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Since the implementation of the Affordable Care Act (ACA) in 2010, and with an increasingly diverse, aging population and a growing shortage of primary care providers, advanced practice nurses (APNs) have assumed more responsibility for ensuring timely access to high-quality healthcare (Duncan & Sheppard, 2015). Indeed, the professional responsibility of APNs has morphed into clinical autonomy, requiring increased decision-making skills for diagnosis, treatment, and evaluation (Facchiano & Snyder, 2012). Thanks to their educational preparation and the variety of clinical practice settings in which they work, APNs are well positioned to offer new and innovative ways to improve access to healthcare, improve quality of care, and decrease the overall cost of care (Gutchell, Idzik, & Lazear, 2014).

For more information about the ACA—specifically, a timeline that shows how and when provisions of the act will be implemented—visit Note, however, that this legislation may be overturned and/or significantly changed by a new U.S. Presidential administration in the year 2017.

Given these healthcare industry changes, it is perhaps not surprising that more and more APNs have launched their own private or independent practices. There are boundless opportunities for APNs who want to practice independently. In addition, running an APN specialty practice can be rewarding in many ways. Designing a practice to meet patient needs, providing patient-centered healthcare, and doing it in a way that is creative and innovative can benefit patients, staff, and providers alike.

Private practice also comes with barriers and challenges, however. The complexities of self-employment can be daunting. APNs looking to open a practice must be aware of national standards, as well as the individual state laws governing practice. More than half the states in the U.S. have Nurse Practice Acts that restrict APNs from practicing to the full extent of their knowledge, education, and certification (Duncan & Sheppard, 2015). These limitations vary from state to state and may come in the form of restrictions on prescriptive privileges, on the ability to sign for referrals, on the ability to determine disability status, on the full completion of worker’s compensation forms, and on the ordering of home healthcare or durable medical equipment (DME) for patients. In addition, APNs may also be required to have collaborative practice agreements with physicians (Duncan & Sheppard, 2015). Nevertheless, starting a private practice can be an exciting adventure that leads to a fulfilling and rewarding career.

“I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. Twenty-six times I’ve been entrusted to take the game’s winning shot and missed. I’ve failed over and over again in my life and that’s why I succeed.”

–Michael Jordon

Some state laws impede nurse practitioners (NPs), certified nurse midwives (CNMs), and certified registered nurse anesthetists (CRNAs) from launching their own expanded or full practice (Duncan & Sheppard, 2015).


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