Capture new revenue from unusual staffing services

Poultry plants, prisons equal profits

You want to make some extra money. You rack your brain and come up with an idea: Staff the local poultry plant; work in the soup factory; send your nurses to prisons. They may not be orthodox staffing contracts, but they have brought revenue to Home Health Care of America in Newark, DE.

Cindy Cunningham, RN, BSN, CNA, associate vice president of continuous care, says that the varied staffing duties she finds for her nurses account for about 30% of revenues at the Salisbury office and 10% at the Newark office. The latter number could rise to 45% if she wins a contract for staffing public health clinics and state nursing homes on which she just bid.

"Compared to our competitors, it’s a lot of our business," she says. "Not many Joint Commission accredited agencies do staffing. It is a real selling point to people that we are accredited."

Cunningham is the former director of nurses for Delaware state prisons and also worked in home care administration before starting a private duty agency in 1986. "I just went looking through the phone book for places that seemed like they would need nurses on-site to meet federal OSHA [Occupational Safety and Health Administration] requirements," she says.

Her first stop was a Campbell’s Soup factory. From there, it was a short hop to the poultry plants that dot Delaware. There were also more traditional staffing possibilities at long-term care facilities, nursing homes, and even a local National Aeronautics and Space Administration facility.

"I’d call and ask if I could do a presentation for them," she says.

Cunningham also got her name out in the community by volunteering nurses for the local Special Olympics, and she got assignments at summer camps, the Senior Olympics, and even an annual postmasters’ convention.

"We did annual flu shots, too, at area businesses," she says. "It wasn’t a big money thing, but it got our name out and led to other business."

Variety breeds contentment

Working at factories and poultry plants gives Cunningham’s staff a lot of interesting work. "You do TB testing and injury treatment," she says. "But those places also do a lot of research on things like carpal tunnel syndrome. It can be an opportunity to do work that these nurses wouldn’t otherwise have."

Pam Cooper, LPN, is a clinical coordinator at Home Health Corporation, but she started her career working as a field nurse in one of the poultry plants for Cunningham. She says that most LPNs — who make up the bulk of the staff — don’t get the kind of opportunity to effect change that factory nurses do.

"If you see a lot of people from one particular department, like deboning, then if you can track that, you can come up with suggestions for the management," she says. "And they are amenable to that. It’s great work."

The prison work was an obvious choice after Cunningham’s previous experience. She has 10 nurses who are given shifts as needed and work under prison staff nurses, and four staff nurses at the state juvenile correctional facility. That work, too, provides variety to nurses. "There are sick call, intakes, and infirmary work for over 2,000 inmates," she explains.

Once you find a niche, making staffing arrangements work can be tricky. But Cunningham and Cooper have this advice:

1. Go for broad-based skills.

Cunningham says with factory assignments, she looks for nurses that have med/surg and emergency department experience. "There are cuts and other less serious injuries," she says. "But there are also heart attacks." Cooper suggests finding nurses with a varied background. "Nursing is becoming very specialized," she says. "But in a plant, there are so many diverse needs."

2. Know the industry.

Because each factory or plant is different — even within a single industry such as poultry — Cooper advises agencies considering such staffing contracts to investigate what each plant needs. "Go there and spend a day," she says. "Ask the nurse manager what she sees regularly."

You should also be aware of what federal and state regulations exist for the plants. "It’s so much better to overprepare your nurses," says Cooper. "Many of them will be working alone, so they should know the industry and its lingo. They should know what each department does."

3. Determine special needs of your customers.

To work with the prisons, Cunningham’s staff is required to undergo criminal background, FBI, and child abuse checks. In her state, she also looks for people who have Spanish language skills. "A lot of our poultry workers here are Spanish speakers."

4. Don’t be snowed by patients.

Cooper says agencies should also warn staff nurses to be wary of "agency nurse flu." She says that when word gets around that a new nurse is on duty, a string of people will come in with unverifiable complaints — women with severe menstrual cramps, workers with bad headaches. "It’s all subjective stuff, and you have to walk a line between taking care of these people who may or may not be ill and satisfying management about why you are sending someone home early."

5. Keep tabs on what’s owed.

"When you start staffing these places, it’s easy to run up big accounts receivable," Cunningham says. "One company owned us $100,000, which for a small agency is a lot of money."

Cunningham says you should do a credit check on any facility you staff, keep track of your accounts receivable, and make sure that the money comes into your office in a reasonable amount of time — 30 to 60 days.

Although the revenue is one measure of success, Cunningham says she likes to focus on the satisfaction of her customers. "I have three [types of] customers," she explains. "There is the payer, the patient, and the nurses themselves. And I pay a lot of attention to the nurses. If they are happy in their work, they do a good job. If they do a good job, they improve our reputation further. There is no substitution for a good reputation in business."