GOMEZ NURSE STAFFING AGENCY

A BUSINESS PLAN

A PROJECT REPORT

Presented to the Department of Health Care Administration

California State University, Long Beach

In Partial Fulfillment

of the Requirements for the Degree

Master of Science in Health Care Administration

Committee Members:

Grace L. Reynolds, D.P.A (Chair)

Cindy Gotz, D.HSc.
Tony Sinay, Ph.D.

College Designee:

Tony Sinay, Ph.D.

By Robert R. Gomez

B.A., B.S, 2014, California State University, Dominguez Hills

August 2017




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 ABSTRACT

GOMEZ NURSE STAFFING AGENCY

A BUSINESS PLAN

By

Robert R. Gomez

August 2017

With the era of the baby boomers getting to an age where health care issues will be at an

all-time high, the shortage of nurses is a problem many health care organizations are already

facing. There is a huge opportunity for many nurses to get hired given the state of California

requires facilities to maintain a nurse-to-patient ratio. These ratios vary depending on the severity

level of the patient’s illness or condition the unit admits.

The goal of the company is to be able to help hospitals, convalescent home, retirement

centers and other skilled nursing facilities meet their patient satisfaction expectations by

providing the nurses needed to maintain quality of care. Nurses that will be provided are

Licensed Vocational Nurses, Registered Nurses and Nurse Practitioners.

The company will have a unique approach to market itself out of Long Beach to be

accessible to both Los Angeles and Orange County population and facilities. This business plan

will go over four different chapters of the Gomez Nurse Staffing Agency in topics such as

Marketing, Feasibility, Laws and Regulations and Financial Statements.

ii
 TABLE OF CONTENTS
ABSTRACT …………………………………………………………………………………….. ii

LIST OF TABLES …….………………………………………………………………………... iv

LIST OF FIGURES ……………………………………………………………..………………. v

1. MARKETING PLAN AND ANALYSIS …………………………………………...….. 1

2. FEASIBILITY AND SWOT ANALYSIS ……..……...……………………………….. 11

3. LEGAL AND REGULATORY ISSUES …………..………………………………….. 19

4. FINANCIAL ASSUMPTIONS ………………………………………………………... 27

APPENDIX: FINANCIAL DATA ……..……………………………………………………… 34

REFERENCES ………………………………………………………………………………… 42

iii
 LIST OF TABLES

1. Nursing Contract Opportunities With Facilities In Target Area......……………………... 8

2. Registered Nurse Salary Averages ………………...…………………………………… 14

3. Registered Nurse Target Area Salaries …………………..…………………………...…15

4. Nurse Practitioner Salary Averages ……………………………………………………. 15

5. Nurse Practitioner Target Area Salaries ….……………………………………………. 15

6. Licensed Vocational Nurse Salary Averages …………………………….…………….. 16

7. Licensed Vocational Nurse Target Area Salaries …………………………….……...… 16

8. SWOT Analysis ……………………………………………………………………...… 18

9. Start-Up Cost …………………...……………………………………………………… 29

10. Annual Expenses …………………………………………………………………….…. 31

11. Monthly Expenses …………………………………………………………………….... 32

12. Assumption of Revenue ………………………………………………………………... 33

iv
 LIST OF FIGURES

1. Life expectancy ……. ...……………………………………………………………….... 5

2. National supply and demand projections for FTE registered nurses 2000 to 2020 .......… 6

3. Target area ……….……………………………………………………………………… 7

4. Organizational chart ………….....………………………………………………...……. 25

v
 CHAPTER 1

MARKETING PLAN AND ANALYSIS

Introduction

The marketing plan will cover aspects of how Gomez Nurse Staffing Agency will

promote and advertise its services to nurses and nursing facilities. There are many social media

avenues that the Gomez Nurse Staffing Agency will utilize to help expand its branding.

Competitors and target areas will be identified. It is projected that by the year 2020, there will be

a shortage of nurses in the United States; the number that is being projected at 1 million

(Feigenbaum, 2017). Some geographical areas have been impacted by this shortage since 2010.

It is important that facilities in California are meeting the nurse-to-patient ratio as California is

the only state that mandates this type of ratio (American Nurses Association [ANA], 2017). The

ratios depend on the type of care and department the nurse is in as they have different ranges of

focus to choose from. That is why Gomez Nurse Staffing Agency is a lucrative business that is

getting into a great field that has a great potential for growth as it relates to providing nurses to

different nursing facilities. The goal of the company is to be able to help hospitals, convalescent

homes, retirement centers and other skilled nursing facilities meet their patient satisfaction

expectations by providing the nurses needed to maintain quality of care.

Company Analysis

Gomez Nurse Staffing Agency will look to hire Nurse Practitioners, Registered Nurses

and Licensed Vocational Nurses to provide their services to hospitals and skilled nursing

facilities. The nurses provided to the facility will meet the description and expertise that the

facility requires. Gomez Nurse Staffing Agency’s objective is to help nursing facilities be able to

maintain their operations at their optimal level. Gomez Nurse Staffing Agency will be providing

1
nurses to different types of nursing facilities, mainly hospitals for general or specialty positions

they need to fill.

Competitor Analysis

Competitors in the area vary from the average temporary help agency to those that are strictly

health care agencies. It is important to know where competitors are to be able to establish

benchmarks for the agency. It is still important to recognize competitors for benchmarking

purposes of the company. Gomez Nurse Staffing Agency will have more opportunities that

nurses will be able to choose from and it will be tailored towards their preferences. Here is a list

of a few competitors Gomez Nurse Staffing Agency would be going up against:

1. MGA Health Care: Has several geographical offices throughout California and in

Arizona. They provide services for nurses, technicians, specialist, administration and

executives to health care organizations (MGA Health Care, 2013).

2. Medipro Medical Staffing LLC: Has several hospitals that they work with, providing

Certified Nurse Assistants, Licensed Vocational Nurses and Registered Nurses (Medipro

Medical Staffing LLC, n.d.).

3. L.A Nursing Services, LLC: Contracts Certified Nurse Assistants, Registered Nurses,

License Vocational Nurses, Respiratory Therapists, Physical Therapists, Medical Social

Workers and X-Ray Technicians for hospitals, skilled nursing facilities, home health

providers, clinics, schools and private duty staff in the Los Angeles area (L.A Nursing

Services LLC, 2017).

