Wisdom Teachers

Corporation of 1: From hospital IP to consultant

'At this stage of my career, I'm really enjoying it.'

Christine J. NuttyWhat's it like to make the move from hospital infection preventionist to independent consultant? Who better to ask than Christine J. Nutty, RN, MSN, CIC, president of Infection Advice Inc. in Clarksville, TN. An IP since 1992, Nutty did not exactly leap lightly into consulting when she made the move in 2006. She did her homework, and advises others mulling the move to carefully do the same. Nutty consults in such areas as outbreak management, infection control program assessment, infection prevention during hospital construction, and legal aspects of infection prevention. We caught up with her shortly after she completed her 2009 term as president of the Association for Professionals in Infection Control and Epidemiology (APIC).

Q. HIC: Why did you decide to make the change from hospital-based infection prevention to independent consulting?

A: Nutty: I worked for almost 34 years in the hospital environment in various settings. I was increasingly burned out on the job — it basically revolved around lack of resources. I wanted to be more independent. I knew several friends who were consultants. I talked to them about their experiences and what was going on in their lives. I talked with my husband a lot about what we could and could not afford. Because when you become a consultant, you probably are going to go without a paycheck for a while.

Q. So essentially, you looked at it like you were launching a small business?

A: Exactly, and you have to go at it that way. You have to think about health insurance, life insurance, the benefits that you will lose. You have to get legal advice and accounting advice and guidance. We decided that we could afford it and we could attempt to do this. I decided to become a small business and at the advice of my lawyer, I became an S corporation. Most consultants who I know are LLC [limited liability companies], but my lawyer recommended going as an S corporation. I'm a corporation of one. The biggest issues around that and the [corporate entity] decision relate to your individual state. You have to decide what you want to do based on the requirements by your state and local [authorities].

It's also very important to think about the area that you are from and ask the questions, 'Do you have customers? Who would those costumers be? How ready are you?' I had done some consulting in long-term care, outpatient settings and some legal consulting. I knew a list of perspective customers. Then you have to make that decision about whether you can afford to do it or not. In 2006, I made the decision.

Q. Fortunately, you launched your business before the Great Recession hit. Given this tough economy, any regrets about leaving the security of a hospital job?

A: No, I don't miss being in the hospital, but I miss the friends I had and those relationships. Working in a hospital or a facility is like a family. I miss those people. But when I got my business off the ground, I was extremely busy and then I became more and more involved with APIC nationally and internationally.

I have been very busy and I already have a lot of work lined up for this year. But many consultants are seeing that the work is slacking off in this economy. Instead of calling a consultant to figure out an outbreak or improve their program, health care facilities are hiring from within or promoting someone [inexperienced] up the ladder and saying, "Here's your new job." It's not necessarily the best thing for the facility, but it saves dollars at the time.

Q. On the other hand, it seems like there are going to be a lot of consulting opportunities with some of the national trends. For example, the increasing federal and state oversight of ambulatory care in the wake of the Las Vegas HCV outbreak.

Yes, especially with the training up front or serving as an interim infection preventionist while they try to find someone permanently. There are areas where it is opening up. There are increasing legal issues and consulting in that arena. There are opportunities, it is just that you have to have the knowledge — No. 1. APIC is filling that need by helping people with the training and the expertise. Of course years of experience help, but even then you have to have the connections — a network of people to contact. There is a lot involved with consulting now. It can be very difficult for the young or the inexperienced consultant to just jump into this position.

Q. So you recommend the IPs acquire hospital experience before trying the consultant route?

A: Yes, the hospital experience is so valuable. We have many very experienced practitioners in long-term care, behavioral health and other settings, but the hospital experience gives the basic education. I think it's easier for the consultant to gain the knowledge if they are in the hospital setting. There are so many components to running a good hospital program; everything from knowing how to design and implement the policies and procedures to giving adult education — that's an entire expertise right there. You have to constantly be educating yourself about infectious diseases. And running a program, you have to know about budgets, about the capital expenditures and a lot of political stuff in your facility. It's a tremendous volume of information that comes out to the practitioners.

But there's just so much expertise you need to get into [consulting] that you need a really strong background. And I think a hospital provides that a little bit better than any of the other settings because you have the disinfection and sterilization people, the microbiology lab, the medical staff — a network of people who are experts in their fields. In many hospitals, you have people that can really help you — diabetes educators, wound therapists, all sorts of people.

Q. You mentioned you missed the people in the hospital, can consulting be kind of isolating?

A: "The big network [in the hospital] is everything from having someone to eat lunch with to having someone to bounce ideas off — having someone to help you guide your practice. No one knows all of the answers. That is the benefit — if someone goes into the consulting business — of being involved in their APIC chapter and with members in their region. It gives them someone to bounce ideas off. In consulting, it really helps to have a network of people that you can work with and learn from as you are helping to design a program or repair a program. But you really have to be a person who is able to work independently and a person that can drive yourself."

Q. Is that the primary benefit of consulting — autonomy?

A: Well, at this stage of my life, I find that it is so much more enjoyable for me to work when I want to work. If I want to be busy 80 hours in a week, I can be. If I want to have my own life and take a few days off, I can, but I'm still connected by phone and Internet. I guide the work I'm doing instead of the work guiding and controlling my life. I think that's the benefit. I am independent. I can make adjustments from day to day. If my granddaughter needs me, I can be there. I feel like I'm in control from day to day. Those are the great things about it.

And that's what the younger or inexperienced IPs see. They see all of the benefits, but there are a lot of other issues that go with it — and a lot of them are financial. You may not be busy, you could go for weeks without a job, so you've got to have a comfortable financial capital base to support you. But there are a lot of benefits. For me personally, at this stage of my career, I'm really enjoying it.