Nurse Practitioner – Independent Practice

Establishing an NP Entrepreneurial/Independent Practice

Nurse practitioners considering establishing an entrepreneurial practice should first complete a community and feasibility assessment, then contact the Small Business Administration, (SBA). The SBA can provide information about financing programs that may be available. Developing a business plan and exploring options for practice types (e.g., partnership, professional corporation, non-profit 501 (c) (3)) are an important next step. Networking within a community before opening a practice will enable the PNP to have the best understanding of the environment in which they will work.

Another opportunity may be to work as a self-employed NP with a physician.  The physician can pay a majority of the overhead, be in a separate office, and consult as needed using free technology such as Skype and you can enjoy the benefits of an independent practice.

Here are some additional considerations for entrepreneurs:

Prepare to work long hours

Nurse practitioners who own their own practice devote six to seven days every week, and numerous evenings to the development of their practice.  It can take as long as five to seven years to see a financial return on the practice, so it is important to establish your practice in a community where you are planning to reside for several years.  Carefully consider what is required prior to establishing an entrepreneurial practice as it takes ongoing commitment (Stevens, 2011).

Plan to care for underserved populations

NP operated clinics frequently deliver comprehensive pediatric health care for people of diverse cultural groups who have historically not had access to medical services.  More than 8 million children are living in the United States without health care insurance; there is likely an opportunity, if not a need, for a clinic in many communities (Children’s Defense Fund, 2011). Patient’s health care needs in these clinics may be different from what the NP is accustomed to seeing in traditional primary care settings. The leading health problems in underserved population clinics may relate to poverty: 1) otitis media, lead toxicity, anemia, scabies, lice, urinary tract infections; 2) drug-dependent babies; 3) mental health—depression and aggression; 4) pregnancies, maternal wellness, and ob/gyn issues that are referred; 5) asthma, bronchitis, viral infections and high fevers. Less commonly sought reasons for health care in this population includes well-child care and immunizations.

Persistence and creativity are keys to success

Consider creative partnerships.  It may be possible to partner with another advanced practice provider to open a family clinic, a dentist to provide more holistic care in one practice environment, or another NP to pool resources.

Prior to opening the practice, obtaining an NPI number and registering with Medicaid for reimbursement are necessary.  Seek out individuals and major foundations to support the practice to offset care costs for those who cannot pay for services.

Apply for grants and foundation funding to enable the practice to have foreign language interpreters.  Reaching out to the United Way may be an additional funding source and may also be a resource to obtain health insurance benefits for providers in the practice.

Maintaining a relationship with key professionals outside of the health care field will support a private practice.  Relationships with bankers, an attorney, and accountant will make financial dealing less complex.  When setting up a practice location a realtor, architect, and designer can give you an advantage in drawing in new business and making the practice environment welcoming to the clients. Using a public relations firm and web designer can boost business as well.  Seeking expertise outside of medicine adjuncts your professional knowledge as an NP.

Stay committed

There are many details for starting an independent practice. The necessary paperwork, realistic time line, business practice approach, marketing plan, legal issues, hiring the right staff, office location, purchasing for the office, and affordability are all issues that must be considered. It is a good idea to seek the experiences of other NPs who have developed independent practices.

Some entrepreneurial NAPNAP members work as Child Care Consultants, own their own practices, or are professional speakers and consultants. Some NAPNAP members have created products that appeal to other professionals and to families. Others have pursued a second profession, for example, as Nurse Attorneys. The possibilities are endless. Having your own business has its challenges, but can be a very rewarding experience.

 

References

Children’s Defense Fund. (2011). Uninsured children by state. Retrieved from: http://www.childrensdefense.org/policy-priorities/childrens-health/uninsured-children/uninsured-children-state.html

Stevens, J. (2011) Business 101: What nurse should know before they jump. [Power Point slides]. Presented at Greater Texas Chapter of the National Association of Pediatric Nurse Practitioners Conference: Arlington, Texas. September 30, 2011.