4. Premier Nursing Services: Provides services throughout the State of California in cities

such as San Diego, Santa Barbara, San Francisco, Los Angeles and Sacramento in all

2
 types of nursing facilities. Focused on Registered Nurses only (Premier Nursing Services

INC, 2017).

5. Nursefinders: National organization with offices in New York, New Mexico, Georgia,

Maryland, California, Massachusetts, Texas, Colorado, Illinois, Hawaii, Tennessee,

Pennsylvania, Ohio, Oklahoma, Minnesota, Arizona, Oregon, North Carolina, Montana,

and Iowa. They range from nurses, technologists, therapists and health care support

professionals (Nursefinders, 2014).

6. Supplemental Health Care: Provides nurses, therapists, physicians, physician assistants

and health information professionals on a national level with offices in many states such

as: Georgia, Maryland, Massachusetts, New York, South Carolina, Illinois, Ohio, Texas,

Michigan, Colorado, California, Kansas, Florida, Oklahoma, Pennsylvania, Oregon,

Arizona, North Carolina, Virginia, Washington and Montana (Supplemental Health Care,

2017).

7. MedStaff Inc.: Works with travel nurses and provides their services throughout the

nation. Hot job locations where they provide staffing are in North Carolina, California,

Florida and Vermont (MedStaff, 2017).

8. First Class Nurses Inc.: Staffing nurse agency is located in Southern California and hires

Registered Nurses, Licensed Vocational Nurses and Certified Nurse Assistants (First

Class Nurses Inc, n.d.).

Market Definition, Potential and Demand

To begin with, the business will begin with opening up accounts in all free social media

account platforms available. For example, it will create accounts in Facebook, Instagram,

Twitter, LinkedIn and Wixsite. Facebook and Instagram will be linked together post the same

3
information and to promote and advertise job opportunities for people to consider. Twitter is a

great way to reach out to potential nurses and nursing facilities. Gomez Nurse Staffing Agency

will be able to follow health care facilities and see what changes they are going through and

possible new facilities which would lead to job opportunities. For example, if nursing facilities

post they will be going to a job fair, it benefits the agency if we are there to connect with them in

person and build a personal relationship to create future job ventures. When it comes to the more

professional social media, this is where LinkedIn is more useful. LinkedIn is used by many who

seek job opportunities and it provides employers the ability and features to post job openings for

many to see. A resume is typically a page long and by providing a LinkedIn presence, it lets us

identify potential nurses we can direct to nursing facilities that match their experience. Health

care facilities also provide a general overview as to their organizations’ history as well as job

opportunities and locations. Wixsite would be utilized to create an online avenue for people to be

able to search jobs. We would have a bank of job opportunities that are open and give more

detailed information about the organization’s history, objectives, job application submission,

mission statement of the company, and provide information to contact us by email, phone or

office visit. Wixsite also gives us an opportunity to show our clients and customers a deeper

understanding and knowledge of what we have to offer them and how we match nursing facility

needs and nurses’ experience together.

This will also give many health care facilities the ability to search and find Gomez Nurse

Staffing Agency easily. The reason it is important to go on all accounts of social media is

because not everyone has an account for each social media avenue mentioned above, but most

people have an account for at least one. It is important to be able to reach as many health care

professionals as possible and to be able to match them up to the job they are seeking as well as to

4
reach health care employers that can utilize Gomez Nurse Staffing Agency to staff their

facilities. All avenues of social media will advertise that we are looking for nurses who need a

temporary and temporary to hire. Temporary positions are those that will require the nurse to

work for an agreed amount of time at the facility. Temporary to hire jobs are positions that will

hire the nurse after the agreed amount of time has been completed.

The shortage of nurses in the health care industry was projected decades ago and is

becoming more of a reality. When we look at the population of the baby boomers, it makes up

20% of the American population. To be a part of this baby boomer generation, people must have

been born between the years of 1946 to 1964 (History, 2010). That would mean those that were

born in 1946 are 71 years old. The U.S. life expectancy in 2014 was 78.94 years. When looking

at the decade the baby boomers era began, the life expectancy at that time was 62.9 years old.

Figure 1 represents the U.S. life expectancy compared with Japan and the United Kingdom for

the last 50 years.

FIGURE 1. Life expectancy. (Google, 2014).

5
 By this estimate, millions of Americans have surpassed their life expectancy but due to

increasing health care advancements, the elderly are living longer lives which has caused this

shift in life expectancy and it continues to go up gradually as years go by (Google, 2014).

When looking at the projected number of nurses needed to meet the demand of health

care by 2020 it is said to be short by 1 million nurses (Maher, 2008). As you can see in the chart

below, there has been a shortage of nurses over the years, but the gap is expected to

exponentially grow:

FIGURE 2. National supply and demand projections for FTE registered nurses 2000 to
2020. (Maher, 2008).

Another focus point for the marketing team will be promoting social events and health

care related activities such as cancer and diabetes walks. By promoting events and attending, it

shows the community that we are serious about these issues and have an opportunity to meet

other health care organizations that are there for a good cause. By networking at these events, it
6
can provide Gomez Nurse Staffing Agency with an opportunity to build partnerships with new

facilities to provide more job opportunities for nurses.

Another tactic Gomez Nurse Staffing Agency will use is recruiting from nursing schools

and this is very important for placement for many nurses just finishing school. It is a good way to

address this issue in the shortage, because facilities will need to meet their patient-to-nurse ratio

standard required by the laws in California, which is defined by the severity level of patients’

illness at the unit.

Customer Analysis

Our customers will consist of health care facilities, matching their personnel needs with

the employees we would be providing. There are other competitors that are in the area and are

thriving due to the health care facilities located in the area. Due to the population in the Los

Angeles, South Bay Cities, Long Beach and Orange County, there are a large number of

potential patients that will need services from these nursing facilities. This map in Figure 3

shows the areas that we have potential of being able to reach and service.

FIGURE 3. Target area. (Google Maps, 2017).

