Nurses are breaking the mold to set out on their own

Kate Messenger was first exposed to IV hydration therapy thousands of miles from her home in North Pole, Alaska, after crossing the finish line of Fort Worth’s Cowtown Marathon, held annually in February.

“I don’t know if you’re familiar with Alaska, but you cannot train in Alaska in February for a marathon,” Messenger says. 

Messenger and a friend went to an IV drip bar, and woke the next day feeling great, even after the long flight back home. She was inspired to bring the service to North Pole with a friend — in February of 2020. 

Shortly after, COVID crushed the hospital she worked at.

“We’re in the middle of COVID, and I’m sitting here thinking there’s got to be something better in life,” Messenger says. She decided to move ahead with her plan in the fall of 2020.

Starting out on her own required payroll, accounting, inventory, a client-facing interface, and the unique extra challenges of the health and wellness industry: medical director oversight, pharmaceutical access, malpractice insurance, electronic medical records, and a HIPAA-compliant server to store patient data on.

Messenger turned to a tech platform called Hydreight for these crucial components. For patients, Hydreight offers an app to find and schedule health and wellness services that can come right to your home. In addition to IV hydration therapy, Hydreight connects patients to providers offering other services, including Botox, select lab tests, and COVID testing.

Messenger uses the app as the backend for her IV business, AK Drip, and employs five nurses. Her clientele include post-bariatric surgery patients, whose hard limits on eating and drinking can make nutrition and hydration difficult — as well as people suffering from colds, say, and the recovering bartender or two wanting to get back on their feet by next shift. 

The unique business proposition of Hydreight is to help providers surmount the “barriers to entry” preventing nurses and other healthcare workers from monetizing their skills outside of hospitals and brick-and-mortar doctors’ offices, says Hydreight CEO and president Shane Madden. 

By going independent, nurses can add supplemental income to help alleviate crushing hours, or go completely full-time for themselves. But nursing and healthcare aren’t like a lot of jobs, where you can just hang out your shingle and say you’re open for business — there’s a lot of highly complex issues that make it tough to start a small business or a side hustle.

“We developed a platform that essentially took all of the barriers to entry, and made them turnkey,” Madden says. “We’re not trying to turn everybody into Elon Musk or an entrepreneur.”

Messenger continues to work at Foundation Health Partners Fairbanks Memorial Hospital while AK Drip gives her a sense of freedom and ownership — and a way to add income without needing to pick up long overtime shifts. 

“When you are [already] working three 12s and you want to make some extra money, one of the last things you want to really do is pick up another 12-hour shift,” Messenger says, and especially when the hospital is short-staffed, with little to no support.

“It’s just gonna be another rough day, right?”

Her nurses can make on average around $300 or so of extra income a week, working in windows of their own choosing — and more if there’s a group, party, or event like a health and wellness expo, Messenger says.

Nursing struggles: Multiple surveys and polls, done by staffing firms, nurse hiring platforms, and the American Nurses Foundation, have found many nurses are frustrated and ready to leave the field.

The top reason can vary from survey to survey, but in the aggregate, they tell a story of nurses whose mental and emotional well-being is suffering from a combination of under-staffing, low wages, and long hours — a recipe for burnout and difficult working conditions, exacerbated by the pandemic.

In response, nursing unions have been going on strike. In December 2022, tens of thousands of members of the UK’s Royal College of Nursing left their posts over their concerns of fair pay and patient safety, with more happening since. In the US, six unions — representing 32,000 nurses — took strike actions in 2022, the AP reported. 

A culture shift is also beginning, with nurses moving to work in clinics, where hours are shorter and overnight and weekend shifts not required, or telehealth, Peter Sidhu, the executive vice president of United Nurses Associations of California/Union of Health Care Professionals, told the AP.

Independent health and wellness services: Working for themselves — either to bring down the amount of hours they need to take at, say, a hospital, or to set out completely on their own — could help alleviate some of these stressors. But in addition to the logistical and legal barriers that make such a move difficult is an institutional one.

“Unfortunately, a lot of nurses do not receive a business background,” says Victoria Tiase, an assistant professor of biomedical informatics, board-certified RN, and strategic director of the Digital Health Initiative at the University of Utah. Prior to coming to Salt Lake City, Tiase worked as a mentor for digital health startups as part of the New York Digital Health Accelerator program.

“I think that’s why nurses would rather be employed by hospitals or physician’s associations rather than setting up their own shingle,” Tiase says. 

That is beginning to change, however, Tiase says; some nursing schools have begun offering education on billing and payment systems — which are “very complicated” — and the American Nurses Association is launching entrepreneurial education programs.

Taking down barriers: Anita Farrelly knew the challenges she would face opening her own business better than most.

For the majority of her 30 years in nursing, Farrelly has worked in critical and intensive care units, predominantly in management positions, more on the operations side of how a hospital works. She earned her masters in business administration and healthcare management. Farrelly now uses Hydrieght to run Aboost Wellness, an IV therapy business in Prescott, Arizona and another business called Hydreight Scottsdale, while also working for Hydreight directly as the area administrator for Maricopa County, home to Phoenix.

Hydreight’s goal is to help take care of both logistical and medical needs of nurses working on their own, letting them focus on their patients.

The barriers nurses face becoming their own provider can be thought of in two main buckets: the typical challenges of running any business — payroll, taxes, billing — and those which are unique to health and wellness services, including physician oversight, pharmaceutical access, privacy requirements, and malpractice insurance.

Hydreight’s goal is to help take care of both logistical and medical needs of nurses working on their own, Hydreight CEO Madden says. The company handles payroll, billing, and inventory management — although, Farrelly stresses, they do not run the business for you. 

“You still have to have the motivation and the ambition to learn business, marketing, client acquisition,” Farrelly says; programming to help bolster the “soft skills” of business — namely the sales side — could be a beneficial addition to the platform.

It can be illegal to offer some health and wellness services unless part of a proper medical network, Madden says, and states have diverse and complex rules about this. Hydreight helps by serving as that network across all 50 states, each with their own varying compliance laws.

That nationwide physician’s network provides oversight and prescriptions, which can then be filled through Hydreight’s own pharmacy, providing easier access and a chain of custody. The app is a forward-facing extension of what is essentially a medical practice, in lieu of a hospital or clinic. The platform’s electronic medical record software stores data on a HIPAA-compliant server, covering the unique privacy and tech needs of independent nurses.

Of primary concern would be malpractice insurance, Utah’s Tiase says. Madden says Hydreight offers malpractice and general liability insurance coverage.

Providers operate on a subscription, and Hydreight gets a 10% service facilitation fee, as well as the profits from buying through their pharmacy. 

Figuring out how more nurses can operate independently has become a big topic of conversation among nursing innovation groups in the past few years, Tiase says, especially in the wake of the pandemic. There is a shortage of doctors and healthcare professionals in the US, and more independent nursing businesses could be a part of the solution. 

But for nurses themselves, running their own businesses offers freedom, flexibility, and independence. 

Farrelly has been able to run her business from her phone, on vacation in Hawaii with her daughters.

Messenger attributes the platform to getting AK Drip off the ground.

“If I hadn’t stumbled upon them, I’d sure that I would still be dreaming, percolating, planning,” Messenger says. “But I probably wouldn’t be where I’m at today.”

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