Nurses Leading in New Ways: Self-Employment
- Terri Kapetanovic PhD RN CPHQ
- Jul 26
- 5 min read
Updated: Jul 27
Self-employment is not new in nursing and has deep historical roots, tracing back to the Crimean War and Florence Nightingale's pioneering work in the late 1800s.
Through the early 1900's, most nurses worked as private duty nurses, establishing and operating their own agencies or nurse registries. This entrepreneurial model dominated the nursing workforce from the early to mid-20th century (1).
Continuing in the late 1800's and into the 20th century, Catholic religious sisters who were nurses created extensive networks of charitable hospitals across the United States. Their mission focused on serving underserved populations, and they developed innovative financing methods to provide care for these individuals. (2)
In the mid-20th century, as healthcare insurance started covering hospital and other types of care, nurses primarily became employees (3). In the 1970s, a revival of self-employment began and continues to flourish today.
Self-employment roles evolved as nurses established staffing agencies, consulting services, educational companies, legal nurse consulting services, nurse-led clinics, and other entrepreneurial ventures. Independent consultants, advanced practice nurses, and other nursing professionals began contracting directly with clients, healthcare companies, and businesses across industries.
Who are self-employed nurses?
Nurses who are self-employed work in diverse arrangements with varying levels of independence. Some may be company founders, others may work as sole proprietors or established limited liability company (LLC), or are a self-employed independent practitioners or independent contractor.
They may have employees or operate solo practices. Nurses who are self-employed usually benefit from more flexible work schedules, but they do not receive standard employee benefits and are responsible for managing their own federal and state tax responsibilities, as taxes are not automatically deducted from their earnings.
Self-employed nursing roles
These nurses are capable of offering patient care services, educational programs for patients or healthcare providers, and consulting services across various specialties.
They apply their knowledge, skills, and clinical judgement in various settings and roles that include direct care, advocacy, health promotion, education, policy development, research, administration, and consultation through negotiated contracts (4).
Today, self-employed nursing includes the following and more:
Solo practitioners such as nurse practitioners operating independent clinics.
Consultants offering expertise in policy, compliance, workflow optimization, and health education.
Health and wellness professionals working as health coaches, patient advocates or wellness advisors.
Content creators working as medical writers and educators.
Nurse providers who own or work in home care agencies, IV infusion services, or specialty care clinics.
Business founders who started-up healthcare staffing agencies, recruitment firms, telehealth platforms, and technology companies.
These nurses serve with diverse clients including individuals, families, groups, communities', educational institutions, corporations, and other healthcare agencies. Their flexibility enables them to customize services to address specific market demands, utilizing their clinical expertise in entrepreneurial endeavors.
Why Nurses Choose Self-Employment
Today's nurses are increasingly drawn to self-employment for several compelling reasons:
Greater autonomy and flexibility. Self-employed nurses can set their own schedules, choose their services, and operate independently as solo practitioners, consultants, or business owners.
Professional control. You have the ability to select your clients and define your business focus, whether that's direct patient care, education, consulting, or specialized services.
Financial and personal rewards. Self-employment offers potential for higher earnings and greater personal fulfillment through creative opportunities to innovate and develop new care models or products.
Getting Started
Helpful advice to launch your nursing business successfully:
Identify your niche based on your clinical experience, personal interests, and market demand (5).
Create a comprehensive business plan and consider business education if needed.
Ensure legal compliance by meeting all licensing and practice requirements.
Develop your client base through strategic networking and professional outreach.
Responsibilities and Challenges
With increased autonomy, self-employment brings responsibilities that employed nurses may not face:
Business operations management You'll handle billing, marketing, finances, compliance, and regulatory requirements independently.
Financial considerations Income can be variable and depends entirely on your business success. You'll need to maintain sufficient earnings to cover business expenses and personal needs.
Benefits and insurance. Health insurance and other benefits aren't automatically provided as they would be through an employer-sponsored plan.
Ongoing requirements. Success demands continuous business development, networking, and staying current with legal, insurance, and compliance requirements.