7
 Populations for regions in the area are: Los Angeles: 3,971,883; Long Beach: 474,140;

Orange County: 3,147,655; and South Bay Cities: 763,166. The total population for the area is

8,356,844 (Daily Breeze, 2015; U.S. Census Bureau, 2016). Los Angeles, Ventura, and Orange

counties had a 14% nurse gap, which is equivalent to 10,115, considering only Registered

Nurses. By 2025 that number will be over 15,000; followed by 20,000 by year 2030 (Spetz,

2006). The location of the office is due to marketing reasons as well. The office location is in

Long Beach because it can be seen as the midpoint between Los Angeles and Orange counties,

meaning the range of potential employees and employers expands exponentially. Table 1 lists the

target areas where the Gomez Nurse Staffing Agency will negotiate with health care facilities for

nursing opportunities. Given the demand of nurses is always great, Gomez Nurse Staffing

Agency could supply the nursing facilities with qualified nurses for their services.

TABLE 1. Nursing Contract Opportunities With Facilities In Target Area

Hospitals Kaiser, Molina, St. Josephs, Little Company of Mary,

Skilled Nursing Facilities
Source: Google Maps (2017).
Torrance Memorial, Harbor UCLA, St. Judes, St
Francis, Long Beach Community, Dignity, Health
Care Partners and Kindred are all facilities that uses
many different type of health care professionals but
when it relates to Nurses, they will have needs from
Licensed Vocational Nurses, Registered Nurses to
Nurse Practitioners with specialties in many different
age groups. Many Registered Nurses are getting their
Bachelors and Master’s Degrees for career
advancements and competitive advantageous.
Sunnyside Nursing Center, Vermont Care, Heritage,
Del Amo, Sunnyside Retirement Center, Carson
Senior Assisted Living, and Welbrook Senior Living
require more standard nurse that are Certified Nurse
Assistants, Licensed Vocational Nurses and
Registered Nurses. Nurse Practitioners are not really
utilized in these facilities. Nurses with Licenses and
certifications up to date are able to maintain a good
standing here.

8
 Marketing Objective and Goals

The organization’s mission is to establish relationships with nursing facilities and provide

them with nurses to help those companies thrive. It is a burden when you have to start paying

overtime wages to nurses who are earning a high wage and to over work the staff can have a

negative effect on the nurses’ long-term quality life. There is research from the U.S. Department

of Health and Human Services that found a direct correlation between overtime and extended

work shifts related to worker illnesses, injuries and overall health (Olympic Staffing Services,

2012). Many businesses view overtime as a short-term solution. This is why providing a nurse to

these locations would be beneficial for organizations that are not trying to go through a long

hiring process and overwork their employees. This also provides an opportunity for the company

to evaluate the nurse before deciding to employ the nurse full-time. The goal of the company is

to provide an opportunity to nurses for possible full-time employment if the workplace offers

that opportunity after the contract has been completed.

Marketing staff will create health care-related topic articles to post for others to see and

gain knowledge that ties back to nurses. Topics could range from educational advancement

opportunities to vaccinations and events the company will attend to support and promote the

agency. Good publicity and a good reputation is always good. There can be online posts utilizing

Indeed.com to attract other companies to find Gomez Nurse Staffing Agency. The company

would start in Long Beach and attract clients in the area. A short-term goal would be to open up

another company office in San Francisco as it has a good base of nurses and a population worth

investing time into. A long-term goal would be to eventually get into other regions in California,

where nurses are needed. This would provide nurses an attractive offer to travel or relocate to

provide nursing services in the facilities that are short-staffed.

9
 Marketing Strategy

Marketing tactics this agency will apply are to stay very active through the online social

media avenues to establish itself as a reputable and well known company. Marketing will build a

relationship with nearby facilities who are offering possible job openings for nurses. Marketing

will eventually be essential in doing all the research for future locations that are lucrative to open

an office, gathering data that pertains to the elderly population and heavily populated cities.

Marketing will prepare all flyers, advertisements, networking events and maintain the social

media accounts.

10
 CHAPTER 2

FEASIBILITY AND SWOT ANALYSIS

This chapter will focus on detailing prices, distribution, communication, management

structure and strength, weaknesses, opportunities, and threats analysis for Gomez Nurse Staffing

Agency.

Pricing Management

The health care industry has a very profitable outcome as nursing facilities are willing to

pay to match staffing regulations. The willingness to pay the agency for nursing services to

operate efficiently and provide quality care to the patients is very important in the health care

industry. Pricing will depend on the contract language and will either take a percentage of the

employee’s salary or charge the nursing facility a competitive price for Gomez Nurse Staffing

Agency services. When it comes to the percentage of the hourly income for the temporary

positions, it depends on the contract language that will vary per facility. Percentages will vary

within a 12-50%. Pricing will follow the current industry averages mentioned in Tables 2, 4 and

6. Gomez Nurse Staffing Agency will stay competitive with other agencies to be able to have a

profit margin that will go into opening up different offices in different regions, considering that

supplemental nurse staffing is a $3.6 billion per year market (Aiken, Shang, Xue, & Sloane,

2013).

Distribution Management

The tactics to get in contact with nursing facilities will be through directories that the

company will pay for to reach out to nursing facility directors. Getting in contact with Nursing

Directors would be the main target. Social media will be a way to be able to follow any events

facilities will be attending which in turn will give the Gomez Nurse Staffing Agency an

11
opportunity to get in contact with an employer. Going out to organization meetings that are

health care related will also increase the networking opportunities for other facilities to hear

about our services. Human Resources will also outreach to nursing schools in the area to help

graduating nurses get a job right after nursing school.

Registered Nurses, License Vocational Nurses and Nurse Practitioners will be highly

needed to meet the demand for nurses in health care. The services that will be delivered will aim

at employers that hire and are in need of nurses. The nursing facilities that the Gomez Nurse

Staffing Agency will target are:

1. Hospitals

2. Skilled Nursing Facilities

3. Assisted Living

4. Rehabilitation

5. Hospice

6. Home Health Aid

7. Independent Living (Bernal, 2017; A Place for Mom, 2015).

Communication Management

The Gomez Nurse Staffing Agency will look for facilities that typically use nursing

agency to target them as primary or preferred locations where nurses are constantly needed.

Agency for Healthcare Research and Quality (AHRQ) research indicated recently that 44% of

hospital nurses believed that there were not enough staff to handle the workload (Aiken et al.,

2013).

