Practicing Functional Medicine within Nursing Scope

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In this episode of the Functional Nurse Academy Podcast, Melissa Schreibfeder, BSN, RN, BC-FMP, explores the rapid rise of functional nurses and the critical role they can play in addressing the growing chronic disease epidemic through root-cause, lifestyle-based approaches. She discusses the growing demand for ethical, clinically grounded functional medicine support and highlights the integrity concerns that can arise in an increasingly unregulated wellness industry. Melissa also breaks down how nurses across multiple licensure levels, including RNs and LPNs, can legally and ethically incorporate functional medicine principles into practice while remaining within their scope of practice. This episode provides clarity on how non-advanced practice nurses can offer educational and wellness-based functional medicine services, collaborate with licensed providers, and utilize their nursing background to support clients in a safe, evidence-informed manner.

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This show is also syndicated every Tuesday at 10am EST on The Nurses Report on America Out Loud Talk Radio 

Transcript

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Hello and welcome to the Functional Nurse Academy podcast. This is your host, Melissa Schreifetter, owner and founder of the Functional Nurse Academy. Welcome everyone. It's always so great to be here with you all. Today I am doing a show solo because it's been a long time since I have just done a show by myself. And I really wanted to just hone in on the ethics of functional nursing. How are nurses practicing functional medicine ethically and legally? And I also wanted to discuss the shortcomings going on in the conventional system and in the wellness industry. And I also wanted to touch on some um issue with practitioners saying that they're practicing functional medicine but not doing so with integrity. Well, first of all, wanted to just chat about the conventional medical model, guys. So there are so many people. I really think that there are more people than ever that are seeking alternative medicine because so many individuals really have broken trust in this system, you know, and things have been going on for a long time. And I feel like it was COVID that was the straw that broke the camel's back. So now we all know that of course conventional medicine has its issues, but so much trust has been broken that it's concerning because what what if we really do have a significant health emergency because public health officials have been irresponsible and deceptive, we could be in big trouble if the public does not trust our government health officials. And that was one thing with functional nursing that I really wanted to do something that could bring trust back to health care. And thank the good Lord, nurses are the largest healthcare profession. We are the largest healthcare specialty in the country, approximately 5 million practicing nurses. And we have enough nurses to actually make a difference. And I also see that within healthcare in the US, it's the nurses. We are the last line to the patient. We are exposed to so much individual suffering. And so many nurses understand that something is wrong and they want to do something about it. And again, for a long time, nurses have been the most trusted profession. And again, I do think that that has also changed because of so many of the wrongdoings that occurred within the system during COVID. But the nurses who are maintaining this high level of trust are the nurses that they saw something was wrong and they didn't want to be part of it. And because of that, they left the system. And now we have this explosion of nurse entrepreneurs. And I am just incredibly grateful that God has put me in a position to where I have been able to mentor over 600 nurses. And many of them, a majority of them, are starting their own functional medicine businesses. And I've had many others that have gotten really amazing jobs working for leading functional medicine clinics. But I do want to share with you guys some issues. Cause again, you know, we know that people, again, coming from conventional medicine because they've lost trust. And then we see these crazy things going on in conventional medicine where there's so many providers that are just overly prescribing medication that they may not have an adequate understanding of how those medications are working in the body and the adverse risks associated. Couple of examples of that are the pediatric population being prescribed things like SSRIs, which we know may be about 10 to 15% more effective than a placebo. But we also know that at least 30% of individuals that are prescribed those medications may have sexual side effects. And sometimes those effects are permanent. And because this was a medication not studied in the pediatric population, there's still a lot we don't understand. And so we have these very high-risk medications being dispensed like it's no big deal. And they're really hurting individuals, especially children and even pregnant women, because things are being prescribed to populations for which the medications were not studied in. So that's just one classic example. But then people go into the wellness industry because they're like, okay, this is the solution. And then we see irresponsible behavior there as well. I want to give you guys a couple of examples of some things that I