States Where Nurse Practitioners Can Open Their Own Practice
- The 10-year job growth projections for nurse practitioners (NPs) is estimated to be 46%, much higher than the 13% growth estimated for all healthcare professionals.
- There are currently 26 states listed with full-practice authority where nurse practitioners can open their own practice. Some states have added criteria that must be met to work autonomously.
- NPs who want to open their own practice must consider many factors and plan to protect their personal and professional assets.
The 10-year projections estimate job growth for NPs will outpace most other healthcare professionals. The U.S. Bureau of Labor Statistics believes the overall job growth in healthcare will be 13% from 2021-2031 while NPs will grow by 46%.
The growth is fueled in part by a physician shortage, excellent patient outcomes, and an aging population with greater health needs. NPs who work in full-practice authority states can offer a greater range of services and options to patients.
Learn more about the practice authority in each state, how to advocate for full-practice authority, and what to consider before opening your own practice.
Nurse Practitioner Scope of Practice
The American Nurses Association defines the 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."
These services are defined by the "who," "what," "where," "when," "why," and "how" of nursing, which make complex considerations clear and define overlapping responsibilities.
The American Association of Nurse Practitioners identifies three types of practice regulations for NPs that define the scope of practice NPs have within state regulations. These three types are:
- Full-practice authority: Under full-practice laws, an NP can prescribe, diagnose, and treat patients without physician oversight or supervision. NPs in these states can practice independently, including operating their own practice.
- Reduced-practice authority: An NP can diagnose and treat patients but require physician oversight to prescribe medications.
- Restricted-practice authority: An NP must have physician supervision or oversight to prescribe, diagnose, and treat patients.
These 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.
Nurse Practitioner Authority by State
Currently, there are 26 full-practice authority states for NPs, 13 reduced-practice authority states, and 11 restricted-practice authority states. This represents a move toward more full-practice authority states since 2019 when there were 22 full practice, 16 reduced, and 12 with restricted authority.
If you're looking to open your own practice, you must know your practice authority in each state. Below are the states and U.S. territories by NP practice authority as of October 2022.
It is vital you frequently check with your state board of nursing as practice authority may change. The legislative action may not remove the "reduced" or "restricted" designation, but the law may allow for progressive practice authority. For example, while Florida is listed as "restricted," under HB 607, NPs are granted an "autonomous" license when they meet certain criteria.
For an autonomous license in Florida, an NP must complete 3,000 hours under a physician's oversight, have an active and unencumbered registered nurse license, proof of graduate-level classes in differential diagnosis and clinical pharmacology, and have no disciplinary action within the last five years.
10 Factors to Consider When Opening Your Own Practice
NPs practicing in full-practice authority states have the option of opening their own practice without physician oversight or supervision. Many factors must be considered and researched to protect your personal and professional assets.
Understand Your "Why"
When the going gets tough, and it will, remembering why you are opening your own practice can help you meet challenges head-on. This clarity can make it easier to resolve yourself to the hard work ahead.
Know the Law
State laws vary on the type of practice you may open. Additionally, you'll need to be up to date on business law and the required licenses and permits to open a practice. Consider working with a business attorney who is familiar with NP practices.
Apply for a National Provider Identifier
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPPA) administrative simplification standard. It's a unique identification number for covered healthcare providers. Providers must use their NPIs in administrative and financial transactions adopted under HIPAA.
You will need your NPI to bill Medicare and access health records.
You'll need malpractice insurance for an independent healthcare provider and business insurance to protect your business assets. You may want to consider cyber insurance to protect your practice against the consequences of hacking.
Cash Flow and Billing
You will need to determine if you are taking insurance, Medicare, and Medicaid, or will the practice be self-pay only. Which private insurance companies will you work with? 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.
Starting a practice is expensive. You need office space designed for an NP practice, furniture, equipment, an office assistant, a website, stationary, and financing.
Leverage Social Media
Join entrepreneur groups and network with other independent nurse practitioners. You'll be surprised at how much you can learn from other NPs.
Marketing your practice may feel foreign to you, but if no one knows you're available, how can you provide care? Network with people in your area and let them know about your practice and anything that makes it different. Consider making YouTube videos to spread the word about your practice.
As you're developing your business, remember you'll need a competent medical biller and coder, an accountant, and an attorney. You'll also want to find reliable medical suppliers.
Seek a noncompetitive mentor who can help you ride out the rough spots, explain business matters, and avoid common pitfalls.
Carranza, A, et al. Comparing quality of care in medical specialties between nurse practitioners and physicians. https://pubmed.ncbi.nlm.nih.gov/32384361/
Florida board of nursing. (2022). https://floridasnursing.gov/licensing/autonomous-advanced-practice-registered-nurse/
Healthcare occupations. (2022). https://www.bls.gov/ooh/healthcare/home.htm
National provider identifier standard. (2022). https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand
State practice environment. (2022). https://www.aanp.org/advocacy/state/state-practice-environment
U.S. Bureau of Labor Statistics, Occupational Handbook. (2022). Nurse anesthetists, nurse midwives, and nurse practitioners.
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