It is an opportune time to be a nurse practitioner entrepreneur, though numbers on that have taken some time to bear out.
Back in 2016, a projected surplus of nurse practitioners was the prevailing worry as Edward Salsberg, director of health workforce studies at the George Washington University, pointed out a ballooning number of nurse practitioners in the education pipeline. Recently, Salsberg noted the healthcare industry seems to have easily absorbed them, npnow.com reports.
The demand appears driven both by long-standing shortages of primary care providers in rural communities, as well as a continuing shortage of primary care physicians in U.S. healthcare, as reported in Modern Healthcare in 2020. This is good news for a nurse practitioner entrepreneur seeking to care for their community through the lens of the nursing model.
Not only is the U.S. healthcare industry taking in the rising numbers of nurse practitioners and asking for more, the increasing numbers of nurse practitioners results in an increase of those interested in having an entrepreneurial approach to their careers.
Nurse practitioners find themselves in an opportune position. Because of the nursing foundation, nurse practitioner’s have the mindset, skills, and heart necessary to lead valued care in their communities at independent practices. Communication, leadership, analytical skills and the ability to remain cool under pressure, all traits of a nurse practitioner, are all also qualities of a successful entrepreneur. A lot of nurse practitioners have noticed they are well prepared to strike out on their own.
The Shifting Landscape of the Nurse Practitioner Scope of Practice
As the increasing number of nurse practitioners responding to the call to lead healthcare change is on pace with the breakneck growth in demand for their services (in both long-underserved rural areas and among a nation-wide aging population), the landscape of the profession’s scope of practice – rules determining the limits of medical licenses – is changing.
Each state differs on the nurse practitioner scope of practice requirements. Generally, states are aligning between three main approaches to regulating nurse practitioners: full practice, reduced practice, or restricted practice. Regulations vary within each approach, with general guidelines:
- Full practice authority for nurse practitioners states allow all nurse practitioners to evaluate patients; diagnose, order, and interpret diagnostic tests; begin and manage treatments, including prescribing medications and controlled substances.
- Reduced practice authority for nurse practitioners states limit at least one element of the scope of practice, either one or more elements of care, or mandate a career-long regulated collaboration with another provider.
- Restricted practice authority for nurse practitioners states limit at least one element of the scope of practice, requiring career-long supervision or management by another provider.
While still debated at a Federal and State level, NP scope of practice is a force leading change and opening opportunities for the NP entrepreneur. NP scope of practice has begun evolving with state-level efforts to increase autonomy for nurse practitioners. Expanding scope of practice allows a nurse practitioner entrepreneur opportunity to satisfy a growing need for primary care.
The three most recent states to expand the scope of practice for nurse practitioners were Maryland and Nebraska in 2015 and South Dakota in 2017, according to the National Conference of State Legislatures. Nurse practitioners in those states can now practice without physician oversight.
The arguments for expansion are not limited to practical expedience either. A 2019 study in the journal Medical Care showed that allowing nurse practitioners to practice without physician oversight was attributed to a lower increase in emergency department use (after expansion of Medicaid, for instance).
According to a 2018 study in the Journal of the American Association of Nurse Practitioners, the Affordable Care Act has also had a positive effect on efforts to expand the nurse practitioner scope of practice in individual states. “Eight states adopted full practice authority from 2011 to 2016, representing a two-fold increase compared with the previous 10 years.” In arguing for full practice authority, nursing interest groups and politicians cited the increasingly insured population because of the ACA, provider shortages, and rural healthcare access issues, the study also noted.
States with the least restrictive nurse practitioner scope of care regulations have 2.5 times greater likelihood of patients receiving primary care from nurse practitioners than the most restrictive states.
Knowing Your Local Scope of Practice as a Nurse Practitioner
If you’re one of a growing number of nurse practitioner entrepreneur prospects starting their own nurse practitioner independent practice, you will need to know the scope of practice you’re allowed to operate in. If you’re practicing near a state with a differing scope of practice, the distinction will be important to keep in mind, to avoid confusion among patients and staff.
