Nurse Practitioner Practice, state by state

Nurse Practitioner Practice State by StateNurse Practitioners frequently have questions about what they can do and where they can do it. So rather than recreate a report, I’d like to share with you an excellent resource to get these questions answered. It’s the Pearson Report. It is published annually in The Nurse Practitioner Journal.

This report, available for download in pdf format, will answer most questions for NPs about practice across the United States. I encourage you to save a copy and refer to it frequently. And make sure you check for updates next year.

Comments

  1. says

    This is a fantastic site!!

    I have been trying to get an absolutely FREE to NP’s Internet listing up and running as a hobby meets “mission”
    The idea is to have a single free to use and be listed on directory for referral.

    In the world of psychiatry, the psychiatrist, psychologist, advanced practice social workers, AAPS certified addictions councilors, and every other flavor of behavioral therapist, councilor, and medication prescriber have such directories, but I don’t think we do???? I have looked for NP’s on the net and haven’t found any :-(

    The problem is a way to keep the shills, pranksters, hackers, and other non-truth tellers at bay???

    Thanks

    -Don

  2. Diana Loynes says

    Hello

    Does anyone have information about how much physicians are paid to have a collaborative agreement and be a medical director for a small NP operated clinic. We are a very small not for profit school based health center. (1500 visits a year).

    Thank you Diana

  3. Sharmin Khan says

    Hello I am thinking about opening a solo business. What are the first things I need to consider? Please help me to start this process. Thanks

  4. says

    Hi Sharmin,

    Here is a simple list:
    1. Identify what it is you want to do. Get very specific.
    2. Identify who are your ideal clients. Who do you want to see? Again, be specific.
    3. Market research…is it needed in your community, will people pay for it? How can you make your business unique.
    4. Take stock of your skills, strengths and weaknesses. Do you really have what it takes to be a business owner? Do you really want to do this?
    5. Why are you doing this? Be clear about your why. It will keep you going when the going is rough.
    6. Get involved in this blog, get the resource directory, ask questions. Check out NPBO as well. Get the ezine “Progress Notes” for more tips on having a business.

    You’ll find more under the startup category:
    http://npbusiness.org/category/startup-and-growth/

    Check out my article on AdvanceNP about starting a practice: http://tinyurl.com/49r8fa

    Hope this helps,

    ~ Barbara
    http://www.NPBusiness.ORG
    http://www.NPBusinessOwner.com

  5. Mel Dueck says

    I live in California and currently work in a rural health clinic. I am considering one of two future directions, and I’d like you input (or perhaps suggested resourced to help me decide which option to take). First, I am considering starting a solo practice (of course with some physician collaboration as required). This practice would be in a mountainous area that currently has no physicians. The thought of launching out on this venture is a bit daunting, but it feels right to me. My second future option has to do with possibly moving to a different state to practice (not necessarily a solo practice, at least not initially). My wife and I are weary of the direction our state of California is going in regards to taxes and social-moral deterioration. In the past I was in the US AirForce and lived in various regions of the U.S. Some states that seem appealing to us (to live in) include Oregon, Kentucky, Pennsylvania, and other locations in that region. I have scanned over the Pearson’s report on the various states. It does a good job of giving information on how NP’s are allowed to practice, but it lacks info regarding the needs for NPs in each state. How many NP/MD providers are already in that state in relationship to the state’s population? Are the rural area in those states under-represented for healthcare providers? I would appreciate your input on thses questions.

  6. says

    i am a nurse practitioner in louisiana who has been owning my own clinic for 2.5 years. the lsbn board just put my license on suspension due to policy and procedure that they say i was not following. they offered to give me back my rn but want to revoke my aprn. i know this is because of a local doctor down the road that is so mad i started my practice and he has been loosing his business to me a nurse. they even put an article in our small town newspaper. can anyone help? i need help. i have a rn attorney, however, she is only rn and i dont know if her advice is the best. i dont want to just be a rn. how can they justify taking my license away after i earned it. thank you!

  7. Valsa John says

    I am nurse practtioner in New york. I would like to start a a business of my own. I want know how to start Nurse practitioner home visit business ( like home care ). Could you give some tips I have an idea n=but not too clear about it.

  8. says

    Hi John,

    You’ll find some tips on house call practices on the blog – such search. You’ll also find info at http://www.nursepractitionerbusinessowner.com

    One organization that several of us recommend as well is the American Academy of Home Care Physicians – http://www.aahcp.org/

    Nanette Lavoie-Vaughan, NP also has a book out – “How to Start Your Own Housecall Practice”. Her website is http://www.nanettelavoie-vaughan.com/nursing1.html

    Best wishes!

  9. Kellyn Freed says

    What states can a nurse practitioner open up his or her own practice without any collaboration with a physician? I know NH is one of them. I believe there are 10 in all.

  10. says

    Kellyn,

    Totally independent practice states (practice and Rx): (according to Pearson report):

    Alaska
    Arizona
    DC
    Idaho
    Iowa
    Maine (after first 2 yrs)
    Montana
    New Hampshire
    Oregon
    Washington State
    Wyoming

    Barbara

  11. al young says

    Barbara,

    You can add to the list of totally independent practice states for NPs : New Mexico
    I know many NPs here who own their own practices. No physician “collaboration” is required, full Rx authority including class II-V is permitted. In my talks with others NM is one of the most favorable climates for NPs, severe shortage of primary care providers. It’s why I moved here several years ago.