went through. Now, as you all know, I was sick for a long time. I am well through functional medicine and through being appropriately treated for Lyme disease, but I have worked with many, many holistic health professionals, some that did help me, and many that did not help me. And I saw some just really just really irresponsible things going on. I want to give you an example. So I have three beautiful children, and I have a tendency, because of the immune shifts, to have autoimmune flares in the postpartum stages. So after one of my pregnancies, I had a referral from someone in a mom group. And again, I always say the mom groups are like the new Google. You can get such good referrals and good information from mom groups, but you may also get some bad ones. So I was referred to a provider, and she her title was doctor. And again, I was newly part of postpartum, having issues. I'm exhausted. I booked an initial appointment with this person, which yes, it was pricey, you know, it usually is because it's out of pocket. But I thought I was seeing a, you know, naturopathic doctor or something of that sort. And she made some really irresponsible recommendations for me. So I was four weeks postpartum. I was exclusively breastfeeding my baby. And she decided that I needed to do a heavy metal detox four weeks postpartum. And she was going to prescribe these homeopathics that help you to detox from all the vaccines that you've ever had. And I, again, my brain is foggy. I don't feel good, but I knew I was like, that's not right. Because I know as a nurse, when you are breastfeeding, you should not be doing anything that could potentially mobilize toxins because nurses understand that if someone is initiating a detox, that there may be the potential of whatever they are trying to detoxify from getting in the breast milk and potentially harming that very vulnerable infant. So I remember asking her, and I was like, you know, usually it's not safe to do a detox postcardum and especially breastfeeding. And she said, Oh, well, you know, the homeopathic treatment is safe in breastfeeding. And she had just absolutely no clue that, like, yes, okay, a homeopathic remedy may be considered safe in breastfeeding. But if that homeopathic remedy initiates detox during breastfeeding, that is not safe. And then also, um, I've talked about this before. I went undiagnosed for about 10 years with the condition that causes hypothyroidism. It's called Hashimoto's disease, and it causes approximately 90% of hypothyroid cases. She also told me, oh, well, many people can actually get off of their thyroid hormone, their thyroid hormone medication once they heal the body. And she put in her notes that I could start titrating off of my thyroid hormone. And remember, when women are postcardum, there's a lot of immune system shifts. The thyroid is really sensitive. Again, another reason for this is the beautiful babies use up a lot of our iron stores and a lot of our other nutrient stores. So we may be more prone to hypothyroid flares and also things like autoimmune thyroiditis because of those immune system shifts, especially in uh women who are more susceptible to that and have history of autoimmune disorders. And again, I looked at this review that she sent me, and I thought, there's no way I'm gonna do any of this. This is not safe. And then I went to her website and then I realized I was like, oh, I should have done my due diligence before I booked this appointment because she had zero information about her medical experience. She did not even have her schooling. She had no licensure information listed on her website. And with individuals that may call themselves doctors, you know, that may be a PhD. And uh there also are some programs that make it pretty easy for individuals to get PhDs. So they may not have really any medical experience, but they may be referring themselves, referring to themselves as doctors. Now, if I did not have any medical experience whatsoever, and then I saw someone who's referring to themselves as a doctor in a place of authority telling me that you need to do these things. It's gonna help you get better. I could have actually gotten injured from that. So again, you know, we we know that there are life-saving, life-transforming stories happening within functional medicine, but there are also these loopholes where people can be, you know, doctors of, you know, natural medicine and whatnot that don't really have the training or the credentials to be in that position. And another thing that I want to mention, I just want to say I am not against health coaches and things like that. I think that health coaches can also have a place and be valuable, but that also is an unregulated area. There's no official board that uh is regulating those individuals. So there are also instances of health coaches that may be really overstepping what they are legally allowed to do. And there are also many programs that individuals, again, with zero education, zero experience, can go through a program for a couple of weeks and get some type of health coaching credential and whatnot. And I just I think that, of course, there are good people in the wellness industry. However, there are a lot of people that I do not think are practicing with integrity. I mean, I think there's a lot of people that are going into the wellness industry, and then next thing you know, this person is grifting and they're just pushing a lot of products and a lot of detoxes and a lot of things that are expensive