I am often asked the Best State for Nurse Practitioner Practice? The best state to own your own practice/business? Let me start off by saying that you can have your own practice in any state by following what ever rules and regulations (scope of practice) are in place.
In addition to looking at practice acts for each state, you’ll want to look at the rules and regulations for business for that state. Can you own a practice outright? Do you have to own the practice with a physician? Who else can own a practice with you? What other potential barriers are there to owning a practice or any other business in your state?
Obviously the first place to start is going to be with your own state’s board of nursing to learn about your own practice act. Make sure you check at least annually, as SOP is constantly being update. What if you are looking for other states? My go to reference is the Pearson Report, which is updated annually and an excellent business resource.
That said, according to my list and information I have from NPs around the country, states without any sort of collaboration are included in the image below. Those with an asterisk are those with independence after meeting a requirement. This slide is from a presentation I did last year, which will be updated to reflect changes that took place in 2011.
When you are looking for a place to practice, considerations including SOP and business climate are certainly important. However, look at all the factors that are important to you and your family and make the choice from there. You’ll be much happier if your business fits into your lifestyle and reflects what is important to you as a clinician. After all, it is your practice.
Feel free to share and to leave you comments below.
Update: North Dakota is independent as of 10/1/11 – http://www.legis.nd.gov/information/acdata/pdf/54-05-03.1.pdf
Update: Vermont NPs can be independent after 2 yrs of practice.
Do you personally believe that more NP’s will be able to practice independently in more states once the program changes for future NP’s in 2015. I’m planning on getting my DNP with a certification in Dermatology and cosmetic medicine and I would like to open a Medical Spa and Dermatology practice in the southeastern Wisconsin and Northern Illinois areas but not until i’m finished with school and get some experience in the field. I’m a current nursing student in Pewaukee, WI. I appreciate any info or opinions you can offer. Thanks!
First, I don’t know just how feasible it will be 2015 to be the date that everything changes. Already I’m hearing “rumors” of a push back of that time frame.
While the DNP may (or may not) influence practice regulations, scope of practice is still a legislative issue that will have to be addressed at the national level and at the state level. We currently have states with independence, states that require supervision and have very restrictive practice acts, and everything in between. While changes are made every year, it’s unlikely that we will see massive changes in the next 3 years.
In terms of your own practice – once you have graduated, get as much experience as you can. Perfect your knowledge and skills and then seek the assistance you might need to get started in practice.
Best wishes in your schooling and future practice!
I am a 52 yr. old recent BSN graduate (second career) who is planning to return to grad school this fall to pursue either a DNP or NP in family practice. Given my age and all of the projected changes coming in the near future, what is your opinion as to which direction (DNP vs NP) I should consider pursuing and what is your reasoning behind your suggestion?
Thank you for your insight.
That’s a question that cannot be answered easily as there are many variables. So here are some things to consider.
1. How long to you intent to work before retiring?
2. What are your program options and what is the time differential. If you are adding just one more year to your masters, then it makes sense to me, as a year is really very little time.
3. What is your goal for a DNP?
Eventually all NPs entering the profession will be required to have a DNP, however we are a few years away for making that happen (not sure the 2015 deadline will hold).
Personally, if I was just starting out, I’d choose the DNP, no question about it. You don’t want to be a degree “behind” if you will. Be sure and look at programs that will meet your professional goals.
I just wanted to comment on the information. It was very helpful. My husband who is also over 50 & is a chiropractor & acupuncturist is wanting to go back to school for nurse practioner since he has expanded his education & isn’t wanting to be restricted in performing his talents anywhere he goes. Under our circumstances he won’t be retiring anytime soon. So thanks for the information.
Hello, I am a BSN nurse, been practicing going on a year now. I am trying to pursue Psychiatric Nurse Practioner, but afraid of not finding employment. Do you know the states that really need Pscyh NP or which states have a higher demand ? Also, I am having a hard time finding universities that have the program itself, do you know of any around the country? thanks
I don’t know of employment needs specifically, but I will tell you, at least in my area (Washington State), there are not nearly enough Psych NPs to meet the needs – especially for patients that are low income. I would anticipate that we are no different than any other state. As a PsychNP you are not limited to employment, many have their own businesses and practices – another option for you. Best wishes.
Hello, I am a DNP with 17 yr in family practice. I have an interest in dermatology and would like to change to that as my specialty. My problem is no one will hire me without derm experience. Are there any online, practicum programs that are of reasonable length? I don’t want to go back to school full time.
I don’t know of online programs, but there are several continuing education programs that focus on derm. You might enroll in some of these courses and then find a preceptor/volunteer position to complete your hands on training.
The Dermatology Nurses Association has a strong NP presence – http://www.dnanurse.org and lots of educational opportunities.
The National Procedures Institute has plenty of week long and weekend courses with hands on experiences in various aspects of deem – http://www.npinstitute.com
For Diane: the Lahey clinic offers a year residency in dermatology for nurse practitioners. There is certification available after 3 years of derm employment.
RE: Sherry’s reply to your post:”For Diane: the Lahey clinic offers a year residency in dermatology for nurse practitioners. There is certification available after 3 years of derm employment.” I did a little research and have the page link for you to explore more in case you haven’t had a chance to yet. Best of luck to you, see the link below:
I am family nurse practitioner and working in central Illinois. I have been working as NP for 16 years now. In regards to demand for Psychriatric Nurse Practitioner the demand is high. I know we finally got one in our mental health clinic, and they have been recruiting for awhile. She is outstanding. We don’t have a Psychiatric track here in Illinois in the programs so she came from Indiana. I see a lot of jobs in that area and higher salaries than family practice. I wish you well if you decide to pursue it.
Hi, I have all my credentials from the state of conectiticut.
Would I be able to do APRN volunteer work in Rhode Island.
If I wanted to do volunteer work in connecticut, would I need a consulting MD, as per state regulations.
You will need to follow state guideline regardless if you are working as a volunteer, employee or if you are self employed.
You need to follow the state practice act in which you will be working. If you will be seeing patients in CT, you will need to have a license and follow that states practice act.
Montana State University College of Nursing (Bozeman, MT) offers a Psychiatric/Mental Health DNP program. Consider the following link: http://www.montana.edu/nursing/academic/fpmhnp.htm. Best wishes!
Arizona completes our list of most nurse practitioner friendly states. Nurse practitioners working in Arizona enjoy the freedom to practice and prescribe independently. Within this freedom, however, state law specifies that NPs must practice only within their area of certification, they should not “exceed the limits” of their advanced practice specialty.
Hi! My name is Shameca. I’m a PMHNP-BC and I’m currently in a DNP FNP program. I’m wanting to know which independent states would be best for independent practice in mental health or integrative health care.
Hi Shameca, NPs have practices in all states, including those without independent practice. They will all have their pros and cons. A better way to look at this is to narrow down the choices of where YOU want to live and grow a practice and then look at each individual state. Being from the Pacific Northwest (WA, OR, ID, AK) however, I’d say those are great states to start a practice. Again…where do you want to be?
Hello. Would you mind updating this list of independent practice states 🙂 Also, a great add-on reference would be the most recent IOM report for the future of nursing.
The NP Journal releases a legislative update every January. Here is a link to the most up-to-date report: https://journals.lww.com/tnpj/Fulltext/2019/01000/31st_Annual_APRN_Legislative_Update__Improving.5.aspx