Advanced Practice Nurses: Developing A Business Plan for an Independent Ambulatory Clinical Practice

By Johnson, Joyce E.; Garvin, Wendy S. | Nursing Economics, May/June 2017 | Go to article overview

Advanced Practice Nurses: Developing A Business Plan for an Independent Ambulatory Clinical Practice


Johnson, Joyce E., Garvin, Wendy S., Nursing Economics


BUSINESS PLANNING is an essential business tool for entrepreneurs - a best practice approach for those interested in developing a small business such as an ambulatory clinical practice. Translating business planning efforts into a properly prepared business plan remains an undisputed, effective necessity in any entrepreneurial endeavor (Sherman, 2016).

For today's advanced practice nurses (APNs) with an eye toward innovation and independence, a new story is unfolding in an exciting era for these expert nurses. Sparked by the Institute of Medicine's (IOM, 2010) landmark report, The Future of Nursing: Leading Change, Advancing Health, which emphasized the contribution of nurses to "...building a health care system that will meet the demand for safe, quality, patient-centered, accessible, and affordable care" (p. 1). APNs have begun enjoying a wider practice scope and establishing their own standalone ambulatory practice centers (American Academy of Ambulatory Care Nursing [AAACN], 2017; IOM, 2010; Yee, Boukus, Cross, & Samuel, 2013).

According to the American Association of Colleges of Nursing (AACN, 2017), there are four categories of APNs: nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists. In at least 45 states, APNs can prescribe medications, while only 16 states have granted APNs authority to practice independently without physician collaboration or supervision. In states where this independent practice is not allowed, APNs must practice under the auspices of a doctor or a medical institution. However, APNs are authorized to receive Medicaid reimbursement. In December 2016, the Department of Veterans Affairs granted three of the four APN roles (nurse practitioners, certified nurse-midwives, and clinical nurse specialists) the ability to practice to the full extent of their education and training. While the new policy excluded certified registered nurse anesthetists, current efforts to include this valuable cohort advances the progressive national trend to enable nurses to practice to the full extent of their education and training.

In addition, population growth and the aging of the U.S. population have substantially increased demand for primary care providers amidst a growing shortage of primary care physicians (Carrier, Yee, & Stark, 2011; Van Vleet & Paradise, 2015). In this environment, APNs find a fertile terrain rich with opportunities and an invitation to enter the world of small business. While such opportunities can help nurses to practice to the full extent of their skills and licensure to improve American health care (Johnson et al., 2012; Wilson, Whitaker, & Whitford, 2012), few APNs understand the regulatory, financial, and general operational business requirements for launching an independent clinical practice. In 2006, AACN recognized this knowledge deficit and defined core competencies for the doctorate in nursing practice academic program accreditation.

These core competencies include proficiency in using economic and financial principles to redesign effective and realistic care delivery strategies and the ability to employ principles of business, finance, and economics to develop effective plans for improving the quality of health care. Many innovative and aspiring APNs, including those with and without advanced degrees, who are interested in establishing independent ambulatory care practices must first understand and appreciate basic business planning principles.

Where does an APN begin to determine if entrepreneurship is right for him or her? The first step is to conduct a serious self-assessment to assure the APN has an above-reproach clinical skill set, an exceptional high energy level, and a fiercely independent propensity to succeed. If the APN meets these rigorous expectations, the next step is to fully understand all the details of what it really means to be an entrepreneur.

Around the beginning of the 19th century, Say coined the term entrepreneur from the French term entreprendre - to "undertake" (Stoy, 1999, p. …

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