27 States Where Nurse Practitioners Can Open Their Own Practice – 2023

Written By: Kasee WiesenKasee Wiesen DNP, APRN, FNP-C

Kasee Wiesen is a practicing family nurse practitioner. Her nursing background includes emergency medicine, pediatrics and peri-op. She started her health career as a nurse’s aid while pursuing her bachelor’s in nursing degree in a hospital setting. Education is a passion of Kasee’s, and after working as a BSN prepared nursed, she obtained in master’s in nursing education and began teaching adjunct for a local university. Read Full Bio »» DNP, APRN, FNP-C

Nurse practitioners are playing a more pivotal role in healthcare. Not only do they have a reputation for providing high-quality patient-centered care. Due to the current physician shortage, they are also playing a significant role in filling the vacant positions.

While nurse practitioners have positively impacted the healthcare system, not all states allow NPs to open their own practice. So, what are the states where nurse practitioners can open their own practice? Below, you will find a list of 27 states where nurse practitioners can open their own practice.

Can Nurse Practitioners Open Their Own Practice?

There are 27 states where nurse practitioners can open their own practice. This is determined by the state’s scope of practice for the nurse practitioner, and these 27 states grant full practice authority to NPs.

Can Nurse Practitioners Open Their Own Practice in All States?

The nurse practitioner's ability to practice independently depends upon their scope of practice in each state. As of 2023, 27 states grant nurse practitioners the ability to practice independently, 12 grant NPs reduced practice, and 11 give restricted practice.

In How Many States Can Nurse Practitioners Open Their Own Practice?

As of August 2023, there are 27 states where nurse practitioners can open their own practice.

Why Did States Start Allowing Nurse Practitioners to Open Their Own Practice?

I am sure each state has its own reason for why nurse practitioners should open their own practice, but the primary reason for most states is to improve access. The healthcare demands of patients are increasing for many reasons, including the aging population and the projected physician shortage. Covid-19 also impacted some states to move forward with a legislature that granted NPs full practice authority and the ability to open their practice.

How Much Does It Cost Nurse Practitioners to Start Their Own Practice?

There is no definitive answer regarding how much it costs for a nurse practitioner to start their practice. One article projects $5,000, while another projects a minimum of $70,000. I gather from these articles that you need to know what type of practice you provide—for example, family medicine or psychiatric mental health. Or telehealth vs. in-person practice. You must also factor in how much ancillary staff you need, resources you will provide, vendors you may need, such as an electronic medical record (EMR), and additional expenses.

In other words, before starting your practice, you need to have a strong business plan that incorporates expected expenses and income that will be received. It would also be beneficial to talk to other NP business owners, banks, and other healthcare providers to fully understand the expense of opening your own business.

How Long Does It Take Nurse Practitioners to Start Their Own Practice?

The time it takes for a nurse practitioner to open their own practice will vary due to regulations from their state of practice, comfort level of the NP, and financial stability. Some NPs can only practice independently once a specified number of clinical hours or years of experience are completed, determined by their state of practice. Other NPs will want to work alongside a physician or APRN for a couple of years to gain knowledge and confidence in themselves as an NP before opening their own practice. One other limitation or barrier to opening one's practice is the financial demands of opening and operating one's own NP practice.

So, to circle back to the initial question—an NP may start their own practice within their first year, or it may take 5-10 years based on the state regulations, comfort/confidence in practice, and financial stability.

3 Main Advantages of Working in a State Where Nurse Practitioners Can Open Their Own Practice

There are many advantages of working in a state where nurse practitioners can open their own practice. Below, you find three of these reasons.

ADVANTAGE #1:

Full autonomy in day-to-day practice and delivery of care to your patients.

ADVANTAGE #2:

Opportunity to create a work schedule that provides optimal work-life balance.

ADVANTAGE #3:

Utilize your nurse practitioner degree to the fullest.

What are the States Where Nurse Practitioners Can Open Their Own Practice?

Listed below in alphabetical order as per the American Association of Nurse Practitioners, the following are the 27 states where nurse practitioners can open their own practice in 2023.

STATE #1: Alaska

Alaska was among the first states to grant nurse practitioners full practice authority. In Alaska, NPs practice as a primary care provider. They can also authorize disabled parking permits and refer to physical therapy. Signing death certificates and provider orders for life-sustaining treatment (POLST) forms are within their scope of practice; nurse practitioners in Alaska cannot sign do-not-resuscitate (DNR) orders.

