By Julie McCoy

Back in 2002, Shannon Ralston, a single mother and registered nurse, was working at three different hospitals, and often seven days a week, to make ends meet. Thinking to herself, There has to be a better way, Ralston decided to take matters into her own hands and start a healthcare staffing company that would give nurses the pay and respect they deserve.

Being a nurse, but not a businessperson, Ralston went on the Internet and bought a $25 guide on "How to Start Your Own Nurse Staffing Agency." She followed the advice, did a lot of research and spent many sleepless nights putting together a business plan. It took months of hard work, but with a mere $257 in the bank, Ralston launched Angel Staffing in San Antonio.

Half of Angel's Business Is RNs

About half of Angel Staffing's business comes from staffing registered nurses (RNs), who earn, on average, $38 per hour, according to Ralston. The company also places physicians, physician assistants, nurse practitioners, certified registered nurse anesthetists (CRNAs), licensed master social workers (LMSWs), licensed vocational nurses (LVNs)/licensed practical nurses (LPNs), registered respiratory therapists (RRTs), certified nursing assistants (CNAs)/certified medical technicians (CMTs), radiologists, pharmacists and operating room technicians, who work at public and private inpatient treatment facilities. On any given day, Angel Staffing has about 700 or 800 people out on assignment.

Angel Staffing also provides medical professionals when natural disasters strike. The company contracts with the Texas Medical Assessment Team (TXMAT) through its involvement with the Texas Department of State Health Services. It also hires nurses across the state to administer the H1N1 vaccine through the Texas Department of State Health Services.
The company generated $33.5 million in 2009, up from $22.9 million in 2008, according to Ralston. The goal for this year is to hit $35 million.

Landing on the Prestigious Inc. 500 List

Angel Staffing ranked No. 165 on Inc. 500's list of fastest-growing privately held companies last year. The company experienced 1,138.5% growth between 2005 and 2008, a period when its revenue jumped from $1.9 million to $23 million.

Nurses Are Angels

How did Ralston come up with the name Angel Staffing? As a bone marrow transplant nurse, she was exposed to people who were dying who would talk to angels before they passed, she says.
Ralston, who has been a nurse since 1996 and went to college on a scholarship to be an Army nurse, adds that she also chose the name because, "Nurses are angels, and we take care of people who often go on to be angels."

Disaster, Emergency Preparedness Training on the Agenda

A Family Affair

It's truly a family affair at Angel Staffing. Ralston's dad, Tim Ralston, and her sister, Amy Ralston Truan, are both involved with the company. Her mom, Laurie, also comes in from time to time and helps out with whatever needs to be done, whether it's receptionist work, filing or recruiting.

Tim Ralston, who serves as executive VP, oversees the company's financials. "I'm responsible for the back end of the business," he says.

Prior to joining Angel Staffing, he spent 25 years at 3M, where he held a variety of roles from sales to management. He took early retirement at 3M, and his daughter offered him a job with her.

He says he is open and honest with his daughter. If there is something he doesn't like or doesn't agree with, he lets her know. "I respect her as a CEO," he says. "I have no problem with that at all. She's the one who built this business. I am extremely proud of what she has done and look forward to many more years of success."

Amy Ralston Truan works for the company as a sales coordinator. She acts as a liaison between sales and recruiting.

While some people who are involved in family businesses say it can be difficult separating the family relationship from the business, Ralston says this hasn't been much of an issue for her family. "We know when business needs to stop and family needs to start," she says, noting that it helped to establish clearly defined expectations beforehand.

Insurance Hikes, Finding Good Internal Staff Among the Challenges

One of the challenges of running Angel Staffing is the rising cost of insurance, Ralston says. Another challenge is the decrease in elective surgery. People are choosing not to have surgery because they don't have jobs and healthcare insurance, she explains.

Other challenges include finding reliable people to work in the corporate office and trying to make everybody happy, Ralston says. "It's virtually impossible [to please everyone]," she recognizes.

Internal Staff Feel Valued, Appreciated

Ralston goes out of her way to make her internal staff feel valued and appreciated. "She actually cares about her employees," says Crystal Frazar, who joined Angel Staffing's internal staff as assistant director
of nurses this spring after having done emergency room and recovery room work for the company. "It's very important [that] you stand [up] for your employees. She does that. I have never been treated the way she has treated me. Just to be appreciated and shown that you are appreciated is a big thing. She does that."

One way Ralston lets employees know how much she appreciates them is by holding an annual employee appreciation gala with prizes totaling more than $150,000.

"She is an amazing person," says Frazar. "She is all about her employees. You won't find anyone else like her out there or her company. It's a great company. She has gone from nothing to a huge company. I think that speaks for itself."

Going the Extra Mile for Clients

Johnie Johnson, contracting officer for the Department of Defense, has worked with Angel Staffing to find RN, LVN, CAN and transcription positions. "They are a very professional company," he says. "Very timely. [They] send you qualified people. They're just a joy to work with. Angel is a cut above. They go the extra mile. They go above and beyond."

On a scale of 1 to 10, Johnson gives Angel Staffing a 10. "They are customer-oriented," he says. "They always try to please the customer. They always want to take care of the customer. They always want to give you a very good product."