  12. says

    You are absolutely correct…that was my omission!

    New Mexico has a wonderful practice act and it was one of the states I’ve considered relocating to (I love visiting there).

    Barbara

  13. Dena Lewis says

    I’m working on my bsn and still have another 1 1/2 yr. I am interested to go on for my master’ s and then possibly my NP. Could you tell me a website that I can find the educational reqs for a NP. I live in West Virginia and I’m on the border of Ohio and Ky. I’m having trouble seeing what is the difference in state req. Do you happen to know what some of the easier and harder states. My husband is in the military and who knows where I’ll be in the next few years. Thanks Dena Lewis

  14. says

    I think New Mexico is a wonderful place to live, and I am a clinic director for an urgent care and we are looking for NP’s . Feel free to check us out on the web www,hcpcareteam.com.

  15. Alvaro Berrios says

    I am a FNP in California. I am planning to open my own practice. My question is regarding insurance companies. How can I get a provider number from the insurance companies? Do I need to be under a doctor? What about Medicare? Can I bill Medicare? Do I need and MD to bill Medicare? Thank you.

  16. Alvaro Berrios says

    I am a FNP in California. I want to open my own practice. I am currently working on finding a good place to establish one. There are many underserved communities that need help. Cash, Medi-cal, Medicare, and some HMOs are the major plans in the area. Does anybody knows if NPs can get a Medical number without an MD? What about Medicare? Do we have to have a Natinal Certification? What about health insurance plans? Can we get into their provider list without using an MD?

  17. says

    Alvaro,

    In California you need a collaborating physician. Unless things have changed, that physician will own your practice (51%). You can get your own Medicare provider number and you do need to have national certification for that. Each health insurance plan is different, you’ll need to check with them.

    Keep us posted with how you are doing.

    Best wishes,

    Barbara C. Phillips, NP
    http://www.NursePractitionerBusinessOwner.com

  18. says

    Dean,

    Most states require national certification, which requires at least a Masters degree. Depending on when you enter and complete your NP education, you may be looking at a DNP. Since you are moving around, you will want to have the highest degree that will be required of you.

    Years ago, before getting a masters, I only had a certificate as a GNP. When I moved to a new state, I could not practice there as a NP. Since you will be moving around a lot, don’t let this happen to you.

    Best wishes,

    Barbara

  19. Alvaro Berrios says

    I have a doctor who is looking for a partner for his practice. How can you determine the value of the practice? Is it 2 times the annual net???? What other things do I need to look for? Any recommendations? Thank you.

  20. Fiona says

    I am a FNP and living in Utah and is planning on sharing office with a OMD/acupuncturist. Do I need a MD to sign some kind of form for DOPL? Or can I just share the office but with my own clinic name (we just alternate the days we work) as a FNP? Also, do I have to have my NPI no. on prescription pad? or just my license no.? Thank you!

  21. says

    Hi Fiona,
    I share my practice with a TCM practitioner as well. In terms of what you need, you will need to follow your state rules and regs. I don’t know of anyone who says you have to have an NPI number on your prescription pad, or even a license. These are all on file with the pharmacies – at least in WA State. Pads are on the way out – I’ve used less that 3 pads in nearly 4 years (e-scribe and emr generated scripts).

    In terms of forms with DOPL you will need to contact them. I do think you can have your own practice (many do) as long as you have your collaboration (for prescribing only) in place.

    Barbara

  22. says

    Good posts. My daughter is a HD senior and somewhat interested in RN and NP path (or pre-med?) in SO Calforinia. I think NP has a lot of opportunities and have even heard in a few years they might include ‘doctor’ as part of the title?

  23. Sean says

    Hi Barbabra,

    I am Sean, I am graduating from a psych NP program in Dec 2012 (1 semester to go). I was thinking about relocating to South Carolina or North Carolina. Currently as a RN I am making more then 80 K.

    My question is,

    (1) is it worth to relocate to one of these states and work as a psych NP? Do psych NPs get paid in six figures in these two states?

    (2) Are the laws/rules in these two states favorable for prescriptive authority?

    Thanks
    Sean

  24. says

    Sean,
    Congratulations on your upcoming graduation.
    1. I am not familiar with the job market in all states. That said, there are several factors that figure into how much one makes. Basically it has to do with reimbursement and overhead with lots of variables.
    2. Both states require some sort of supervision and/or collaboration. I recommend you check the Pearson Report (it is a paid subscription, but if you are checking out several states, it’s invaluable). http://www.pearsonreport.com. State NP organizations will be able to also provide you with further details.

    Best wishes to you,

    Barbara

  25. Joe says

    Hi,

    I am an NP in California. I am looking to open a small office to basically do urgent care- sinus infections, birth control, pharyngitis. simple stuff. No insurance. Absolutely NO controlled substances. I will write only antibiotics and benign meds. I have an MD friend who is willing to “collaborate”. My question is do I just print out a standardized procedure list and have him sign it along with a collaboration agreement? Since there is no chart co-signature required he just needs to say that he is telephonically available for consultation right? is there a particular form or format that you would recommend? Any other California pitfalls that you know of that I need to do to avoid issues? Thanks so much!!!!

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