may not be beneficial, and there's no thought about what is this person's medical history, what medications are they on, and is this appropriate for this individual? So I do want to just talk about how nurses can really bridge this gap. And then I also want to address how nurses can do this ethically, and I also want to talk about this fear-mongering because oh my goodness, there is so much fear-mongering about nurses practicing functional medicine. And I really, I just, I just think it's really sad, you know. Um, because for an example, a registered nurse, on average, when they graduate nursing school, okay, nursing school is grueling. We are graduating nursing school with approximately 700 clinical hours behind our belt, okay? And then we understand anatomy and physiology and pharmacology, and they they torture us in nursing school guys. I remember one week having said 600 pages of assigned reading. So, yes, they are not really teaching us in depth about nutrition and nutraceuticals and all of those things, but they do teach us in depth about how the human body works. And we have so much experience working with patients, which is really great. So I think it's amazing to take that experience and that education and then go through and blend it with functional medicine training. And a couple of things I also wanted to mention is that sometimes people get a little confused because they think that functional medicine, because it has the word medicine in it, that that inherently means that that person is engaging in the practice of medicine. However, like functional medicine, there are also modal, there are also other modalities, such as herbal medicine, lifestyle medicine. And when we say the word practice of medicine, that is generally defined at the state level in the U.S. as diagnosing diseases or medical conditions, treating diseases or medical conditions, prescribing medications and medical treatments, performing medical procedures, and whatnot. Functional medicine is an individualized root cause-focused approach to health that considers how factors like nutrition, lifestyle, sleep stress, environment, genetics, physiology may influence overall wellness and chronic disease patterns. So for a nurse that is not a nurse practitioner, a nurse that is not advanced practice, there are so many ways that we can practice functional medicine appropriately within our scope. And a lot of that really does center around education, which is a universally accepted scope of nursing practice. And not only can nurses be educators, but they also can provide health coaching. They can do assessments, they can help with advocacy. I always say, you know, a functional nurse is kind of like a combination of a nurse, a health investigator, a case manager, an advocate, um, you know, an educator, a coach. There's so many things that that we can do. So I want to, I really would like to do some myth busting about functional medicine nursing. Okay. So the most classic myth is the most popular one is that you need to be a nurse practitioner to practice functional medicine. So the nurse practitioners who are practicing functional medicine, the biggest differentiating factor is a nurse practitioner because they may be able to diagnose, treat medical conditions, prescribe medications. They can actually have a legitimate medical practice. Okay. Now, a registered nurse or even LPN, they can still practice functional medicine and they can have their own businesses, but they need to stay within scope of practice under their independent nursing functions. So they are able to have a wellness practice, okay? So where they're not doing anything medicalized. They're not going to be performing wound care assessments. They're not going to be doing these highly medicalized things that we do in the hospital, like something like trait care, okay? It is more about providing health promotion, doing assessments and whatnot. And they can incorporate lab testing into their businesses as well, which is highly valuable. And this is something else I get a lot of questions about because a lot of people don't understand that in 47 states of the US, in all states except for New Jersey, Rhode Island, New York, patients can actually go online. They can go to like a lab corp direct website and they can order all of their own blood tests, guys. But one of the problems with that is they're gonna pay a much higher price than that. And then many times they get the lab work back and they don't know what it means and they don't have any guidance. And then in the US, we have a very sick population. We actually had a study uh from CDC researchers published in 2022. And yes, I know it was from the CDC, but they collect good data sometimes. And they found that approximately 7% of the US population was considered metabolically healthy. They also found that about 40% of US adults are struggling with obesity. So what do we do in the U.S.? We know we have this very, very, very, very chronically ill obese population. And when we utilize standard lab ranges, they take a statistical average of the chronically ill US population. You know, if you have a population with chronic illness that is that high, why would you do use a statistical average for your reference ranges? So again, the patients get they get their labs back and their labs may look like they're normal based on the US ranges. And that is something that really differs functional medicine and where nurses can play a huge role in here is being able to do educational