How to Open a Nurse-Owned Practice in Washington

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. The Pacific Northwest is where most of the Five Square network practices, and Washington is the biggest piece of it, from the Puget Sound corridor out to Spokane. If you're starting here, you'll have neighbors who've already done it. (Already run your own practice? Skip ahead, there's a section below built specifically for you.)

The thing that stops most nurses in Washington 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 Washington nurse asks first.

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

Yes, with the right setup. Washington enforces the corporate practice of medicine through case law: someone without a health care license can't own a business that employs clinicians to treat the public (Columbia Physical Therapy v. Benton Franklin Orthopedic Assocs., 168 Wn.2d 421 (2010)). The entity is a professional service corporation or PLLC, and Washington is unusually friendly here: nurses and physicians may co-own one professional entity (RCW 18.100.050(5)(a); RCW 25.15.046(2)). Co-owning with a physician doesn't widen your scope.

The Washington rule that catches almost everybody

Washington ties the physician's physical presence to the FDA label on the product in your syringe. When a physician delegates a cosmetic procedure using a product the FDA hasn't approved for the purpose you're using it for, the physician must be on site for the entire procedure (WAC 246-919-606(12)). On-label, the physician can be off site if they're reachable by phone and able to respond within thirty minutes (WAC 246-919-606(13)). A lot of everyday aesthetics is off-label use of an approved product, so a physician-directed practice can end up with a physician in the building far more than the nurse planned. Somebody has to map every product you inject against its FDA indication before you build a schedule, which, yes, is as tedious as it sounds. IV therapy, by contrast, is expressly carved out of this rule (WAC 246-919-606(2)(e)), though the Department of Health still treats an IV bag as a medication that needs an order.

Your medical director's credential decides whether any of that applies to you. The on-site rule, the thirty-minute rule, and the cap of three physician assistants per physician all sit in the Medical Commission's rule for physicians. There is no parallel WAC putting those duties on an ARNP. The Board of Nursing has said in writing that Washington has no medical director license and nothing prohibits an ARNP from serving as one at a medical spa (WABON Advisory Opinion, Business Practices for the ARNP, adopted January 10, 2025). ARNPs have full practice authority under RCW 18.79.250, and an RN may practice under the general direction of an ARNP (RCW 18.79.260).

Washington doesn't use the term good faith exam. Before authorizing a cosmetic procedure the physician takes a history, examines, diagnoses, and documents (WAC 246-919-606(5)). The initial patient evaluation, which some states call a good faith exam, can't be handed to an RN, because an RN or LPN can't diagnose or determine medical treatment (WABON Advisory Opinion on Cosmetic, Aesthetic, and Dermatologic Procedures, effective September 12, 2025). The rule is silent on telehealth for that visit, so ask before you plan around it.

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 Washington 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

"As a nurse, taking risks is not in our vocabulary. Five Square made me excited about starting my own business. Timely responses, professional, highly knowledgeable, and a team that wants to see me succeed. I say my risk was absolutely worth it."
- Patricia G., 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 Washington? 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 Washington, you can join whether you're just starting out or already running a practice.

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 Washington, 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.

Washington-specific costs to budget for

Filing a Certificate of Formation with the Secretary of State is $180, and the annual report is $70 (it jumps to $95 with the delinquency fee if you miss it). Washington doesn't license medical directors and doesn't require a facility license for a nurse starting a practice, so there's no state fee on that side. If you sell product to patients, retail sales tax is 6.5% at the state level plus a local rate that varies by city or county, and you collect the combined rate for wherever the patient takes the product home.

So, where do you actually start in Washington?

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 Washington 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 Washington

Does my medical director have to be in the room in Washington?

Only if your director is a physician and the product is being used off-label. WAC 246-919-606(12) puts the physician on site for the entire procedure when the FDA hasn't approved the product for that use; on-label, they can be off site and reachable within thirty minutes (subsection 13). Those duties sit in the Medical Commission's physician rule. There's no parallel rule for an ARNP medical director, and the Board of Nursing has said nothing prohibits an ARNP from serving in that role.

Can I co-own my PLLC with a physician in Washington?

The statute says yes. RCW 18.100.050(5)(a) lets licensed health care professionals across a listed set of chapters, including nursing and medicine, own stock in one professional service corporation, and RCW 25.15.046(2) applies those provisions to PLLCs. Your scope of practice doesn't change because a physician is on the cap table. What's still open is whether a plain, non-professional LLC works for this mix of services; the Department of Health won't answer that and points people to counsel.

Does the off-label on-site rule apply to IV therapy in Washington?

No. WAC 246-919-606(2)(e) says the cosmetic delegation rule does not apply to intravenous therapy, so the on-site and thirty-minute provisions don't reach your IV hydration and vitamin injection work. You still need a medication order before starting an IV, because the Department of Health treats the bag itself as a medication, and the standing rules on RN scope and general direction still apply.

Can a registered nurse own a med spa in Washington? Yes, with the right setup. Washington enforces the corporate practice of medicine through case law: someone without a health care license can't own a business that employs clinicians to treat the public ( Columbia Physical Therapy v.

Do I need a medical director for aesthetics in Washington? Yes. Washington 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 Washington? Yes, within a compliant setup and with the oversight Washington 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 Washington. 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 Washington? Yes. Five Square already supports nurses in Washington, so a discovery call is about your timeline and your goals, not whether we're there yet.

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.