It began as a hobby and grew into a career. Barbara C. Phillips, NP, launched the Web site www.OlderWiserWomen.com in the summer of 2004 to solicit stories for a book she was putting together about women and aging. At the time, Phillips was securely employed as a family and geriatric NP at the Shoalwater Bay Tribal Clinic in Tokeland, Wash., and she had no plans to start her own business.

But running a Web site about healthy aging was too much fun.

"What I found out in doing this is that I absolutely love it," says Phillips, who left her clinic job in January 2005 to devote more time to the endeavor. "And I never, ever would have anticipated that."

Increasingly, nurse practitioners are looking beyond the limits of traditional practice. In some cases, entrepreneurial risk-takers are bidding adieu to reimbursement hassles, clinic politics and abbreviated patient visits altogether to pursue businesses outside the typical practice arena. In others, they're nourishing side projects that pad their paychecks and fuel their passion.

"I enjoy what I'm doing every single day," Phillips says. "I put in very long hours, but I'm having fun at the same time. Sometimes I wonder how come I didn't do this earlier."

Aesthetic Aspirations

To make time on the road less traveled, you have to be willing to work hard, plan well and take chances, says Lisa Williams, NP, owner of Ultra Smooth Skin Medical Aesthetics in Scottsdale, Ariz. As a senior NP student in 2003, Williams dreamed of working as a cosmetic dermatology contractor. Her goal was to charge practices an hourly rate to administer Botox, Restylane and other aesthetic procedures in their clinics.

"I was a little fearful to tell my professors what I wanted to do. Here we were learning about medicine and health and prevention, and I wanted to go into a field where I'd primarily be working with people who just want to be beautiful," she says.

"But I got up my nerve and asked my professor about it, and she said I absolutely should go for it," remembers Williams.

Williams scouted the Internet for opportunities and came across a company that hired her, trained her and sent her to open up the first cosmetic laser center in a mall setting in Arizona. With the input of a collaborating physician working in a similar center in Idaho, Williams provided the very services she aspired to and watched the practice grow busier and busier. She stayed with the company for a year, then moved on to open her own cosmetic practice.

It hasn't been easy. Williams rises early, works late and spends many a weekend in her office. Fueling her are a supportive husband, daily exercise and a competitive spirit. "I've always wanted to win," she says. "Even as a child, winning games, chess matches, tennis, ping pong, tap dancing - anything I could - was important. Having that competitive nature has been a good attribute."

Williams is beginning to see the payoff: Last month, she made around $45,000 in revenue. By reinvesting the profit in equipment and hired help, she continues to expand and strengthen her enterprise. She recently began hiring and training other NPs interested in opening aesthetics practices.

"My business is successful, but it's not where I'd like it to be yet," she says. "Obviously, your ultimate goal is to have other people working for you so you're not the one who is working so hard. I hope to be where I want to be in 2 years."

Expert Witness

For Andrea Thoman, NP, of St. Augustine, Fla., the journey to part-time self-employment began with a roadblock to full-time clinical practice. "When my family moved to Florida 2 years ago, I was having trouble finding a job. There isn't a lot of opportunity for pediatric nurse practitioners in this particular part of the state, so I began thinking about another way of working," she recalls.

Thoman had a longstanding interest in law, and a semester-long course on legal nurse consulting caught her eye. The nurse practitioner took the course and enjoyed it, but she has yet to work as a legal nurse consultant reviewing medical cases for a law firm, hospital or insurance company. Instead, she's discovered the specialty of expert witness.

Expert witnesses are professionals who are knowledgeable in a specific area and are hired by lawyers to testify on behalf of clients. Nurse practitioners don't have to be a legal nurse consultant to qualify as an expert witness, but the background education and specialty certification don't hurt. And, if you can get your foot in the door, the pay can be quite lucrative.

"Depending on whether you are testifying for the state or for private practice, you can earn upwards of $250 an hour," says Thoman, who practices part-time at Acute Care Pediatrics in Palatka, Fla. Within 12 months of finishing her legal nurse consulting course, Thoman had been hired for expert witness testimony three times. All three cases involved children who were allegedly abused, and Thoman used her clinical experience to tell the courts whether she thought they actually were.

Expert witness work isn't for everyone, however. Nurse practitioners who are already working full-time could find the scheduling tricky. Since witnesses are expected to be in court when called, a flexible work week (or employer) is essential. Clinical expertise is another must, as is the ability to be objective and stand your ground under scrutiny.

"You have to be tough and stick by your clinical assessments. Attorneys are interesting people; there are good ones, and there are bad ones. You have to be confident enough to stand up against them," Thoman explains. "But the ability to be objective is probably the most important thing. I give my opinion based on fact and review of information. I've always prided myself on being completely objective."

Supplement Sales

Lynda Smith, NP, has discovered a way to earn an extra $300 to $500 a month - and at the same time satisfy patients' demands for quality supplements. Providers at the Center for Integrative Medicine in Chattanooga, Tenn., have been selling nutritional products for years. When Smith, a family nurse practitioner, came to the center 3 years ago, it was only natural that she joined in the effort.

"It was something the practice didn't want to get into in the beginning, because it can be viewed as getting a kickback from the products we tout," Smith says. "But our patients are interested in taking care of themselves and kept asking if they could get these types of products in our office. They wanted the convenience and also to know that we had OK'd the product they were purchasing."

The clinic relented and today offers two lines of nutritional products: Vital Nutrients and Metagenics. The available supplements range from fish oils to multivitamins to herbal immune system boosters to green teas. Products are displayed on a bookshelf in the waiting room, payment is taken at the front desk, and profits are split evenly among the providers on a monthly basis.

It's important, Smith says, to investigate the value of any nutritional product before giving it lip service or shelf space. See what the research says, and if you think the supplement has scientific merit, find a line that has a reputation for quality and offer it in your practice. When marking up products (50% is typical for lower-priced items, Smith says), make sure the cost is still within patients' price range. With some of the more expensive items, such as coenzyme Q10, the markup will be less to keep it affordable.

Smith estimates that 40% to 50% of her patients purchase supplements from the clinic, but she doesn't employ a hard sell. "If I think the patient would benefit by taking a certain supplement, I say, 'We offer these products for your convenience. We don't push them, and you are welcome to look at other products at other places. If you have a health food store where you'd like to buy them, I'm fine with that. We just offer these for your convenience.'"

On a more independent level, Terri Ulichney, NP, of Makawao, Hawaii, sells supplements, too. She began doing so 3 years ago after purchasing a product that relieved irritable bowel syndrome that had plagued her on and off for more than 2 decades. She investigated the company and its line, and she became convinced she needed to share the opportunity to buy Shaklee products with others.

However, Ulichney limits sales to friends, family and customers who find her via word of mouth or her Web site (www.shaklee.net/smokie), believing that her employer would not be comfortable if she peddled directly to patients in the women's health practice where she works.

"But if I were in independent practice, I would not have a problem with it," she told ADVANCE. "Frequently patients ask me what multivitamin to take and to recommend a good calcium supplement. I believe my products are the best, but instead I name commercial brands that they might be interested in trying."

Ulichney, who in addition to her NP training has a master's in health education, collects an extra $200 a month through her part-time business. She expects the amount to grow considerably in the future and plans to eventually reduce her clinical duties to devote more time to the endeavor.

Menopause Coach

Rebecca Hulem, NP, worked at Kaiser Permanente for 25 years before she left to focus on a speaking career. Looking back, she wonders if maybe she moved too quickly. "If I had it to do over again, I would have worked at Kaiser a little longer and developed the business skills I needed to make the switch less anxiety inducing," said Hulem, who is also a certified nurse midwife.

When it comes to starting a business, new entrepreneurs commonly grapple with how to pace themselves. Those with a sink-or-swim mentality reason that desperation is the mother of invention and quit their jobs to focus on their start-up full throttle. Others are more comfortable with a start-slow-make-some-dough approach.

Hulem actually planned her break 3 years before she officially gave notice. She began lecturing about menopause on the side, and by the time she left Kaiser, she had a 16-city tour scheduled and contracts signed with two seminar companies. She published a book.

Then the economy slumped, and the pace began to slow. Hulem realized she needed to focus on marketing and sales - areas she knew little about. Had she studied them while still a full-time employee, she reasons, the ride may have been a little smoother.

Still, Hulem has rebounded well. Her speaking business has grown to include a Web site (www.themenopauseexpert.com), a monthly e-newsletter that reaches 2,900 subscribers, and teleseminars.

She has also launched a private menopause coaching service. For a $125 fee, women can hire Hulem to help them come up with a plan to transition comfortably through menopause. The 3-month deal includes an initial consultation and medical history, weekly phone calls, unlimited e-mails and collaboration with the patient's general health care provider when necessary.

"I have several coaching clients who I am working with now. Most of them have found me through the Web site or my newsletter," she says. "The beauty of providing coaching over the phone is that women can be from all over the country - or all over the world."

Although she's not earning the six-figure salary she commanded at Kaiser, she's pleased with how things have turned out. "The move to entrepreneurship has been both financially and personally successful," she says. "It takes several years to fully establish a business. I'm not quite at the income level I was before, but to get back up there is certainly my goal."

Aging Authority

Nurse practitioners yearning to spread their entrepreneurial wings should let passion be their guide. "Visualize what you enjoy doing already. Take that - whether it's counseling, consulting or teaching - and create a business around it," Hulem advises. "I would recommend taking a few business classes, too. The Small Business Association has a lot to offer."

Be wary of naysayers, adds Phillips, who has collaborated with Hulem to provide teleseminars to the www.OlderWiserWomen.com crowd. "Get your ideas on paper, and talk to friends and family. It's good to get input, but be aware of limited thinkers, and trust yourself," she says. "Explore."

The journey through possibility has allowed Phillips to expand her Web site from a tool to gather stories to an information center filled with articles, merchandise and an interactive forum. More than 1,000 subscribers receive her bimonthly e-newsletter, and last August many celebrated what she deemed International OlderWiserWomen Day.

This year, she hopes to commemorate the occasion with a weekend workshop for women. She also plans to offer teleseminars and home courses throughout the year.

"My passion remains in working with women, seeing that light bulb go off and making a difference in their lives. I just have a different way of doing it now," says Phillips, who, like most full-time entrepreneurs, has had to fall back on some personal savings while building her business.

"It's still gaining momentum, but I have no doubt that this venture will be financially successful," she adds. "It can't be anything but."

Jolynn Tumolo is the former managing editor. She is now a freelance writer based in Morgantown, Pa.