Tactics such as visiting and calling staffing directors of hospitals will be vital to gaining

their trust and determining their demand for nurses. It is important to obtain directories of

12
nursing facilities in targeted area. This will help identify potential client contacts. There are also

trade organizations such as American Hospital Association that sell directories of their members.

Gomez Nurse Staffing Agency will reach out to these facilities to see if they are in need of

nursing services.

Networking events and health care issue events will be targeted to be able to advertise the

Gomez Nurse Staffing Agency as a way to attract attention to the brand, clients who are in need

of nurses and potential nurses who are looking for a job. It is important to know that many

hospitals hold events that require them to have volunteers and by partnering up with these

facilities, it is giving us an opportunity to reach out to the community.

Management and Control

Control of the Agency will be led by the chief executive officer, chief operation officer

and chief financial officer. The chief executive officer will oversee the company’s activities and

work closely with human resources. The chief financial officer will work closely with the

accounting and billing aspects of the agency. The chief operation officer will handle the

contracts, marketing and events the agency will attend. All three officers will make sure that

communication amongst all departments are running efficiently and as needed to achieve

objectives and goals.

Giving exams to nurses as they come in to apply for positions will help break down

communication barriers. There are certain facilities who give an exam first before employing

nurses to be sure they have the knowledge and experience to be able to work for them. These

exams could be administered by the Gomez Nurse Staffing Agency to have immediate results to

give to these nursing facilities that are in search of qualified nurses. Nurses would sign a contract

with us and we would be paying the nurses out of the contract signed with the nursing facility.

13
The nurses are to report to both the Gomez Nurse Staffing Agency and to the facility they are

working at so that we can all work in conjunction.

The primary supervisor when at work will be the nursing facility but any details outside

of work as it relates to requesting days off, vacation, and their pay check would go through the

Gomez Nurse Staffing Agency. The nursing facility would then be notified through the Gomez

Nurse Staffing Agency but the nurses would still need to adhere by the rules and regulations

given by the facility. Nursing facilities would provide nursing training packages to the nurses so

that they are aware of the rules and regulations to abide by.

All facilities that deal with staffing a nurse will be contacted to see how their staffing

levels are and if our services could help them in any way possible. Depending on the facility the

nurses are working at, hourly wages are in a range that gives us an average of what to expect

from each nurse.

There is a total of over 180,000 registered nurses employed between the Long Angeles,

Glendale, Long Beach and Santa Ana, Anaheim and Irvine communities (Nurse Salary Guide,

2017). Table 2 gives a breakdown of the income that registered nurses earn on a state and

national level. Table 3 gives a breakdown of hourly, weekly, monthly and annual pay in the

target areas.

TABLE 2. Registered Nurse Salary Averages

Source: Nurse Salary Guide (2017).

14
TABLE 3. Registered Nurse Target Area Salaries

Source: Nurse Salary Guide (2017).

There is a total of over 6,000 nurse practitioners employed between the Long Angeles,

Glendale, Long Beach and Santa Ana, Anaheim and Irvine communities (Nurse Salary Guide,

2017). Table 4 gives a breakdown of the income that nurse practitioners earn on a state and

national level. Table 5 gives a breakdown of hourly, weekly, monthly and annual pay in the

target areas.

TABLE 4. Nurse Practitioner Salary Averages

Source: Nurse Salary Guide (2017).

TABLE 5. Nurse Practitioner Target Area Salaries

Source: Nurse Salary Guide (2017).

15
 There is a total of over 51,000 licensed vocational nurses employed between the Long

Angeles, Glendale, Long Beach and Santa Ana, Anaheim and Irvine communities (Nurse Salary

Guide, 2017). Table 6 gives a breakdown of the income that licensed vocational nurses earn on a

state and national level. Table 7 gives a breakdown of hourly, weekly, monthly and annual pay in

the target areas.

TABLE 6. Licensed Vocational Nurse Salary Averages

Source: Nurse Salary Guide (2017).

TABLE 7. Licensed Vocational Nurse Target Area Salaries

Source: Nurse Salary Guide (2017).

SWOT Analysis

The strengths, weaknesses, opportunities and threats of the Gomez Nurse Staffing

Agency will be summarized and then assessed in Table 8. The analysis will point out details that

will be vital to thrive in the market.

16
 Strengths

One of the strengths of the Gomez Nurse Staffing Agency will be to utilize effective

communication tactics to build relationships with the community and nursing facilities. The

office location is vital as it relates to target area. Gomez Nurse Staffing Agency will create

strong relationships with many community based organizations and nursing facilities.

Weaknesses

A potential weakness of Gomez Nurse Staffing Agency will be that relationships will be

needed to create a contract with nursing facilities, meaning trust and confidence needs to be

gained to sign the contract. Competitors may be already established at target area facilities that

would hinder the progress of contract negotiations. Gomez Nurse Staffing Agency may have to

start off with a loan for start-up costs.

Opportunities

One of the Gomez Nurse Staffing Agency’s many opportunities is addressing the

shortage of nurses that is projected to continue. California laws require facilities to follow a

certain nurse-to-patient ratio pending the severity level the unit is treating. There is plenty of

space for expansion throughout the state past Los Angeles and Orange counties. Baby Boomers

are in high demand for health care due to aging and health issues meaning nurses will be needed

for their care. Networking events and social events will be a great help in building relationships

with organizations.

Threats

One of the threats to Gomez Nurse Staffing Agency is its lack of branding in the

community. Lack of income could jeopardize the company’s progress to expand into different

17
regions. If relationships and communications are not going well, it will make it difficult to create

business ventures.

