Can Nurse Practitioners Have Their Own Practice?
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Nurse practitioners are registered nurses with advanced education. They either hold a master’s of science in nursing or a doctoral degree, such as a DNP or PhD. In the United States, there is a need for more skilled medical professionals and not enough physicians to meet it. A nurse can further their studies and seek additional training to become an NP and take on a more advanced role in healthcare.
Common duties of an NP include performing physical assessments; ordering and analyzing labs and imaging; diagnosing and identifying illnesses; consulting and referring patients to specialists; prescribing medications; and monitoring and administering treatment.
The U.S. Bureau of Labor Statistics (2023) projects a 45 percent national increase in NP jobs between 2022 and 2032. The increasing prevalence of chronic illness and a renewed focus on disease prevention furthers the need for additional NPs. Additionally, the shift to creating community-based clinics in underserved areas increasees access to care and is an opportunity for NPs to start their own practice.
Scope of Practice and NP Practice Regulation
NP scope of practice varies by state. Scope of practice is defined as the services that a licensed healthcare professional is believed competent to perform. It depends on the state whether NPs need career-long physician supervision or can practice independently. There are three types of practice regulations that a state uses to define the scope of practice of NPs.
The first type is full practice authority. This is when an NP can practice autonomously. They can prescribe, diagnose, and treat patients without a supervising physician. They can also independently own their own practice.
The second type of practice regulation is reduced practice authority. State licensure laws reduce the ability of NPs to employ at least one element of NP practice. The most common example is that an NP can diagnose and treat patients on their own but require physician oversight to prescribe medications. The NP would need a written supervising agreement that dictates what medications an NP can prescribe.
The third type of NP practice regulation is restricted practice authority. This is when an NP must have a career-long supervising physician to prescribe, diagnose, and treat patients. A written agreement between the NP and physician will specify what tasks an NP can perform. Depending on the state, the supervising physician can be a phone call away or must be physically present in the same building as the NP.
Presently, there are 27 full practice authority states for NPs. The other states comprise 12 reduced practice authority states and 11 restricted practice authority states. Some states allow the reduced or restricted designation to be removed over time. They have laws allowing for progressive practice authority.
For example, in Florida, an NP can only obtain an autonomous license after they complete 3,000 working hours under physician supervision. California, Illinois, and Virginia are other states that offer full practice authority after a provisional period.
In 2010, the Institute of Medicine published The Future of Nursing: Leading Change, Advancing Health report. It recommended that nurses should practice to the full extent of their education and training, including NPs. Since then, many states granted full practice autonomy to NPs. According to the 26th Annual Legislative Update from The Nurse Practitioner, in 2013, more than 20 states approved or implemented legislation that expanded NPs’ practice ability.
Although the number of states that have transitioned to full practice authority for NPs has increased since then, not all states are on board with this measure. As stated above, many states still require an NP to have a signed collaborative agreement with a physician or direct oversight from a physician. Depending on the state, the physician may have to be physically present with the NP during patient care, or available by phone.
Benefits of Full Practice Authority
One of the main benefits of allowing autonomous NP practice is that it increases patients’ ability to access health care. By eliminating unnecessary legislation limiting the autonomy of NPs, more patients can have their medical needs met. It also gives patients more options in the healthcare market and reduces wait times to be seen.
Full practice authority creates a more efficient healthcare system. This is especially because focusing on collaboration is the education model for NPs. NPs identify diseases and facilitate appropriate referrals to specialists. Full practice authority also lowers healthcare costs overall. Multiple research studies have shown that NPs provide high-quality care at a lower cost than physicians.
Another added benefit of full autonomy is that it increases NP job satisfaction. Many nurses transition to the NP role because they want to be empowered to make a large impact on their patients. Full practice authority allows NPs to accomplish this goal. Workplace limitations increase burnout in NPs.
According to the American Association of Nurse Practitioners, NPs deserve full practice authority as they consistently demonstrate their value in the health care system. NPs are required to meet national education standards and obtain national certification in their specialty prior to practice. Moreover, NPs are held accountable by their state board of nursing to provide quality care to patients.
Opening an NP Practice
After considering what level of practice is allowed by state law, an NP can decide to open their own practice. If the state requires the NP to have a supervising physician, the NP must find a collaborating physician. In general, the physician will not be working at the NP’s clinic, but they would need to be available in case the NP has questions.
Also, depending on the state, the physician may have to oversee the NPs charting, be physically present at the site, or be obligated to serve as the facility’s medical director. Nowadays, some websites can match NPs with a collaborating physician such as Doctors For Providers.
Nurse practitioners should be competent in their skills before opening a practice so that they can focus on the business aspect of their clinic. They must learn about marketing, bookkeeping, networking, and management. They will also have to create a business plan. The NP can use the business plan to organize, operate, and grow their practice. This plan must include services and products their practice will offer patients.
Additionally, the NP should consult with an attorney who has experience setting up NP-owned businesses and is familiar with state laws. The NP must incorporate the business and register with the IRS for a federal tax ID number. Plus, they must obtain a national provider identifier number for the practice. To protect the practice, the NP should acquire professional liability insurance.
Conclusion: Can NPs Open Their Own Practice?
In conclusion, yes NPs can have their own practice. As more physicians pursue specialties rather than family medicine, the demand for NPs increases rapidly. NPs in states with the most practice autonomy will find the easiest path to opening their own practice. Whereas NPs working in states with restricted practice must find a supervising physician to collaborate with them.
NPs provide patient-centered care, which entails a comprehensive understanding of a patient’s condition and lifestyle to deliver personalized treatment. The main benefit of full practice autonomy for NPs is that it will allow greater access to healthcare for patients.
Sophia Khawly, MSN
WriterSophia Khawly is a traveling nurse practitioner from Miami, Florida. She has been a nurse for 14 years and has worked in nine different states. She likes to travel in her spare time and has visited over 40 countries. Being a traveling nurse practitioner allows her to combine her love of learning, travel, and serving others. Learn more about Sophia at www.travelingNP.com.