In many states, Nurse Practitioners (NPs) can open their own practices. But just because you can doesn’t mean you should. Here’s how to decide and, if you choose to, the types of actions you’ll need to take.
When Scharmaine Lawson, FNP-BC, FAANP, FAAN, had been a nurse for 15 years, she had worked in many different specialties. One of her favorites was home care. In fact, it was her passion.
“I wanted to help my community, and a physician approached me about starting my own clinic/housecall service. It was a ‘right time/right place’ moment,” she recalls.
Lawson ended up founding a VIP housecall practice, Advanced Clinical Consultants in Louisiana, which has been successful for the last 15 years. She also penned Amazon’s number one house call book, Housecalls 101: The Only Book You’ll Need to Start Your Housecall Practice. Finally, she’s designed a course called Housecalls 101, in which she teaches other clinicians how to start and maintain a successful home visit program. Since 2008, Lawson says she has trained more than 600 nurses on how to do this themselves.
“When the opportunity presented itself, it was a natural fit in an environment I felt comfortable operating in,” says Lawson. “Plus, I saw the community need and felt I could best be a servant leader. At the end of the day, the ability to serve is my superpower. It’s an honor that I don’t take lightly.”
Should You Open a Practice?
As Lawson says—and as do our other sources—first, you need to find your passion. You also need to decide if this is something you really can do. “Opening your own practice takes guts, time, and dedication. If you’re missing any of those, it’s not worth it,” says Graig Straus, DNP(c), APRN, CEN, FF-NREMT, founder and owner of Rockland Urgent Care Family Health NP in New York. “I always knew that I wanted to be my own boss, make my own rules, and care for my patients on my own terms. Having that desire really drove me to the point of wanting to open my own business.”
While fulfilling, opening and running your own business isn’t easy. “Nurse practitioners should only open their own practices if they want all the things that go along with owning any business: bookkeeping, marketing, networking, hiring/firing, social media, etc.,” says Bradley A. Bigford, MSN, APRN, NP-C, CCHP, founder and owner of Table Rock Mobile Medicine, PLLC in Idaho. “If they like working 9-5 jobs, owning their own businesses likely isn’t for them. They have to put in long days and nights, weekends, and holidays.”
If you’re up to the task, the next step is to determine what kind of impact you want to have on your community and profession, while making sure that what you want to do matches up with a need in the area you want to serve. “It was a simple decision for me,” says Maurice D. Graham, DNP(c), MSN, APRN, FNP-BC, CEO of Graham Medical Group, a concierge medical practice in Maryland. “As an African American male, [I know that] we are often undertreated for health care issues, accompanied with the fact that African American men do not seek routine screenings and prevention.”
Ask yourself tough, but important, questions. Melanie Balestra, JD, NP, MN, of the Law Offices of Melanie Balestra, is a lawyer and an NP and has been working with other NPs in a legal capacity to help them set up their own practices for more than 25 years. She says you should ask yourself some of the following questions:
- What are the goals of opening your own practice?
- Where will it be located?
- What will be the focus of it?
- Will you take insurances or be cash based?
- Will you need support help?
- Will you be taking out a loan? If so, where will you apply for one?
- Will you be able to function in the red for at least a year?
“The biggest challenge is that it does not happen overnight,” says Balestra. “The NP needs patience and be able to evaluate what might not be going right in the practice. This is why location is important. Collections can be a nightmare, so it’s important to have a good billing and collection service. The biggest mistake is expecting overnight success, and then when it does not happen, giving up.”
What to Do First
The first thing you need to do if you plan to open your own practice is to develop a business plan, says Balestra. “If you are in a state that requires a supervising physician, make sure you have him/her on board. When this is done, hire an attorney who has experience with setting up NP businesses and understands the laws of your state. Hire an accountant to work with the lawyer on setting up the best entity for you legally and tax wise,” she explains. Have several office spaces in mind and make sure they are zoned for medical practices. If you need a loan to start business, it may be a personal loan but a note can be written so that the business pays back the loan.”
Do your research. “Nobody should just open a practice for the sake of opening one without any research into their idea or doing market analysis,” says Lawson. “This is a disaster waiting to happen.”