Essential Skills for Success
Successful self-employment as a business owner, entrepreneur, consultant or other role generally includes a background and experience in clinical specialization or advanced practice, leadership and management capabilities, strong communication, and advocacy skills, financial and regulatory literacy, and marketing and networking abilities.
The Future of Nurse Self-employment
Healthcare delivery continues to evolve with new legislation and changing patient needs. Nurse - owned businesses are thriving in areas such as home health services, healthcare consulting and technology that includes digital solutions, education and training, and direct patient care.
Nurses continue to demonstrate adaptability in creating impact when combining clinical expertise with business knowledge to create innovative, patient-care solutions. Nurses can supplement their clinical background with business education, including continuing education, MBAs or healthcare administration degrees, and entrepreneurial coursework, positioning themselves as leaders in the evolving healthcare marketplace.
The perception of nurse-owned businesses has transformed significantly in recent decades. Industries outside of nursing and healthcare readily understand and accept nurse-owned companies as legitimate businesses. Today, as more nurses work to address service gaps, businesses increasingly recognize the value nurses bring in covering care gaps, meeting community needs, and driving healthcare innovation.
Empowering Nurses as Innovators and Entrepreneurs
To fully realize nurses' potential as innovators and leaders in healthcare, nursing must engage in and can benefit from the renewal and comprehensive transformation of our healthcare system. This includes educational reform that emphasizes the array of options available to nurses who want greater independence in their professional practice and expanded professional roles consistent with each’s qualifications and licensure. Ongoing efforts are crucial to ensure that nurses are recognized as equal partners in transforming our current healthcare delivery system.
Call to Action
As self-employment through business ownership or entrepreneurial endeavors continues to rise, actions that can enhance the impact and significant contributions nurses can make include,
Regulatory and policy reform to enable nurses to practice and lead to the full extent of their education and training and remove unnecessary barriers that limit nurse autonomy and decision-making authority.
Educational transformation that includes integration of entrepreneurial thinking, innovation, and business skills into nursing curricula. Modernized education pathways can be created that prepare nurses for both traditional and emerging roles and foster creativity and strategic thinking.
Support System design that encourages the development of mentoring networks for self-employed and entrepreneurial nurses can be helpful and allow for thinking of business ideas and incubation programs specifically designed for nursing innovations. Professional communities can connect like-minded nurses and innovative ideas.
Partnership Recognition that positions nurses as full collaborators and leaders on healthcare teams while recognizing nursing expertise in system transformation initiatives and creating opportunities for nurses to lead major healthcare innovation opportunities for nurses to lead major healthcare innovation projects.
Nurses can move fluidly between traditional employment and entrepreneurial ventures in their careers, adapting their roles based on experience, goals, and market opportunities.
The future of healthcare and nursing's contribution toward its improvement depends on unleashing the full innovative potential of nursing that includes business development, an entrepreneurial spirit, and offering mechanisms for support, educational reform, and recognition of nursing’s critical leadership role in transforming healthcare delivery.
References
Whelan, J. C. (2012). When the business of nursing was the nursing business: the private duty registry system, 1900-1940. Online J Issues Nurs, 17(2), 6. Retrieved When the Business of Nursing was the Nursing Business: The Private Duty Registry System, 1900-1940 | OJIN: The Online Journal of Issues in Nursing.
Wall, B. M. (2002). The Pin-Striped Habit: Balancing Charity and Business in Catholic Hospitals, 1865-1915. SO - Nursing Research January/February 2002;51(1):50-58.
National Nurses in Business (NNBA). 2012. Brief History of Nurse Entrepreneurs. Retrieved at Brief History of Nurse Entrepreneurs - National Nurses in Business Association
Indeed (June 9, 2025) 10 Ideas To Become a Self-Employed RN (With Launching Tips). Retrieved https://www.indeed.com/career-advice/finding-a-job/self-employed-rn
Kapetanovic, T. (June 2, 2025). Carving out your place: Finding a business niche that fits. RN Leader, Carving Out Your Place: Finding a Business Niche That Fits
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