How to Open a Nurse-Owned Practice in North Dakota

You've done the math in your head more than once. A few injectable appointments on your day off, on your own schedule, in your own space, and suddenly the shifts you pick up out of obligation start to look optional. North Dakota is a smaller market, and that's the opportunity. The nurses who plant a flag early tend to become the name in their town before anyone else shows up. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in North Dakota was never the clinical work. You already do harder things on a Tuesday than a first tox or IV appointment will ever ask of you. What stops people is everything around it, the ownership rules, the medical director, the setup, all sitting there as one giant undefined to-do. So let's take it in order, starting with the question every North Dakota nurse asks first.

Can a nurse own an aesthetics, wellness, or functional health practice in North Dakota?

Yes. A standard LLC is the common and defensible default here, and a nurse can own it. (N.D.C.C. ch. 10-32.1.)

There's a genuine wrinkle in the entity question that most write-ups skip. North Dakota reserves professional entities for services that require an undergraduate or advanced college degree in the specific field as a condition of licensure. Whether registered nursing meets that definition is arguable both ways: an associate degree is an undergraduate college degree, and North Dakota also licenses registered nurses through non-degree diploma pathways. The standard LLC is the defensible answer, not the only conceivable one.

North Dakota won't let a for-profit company employ a physician

This one statute drives the whole architecture, and it surprises people who've set up in other states.

Under N.D.C.C. 43-17-42, only a hospital licensed under chapter 23-16, a nonprofit entity, or a charitable trust may employ a physician, directly or indirectly. A for-profit, member-owned LLC isn't on that list. So if your medical director is an MD or DO, they have to be engaged as an independent contractor rather than an employee.

If your medical director is an APRN, section 43-17-42 doesn't apply, and you can engage them as either an employee or a contractor. North Dakota grants APRNs full practice authority, so they practice and prescribe independently with no physician collaboration or supervision required.

The doctrine is clear on physician employment and less tested on lay ownership of a delegated-medical-services business, which is worth knowing rather than assuming.

No on-site rule, and no cosmetic-procedure regime

North Dakota states this flatly: there's no codified cosmetic-procedure delegation rule, and no rule requiring the medical director to be on site or within a set response time for delegated aesthetic procedures. That's true under both credentials. Any availability expectation you build into your agreement is practice best practice, not codified law, and it's worth writing down for that reason.

The evaluation rule, and the photo trap

North Dakota doesn't use the term good faith exam, but the requirement is the same in substance: a documented provider evaluation and order. It can be conducted by telehealth. It cannot be satisfied by photographs of the patient, which the Board says specifically.

And the part that catches busy practices: any change to the treatment plan or order, including the type of treatment, the treatment location, the product, or the dosage, requires a new documented assessment before the change is implemented. Switching a patient from one neurotoxin to another isn't a small chart note here.

An RN may perform injectables with documented, comprehensive, accredited training and demonstrated competency, executing the prescriber's order. An RN may not select or clear the patient as a candidate, because candidacy is the prescriber's assessment, and may not accept delegation of prescribing authority from anyone.

How Five Square actually gets you started

The whole thing lives in one place: the free Five Square Nurses app. Your medical oversight, the step-by-step training, your pharmacy and vendor accounts, and the entire community of nurse business owners are all in there. You can open it between patients, on a lunch break, or on the couch at 9pm, and pick up right where you left off.

When you join, you're not handed a login and wished good luck. There's a Getting Started path that puts the order of operations right in front of you, so the mountain becomes a checklist.

You pick your lane, or combine them. Five Square supports three:

• Aesthetics. Tox and dermal filler, the core of a nurse-injector practice, with room to add more as you train.
• Wellness. IV therapy and vitamin injections. Low startup, very mobile-friendly, and a natural add-on to aesthetics.
• Functional Health. Peptides, lab work, and whole-person care for nurses who want longer-term, relationship-based patients.

