Nurse Practitioner Private Practice: How FNPs Can Start Their Own Practice

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A family nurse practitioner takes a patient’s blood pressure.

By the year 2034, the U.S. is expected to face a shortage of up to 124,000 physicians, according to a 2021 report published by the Association of American Medical Colleges (AAMC). To help fill the gap, many of the country’s licensed nurse practitioners (NPs) are opening their own practices.

Starting a practice requires business acumen and the skill and passion for nursing. As Florence Nightingale said, “Nursing is an art, and if it is to be made an art, it requires an exclusive devotion as hard a preparation as any painter’s or sculptor’s work.”

Pursuing an independent practice can present a variety of challenges, as well as bring substantial rewards. Ideally, NPs should have a few years of experience in the field to become comfortable and gain confidence in their role.

An online MSN program prepares registered nurses (RNs) and other Bachelor of Science in Nursing (BSN) graduates for advanced careers as family nurse practitioners (FNPs) — many of whom will go on to open their own practice. The program provides FNPs with the knowledge and training to build on their expertise, as well as opportunities to grow their professional networks.

How to Start a Nurse Practitioner Private Practice

Starting a private practice is an exciting goal to pursue, but it is also one that cannot be rushed. After all, delivering the best patient care possible is the core goal of any private practice, so it’s extremely important to carefully follow a path that ensures effective, efficient care is in place. As such, there are several steps that are advisable to follow for NPs to deliver quality patient care on a consistent basis.

Step 1. Understand the Legal Requirements

Nurse practitioners who are looking to open a private practice must secure any licenses and certifications required by the county, city, state, and federal laws. They must also be fully cognizant of the regulatory laws within their state of practice, and they must prepare themselves to be in compliance with these mandates. Additionally, they may need to obtain malpractice insurance.

Step 2. Learn the Business Side of Private Practice

Before transitioning into private practice, FNPs need to do their research and consider the logistics and potential pitfalls of owning a business. Operating a practice requires an understanding of business, including such aspects as insurance verification, billing, accounts receivable, payroll, and other financial and operational matters. An accountant can help FNPs choose the type of company (e.g., LLC, PLLC, or S-Corp) that would best benefit their financial situation and tax structure. However, in some cases, that decision may be up to the state.

Step 3. Create a Business Plan

A strong understanding of business can help FNPs when they write a business plan and develop their goals. Serving as a blueprint for the practice, the plan should detail service and product offerings, pricing structure, expenses, projected income, and marketing strategies. It should also establish which types of payments FNPs want to accept (e.g., Medicare/Medicaid, HMOs, fee-for-service plans).

Step 4. Consider a Specialization

While creating their business plan, FNPs should consider whether they want to specialize. While choosing a specialization is optional, doing so may allow their practice to stand out as a niche form of care delivery. This can be beneficial to a burgeoning practice; 69.7% of NPs practice primary care, according to the American Association of Nurse Practitioners (AANP), meaning there is a lot of competition in that particular sector. Choosing an underserved niche — psychiatric care, gerontology, or holistic medicine, for example — could mean more business and more referrals from physicians.

Step 5. Build the Private Practice Infrastructure

It’s important to turn a business plan into a physical presence by giving significant consideration to the expenses that come with this transformation. Leasing office space, buying furniture or equipment, and hiring staff are some of the upfront expenses to expect when starting a practice.

To get their practice up and running, FNPs should determine how much money they will need — and where they may find it. Options may include withdrawing savings, cashing out or borrowing against investments, taking out a loan or second mortgage, using a credit card, or borrowing from family and friends.

Step 6. Ask for Advice

Challenges do not cease once a private practice has been established. Working with an attorney and finding a mentor can help NPs navigate the difficulties of running their own business with greater effectiveness. Ultimately, this can put them in a better position to deliver optimized care that can improve patient outcomes.

Private Practice vs. Practice with a Physician

Before starting a nurse practitioner private practice, FNPs should know their state’s laws and carefully review its Nurse Practice Act, available through the National Council of State Boards of Nursing (NCSBN).

About half of the states grant full-practice authority (also known as autonomous practice). This allows NPs to operate without supervision, management, or delegation from a physician. In those states, nurse practitioners are free to run a private practice where they can independently evaluate patients, order and interpret tests, make diagnoses, and write prescriptions.

“I get to determine my own schedule, my own income, how much to charge each patient, and how much time to spend with each patient,” says Carol Dalton, a women’s NP who has started three practices, in her article titled: “Open your own nurse practitioner practice.” “Starting your business is determining your own destiny. But you have to be willing to do the work to make that happen.”

While offering complete autonomy, full-practice authority for NPs comes with full responsibility. To be successful, they must make the right decisions for their patients, their company, and their employees. Despite the challenges of owning a business, NPs in private practice offer their communities better access to care, especially in underserved rural or urban areas. They can also provide the treatments they believe are in the best interest of their patients.

Other states only allow reduced-practice or restricted-practice authority for nurse practitioners, which precludes an independent office.

According to the American Association of Nurse Practitioners (AANP), the reduced practice requires “a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the set of one or more elements of NP practice.” The AANP defines the restricted practice as requiring “career-long supervision, delegation, or team management by another health provider in order for the NP to provide patient care.”

With requisite physician oversight in reduced and restricted practice, nurse practitioners may be more protected against liabilities. However, NPs are also obliged to follow their supervisor’s decisions, even when they may disagree with treatment or prescribed medication.

The good news is, whether nurse practitioners choose to work independently or under a physician, their opportunities for employment remain plentiful. From 2020 to 2030, the employment of NPs is projected to grow by 52%, according to the U.S. Bureau of Labor Statistics (BLS). This is much faster than the average for the job market as a whole. The BLS also reports a 2020 median annual salary for NPs of $111,680.

Play a Vital Role in Shaping Health Care’s Future

Opening and operating a private practice is a bold step for a nurse practitioner. However, it can also be a crucial step that can help bring about more options for high-quality patient care. As the concept of care delivery continues to evolve, nurse practitioners will increasingly find themselves at the forefront of this dynamic and essential field.

Ohio University’s online Master of Science in Nursing program is designed for practicing RNs who want to advance their expertise in the nursing field. The curriculum is carefully designed to help students cultivate their knowledge and skills to a high level, allowing them to be confident health care leaders.

Learn how Ohio University’s MSN program can help prepare you to excel in health care.

Recommended Readings

MSN vs. FNP: Opportunities in Advanced Nursing Practice

What Can You Do With an MSN?

What Does a Family Nurse Practitioner Do?


American Association of Critical-Care Nurses, “A Conversation With Florence Nightingale”

American Association of Nurse Practitioners, NP Fact Sheet

American Association of Nurse Practitioners, State Practice Environment

Association of American Medical Colleges, “New Findings Confirm Predictions on Physician Shortage”

Monster, “Open Your Own Nurse-Practitioner Practice”

National Council of State Boards of Nursing, Find Your Nurse Practice Act

U.S. Bureau of Labor Statistics, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners