This NP needs Assistance.

When we start out thinking about building a practice, sometimes we have on rose colored glasses. We think of all sorts of wonderful things, sometimes glossing over the negative items.. Anyone will tell you that is the worst way to start a business.

I received an email from Nina Ravey, NP in Louisiana. As you’ll see, she has been in practice for over 5 years, and is struggling right now. Of course, anyone in business can tell you that a business will struggle from time to time. As Nina put it in another email it is not so easy to just start a practice without considering all of the unknowns. Wise words that should be heeded.

Please, if you have information or suggestions that will help Nina, please leave your comment below or contact Nina directly. Better yet do both. I’m sure it will be most appreciated.

I have a big problem that I hope some of you may have good ideas to solve. I have been in business for 5 1/2 years and have been having a uphill battle to get doctors to be a collaborative doc which they all don’t want to do because I predominantly have Medicare and Medicaid and because I am very outspoken and ask questions when I don’t know the answer. They have blackballed me in this small town in south Louisiana – the good ole boy network!

That has cost me a fortune. Some of the staff most who have come in with me end up stealing items from my office and I don’t know until a lot later.

Right now I am strapped for cash because of the poor billing (staff not billing some of the people) and a general exodus from my practice – guess they don’t want to get started since they believe that the doc who deserted me is going to open a practice here in town and several of my staff went over to him which really hurts, but then life goes on.

I question if anyone has grants that help pay overdue bills, pay off loans, buy new equipment, and whatever comes up? If you know of sites and can send them to me I would be most appreciative! Also, anyway, anyone have ability to write grants or know of someone I could contact for same?

I am down to the wire and looking at all avenues. Any suggestions would be appreciative.

Thanks to all of you for listening.

Nina Ravey, RN, MSN, CNS, C-FNP, APRN
Family Nurse Practitioner
Shirley Medical Clinic
711 N. Main St.
Jennings, LA 70546
Programs we offer: Pharmacy Assist, Kid-Med, LEAP Testing, WeightManagement, Physical Medicine and Rehabilitation, Diabetic Education
Classes, Walk-ins, Appointments
“What does not destroy me, makes me stronger.” by Nietzsche.

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  1. Hi Nina,

    I am not much assistance right now but want to offer support. I am on the other side of the fence getting started, and the financial struggles are huge. It sounds very rough in the region you are in regarding the physician situation, and staff leaving. I also am looking for grants/bill assistance, etc. I will let you know as soon as I find something. As I said before, you are very inspirational, and actually ahead of your time with your website, and newsletter, classes and programs. I know this ironically makes it tougher when you need support. Hang in there, and I will let you know if I come up with solutions. Carla/Oregon.

  2. Thanks to ya’ll Barbara and Carla for first of all, Barbara, explaining my situation with so much tact and feeling and to you both for your support. It really means alot and although i may not be able to go on with my clinic and have no idea what i will do in its’ stead with current negative climate here, I will persist! It’s hard to keep a good Cajun down! I may have lost the battle, but the war is not done yet and i will be there. Carla, if i find anything, i’ll let you know also.
    Thanks again,

  3. Nina, you have not lost the battle! I can tell you are an excellent provider and your patients need you! In my building there is a financial planner, and she prefers naturopaths and NPs as her providers, and she said it would tear her up when a “wonderful provider” would close up shop due to financial loss. She said it was a matter of not knowing how to financially plan. I myself dont know. I am down to the last 3,000 and I have a 2,000 dollar mtg, an 800.00 lease for the office. I just now sent all the insurance credentialing apps in to about 11 major insurance companies, BCBS of Oregon, Lifewise, ODS, Pacificare, Aetna, Cigna,Providence, Pacific source, and Health Net, and Great West, and United, which includes Pacificare now, including oregon medicaid. But there is a 3 month delay, and patients that have insurance may not want to come in til then. I am about to hand carry 15 letters to merchants announcing my opening, I have asked the local newspaper to do a feature articke, and have a computer guy coming over tomorrow to make sure my printer works with the lap top, and then I will get Amazing charts on the phone, and do a practice patient ( a friend) to make sure everything runs smooth. I am meeting with the chamber today. I will have an open house in about a month after I feel a bit more comfortable about dotting all my i’s and crossing t’s. I will focus on the “uninsured” in town, until I get credentialed, but am seriously considering, since I did not have a patient following from a nearby clinic (did not work recently in Wilsonville), maybe I will have to open the clinic only 2 days a week, and work for a steady paycheck 3 days a week. Have you thought of doing that? One NP I know,did have a following, but she is only open M, W, F. She also had some financial help, and she is now fully booked. It is hard to be open to job opportunities if you are advertising your practice as 5 days a week, and do not have a second income. I am also in that dilemma. The only other way I can see is to get some Angel investor, or a bank loan. I am praying hard for this, because I have one more month, before significant changes need to happen.