You bring the nursing license and the nerve. We bring the medical director, the compliant North Dakota setup, the training, member pricing on products, marketing help, and weekly live calls with experts and other nurse owners, so you're never stuck guessing alone.

And every Five Square member, brand new or already established, gets instant on-demand Good Faith Exams for $19.99 each, a price we subsidize because we believe in nurse success. A walk-in can be cleared in about a minute, seven days a week, and the exam paperwork lands right in the patient's chart, which is exactly what a state board wants to see.

You start before you feel ready, and that's the point

Most programs make you wait. Watch every module, sit through every call, and someday you finally see a patient. By then half the people who started have lost momentum. Five Square runs the other way: you start your practice while you're still finishing the training, because the training sticks when there's a real patient on next week's calendar.

Kayla, an ER nurse in North Carolina, had never injected anyone when she joined. She watched the videos, took notes, and set a goal of 30 people in 30 days. Here's the advice she'd give a nurse who's scared to start:

"Believe in yourself, even when you don't know how to do something. Figure it out. The clinical knowledge from your nursing career is more than enough to get started, and there's a community of people around you who want to help. Do it scared."
- Kayla, ER nurse

She launched April 4. Her first month: 46 appointments, 28 good-faith exams, and $10,320 in revenue, run out of a single room inside a salon she'd been a client at for years. That's one real month from one real nurse, not a typical result and not a promise, and your market and hours are your own. The point is she was exactly where you are, never-done-this-before, and she started anyway.

Does it actually work once you launch?

Getting launched is step one. What you really want to know is whether it works after that. Here's the honest picture, numbers included, because income claims in this industry deserve a skeptical read.

Results vary, and they depend on things no membership controls: your market, your hours, how long you've been at it, how consistently you market. As practices mature, some established members report months in the $10,000 to $20,000 range. Individual results vary widely. Some land higher, some lower, and nobody here will promise you a number.

What's more useful is the math underneath, which is public. Neurotoxin appointments bring in $200 to $600. A syringe of filler runs $500 to $800. IV sessions run $150 to $350. Functional health consults run $150 to $300, often with patients coming back monthly. At those prices, two to four appointments a month would cover the $899 membership before product costs, and everything past that is the business growing. Want to see it with your own pricing? Run your numbers in the Five Square membership earnings calculator.

The nurses say it better than a revenue range does:

"Five Square is the reason I was able to launch my career as an aesthetic nurse injector. From setting up my LLC and making sure I'm compliant in my state, to a dedicated medical director, weekly live calls with experts, and a huge network of nurse entrepreneurs, it was the best decision I made."
- Krystle N., 5-star Google review

"I started with Five Square last spring and they've helped me every step of the way. Trainings, weekly meetings, check-ins. An abundance of resources to actually make you successful."
- Kendra P., 5-star Google review

Inside the community, the wins show up in real time. A nurse a few weeks into her launch posted she was already up to eight bookings, nearly all of it from one post in a local mom's Facebook group. Another saw a husband and wife for their good-faith exams in under ten minutes using the same-day exam tool when her director wasn't free. Scroll the forum any week and it's full of small wins like these.

The Google rating sits at 4.8 stars, and the reviews keep naming the same things: the setup help, the medical director, the training, and a team that answers when you're stuck.

Already run a practice in North Dakota? There's a membership for that too

Not every nurse reading this is starting from scratch. Plenty of you already run your own practice and already pay for a medical director somewhere. If that's you, a lot of what's above is stuff you sorted out a while ago, and Five Square has a leaner membership built for exactly your spot. In North Dakota, it's actually how we're opening first.

It's called the Established Nurse Membership. It's $799 a month, month to month, no annual lock. You get a medical director who's actually engaged, a compliant structure in North Dakota, vendor and product pricing, the Five Square Nurse Community, and those instant on-demand Good Faith Exams at $19.99 each, a price we subsidize for our members because we believe in nurse success. There's no new-injector training folded in, because you don't need it and shouldn't pay for it. If you ever want the full education stack later, you can add it.