Johnson stresses that his comments are his personal views and not the views of the Department of Defense.

John Looper, who was an H1N1 coordinator for Denton County, worked with Angel Staffing to staff H1N1 clinics. "They are a good bunch of people to work with," he says. "They really are. I couldn't say enough nice things about them. [Nurse manager] Kathy Gallagher was just great. There were no ifs, ands or buts about it."

Like Johnson, Looper gives Angel Staffing a 10 on a 10-point scale. "They were attentive," he says. "They took care of everything we asked them to do. We had a good experience with them."

Sherry Williams, program administrator for Waco-McLennan County, also worked with Angel Staffing to provide staff for H1N1 clinics. "They were always very professional and responsive to our needs," she says. "Whenever we had any issue, we could get right with them and they'd take care of it. I thought they did a great job for us."

Williams says she would work with Angel Staffing again if the need arose. "The caliber of staff they sent us was excellent," she says.

The San Antonio Metropolitan Health District worked with Angel Staffing from last December to this past March to administer the H1N1 vaccine in schools, according to Christine Rutherford-Stuart, executive assistant to the director of health. "We got good feedback from the schools," she says. "They enjoyed Angel being there. They were great about last-minute requests."

Overall, Angel Staffing provided 9,000 staffing hours for the project. The goal was to complete vaccinations at all elementary schools in two and a half weeks so there was a lot of work to do in a short amount of time, Rutherford-Stuart points out. But Angel Staffing was up for the challenge.

MetroHealth worked with other staffing companies as well but "had a comfort level with Angel from the bat," says Rutherford-Stuart. "They had a larger pool of nurses and nurses who were more experienced with vaccinations and giving vaccinations to kids."

Making an Effort to Get to Know Candidates

Angel Staffing makes an effort to really get to know the medical professionals it places, Ralston stresses. "We know our people," she says. "I know the majority of nurses by name. My staff is very good at open lines of communication. We kind of still treat this large company like a family business."

Candidates Able to Challenge Themselves

Crystal Davila has had the opportunity to do a variety of things in the seven years she has gotten work through Angel Staffing. She has done ICU and emergency room work as well as psychiatric nursing and floor nursing. She's also worked with burn patients. "I like to challenge myself and go into every area," says Davila. "She [Shannon] knows I like it. She helps us all when it comes to continuing education. She wants us to speak out so we can empower ourselves and feel more comfortable in our areas. She has always had an open door policy. It's always been about open communication. It's like family. I have never felt that it has been about competition. It has always been about personal and professional growth." Davila has actually known Ralston for 10 years. The two worked as bone marrow transplant nurses together before Ralston launched Angel Staffing. Back then Ralston was "always very compassionate, very driven. Articulate, able to handle high-threshold situations," Davila says. "People just felt at ease around her." And nothing has changed since then, Davila points out. "She's still very humble. She's still very giving, open-minded, creative."

Davila works with other staffing companies but prefers Angel Staffing. "I give Shannon most of my hours."

On a scale of one to 10, Davila gives Angel staffing a nine. "I don't believe there is such a thing as perfection," she says. "But there is greatness. Angel Staffing has done great things. They're doing great things in Haiti."

Helping Out in Haiti

Angel Staffing, which has a long tradition of giving back to people and communities in need, is sending physicians, registered nurses, LVNs and paramedics to Haiti in the aftermath of the devastating earthquake that rocked the Caribbean country early this year.

The company pays for their trip and their supplies, but all of the work they do is on a volunteer basis. "It's been amazing," says Ralston. "I have everybody write a paragraph and give us pictures. We really enjoy this type of work because it brings a depth and perspective to healthcare."

Angel Staffing has made a one-year commitment to send two nurses to Haiti every 10 days, according to Ralston. "It's a wonderful program," she says. "Everybody has thoroughly and totally enjoyed it." Concludes Ralston: "The Haitians are wonderful people. I have never felt unsafe down there. None of my employees have, either."

Medical professionals who go to Haiti and are greatly impacted by what they see and experience can take advantage of the free counseling services Angel Staffing provides. "They [can] get the counseling they need if they feel they need it," says Ralston.

Angel Staffing also runs the Angel Charitable Foundation, which raised $150,000 for the relief effort in Haiti. The company is sponsoring an orphanage in Haiti called Haiti's Children Relief Mission.

Soon-to-Be Mom of Five

Ralston herself is in the process of adopting four boys from Haiti, which will make her the mother of five. "I'm thrilled," she says. "This is life-changing for myself, my son and the rest of my family, who are very supportive."

A Family Person

What does Ralston like to do when she's not super busy running her company? A self-described "family person," Ralston enjoys spending time with her 10-year-old son, Dakota, who is a hockey player, and her mom. She also likes to faux paint, go to movies and get facials.

Ralston, who says she is a "big animal advocate," currently has three dogs, all of whom she adopted from shelters. She also enjoys traveling and has a trip to Greece planned this month. "I'm really into European history," she says.

Making Life Better for Medical Professionals -- and Then Some

When Ralston launched Angel Staffing, her goal was to make life better for medical professionals so they wouldn't have to struggle like she did. She didn't start with much but eight years later she has certainly accomplished her goal and is running a thriving healthcare staffing company that no doubt will continue to grow.