Should a New Graduate NP Start a Practice?

It’s not uncommon for new graduate nurse practitioners to ask questions about starting their own practice. Any why not? When you look around you find physicians coming out of residency starting practice, alternative health care providers starting practices right out of school (mostly due to lack of employment opportunities), and the fact they see their colleagues starting practices.

That said…is this the right step to take right out of school?

I’ll put it out there…in my opinion….it’s not the right step. Recently I was criticized for saying this, that I should be giving professional advice and not personal opinions. Having practiced for many, many years, my personal opinions comes from years of professional experience as well as experience in working with NPs who want to start businesses for the past 10 years.

I’m not alone in my opinion. If you look at the literature, you’ll find studies pointing to the needs of new graduate NPs and their needs (feel free to do a search). That said, here is why I and other expert clinicians feel that NPs should not be starting a business directly out of school.

Why I say No

When an NP first graduates from his or her university program, they are not yet expert clinicians. That NP may have been a nurse with 20 years of experience (and thus likely an expert nurse clinician), but being an NP is a completely different level of care and responsibility. Yes, we bring our nursing background to the table…and indeed it allows us to work with patients far easier than someone without this background, yet it does not equate to the level assessment, interpretation of finds and medical decision making that an NP must make.

Most new graduate nurse practitioners require some time to learn the role and get comfortable with the level of care they are now giving. Indeed, as a new grad, it generally takes an employer about a year of working with you to starting getting a return on investment (your level of care, productivity levels, using less time for your mentors, etc).

In fact, one NP I’ve recently worked with is looking how to support a new graduate NP from his/her novice role to being a functional, “independent” clinician her organization. She and other employers have stated, that their experience, it takes nearly a year to begin to see a return on investment with a new clinician.

Hardest Tasks...

"Starting an NP business is one of the hardest tasks any NP will ever do. Being an NP business owner means you are performing 2 full roles, that of business owner/manager and a clinical practitioner. The NP needs to have expertise in both to succeed and survive. New NP grads are novices who need time to fully develop their clinical skills and grow professionally. Most new grads are not in a financial position to be able to capitalize a new business, go without salary for the first few years, and pay back student debt."

Nancy Dirubbo, DNP, FNP, FAANP
Laconia, NH

These words of wisdom are by:

Nancy Dirubbo, DNP, FNP, FAANP
Travel Health of New Hampshire


Surely there are exceptions?

Of course, not all new graduates are the same. I’ll give you two examples with clients I have worked with who were new graduate NPs, but were bringing a lot more to the table.

Example One

Two (then) students contacted worked with me. They planned to open a primary care clinic when they graduated. But here is what is different.

They already were successful business owners in a healthcare related field. Their business knowledge was pretty good with the except of the type of billing and codes that are done in primary care. They planned to hire the help they needed, including to seasoned FNPs who would function as their clinical mentors. So in this case, they had already identified their strengths and weaknesses and made plans to address each of these.

Example Two

The second example was a new graduate psychiatric nurse practitioner. In her life before becoming an NP, she was a family therapist and had run her own successful practice for over 10 years. Her goal was to return to her own practice, but this time as an NP/therapist. In this case, she hired an experienced psych NP who would function as her mentor around medications and other areas that she felt she was weak in.

In both cases, the NPs sought out the support they needed in order to practice independently. They were also already successful business owners and thus did not also need to learn business skills.

Wait a few years...

"It is difficult being a new nurse practitioner, but scary when you begin to assess, diagnose, plan, implement, and evaluate your first client. However, opening a solo practice after graduation brings about a greater fear. The technical and business savvy skills are stressful, especially if you have not been employed in this type position. The transitioning from a registered nurse to a nurse practitioner is time-consuming. You find yourself researching every detail of a patient’s symptoms, medication, and follow-up treatment. My suggestion is to abstain from opening a practice for approximately five years when you are comfortable to practice independently."

Irene Bean, DNP, FNP, FAANP
Nashville, TN

These words of wisdom are by:

Irene W. Bean, DNP, FNP, FAANP

Serenity Health Care

New graduates not only have to become expert clinicians but if you are starting a practice, you’ll also need to learn everything it takes to start and operate a business and healthcare practice. That’s a tall order the first year out of school.

In fact, if you are a novice clinician and a novice business owner, you may be doing yourself and your patients a disservice by trying to learn both at the same time. You’ve invested a lot to become a nurse practitioner – your time, your money, your effort and the sacrifices that may have been placed on your and your families lives.

My advice, in most cases, is to get comfortable as a clinician. Even a year or two full time (or more!) depending on the area you are currently work and would like to work, will allow you the time to hone your clinical skills. Once you are there, then start learning about business and how to be a practice owner.

When you are ready, we’ll be here to help.

Your Turn

  • Are you a practice owner? Do you agree? Disagree?
  • Are you a new graduate? What are your thoughts?

Please share below.

Comments 9

  1. I say no to new grass starting a practice immediately after finishing school.
    Not enough experience for treatment and variations.They need a couple years under their belt to build their confidence and sound decision making.
    I personally have been an NP for 38 years.

  2. Much agreed , I have been NP for 22 years private practice for the last three. There is absolutely no way that I could have managed to be successful as a new Grad !

  3. I am a new graduate NP and of course one day I aspire to open my own clinic however I have always felt that in order to be successful I would need obtain a few years of experience in the role of a NP as well as learn all there is to know about business ownership etc. I can only imagine that there are a lot of things I would need to know in order to be successful. I thank you for your remarks as it pertains to this topic because it provides confirmation as to what I should be doing as a new NP. I also thank you for sharing your thoughts and comments and I look forward to learning more from you. Again thanks

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  7. Thanks for sharing this Barbara – as a seasoned recruiter in this field we see new grad NP’s just having a tough time getting their first job as most facilities or attending physicians rarely look at the RN background. Now if that RN background is very specialized and matches their certification they have a much better shot. But the thought of NP’s starting their own clinic right out of school is scary – don’t get me wrong I am all for entrepreneurship but the required expertise and skill set should take precedence prior to taking on a business. Patient Care should remain the number 1 priority. Get a job that pays off your school loans, get 2-3 yrs exp and then go rock out with a kick ass clinic.

  8. How can you ever gain the experience needed to one day open your own practice when you cannot even find a job as a new NP? I graduated 2 years ago and still I have not found a job. I am volunteering in a charitable clinic just to keep with my skills but I what I do there is not enough to help me grow. Looking into going back to school to get another specialization, but I know very well I might encounter the same predicament then too.

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