lab reviews with a nurse that understands the optimal ranges and then also understands potential patterns of dysfunction. Because we have, you know, individuals who they do need to be under the care of a medical provider because they may have complex medical conditions because they've been sick for a long time. It's been advanced to the point that they may need medical management. And again, of course, lifestyle and nutrition, of course, that will help. But then we also have all of these other people who are kind of in between, you know, they don't have an official diagnosis yet, or maybe they have some minor things going on, like reflex, or maybe they have fatigue, or maybe some anxiety, or, you know, inflammatory like symptoms, but they haven't been diagnosed with anything. They're not medically complex. And those are just ideal individuals to be able to receive services from functional nurses. The functional nurses can work with them to figure out okay. What could be some potential obstacles to that that's preventing you from heal, from healing? Are you living in a moldy environment? I cannot tell you how many times I have helped individuals discover that they are living in an environment with toxic mold. Do you have significant nutrient deficiencies? Is your gut microbiome such a mess that you are having difficulty absorbing essential nutrients from your food? We know that the body needs essential nutrients and minerals to function properly. To give you an example, to be able to effectively and efficiently produce your steroid hormones like estrogen and progesterone, there are mineral precursors to that. You also need to have sufficient cholesterol production. You need nutrients for all of these wonderful things to happen within the body. And there's a lot of things that nurses can do to help individuals with these issues. And then we also know that there are so many people that are just stressed to the max and they're not sleeping and they're having all these issues. And there's a lot we can do with stress reduction techniques. And also, again, just circling back to the labs. I do want to mention for RNs and LPNs and non-advanced practice nurses to do labs ethically and legally. The best way to do that is going to be to actually order those labs under a medical doctor at a partnering laboratory. We actually have a partnering laboratory at the Functional Nurse Academy. And then they then would use that data not to diagnose, but to educate. So to give you an example, you know, functional medicine services are typically not a replacement for a primary care provider. You know, I still recommend that my clients have a primary care provider. I actually have a policy that they need to have one because in the case that I get a critical lab back, I need to be able to have an advanced practice provider that I can reach out to and that I can collaborate with. I get so many questions about this. Now, it is true that for the vast majority of states in the U.S., RNs and LPNs can order under an MD at a partnering laboratory. But there are also some functional medicine tests that are non-invasive, such as a urinary test that a non-advanced practice nurse may be able to order directly. But again, that is a state-by-state basis. And that is because those tasks are usually not used to diagnose. And these are also the same tests that patients can go and order directly online as well. But again, very gray area. So now I do know that Dutch and also real-time lap, also Max Gen. So Dutch Tasch is a functional medicine hormone test. Max Gen is a genetic test that is a cheek swab and a urinary mycotoxin test can help to uncover issues with mold. So those are just three examples of companies that may allow a registered nurse or even an LPN to set up a direct account. But my recommendation for that is to check with your board of nursing and or your legal counsel before setting up those accounts under your name. So again, if you are a new functional nurse in practice and you are not sure if you can have those accounts under your name, do not do anything that you are not sure about. Just utilize the ordering from the partnering laboratory under the medical doctor. That will be the safest route until you can get further clarification on that. Now we're about halfway through the show. I do want to cut for break. And when I come back, I want to talk more in detail about the ethics of functional nursing. Before we cut to break, I do want to remind all of our listeners that Functional Nurse Academy is the most comprehensive functional training program on the market, specifically designed for nurses. Our graduates receive 90 nursing CE comprehensive training, business mentorship. They are even eligible for multiple board certification pathways, and they receive six months free of business mentorship with me. So not only are they getting all of that clinical education, but they also are receiving the tools and resources to be able to effectively launch their own functional medicine businesses. So be sure to check that out at functional nurseacademy.com. And also, if you'd like to attend my next informational webinar, you can register for that in the show notes. This show is also syndicated on America Out Loud Talk Radio on the Nurses Report Radio Show and Podcast. So you can also find me there on any major app. Welcome back. This is Melissa Schreibfadder. And today I am talking about one of my favorite topics, which is functional medicine nursing. Because not only is this just such