Bigford stresses that you also need to talk with your family. “It takes a buy-in from everyone because of the significant work it takes from everyone involved and their loved ones to pick up their slack,” he says.
As for how long it will take—for our sources, it took anywhere from four months to two years before they opened their practices.
Straus says that after you incorporate, you should also get a group NPI number—this is different from the personal one you would have gotten when you initially began practicing. “This establishes your company as an organization capable of being recognized by CMS,” he says. He then went and spoke with his local Industrial Development Agency to determine what tax breaks and industry connections he could get. “This will help to reduce costs and potentially hasten any permits needed to build a practice. These are quasi-governmental agencies who have the ability to lessen the tax burden placed on you in the initial stages of opening a business. The goal of these agencies is to promote sustainable businesses and help support local communities.”
You’ll also need insurance—for yourself and your business. “Insurance is a necessity prior to your business opening,” says Emily Keller Rockwell, RN, MSN, CRNP, owner and founder of The Montchanin Center for Facial Aesthetics in Delaware. “Without question, have a detailed meeting with your insurance agent, discussing your business in detail—making sure they understand all aspects of your business and will provide the adequate coverage and limits to protect you and your business.” A few kinds of insurance to discuss, she says, are property, liability, errors and omissions coverage, umbrella, and disability, among others.
Some of our sources didn’t hire staff—at least for the first year. “Staffing depends on the volume of business being generated,” says Graham. “My first year, I didn’t hire anyone. I did all my administration duties and cared for my patients. My goal was to keep my overhead as low as possible without lowering the level of care given to my patients. This worked out well for me.”
Rockwell also waited a year to hire an assistant. Now she has three and a full-time publicist. “I am able to do speaking engagements, conduct trainings, and attend training events to further my professional knowledge,” she says.
If your type of practice requires that you have staff from the beginning, Balestra says to know what you’re looking for in attitude, skill level, and personality.
Bigford says that “Hiring non-revenue generating staff should be kept at a minimum.” When you hire anyone, he suggests that you find people who have a good work ethic. “Someone personable, easy going, and friendly is important,” says Straus.
Once you’ve determined your business, you may need to find a place. (Obviously, if you choose to have a house call business, you don’t need a brick-and-mortar office.)
“Think about the services you want to offer and the space you need to do it in,” says Straus. His urgent care facility needed a lot more resources than a primary care office. “I specifically met with architects who specialize in medical offices to help determine the size and capabilities of the space, based on my needs.”
Graham had one large room that included his own personal desk as well as all the equipment he needed to conduct assessments and provide routine care to his patients.
Rockwell says that when designing your space, keep your clients’ need in mind. “Design a warm, comfortable waiting area to keep patients relaxed,” she says.
All our sources say that you must have a website. Even if it doesn’t bring clients in directly, they will want to look at it to get information about you and the kinds of services you offer.
Don’t discount word of mouth. This can be one of your best marketing tools.
Social media is your friend. Learn how to use it. If you don’t know how, hire someone who does.
When using social media, decide which is best for you. For Rockwell, Instagram has brought her the most clients. Bigford says to go where your core consumers are. His are on Facebook and Instagram. “Post every single day. Go to Facebook groups. Facebook and Instagram ads work really well for me to build trust,” he says.
Straus suggests having “coming soon” ads before you actually open to build up curiosity. “Ads in local papers that cater to your community could be beneficial,” he says. He adds that advertising in church newsletters, school calendars, and through the police athletic leagues—any organization that involves your community—can be beneficial to your business.
Our sources also stress getting patients/clients to give you reviews on Yelp, Google, and Facebook. High ratings attract new consumers.
Before you start your own business, there’s still more to know. “Get experience elsewhere first,” says Bigford. “If you’re trying to learn to be an NP and start your own business, you’re going to struggle at both.” He also suggests that you get traction with patients. It took Bigford about a year to get a steady stream of patients and referrals. “If you have a high overhead in the beginning, you can go out of business before you even see your first patient,” he cautions.
