Florence Nightingale Inc.

By Janice Castro

Often overworked and usually underpaid, the nurse has long been the doctor's reliable helpmate. Now more and more nurses, not content to be second-class citizens in the medical establishment, are hanging out their own shingles. They are seeing patients independently of doctors and opening up clinics. A San Rafael, Calif., newsletter, Nurse Entrepreneurs Exchange, estimates that in the past few years more than 10,000 nurses have gone into business for themselves. "Nurses can do more than change the bed and throw out the bedpan," says Joanne Gersten, who runs Erie Family Health Center, a 14-nurse clinic in Chicago.

The nurse practitioners do not pretend to be doctors. They generally restrict themselves to performing routine tests, treating minor ailments and suggesting over-the-counter medications. Even so, they can spare patients many costly trips to the doctor, and they often make house calls. These nurses are especially helpful to the elderly and people with chronic diseases, who may need close watching but not always by a physician.

The nurses' main attraction is their reasonable prices. Nurse Mary Baker, who heads a clinic called Chicken Soup Plus in Sacramento, charges only $30 for a pre-employment physical, far less than the $50-to-$75 fees that the city's doctors command. And, yes, she sometimes prescribes a pot of her own chicken soup, which she drops by a patient's home. Jean Sweeney-Dunn, who runs Community Nursing Services for the Elderly in Elmira, N.Y., asks $2 for a urine test and $5 for a blood-sugar analysis, a fraction of what a physician would charge.

While many harried physicians salute the ancillary care provided by the new entrepreneurs, others fear that nurses playing doctor may fail to spot serious ailments. Says Dr. M. Roy Schwarz, assistant executive vice president of the American Medical Association: "They want to diagnose and treat disease. Our reaction is very simple: if you want to practice medicine, then go to medical school."

Nurses, though, are not exactly untrained. Like doctors, they are licensed by the states, which set educational standards and put limits on what they can do. Most registered nurses must spend four years earning a university nursing degree, which gives them the fundamentals of medical science. They cannot legally perform surgery or many other medical procedures, but in 19 states they can prescribe some types of mild drugs.

To get around their limitations, some established nurse entrepreneurs are hiring staff doctors. Chicago's Gersten, for example, has recruited nine physicians. A few nurses have also moved far beyond their original calling to head substantial medical firms. In 1982 Elizabeth Dayani, a Kansas City nurse, helped found American Nursing Resources as a supplier of professional workers to hospitals, corporations and individual clients. Now the firm employs more than 2,000 nurses, therapists, dietitians and other specialists at 19 branches in nine states. Revenues were $11 million last year.

But most nurse entrepreneurs did not go into business to make a fortune. In fact, Baker of Chicken Soup Plus says that her current income after expenses is not as high as the $30,000 to $36,000 that she once earned as a public health nurse. The value she puts on her independence, though, more than makes up the difference.

With reporting by Cristina Garcia/San Francisco and Raji Samghabadi/New York