Photo: Jon M. Fletcher
Small Business 2013
Nursing Itself Back to Health
Dwight Cooper's staffing business has had to adjust to changing market conditions.
PPR Healthcare Staffing in Jacksonville Beach rode its expertise in supplying nurses to hospitals to No. 116 on Inc. magazine’s 2003 list of the nation’s 500 fastest-growing companies. The company had increased revenue 1,350% from 1998 to 2002 to $30.3 million. The good times kept coming, as all the buzz was about a national shortage of nurses. By 2007, PPR was nearing $50 million in revenue. And then? “Kind of rode off the cliff with the economy in 2008,” says founder and CEO Dwight Cooper.
It’s not that fewer people needed nurses in a recession. But health care operator incentives such as signing bonuses landed more permanent nurses. A big push to educate more — the number of graduates from four-year nursing programs more than doubled from 2000 to 2010 — eased the shortage as well.
But the economy played the biggest role in harming companies such as PPR. Part-time nurses and those who had left the workforce entirely found they needed full-time work when spouses lost jobs or alternative careers cratered. They returned to nursing full time in droves, knocking down the need for hospitals and other facilities to call on PPR. Similar companies suffered. Cross Country Healthcare in Boca Raton struggled as the shortage evaporated, and Boca-based Medical Staffing Network wound up in Chapter 11.
PPR saw revenue drop by half. A strong balance sheet kept the doors open but could carry the company only so far. Cooper, in what he describes simply as an “awful” process, cut the workforce from 100 to 47.
Those who remained made “lots of sacrifices,” Cooper says. The silver lining was that the company, until then focused on keeping up with growth, had no choice but to examine ideas that it had considered for diversifying the revenue stream but had never acted upon. PPR offered itself as an outsource, on a per-visit fee basis, for insurance companies that need to conduct annual health assessments of Medicare recipients. It also became a vendor management company, earning a percentage of revenue, for health care companies juggling myriad vendors.
A promising new endeavor is consulting for health care clients on recruiting everyone from housekeepers to nurses. Invisible to the applicants, PPR recruits and does interviews and other hiring work. Supplying nurses remains the lion’s share of PPR’s business, but the new “managed service” businesses are growing fast and have a higher net profit, Cooper says.
PPR is up to $40 million in revenue and 80 employees. After 2½ years of losses, the balance sheet is much diminished. Cooper says it isn’t clear how the new health care law will affect the business. Long-term trends are in PPR’s favor. As the population ages, demand for nursing services will grow, according to the American Association of Colleges of Nursing.
PPR for nine consecutive years, including the year Cooper laid off half the staff, has made the Great Place to Work Institute’s Best Small Company to Work for list.
“I’m just working with great people. Love what I do,” says Cooper, 47. “These are some of the best experiences of your life, when you go through that adversity. That’s what it’s really all about. I wouldn’t trade those years for anything.”