Here's the honest pitch. Most established practices are either paying $1,500 to $5,000 a month for a director who's genuinely involved, or a few hundred for one who signs protocols and disappears, which is its own risk when a board comes asking. For most nurses, $799 all in beats both, on price and on what you actually get. Tell us what you're paying now and we'll show you the side by side. No pitch, just the math.

What it costs, and the catch nurses look for

For a nurse starting out, membership is a flat $899 a month for one tier, $1,199 for two, $1,499 for all three, on a 12-month term. Startup beyond that is lighter than people expect: a starter tox order, insurance that runs well under most nurses' guesses, and the products you actually use. No revenue share, ever. (Already have a practice? The Established Nurse Membership above is $799 a month, month to month.)

That's usually the moment the skeptical part of your brain asks where the catch is. Fair. So, plainly: you own your practice and your patients through your own LLC. Five Square does not take a cut of what you make, and if a discovery call turns up that the honest answer for you is 'not yet' or 'start smaller,' the team will tell you that too.

North Dakota-specific costs to budget for

Workers' compensation is a state monopoly here. Workforce Safety and Insurance is the sole provider and private workers' compensation insurance isn't permitted in North Dakota, so there's nothing to shop. The WSI Certificate of Payment is also one of your required postings. On the lighter side, North Dakota doesn't impose a formal manifest or recordkeeping requirement on infectious-waste generators, though glass sharps containers are prohibited.

So, where do you actually start in North Dakota?

You book the call. That's genuinely it. Not a six-month research project, a 15-minute conversation about your license, your goals, and what launching (or leveling up) in North Dakota would look like for you. Whether you're brand new or already running a practice, the whole reason Five Square exists is so you're not doing the hard parts alone.

Schedule a discovery call

Common questions about starting a practice in North Dakota

Can my LLC employ my medical director in North Dakota?

Not if they're a physician. Only a licensed hospital, a nonprofit, or a charitable trust may employ a physician in North Dakota, directly or indirectly, so an MD or DO medical director has to be engaged as an independent contractor. An APRN medical director can be either an employee or a contractor.

Does a photo of the patient count as the evaluation in North Dakota?

No. The Board says specifically that photographs don't satisfy the required provider evaluation. Telehealth does. And any change to the treatment type, location, product, or dosage requires a new documented assessment first.

Can a registered nurse own a med spa in North Dakota? Yes, with the right structure. North Dakota lets a nurse own your practice, it just has to be set up a specific way. Five Square provides that setup so you own and run the practice within it.

Do I need a medical director for aesthetics in North Dakota? Yes. North Dakota requires oversight for medical aesthetic services, and every Five Square practice includes a medical director as part of the membership.

Can a nurse do Botox in North Dakota? Yes, within a compliant setup and with the oversight North Dakota requires. The question is rarely whether a nurse can do the work; it's whether the practice around it is set up right.

I already run a practice in North Dakota. Can Five Square still help? Yes. The Established Nurse Membership is built for nurses who already have a practice: $799 a month, month to month, with a medical director, a compliant structure, vendor pricing, and $19.99 on-demand Good Faith Exams. No new-injector training you don't need, and no annual lock.

How much are Good Faith Exams? For Five Square members, simple Good Faith Exams are $19.99 each, on demand, seven days a week, a price we subsidize because we believe in nurse success. One exam can clear a patient for several treatments at once, and the documentation attaches right to the patient's chart.

Is Five Square available in North Dakota yet? Five Square is expanding into North Dakota, and in many new states the Established Nurse Membership opens first. The fastest way to get the timeline and hold your spot is a discovery call.

How much does it cost to start? For a new nurse, membership is $899 a month for one tier, and startup beyond that (a tox order, insurance, products) is lighter than most nurses expect. If you already run a practice, the Established Nurse Membership is $799 a month, month to month. No revenue share either way.