TABLE 8. SWOT Analysis

 Gomez Nurse Staffing Agency will create strong

relationships with many community based organizations
and nursing facilities.
 Gomez Nurse Staffing Agency will have exams required
Strengths
by each facility based on knowledge and experience,
relating to the position they are applying for.
 Location of office will help expand the brand name of
Gomez Nurse Staffing Agency to many nursing
facilities as its central location will be in Long Beach.
 Gomez Nurse Staffing Agency is a brand new company
so its branding has not been well established in the
communities and with nursing facilities.
 Relationships with nursing facilities will take time to
Weaknesses build.
 Competitors may already have an established
relationship with facilities, making it harder to get into
these locations.
 Gomez Nurse Staffing Agency may have to start off
with a Loan for start-up cost.
 There is a huge shortage for nurses and the need for
nurses will continue to increase over the next decade.
 California laws state that a ratio of nurse to patient must
be maintained meaning the facility has to meet that
requirement and hire new nurses.
Opportunities  There is room for expansion into different regions in the
State.
 A large population of older individuals reside in the area
of Los Angeles County and Orange County.
 Baby Boomers are in high demand for health care due to
aging and health issues meaning nurses will be needed
for their care.
 Networking events and social events will be a great help
in building relationships with organizations.
 Threats are immediate nursing staffing agencies.
Threats  Failure to establish relationships and communications
with nursing facilities.
 Lack of income could put Gomez Nurse Staffing
Agency in jeopardy if payments are not being made to
loan or office lease.

18
 CHAPTER 3

LEGAL AND REGULATORY ISSUES

Gomez Nurse Staffing Agency is subject to numerous of federal, state and local laws it

must abide by. The agency will run as a small business to start up and have an attorney to check

all contract language and make sure Gomez Nurse Staffing Agency is operating legitimately and

in accordance with applicable laws and regulations.

Patient Focus

There are a few major federal laws that are patient focused that are applicable to the

nurses being provided through Gomez Nurse Staffing Agency to nursing facilities. One law is

the Health Insurance Portability and Accountability Act and its applicability to protected health

information in many states is to be carefully administered by the agency. Although the Gomez

Nurse Staffing Agency will not be dealing with patients directly, it is important for the nurses to

understand the Health Insurance Portability and Accountability Act, as it will affect them when

they are working at the various nursing facilities. The main things that pertain to the nurses with

the nursing facility are the Privacy Rule and security of health information. The Privacy Rules

basically established a national standard to protect health information while the Security Rule,

known as Protected Health Information (PHI), established a national set of security standards for

any PHI that is being held by an organization or transferred electronically (U.S. Department of

Health and Human Services, 2013).

Under the Health Insurance Portability and Accountability Act, nurses will deal with

handling patient information that is very sensitive and highly private for patients. The nurses will

deal with blood pressure, pre-diagnosed diseases, chronic illnesses, medications and many other

medical factors that are protected under the Health Insurance Portability and Accountability Act

19
law. Nurses will be trained that they have to be aware of the privacy rule as it relates to the

nursing facility patients they will be providing care for.

The Security Rule will play a factor when it comes to the nurses sending information to

other health care providers who are in need of referral information or asking for health care

information for medical decision-making or payment purposes. Information must be given only

to those who are authorized by the patient and those directly involved in the health care plan of

the patient. When transferring information, the nurses have to be aware that they are sending the

information to the right location and not share it with those who are restricted from having

patient information.

This leads up to the next federal law nurses will have to abide by, which is the Patient

Protection and Affordable Care Act, nicknamed Obamacare. Enacted in 2010, it has rules that

Gomez Nurse Staffing Agency must abide by as well. Gomez Nurse Staffing Agency will be

able to operate without providing health care to its nurses, but once the agency has 50 or more

employees, it will have to offer health care benefits to all nurses (Akken Cloud, 2017). The

commonality this federal law has with the Health Insurance Portability and Accountability Act is

that it requires many health care entities to share health information, to prevent duplicating

health services provided to patients. Health care organizations are becoming more integrated

with one another and have to share information to better help the patient’s care plan and

treatment. Medical decisions are done more effectively having all the information together in one

place and accessible to all providers.

Employees will be covered by the insurance of the Gomez Nurse Staffing Agency. It will

contain two sections:

1. Workers’ Compensation

20
 2. Employers Liability

This means that a policy will be in place in case a nurse is injured or gets an illness that

isn’t covered by state statutory benefits (Insurance Information Institute, 2017). Workers receive

benefits regardless of who was at fault in the incident. Injured workers wages are covered for a

certain percentage and for certain amount of time.

Human Resources and Employee Laws

The Equal Employment Opportunity Commission is a federal agency that controls and

implements civil rights laws against workplace discrimination. That means that Gomez Nurse

Staffing Agency will not discriminate against any employee or job applicant based on race,

color, religion, nationality, sex, age and physical or mental disability (Equal Employment

Opportunity Commission, 2017).

The Fair Labor Standards Act is another federal law that the Gomez Nurse Staffing

Agency will have to abide as well as state laws that overlap with this Act. The Fair Labor

Standards Act creates a basic wage standard that all states have to follow. It will be increasingly

important to know the different state laws in regards to established minimum wage, overtime

pay, recordkeeping, and child labor standards (Department of Labor, 2016). Local government

may also be a factor because local ordinances may require minimum wages that are higher than

either the state minimum wage or the federal minimum wage and it is very important to be aware

of these difference before they become an issue. For example, although minimum wage at the

federal is $7.25, California’s minimum wage is currently at $10.50 and is set to be at $15 by

2023 with a steady increase each year. California’s Governor Jerry Brown signed legislation

after lawmakers and labor leaders announced the agreement on wage increases (Siders, 2016).

California has also enforced a different law as it related to overtime pay. Overtime is paid when

21
the employee has worked over 8 hours in a day or has over 40 hours in their work week.

Employers pay the employee who is paid for one and a half times more than their usual pay for

the first 4 hours over 8. If the employee works over 12 hours in one day, then double overtime is

implemented as their pay rate.

The Family and Medical Leave Act is a federal law that mandates employers to provide

employees with job protection and unpaid leave for qualified medical and family reasons. Gomez

Nurse Staffing Agency will follow the Family and Medical Leave Act as it relates to family

leave under pregnancy, death in the family and other qualified reasons (Department of Labor,

2017). Additionally, California has a new Paid Sick Leave Act that the Gomez Nurse Staffing

Agency will follow.

Gomez Nurse Staffing Agency will utilize the employer identification number as a tax

identifier number. It is a nine-digit code that the agency will use for taxes, banking, and many

other purposes.

If employee is directly hired by the nursing facility then the nurses will abide by the

employers rules and regulations. Gomez Nurse Staffing Agency will receive a one-time fee for

providing the facility with a nurse or other compensation based on the contract language. It is

important to stick to the contract and not alter it, unless agreed upon by employer and the Gomez

Nurse Staffing Agency.