Why NPs Are Opening Independent Practices
In the states that provide nurse practitioners more authority, an independent NP practice is an attractive option for providers eager to care for their patients with the quality attention they have been striving to bring to bear. Within a private practice, the nurse practitioner is operating according to their own professional assessment of the best care for their patients.
An entrepreneurial spirit and the freedom to build a practice from the ground up, choosing everything from telehealth software to the name on the door, a notable benefit of NP independent practice, doesn’t hurt.
Increasing Access to Healthcare in Underserved Areas
Nurse Practitioners help increase healthcare accessibility in rural and other underserved communities, just as one might conclude from a growing body of medical professionals able to deliver needed care in a high-demand area. Often, the increase in accessibility coincides with an expansion of the nurse practitioner scope of practice or operating at the full level of the scope of practice.
A study in the Journal of the American Psychiatric Nurses Association (JAPNA) showed mental health nurse practitioners (PMHNPs) having more discretion increased access to care in underserved rural communities. By practicing at the full extent of their scope of practice without supervision, nurse practitioners expanded PMHNP rural mental health education and research to meet mental health challenges.
In 2017, when nurse practitioners were granted the authority to prescribe buprenorphine, used to treat opioid addiction, rural areas received better access to care and addiction treatment, according to a report in Patient Engagement HIT. Allowing nurse practitioners to prescribe buprenorphine, the gold standard treatment for opioid addiction, made the treatment available to people who might not have had access to it before, according to the report.
NPs address a growing need for primary care
Simply put, there are a growing number of nurse practitioners and a shortage of primary care providers, especially in underserved communities. AANP reports there were more than 325,000 nurse practitioners practicing in 2019, with about 30,000 new nurse practitioners entering the healthcare workforce every year.
The shortage of primary care providers is particularly acute in rural areas. NCSL reports as of July 2017 there were more than 6,700 primary care Health Professional Shortage Areas (HPSAs) —federal designations indicating healthcare provider shortages (which may be geographic, population or facility-based). About 59 percent of all primary care HPSAs are located in rural areas.
The need is compounded by recent trends. About 81 rural hospitals closed between January 2010 and May 2017, with more at risk of closure. Rural communities also face significant health disparities—including higher rates of chronic disease and indicators of poor overall health—compared to urban communities. Higher teen birth rates, diabetes and preventable hospital stays are more likely in rural communities, and rural adults are more likely to smoke and less likely to maintain healthy body weight.
Only scope of practice restrictions on the type of care they can provide limit nurse practitioners’ ability to fill in these gaps, so there is an already-growing source of primary care for states with large rural areas to draw from.
“Nurse practitioners can offer quality care to patients and help offset the shortage of primary care providers in rural areas,” as Simmons College proposes. And, as Salsberg informed the Anneberg Center for Health Journalism, the rapid growth of nurse practitioners that he once warned about is proving a ready source of primary care to fill the shortages.
“Nurse practitioners can offer quality care to patients and help offset the shortage of primary care providers in rural areas,” – Simmons College
The Challenges Nurse Practitioners Starting Independent Practices Face
Challenges nurse practitioners face while starting their own nurse practitioner independent practice run the gamut from building a website to systems setup, electronic health record documentation software selection and set-up, marketing, and credentialing.
Because the Nursing Model is person-centered and relationally rich, other challenges may include: emotional fatigue, increased stress from helping others carry their burdens, and finding the time to improve and grow your skill set.
That is a lot for a single nurse practitioner to take on themselves, and while you have the confidence to know you can do all of it, to do so would defeat the purpose of starting one’s own independent nurse practitioner practice – focusing on patients.
NP Advantage Can Help
NP Advantage provides solutions for what you need to set up a nurse practitioner private practice. Partner with us and receive exceptional support from our experienced team of healthcare consultants and data analysts. As partners, we follow a transparent revenue share model based on our initial investment in upfront costs and ongoing relationships, sharing in revenue over time. We’ll set you on the best path for a bright future for your patients, your practice, and its success.