Be sure that you know how to properly manage your time. That was Rockwell’s biggest challenge. “I wanted to see and help every patient who inquired,” she recalls. “I quickly found out that I needed to manage my work time and personal time equally. As with anything in life, you need to reboot or you will burn out. Schedule yourself into your schedule!”
Look for a mentor. “NPs should look for a mentor or someone who has already established a clinic, and pick their brain. That’s what I did,” says Graham.
Have enough money to get you through. “In jobs that rely on insurance, payments are delayed. You do not simply offer a service and get paid the exact moment of exchange. A claim has to be made, filed, and processed. Then payment is issued per contracts,” says Straus. “A solid 4-6 months of cash on hand to cover expenses is needed while you establish your practice, build clientele, and await the beginning of insurance reimbursements.”
Despite all the hard work and sacrifice needed to run your own practice, our sources wouldn’t have it any other way.
Lawson’s biggest reward in having her own practice? “Complete autonomy,” she says. “It is the biggest entrepreneurial superpower.”
Disclaimer: This story is meant to give general advice. For specific individual advice on starting your own business, be sure to consult a lawyer, an accountant, and other professionals.
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Opening your own business is not quite like nursing school or your first nursing job.. First, you should decide which type of business will work best for you and your company.. You want to open your nursing business, but how will you fund it?. When opening a business, you may think all attorneys are created equal.. Roberts is based in New York, so her attorney came with a hefty price tag.. Jules suggests getting the certifications your practice is going to require.. In the age of social media, finding resources to help guide your path of nurse entrepreneurship shouldn't be too difficult.. Other beneficial resources to support you along the way include:. Jules' top goal at Fleur De Lis Beauty is to engineer skin care and wellness that will take center stage in the lives of her clients by providing a focus on beauty, self-care, and a healthy lifestyle.
These practice settings include some of the following: women’s health, college health, emergency rooms, nursing homes, public health, psychiatric health, and pediatric health.. They are also able to provide treatment for acute minor illnesses.. As the country seeks to make health care more accessible and affordable, we have an opportunity to educate the public about the roles of nurse practitioners.. Some degree programs offer specializations in practice related to particular populations, such as family nurse practice and adult-gerontology nurse practice.. A student might be a health care administrator, someone who’s worked as a pharmacist, or someone who hasn’t been in health care at all.. MORGAN: Experienced nurse practitioners can serve as administrators for hospitals or clinics.
NPs who want autonomy in operating their businesses while having greater freedom to provide medical care can start a nurse practitioner independent practice.. Patients can receive a range of primary and specialty care services from a nurse practitioner private practice, similar to those offered at a physician’s office.. While many nurse practitioners work autonomously in private practice, some states limit the scope of services they can provide independent of physician oversight or involvement.. In these states, nurse practitioner independent practices can provide a range of services without physician oversight, including patient exams; performing, ordering, and interpreting diagnostic tests; prescribing medication; and managing treatment plans.. NPs must hold an active registered nursing license in their practicing state, along with an advanced practice registered nursing license.. Among the more common nurse practitioner private practices are those specializing in psychiatric, family, or acute care.. The coursework and clinical experience that an advanced nursing program provides can help family NPs develop the necessary skills to provide comprehensive care to diverse patient populations, such as:. Family NPs often work with other health care professionals, including other nurses and physicians, to coordinate patient care.. Resources: Family Nurse Practitioner Private Practice Family care is the most common specialization among nurse practitioners, with nearly 70% of NPs holding their primary certification in this area, according to AANP.. Acute Care Nurse Practitioner Private Practice. Many acute care NPs focus on adult-gerontology acute care, primarily working with older patients in settings such as nursing homes, emergency rooms, and trauma units.. Resources: Acute Care Nurse Practitioner Private Practice As the population of the country ages and people live longer with chronic and acute health conditions, the health care industry will need AGACNPs to care for them.. Starting a nurse practitioner independent practice allows NPs to build a network of referrals, gain greater independence caring for patients, and the freedom to run their business and potentially earn more income.
