The Modern Hero TV series has been picked up by Amazon Prime Video! That’s right!!!! You can now see Dr. Scharmaine Lawson on Season 1: Episode 3 of this HOT NEW Amazon series about phenomenal women who are changing the world!! Go check it out and leave a review!!!!!! As the only nurse featured in this series, we are OVER-THE-MOON with excitement!!!
What a way to end NP Week!!!
by Brett B. Snodgrass FNP-C, CPE, FACPP, FAANP
It only takes minutes, turn on your TV or radio and you will hear we are in the midst of an opioid crisis. It seems every professional healthcare groups in America are weighing in. Guidelines, recommendations, ideas and sometimes sensationalism is flooding the arena of healthcare. Everyone feels they have an answer to the opioid crisis.
What is always important to ask is… Is the information being reported correct? Are you really seeing the entire picture of the crisis? I really don’t think we are. The media reports that opioid overdoses have overzealous, greedy pharmaceutical companies, and overprescribing healthcare providers to blame.
Hold on.
It’s just not that easy.
Here is what we know-The current statistics about drug deaths say:
o All drug deaths (including ANY drug/medication a patient takes) account for 60,000 to 70,000 annual deaths.
o All opioid deaths (including heroin/fentanyl and prescription opioids) account for 30,000 to 40,000
Now, let’s compare to:
o Hospital-acquired infections deaths: 99,000 annually
o Tobacco, Alcohol, Guns and Traffic Accidents: >700,000 annually
It’s just important to put things into perspective.
Now let’s look at the opioid death statistics.
The number of actual prescription opioid overdose deaths are only a small percentage of the overall opioid overdose statistics.
o For instance, Fentanyl is responsible for 79% of all opioid overdose deaths. So, your first reaction might be “no one should ever prescribe fentanyl.”
o YET, only 5% of all fentanyl overdose deaths are due to pharmaceutical grade fentanyl.
For instance, in Illinois, opioid overdoses increased from 589 in 2015 to 1233 in 2016, despite significant decrease in opioid prescribing in that state. The increase appears to be almost completely driven by illicit fentanyl analogs, not legitimate fentanyl prescribed for the chronic pain patient. Schatman, Zieglar (2017) Pain Management, Prescription Opioid Mortality and the CDC.
To quote Dr Stefan Friedrichsdorf, “We do not have an “prescription opioid crisis” but really we have a polypharmacy crisis.” He cited that in New Hampshire, 72% of deaths involving oxycodone, also included alcohol, and/or benzodiazepines, cocaine, kratom, methamphetamine, and other opioids (which may not have been prescribed concurrently).
One accidental death from a prescribed opioid, illicit opioid or any other medication is one too many. But the answers are not simple. The present problem is more about illicit drugs than prescription drugs, as well as, combinations of both prescription and illicit drugs. Multiple sedating prescribed medications is also an issue. To add, more deaths are associated with illicit use of prescription opioids, than the intended prescribed reason. So many in our society, are looking for an escape and dangerously finding it through polypharmacy.
We have an epidemic of substance use disorder.
Substance Use Disorder.
THIS is what’s being ignored. That’s because there are so many factors associated: unemployment, poor education, depression, limited mental health access, mental health stigmas, availability of illicit drugs, diverted prescription opioids, genetic predisposition to substance use disorder, and psychiatric co-morbities.
Where do we go from here? More providers need to be screening for Substance Use Disorder. States need to allow more NPs and PAs to have the ability to treat Substance Use Disorder. There needs to be more education on how and when to prescribe opioids. Also, an increase in national education on appropriate disposal of medications when they are no longer needed. This act alone will help reduce the likelihood of diversion. It’s just the beginning, but it’s a start!
Reference:
Schatman, Zieglar (2017) Pain Management, Presctiption Opioid Mortality and the CDC.
Brett B. Snodgrass FNP-C, CPE, FACPP, FAANP
Director of Clinical Operations
LifeLinc Pain Center
8001 Centerview Parkway, Suite 215
Memphis, TN 38018
(P) 901-249-5905
(F) 901-249-5940
By Tina M. Payne, RN, MSN
Launching a business can be exciting as well as stressful. In August 2017, while working as a Telemetry float pool nurse, homeschooling 3 of my 5 children, being a wife, and taking care of my infant son, I founded Grace Health Scrubs. Grace Health Scrubs is a premier mobile and onsite uniform retail business located in Cincinnati, Ohio. It is one of very few uniform businesses which is owned and operated by a nurse in my area. Our company is growing steadily and we are partnering with local hospitals, doctor’s offices, and nursing programs.