STATE #2: Arizona

Arizona is one of the states where nurse practitioners can open their own practice. They can practice as primary care providers and order physical therapy when needed. NPs in Arizona are also authorized to provide proof of disability for parking permits, sign DNRs, and sign death certificates.

STATE #3: Colorado

In Colorado, the scope of practice of nurse practitioners is full practice authority. In other words, they can practice independently of a supervising physician and own their practice. Nurse practitioners can practice as primary care providers, refer to physical therapy, and provide proof of disability for parking permits. They can also sign DNR orders and POLST/Medical Order Scope of Treatment (MOLT) forms. In Colorado, NPs can not sign death certificates. They must also have malpractice insurance that pays at least $500,000 per claim and $1,500,000 in the aggregate.

STATE #4: Connecticut

Connecticut grants nurse practitioners full practice authority, authorizing them to practice independently. However, before they can practice independently or open their practice, they must be a licensed APRN for a minimum of 3 years and have practiced at least 2,000 hours. NPs can practice as primary care providers who refer to physical therapy authorized to provide proof of disability for parking permits. They can also sign DNR orders, death certificates, and POLST/Medical Orders for Life Sustaining Treatment (MOLST) forms. In Connecticut, nurse practitioners must have malpractice insurance that pays at least $500,000 per claim and $1,500,000 in the aggregate.

STATE #5: Delaware

Nurse practitioners in Delaware can practice independently and own their own practice after completing a minimum of 4,000 practice hours as an advanced practice nurse practitioner (APRN) and a minimum of 2 years of experience. They are defined as primary care providers and can refer to physical therapy. They are also authorized to sign death certificates and POLST/MOST forms.

STATE #6: Hawaii

Hawaii is one of the states where nurse practitioners can open their own practice. Nurse practitioners can practice as primary care providers and refer to physical therapy. They can also sign DNR orders, death certificates, and POLST forms.

STATE #7: Idaho

Idaho is one of the states where nurse practitioners can open their own practice. They are defined as primary care providers and can refer to physical therapy. NPs can also sign death certificates, DNR orders, and POLST/POST forms.

STATE #8: Iowa

In Iowa, nurse practitioners can practice independently of physicians, including opening their own practice. The NP in Iowa can assess, diagnose, and treat patients (pharmacologically and non-pharmacologically). Depending on where they work, they may have a collaborative agreement; it just isn’t required by the state. NPs are defined as primary care providers and can refer to physical therapy. They can also sign death certificates, POLST/POST forms, and DNR orders.

STATE #9: Kansas

Nurse practitioners can practice independently from a physician in Kansas, which includes opening their own practice. As of 2022, NPs in Kansas can practice independently of physician supervision, and the physician-authorized prescribing protocol was eliminated. In other words, NPs can now prescribe medications, including controlled substances, and durable medical equipment without supervision or collaboration with a physician.

NPs are defined as primary care providers, can refer to physical therapy, and provide proof of disability for disabled parking permits. They are not authorized to sign DNR orders or death certificates.

STATE #10: Maine

Maine grants NPs full practice authority, allowing them to practice independently from a physician collaboration. They can also open their own practice—giving the NPs full autonomy in their practice. NPs are considered primary care providers, and insurers must cover NP services. They can refer to physical therapy, sign DNR orders, death certificates, and POLST forms.

STATE #11: Maryland

Maryland is one of the states where nurse practitioners can open their own practice after completing an 18-month mentorship with a certified NP or physician. They are defined as primary care providers, refer to physical therapy, and can provide certification for disabled parking permits. They can also sign DNR orders, death certificates, and MOLST forms.

STATE #12: Massachusetts

As of 2021, nurse practitioners can practice independently in Massachusetts. This grants them the authority to open their own practice without needing a collaborative agreement with a physician. They are defined as primary care providers and must complete fifteen hours of continuing education every two years, and additional hours may be required for NPs who prescribe controlled substances. They can refer to physical therapy and sign DNR orders and MOLST forms.

STATE #13: Minnesota

Nurse practitioners in Minnesota can practice independently and open their own practice—and 4.8% of NPs in Minnesota own or co-own their practice without another healthcare professional. Before the NP can practice independently, though, they must have at least 2,080 hours in a collaborative agreement with a physician or APRN. They are defined as primary care providers and are authorized to sign death certificates and POLST forms. They cannot sign DNR orders.