NPs who want autonomy in operating their businesses while having greater freedom to provide medical care can start a nurse practitioner independent practice.. NPs must hold an active registered nursing license in their practicing state, along with an advanced practice registered nursing license.. Family NPs often work with other health care professionals, including other nurses and physicians, to coordinate patient care.. Resources: Family Nurse Practitioner Private Practice Family care is the most common specialization among nurse practitioners, with nearly 70% of NPs holding their primary certification in this area, according to AANP.. Resources: Acute Care Nurse Practitioner Private Practice As the population of the country ages and people live longer with chronic and acute health conditions, the health care industry will need AGACNPs to care for them.
That’s why we asked savvy nurses and career experts for their answers to your resume and profile questions.. When you’re a new nurse graduate…. “Nursing students think employers would rather hear all of their clinical experience, but what’s more impactful to a hiring manager is learning about all of the other experiences a potential candidate has—like other employment history, even if it’s not related to health care.”. There are some areas where it’s easy to find a nursing position and others, such as California , that are much more competitive markets.. It’s not easy to find connections in a town where you don’t know anyone, but it can be done.. For instance, employers may prefer local candidates.. This worked out well for me.”. “Someone personable, easy going, and friendly is important,” says Straus.. Additionally, there are now several nursing articles that can provide further insight on behaviors that can negatively impact health care environments, health care workers, and patients.. According to the National Association of School Nurses (NASN), about 40% of our nation’s schools only have a part-time nurse, and 25% don’t have a nurse at all.. A recently published research article in the NASN School Nurse journal focused on one of the most difficult problems for school nurses and families: the issue of suicide.. By understanding the benefits and responsibilities of school nurses working in collaboration with the school physician, pediatricians can support and promote school nurses in their own communities, thus improving the health, wellness, and safety of children and adolescents.. Moore’s experience because of her assignment as a dedicated nurse to one school on Staten Island, New York is able to compare that experience to her North Carolina experience where she rotated up to three schools each school year over the course of her tenure.. Maybe this was part of patient care .
“The biggest mistake students make when choosing schools is not researching the full scope of the nursing profession,” says Ruth Johnson, RN, EdD, FAAN, professor and chair of the Department of Nursing at South Carolina State University, a historically black school.. Similarly, too few students considering graduate school have solid long-term goals for their nursing career, believes Kem Louie, RN, PhD, FAAN, an associate professor at William Paterson University in New Jersey and president of the Asian American/Pacific Islander Nurses Association.. The Mentor Connection Dr. Maria Warda, RN, assistant dean of UCSF’s nursing program, agrees that faculty support plays a vital role in helping students make the most of their graduate school experience.. Another highlight of the 2004 convention was a special reception commemorating the 30th anniversary of the ANA’s Minority Fellowship Program (MFP), established in the 1970s to increase the number of doctorally prepared minority nurse researchers and clinicians working in the field of mental health and psychiatric nursing.. In October 2004, the American Association of Colleges of Nursing (AACN) issued a landmark position statement endorsing a new type of terminal degree: the Doctor of Nursing Practice (DNP).. As the name implies, this new doctoral degree option—unlike the traditional research-focused PhD in nursing—is a practice-focused doctorate designed for advanced practice nurses (APNs), such as nurse practitioners, clinical nurse specialists, nurse-midwives and nurse anesthetists.. For More Information To learn more about the Doctor of Nursing Practice degree, visit the DNP section of the American Association of Colleges of Nursing (AACN) Web site at www.aacn.nche.edu/DNP.. • A list of nursing schools that offer Doctor of Nursing Practice programs.. Although Zychowicz completed his program in three-and-a-half years, the amount of time it takes to earn a DNP degree varies, depending on such factors as the structure of the program, whether students attend full or part time, and whether or not students already have master’s degrees and experience as clinical practitioners.. Choosing a DNP Program With more and more nursing schools adding practice doctorates to their graduate-level offerings, students have a wide variety of DNP programs to choose from.
