Lessons Learned From Nurse Practitioner Independent Practice

A Conversation With a Nurse Practitioner Entrepreneur

Joyce A. Hahn, PhD, RN, NEA-BC, FNAP; Wesley Cook, APRN, FNP-BC, CPSN


Nurs Econ. 2018;36(1):18-22. 

In This Article

Abstract and Introduction


ADVANCES IN NURSING regulations alongside strained access to primary care for an aging population present entrepreneurial opportunity for nurse practitioners (NPs), especially NPs in states with full practice authority. Twenty-two states and the District of Columbia grant advanced practice registered nurses (APRNs) full practice authority, wherein APRN practice is governed solely by the local board of nursing and practice is absent any locally regulated non-nursing involvement or physician involvement (American Association of Nurse Practitioners, 2017). Full practice authority not only affords the NP, as an APRN, lawful control of and full liability for evaluation and management of patients in his/her charge, it eliminates financial barriers to entrepreneurship unique to APRNs and allows for fair market competition (Gilman & Koslov, 2014). Full practice authority also serves to advance the profession by allowing creative pursuits outside the framework of medicine (Wilson, Whitaker, & Whitford, 2012).

APRN entrepreneurs innovate by seeking market gaps unseen by other health disciplines (Johnson & Garvin, 2017). However, overcoming entrenched scope-of-practice barriers is of paramount importance to nurse entrepreneurs. After all, how can nurses bring about true innovation without full access to all available potential? Since 2010, the Institute of Medicine has recommended removal of scope-of-practice barriers for nurses at all levels of practice so patients may benefit from unfettered access to nursing expertise. Dillon and Gary (2017) opine, "NPs are positioned to effect positive change in health care and new models of health care delivery" (p. 88).

It is now well documented APRNs with full practice authority provide cost-effective care with high-quality outcomes (Conover & Richards, 2015; Oliver, Pennington, Revelle, & Rantz, 2014). Reducing scope of practice barriers should encourage broader participation in NP-led primary care efforts which should extend the reach of cost-effective, high-quality care to those with chronic and complex health needs in underserved areas (Van Vleet & Paradise, 2015). As such, APRN entrepreneurs find themselves practicing in an exciting epoch. While less than half of U.S. states afford APRNs full practice authority, critical mass is being gained and current trends show an encouraging trend toward universal full practice authority in the near future, opening the door for more patients to experience the benefits of nurse-led innovations in advanced care modalities.

The American public places it's trust in nurses (Norman, 2016) and nurses not only advocate for patients but seek new opportunities and innovative ways to provide quality, cost-effective care. APRNs, in states with full practice authority, are developing practices outside hospital walls to increase access of care to the most vulnerable while leveraging emerging reimbursement from commercial healthcare providers. APRN entrepreneurs, working as agents of change, are combining entrepreneurial motivation, clinical skills, and knowledge with business acumen to address gaps for direct patient care found in the healthcare industry (Johnson & Gavin, 2017). Self-sufficient independent practice has afforded the opportunity for NPs to specialize and maximize patient care, allowing clients to become true partners in their care planning (Barberio, 2010). The demand for quality care from a population of aging baby boomers, coupled with healthcare legislative changes, and the increased emphasis on preventive care provides an opportunity for NP entrepreneurs (Johnson & Garvin, 2017; Sharp & Monsivais, 2014).

Policymakers are discovering NP independent practice can increase access of care, particularly in urban and rural areas. Several states have already passed independent NP practice legislation with several more considering such legislation, making this policy issue one of few bipartisan areas of agreement in healthcare (Jaspen, 2017).

Wesley Cook, DNP(c), APRN, FNP-BC, CPSN, is an NP entrepreneur in Washington, DC, a full practice authority jurisdiction. He is owner and president of District Primary Care, LLC (DPC). DPC is a solo-practice with three operational divisions: a primary care practice, a clinical aesthetics practice, and a consulting shop. Each division has a discrete focus. The primary care practice division focuses on meeting the evaluation and management needs of the facility or homebound geriatric population; the clinical aesthetics division serves those patients who want to benefit from innovations in cosmetic medicine; and the consulting arm provides health-related business consulting and direct care on a limited basis. In this interview, Mr. Cook discusses lessons learned in establishing and maintaining a sustainable business model within the context of full practice authority.