a great way that we can just work to fill in the deficits of both conventional and functional medicine, we can actually get people healthier. We can get people healthy enough to where we can reduce the burden, the where we can reduce the chronic disease burden within our healthcare system. And also we know that nurses are pretty miserable in the profession. We know that the system has been mistreating nurses for years and years, and it's just been getting worse. So it's also another way that nurses can really regain that purpose within their career. So there are just so many, so many benefits to it. But I do get questions frequently about how nurses can do this legally and ethically. And I also do want to speak to the individuals listening that may not be nurses. This is still beneficial to you because it is really important to just know where to go to find an ethical, qualified functional medicine practitioner. So I do want to touch a little bit more on the labs. I did mention that the safest way for RNs and LPNs to order is through a medical doctor or another advanced practice provider at a partnering laboratory and then use the data to provide education. And then you can also use that to collaborate with your client's healthcare team. However, when you are offering these types of services, because we want to be crystal clear that if you if you are not a nurse practitioner, you need to be very clear about your scope of practice. Okay. And especially if you are practicing functional medicine, you want to be clear with how you are using functional medicine modality. So I always like to recommend to the nurses I train, when you work on your list of services, you're about to you're about to launch your business, that you really need to go through and review your nursing practice act. And you need to ensure that whatever services that you are providing, that those services are legally compliant in your state. And also, I hear these other myths about how, oh yeah, you know, nurses, they're not allowed to become board certified as functional medicine practitioners. That is absolutely not true. It is not unlawful for a nurse to receive a private board certification credential. And we see this all the time. You know, we see nurses that you may be a registered nurse in your state, but they may also be a board certified lactation consultant. They may also have their certification as a dual. Nurses can do different things. However, when a registered nurse is combining functional medicine, that board certification credential is not something that's going to expand your legal scope of practice. You are still a nurse. So you still need to abide by your nursing licensure with what you are in your legal scope. However, the board certification just offers that additional layer of credibility. And we know that functional nursing is a subspecialty under the Holistic Nurses Association because we know, for example, that the Functional Nurse Academy is a program that is endorsed and peer-reviewed by the American Holistic Nurses Association. So it is a verified specialty within nursing. But how you present yourself is really important. So I mentioned, yes, you can absolutely have a board certification as a functional medicine practitioner, but you want to ensure that you are communicating your credentials and your services very clearly. So something that I advise against doing, you should not use vague language. Do not use terms such as functional nurse practitioner, because a patient could read that on your website and then potentially sign up with you because they are confused and they think that maybe you are a nurse practitioner and maybe you can manage their medical conditions. So I do recommend on your website and your marketing materials, being very clear about your legal scope of practice. For example, what I do on my website, I have that I am a registered nurse, I have my license number, I have the state where I am licensed in, and then I have all of the programs that I've received training from. And my board certification credential, which the one that I did choose to go with is the functional medicine practitioner credential. With that one, I list that I am a board certified functional medicine practitioner, but then I also list that that is a private organization. And then in parentheses, I put what organization that is. You want to be really, really clear about that. And then also when you do that initial discovery call, which again, I think it is amazing when nurses are offering these types of services, if they have an option for the client who wants to work with them, to where that client can just book a risk-free call with them to see if it's a good fit. I think that's amazing. And I call those discovery calls. You want to be able to chat with that individual, see if it's a good fit, listen to their story, and then tell them how you can help them and then present your services to them and you know your packages. And during that call, you also need to further clarify your scope of practice. I always tell the prospective clients that I do a discovery call with that I am a registered nurse, I am not a nurse practitioner, meaning I can't diagnose or treat. But then I explain to them what I can do. And then I also tell them that, you know, if for an example, we do testing and there is something abnormal, or say your thyroid markers are suboptimal or even low, I explain I can't give you that diagnosis. I can't write you that prescription. But what I can do is I