To help foster greater understanding of the issues surrounding health equity in the U.S. and the critical role nurse practitioners (NPs) play in creating a more equitable future for health care, two members of the American Association of Nurse Practitioners® (AANP) Diversity, Equity and Inclusion (DEI) Committee are sharing their insights and experiences.. Our practice is based on the law, so if we want to make it better for our patients and those working in the profession, we need to be involved with policy.. Ruffin : First off, NPs — and especially novice NPs — need to get involved with their professional nursing organizations .. Patrick : People want to know if these organizations are truly practicing what they preach.. In leadership roles, you don’t see a lot of people of color, and although the Black community makes up about 13% of the U.S. population, less than 7% of the nursing population is Black.
Explore unique career ideas for burned out nurse practitioners looking for flexibility, personal fulfillment, and better work-life balance in nontraditional work opportunities.. From this research, it’s clear nurse practitioners experiencing burnout may need to reevaluate the environment where they work and seek alternative career opportunities with more favorable conditions.. There are innovative telehealth companies all over the country looking for NPs to provide remote synchronous and asynchronous care for a wide variety of treatment areas for diverse patient populations.. These programs work with vulnerable communities to provide critical health services, primary care, screenings, treatment for conditions common among homeless populations, and more.. Nurse practitioners who want to enter the field of research but need more experience in a clinical research setting can begin as a research assistant, clinical researcher monitor, or clinical data coordinator.. Nurse practitioners experiencing burn out or who are seeking a change in environment can practice in the great outdoors working as a camp nurse .. Many, if not all of these roles, can be done remotely.. Nurse practitioners who want to work in education, but do not want to teach, can find opportunities as an education consultant working for public or private universities.. Nurse Practitioners can also be hired as product managers to conduct research and partake in strategic planning and implementation of health related products.
These self-guided health care professionals can put their nursing experience to work to start their own business.. Some nurses operate their own medical product sales business, traveling to clinics, hospitals, and other health care facilities and selling to nurses or other medical professionals.. Generally, however, nurses who start their own business begin as registered nurses (RNs) who hold a bachelor’s degree and have experience in a clinical setting.. Many nurse entrepreneurs are RNs who hold an advanced nursing degree, such as a master’s in nursing or DNP.. Most nurses who start their own business have clinical nursing experience.. Entrepreneurial nurses should possess the skills to succeed in business as well as in nursing.
But beyond patient advocacy, nurses can rally on behalf of other nurses and healthcare providers.. Here are 15 ways that nurses and nurse educators can impact healthcare legislation and support local organizations.. The United Nurses March , scheduled for May 12, 2022, is an opportunity for nurses to demonstrate and gather in support of other nurses.. Noah encourages nurses to write to state representatives and advocate for policy decisions that can lower healthcare costs or widen the scope for nurse practitioners, for example.. Experienced registered nurses (RNs) can be strong teachers and nurse mentors for nursing candidates.. Attracting veteran nurses to nurse educator roles arms aspiring nurses with the tools needed to advocate and pursue healthcare change.. Anne Dabrow Woods, chief nurse at Wolters Kluwer, Health, Learning, Research, and Practice, says we must be innovative in attracting veteran nurses to consider becoming nurse educators.. Healthcare organizations and nurses can help support the development and funding of nursing programs at community colleges.. Licensed practical/vocational nurses (LPNs/LVNs) and associate degree in nursing (ADN) programs are more racially and ethnically diverse than bachelor of science in nursing (BSN) programs.. A nurse for over 37 years and a nurse practitioner since 1998, Dabrow Woods currently practices as an acute care/critical care nurse practitioner at Penn Medicine, Chester County Hospital.