We have a convenient website that allows healthcare professionals to shop 24 hours a day. As a nurse and business owner, part of purpose is to empower and share with other nurses that they have a unique advantage within the scrubs market that scrub manufacturers have yet to realize. The insight that we have based on years of wearing one specific product can really offer a lot of value to scrubs distributors and manufacturers alike.
Medical uniforms, also referred to as scrubs or nursing scrubs, are a necessity in our ever-growing economy. As long as there is a need for medical care, there will be a need for scrubs. Wearing scrubs is most often a requirement of healthcare professionals but is also expanding to other service industries such as housekeeping, massage therapy, and cosmetologists, just to name a few.
There is a global need for scrubs as well. Hospitals are one of the top employers who require medical scrubs in the world. In hospitals, there are doctors, nurses, laboratory personnel, and other personnel who are required to wear departmental colors such as all blue, grey, green, or even white uniforms.
Although scrubs are constantly in high demand, not all styles, colors, and sizes are readily available for purchase in regular stores – which is where you come in. I have heard many nurses say they only have Walmart in their local area to buy scrubs from. There may only be a handful of stores in your area, and it is guaranteed that they will still not carry every possible brand, size, or color desired by everyone needing them, so many consumers must resort to online shopping instead. As a result, why not be the bridge in your community and provide a needed service?
This article is geared towards the experienced healthcare professional wanting to start a viable business that will require in-person and online sales. So whether you are a nurse, nursing assistant, doctor, or lab technician, you likely will have a lot to bring to this business, including your insights as a consumer of scrubs, as well as your network of healthcare workers and colleagues whom you already have a relationship with. Having a solid network and relationships in this business will take you further than you can imagine. Over time, the uniform business can be lucrative and rewarding.
On my business journey, I have had many people inquire as to how to start a scrubs business. Earlier this year through my blog platform and Facebook group for moms and nurses goalsofaceomom.com, I provide support, encouragement, and tips on starting a business. As a result, I have since launched a coaching business, helping other women and nurses to start their first business. As part of an upcoming series about the scrubs business, this post will outline 7 basic steps to starting a scrubs business.
HOW TO START A SCRUBS BUSINESS IN 7 STEPS
Step 1: Create a Business Plan
A business plan can seem intimidating at first, although breaking it down into smaller pieces will help. This is the step a lot of people skip and find out later that they really needed a business plan. Outlining your business structure, budget, marketing strategies, and future plans will surely put you in a better position to obtain the necessary funding and create a more appealing business entity.
Step 2: Business Registration and Licensing Requirements
You will need to establish your business entity with the Secretary of State office within the state you reside in. Go to their website or call the office if you have any questions about registering your business.
Next, apply for a business license from your local municipality. This serves to acknowledge the existence of your business in your city. This license may have a variety of titles depending on your location, it may be “vendor’s license”, “sales tax certificate” or “business license”. Also, if your state has a sales tax, apply for a tax account with your state department of taxes as you will need to collect sales tax on items sold. Get a tax identification number too, or an employer identification number with the Internal Revenue Service. If you have a previous or current business which is related, contact a tax attorney or lawyer with regards to establishing a DBA or “doing business as” entity.
However, if you are still not sure about all the licensing requirements to become a medical scrubs and uniform retailer, you can contact the Uniform Retailers Association (URA), which is a non-profit trade association dedicated to the growth and prosperity of the independent uniform retailer.
Step 3: Get Capital
Having capital is the number one thing that can make or break a business. Use your business plan for guidance. Create a budget for operating cost, expenses, etc. There are a few ways to go about this if you don’t have the cash yourself.
Step 4: Learn the needs and wants of your customers
Before you start a business, you have to be sure that you are solving a problem. Some ways to find out information is by sending out polls to your healthcare network by email or social media, conduct surveys, and research the requirements of the local hospitals, nursing homes, doctors’ offices, etc.
Find out the most common brands, colors, material preferences, etc. that the staff in your location wear. In addition, you may want to visit the hospitals and medical facilities and request their staff uniform requirements, including color and style parameters, and ask about the uniform material preferences. Just remember that knowing your customers’ desires and behaviors will help you in your marketing strategies.
