important advantage of AORN membership is the availability of information by fax and telephone. In addition, the following services and benefits are a few of those provided by AORN:

* specialty assembly membership (eg, RN First Assistant; Nurses in Business, Industry & Consulting; Perioperative Nursing Informatics);

* e-mail based Internet discussion forums (eg, MemberTalk, which is open to all AORN members; RNFA Assembly Connection, which is available to all members of the RN First Assistant Specialty Assembly);

* the perioperative resource network, a directory of volunteers who serve as content specialists in various categories;

* consultation with AORN's Center for Nursing Practice;

* education (eg, Clinical Educator and Ambulatory Surgery Administrator Certificate Programs, online continuing education programs, Perioperative Nursing Course 101);

* government affairs information; and

* a directory of current laws by state. (16) Additional benefits provided by both organizations include educational programs for personal and professional development, committee membership, representation on health care issues and legislation, chapter membership, scholarly journals, periodicals, newsletters, research, and grants.

Business plan. Establishing a business begins with writing a business plan. Consider self-help books, business consultants, computer programs, and public or college library resources when gathering information on writing a business plan. Another option is joining a local chamber of commerce for small business development seminars, workshops, or lecture series or finding comprehensive small business information on the Internet.

Legalities. Critical elements include naming the practice and applying for a tax identification or employer identification number (EIN). An Application for Employer Identification Number (ie, form SS-4) must be obtained from the Internal Revenue Service (IRS), completed, and returned to obtain an EIN. General instructions and the application form can be downloaded from the IRS web site. (17) Applications are accepted by telephone for immediate processing, or they can be mailed. If mailing, expect a response in approximately four weeks. The purpose of the EIN is to identify the business account, tax returns, and all documents. A self-employed entrepreneur, however, can use his or her social security number in lieu of an EIN. Registered nurse first assistants should consult a tax accountant regarding the pros and cons of using an EIN versus a social security number.