Before you start dreaming of entrepreneurship, make sure that you’ve thoroughly explored all aspects involved in starting an Independent Nurse Practitioner Practice. While your drive to succeed, your dedication to your patients, and your extensive experience in the field is certainly integral to your success, it’s important to identify other potential roadblocks along the way.

  1. What are the legal limitations defining your practice?
    While it seems that every state should recognize an NP’s right to perform at the full extent of their training, legislation can sometimes lag years behind that modern-day mindset. Do you know your state’s legal system inside and out? If not, it’s time to study up on the current legal parameters that will define your scope of practice. In many states, NP’s are bound by the provisions requiring physician collaboration or supervision; know your legal boundaries to avoid any future ramifications. When it comes to owning your own practice, what you don’t know can hurt you.
  2. How do state laws affect your ability to write prescriptions for your patients?
    According to the Advance Healthcare Network, only twelve states and the District of Columbia allow NP’s to independently prescribe controlled substances. 28 states require physician collaboration when prescribing controlled substances, 10 require physician supervision, and four states ban NP’s from prescribing controlled substances altogether. While it’s important to know your state’s laws regarding independent prescriptive authority and the level of physician involvement required, always be aware of legal developments. With increasing demand for quality providers, it seems that states will all move to recognize NPs as licensed independent providers…eventually, but in the meantime, know where you stand.
  3. Are NP’s given hospital privileges in your area?
    When running an independent NP practice, many of your patients will unfortunately require hospital admittance in critical situations. Will you be permitted to independently admit your patients for hospital care, and, once admitted, will you be able to continue advising them during their stay? Find out how to apply for hospital privileges in your state- depending on where you reside, the application process may require a ‘sponsoring physician”, personal references, an application fee, and a formal interview.
  4. How will you be reimbursed by third-party payers?
    As a Nurse Practitioner, you may face inequitable reimbursement due to inconsistencies in the legal system. Because not all states recognize NP’s as primary care providers who must be directly reimbursed, you may be reimbursed from third-party payers at a lesser rate- or in some states, not at all. Under Medicaid, only 33 states and Washington, D.C. categorize NP’s as primary care providers; Federal Medicaid only requires that pediatric and family NP’s are directly reimbursed. Private insurance is even less predictable.
  5. Do you have enough financial capital to weather the storm?
    From startup costs to insurance coverage to attorneys and accountants, starting a new practice requires both enough startup capital to get things off the ground and enough cash flow to keep you in the black. When owning any business, unexpected expenses will arise, and even the most prepared NP practice will take time to turn a profit. Hang in there! Money follows passion- never forget why you became an NP…even when the going gets tough.

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