    I am too new to know yet about opposition from the medical arena, but in your case, that is awful. First you need funding so you can fight. Maybe cut down a couple days, get another income, and I know online there is an angel network, and the sba has loans. Maybe even grants still available. SCORE offers free counseling. Is there even one doctor you are on good terms with? I am wondering if you could sort of do a reverse sale? Sell it to a doc, with a contract that you are a mandatory employee, and after 2 years, he/she has to sell it back to you, and he/she can be a partner if you work well together, that might build up the patient base for you again. I am sure they would rather see you, but they are just afraid of the pressure. Fear is a powerful motivator. I will continue looking, and for myself too. Regards, hang in, Carla

  4. Nina, here is one idea, another NP brought it up again,as we were talking about other issues. Have you tried contacting Carolyn Buppert? She is an NP attorney as you may know, and she is available by phone or email. Her website is She will do a consultation, and may be able to give you great legal advice regarding your situation. I would be interested in an update. I will also email you, to see if you wish this situation to go to a couple list serves. Carla

  5. Nina, I just saw this information about you. I hope things are better now. How far are you from Slidell, La. My friends lives there and she use tohave a successful practice in Los angeles California… she is always full of ideas but she is out of town right now.

    One of my associates Dr. Bettye Ward Fletcher can write grants and may be able to do a grant search for you but she does charge for her services and depending on the grant you know this can take time. The local college where I live has small business assistance and I am sure that they probably do there and it is a free service… what about your accountant….? what does he orshe say?

    Contact info for Dr. Bettye Fletcher : Professional Associates, Inc

    When my friend Geri gets back in town I will give her your contact information.

  6. Thanks all and I appreciate to words of advice and encouragement. Ritha, I would appreciate your contacting your friend in Slidell – its a little far (2 1/2 hours on I-10 going west – halfway between Houston and New Orleans) but she may know someone. It’s terrible to say, but some of the NPs in my area are too afraid of the docs to even support me and tell me to keep my mouth shut – don’t write articles for the paper, town newsletter, on my website, etc. and cut out any teaching like i have been doing for 5 years – free diabetic classes every 3-4 months in my town and in the next town 20 minutes away. I respond that it is OUR JOB to educate the public and we will never get our cause known and show how valuable a health care provider we are unless we do speak up and express the knowledge that we’ve had crammed in our heads for in my case 12 years thank you very much! One NP is even viscious and is a doc want-a-be and looks on list serves and anywhere he thinks i might go to catch me saying somehting he can twist to sound sinister. Its horrible to be treated like a pariah and it has happened to a few more NPs who had to close their clinics under the pressure and expense. Only those in private practice know what it’s like to be shunned – those working with docs or for docs have no idea what we are up against and don’t think things like getting rid of the collaborative practice agreement is important “right now”. If the AMA wins a case against the retail clinics we may as well kiss our professions good bye because they will continue to press for more and more authority over us and they ahve too much already. We need to get the govener of Pennsylvania to go around the country speaking out for NPs since he has opened the door full throttle for NP practice – or maybe we just need to move to PA!

    Thanks again and all of you keep on plugging away because the more of us that are in independent practice, the more we are gaining acceptance with the public.

    Happy belated 4th to all of you also – double for you Carla for sending me a greeting first and thanks!


    i don’t know if I told ya’ll but I have an additional web site ; – check it out if you get a chance.