can collaborate with your primary care provider. And I tell them the number one reason why I am writing letters to primary care providers is because someone needs a readjustment on their thyroid hormone. And again, when individuals are doing these calls with you, if if you are confident, if you are clear with them exactly how you can help them, many people will feel good about working with you. And again, as you get more experience as a functional nurse, you will start to see that your conversion rates will start to increase over time as you build that confidence and confidence and experience. But but yes, we want to be very clear that we're not sending out any confusing messaging or anything like that. A common question that I get about board certifications, I get this question all the time from nurses asking, okay, well, say for an example, a nurse is in California, which is not in the compact. Can that nurse then use a private credential, such as a credential as a functional medicine practitioner or a credential as a health coach, and then offer functional medicine services that are not nursing based in other states where they are not licensed as a nurse. And again, that is another gray area. So I actually do not ever advise that people do that without first seeking legal counsel. I highly recommend legal counsel for that. And it's really important to go that route because you want to ensure that your nursing license is legally protected. Now, I do know that there have been many nurses who have health and wellness and functional medicine certifications. And I do know of many nurses that did work with attorneys to where they may be a functional nurse in one state that they're licensed in, but then in other states, they may open up services as a health coach. But again, the attorney may recommend at a minimum that you have a different list of services because, again, you cannot advertise that you are a nurse in a state that you are not licensed in. The attorney may also recommend that you even have a separate website for services that you may be offering as a functional medicine consultant or health coach, and to ensure that that is separate from your functional nurse business. But again, you really, if you want to go that route, you really need to work with an attorney. And then another option, if you are not in a compact state and you want to open up more services, is of course seeking multi-state licensure. I know that that is a lot of additional paperwork and whatnot, but those are options that may be available. And I also do want to talk about nutrition and nutraceuticals. So in many states, RNs and LPNs cannot do things such as prescribing a meal plan. And I know that that may sound a bit interesting because we think, okay, well, what's wrong with anti-inflammatory nutrition and things like that? Many states actually have laws that only the advanced practice providers and registered dietitians can do things like prescribing meal plans. So basically, how I would describe that, general nutrition education is broadly permissible. Okay. So things like discussing healthy eating habits, educating on macronutrients, discussing anti-inflammatory foods, discussing hydration, sharing general wellness meal ideas, giving recipe bundles, things like that is usually considered, you know, nutrition coaching, wellness education. But what non-advanced practice nurses cannot do is they cannot design individualized therapeutic meal planning for disease treatment. Okay, that tends to be restricted in many states, um, again, to advanced practice and registered dietitians. And I also want to mention that I know that that is something that may not make sense to a lot of individuals. And again, I do find this is how Tennessee is. I do think it's interesting that a medical doctor with maybe, I don't know, maybe what is it, three hours or less of nutrition education that tends to be very outdated nutrition education, they can prescribe any dietary or any meal plan to their patients without a thorough background in that. But then a, you know, registered nurse that may have dozens and dozens of hours of nutrition education and training is not allowed to do that. So again, a lot of what we are doing is providing education. And again, there are certain, you know, that there may be certain dietary plans that could be beneficial for an individual. For an example, the low FODMAP diet is a diet that is commonly used for symptom management for individuals with small intestinal bacterial overgrowth. Okay. The RN and LPN would not be able to say, okay, I am going to prescribe you a low FODMAP diet for six to eight weeks. But what they can do is educate about what is a low FODMAM diet. How could it potentially help you? And here are some resources that you can discuss with your medical provider, things like that. And then also going on, going into nutraceuticals, okay? So supplements and vitamins and things like that. And again, we are really entering a gray area. Um, I want to give you guys another example. So, as you all know, I've talked about this a lot. The home I am sitting in has had three mold remediations. And I actually had a mold remediator that after he remediated my home, he was then trying to recommend that I take certain finders for mold. And he, again, like zero medical experience, has no idea what medications I'm on or what my medical history is, nothing like that. But because this area is unregulated, you know, an individual with zero healthcare experience can open