Step 5: Lease the best building and/or Launch Your Website
If you have decided to open a brick and mortar space, the capital you have raised will hopefully cover your first year of expenses. Brick and Mortar shops are at a minimum a 6-figure operation and it will take a lot of funding to open one with full inventory and staff for the first year. So please take the time to consult with a business strategist and accountant if this is your preferred route. So, after you have done all of that, you want to make sure that your building or storefront is in a great location, with easily visible signage, being handicapped-accessible. The location of your business should be somewhere that can be easily reached from all roads. Ideally, your location should:
Launch your website
Websites are a must-have in this business. Consumers have so many options available to them, they are always comparing prices and checking the reviews. Just think of the last time you made an online purchase, did you cross-check the price? Did you check the reviews? So it is non-negotiable as to whether or not you need a website. Now, whether you will use your website solely as an e-commerce site for your business or as a convenience to a mobile scrubs business, there are a few things you need, including but not limited to:
Step 5: Purchase the products
Unless you are creating your own scrubs line, then you will need to purchase inventory. So, the best way to go about this step is to research the brands you are interested in selling based on your market research in your area.
This most likely will lead you to specific wholesalers and/or manufacturers. A good wholesaler is a link between the manufacturer and the retailer (you), while the retailer is the link between the manufacturer and the customer. Now, a good wholesaler will usually give good discounts for buying in bulk, which will allow you a greater profit margin. Anything greater than 25-30% is ideal for a profit margin.
However, the better option is to contact the manufacturer directly. Please know that not all manufacturers sell their scrubs in every location in America, so be sure to check with them individually. Many of them will have an application process and different requirements, such as a minimum opening order.
Additionally, some will only sell to you if you have a physical brick and mortar store. Most of them do not agree with solely online scrub stores. The best way to find out is to call them directly. As a business owner, you have to reach out to these companies yourself in order to earn their respect. For additional help, you can check out my 10 Strategies for Buying Scrubs.
Step 6: Market your Business
For good marketing, it is necessary to recognize your target audience or demographic. In this case, we know that it is medical professionals. We have already established that these consumers are very busy, with some working off shifts and long hours. As a result, marketing to them must be adjusted in a way that they are made aware of your business both locally and online, and it must be done in a quick and efficient manner.
In today’s digital age, social media marketing is necessary. Having a strong internet presence is necessary to make an impact with consumers. An example would be to hire people to model your uniforms in promotional videos. Boost or run ads on these videos on popular social media sites like Instagram or Facebook. Even if you have a brick and mortar store, your website should be compelling and display content that introduces your business to the world.
Step 7: Start selling
Before you are ready to launch, make sure you are set-up to accept payment in a variety of ways; we are in the era of CASHAPP where people are fueled by convenience and speed! Whether you are selling your merchandise in person, online, or through social media, it is a good idea to accept all types of payment. You have to be able to accept cash, purchase orders, credit, debit, PayPal, etc. if you want the sale these days.
If you are not willing to accommodate people, then you will likely miss out on the money. Starting out as a new business, you do not want to turn any customers away, so be prepared for these types of payments or at the very minimum make people aware of what you will accept when you advertise. Do you already have a scrubs business but need help with sales? Check out this free resource: 5-Ways to Make Money in Your Scrubs Business This Week.
So there you have it, the initial 7 steps to starting your scrubs business. Of course, there are many more steps in the process. It is important to note that although worthwhile, this is a serious business, not a side hustle. There is a lot of time that will need to be invested in it. It is not as straightforward as simply buying inventory, that does not make a “business”.
Buying a case of scrubs with no additional research or training will leave you discouraged and unmotivated. So before you start a scrubs business, please do the necessary research and get help from experts to diminish your learning curve. I have successfully helped several nurses start and launch their scrubs business, with the hope of helping others too. So if you need additional support or VIP coaching please email Tina Payne at Tina@goalsofaceomom.com for an application or you may check out my available programs at www.goalsofaceomom.com/programs.
Click Here to be added to the waiting list for my group coaching program:
Tina M. Payne, RN, MSN
Owner of Grace Health Scrubs
Business Mentor/Blogger
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by Dr. Sonia Smith, NP
Sleep disturbance is one of the most common concerns of childhood. Estimates are that approximately 20-30% of all children have problems related to sleep. Sleep disorders in children are varied. Children may present with insufficient sleep due to difficulty with either initiating sleep or maintaining sleep. Sleep disturbance may be associated with pediatric insomnia, disorders of circadian rhythm, or may manifest as hypersomnolence or narcolepsy with or without cataplexy. Problems with sleep-disordered breathing (SDB) may include obstructive sleep apnea (OSA), central sleep apnea, and hypoventilation disorders. Common parasomnias in childhood may include night terrors, nightmares, sleep talking, somnambulism, bruxism, and frequent limb movements.
