So, you’re ready to ditch the night shifts, endless charting marathons, and cafeteria coffee for something a little more your own? Welcome to the rollercoaster of starting your own nursing practice! Spoiler alert: it’s not as simple as slapping a shingle on the wall that reads, “Nurse Magic, P.C.” Nope. You’ve got some legwork to do. Here’s what to keep in mind if you want your practice to be less “Oh no!” and more “I’m my own boss now!”

1. Choose Your Corporate Entity (and Choose Wisely)

First things first: you need to pick the right business structure. This isn’t like choosing between scrubs or street clothes for casual Friday—it’s serious business. The structure you choose can either protect your assets or leave you weeping into your expired CPR card. Having a corporation or LLC protects your personal assets whereas being a sole-proprietor does not protect your personal assets.

• LLC (Limited Liability Company): Think of this as the “sensible shoes” option. It gives you liability protection without strangling you with as many corporate formalities. Many states, including California, do not allow clinical professionals to have LLCs.
• Professional Corporation (PC): In some states, healthcare professionals are required to form a PC or PLLC. This is like the state saying, “Sure, you can be independent, but don’t get too wild!” It’s built for licensed professionals and ensures you’re on the up-and-up.

• Sole Proprietorship: This is the YOLO of business structures. It’s easy, it’s simple—and it places 100% liability on you. In other words, it’s not for the faint of heart (or the faint of wallet). Keep in mind that typically, it won’t shield you from any clinical malpractice liability, but it may help safeguard against liability for debts or non-malpractice lawsuits.
• C Corp or S Corp: These are the more complex, sophisticated siblings. The thing to remember is that C and S corps are not actually types of corporations but rather refer to the way that the IRS treats corporations. There are benefits to each depending on your individual financial situation and goals.

If you choose the wrong entity structure, it can not only increase legal liability for lawsuits, but it can also land you in hot water with the board of nursing. It’s not as simple as filing articles of incorporation with the secretary of state—and if someone tells you to do it through a company like LegalZoom, run the other way! There is so much more than filing articles of incorporation to setting up a properly formed entity for your nursing business.

2. Get Cozy with Your State’s Nurse Practice Act

If you’ve ever had a fun Saturday night of “light reading,” then you’ll love diving into your state’s Nurse Practice Act. (And if you haven’t, well, it’s time to start.) This isn’t just bureaucratic mumbo-jumbo—it’s the holy grail of what you can and cannot do. Every state has its version, which means your cousin’s tale from three states over about her independent practice may not apply to you.

• Scope of Practice: Are you allowed to prescribe medication? Diagnose patients? Whip up essential oil potions in the back room? Your state’s regulations will tell you. Or they may not—some nurse practice acts are more specific than others.
• Prescriptive Authority: Some states allow advanced practice nurses (such as NPs) to prescribe freely, while others will make you jump through more hoops than a circus tiger. Don’t guess—know.
• Local and State Regulations: Beyond the act itself, prepare for fun side quests like local zoning laws and business licenses. Because nothing says “I’m ready to heal the community” like a bureaucratic scavenger hunt. For example, many states require that you have a physical, medically-zoned business address (and no, it can’t typically be your home office).

3. Don’t Forget the Feds

State laws aren’t the only show in town; Uncle Sam wants in on the action, too. Federal regulations are a must-know if you don’t want to be featured in the next episode of Healthcare Practices Gone Wrong.

• HIPAA Compliance: Patient privacy isn’t just good manners—it’s the law. Make sure your practice isn’t the reason someone’s embarrassing medical details are splashed across social media.
• OSHA Standards: The Occupational Safety and Health Administration has a few rules about keeping your workplace from resembling a scene out of Grey’s Anatomy (the dramatic parts, not the neat, sterile ORs).
• Medicare and Medicaid: Thinking about accepting patients on Medicare or Medicaid? Be prepared for paperwork that makes nursing school exams look like child’s play. You’ll need to master the art of billing and coding, or at least know when to call in reinforcements. You should also know about opting out of Medicare and/or Medicaid, as it's typically all or nothing with these CMS-based insurances.

4. Hire a Nurse Attorney (Yes, They Exist, and Yes, You Need One)

What’s better than having an attorney? Having a nurse attorney who actually understands why the words “scope of practice” make your palms sweaty. These magical beings (I am a little biased, in case you couldn’t tell) can help with everything from practice setup to dealing with potential board of nursing scuffles. And trust me, the last thing you want is to be caught off guard by regulations you didn’t even know existed.

Pro tip: Find an attorney who won’t look at you blankly when you talk about licensure and who knows that “RNs” aren’t just the people on ER reruns. If they haven’t done licensure defense before the board of nursing, find an attorney who has.

5. Find an Accountant (And Not Just Any Accountant)

If the thought of balancing your checkbook sends a chill down your spine, it’s time to get a good accountant. No, not your cousin who “took a tax class once.” You need someone who knows the ins and outs of healthcare practices.

• Manage Financials: They’ll help set up bookkeeping that makes sense, so you don’t end up with a pile of receipts that might as well be kindling for your winter fireplace.
• Tax Strategy: The right accountant will save you more on taxes than you’d save on bulk packs of nitrile gloves.
• Budgeting and Forecasting: They’ll help you figure out how much you’ll need to keep the lights on—and how long before you can afford that second coffee machine for the break room.

6. Build a Solid Business Plan (It’s More than Just a To-Do List)

You can’t just go into this saying, “I’m gonna be my own boss, yay!” and call it a day. You need a business plan that doesn’t just exist to make you feel official. It should include:

• Mission and Vision Statements: This is where you say what your practice is all about. Think beyond “make money, don’t lose license.”
• Market Analysis: Yes, you do need to research the local healthcare landscape. No, you can’t skip this step even if you were the queen (or king) of clinical shortcuts.
• Services Offered: Spell out what you’re doing. “Making sick people better” isn’t quite specific enough.
• Financial Plan: Don’t just hope money will show up. Plan for it. Include startup costs, revenue projections, and what you’ll do when insurance reimbursements take 87 years to process.

7. Make Friends (The Professional Kind)

You might be the lone ranger of your practice, but you don’t have to do it all alone. Networking isn’t just for extroverts and LinkedIn enthusiasts. Join professional nursing organizations and hobnob with other nurse-preneurs. You’d be surprised how many people are willing to share their wisdom (and mistakes) over a cup of decent coffee.

8. Think Long-Term (Not Just Next Week)

Plan for the growth of your practice even if you’re currently the only one in the office besides a potted plant named Phil.

• Tech Investments: Electronic Health Records (EHR) systems and telehealth aren’t just trendy—they’re necessary. Make sure you have a nurse attorney read your EHR contract, as the average cost to switch EHRs is about $15,000.
• Hiring Staff: Start thinking about how you’ll expand. No, you can’t clone yourself, but hiring help is the next best thing. Delegate what you (legally) can.
• Continuous Improvement: Keep learning and adapting. Patient feedback isn’t just a suggestion box item; it’s your secret weapon.

Final Thoughts

Starting your own nursing practice is like learning to insert an IV on a moving patient during a blackout—it’s not easy, but with preparation, skill, and maybe a dash of caffeine, you’ll nail it. Just remember: it’s a journey filled with regulations, paperwork, and a few moments that will have you questioning your life choices. But the payoff? That’s all (mostly) yours.

Nick Webb, RN, DNP, ESQ is a licensed attorney and doctorally-prepared registered nurse. He is partner at Balestra Webb Law in California, where he focuses on entity and business formation for nurses, NPs, PAs, physicians, and other clinicians, as well as licensure defense, medical malpractice, and civil litigation.