As the United States makes slow but steady progress in granting nurse practitioners the authority to practice autonomously (according to the American Association of Nurse Practitioners, nearly half the states and U.S. territories allow this), nurse practitioners around the country are finding professional and personal career satisfaction in practicing on their own.. When you work for someone else, you are not able to set good limits.”. “When I worked as a nurse in a hospital and a doctor would give orders, I would sometimes think, ‘I would do this instead,’” says Kathy Fresquez-Chavez, DNP, FNP-C, MSN, the owner of Bella Vida Health Care Clinic and Medi-Spa in Los Lunas, New Mexico.. Early in her career, she approached every responsibility as a learning experience, taking on both nursing and administrative tasks to learn.. “As a solo practitioner, if you’re afraid to communicate with your peers, you’re not going to get too far in this business,” says Bean, who also founded the Tennessee Nurse Practitioner Association chapter.. Building connections and collaborations with others in the medical and business communities is important to keep things running smoothly.. “As a solo practitioner, if you’re afraid to communicate with your peers, you’re not going to get too far in this business,” says Bean, who also founded the Tennessee Nurse Practitioner Association chapter.. In New Mexico, where FresquezChavez and Schare practice, nurses have authority to practice with full autonomy and require no physician oversight.. Bean’s solo practice, however, is in a state that restricts full autonomy.. “Practicing in a restrictive state has many challenges, especially for an NP-owned practice,” says Bean, a nurse for more than 20 years and a solo practice owner for 13.. Solo NPs say the patient relationships are meaningful, and they know solo practices help the crunch on family care providers.
Nurse navigators are becoming ever more important in helping patients “navigate” their way to timely and quality care.. The nurse navigator responds to questions in a timely manner, explains the rationale behind the planned treatment, and coordinates care across the healthcare continuum.. Nurse navigator roles and responsibilities vary depending on the nurse’s level of preparation and the healthcare setting in which he or she works.. But all nurse navigators advocate for patients by helping translate complex medical information into language they can understand and apply, and making the overwhelming more manageable.. Educate patients about their disease, prescribed treatment, and side effects of treatment and how to manage themProvide clinical resources -- where to seek a second opinion, treatment or testing that may not be available locally, and how to access reliable sources of informationAssess patients for psychosocial distress and referral to a medical social worker or counselor if more intensive support is neededAnswer questions as appropriate and serve as liaison to the physician for additional questions and concernsAddress tangible barriers to care such as finances, housing, transportation, childcare, prescription costs, and much more.. They refer patients to the appropriate contact, such as a social workerEnsure any health information provided is accessible: this may include securing documents printed in the patient’s own language or arranging for certified medical interpretation, either in-person or by phone/video conferenceFunction as a member of an interdisciplinary team to assess, secure, and coordinate appropriate services through the continuum of careEmpower patients, families, and caregivers to assume as much responsibility for their care as possible, within the constraints of age, illness, and other factorsIn consultation with other members of the healthcare team, promote awareness of clinical trials as appropriateSupport the timely scheduling of appointments, diagnostic testing, and proceduresEducate/identify patients for genetic counseling or fertility preservation, and facilitate appropriate referrals There is more to being a successful nurse navigator than having specialized clinical skills, although clinical competence is certainly essential.. Cultural openness: the nurse navigator will be open to learning from patients, about values, beliefs, and how they see the world – all which may be very different from the navigator’s personal culture and beliefs.. Respect for others: this may seem like a given, but the nurse navigator role requires the nurse to be especially diligent in this area and to show patience and understanding while setting reasonable boundaries and expectations.. Any nurse navigator must have solid clinical experience in a specific area of nursing care (usually several years).. Some nurse navigators may be nurse practitioners or clinical nurse specialists, depending on their work setting and disease focus (lung cancer, cardiology, or organ transplant).. Salaries for nurse navigators usually align with those of others in their level of practice, whether nursing with a specialty certification or an advanced level of nursing practice.. By inventing the field of patient navigation, where lay providers working in the community assisted patients in obtaining early mammography screening, and then helped them get into and “navigate” the healthcare system, Freeman actually saw a remarkable increase over time in patients’ five-year survival rates, from 39% to 70%, which he discussed in Oncology Issues .. As discussed in AONN online community navigators are lay persons who focus on health teaching and prevention/screening activities in the community setting; patient navigators (unlicensed individuals) and social work navigators focus on making sure practical, tangible resources are in place to assist patients in obtaining needed care (e.g., transportation, Medicaid, medical housing, and other community resources); and nurse navigators, who focus on the clinical aspects of care and making referrals as appropriate to others on the multi-disciplinary team and beyond.
