I’m building NextStep - a mobile nursing service that helps people get home and recover after same-day surgery. My logic is that if I’m going to build something that matters in this space, I need to understand what it means to actually care for someone-not in theory or pitch decks but in real life. Also, I’m very hands-on as a leader so it feels on brand.

What I’m Learning

At one point we looked at the idea of letting any kind of healthcare professional be a NextStep companion - medical assistants, EMTs, even trained caregivers. But the more I listened to patients, remembered my own experience, thought about recovery, and paid attention to what people actually need after surgery, it became clear:

What people need is nursing.

When you come out of surgery, your #1 goal is to heal. To get your independence back. To start walking again. Bathing. Eating. Going to the bathroom without help. All the basic things you take for granted until your body stops cooperating.

And what are those things called? Activities of Daily Living (ADLs)-which just so happen to be the foundation of the nursing profession.

It’s perfect alignment.

CNA Work is the Backbone of NextStep’s Model

I’ve been listening to a lot of CNA stories. Stories of being overworked, emotionally exhausted, and underpaid. Stories of going from patient to patient with no real support. It’s also crazy to think many of them could make more in retail or fast food than they do caring for people full-time.

I want NextStep’s business model to pay CNAs who work with well enough to supplement or even replace their income. I want them to feel respected, to have flexibility, and to feel like this is a job they can choose but aren’t stuck in. If we could manage it, there should also be a portion of the model that injects capital for career changers and other interested parties to transition.

Somewhere in this I feel like better conditions for caregivers will lead to better care experiences for customers.

Centering Care in our Lives

There’s an element to the CNA course and licensure that includes executing clinical skills correctly. These are actions such as moving a patient from bed to wheelchair, washing your hands, and many other activities. As I practice these more and more it makes me reflect on how I wish I had these skills long ago in my personal life. I would’ve probably provided better care to those I loved. I think we should also curate more spaces to discuss what it means to care for each other - maybe those spaces exist and I’ve been late to the conversation. Either way, I’m happy to be here now.

I went as someone who wanted to meet a bunch of strangers and make something.

I didn’t go to Tulsa with a startup idea.

When the mic opened up for pitches, something jolted in me. I didn’t have an idea planned but I asked myself:

What’s the biggest problem in my life right now?

I was days away from surgery. I lived alone and I needed someone to sign me out afterwards. I had no clue who that would be.

I pitched a post-surgery companion and got a lot of votes.

I pulled together a team and we got to work.

I probably slept for two hours total (on the floor of our workspace) before jumping back into building. Crystal drove around to hospitals and clinics to get feedback on the idea. Eddie dug into market dynamics and a business model. Max and Jacob worked on high-fidelity mockups and visuals for the pitch deck. I spent time leading the orchestra and talking to people about their surgery experiences - which not only shaped the product but also helped calm my nerves before my own procedure. Here’s a video of the pitch we gave:

ACT House ran workshops throughout the night. Their innovator archetype model helped us understand our strengths - I came out as a dominant Architect, sub-dominant Techie. That felt right.

Our team hustled and we won.

Then came the surgery.

I prepped my apartment, learned what to expect, and reviewed the hospital’s policies. But once I came out from under anesthesia, it was clear: none of that truly prepares you.

I ended up needing an overnight stay because there wasn’t someone to monitor me full-time. After being discharged I had to coordinate an Uber while a bit sore and out of it.

I argued with the pharmacy about meds.

And once I got home, alone, there was so much to do. I tried to remember the right way to drain my blood, manage medication timing, and remember all the other instructions I had been given - while also just trying to exist.

I was pissed, tired, and overwhelmed.

I kept thinking - if I went through this with a “minor” surgery - what are people recovering from more complex procedures experiencing?

That’s when the idea became a mission.

What is NextStep?

We’re rethinking what care looks like after the hospital discharges you.

We’re starting with three core assumptions:

1. Would surgical coordinators and discharge teams refer patients to services like this?

2. Would patients be willing to pay for post-surgery support?

3. Would healthcare workers (CNAs, RNs, EMTs, etc) take on short gigs helping people begin the healing journey after surgery?

Right now we’re focused on a lean offering to validate these assumptions and solve real pain points. The next two months are about building, connecting, learning, and making sure what we’re building actually works.

Why Now?

There’s a real set of colliding trends that we’re responding to:

• Patient surgeries are increasing — In 2022, there were approximately 12.4 million ambulatory surgery encounters in the U.S., marking a 4% increase from the previous year.(Overview of the National Ambulatory Sample)
  
  

• Nearly 1 in 3 U.S. households is a single-person household — As of 2023, about 29% of U.S. households consist of just one person, reflecting a significant rise in individuals recovering alone.
  
  

• Healthcare professionals are increasingly seeking flexible, gig-style work — The healthcare industry is facing a projected shortage of over 100,000 workers by 2028, prompting many professionals to seek more flexible, gig-style employment opportunities. (Mercer - Addressing a Challenging Healthcare Market)

We’re building a solution for an overlooked moment in recovery - after the hospital discharges but before healing has fully begun.

What’s next for NextStep?

You’re very early.

This Substack will serve as a mix of roadmap, founder journal, and landing page for the work of building this out. We’re moving really fast and creating with deep intention. This space is to surface a lot of that work.

Let’s build what comes next.

Let’s make a world where no one recovers from surgery alone.

—Travell

Founder of NextStep