How to Start Your Own Nursing Practice in 2026
Seven steps, one checklist. What it actually takes to open your own practice this year.
Step 1: Decide What Kind of Practice You Want to Build
Independent nursing practice isn't one-size-fits-all. The first decision is choosing which clinical area fits your interests, your strengths, and the kind of patients you want to serve. Five Square offers three membership tracks, and each one gives you a different practice model.
Aesthetics is the most established path. You'll offer tox, dermal fillers, and advanced cosmetic treatments. Your patients are cash-pay, your margins are strong, and the demand is consistent. If you're drawn to visible results and the energy of a patient who walks out feeling like a new version of themselves, this is your lane.
Wellness is built around preventive care and whole-body health. Think IV therapy, vitamin injections, and NAD+. Your patients are proactive about how they feel and willing to invest in it. If the cosmetic side doesn't excite you but helping someone get their energy back does, this track is for you.
Functional Health sits at the intersection of clinical care and health optimization. Peptides, GLP-1 medications, lab panels, and protocol-driven treatment plans. This is a self-pay track, so there's no insurance billing to manage. If you follow the research and want to offer care that most primary care providers aren't delivering, this is where you belong.
You don't have to pick just one. Many Five Square nurses combine tracks to build a broader service offering and multiple revenue streams.
For a full breakdown of each track, read: [Aesthetics vs. Wellness vs. Functional Health: Which Path Is Right for You?](/aesthetics-vs-wellness-vs-functional-health)
Step 2: Get Your Training and Certification
You don't need to go back to school. You don't need a weekend boot camp that costs $10,000 and leaves you with a certificate but no real confidence.
Five Square's training library is comprehensive, self-paced, and available 24/7. It covers clinical techniques, patient consultations, treatment protocols, and the business fundamentals you need to actually run a practice. Most nurses complete their core certifications within 30 days.
The training is built for working nurses. You can do it around your current schedule, at your own pace, on your own time. Tuesday office hours give you a live space to ask questions every week. Friday Ask the Expert sessions let you bring real clinical scenarios to experienced practitioners. And the Five Square Nurse Community is full of nurses at every stage who will answer the question you're too embarrassed to ask out loud.
You already have clinical skills. The training fills in the gaps, not the foundation.
Step 3: Set Up Your Medical Director
Every independent nursing practice needs a medical director. This is the licensed provider who reviews your protocols, co-signs your clinical decisions, and provides the collaborative oversight required for you to practice independently. Medical directors can be physicians, nurse practitioners, or doctors of nursing practice.
If you've never worked with a medical director before, here's what it actually looks like: they review and approve your treatment protocols before you see patients. They're available for clinical questions when you need guidance. They provide the legal and clinical framework that allows you to deliver care under your own practice.
Finding a medical director on your own is one of the biggest barriers to going independent. It's expensive (typically $500 to $1,500 per month on your own), time-consuming, and most nurses have no idea where to start.
Five Square handles this. Your membership includes a medical director. No separate contract to negotiate. No extra monthly fee. It's built into the infrastructure so you can focus on patients, not paperwork.
Step 4: Handle the Business Basics
This is where most nurses stall. Not because it's hard, but because it feels unfamiliar. Setting up an LLC, getting malpractice insurance, understanding state compliance requirements. None of it is complicated. But when you've never done it before, it looks like a wall.
Five Square walks you through each step. You'll get clear guidance on:
- LLC formation: Which entity type to choose, how to file, and what it costs in your state
- Malpractice insurance: What coverage you need and how to get it in place before you see your first patient
- State compliance: Licensing requirements, scope of practice considerations, and collaborative practice agreements
You don't need a lawyer to figure out your business structure. You don't need an accountant before you have revenue. You need a checklist and someone who's walked hundreds of nurses through this exact process. That's what Five Square provides.
Step 5: Set Up Your Vendor Accounts and EMR
Your cost of goods matters from day one. Buying supplies at retail pricing kills your margins before you even start. Five Square's preferred vendor relationships give you access to pricing that keeps your margins strong and your startup costs low.
Aesthetics track: Preferred pricing through Epicutis, Rejuvapen, and the Five Square Product Store. Your EMR is Aesthetic Record, which handles scheduling, charting, and payments in one platform.
Wellness track: Preferred pricing through Olympia Pharmacy, ShineRx, and the Five Square Product Store. Your EMR is Aesthetic Record.
Functional health track: Preferred pricing through Version2, ShineRx, and the Five Square Product Store. Your EMR is Aesthetic Record.
This isn't a minor perk. The difference between retail and preferred pricing on supplies is the difference between a practice that barely breaks even and one that's profitable from month two. Five Square sets up your accounts as part of onboarding so you're not chasing vendor reps and negotiating contracts on your own.
Step 6: Start Seeing Patients
Here's where it gets real. And here's the part that matters most: you don't have to quit your job to do this.
Most Five Square nurses start part-time. They keep their hospital or clinic position and see patients on their days off, evenings, or weekends. You test the model, build confidence, and generate revenue before making any major life changes.
The revenue math is straightforward:
Aesthetics: A single tox appointment brings in $200 to $600. Two to four patients per month covers your membership cost. A part-time aesthetics practice seeing 8 to 12 patients per month can generate $3,000 to $5,000 in monthly revenue.
Wellness: IV therapy sessions typically run $150 to $300 per patient. A handful of weekly appointments builds to $2,000 to $4,000 per month quickly, especially as patients book recurring sessions.
Functional health: Peptide therapy and GLP-1 management patients are high-value and recurring. Monthly patient revenue ranges from $200 to $500 per patient. A panel of 15 to 25 patients generates $3,000 to $7,500 per month.
Most Five Square nurses recoup their startup investment within 90 days. That's not a marketing claim. That's the math.
Your first patients will come from your existing network more often than not. Friends, family, coworkers, neighbors. Five Square gives you strategies for building a local patient base through community outreach, social media, and word of mouth without feeling like you're selling to your friends.
Step 7: Grow at Your Own Pace
There's no timeline you have to follow. Some nurses go full-time within six months. Others keep their day job for a year or more while they build. Both paths work.
Here's what growth looks like in practice:
- Add services. Once you're confident in your core offerings, you can expand. Aesthetics nurses add advanced treatments. Wellness nurses add new IV protocols. Functional health nurses add lab panels and new peptide protocols. Your training library grows with you.
- Add patients. As your reputation builds and your patient base grows through referrals and repeat visits, your revenue compounds. The nurses who succeed aren't the ones who start with 50 patients. They're the ones who take great care of their first 10.
- Add tracks. If you started with aesthetics and want to add wellness or functional health, you can combine memberships at a reduced rate. Your infrastructure scales with you.
- Go full-time when the numbers make sense. The milestone most Five Square nurses target: $2,000 to $5,000 per month in consistent revenue and 10 or more repeat patients. When you hit that, the conversation about leaving your day job changes from "what if" to "when."
You're building equity in a practice you own. Every patient you see, every relationship you build, every system you put in place compounds over time. That doesn't happen when you're working for someone else.
You're Ready. Even If You Don't Feel Ready.
Every nurse who's built a successful independent practice through Five Square felt the same thing you're feeling right now. The doubt. The "who am I to do this?" The gap between knowing you're capable and actually believing it.
That feeling doesn't go away because you read one more article or take one more course. It goes away when you take the first step and realize the support is real, the path is clear, and you're not doing this alone.
You have the clinical skills. Five Square gives you the infrastructure, the oversight, and the community to turn them into a practice you own.