Liasion Pulse

I began my career as a nurse with the expectation that much of my professional path would remain in hospitals. Now, after more than 15 years as an ICU RN, hospitalist APRN, and outpatient APRN, I know this is not necessarily the case. As APRNs continue to expand their roles in healthcare delivery, it is increasingly important for professionals to explore opportunities beyond traditional employment. APRN students can and should begin to explore the possibilities of independent practice after graduation. Independent practice and private practice ownership are no longer distant possibilities, but realistic options for APRNs who are willing and excited about the possibility to step into leadership.

APRN Entrepreneurship

Few graduate nursing programs teach APRNs how to build, operate, and sustain private practice. As a result, APRNs must depend on their professional network including mentors to learn how to operate their own private practice. Despite these challenges, graduate school provides a valuable opportunity to explore independent practice options and begin gathering the knowledge, resources, and connections needed for success. Below are some clear steps to help you get started as you consider independent practice.

The Value of Experience and State Practice Laws

Before formalizing a plan to open a private practice, it is important for APRNs to build the practical confidence and competency needed to succeed, whether through experience in a hospital, clinic, or healthcare organization. After building on their competencies, an APRN

should familiarize themselves with their state’s practice requirements. Scope of practice laws can vary widely between states and determine whether physician collaboration is required.As of 2025, there are 30 U.S. states and territories, that allow APRNs to practice independently with Full Practice Authority (FPA) (Feeney, 2025). Upon licensure, the state of California offers FPA opportunity to nurse practitioners in a phased, step-wise manner, rather than full independence immediately (California Board of Registered Nursing, 2026). Therefore, it is important to check the specific legislation related to the state where you will practice.

Registering a Business

Once an APRN understands their state’s practice laws, they can establish their business structure. One option for operating a private practice is registering it as a Limited Liability Company (LLC). Registering as an LLC can often be completed through the Secretary of State’s website. Applicants are required to obtain an Employer Identification Number (EIN) and apply for a group National Provider Identifier (NPI) number. The process of securing a group NPI is similar to the process of securing an individual NPI.

Insurance, Collaboration, and Practice Tools

Securing malpractice insurance is another critical step for creating a private practice as an APRN. Practitioners who provide telehealth services should also consider coverage that includes cyber liability. Although occurrence-based malpractice coverage may be more expensive, it is often preferred for long-term protection. For practitioners working in states that require physician collaboration, a collaborating physician will need to be identified. It would be valuable to consider physicians who were previous colleagues. A collaborating physician can also be found through online platforms such as Single Aim, which connects APRNs with collaborating physicians. It is important to interview potential collaborators and ensure the partnership aligns with one’s goals and practice needs.

Finally, selecting an electronic medical record (EMR) system is essential. The best platforms are modern, user-friendly, and have reasonable billing and collection rates. Some EMR systems offer credentialing, billing, and revenue cycle management (RCM), which may reduce startup costs. When selecting an EMR, you may want to consider the following factors: HIPPA compliance, the use of AI for dictation, lab ordering and imaging order integration, built-in telehealth/video visit integration, patient portal functionality, E-signatures, and data encryption and backup systems.

Conclusion

Building an independent APRN practice requires preparation, persistence, and confidence. With proper planning and support, APRNs can successfully become independent providers and expand access to high-quality healthcare in their communities. To help students be better prepared in considering private practice opportunities, graduate nursing programs should consider offering courses or resources that can support students interested in establishing private practices.

References

Feeney, A. (2025). Nurse practitioner practice authority: A state-by-state guide. Nurse Journal. https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/

California Board of Registered Nursing (BRN). (2026). Assembly Bill 890 (Wood, Chapter 265, Statues of 2020). https://www.rn.ca.gov/practice/ab890.shtml

Critical thinking, by nature, is a cognitive learning process of analyzing information, forming a plan, and making a decision, thereby providing patient satisfaction and safety (Nemati-Vakilabad et al., 2021). As professional nurses, we are continually learning new skills, acquiring new evidence-based research, and applying this in our daily patient practices. Newly graduated nurses have the beginnings of these skills, and as mature, seasoned nurses, we need to find ways to help our new nurses build on them. Academic education begins in both didactic and clinical settings.

Patel and Metersky (2021) explain that truly understanding a patient involves connecting what you know with what you do in practice. This connection is achieved through reflective practice and bridges the gap between nursing theory and hands-on care. Upon graduation,

these new nurses find themselves in the real world, struggling to grasp the knowledge their employers demand, leaving them in a state of mindful disarray. Not that their education lacks theoretical teaching, but they question whether experience is teachable. Mentoring these new nurses entails not only refining their skills but also refining their thought processes. The best learning experiences occur through repetition and recognition of actions.

