States Where Nurse Practitioners Can Open Their Own Practice

Federal 10-year projections estimate that job growth for advanced practice registered nurses (APRNs), a classification that includes nurse practitioners (NPs), will dramatically outpace other occupations.

The Bureau of Labor Statistics (BLS) projects that NP jobs will grow a whopping 40% from 2032 to 2033. By comparison, all U.S. occupations combined are slated to grow an average of 3% a year.

The demand for NPs is fueled largely by the ongoing nursing and physician shortages — the U.S. is predicted to face an 86,000 physician shortage by 2036. This creates a need not for more healthcare providers overall, including NPs who are authorized to work independently. Additionally, an aging population and the burden of chronic conditions are further straining the delivery system.

NPs who work in full-practice authority states can offer patients a greater range of services and options than doctors.

Learn more about the NP practice authority in each state, how to advocate for full-practice authority, and what to consider before opening your practice.

The American Nurses Association (ANA) defines the nursing scope of practice as the “services that a qualified health professional is deemed competent to perform, and permitted to undertake — in keeping with the terms of their professional license.”

The advanced training NPs receive allows them to service communities by working within their scope of practice. In broad terms, an NP’s scope of practice includes:

Medical procedures such as performing surgeries are strictly performed by physicians.

The American Association of Nurse Practitioners (AANP) identifies three types of practice regulations for NPs that define the scope of practice NPs have within state regulations. These three types are:

The practice regulations are legal and legislative restrictions on practice authority. In other words, data demonstrate that NPs offer excellent primary and specialty care, whether it is offered under physician oversight or independently.

There are 29 full-practice authority states for NPs, including the District of Columbia, 11 reduced-practice authority states, and 10 restricted-practice authority states.

If you’re looking to open your practice, it’s important to know the details of your practice authority in each state, including any recent or potential changes. You can do this by checking with your state board of nursing.

As an example of the potential complexity of these laws, the state of Florida became a full-practice state in 2020. However, NPs are granted an “autonomous” license when they meet certain criteria.

To work independently, an NP must:

Although NPs can practice independently in many states, there is limited data on the number of NPs who open an independent practice.

Navigating information on how to open your primary care practice as an NP can be confusing. You may be unsure where to begin.

Here are 11 factors to consider.

When the going gets tough, and it will, remembering why you are opening your practice can help you meet challenges head-on. This clarity can make it easier to resolve yourself to the hard work ahead.

State laws vary on the type of practice you may open. Additionally, you must be current on business law and the required licenses and permits to open a practice. Consider working with a healthcare or business attorney familiar with NP practices.

As a licensed and certified NP, you should already have your unique National Provider Identifier (NPI) number. Providers must use their NPI number in administrative and financial transactions adopted under the Health Insurance Portability and Accountability Act (HIPAA). You will need your NPI to bill Medicare and access health records.

Your business may also need a unique NPI number to practice in your state.

You’ll need malpractice insurance for an independent healthcare provider and business insurance to protect your assets. You may want to consider cyber insurance to protect your practice against the consequences of hacking.

NPs must be credentialed with specific insurance companies to bill insurance companies for their services. The credentialing process may take a few months, so start before you open your practice. Contact individual insurance providers to find out their credentialing process.

As an NP and business owner, you must determine if you are taking private and governmental insurance like Medicare and Medicaid. You can also decide if your practice will be self-pay/cash only.

Consider the billing and payment software you’ll use. Will you outsource billing initially or hire someone? Since expenses likely outsource income for at least six months, you may want to consider having a part-time job until the practice is profitable.

A business plan will help you organize how you want your business to run. It will also address your financial requirements before opening your private practice. For example, you need office space, furniture, equipment, an office assistant, a website, and a marketing budget. It is important to create a business plan before opening your practice. Contact your local small business association (SBA) for help in starting your business.

Join entrepreneur groups and network with other NPs and healthcare professionals. You’ll be surprised at how much you can learn.

Marketing your practice may feel foreign to you, but how can you provide care if no one knows you’re in business? Network with people in your area and tell them about your practice and what makes it unique. Consider these marketing options to spread the word about your practice:

As you develop your business, remember that you’ll need a medical biller and coder, an accountant, and an attorney. You’ll also want to find reliable medical suppliers. Internal processes and procedures are equally important. How will you gather and share medical information? Will you e-prescribe or use a paper-based service? These are just a few questions to consider.

Look through your contacts and seek a mentor. Having a mentor can help you understand your business better, avoid common pitfalls, and help you bounce ideas for your business.