From house calls to wellness clinics, nurse practitioners are making a name for themselves in the world of medicine by opening their own practices. NPs are proving now more than ever that the profession is constantly evolving and encompassing a group of providers who offer medical services on their own terms.
Take Jessica Pawlicki, RN, MSN, APRN, FNP-C, who opened her own pediatric practice, Well-Rooted Pediatrics, in Crystal Lake, Illinois.
“It has always been my dream, but knowing it [wouldn’t be] easy, it was always thrown on the back-burner,” she says. “Suddenly, I had a change of heart and knew that I was meant to have my own practice and practice how I wanted and how I felt was best for patient care and relationships. I don’t want my patients to be a number. We are family.”
It probably goes without saying that starting your own private practice won’t be an easy task. But one way to make your journey a little smoother is by learning from the experiences of other NPs who’ve already been there and done that. To help you out, we asked Pawlicki and Sapana Patel, DNP, APN-BC, consulting director of Healthcare Innovation & EntrepreNURSEship at Northeastern University’s Bouve College of Health Sciences, to share what they think are some of the most important considerations and steps to take when starting your own NP private practice.
Where Can a Nurse Practitioner Have Their Own Practice?
While you can open your own practice as an NP, the exact operating rules vary by the state in which you’ll be operating. Some states still require you to open your practice with a collaborating physician, while other states allow NPs to open and practice independently without a physician. So, if you don't know what your state's requirements are, your first step in the process should be to figure this out.
The American Association of Nurse Practitioners (AANP) lists the three practice authority designations for each state as full, reduced, and restricted. Here’s how it breaks down:
Full Practice States
NPs are usually able to practice independently and perform all elements of NP practice in full practice states, including evaluating and diagnosing patients, prescribing medications, and managing treatments. These are the often the easiest states for NPs to open their own practice. Here they are:
Full Practice States (22)
| Alaska | Arizona | Colorado | Connecticut |
| Hawaii | Idaho | Iowa | Maine |
| Maryland | Minnesota | Montana | Nebraska |
| Nevada | New Hampshire | New Mexico | North Dakota |
| Oregon | Rhode Island | South Dakota | Vermont |
| Washington | Wyoming |
Reduced Designation States
NPs in reduced designation states can practice independently after a certain number of hours working under another health care provider. Here they are:
Reduced Practice States (16)
| Alabama | Arkansas | Delaware | Illinois |
| Indiana | Kansas | Kentucky | Louisiana |
| Mississippi | New Jersey | New York | Ohio |
| Pennsylvania | Utah | West Virginia | Wisconsin |
Restricted Designation States
NPs in restricted designation states are restricted from certain elements of practice and are required to have oversight from another health provider for their entire career. In these states, an NP’s practice is limited to working under a physician. Here they are:
Restricted Practice States (12)
| California | Florida | Georgia | Massachusetts |
| Michigan | Missouri | North Carolina | Oklahoma |
| South Carolina | Tennessee | Texas | Virginia |
5 Steps to Opening a Private Practice as a Nurse Practitioner
Patel is in the midst of opening her own dermatology practice and, as a result of this experience, has become a resource and inspiration for other NPs looking to do the same. Through her website, Let’s Practice, she offers nurses and NPs a free toolkit that assists them in creating innovative business models.
The toolkit, which she estimates about 150 NPs have used, is useful for any NP looking to start their entrepreneurial journey, with sections on marketing, credentialing, handling finances, leasing vs. buying space, and even links to sample business plans. And while the specifics will depend largely on what type of practice you’re looking to open, Patel has provided a loose list of general steps that any NP can expect to take when establishing their own practice.
Step 1: Know your state’s laws.
Patel notes that it’s vitally important for you to be aware of your state’s laws to help guide what type of practice you can legally set up. You should know what types of allied health professionals you’re allowed to partner with, and whether you need a collaborating physician.
If you need to partner with a collaborating physician, you can try being matched through CollaboratingDocs.com, which also helps provide legal documents, state-based assistance, and covers malpractice insurance for your physician. Patel also recommends consulting with a business attorney (ideally, one who specializes in medical practices) to help you set up your initial business structure correctly.
Step 2: Get the logistics down.