Abdalhafith et al. (2025) support the idea that nursing knowledge of critical thinking stems from gaining confidence in performance and attitudes toward nursing tasks, fostering self-efficacy, and strengthening knowledge of making clinical judgments. Closing the gap between inability to perform and knowledge can be affected by organizational factors, such as turnover rates and patient flow rates. The effect on nurses’ judgement due to anxiety and feelings of being overwhelmed can result in task-oriented rather than cognitive thinking. As preceptors, we need to foster open communication to enhance positivity, support confidence, and build their critical thinking skills. Positive reinforcement and encouragement of performance not only enhance skills but also reduce anxiety and foster a positive attitude.

Another supportive stance for newer nurses and current staff alike is organizational education. Ongoing educational support on disease protocols and newly acquired equipment is a must-have to keep everyone on the same page. For a new nurse, nothing is worse than not knowing how a piece of equipment works or the correct protocol for a procedure. As our newer nurses mature, gaining confidence in themselves and deepening their understanding of clinical reasoning, we, the preceptors, lead these new nurses by reinforcing theoretical knowledge and applying it in complex patient care situations, much like educators who bridge classroom learning with practical skill development.

References

Abdalhafith, O., Rababa, M., Hayajneh, A. A., Alharbi, T. A. F., Alhumaid, B., & Alharbi, M. N. (2025). Critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis

Management: A systematic review. BMC Nursing, 24:424. https://doi.org/10.1186/s12912-025-02986-1

Nemati-Vakilabad, R., Mojebi, M. R., Mostafazadeh. P., Jafari, M. J., Kamblash, A. J., Shafaghat. A., Abbaso, A. S., & Mirzaei, A. (2021). Factors associated with the Critical thinking ability among nursing students: An exploratory study in Iran. Nurse Education in Practice. 73(2023),103814. https://doi.org/10.1016/j.nepr.2023.103814

Patel, K. M., Metersky, K. (2022). Reflective practice in nursing: A concept analysis. International Journal of Nursing Knowledge, 33, 180–187. https://doi.org/10.1111/2047-3095.12350

I have always been fascinated by healthcare and aspired to care for people, protecting and enhancing their lives, even from a young age. I became a nurse in 2002 and an Adult Nurse Practitioner in 2005. Soon after graduation, I began practicing in hospitalist medicine, where I have had the opportunity to learn from brilliant colleagues and teach new nurse practitioners. Fast forward 20 years, with great trepidation, I decided to go back to school with the aspirations to practice at the highest level of my professional scope. I am now in my final semester of the Doctor of Nursing Practice program at the University of Florida, striving to keep an equilibrium between professional, academic pursuits, family commitments, and personal life. With self-reflection, I have concluded that returning to school after so many years has been both challenging and rewarding. Most importantly, it has taught me that learning is an ongoing journey and should be embraced at each season of life.

The primary obstacles I encountered were time management and the balancing of the roles and responsibilities I carry. Being a wife, mother, nurse practitioner, and student has been trying and complex. However, it has also amplified the value of each role. Rather than stressing over the time constraints of the range of obligations I balance, I intentionally focus on the value and positive impact of the opportunities. The multitude of adversities has compelled me to be disciplined, prioritize, and more efficiently manage my time. It is a blessing to have a family, a gift to be able to go back to school, and a privilege to help save lives as a profession. Balancing life requires intentionality, planning, and flexibility, but how we choose to perceive difficulties can transform adversity into valued achievements.

At times, raising three teenage daughters seems more taxing than my doctoral studies or professional practice combined. Offering guidance, teaching, and demonstrating values in action have become an integral aspect of my daily parental routine. I suspect my ongoing pursuit of education models multiple life lessons to my girls. It is essential to take risks, embrace new experiences, and be courageous even when uncertain of the outcomes. Learning is a lifelong process that promotes both professional and personal growth. We should always strive towards goals and set new dreams at all stages of life. Curiosity, perseverance, and self-improvement are values I hope to model to them. Challenges can be faced with confidence, and the most important component is merely our willingness to try.

When anyone asks me, “How has it been going back to school?” I always respond with a single word, “humbling”. Never in my life have I been humbled in such numerous ways. I have re-learned scholarly writing, APA format, extensive new content, AI, and technology. Participating in a fully online program has required me to acquire proficiency in technology platforms, applied abilities, and concepts at an accelerated pace. At the expense of a smirk, or even an eyeroll, my teenagers have assisted me countless times as I acquire new skills with technology. The demanding adjustment process, troubleshooting, and navigating hurdles have forced me to develop resilience, personal growth, and confidence in myself and my capabilities. Prevailing over my frustrations with technology has successfully reinforced the value of perseverance and adaptability.

Returning to school after almost 20 years has been a sobering and perspective shifting journey. Changing my perspective on balancing multiple roles and responsibilities has allowed me a new path to grow and overcome the fears and doubts that once hindered me. Learning is a lifelong journey worth pursuing, enriching both personal and professional evolution, but more importantly, inspiring growth and character. After many years away from the classroom, it has been an honor to rise above my fears and embrace something new, leading by example to my teenage daughters. Education, specifically in healthcare, does not have a finish line, nor is it something that is completed after graduation. Attaining knowledge is an ongoing journey. This humbling, but profoundly rewarding, experience has taught me that it is not about what you know but rather being brave enough to keep learning.