Sleep is necessary for maintenance of both physical and psychological health. Sleep deprivation has known detrimental effects on both somatic and neuropsychiatric health issues. Children with lack of sleep have been shown to be susceptible to development of obesity as well as predisposed toward higher body mass indexes later in life. Consequences of SDB related to OSA may include development of cor pulmonale and growth retardation. Sleep loss can also contribute to changes in human immune responses.
The neurocognitive effects of poor sleep are well documented in the literature. Domains affected by inadequate sleep include effects on cognitive and academic functioning as well as emotional and behavioral operations. Children with sleep disturbance may manifest behaviors consistent with hyperactivity and aggression as well as emotional lability, depression, and anxiety. These negative behaviors are associated with an increased risk for youth injury. Children who experience sleep difficulties between the ages of 5-19 have also been shown to have problems with depression, anxiety, and other emotional concerns later in life.
Sleep loss has been directly associated with decreased academic performance due to an inability to remain alert and subsequent difficulty concentrating in school Executive functioning skills including the ability to generate hypotheses, reason abstractly, and process information are also adversely affected when children do not achieve adequate sleep. Children who do attain restful, restorative sleep have been shown to have higher levels of optimism and self-esteem than children with disturbed sleep.
Emerald Coast Pediatric Sleep Consultants, LLC
Emerald Coast Pediatric Sleep Consultants is a nurse practitioner-owed sleep clinic located in beautiful Gulf Breeze, Florida. Emerald Coast Sleep provides comprehensive sleep diagnostic and treatment services to children from birth to age 21 years. A collaborative approach to patient care, with emphasis on addressing biopsychosocial and cultural patient factors, is utilized to determine individualized plans of care. A paradigm of health and wellness is the foundation for treatment. The staff also has extensive experience caring for children with special needs. Emerald Coast Pediatric Sleep Consultants is dedicated to bring awareness of sleep disorders and the need for pediatric sleep assessment to pediatric health providers in the community and nationwide. Visit us at www.emeraldcoastsleep.com for more information.
Sonia A. Smith MN, CPNP/CNS obtained her BSN from the University of North Carolina at Greensboro and her MN in Child Health Nursing from Emory University in Atlanta. She has been a pediatric nurse for 29 years and has been a pediatric nurse practitioner for 24 years. Sonia has experience in primary care, pulmonology, and neurology. She is currently the owner of Emerald Coast Pediatric Sleep Consultants located in Gulf Breeze, Florida. Her sleep practice specializes in the diagnosis and treatment of sleep disorders in children with an emphasis on health and wellness. Sonia enjoys living in the country on a 40 acre pecan orchard in Foley, Alabama, located 20 minutes from the Gulf of Mexico. She is one year away from obtaining her Doctor of Nursing Practice from Troy University. In her spare time she enjoys travel, good wine, good friends, and making fused glass art.
by Victoria Randle, NP
Deciding to become an entrepreneur can be a scary task to tackle, especially if you lack a mentor or support. You ask your self “ Where do I start? Which way do I go? Who can I trust?” It can all seem so overwhelming that you may give up before you even get started. However, with determination, perseverance, and a strong support team, it can be done! Remember, no one determines your fate but you!
In my practice as an RN, I saw a decline in the quality of CNA’s. I felt this stemmed from multiple issues. One big issue was a lack of nurse support for CNA’s thus causing a lack of pride in their work. I also noticed that many schools seemed so fly by night, “Become a CNA in 10 days!” Are these students really getting the exposure and sense of pride that they need for the job? That’s when I decided someone has to take action and that someone would be me!
I had no idea where to start and figured lots of things out along the way. I must say I did some major head bumping along the way. I met people who were very helpful, people who donated time and money in my vision and then there where those who of course just wanted my money and gave me only half of what I needed. Unfortunately we can’t always see those people coming. Nevertheless it took me two years to get my CNA program up and running. I would like to share with you the steps to get moving in the right path. I happen to be in the state of Georgia so much of this will be Georgia based, however other states are very similar.
