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So you’re ready to take the plunge and be your own boss. Having your own medspa can be an extremely fulfilling step for your nursing career.
But before you dive in, there's a crucial first step: Figuring out where you can legally operate independently. Different states have different rules for how nurse practitioners can own or run their own practice. So the real question is, “In what states can a nurse practitioner open their own practice?”
We want you to build the business empire that you dream of. We want you to discover the freedom of independence — so let’s get straight to it.
Disclaimer:
The information provided in this article is for general informational purposes only and does not constitute legal advice. It is recommended to consult with your respective state boards, a licensed attorney, or your malpractice carrier to ensure that you are practicing within the letter of the law and adhering to all regulatory requirements. The regulations regarding aesthetic treatments and medical spas can vary from state to state and may change over time.
Understanding practice authority
Before you begin, you need to understand your practice authority as a nurse practitioner (NP). This boils down to the legal nitty-gritty of what you can and can't do when it comes to running your own show.
Here are the three main types:
1. Full practice
In full practice states, you, the qualified NP, can call the shots. You can evaluate patients, diagnose conditions, interpret test results, and develop treatment plans — all on your own.
This is what allows you to open your medspa and practice independently, without physician oversight.
2. Reduced practice
In a “reduced practice” model, you will still be a highly skilled NP, but there might be some limitations on what you can do independently when it comes to medspa treatments.
These states need you to have a collaborative agreement with a physician to provide patient care. This means you'll likely need to partner with an MD who can oversee certain aspects of your practice, depending on your state's specific regulations.
Don’t worry; you can shine even in a reduced practice state. Focus on building strong relationships with potential physician collaborators. Highlight your expertise in aesthetics and patient care and how your collaboration can create a win-win situation for both of you.
3. Restricted practice
A few states have this model where you have the most limitations on your independence as a medspa owner.
You will need to work under the direct supervision, delegation, or team management of another healthcare professional, typically a physician. This means your practice will likely look a lot different than one in a full-practice state.
Restricted practice states can still be a great place to launch your medspa career. Gain experience working under a physician while building your reputation and patient base.
As you establish yourself, you can explore opportunities to move to a state with a more favorable practice authority model.
In what states can a nurse practitioner open their own practice?
This is a list of the states where you, as a nurse practitioner, can run your own medspa:
Arizona
NPs must be certified by the Board of Nursing as a Registered Nurse Practitioner (RNP) and have prescribing and dispensing authority, which includes meeting certain hours requirements.
Medical spas in Arizona can provide non-surgical cosmetic procedures within the scope of practice of licensed RNs or APRNs with prescriptive authority. NPs do have full practice authority, meaning they can evaluate patients, diagnose conditions, interpret test results, and develop treatment plans independently without physician oversight.
Colorado
NPs in Colorado have full practice authority, allowing them to provide nonsurgical cosmetic procedures without restriction to the licensed scope of physicians or PAs. They can evaluate patients, diagnose conditions, interpret diagnostic tests, initiate and manage treatments, prescribe medications, and operate their own independent practices.
Medical spas in Colorado can offer a wide range of non-surgical cosmetic procedures under the supervision of licensed APRNs with prescriptive authority.
Connecticut
NPs with three years of practice experience and 2,000 hours can operate without supervision. Until these thresholds are met, they require a collaborative agreement with a physician.
NPs, PAs, and RNs can inject without a medical director on-site, though RNs require an NP or PA on-site for supervision.
Oregon
NPs have full practice authority and can operate independently. RNs must have H&P, assessment, and treatment done by an MD or NP, and many treatments require on-site supervision for RNs. The Board of Medicine recommends MD supervision for RNs
Minnesota
NPs have full practice authority and can operate independently.
States with reduced practice authority
This is a list of the states in which you need to agree to collaborate to provide patient care. This agreement typically involves some level of physician oversight or limitations on the NP's ability to practice independently.
California
NPs don’t have full practice authority. Medical spas in California are limited to providing non-surgical cosmetic procedures within the scope of practice of licensed physicians, RNs, PAs, and NPs under the supervision of a licensed physician.
NPs need to work as a 103 NP in good standing for at least 3 years and complete a 104 NP application for independent practice, which medical aesthetics is not a part of.
Michigan
NPs must have a written agreement with a supervising physician filed with the state. Medspas in Michigan are limited to providing non-surgical cosmetic procedures within the scope of practice of licensed physicians, PAs, or APRNs with prescriptive authority.
Additionally, an MSO (Management Services Organization) is required for NPs to operate. This ensures that all practitioners meet the necessary regulatory and oversight requirements.
North Carolina
NPs must have a collaborative practice agreement with a supervising physician. This agreement must be in writing and reviewed annually. Monthly meetings are required with the supervising physician, and after the first six months, the meetings should be held annually.
These meetings must include documentation of clinical issues discussed and quality improvement notes, which both the NP and supervising physician must sign.