up, you know, resale accounts for supplement companies. And they can then work to sell those products, you know. So, but I thought that was interesting that he was trying to advise me on how to do a mold detoxification. So, again, very, very gray area. And again, nurses, I just cannot put into words how suitable we are for these types of things because we do understand that when individuals may have certain medical conditions, but maybe detoxification may not be appropriate for them at that time. For example, we understand, especially functional nurses, they understand that someone who may be in a hypothyroid state, sluggish thyroid, sluggish everything, there's things that we may need to do first before initiating a detox. We also understand that when people are extremely nutrient deficient, well, we need essential nutrients for our detoxification pathways to function appropriately. And so nurses actually can recommend supplements, but how that works is they cannot recommend supplements to treat a medical condition. For example, if I had an individual Who have type 2 diabetes, okay? That is a recognized medical condition. I could not tell them that I am going to treat their diabetes with berberine, even though I know that the herb berberine has been studied and it has been shown to have similar efficacy when it comes to lowering blood glucose as the medication that is known to deplete B12 and has a lot of side effects called metformin. So now a nurse practitioner, since they're advanced practice, they could absolutely titrate someone off of their metformin and then treat them with berberine. Like that would be possible for a nurse practitioner. But how a registered nurse or an LPN could go about that is again, they could provide the education, the resources. And then usually, if I am making recommendations, I type out my recommendations. And then before I even give my recommendations, in all caps underlined, it says to discuss with your medical provider. And then I also have many wonderful providers that are in my referral network. And I actually have providers that will refer their patients to me and we communicate back and forth. So I've even had, you know, providers that when I'm working with their clients, I put together their wellness plan. I have their recommendations. And then I will ask them, you know, um, if they would like me to send their recommendations over to their primary care physician's office or if they would like to bring them in. Also wanted to mention just briefly about nutraceuticals. So I know I gave the example about how a non-advanced practice nurse absolutely cannot treat a medical condition with an herbal supplement. Okay. But there are other situations where we're talking about optimization, such as taking a multivitamin or a gut support supplement, things like that, a fiber support supplement. That is very different when we are talking about certain nutraceuticals for optimization and for general health and wellness. However, because nursing scope of practice, it tends to vary just slightly state by state. That's why I tend to be very careful and not tell people, okay, this is exactly what you can do in your state. So I speak more in general terms, but I do think that this will help to give you that proper guidance moving forward. And, you know, what I see is there are so many good providers that are just kind of like sprinkled into the system and they are frustrated that they don't have enough time to actually get the patients that they are working with well. So they really appreciate a functional nurse who is practicing with integrity, who is clear about their scope of practice. And one of the top reasons that the holistic-minded primary care providers, the ones that maybe a network with insurance and whatnot, are hesitant to refer to functional medicine is because there are issues with integrity within this specialty. Okay. So there are some practitioners, and I'm sure many of our listeners may have had and this unfortunate experience, where you may go to a functional practitioner and you know, you walk in the door and they are like immediately wanting to order $2,000 of functional medicine tests on you, which end up being the same test they run on everyone. So it's not bioindividualized. So they want to do all of this really expensive test. And then when those results come back, then they want to essentially prescribe you buckets of supplements. I mean, the first functional provider I went to, I wasted so much money and they made me worse. And what I think happened with that is that functional practitioners can fall into this trap where they start their business. Their overhead is way too high. Okay. And then they end up in this trap where they are dependent on commission from supplement sales and from testing. And that is not the formula for good patient outcomes. And we know that when functional medicine is practiced appropriately, we actually know that it can reduce overall healthcare costs and improve patient outcomes. But it is really important that that practitioner, that their business model is set up in a way for success. And this is one of the reasons why I recommend to my students that if you are able, if it is possible for you to offer supplements at cost where you're able to pass off your discounts to them, that is going to make you stand out among over 90% of functional medicine practitioners out there. And then if you are not marking up supplements, you are far less likely to be over-recommending