ENTREPRENEURS
Rx for success: read the trends, translate them into business

by Lisa Antonelli Bacon
For Virginia Business
August 2005

In the early 1980s when Henrico Doctors’ Hospital opened its first outpatient surgery unit, registered nurse Deborah Johnston realized the treat-and-release method had some bugs to work out. “We were wheeling patients out who were vomiting,” she recalls. “I could see that, when these people leave there, they still need care. I said, ‘This is my future.’”

Little did she know then, but Johnston was on the front end of a trend. As anyone who been hustled out a hospital door knows, long hospital stays are a thing of the past, increasing the need for continued care. Seventeen years later, Johnston runs Richmond-based Care Advantage, a $14 million-a-year home health and nurse staffing agency with eight offices in Central Virginia and 2,000 employees.

It took a while for Johnston to start her company. While still tossing around the idea of a home health enterprise, she agreed in 1985 to start a home care and staff relief company for Chippenham Hospital. By 1988, Johnston had learned the fundamentals of the business and wanted to strike out on her own, but she wasn’t financially prepared.

“In business, you need three things,” she says matter-of-factly. “Money, money, and money.” The solution was to take on a partner, and Johnston says she was lucky to find the right one, Buddy Allen, a lawyer now with the Richmond firm LeClair Ryan. “We grew like wildfire,” she says. “We did $225,000 in business in our first three months.” By 1991 — just more than two years into the venture — Johnston bought out her partner.

On the alert for growth opportunities, she found a new niche in 1998 by recognizing that nursing shortages were causing staffing problems across the board. Nursing homes, hospitals and even doctors’ offices frequently need — on short notice — nurses for temporary or permanent assignments. So Johnston began Nurse Advantage, a service that matches nurses to staffing needs. “By creating two divisions,” she says, “we could focus our full attention on our clients and nurses.”

At one point, growth overtook time and energy. After setting up 11 offices in Virginia, Johnston forced herself to slow down. “I was running myself crazy. Offices more than two hours away were hard to manage, so I sold three.”

The slowed pace, however, didn’t last long. In February, she began another venture, All About Care, the company’s Medicare division, which serves patients over 65, a growing segment of the population. “It’s zooming. We’re projecting revenues in our first 12 months to exceed $1.2 million,” she says.

Through the years, Johnston’s ability to read trends and grow her business have brought many awards including Ernst & Young’s Entrepreneur of the Year for Virginia in 1996 and citations from Working Woman magazine for entrepreneurial excellence in 2000 and 2001. Johnston also donated funds to start a certified nursing assistant training program for low-income women in partnership with the Richmond Redevelopment and Housing Authority. Joan Seldon, assistant director of resident services at RRHA, says 220 residents have gone through the training so far. “We never envisioned that she would start a state-certified program. She believes in going all out with whatever she gets involved in,” says Seldon.

Overall, Johnston’s most consistent challenge in the nursing business is managing women. “Men aren’t my problem,” says Johnston. “I work with mostly women. Occasionally, they may not get along. That is the challenge: to keep everybody getting along.” Still, she feels she was born to be an entrepreneur. “The bigger the mountain, the harder I climb.”