Gomez Nurse Staffing Agency will conduct background checks on all employee being

hired as it is important to check that the nurses we are providing have no criminal background

and the proper licensing required to operate as a nurse. Nurses are required to have a certain

amount of hours accumulated to stay updated with their licensure practices. Any nurse found not

meeting their requirement will be advised of their lack of hours to complete before being put in

22
the workforce. Nurses’ licensure will be checked to be sure that they are not giving false

information and check with their respective boards to verify their information. Each nursing

certification and license has a different governing body that manages each nursing division.

Human Resources will be tasked to stay up to date with any changes that the board decides for

nurses to maintain their status as nurses. Each nurse who is registered with Gomez Nurse

Staffing Agency will be required to maintain logs of continuing education units that they

complete each calendar year, as required to maintain their nursing license; they will be required

to submit these logs to Gomez Nurse Staffing Agency for verification each year.

Health care facilities will also be checked that they have the correct certification to be

able to operate the facility properly. Skilled nursing facilities must have a nursing home

administrator to be able to operate and understand the different laws and regulations they have to

abide by as they are different than a hospital. All health care facilities are licensed, regulated,

inspected and or certified by a number of public and private agencies at the state and federal

levels. This also includes the California Department of Public Health and Licensing and

Certification Program and the United States Department Health and Human Services Centers for

Medicare and Medicaid Services. Each of these entities focus on different aspects of a nursing

facilities such as payments that meet federal requirement, certification of nurses, acceptance of

Medicaid and Medicare and many more functionalities (California Department of Public Health,

2017).

The Immigration Reform and Control Act was passed in 1986 and the objective of this

Act is to amend, revise and reform or reassess the status of illegal workers. A person cannot be

discriminated in hiring, firing, recruitment or referral based on the citizenship of an individual

(Mees, n.d). The Immigration Reform and Control Act mandates employers to verify

23
employment eligibility of all new hires. Federal law prevents employers from rejecting valid

documentation and cannot insist on additional documentation from what is requested from them.

If the documentation appears to be legitimate, then the employer has to accept it. One example of

proof to work in the United States can be a social security card.

The Fair Employment and Housing Act is a California law that enforces civil right laws.

This California law protects individuals from being discriminated by employers on the basis of

race, color, ancestry, national origin, religion, creed, age (over 40), disability, mental and

physical, sex, gender (including pregnancy, childbirth, breastfeeding or related medical

conditions), sexual orientation, gender identity, gender expression, medical condition, genetic

information, marital status, military and veteran status (California Department of Fair

Employment and Housing, 2017).

Organizational Incorporation and Legal Framework

Gomez Nurse Staffing Agency will be a for profit corporation. A corporation is a legal

entity that is separate and distinct from its owners. C Corporations are able to utilize most of the

rights and responsibilities than a person can have, meaning it can enter into contracts, loans, sue

and be sued, hire employees, own assets and pay taxes (National Nurses Business Association,

2017). The Internal Revenue Service requires the business expenses be separate from personal.

The company will purchase computers, software, printers, and other equipment and supplies the

company will need to utilize to conduct business and communicate with nursing facilities. By

being a corporation, Gomez Nurse Staffing Agency will be able to get most tax deductions and

liability protection. The owner of the agency will not be liable for debts incurred by the

corporation, meaning their personal assets are not in danger.

24
 The management structure of Gomez Nurse Staffing Agency will have a chief executive

officer, which will oversee the whole company. The chief financial officer and chief operation

officer will report to the chief executive officer. The chief operation officer will be in charge of

contract negotiations with nursing facilities and making sure we have a presence at events, such

as networking, social and health fairs, etc. The chief financial officer will focus on the

accounting aspects of the agency as it pertains to billing the nursing facilities. Human resources

will utilize a software to maintain the database of nurses we have available to work for nursing

facilities. They will be in charge of making sure the nurses’ timecards are being submitted and

paid on time. Marketing will focus on advertising the business and all social media avenues of

the agency. The organization’s structure will be as follows:

Chief Executive
Officer

Chief Financial Chief Operation

Officer Officer

Accounting Contracts Event

Nursing
Billing Networking Social
Facilities

Health Fairs

Human
Marketing
Resources

Software Nurses Advertsing

Time Cards Social Media

FIGURE 4. Organizational chart.

25
 Miscellaneous Laws and Regulations

The Business License Division in Long Beach is responsible for licensing and permits for

all businesses in the City of Long Beach. Section 3.80.210 of the Long Beach Municipal Code

requires all businesses operating in Long Beach to pay a business license tax.

26
 CHAPTER 4

FINANCIAL ASSUMPTIONS

The following chapter will provide financial details assumptions for the Gomez Nurse

Staffing Agency. Topics being covered will range from monthly and annual expenses and

assumptions of expenses and revenue.

Assumptions for Expenses

Expenses will be very minimal as far as equipment is concerned. There are a few pieces

of office equipment that will be needed such as computers, desk, pens, chairs, furniture, and

Internet. Technological software will be needed for accounting, marketing and human resources

purposes.

Emergency kit and storage room will be needed for unpredictable/disastrous events that

could happen. The office should have a restroom for employees and the office space will be

rented/leased. The location to be rented/leased will not need any upgrades or renovations and

staff will keep office clean so we will not have any janitorial expenses.

There will be expenses for marketing purposes for social and networking events when the

employees goes out to the community. They will support other events and health fairs that will

promote and advertise for Gomez Nurse Staffing Agency. Material and equipment such as

portable chairs, tables, tent/canopy, banner, table cloth and giveaways for participants and

volunteers.

Expenses will also include employees’ compensation packages. Gomez Nurse Staffing

Agency will pay for insurance and for the proper licensure to do business in the city of Long

Beach. The following sections will break down expenses by start-up, annual and monthly

followed by how Gomez Nurse Staffing Agency plans on generating revenue.

27
 Start-Up Cost

The City of Long Beach requires a license to conduct business in the city, so the Gomez

Nurse Staffing Agency will complete the process to be able to operate out of Long Beach. The

rental location will require a three month deposit for the first year. The total amount for the

deposit will be 8,000 dollars. Office Equipment will then be gathered and the equipment needed

will be computers, furniture, desk, chairs, telephones, printers and finally some interior office

setup. Computers desk and chairs will be utilized by staff and nurses for work purposes.