The logistics of forming your own business will include everything from staffing your practice, to budgeting for your launch, to choosing your location. If you have a business plan in place, you’ll be in a much better position to manage all these moving parts and keep yourself organized. Plus, as Patel notes, your business plan can also help guide your expenses.
You should also protect yourself from the get-go with business insurance and malpractice insurance. Patel also suggests considering cyber insurance in the event your computer system gets hacked. For staffing your practice, she recommends knowing when you’re ready and financially able to bring staff members on and consulting an attorney and tax professional to help you set up employees legally with the right classifications.
Step 3: Initiate a marketing plan.
Patel says a marketing plan is critical when opening your own practice, no matter what type of service you can offer. For instance, even if your target population is not on social media, chances are their caregivers will be.
When it comes to executing the marketing plan: “Initially, I always say free is best,” says Patel. “If you’re not utilizing your free social platforms, you’re doing yourself a disservice.”
Patel recommends buying a URL and creating a basic website as a good starting point. (Look at tools like Wix and WordPress.) Then, use free graphic design services (Inkscape and Canva are two examples) and post your announcements on your social media accounts, such as Facebook and Instagram, to get the word out about your business.
Tip: Figure out which social media platforms your target audience uses the most and focus your energy on them. (For example, if you know anecdotally that most of your patients use Instagram or Facebook, go with those.) Once you get the hang of using those channels, you may also want to consider doing some advertising on them as well. This will help you boost your brand’s presence and get you in front of the customers you’re trying to attract.
Step 4: Establish your billing system.
If you’ll be seeing patients and billing with reimbursement through insurance, make hiring a good biller a top priority (before you open your doors). After all, Patel says, your passion and the most lucrative part of your business strategy is to see patients, not handle bills. Plus, NPs are only reimbursed from insurance companies at an 85% rate (compared to physicians at 100%), Patel says, so the business absorbs the 15% remainder of the cost of the visit.
Step 5: Be bold.
Last but not least, Pawlicki adds what might be the most important step to opening an NP practice: “Own it!”
Confidence is key when launching a new endeavor. You’re serving a vital role as a medical provider in the community. Your passion, resilience, and strong business plan will take you far.
8 Resources for Nurse Practitioners Who Are Building Private Practices
Just like the tricks and tools you rely on when caring for patients, there will also be resources to help you open your own practice. Patel says you should keep searching for what you can learn and who you can lean on.
Some of the resources you'll want to consider looking into include:
Advisors
You’ll want to carefully hire a team to make sure you check all the boxes before you open. This includes finance, tax, and insurance professionals, as well as an attorney who specializes in medical practices.
A DEA Number
If you’ll be ordering medications in your practice, you’ll need a DEA number for your state.
Business Plan Templates
There are many free business plan templates online, but it may be helpful to purchase a template specific to a nurse practitioner, such as this one from the Journal for Nurse Practitioners. Patel’s “Let’s Practice” website also offers an online toolkit.
Continuing Education
Online courses can help you get equipped with everything from how to incorporate social media into your practice to profit and costs training. Here are some from the AANP.
MRSA
Fortunately, not that MRSA. This one stands for Multistate Reimbursement Alliance, and it can help you make sure you’re getting properly reimbursed in your practice.
Practice & Legal Guides
The Nurse Practitioner’s Business Practice and Legal Guide contains state-by-state information on ethics, risk management, and practice guidelines.
Professional Association Memberships
For instance, the AANP has everything from professional development to practice management tools to help you run your own office.
Technology
There are many digital tools you’ll need to start and manage your practice. Patel favors Canva, for creating your own flyers, ads, and social media displays — and QuickBooks for basic accounting.
Final Thoughts
As Pawlicki explains, the process to opening your own practice may not be easy, but it’s just part of what is expected as an NP — a constant journey of growth, learning, and striving to give patients the very best care.
“The process was harder than I expected, but never once did I back down or think it wasn’t the right thing to do,” Pawlicki says. “As practitioners, we constantly face challenges, and the best thing we can do is find the answers and continue to push ourselves to learn more. Since opening, I have never looked back. This has been the most rewarding experience I could have imagined. Trust in yourself. It’s never too late.”
Image courtesy of iStock.com/phototechno