Texas
NPs need a prescriptive authority agreement with a supervising physician. This agreement must be filed at the medspa and be readily available.
Detailed steps for completing the prescriptive delegation application include registering your supervising physician through the system before your medical director completes the full delegation registration. Monthly meetings are required to review the scope of practice, and chart reviews may be necessary.
States with restricted practice authority
This is a list of states where nurse practitioners are often limited in their ability to practice independently and must follow specific protocols and supervisory guidelines.
Ohio
NPs need a collaborating physician for practice and must have a standard care arrangement. They must notify the Board of Nursing of their collaborating physician within 30 days of starting practice.
Medical spas can provide non-surgical cosmetic procedures within the scope of practice of licensed physicians, PAs, or RNs.
Pennsylvania
NPs must have a collaborative practice agreement. They require supervision and regular reviews by a collaborating physician.
Florida
NPs need a supervising physician within a specified distance. The MD must be within 25 miles from the MD's primary practice location or in a county contiguous to the county of the MD's primary practice, and the distance cannot exceed 75 miles. Additionally, the MD can only have two practices, and both must be filed with the Board of Medicine.
Tennessee
NPs must have a written protocol with a supervising physician and regular site visits. An MSO is required for NPs, PAs, and RNs. Regular site visits by a supervising physician are not mandated, although a written protocol is required.
Things to keep in mind when opening a medspa as a nurse practitioner
1. Verify licenses and certifications
Now you've identified your ideal state for independent medspa ownership. Fantastic.
It’s time to tackle some essential groundwork. First on the list is verifying your licenses and certifications.
Here's what you need to ensure you're squeaky clean (from a legal standpoint):
- Active nurse practitioner license: This is your main license. Make sure your NP license is current and in good standing with your state's Board of Nursing.
- Prescriptive authority: Think of this as your "medical clearance" to prescribe medications in your medspa. Double-check that your prescribing authority is active and aligns with the services you plan to offer.
- Medspa-specific certifications (optional, but beneficial): Additional certifications in areas like aesthetics or laser treatments can enhance your credibility and potentially expand your service menu. Consider these as advanced courses that boost your expertise.
Try to start the verification process early to avoid any delays in opening your medspa doors.
2. Develop a business plan
By securing your licenses and certifications, a major hurdle is cleared. Now begin to map out your rock-solid business plan.
Here's what your business plan should cover:
- Executive summary: This is your elevator pitch for investors or partners. Briefly outline your medspa concept, target market, and competitive advantage.
- Market analysis: Who are your ideal clients? Research your target demographic, including age, income, and desired procedures. Analyze the competition in your area to identify your unique selling proposition.
- Services offered: Chart a course for your medspa's service menu. Will you focus on injectables, laser treatments, or a combination of them? Consider the needs of your target market and align your offerings accordingly.
- Financial projections: Crunch the numbers. Forecast your startup costs, ongoing expenses, and projected revenue. This will help you secure funding and ensure your medspa stays afloat.
- Marketing strategy: How will you attract patients and spread the word about your amazing medspa? Explore digital marketing options, social media strategies, and potential partnerships.
- Management team: Who's beside you? Outline the expertise and experience you and your team members bring to the table.
Developing a business plan can feel overwhelming. Don't go it alone — there are plenty of online resources and templates specifically designed for medspa startups.
Remember, Moxie is here to help you navigate the business planning process. Reach out to our team of experts for guidance and support.
3. Obtain insurance coverage
You've got the licenses, the plan, and the dream team. There’s one thing you need to safeguard all of this: insurance. Think of it as a safety net, deflecting unexpected blows and keeping your business safe.
A professional liability insurance policy (a.k.a. medical malpractice) is your shield against lawsuits. If a client ever throws shade your way for a treatment gone awry, this insurance steps in, covering any financial fallout. It's a non-negotiable for ultimate peace of mind.
Ever heard of a rogue injection needle or a mystery spill on a brand-new laser machine? General liability insurance is your BFF in these situations. It covers the costs of accidents, injuries, or even damage to your equipment.
Life throws curveballs sometimes. Business interruption insurance is your backup plan, providing financial support if you have to temporarily close your doors. Since you have a team of people helping you run your medspa, workers' compensation insurance is a must-have. It covers medical bills and lost wages if any of your crew gets hurt on the job.
We recommend that you don't settle for the bare minimum. Seek out an insurance agent who gets the medspa world. They can create a customized coverage plan that protects you from head to toe, allowing you to focus on what you do best — making your clients feel like a million bucks.
4. Choose the right location
Your medspas location is of prime importance and will determine how well you do as a business. Let’s talk about what to consider when scouting the perfect location for your medspa.
Think of your target market. Who are your ideal clients? Are they busy professionals seeking convenient lunchtime appointments, or do they prefer a more luxurious spa experience? Understanding this will help you choose a location that's easily accessible to the right audience.
