It’s one of the biggest decisions that startup entrepreneurs must make — when to quit their day jobs.

Chantale Trouillot has been debating that question for the last five years. She dreams of when she can permanently exchange her nurse uniform for a business suit. For now, she juggles caring for patients with selling decision makers on her innovative product, a more functional hospital gown.

The balancing act, she says, “hasn’t been easy,” but from a practical standpoint “we have to pay the bills.”

Although U.S. business startup activity has jumped above pre-recession levels during the last four years, entrepreneurs like Trouillot still are hesitant to take the full-time plunge. Making the decision requires a tricky calculation: weighing passion and persistence against financial stability and viability.

If you’re too poor or too unsure, you can start a company while employed — no investor will knock you for that, says Violette Sproul, founder of Femfessionals, which organizes events in U.S. cities to help businesswomen connect. But starting a company and holding down a day job takes time management and focus. “You quickly discover it is not as easy as you think it will be,” says Sproul, who started her business while working a full-time job before making the leap.

A few months after Trouillot secured a patent for her innovative hospital gown, her husband, Eric, left the souring real estate business to take over marketing and sales. Together, the two have taken Peak Textiles in Coral Springs to the next level — finding a financial partner to manufacture and warehouse the innovative, less revealing hospital gowns. Eric does the heavy lifting — cold-calling, attending trade shows, negotiating contracts, and meeting with prospects — while Chantale makes the high-level presentations to hospital decision-makers about the clinical benefits of the gowns. The Trouillots sold 100,000 hospital gowns in 2011, and they expect to double that this year. “It would have been impossible for us to get to this level without one of us devoting ourselves to it full-time,” Chantale says.

By becoming an agency rather than hospital staff nurse, Chantale says she has managed to get some flexibility in her schedule. In some ways, her work has been good for business. It allows her to further build relationships in the hospitals and speak authoritatively on need.

“Our goal is we want our gown to be the standard hospital gown,” Eric says. Chantale says it might take another five years before the business generates enough profit to make it her full-time job. Meanwhile, the key to balance, she says, has been keeping one day a week for herself. “We all need to unwind. For me, Sundays is my day with family.”

One of the biggest challenges for entrepreneurs is the risk of burning out. Holding down a full-time job while running a part-time business can leave you with little, if any, leisure time. Heidi Elden has discovered balancing both takes intense organization. She works a full-time job in the evenings as a bar manager at a restaurant in Delray Beach. During the days, she focuses on her entrepreneurial venture, Lingerini, a fashionable hybrid between lingerie and swim wear. “It is tough trying to keep focused,” Elden says.