  7. Hi Nina,

    Here are Megs suggestions from the NPinfo list serve, after reading about your situation. She has some very good ideas:

    I would speak with all the legislators in the community and help raise
    awareness to your plight in Louisiana…I would do newspaper
    interviews, business journal interviews…gain support from banks, get a really
    good lawyer!! and set up a trust fund with the bank so donations can be
    sent to the bank from those of us who can help out
    financially……have a good business plan written…I would contact every state legislator
    and tell them why you think your clinic is important.!!…. some of my
    Meg Helgert FNP
    Portland OR


  8. Thanks Carla for sending that on and for Megs suggestions which are wonderful! Please send me the address of the np info listserv – i must not belong.
    I will try very hard to put into action all that she has mentioned – i had thought of it but the time factor is really eating my lunch. The crying jags don’t help much either. Found out this wkend that my x staff let my DEA lapse and now i have to call DEA and try to salvage my license. I caught my RHC renewal a few days before that would have been too late. I just don’t know what else they have in store for me in the way of booby traps and am frankly afraid of what they might have done out of spight or whatever their reason for all of this undermining. It breaks my heart to think that i befriended these people and actually knew my office manager for over 20 years when I taught her in PN school, then did a refresher course with her in my clinic when I first started to allow her to get her license back after sitting out to have children, took care of all their family and friends, sometimes for free and they pay me back with this treachery. It is so disheartening.
    I’ll be back up to snuff tomorrow (I hope) but now I’m taking a nap because I have a huge headache from all the crying that I do everytime I start talking about it or someone asks me about it. Have to put on a good face for tomorrow for patients.

    Thanks for your words of support and comfort. Know that I appreciate them more than you know.

    Nina Ravey

    Barbara, my additional web site is

  9. Hi all,
    Just a short note on the latest news with my clinic. My ex-office manager and ex-friend of 20+ years went behind my back and managed to convince the police jury that i was horrible as a jail nurse and she and her doctor could do a much better job for the same money. Well the contract was signed and I was notified a week later that I was “terminated” from the jail job. She knew that I derived a huge bit of my monthly income and what I am paying my current staff with right now, and so she plotted to get it from me. I went to the police jury meeting Wednesday nite only to have the newspaper print a front page article practically cutting me down while singing the praises of this new doc. I called the guy from the paper the next day and told him I did not appriciate him wrtiting such a slanted story about the whole affair and make it look so bad for me. He told me he wrote it to be fair for both sides. I told him he did not make it fair for both sides because it made me look bad from the getgo. The jury will vote on the issue this next Wed. and I’m pretty sure I will not get it back, but I have to try to the end.
    I fear the worst is up ahead. They are being so devious in their plans of treachery against me. It hurts to the core. But worst of all, I have no idea how I will make ends meet now and fear all may be lost.
    On a good note, two people who used to work for me and who were practically pushed out by my ex-office manager, have come in to help me for free on their days off to do the billing. They are such a blessing. They have unearthed much of the stealing that went on by the other crew and are trying to straighten everything out so it will all balance correctly.
    It’s a sad state of affairs when things like this go on right in front of your nose and you trust people so much that they are doing the right thing, only to find out that everything they have done has been to destroy me.
    Later all,
    Will keep you all posted on any progress,


  10. Gosh Nina,

    This all seems so unreal! While I hate to see it happen, I do hope that it serves as a reminder to the rest of us to check on things as we go forth.

    There was an article in our local paper a few months ago about a dental practice that had discovered their office manager of many years had stolen a few hundred thousand (if I remember correctly) from the practice over the years.

    She was eventually caught and convicted. It show you though…you really can trust no one too much when it comes to your business.

    I’ve seen it written that we should be splitting up some of the duties so that no one person has so much control. It would put a few checks and balances into place.

    I am wishing you the best.