Telephones will be needed for nurses and nursing facilities to contact our office. Furniture will

be in the office in the lobby so the nurses and nursing facilities staff can have a place to wait

comfortably. There will be ten desk for the Gomez Nurse Staffing Agency, such as the chief

executive officer, chief financial officer, chief operation officer, accounting, human resources

and marketing. Pens will be bought for promotion, advertising and gift purposes inside and out

of the office. Chairs will be bought for staff and possible employees and partnership facility

representatives. There will be printers that will be in the office so that anyone can get copies of

documentation that we can share with them with regards to their employment status and contract

negotiations. A software called Paychex will be bought for human resources to utilize to

efficiently manage nurses. Interior office setup will be to fix any maintenance problems the

location may have and as well set up offices for each department. Privacy is needed for dealing

with employment and contracts so rooms need to be secure and not out in the open for others to

hear conversations related to contract negotiations. Gomez Nurse Staffing Agency will also need

to buy material to be able to have a presence and be represented at events focused on marketing

services. Banners, tent/canopy, chairs, tables, literature stands, flyers, stands, and other

promotional material will be necessary to provide to the participants at the event that the Gomez

28
Nurse Staffing Agency will attend. When it comes to the quantity of equipment that will be

needed, there will be 10 computers, 2 couches, 10 desks, 5,000 pens, 30 chairs, 10 telephones, 2

banners, 2 canopies, 4 portable chairs, 2 portable tables and 2 tablecloths with the Gomez Nurse

Staffing Agency brand customized on all possible material. Miscellaneous will include

equipment and material that are required small in cost and unexpected material that may have not

been mentioned.

TABLE 9. Start-Up Cost

City of Long Beach Licensure $500

Contingency Fund $10,000
Deposit $8,000
Software $12,000
Computer x 10 $7,500
Furniture x2 $2,000
Desk x 10 $4,000
Pens x 5000 $4,800
Chairs x 30 $6,000
Telephone x 10 $1,200
Printer x 4 $3,200
Interior Office Setup $5,000
Banner x2 $800
Tent/Canopy x2 $3,200
Portable Chair/Table/Table Cloth x 4/2/2 $1,600
Insurance $10,000
Miscellaneous $5,000
Total $74,300

Annual Expenses

The Gomez Nurse Staffing Agency will have annual expenses including the salaries of

employees, rent, utilities, website maintenance, insurance, marketing, office supplies, event

material, and miscellaneous. Payroll will consist of the amount to be paid to the nurses which

will be dictated in the contract language. Each nurse will have a deduction of 30% from what the

hospital will pay, meaning that the Gomez Nurse Staffing Agency will be taking 30% of the

29
nurse’s hourly wage. The annual rate for rent at the Long Beach office will be set at $32,000 in

total. Utilities which will include trash, electricity, water, phone and Internet will be at $2,400.

Website maintenance is separate from the marketing because it is to renew the websites annual

fee. That will not be deducted from the marketing positions; rather it will go on their budget.

Marketing will require two people to manage to separate the advertising and promotion of the

company, but will start off with one for the first two years. Marketing will be collaborating

together with the chief operation officer in the event planning and coordination. Office supplies

will be a continuous order of paper, ink, pens, staples, computer accessories and other material

that will be necessary to run the office. Accounting services will require one accountant and they

will deal with all the finances with the chief financial officer overviewing their work.

Accounting will deal with all the billing and collecting from the nursing facilities. The chief

financial officer will oversee that the whole company is going in the right direction with reports

from the chief operation officer. The chief financial officer will report to the chief executive

officer on all the finances being collected and look for other possible ways to utilize finances and

assist with negotiations with nursing facilities with the chief operation officer. The chief

financial officer will not be hired until the second year to help with the expansion of the

organization. The chief executive officer will have final say in contract negotiation with the

lawyer approving them and making sure that the contract language is proper and ethical. Events

material will be an annual cost when it comes to the participants and volunteers for prizes and

giveaways. Materials can range from bags, water cups, lip balms, pens, echo dot, gift cards and

other miscellaneous expenses. The chief operation officer will also look into the planning and

coordination of events to attend to help promote and advertise agency in multiple cities.

Conferences and volunteer opportunities will be at the top of the list to create partnerships with

30
nursing facilities. The chief operation officer will use directories from associations to contact

facilities on their staffing to be able to create work relationships with them for possible future

staffing necessities. This is a great way to be able to network with these facilities and at the same

time be able to have a bigger impact in the community. Human resources will have a vital

position in implementing the software that the facility will be using as it relates to all

departments. They will see which options are feasible and it will be a two-person job by year 3.

Human resources will focus on the recruitment and retention of nurses, making sure that time

cards are being submitted on time, searching for nurses, attend social and networking events,

talent acquisition, creating workers compensations packages and keep track of who is referring

nurses. Human resources will also be attending many nurse school fairs to promote and attract

nurses to work through us to facilitate them into a desired work place that would be rather harder

trying to apply there directly.

TABLE 10. Annual Expenses

Expenses Year 1
Rent $32,000.00
Utilities, electricity, etc. $2,400.00
Website maintenance $1,200.00
Liability insurance $600.00
Marketing $45,000.00
Office supplies $4,800.00
Accountant Services $45,000.00
Chief Operation Officer $50,000.00
Chief Executive Officer $60,000.00
Lawyer $30,000.00
Event Material $25,000.00
Human Resources $60,000.00
Software $15,000.00
Miscellaneous $5,000.00
Total Expenses $376,000.00

31
 Monthly Expenses

The monthly rent for the office space in Long Beach will be $2,666.67 a month. Other

monthly expenses that the Gomez Nurse Staffing Agency will incur will be from office supplies

such as paper, printer ink, business cards and brochures. Electricity, phone/Internet and water all

fall under utilities necessary to operate efficiently.

TABLE 11. Monthly Expenses

Expenses
Rent $2,667
Utilities $200
Maintenance and Repairs $100
Insurance $300
Marketing Budget $100
Additional Monthly Expenses $200
Total $3,567

Assumptions for Revenue

By looking at the averages given in the Chapter 3, it is determined that the average

amount contributed by the nurses practitioner’s will be $13.16 an hour, registered nurse’s $12.55

an hour and licensed vocational nurse’s will be $7.13 an hour. These amounts will be revenue for

the Gomez Nurse Staffing Agency and the agency will be able to generate additional profit on

top of the contract language.