supplements. And again, the good primary care providers out there, they will be more likely then to refer their patients to you when they know that their patients are not going to be preyed on and are just going to be sold all of these things. So, but again, this is something when with new functional practitioners, I think you should be very, very cautious about this because sometimes it can be scary starting a business, you know, and we all know how it is. Everybody is trying to sell you something and trying to convince you that you need all these things in your business and you really don't need that much stuff. So I do recommend for low overhead. Now, again, if you have a brick and mortar, if you have like a physical office location, very likely it's not going to be possible for you to be able to offer things like testing and supplements at cost, okay? Because the overhead of running a physical business is going to be much higher. But I'm speaking to the practitioners who are operating virtually. It is possible to have a successful functional medicine business and to operate 100% virtually. And that significantly cuts down your overhead. And to give you an example, because my business, it is a wellness practice, not a medical practice, okay? They are going and they are getting their medical care at their primary care provider's office. That's where they will go once a year and they will get their head-to-toe physical and whatnot. Okay. So I don't need to have a medical exam table or anything like that. I have a partnering laboratory. So I don't need to have an office where I have to go and hire somebody to provide phlebotomy services. I don't have to have any of that because I can type in the order, the medical doctor signs it, and then it goes directly to a lab court and then they go there for their labs. And then that also really cuts down on liability if you're not doing any type of invasive procedures and you also have clients in your practice, but they're never setting foot in your physical office. So that means again, on the liability side of it, your insurance is going to be much cheaper, much affordable than, say, for example, if you had that office location and whatnot. So again, uh another thing about having a virtual business like this. So to give you an example, for me to run my functional health business, it costs less than 200 per month. And because my overhead is so low, I do not have to mark up supplements and tests. And I really think that that is why I, one of the reasons why I have such a strong referral basis, because again, I am not, I don't have conflicts of interest. I am not motivated by how much I can sell this individual. I truly, genuinely want them to get well. And I want to do this in a way that is ethical. And again, when you work with individuals and you are ethical, you're not pushing products on them. You help them get results. You have good relationships with their primary care providers. Those individuals and the primary care providers, they will do your marketing for you. Remember when I first got started, I had to spend so much time getting my name out there. And I had to spend so much time on social media, going to networking events and things like that. And now I don't have to do any of that because my referral basis is so strong. I mean, I have had individuals I have worked with and they went and blew my name up in the Facebook groups. They went and told their friends, family, their people at church. And then next thing I knew, all these people knew what I was doing and was wanting to book discovery calls with me. So they really, they're really, there's just so much opportunity for nurses to do this type of work legally and ethically. And honestly, I really feel like my nurse, my nursing license was at more risk when I was working in the hospital system because oh my goodness, the hospital system puts nurses in dangerous situations. And not only can you get fired and use lose your license if you make an error. Nurses can actually be criminalized for making errors when it leads to something like it, like a sentinel event. It's just, it is, uh I do feel like working in the hospital system is very, very high risk for nurses. I remember being so short-staffed. I had 15 patients one time to myself when I was the charge nurse. It's just, there's just so many unsafe situations that nurses are put in. So again, you know, working on the health promotion side, working in functional medicine, I feel so much more secure with my nursing license. And also for clients, like say that you are an individual, you're not a nurse, and you're listening to this. If you are interested in working with a functional nurse, I do have a robust directory at the Functional Nurse Academy. So just go to functional nurseacademy.com and then you can click on the directory, and then it'll pull up all of the nurses that I have trained that have successfully launched their businesses. There are so many of them. We're adding more nurses in every week. Many of the nurses there will have their locations listed with their website and their specialty. So be sure to check that out. That is all the time that we have today. If you want to learn more about the Functional Nurse Academy, please feel free to register for our next live webinar, and you will see that link in the show notes. You can also check out Functional Nurse Academy on our social media platforms or on our website at functional nurseacademy.com. Until next time, be safe, be well, and God bless.