Nurse practitioners care for patients across the lifespan in a variety of settings and are one of four recognized advanced practice registered nurse ( APRN ) roles, which also includes Clinical Nurse Specialists, Nurse Anesthetists, and Certified Nurse Midwifes.. All NPs must complete a master’s (or doctorate) degree program, and they hold certificates in one of 8 recognized specialties, with Family Nurse Practitioner (FNP) being the most popular at 54.5%.. In addition to diagnosing and managing acute episodic and chronic illnesses, NPs also focus on health promotion, disease prevention, health education and counseling, and guiding patients to make smarter health and lifestyle choices.. The role and capacity in which a NP can work is ubiquitous.. Due to a shortage of primary care physicians in the United States, the need for NPs developed.. All clinical training is completed in a specific population focus and upon completion of school, graduates must pass a board examination in order to practice.. Graduates must also fulfill state nursing board requirements to be recognized within their respective state—including prescriptive authority, in order to practice in that state.. The doctor of nursing practice ( DNP ) is considered the terminal clinical degree for the profession, but there is no current requirement for it to be the entry-level education for NPs.. Both Clark and Ingram’s path to the NP profession was a long one; Clark spent 15 years as a nurse before pursuing advanced education and Ingram was a nurse for 21 years before enrolling in NP school.. Why It’s a Good Time to Consider the NP Profession Once again, the United States is faced with a primary care provider shortage.. Less physicians are going into primary care, whereas over 80% of NPs specialize in a primary care role—which is good news considering NPs can help fill that gap.
Nurse practitioners could be a vital resource for overburdened hospitals. Red tape is getting in the way. ›
But a vast patchwork of state healthcare regulations has made moving some of these workers across state lines complicated—especially for highly trained nurse practitioners.. “Any time you have multiple states creating laws, rules, and regulations through legislative process it’s going to look different [by state],” says Melody Wilkinson, a family nurse practitioner and program director for Georgetown’s School of Nursing & Health Studies.. “There are these ridiculous state restrictions that are not enhancing patient safety in any way shape or form.”Leslie Sharpe, a practitioner who teaches at University of North Carolina School of Nursing put it another way: “There are these ridiculous state restrictions that are not enhancing patient safety in any way shape or form.”. Thanks to a compact among 30 states, licenses for registered nurses are recognized by most jurisdictions, which means that most of the 3.8 million RNs in the US can travel from state to state and immediately join frontline efforts—and many have.. But for the nearly 300,000 nurse practitioners , their “scope of practice…is determined by the state, rather than by the education and training,” says Wilkinson, which explains why this group of health care practitioners now find themselves mired in restrictions should they want to serve outside their local communities during a global pandemic.. The result is that nurse practitioners are only permitted to work in their home states.. Even if all states dropped the licensure restrictions, many states require practitioners to strike up collaborative practice agreements—which is different from the administrative relationship—with in-state physicians, another requirement that becomes particularly difficult during an emergency.. “This is creating a challenge for nurse practitioners to respond at the top of their ability to deal with the COVID-19 crisis,” Tay Kopanos, vice president of government affairs at the American Association of Nurse Practitioners, says.. In 2010, the Institute of Medicine, an influential healthcare non-government organization, released a report entitled, “The Future of Nursing: Leading Change, Advancing Health,” which recommended standardizing the nurse practitioner role and allowing them to “practice to the full extent of their education and training.” That education and training is consistent nationally; all nurse practitioners carry the same practice certification.. But how much of that training they’re permitted to use in a clinical setting “looks different in each state, because the state sets a scope of practice for nurse practitioners,” says Wilkinson.. In 22 states and Washington, DC, nurse practitioners can offer healthcare services that reflect the full scope of their qualifications.. “They’re left trying to find someone they don’t know on the other side of the state,” says Leslie Sharpe, a practitioner who teaches at University of North Carolina School of Nursing.. On March 26, secretary of Health and Human Services Alex Azar recommended that states relax those rules and allow nurse practitioners to cross state lines and skip the process of tracking down a sponsoring physician.. A number of other states are also accepting the licenses of retired and inactive nurse practitioners.. According to Kathy Baldridge, a nurse practitioner and president of the Louisiana Association of Nurse Practitioners, the change didn’t come a moment too soon.