  11. Thanks for all the best wishes. And my worst fears did come true when I went to the police jury meeting only to be treated as a small child and chastised that I should not have a smart mouth – please, as the only professional in the room full of good ole boys and farmers and small town (and small minded) gossips, I was made to feel like I had done everything wrong even as I tried to explain that I had been sabotaughed by my ex-office staff especially my ex-office manager/nurse after all the treachery they did. I was hurt to the core and my first thoughts were to get revenge and get even. I was talked out of that and made to stand down and let my silence be the best revenge against all the jackasses out there. I don’t know how effective that will be because this is a small minded town and I can see I am spinning my wheels here, but cannot stand to see my patients thrown to the wolves. I keep saying that I am going to write a book with all of my experiences – some good, but mostly bad. Had a conversation with our state representative who is running for state senator and graduated from high school with my husband and his wife worked for me for a little while and he was about as pig-headed as the bunch of the good ole boys can bee when I asked him to support NPs in their bid for practice without collaborative practice. He told me that he firmly believed that we had to have doctors supervising us and that’s what they made medical schools for. I told him I might have to move to Pennsylvania because the govenor was so far ahead in his thinking that it must be a much better place to live than here (Louisiana) where we were so oppressed as NPs. He made a few more comments about how doctors needed to supervise NPs and I lit into him and recounted quite a few occurences where I had seen patients where the good doctors were too good to even put their hands on the patients because they were medicaid, poor, uneducated, dirty, ugly, etc. and in one instance a 30 year old woman who had gone to 3 doctors in a few weeks complaining of being very tired, constipated, no appetite, losing hair, etc. and when she came to me, I took one look at her thyroid and it was enlarged and when I palpated it, felt a mass. I sent her for a U/S and sure enough the results showed she had a mass in her thyroid. She goes for a surgical consult in am. I told him she might die because those doctors wouldn’t even touch her. And I told him – and explain to me why I need doctors supervision? I also shared with him all the occurences I have had for doctors to steal from me, one embezzeled $100,000 from me because some insurances don’t reimburse NPs and so this bozo kept all the money from the claim we submitted under his name, paid off his credit cards, built an office and then when BCBS wanted their money back, he wanted me to pay up and I refused so he sent a maffia type person to get it from me and after many times of him warning me, I finally told him to report me, I didn’t care if I went to jail, but he wasn’t getting one dime from me because I didn’t even have one EOB with which to identify my clients from his. He finally left me alone. I recounted several more stories and he was speechless. He was supposed to call me the next day and never did, so I guess I scared him and his doctor praising attitude for good.
    Well way past time for bed. I’m sure more wonderful things are in store for me tomorrow and I can hardly wait (I’m being fecisious!)
    Barbara, did you get the link I sent you with all the forms for all of us to use? It was a great site and if you didn’t get it, I will resend.
    Thanks for all of your prayers. Always be watchful because you never know who will try to undermine you.


  12. Nina,

    I’m speechless. I’m so sorry that any NP has to put up with this. While I understand what you are saying about your patients, please take care of yourself. You patients will not be helped if you don’t.

    Do you have a state organization for NP’s? What about the local chapter of the ANA, AANP or ACNP? Have you contacted them?

    Thank you…I did get the link and will be adding it to the resource list.

    Take care,


  13. Thanks Barbara,
    We do have a state org but they will not get involved with any such issues. I’ve asked if we couldn’t file a restraint of trade and they vehemently denied doing so.
    I never thought of the national org. though. I will try that avenue – I’ve tried every other to no avail.

    Thanks again,


  14. Hi Nina,

    Just wanted to get back to you on this site. I hope you have the strong support of your family through all this. It really sounds like you are in a “backwards” area of the nation to have that type of such old fashioned thinking. It is awful. We all have seen example after example of excellent NPs, and medical errors committed by physicians. Not that they are all like that, but to ostracize you, and scapegoat you and your practice is despicable. You are very passionate about your views and what you do, but what would be your priority now if you could have it? What is your main goal? Or even the second one? Do you want to keep seeing patients? Is your overhead low enough that you could get by with 5-6 a day, while you pursue restraint of trade issues? It sounds like you have had your good name and practice maligned which is criminal as it ruins reputation and loss of income for years, so that would be something to pursue. I truly wish the best for you, and I know things will start to turn around, but maybe you need to find a good attorney that will be on your side, not the “good ol boys”. Carla

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