STATE #14: Montana

Montana is one of the 27 states where nurse practitioners can open their own practice are defined as primary care providers and must complete 24 continuing education hours every two years. They can refer to physical therapy and sign DNR orders, death certificates, and POLST forms.

STATE #15: Nebraska

Nurse practitioners in Nebraska must enter into a collaborative agreement between the NP and a supervising provider for 2,000 hours of practice, and once completed, they can practice independently and open their own practice. They are considered a primary care provider and can refer to physical therapy. They must also hold malpractice insurance.

STATE #16: Nevada

Nevada is one of the states where nurse practitioners can open their own practice. They are required to complete 45 hours of continuing education every two years. They are authorized to refer to physical therapy, sign DNR orders, POLST forms, and sign death certificates.

STATE #17: New Hampshire

Nurse practitioners in New Hampshire can practice independently, including assessing, diagnosing, and treating their patients. With their scope of practice, they can also open their own NP practice. They are defined as primary care providers and must complete 30 continuing education hours every two years. They can also sign DNR orders, death certificates, and POSLT forms.

STATE #18: New Mexico

New Mexico is one of the 27 states where nurse practitioners can open their own practice. They must complete continuing education requirements per their national certifications, and 50 continuing education hours are required every two years. Insurers are required to provide coverage for services by NPs. Nurse practitioners in New Mexico can sign DNR orders, death certificates, and MOST forms.

STATE #19: New York

New York is one of the states where nurse practitioners can open their own practice after completing 3,600 practice hours per a written practice agreement and written practice protocols with a collaborating physician. They must meet the continuing education requirements in accordance with their national certification requirements. They must also complete three continuing hours in pain management, palliative care, and addiction every three years.

NPs in New York are defined as primary care providers who can sign DNR orders, death certificates, and MOLST forms. They can also refer to physical therapy.

STATE #20: North Dakota

The scope of practice for nurse practitioners in North Dakota is full practice authority making it one of the states where nurse practitioners can open their own practice. Nurse practitioners are defined as primary care providers, can refer to physical therapy, and can provide proof of disability for disabled parking permits. NPs are also authorized to sign death certificates and POLST forms.

STATE #21: Oregon

Nurse practitioners can practice independently in Oregon, which includes opening their own NP practice. They are defined as primary care providers, can refer to physical therapy, and provide proof of disability for disabled parking permits. NPs are authorized to sign DNRs, death certificates, and POLST forms.

STATE #22: Rhode Island

Rhode Island is one of the 27 states where nurse practitioners can open their own practice. NPs in Rhode Island must complete ten continuing education hours every two years and maintain malpractice insurance in the amount of $100,000 per claim and $300,000 in the aggregate.

They are defined as primary care providers and refer to physical therapy. NPs in Rhode Island are authorized to sign DNR orders, death certificates, and MOLST forms.

STATE #23: South Dakota

In South Dakota, nurse practitioners can practice independently from a supervising healthcare provider after completing 1,040 hours under a written collaborative agreement with a physician, certified nurse practitioner, or midwife. Once this requirement is complete, NPs in South Dakota can practice independently and open their own practice.

NPs in South Dakota are defined as primary care providers and can refer to physical therapy. They are authorized to sign DNR orders, death certificates, and MOST forms.

STATE #24: Utah

The scope of practice for nurse practitioners in Utah is full practice authority making Utah one of the 27 states where nurse practitioners can open their own practice. They can refer to physical therapy and provide proof of disability for disabled parking permits. NPs in Utah are authorized to sign DNR orders, death certificates, and POLST forms.

STATE #25: Vermont

Nurse practitioners in Vermont can practice independently after completing a minimum of 24 months and 2,400 hours of active NP practice with a collaborating agreement with a Vermont licensed physician or APRN. Once this requirement is met, the NP can assess, diagnose, and treat patients independently, which includes being able to open their own practice. They can sign DNR orders, death certificates, and Clinician Orders of Life Sustaining Treatment (COLST) forms.

STATE #26: Washington

Washington is one of the states where nurse practitioners can open their own practice. They must complete thirty continuing education hours every two years, and an additional 15 hours are required during that same time for those with prescriptive authority.

NPs in Washington are defined as primary care providers and can refer to physical therapy. They are authorized to sign DNR orders, death certificates, and POLST forms.

