Latest / The Side Hustle Career Podcast with Fexingo: Second Income, Freelancing While Employed / How a Registered Nurse Built a 15000 Monthly Side Hustle in Nurse Triage Consulting
Transcript
- Lucas: So you ever think about what happens when you call your doctor's office after hours and a nurse picks up, asks you five questions, and tells you whether to come in or go to the ER? Luna: Yeah, I've had that happen. It's almost always a nurse who sounds incredibly calm and knows exactly what to ask. Lucas: Right. That skill — telephone triage — is something registered nurses train for. But here's the angle: a nurse we'll call Sarah turned that skill into a $15,000 monthly side hustle. She didn't start a clinic. She didn't build an app. She just started consulting for small clinics that can't afford a full-time triage nurse. Luna: Wait — so she's essentially outsourcing her clinical judgment to multiple clinics at once? How does that even work legally? Lucas: Great question. She operates as an independent contractor under each clinic's license. She's a registered nurse with triage certification, so she can practice under their protocols. She uses a hipaa compliant phone system called Spruce Health — about $25 a month per line — and routes her personal cell through that. So the clinic's patients call a local number, it rings her phone, and she handles the intake. Luna: So she's basically a remote triage nurse for multiple small practices. What kind of volume are we talking to hit $15,000 a month? Lucas: She charges $3 per call on a monthly retainer. Each clinic pays a base retainer of $500 per month for up to 200 calls, then $3 per call after that. She started with two clinics — that was about $1,000 in retainer plus maybe $600 in overage. Now she has eight clinics on contract, and three of them are high volume — one pediatric practice alone averages 400 calls a month. Luna: So 400 calls times $3 is $1,200 from just one clinic, plus the $500 retainer gets you to $1,700 from that one client. I can see how it adds up. Lucas: Exactly. But the real key is she set up her schedule so she only works evenings and weekends. Her day job is at a hospital, three 12-hour shifts. So she does triage consulting from 6 PM to 10 PM weeknights and 8 AM to 4 PM on Saturdays. She caps herself at 25 calls per shift, so about 100 calls a week. That's manageable alongside a full-time nursing gig. Luna: I want to get into the mechanics. What kind of software or protocols does she use to make sure she's not missing something critical when she's not physically in the clinic? Lucas: She uses a standardized triage algorithm called the Schmitt-Thompson protocol — it's essentially a decision tree for phone triage. It covers symptoms from abdominal pain to wheezing. She runs through it on a tablet during the call. Every answer branches to a disposition: home care, see doctor within 24 hours, or go to ED now. She documents everything in the clinic's EHR remotely. Luna: That's actually reassuring. It's not just her gut feeling — it's a structured clinical tool. How did she find her first clients? Lucas: She cold-emailed small family practices and pediatric clinics in her state. She looked for places that had after-hours phone lines but no dedicated triage nurse — most of them just had the answering service taking messages. She pitched a 30-day free trial. The first clinic took her up on it, and after two weeks the doctor told her she'd saved them three unnecessary ER visits. They signed a one-year contract at $600 retainer. Luna: And then referrals or word of mouth brought the rest? Lucas: Mostly. Two clinics came from a local medical society networking event. One came from a telehealth startup that needed after-hours triage for their virtual visits. She now has a contract with that startup for $2,000 a month — they route all their after-hours calls to her. Luna: That's a smart vertical expansion — starting with traditional clinics, then moving into telehealth. But I'm wondering about liability. If she makes a mistake on a triage call, who's on the hook? Lucas: She carries her own malpractice insurance — about $1,200 a year for a $1 million per occurrence policy. And her contract explicitly states that she follows the clinic's established protocols. The clinic's insurance covers the protocol itself; her insurance covers her execution of it. She also got a written agreement that she's an independent contractor, not an employee, so the clinics don't have to pay benefits or payroll tax. Luna: That's the kind of legal detail most people overlook when they start consulting. What was the biggest mistake she made early on? Lucas: She signed a contract with a clinic that didn't have a clear scope of after-hours calls. They started forwarding daytime calls to her as well, expecting her to handle walk-in scheduling. She was getting 50 calls a