Imagine a steady stream of clients effortlessly finding your medspa. Prioritize locations with easy access, ample parking, and good signage. Don't underestimate the power of high foot traffic or being situated near complementary businesses.
Think functionality meets chic. Choose a space that allows for efficient use of square footage, with dedicated areas for consultations, treatment — sleek and modern, or warm and inviting?
You do not want to get caught in a bureaucratic storm. Ensure the location meets all zoning regulations and building codes for operating a medspa. It's always best to consult with an architect or contractor familiar with healthcare facilities.
Location hunting can be a time-consuming adventure. Consider partnering with a commercial real estate agent who specializes in the healthcare industry. Their expertise can save you valuable time and ensure you find a spot that perfectly fits your needs.
5. Focus on marketing and branding
A strong brand identity and a strategic marketing approach are key to attracting your dream clientele and building a thriving medspa business. Try to work on creating a brand that will have clients clamoring at your doors.
To begin with, know your "Why" and "Who." What makes your medspa unique? What sets you apart from the competition? Clearly define your brand identity and core values. Who is your ideal client? Understanding their desires and motivations helps you develop messaging that resonates.
People connect with stories. Develop a unique narrative that captures the essence of your medspa. Highlight the experience you offer, the transformations you create, and the confidence you empower.
Of course, visuals are powerful. Create a brand identity with a logo, color scheme, and fonts that reflect your personality and values. Ensure consistency across your website, social media, and marketing materials.
The digital world is your oyster. Develop a user-friendly website that showcases your services, staff expertise, and client testimonials. Use social media platforms like Instagram to connect with potential clients, share photos, and showcase your medspa's culture.
Do consider the strategic use of social media advertising or pay-per-click campaigns to target your ideal demographic and drive traffic to your website. Remember to collaborate and network with local businesses, influencers, or complementary healthcare providers. Explore co-marketing opportunities to expand your reach and attract new clients.
Note on advertising laws: Unless you have a LegitScript certification, you aren’t allowed to conduct any explicit advertising of Botox, Dysport, Xeomin, Daxxify, Jeuveau, or other injectables like these using their brand names. These are prescription-only medicines (POM) and cannot be promoted on social media or websites by anyone except licensed pharmacies or resale companies. Also, avoid using before-and-after photos, any photos with blood or of a graphic nature, and photos of needles that are blocked on social media platforms like Instagram and Facebook.
6. Streamline financial management
Strong financial management is the backbone of any successful business. If you have the right insights into your medspa's financial health, you will be able to make data-driven decisions with long-term profitability in mind.
Choose the right accounting system. Ditch the spreadsheets and embrace user-friendly accounting software designed for medical practices. This will make tracking income, expenses, and payroll a breeze.
Streamline your workflow by automating recurring tasks like invoicing, bill payments, and payroll processing. This saves you precious time and minimizes the risk of errors.
Every receipt, invoice, and bank statement tells a story. Maintain meticulous records for all financial transactions. This not only simplifies tax filing but also allows you to analyze your spending and identify areas for cost optimization.
Don't be afraid to geek out on numbers. Create a realistic budget that outlines your projected income and expenses. This will help you make informed decisions about staffing, inventory, and equipment purchases.
Key Performance Indicators (KPIs) work like your financial compass. Track metrics like revenue per client, treatment conversion rates, and profit margins. Regularly analyzing these KPIs will reveal areas for improvement and ensure your medspa remains financially healthy.
Consider seeking guidance from a financial advisor experienced in the healthcare industry. They can help you develop a customized financial plan and navigate complex financial decisions.
Ready to launch, run, and grow your own medspa? Try Moxie
We hope this guide answers your question about in what states a nurse practitioner can open their own practice.
Our goal is to help you launch your business with confidence, clarity, and the full assurance that you have everything you need to succeed.
That’s where Moxie comes in. We help you grow your business and attract loyal clients. Moxie empowers med spa owners across the country to launch faster, bring in more profit, and achieve real success.
We take the burden off your shoulders so you can focus on what you do best — providing exceptional care to your clients.
Here's how Moxie can help your med spa thrive:
- Find a medical director without hassle: Moxie can pair you with the right qualified med spa medical director for your practice through our extensive network of professionals.
- Simplify compliance: Moxie provides pre-made consent forms and protocols crafted by industry-leading lawyers and MDs to reduce your legal consultant fees.
- Marketing done for you: Moxie manages everything from website creation (under your brand) to targeted advertising that drives new clients through your doors.
- Hands-on, expert coaching: Our dedicated coaches meet with you regularly to support your growth, give you hands-on help, and guide you through the process of growing your med spa.
- Software that’s built for med spas: From online appointment scheduling to charting to text message marketing and memberships — we’ve got you covered. With Moxie, it’s easier than ever to run your business and wow your clients.
