Lately our firm has had a lot of clients with nursing background come to us to escape their employment as a nurse in a hospital or other traditional health care organization, or to start a side business as a nurse coach, IV hydration business owner, med spa owner, or combination of all three. Why they are fleeing traditional medical care facilities, or at least branching out to the wellness world is simple: burnout. According to a 2022 Surgeon General Advisory, health workers were feeling burned out even before the COVID-19 pandemic. Contributors to this burnout include:
- Limitations from national and state regulation;
- Misaligned reimbursement policies;
- Burdensome administrative paperwork;
- Poor care coordination;
- Lack of human-centered technology;
- Lack of leadership support;
- Disconnect between values and key decisions;
- Excessive workload and work hours;
- Biased and discriminatory structures and practices;
- Barriers to mental health and substance use care;
- Limited flexibility, autonomy and voice;
- Lack of culture of collaboration and vulnerability;
- Limited time with patients and colleagues;
- Absence of focus on health worker wellbeing
- Harassment, violence and discrimination;
- Politicization of science and public health
- Unrealistic expectations of health workers.
Id. at 12. A 2022 survey of over 1,500 US physicians found that 61% feel they have little to no time and ability to effectively address their patients’ social determinants of health, and 87% want greater time and ability to do so in the future. Id. “This gap between health workers’ desire to contribute more to their patients’ health and social security, and their ability to do so in practice, seeds and compounds their sense of moral distress and burnout.” COVID-19 exacerbated these feelings of burnout even more. Id. With no end in sight of fixing many of these contributors to health worker burnout, many are exiting traditional health care roles in search of a better way to use their knowledge and skills.
We have helped many health workers transition from delivering traditional health care services in traditional settings (like hospitals, nursing homes and medical clinics) to delivering wellness services in a variety of methods and capacities. The wellness industry offers health workers a number of advantages over traditional health care. First, it is not regulated in the same way as health care. Indeed, unlike health care, there are very few regulations in wellness, which is both a blessing and a curse. It’s a blessing because there are certainly fewer administrative burdens when delivering wellness services compared to health care services that are reimbursed by public or private health insurers. Because of fewer administrative and regulatory demands, wellness practitioners have more time to spend on getting to know and helping their clients, as well as more time to help themselves. By practicing what they preach, wellness practitioners often adopt healthier behaviors and lifestyles that are more conducive to living a more balanced life. The downside to having fewer regulations in wellness is that the legal risk is more “grey.” There just isn’t a lot of guidance as to what is “right” or “wrong” when delivering wellness services. Health workers must get comfortable with operating in an uncertain regulatory environment. That is one of the biggest roles our law firm plays with regard to wellness practitioners: finding their legal comfort zone to deliver the services they want to deliver.
One popular alternative for nurses facing burnout has been establishing a career as a “nurse coach.” Put simply, a nurse coach is a nurse by training (either as a registered nurse or advanced practice nurse) who uses their nurse education to coach “clients” or “patients” to a state of greater wellbeing. Nurses who are licensed in nurse licensure compact states could conceivably practice nursing via telehealth to patients who reside in nurse licensure compact states. Many states in the U.S. are part of the nurse licensure compact, but a few are not (California being one of the few states not part of the compact). You can learn more about the nurse licensure compact and its implications, here. Nurses who have a multistate license through the nurse licensure compact can practice as a nurse using telehealth as long as they meet the legal requirements for nursing practice of the states in which their patients reside. Within a typical nursing scope of practice is providing a nursing diagnosis. A lot of nursing diagnoses could be very useful when coaching patients on achieving greater wellbeing, such as risk for metabolic imbalance syndrome, risk for injury, risk for nutritional excess, anxiety, chronic pain, loss of hope, spiritual distress, ineffective coping strategies, fatigue, among others. See https://nursestudy.net/nursing-diagnosis-vs-medical-diagnosis/. As a result, nurses are well equipped to provide wellness coaching services, but because they hold a nursing license, they can offer much more tailored services to clients than unlicensed health coaches.
There are nurse coaching certification programs from a variety of organizations, but as we inform our clients, there is no law that requires a nurse coach to have a certification. It certainly helps in providing the nurse greater confidence in acting as a nurse coach, but it is not legally required. This lack of legal requirement to hold a certificate is also true for health and wellness coaches. No state currently regulates coaching, in any form. The key difference between nurse coaching and health/wellness coaching is that nurse coaches can apply principles of nursing to and act as a nurse in their coaching practice so long as they hold a nursing license in the state in which they reside, as well as the state in which their client/patient resides. They must also follow the laws of those states when it comes to nursing practice, which may include physician supervision for some services, corporate practice of medicine and fee splitting regulations, scope of practice and standards of conduct regulations.
With the proliferation of virtual coaching platforms and the lack of regulatory restrictions for those who stay within the coaching scope of practice, it is no wonder that coaching offers an attractive alternative to traditional nursing practice.