This article appeared in the Winter 2011 issue of Practice Management: A Business Guide for Nurse Practitioners. 

For nurse practitioners (NPs) looking to supplement their existing income, there are several traditional and nontraditional avenues to consider. For example, they might choose to leverage their experience and skills as an expert witness or add services to their current practice that do not require a lot of extra practice management or work.

NPs are increasingly serving as expert witnesses, ie, using their specialized knowledge, skills, experience, and training as the basis for submitting independent opinions as consultants (by verbal or written report) or acting as expert witnesses at depositions or trials. Expert witnesses might be called on to testify in matters involving NP care, registered nurse care, and/or physician care and in cases regarding medical evidence. They may be called on to evaluate the standard of care provided by a hospital, nursing home, or other healthcare facility. An important point for NPs seeking to increase their revenue stream is that income from acting as an expert witness can be significant, with rates ranging from $75–200 per hour to $2,000 for a half day and $4,000 for a full day of testimony.

Where do you begin? The first step is to accrue extensive experience as an NP. The second step is to look at your specialty skills, as well as education, licenses, certifications, professional organizations, publications, lectures, and research experience. All of these factors contribute to your ability to serve as an expert witness.

How can you build up your resumé to qualify as an expert witness? As previously mentioned, the most important requirement is to build up clinical knowledge. Once you feel that you have sufficient professional experience, take a look at increasing your qualifications as an educator and polishing your presentation skills.

Who will hire you? Once you feel confident that you can serve as an expert witness, you can start looking for consulting opportunities. Send your resumé to physicians and hospitals in your area, as well as to the Board of Registered Nursing. Tell them that you are available to testify in your area of expertise.

Also research malpractice plaintiff attorneys and malpractice defense attorneys and notify them of your availability. It is a good idea to work for both sides of legal actions, since your goal is to be viewed as a neutral and honest expert. It is important to get references as your experience increases; they will be invaluable as you grow your consulting business.

When working as an expert witness, remember to be professional and responsible. Be well prepared and familiar with the local law, the appropriate standard of care, and the individual case, including the timeline and the patient, institution, and professionals involved. Once you are armed with the facts, you should focus on your presentation, which is also important. You want to testify like a professional. Here are some things to consider for your testimony.

Remember to stick with your area of expertise. Start small, and work your way up. As your experience grows—previous testimony given and proven success serving as an expert witness in other trials—you will find that recommendations from attorneys will increase and your income will grow as well.

Selling dietary supplements and skin care products through your practice is another way to increase your income. It may seem a bit unorthodox at first, but there are a myriad of useful dietary supplements and skin care products available today. Patients interested in trying homeopathic products and  vitamins/supplements will appreciate being able to purchase items that have been researched and endorsed by your practice. In the case of vitamin or vitamin/mineral supplements, you will want to purchase products from reputable companies with good quality controls.

Dietary supplements are a little more complicated. Keep in mind that the US Food and Drug Administration (FDA) does not have the authority to oversee dietary supplements in the same comprehensive way it does medications. The only way the FDA can stop the manufacture of a harmful supplement or crack down on the improper or substandard manufacture of an acceptable supplement is after complaints have been lodged. So, there are three issues to consider before endorsing a particular dietary supplement by offering it to your patients: the basic safety of the product, any possible interactions with other drugs the patient may be taking, and the quality provided by a specific manufacturer. Before offering any dietary supplement, check it out at the National Center for  complementary and Alternative Medicine (www.nccam.nih.gov) to be certain it is considered safe. Then, use the FDA website (www.fda.gov) to investigate the particular brand of dietary supplement you consider offering to see if the company’s products have been involved in complaints to the FDA or have been the subject of FDA actions.

You might also want to consider offering skin care products if they fit with the focus of your practice. There are a growing number of items on the market, and female patients are always looking for quality skin care products. Having high-quality products available for purchase makes your practice a “one-stop shop” for your patients. Plus, selling skin care products has the potential to generate significant income because their prices can be marked up considerably.

You also can expand your sales of dietary supplements and skin care products by offering your services as a speaker at community events such as health fairs or at senior citizen centers, schools, conferences, churches, or temples. Your presentation can cover any number of general health or wellness topics, as well as vitamin supplements and what dietary supplements may potentially help prevent certain maladies. If the venue allows marketing directly to audience members, you can sell your products after your presentation. It is important to note that giving presentations also allows you to answer questions about your practice and pass out information for possible referrals.

If you are focusing on skin care products, you can follow this same model at aesthetic seminars, volunteering to talk about general skin care topics and staffing a table following your presentation. When speaking opportunities are not available, consider renting a booth to sell your products and provide information such as business cards and a brochure about your practice for interested patients.

Finally, if you are interested in selling vitamin/mineral and other dietary supplements or skin care products, do not forget to obtain asset protection. Be proactive about separating your business interests from your personal assets. Remember, if you work to build a business, you need to be prepared in case something happens so it does not affect your personal wealth. Since rules differ by state, be sure to work with a professional to set up any asset protection tactic you decide to pursue.

NPs who want to expand their horizons and earn some extra money need to try thinking outside the box. There are a variety of avenues to consider, two of which are explored in this article. Just do not underestimate yourself. Remember that preparation, in combination with some innovation, will help you achieve your goals.

Melanie Balestra, NP, is a partner at Cummins & White, LLP, a business and insurance law firm based in Newport Beach, CA. Ms. Balestra’s practice focuses on issues that affect healthcare providers, including nurses, nurse practitioners, physicians, physical therapists, pharmacists, and dentists. She also continues to be actively involved in her profession as a pediatric nurse practitioner at the Laguna Beach  Community Clinic in Laguna Beach, CA.