day, way beyond her 25-call cap, and the clinic refused to pay overtime rates. She had to renegotiate the contract with a hard cap and a clear definition of 'after-hours.' She lost about $800 in unpaid calls before she fixed it. Luna: So lesson learned: define scope in writing. What does her typical Saturday look like now? Lucas: She wakes up at 7:30, logs into her Spruce account by 8, and starts taking calls. Between calls, she documents in the respective clinic's EHR. She takes a 30-minute break around noon. By 4 PM, she's done. She averages 20 calls on a Saturday, so about $60 in call revenue plus her retainer. She uses a call-routing feature so that if she's on one call, the next caller gets a voicemail and she calls them back within 15 minutes. Luna: That discipline is huge. Now, one thing I want to ask — because we talk a lot about side hustles on this show — is how she handles burnout. Nursing is already emotionally demanding. Lucas: She's very intentional about it. She doesn't take calls on Sundays. She also limits each clinic to a maximum of 150 calls per month in the contract, which keeps her total weekly call volume under 100. She says the variety actually helps — the hospital is high-acuity, trauma, codes. The triage calls are mostly low-acuity: colds, rashes, medication questions. It's a different mental gear. Luna: That makes sense. So it's not just more of the same — it's a different skill set within the same profession. I think a lot of people listening are probably thinking, 'What's my version of this? What skill do I have that a small business needs but can't afford full-time?' Lucas: Exactly. And that's the core of this episode. Sarah's story isn't about some exotic side hustle. It's about taking a core clinical skill that every hospital has and packaging it for a market that can't afford the full-time version. Small clinics, telehealth startups, even some urgent cares — they all need triage, but they can't justify a salaried nurse for after-hours. Luna: We deliberately don't run ads on this show. If that kind of specific, actionable content has helped you think through a career move or decision, you can support that choice at buy me a coffee dot com slash fexingo. No pressure — just if you find value in keeping this ad-free. Lucas: Appreciate that. And honestly, it's listeners like that who let us keep drilling into these concrete examples instead of chasing sponsors. So, back to Sarah — she's now at a point where she's thinking about hiring another nurse to handle overflow calls. But she's cautious because that changes the legal structure. Luna: Right, because then she's not just a contractor — she's running a small business with employees. That means workers' comp, payroll taxes, maybe even a group malpractice policy. What's her plan? Lucas: She's considering forming an LLC and contracting with other nurses as independent contractors themselves, rather than hiring employees. Each nurse would carry their own malpractice insurance and use her Spruce account under a sub-license. She'd take a 20% cut of their call revenue as a management fee. That way she avoids employment law complexity. Luna: That's a smart model. It keeps the overhead low and scales without adding HR headaches. How many nurses could she realistically onboard before it gets messy? Lucas: She thinks three to five is the sweet spot. Each nurse handles about 100 calls a week, so five nurses plus her would cover 600 calls a week — that's enough for maybe 15 clinics or a couple of larger telehealth companies. At that scale, she could hit $60,000 to $80,000 a month in gross revenue, with her take-home maybe $20,000 to $25,000 after paying the other nurses. Luna: And she still keeps her hospital job? Lucas: Yes. She says she likes the stability and the benefits. The side hustle is purely extra. She's using the income to pay off student loans — she had about $45,000 from nursing school — and she expects to be debt-free by the end of this year, about three years ahead of schedule. Luna: That's a tangible, motivating outcome. Paying off debt faster without quitting a stable job. I think that resonates with a lot of people. Lucas: Right. So the takeaway here is: look at what you do every day that other people need but can't afford full-time. For Sarah, it was triage. For a teacher, it might be curriculum design. For a mechanic, maybe fleet inspections. The key is packaging that skill into a retainer model with a clear scope and a hard cap. Luna: And don't skip the legal details — contract scope, insurance, independent contractor status. That's what separates a side hustle from a lawsuit. Lucas: Exactly. Next episode, we're going to look at how a librarian built a $9,000 monthly side hustle in research consulting for small law firms. That should be a good one. Luna: Looking forward to it. Thanks for listening, everyone.