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Making the Jump to Solo Practice: How Solo NPs Built Jobs They Love
BY JULIA QUINN-SZCESUIL
As the United States makes slow but steady progress in granting nurse practitioners the authority to practice autonomously (according to the American Association of Nurse Practitioners, nearly half the states and U.S. territories allow this), nurse practitioners around the country are finding professional and personal career satisfaction in practicing on their own.
With a considerable professional nursing foundation and the business acumen to build a practice from scratch, these nurses are filling a health care need that continues to grow.
Overscheduled Nurses Say Enough
Tani Schare, RN, MSN, FNPC, CCRN, is the founder and owner of Mariposa Family Medicine in Albuquerque, New Mexico, and says her drive to strike out on her own stemmed from an increasingly hurried way of nursing. “You don’t feel like there’s enough time,” she says. “You are always rushed. When you work for someone else, you are not able to set good limits.”
That changed, she says, when she started her own practice. “Now I get to set the opening and closing hours and determine the amount of patients we see in a day or how may acute visits,” Schare says.
The workload is greater when you own your own business, but they are motivated by the rewards. “When I worked as a nurse in a hospital and a doctor would give orders, I would sometimes think, ‘I would do this instead,’” says Kathy Fresquez-Chavez, DNP, FNP-C, MSN, the owner of Bella Vida Health Care Clinic and Medi-Spa in Los Lunas, New Mexico. “And I found that what I was doing was the correct way to go.”
The flexibility to schedule fewer patients and spend a longer time with them offers relief for many NPs and their patients. “I’ve heard of nurse practitioners who are expected to see 20 to 30 patients a say,” says Schare. “Health care doesn’t have to be like this.”
Fresquez-Chavez says the patient/NP bond is exceptional. “I become a part of their family,” she says. “I see their kids as babies and as they get older.”
Preparation Is Key
Solo nurse practitioners say preparation is essential, and even when you think you are fully prepared, be ready for the unexpected. “It’s a huge learning curve,” warns Schare.
Fresquez-Chavez says she gained important knowledge by working in many areas of nursing. “If I could do it, I did,” she says. By doing so, each task built a foundation she would come to rely on.
Irene Bean, DNP, FNP-BC, PMHNP-BC, FAANP, a family psychiatric nurse practitioner and CEO of Serenity Health Care, PC & Weight Loss Clinic in Madison, Tennessee agrees. Early in her career, she approached every responsibility as a learning experience, taking on both nursing and administrative tasks to learn. “I never turned anything down,” she says. Both NPs gained a thorough skill set and became trusted colleagues of many physicians and other NPs.
Know the Business Side of Nursing
Solo practitioners need to familiarize themselves with even the smallest details about running a practice so their business is successful, says Fresquez-Chavez. For instance, will you want hospital privileges? What kind of insurance will the practice accept and how will you set those contracts? How will you effectively manage your staff? How will you market your new practice?
“There’s not a lot of training for this in nursing school at all,” says Schare. She took an online course that was geared toward nurse practitioners who wanted to open their own business.
Building connections and collaborations with others in the medical and business communities is important to keep things running smoothly. Fresquez-Chavez collaborated with many medical teams and could call on them if she had questions early on. “Those things stay with you,” she says. “I had their respect, and they supported and helped me.”
And get involved with your local or state nurse practitioners’ professional organization. “As a solo practitioner, if you’re afraid to communicate with your peers, you’re not going to get too far in this business,” says Bean, who also founded the Tennessee Nurse Practitioner Association chapter.
Be Familiar with State Regulations
Understanding your state’s regulations is key as well. In New Mexico, where FresquezChavez and Schare practice, nurses have authority to practice with full autonomy and require no physician oversight. Bean’s solo practice, however, is in a state that restricts full autonomy.
“Practicing in a restrictive state has many challenges, especially for an NP-owned practice,” says Bean, a nurse for more than 20 years and a solo practice owner for 13. “In Tennessee and other states requiring collaboration, the physicians are paid to review charts of patients they have not seen,” explains Bean. “In the 13 years of ownership, I have not called my collaborative provider for assistance with a patient because I will
refer to the appropriate specialist if it is a complicated case.” And while Bean is able to own her practice, the barriers are unnecessary, she says, noting that the restrictions were temporarily lifted during COVID. “Patients should have the right to choose who provides their care and should be able to select an NP as their primary care provider,” she says. “NPs are not trying to replace physicians. We are here to offer an affordable and quality care option for the patient.”
Career Satisfaction, Better Outcomes
As you begin your solo practice, recognize that you’ll definitely be scared, but, says Fresquez-Chavez, that shouldn’t stop you. “I encourage every nurse to stand up and go for it,” she says. “This gives you a lot of freedom, but it’s also just a good feeling to make a decision to help a patient and to be able to do everything you possibly can.”
Solo NPs say the patient relationships are meaningful, and they know solo practices help the crunch on family care providers. Schare says that she takes pride in her growing practice, and she never stops trying to make it better. “I am providing a service people haven’t had before,” she says. “When you own it, you protect it.”
Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.