The objective of Gomez Nurse Staffing Agency for the first 6 months is to attract nurses,

have at least five contracts with different nursing facilities, and slowly begin to hire the

necessary staff. Gomez Nurse Staffing Agency will look to have 10 Nurse Practitioners, 10

Registered Nurses and 10 Licensed Vocational Nurses. These numbers below is what the

projected numbers would be if they worked full time for a whole year for the facility.

Given the startup process would not require much staff in the beginning, they would start

with only those positions that are necessary to operate. This means that expenses would be much
32
lower to still generate a profit. The agency is feasible given that the break-even point is at

$41,262.31 a month. The expected gross income for year one is $377,536.00 and the expenses is

expected to be at $376,000.00. Services will continue to expand in the next 2 years generating

more profits for the Gomez Nurse Staffing Agency.

TABLE 12. Assumption of Revenue

Gross Income Year 1

Nurse Practitioners $136,864.00
Registered Nurses $130,520.00
Licensed Vocational Nurses $74,152.00
Contracts $30,000.00
Total Gross Income $371,536.00

33
 APPENDIX

FINANCIAL DATA

34
 Balance Sheet
As At
2018

Unaudited

2018
ASSETS
CURRENT
Cash $ 333,253
Accounts Receivable -
Deposits and Prepaid Expenses -
Inventory 5,000
338,253

PROPERTY, PLANT, & EQUIPMENT 28,700

INVESTMENTS -
366,953

LIABILITIES
CURRENT LIABILITIES
Line of Credit $ -
Accounts Payable and Accrued Liabilities -
Long-term debt - current portion 6,657
Income Tax Payable -
6,657

LONG-TERM DEBT 7,103

13,761

SHAREHOLDER'S EQUITY
CONTRIBUTED CAPITAL -
RETAINED EARNINGS (DEFICIT) 273,192
273,192
286,953

35
 Statement of Income and Retained Earnings
For The Year Ended
2018

UNAUDITED

2018
REVENUE $ 813,581

COST OF SALES
Opening Inventory 5,000
Purchases -
5,000
Closing Inventory 5,000
-

GROSS PROFIT 813,581

OPERATING EXPENSES 340,160

INCOME FROM OPERATIONS 473,422

OTHER INCOME (EXPENSES)

Loss on disposal of property, plant and equipment -
Gain on sale of investment -
Miscellaneous (10,861)
(10,861)
NET INCOME BEFORE TAXES 462,561
INCOME TAX EXPENSE 189,369
NET INCOME 273,192

(DEFICIT) - Beginning of Year -

DIVIDENDS -
RETAINED EARNINGS (DEFICIT) - End of Year $ 273,192

36
 Gomez Nurse Staffing Agency
Statement of Cash Flow
For the Year Ended
2018

UNAUDITED

2018
CASH FLOWS FROM OPERATING ACTIVITES
Net income for the year $ 273,192
Adjustment for:
Amortization -
Loss on disposal of property, plant and equipment -
Gain on disposal of investment -
Cash derived from operations 273,192

Decrease (increase) in working capital items

Accounts receivable -
Deposits and prepaid expenses -
Inventory (5,000)
Accounts payable and accrued liabilities -
Long-term debt - current portion -
Income tax payable -
Cash flows from operating activities 268,192

CASH FLOWS FROM INVESTING ACTIVITIES

Acquisition of property, plant and equipment (28,700)
Proceeds from disposal of property, plant and equipment -
Proceeds from disposal of investment -
Dividends -
Cash flows from investing activities (28,700)

CASH FLOWS FROM FINANCING ACTIVITIES

Advances from (repayments to) shareholder -
Acquisition of (repayment of) long-term debt 13,761
13,761

NET INCREASE (DECREASE) IN CASH RESOURCES 253,253

CASH (DEFICIENCY) RESOURCES - Beginning of Year -
CASH RESOURCES (DEFICIENCY) - End of Year $ 253,253

37
Business Name Gomez Nurse Staffing Agency
Current Fiscal Year 2018
Contributed Capital $80,000.00

Startup Costs
Tennant Improvements $5,000.00
Office Equipment $26,700.00
Furniture $2,000.00
Permits (Licensure) $500.00
Deposit $5,000.00
Miscellaneous $5,000.00
Grand Opening Promotion $1,000.00
Cash On Hand Contingency Funds $10,000.00
Social/Networking Events $5,600.00

Yearly Expenses
Year 1 Year 2 Year 3
Total Employee Compensation $290,000 $440,000 $605,000

Monthly Expenses
Rent $2,667
Utilities $200
Maintenance and Repairs $100
Insurance $300
Marketing Budget $100
Additional Monthly Expenses $200

-
Financing Needed $19,200.00
Capital to be raised $20,000
Term Loan Interest Rate 6.50% per year
Length of Term Loan 3 in years

Sales
Average COGS 0.00%
Initial Monthly Sales Estimate $31,461
Monthly Sales Growth 21.00%

Effective Annual Tax Rate 40%

Summary Financial Data
38
Start Up Costs $60,800.00
Average Monthly Gross Revenue $147,080.18
Maximum Monthly Debt Payment $612.98
Monthly Break Even Sales $41,263.31
Average Monthly Pre-Tax Income $105,816.86
Venture Capitalist Valuation $1,022639.38
Discount Cash Flow Valuation $3,818,065.95

0%
0% 2% 1%
Monthly Costs Monthly Rent

0% Monthly Utility Costs

6% 1%
Monthly Maintenance and
Repair Costs
Monthly Insurance Costs

Average Monthly Wages and

Benefits
Monthly Marketing Budget

Additional Monthly Expenses

90%
Monthly Debt Servicing Cost

39
Breakdown of Monthly Cost

$2,500,000.00

$2,000,000.00

$1,500,000.00
Sales
Net Income
$1,000,000.00 Cash

$500,000.00

$0.00
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36

36 Month Financial Projections

2018 Financial Projections

40
2019 Financial Projections

2020 Financial Projections

41
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42
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