Q&A with James DeMaria, BSN, Renal Care Nursing Executive interviews James DeMaria, BSN and Vice President of Renal Care Registered Nursing Services in New York. Renal Care is one of the Northeast's leading acute mobile hemodialysis providers.

Below DeMaria discusses renal care nursing and entrepreneurship.

Q: What is your current position?

My current title at Renal Care is Vice President.

Q: What is renal care nursing?

Renal care nursing is an acute care service founded in 1991. My mother, Valerie Miller, actually founded it. It's acute dialysis at the bedside for the hospitals that don't really have a dialysis unit affiliated with them. We essentially become that hospital's acute care dialysis service. They don't have to buy the machines; they don't have to find the staff or cover on-call. We do that for them.

Q: How did you get started in this field, and what kind of preparation does someone pursuing this career need?

I've been a nurse for 13 years. I graduated from Dominican College in New York with a Bachelor's of Science in Nursing. After that, I went to work at Westchester Medical Center on med/surg because that was going to offer me the best experience at the time. Just interest will get you started. When I try to hire somebody new -out of dialysis - I really like them to have a critical-care background. They have a better picture of the patient. Most critical care nurses come through a med/surg background. You can't say enough about that background for your assessment skills - and I believe your nursing gut comes from there. You have to be able to work kind of by yourself, and your situations are changing by the minute.

Q: In your work in renal care, what is an average day like?

In renal care, in the acute setting, the office is really a call center. We coordinate things - the office days are boring. We laugh a lot, but essentially in the office, you're putting out little fires because you're dealing on the administrative level. If you're a nurse on the outside, you get your assignment the day before kind of like a special agent. We call you up and say, "You need to go to St. Anthony for Jones and Smith tomorrow." The nurses can basically make their own hours unless the patients need care earlier - at the request of the doctor maybe the [patient] has another appointment, has to get to surgery or needs blood. Depending on the acuity, [nurses] can go in at any time. Usually, two patients consecutively will probably be an eight or nine hour day. Each treatment runs about three or four hours on average.

Q: In general, are there any specific traits that work well in this career?

You need to essentially be friendly and unafraid to assert yourself without being "nudgey." You have to walk a fine line because you're the guest in the hospital. You have to be the guest, but feel like you're part of the family.

Q: You're also a nurse entrepreneur - how did you move into entrepreneurship?

My mother was in the business, and I was working in a bunch of different jobs. I figured, "Hey, let me give the nursing thing [a try]." It's good for your brain; it's a good umbrella career. You can have that nursing degree and find your niche [within it]. The entrepreneur thing - you just have to be prepared to work. Some days you're working really hard, and some days you're not. To me the perks far outweigh the minuses, but you're going to work harder for yourself than you'll work for anybody else. You're essentially always working because something's always happening - something is always going on with the business. It's a 24-hour service, as well, so...

Q: What additional skills do students who are interested in entrepreneurship need?

You need ideas to go into entrepreneurship. You need a commitment to see them through. Be prepared for setbacks; there are a lot of setbacks. I say this all the time - nobody gets rejected by more women on a daily basis than I do just because of the nature of my profession. With entrepreneurship, you have to be kind of assertive, and you have to be kind of strong-willed. Some people call that stubborn, but some people want to do things their way. If you have an idea, don't be afraid to go for it. That's what it really comes down to. If you don't go for it, you're never going to be an entrepreneur. You find out a lot about yourself. You're going to make a million mistakes. You need the idea, and you need the commitment to see it through.

Q: As a male nurse what, if any, special challenges do you encounter?

The male nurse thing - it's just funny. You can never shake that - a "male doctor;" we don't even call them "male doctors," but we call them "female doctors." She's a "female doctor," not just a doctor. I'm just a nurse, but I'm a "male nurse." As a male nurse, there are certain things that come up. A lot of younger women [don't] want a younger man as their nurse. For me, sometimes I can't connect that. They'll go to a younger [male] doctor, but they can't have a younger [male] nurse, which is all right - it's a preference. But, that is one of the obstacles you run into on the floors of med/surg. I essentially don't run into that in renal care. For men, it's a little different because [nursing] is perceived as a women's profession, and there's still some stigma attached to being a "male nurse," especially with the younger female population. They don't really want to have a male nurse. You have to learn how to not take that personally and still give the best care that you can.

Q: What advice would you offer other men thinking of entering the nursing profession?

More men entering the profession help to bring salaries up. A lot of cops and firemen come into the profession. When they've retired at 40, they start to go to nursing school. They come in, and they're used to working three, 24-hour [shifts], so what are three, 12-hour shifts a week to them - it's part time. Some blue-collar guys come in at the end of 20 years on their job and do nursing. It's a nice gig; they get paid well.

Q: What do you wish someone had told you about the nursing profession?

I guess what I wish somebody had told me about the nursing profession at the beginning is how difficult it could be. It's a shock to the system. People think [being] a nurse is like what they see on "ER." They don't really see the nitty-gritty of things - how sick people can really be, and how frightening it can be to walk into that situation. It doesn't have to be that they're on death's door, they can just be incontinent, and you have to clean that person up. I don't think anybody can prepare you for things like that. Also, you don't know how rewarding it is until you work in the situation. This is a great profession not because you can make good money, and you help people, but because it's extremely rewarding when you do.

Q: What kind of changes have there been in renal care over the last few years?

The patients aren't staying in the hospitals as much. A lot more of our patients are more acute. We don't have a lot of the patients that come in for dialysis-related issues, or some other related issue, and stay for two or three weeks. A lot of the people... have multi-system failure, so you have to navigate those things.

Costs are another thing. Over the last couple years, with the economy being what it is, you have had to become more cost-conscious. Every facility where you're working is becoming cost-conscious. While your costs are going up, you're trying to still maintain a business and give the hospitals the best quality you can, while keeping your prices low. Everybody wants something for nothing - that's really the way it goes in the medical profession.

Q: What do you see for the future for nurses practicing in this area?

We're a small nurse-owned and operated company that's been around for 18.5 years. We kind of operate in the community hospitals where...[some might] think it's small potatoes. We add up a bunch of those [potatoes], and it makes for a nice business. [Renal care] is a great area to be in. If you're an idealist, like to work semi-autonomously and aren't afraid to use the phone as a resource, it's a great job.