Identify your authorizing body for the CNA program in your state. Each state is different. The CNA program may be governed by the Health Department, the State Board of Nursing, or a separate branch that is specific to nurse aids only. In the state of Georgia the certifying body is the later mentioned. The nurse aid-training program certifying body is the Georgia Medical Care Foundation (GMCF). Please click here for more info GMCF Nurse Aid info. In the state of Georgia you must attend a FREE two day workshop offered by the state called “ Train the Trainer” in order to become a CNA instructor and/or start a CNA school. Dates for this workshop can also be found at the link above. Please note this workshop fills up FAST and is offered once a month so have the site booked marked and check it religiously every day to catch an open spot. I would also like to note you do not have to be a nurse to own a CNA school, however you must have a nurse (RN) be on staff to coordinate the program.
In many states you are responsible for writing your own curriculum and submitting it for approval. This affords you the ability to expound upon certain aspects you may feel are important to teach and can help you create a unique set of CNA graduates that facilities will seek out. The state of Georgia requires that your curriculum be at least 85 hours of instruction, lab and facility time. You can choose more hours if you wish. Choosing a book and writing a curriculum is VERY time consuming. It took me a year to write my own. Many states are open to which book you can use but be sure to check with your state to ensure you choose an approved book. In Georgia they discuss how to write your curriculum and which books are approved at the Train the Trainer workshop. If you still feel stuck or overwhelmed, feel free to consults someone like myself who has been there and done that. I will be happy to provide a consult to help you with your curriculum. Just email me at thesecretcocktail@gmail.com
Find a nursing home that is willing to contract with you. It is a state requirement that you have a contractual agreement with a facility to bring your students to so that they may gain hands on learning. Depending on where you live and the number of schools in your area, this process can take a while. Many facilities already have contractual agreements with other CNA schools or nursing schools and may be at capacity. Also some facilities insurance do not allow them to have students in their facility. Make a list of nursing homes far and near, find out who the DON is and make contact with them. Sell your vision and school to them. Why should they let your students practice there? Will you offer their employees a discount to attend your school? Can you promise them future staff members out of your graduates? Can the two of you partner to help fill their CNA shortage?
Submitting your curriculum and waiting for approval can take up to three months in Georgia. If you are lacking any documents or something needs to be corrected in your first submission, you have two additional chances to re-submit in a one-year period. If your curriculum fails all three times, you must try again in a year so you must be diligent! In the event your curriculum passes (which it will because you will be diligent) you are contacted for a site visit by the state and the site visit can occur up to 3 months after the curriculum has been approved. It is imperative you have a site identified and all required items ready at the site for inspection. An equipment list can also be found at the link above. For more info on curriculum help join my email list HERE. I give out free tips to help you along the way.
WHAT SOMEONE NEVER TOLD ME!! There are additional items that need to be submitted with your curriculum. In the state of Georgia, there are a multitude of forms you have to craft such as: Clinical sign in sheet, Class sign in sheet, instructor evaluation form, student evaluation form etc. If these are missing, you must resubmit, even though it is not part of the curriculum. Also the entire curriculum and all these forms MUST be printed out and hand delivered to GMCF for approval. All additional documents must be resubmitted the same way so have plenty of paper and ink handy because you will become a self made Kinkos! If you would like more tips on the SECRETS behind starting your own CNA school, visit my YouTube channel The Secret Cocktail. There you will find videos to answer your questions and give you insight on topics of interest.
Once your curriculum has been approved and you pass the dreaded site visit, they will let you know right then and there if you are approved to start, however you cannot open the doors of the facility until you received an actual letter in the mail. Being completely approved is the best felling in the world!!!
Personal words of advice: PLEASE! PLEASE! PLEASE! Have a business plan written. Ensure you have a solid marketing plan and be sure to have a strong partner (this was my failure). There is no way you can do this on your own. You need someone who is just as vested as yourself in the endeavor. Of course you will need an instructor to help teach and secretary to secure those students when they call, but you certainly need someone to help you in the background. Ordering supplies, marketing, accounting, building community partnerships, preparing for annual state inspections, cleaning the building, I mean the list goes on!!! I promise you, you cannot do it all alone. Both of you must understand this is not an instant cash business and you will initially be working for free just as you would with any other entrepreneur endeavor. However, with determination and perseverance you will strive for success and you will succeed!
I am excited for your venture and hope this article was helpful. This is just an over view as there are many other in-depth items and situations to ponder that may come up. Never get discouraged and remember the goal in mind. You can do this! Please feel free to ask any questions below in the comments section or email me if you are more specific questions I can address. If you feel you are ready to move forward with starting your own CNA school, register for my next seminar HERE.
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Victoria Randle NP-
