Introduction
The innovative spirit of nurses is legendary. Florence Nightingale, Clara Barton, Lillian Ward and of course Loretta Ford have carved a path for the nurses of the future. As nurses and nurse practitioners become more numerous, higher educated and more independent, the entrepreneurial itch is sure to blossom.
Though traditionally nurses have stood beside and collaborated with other health care practitioners, the wish for independence deepens as entrepreneurial nurse practitioners explore the numerous possibilities. As the numbers of nurse practitioners (NPs) expand the desire for individual and independent practice deepens. It is time to spread the wings of nurses into independent practice.
Initiating an endeavor such as opening one’s own practice can be a daunting task. The thoughts of how to maneuver through the process, the expenses, the legal and business hazards and being alone in practice can overwhelm the entrepreneur which may halt the idea in its track. Having a step-by-step toolkit that would help guide one through the considerations of opening a practice can be extraordinarily valuable.
This project aims to provide the entrepreneurial nurse a toolkit of steps to consider with all areas of opening an independent practice in Texas. Not all practices are the same. The type of practice such as a home health practices will require different considerations than a brick-and-mortar practice. Reimbursement for services depend on many often-unforeseen factors. These examples are only a few of the many decisions to be explored in this endeavor. This toolkit hopes to discuss and give guidance through the many possible considerations of opening a practice.
Most nurse practitioners work for other institutions or for physicians. In fact, Donna Reese MSN, RN, CSN, described in Nursingprocess.org (Reese, n.d.), twenty-five of the top settings where NPs work. These included hospitals, nursing homes, correctional centers, and urgent care centers but the list did not include independent practice. So why would a nurse practitioner want to start and independent practice?
Nurse practitioners in independent practice have been proven to be effective and cost-saving. Christina Bennet (2021) in Medscape explores the evidence supporting NP independent practice. The evidence shows: 1) NPs and physician quality of care is largely equivalent, 2) states granting NPs greater scope-of-practice authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded healthcare utilization, especially among rural and vulnerable populations, and 3) healthcare expenditures were 6% lower for patients cared for by an NP compared with a physician.
There are many fulfilling reasons for NPs to own and operate private practices. These include: a positive job outlook, the ability to control a positive outlook on your patient’s health, improving access to care for you patients and trust that your patients will instill in you alone as their health care provider. Though Texas does not yet allow full practice authority, once achieved the independent provider can offer the ability to perform procedures based on your education, training, license, and certification and not have to pay a delegation fee (Schlette, 2021).
Step One: Learn what is involved in running a business
When it comes to education, experience, and passion, nurses have always led the charge. Obtaining and holding degrees and certifications within the nursing specialty solidifies the nursing expertise. How well though, are nurses when it comes to running a business? According to data from the U.S. Bureau of Labor Statistics, about 20% of U.S. health care businesses in Texas will fail within the first year (Bureau of Labor Statistics, 2021). The success of opening and maintaining a healthcare practice will depend on preparation and determination.
It is a common belief that healthcare professionals are poor businesspeople because the concerns of the patient's needs lead to poor business decisions. Lorie Brown with American Nurse debates that myth stating that nurses are uniquely qualified to start their businesses in legal consulting, coaching, and home healthcare. The skills they've learned and honed through their education and practice—critical thinking, prioritizing, organization, and managing emergencies—make them excellent potential business owners (Brown, 2019).
The success of the business will depend on the preparation, not in nursing, but in business management. A college degree in business management is not required, but a basic understanding of business concepts is essential. The following are links for the preparation of opening a business.
Step 2 - Determine the type of practice you wish to open.
Types of Practices
Brick and Mortar – The traditional practice is a building/office that patients can travel to and walk into the office. The office can be in an independent office building, a professional building, a mall, a strip mall or in a house. Offices are seen in grocery stores, department stores or pharmacies.
Telehealth – The telehealth practice is a recently exploding type of practice. The need for reaching out to patients that are unable to get away from their home or work has fashioned a style of healthcare in which face to face encounters have not been necessary. Telehealth allows the practitioner and the patient to interact on computers or cell phones allowing a conversation and limited exam for a patient visit.
Home Health – The concept of providing home health has been around since the beginning of nursing. The idea of home health is the providing of nursing services at a patient’s home. As a nurse practitioner home health services would mimic the house call.
Step 3: Determine the types of Services that you wish to provide
The American Association of Nurse Practitioners listed eighteen different NP certifications including Family, Pediatric, Emergency, Gerontology and Acute Care (AANP, 2021). The service the NP will provide in their practice will mimic their training and certification.
Family Practice – The traditional health care practice consists of seeing the entire family from pediatric to geriatric for all their health care needs. The services expected to be covered include treatment for common ailments, common chronic diseases, injuries, and health care maintenance.
Pediatrics –A pediatric practice would focus on well-childcare and the prevention or management of common pediatric acute illnesses and chronic conditions.
Cosmetic – An NP with a passion for assisting patients with improving body image and the pampering of those wishing for cosmetic and beautification can find the practice of cosmetic a dream job. Opening a practice as part of a med spa or boutique
Other types of practice to consider are:
- Pain management
- Wellness
- Women’s Health
- Midwifery
- Psychiatric
- Diabetes
- Urgent Care
Step Four – Develop a business plan
A plan to guide you through the process of opening the business is essential. A business plan is a written document describing a company's core business activities, objectives, and how it plans to achieve its goals (Hayes, 2021). The Small Business Association explains a traditional business plan format contains an:
- executive summary
- company description
- market analysis
- organization and management
- service or line product
- marketing and sales
- funding request and financial projections
Details explaining in-depth each component of the business plan in available at:
https://www.sba.gov/business-guide/plan-your-business/write-your-business-plan
There are many styles and methods of completing a business plan. INC. gives ten business-plan templates that you can download for free (Kim, 2015). You can find them here:
https://www.inc.com/larry-kim/top-10-business-plan-templates-you-can-download-free.html
An example of a nurse practitioner specific business plan can be found here (Nwokoro, 2021):
https://www.profitableventure.com/nurse-practitioner-clinic-business-plan/