STATE #27: Wyoming

Lastly, Wyoming grants nurse practitioners full practice authority, or in other words, NPs can practice independently, which includes opening their own practice. Regarding continuing education requirements, they must comply with the requirements determined by their national certification body and complete three hours related to prescribing controlled substances to maintain prescriptive authority. They are able to refer to physical therapy and provide proof of disability for disabled parking permits. NPs in Wyoming are authorized to sign death certificates and POLST forms.

My Final Thoughts

So, what are the states where nurse practitioners can open their own practice? After reading above, I hope you know the 27 states where nurse practitioners can open their own practice. Nurse practitioners are incredibly important to our healthcare system and are linked to positive patient outcomes. It will be interesting to see how long it takes the remaining states to grant NPs full scope of practice and the ability to open their own practice.

Frequently Asked Questions Answered by Our Expert

1. What Were The First Few States To Allow Nurse Practitioners To Open Their Own Practice?

The first few states to allow NPs to open their practice include Alaska, New Hampshire, Oregon, and Washington. These 4 states granted full practice authority and the ability to practice independently in the 1980s.

2. Can Nurse Practitioners Open Their Own Practice In Any State?

The nurse practitioner's ability to practice independently is based on their scope of practice within their state. If the state grants full practice authority, the NP can practice independently. Restricted practice requires the NP to practice under the supervision, delegation, or team management by another health provider—and restricts their ability to complete at least one aspect of the NP practice.

3. Can Nurse Practitioners Open Their Own Practice In California?

No—the scope of practice for nurse practitioners in California is restricted practice. Restricted practice requires the NP to practice under the supervision, delegation, or team management by another health provider. They are also restricted to participate in one aspect of the NP practice.

4. Can Nurse Practitioners Open Their Own Practice In Florida?

No—the scope of practice for nurse practitioners in Florida is restricted practice. This means that the nurse practitioner is restricted to complete at least one aspect of the NP practice. They must also practice under the supervision, delegation, or team management by another health provider—and restricts their ability to complete at least one aspect of the NP practice.

5. Can Nurse Practitioners Open Their Own Practice In Texas?

No—the scope of practice for nurse practitioners in Texas is restricted practice. This means that the nurse practitioner cannot participate in one aspect of the NP practice. They must also be under the supervision, delegation, or team management by another health provider in order to practice.

6. Can Nurse Practitioners Open Their Own Practice In New York?

Yes, nurse practitioners in New York are granted full practice authority and can open their practice.

7. Can Nurse Practitioners Open Their Own Practice In Pennsylvania?

No, the scope of practice for nurse practitioners in Pennsylvania is reduced. In other words, nurse practitioners have a reduced ability to participate in at least one aspect of NP practice. They must also have a career-long regulated collaborative agreement with another healthcare provider, or it further limits aspects of the NP practice.

8. Can Nurse Practitioners Open Their Own Practice In Georgia?

No—the scope of practice for nurse practitioners in Georgia is restricted practice. Restricted practice requires the NP to practice under the supervision, delegation, or team management by another health provider. This also restricts their ability to complete at least one aspect of the nurse practitioner practice.

9. Can Nurse Practitioners Open Their Own Practice In Massachusetts?

Yes, nurse practitioners in Massachusetts are granted full practice authority and can open their practice.

10. Can Nurse Practitioners Open Their Own Practice In Illinois?

No, the scope of practice for nurse practitioners in Illinois is reduced. This means they must have a career long regulated collaborative agreement with another healthcare provider. They also have reduced their ability to participate in at least one aspect of NP practice. In other words, nurse practitioners have a reduced ability to participate in at least one aspect of NP practice. They must also have a career-long regulated collaborative agreement with another healthcare provider, or it further limits aspects of the NP practice.

11. Can Nurse Practitioners Open Their Own Practice In Ohio?

No, the scope of practice for nurse practitioners in Ohio is reduced. In other words, nurse practitioners have a reduced ability to participate in at least one aspect of NP practice. They must also have a career-long regulated collaborative agreement with another healthcare provider, or it further limits aspects of the NP practice.

12. Can Nurse Practitioners Open Their Own Practice In North Carolina?

No—the scope of practice for nurse practitioners in North Carolina is restricted practice. Restricted practice requires the NP to practice under the supervision, delegation, or team management by another health provider—and restricts their ability to complete at least one aspect of the NP practice.