Full Practice Authority for Advanced Practice Registered Nurses
By State Senator Josè R. Rodríguez and State Representative Cecil Bell, Jr.

Austin, TX – Texas has a health care delivery crisis where poor usage of limited resources compounds the complex health needs of a rapidly growing population. At the same time our uninsured and underinsured populations are expanding, our Medicaid budget is on the brink of financial disaster. The answer cannot find its solace in more money, but instead requires restructuring the medical matrix to more efficiently utilize the resources which are already available in our healthcare provider system. Granting full practice authority to advanced practice registered nurses (APRNs) would go a long way toward alleviating the crisis.

That is why SB 751 and HB 1885 were introduced last month. These bills would enable all APRNs to practice to the full extent of their education and clinical capability, providing much needed access to primary healthcare.

Texas APRNs are already providing critical health care functions, including evaluating and diagnosing patients; ordering and interpreting diagnostic tests; and initiating and managing treatments, including prescribing medications. This legislation would authorize them to continue with these activities, but would eliminate needless statutory and regulatory mandates that limit APRNs’ ability to practice, particularly in rural areas.

Under current Texas law, APRNs can only prescribe under the authority delegated by physicians, and they must meet face-to-face with a supervising physician periodically. With few physicians opting to practice in rural areas, this requirement prevents many APRNs who are willing to do so from delivering care in these underserved settings.

Because Texas requires supervision, we are losing APRNs to other states. Consider that the New Mexico governor spends funds appropriated by the New Mexico Legislature specifically to recruit APRNs from Texas. This places Texas in the dubious position of paying to educate APRNs only to have states like New Mexico siphon the human resource off to fill that particular state’s shortfall in primary care providers. We cannot afford this drain on our resources.

Texas currently ranks 42nd among the fifty states in the ratio of physicians per population and 47th in the ratio of primary care physicians. In rural areas, the primary care shortage is even worse; 185 of our state’s 254 counties are medically underserved.

Opponents claim this legislation runs counter to the trend of team-based practices. However,
even with full practice authority, APRNs will continue to collaborate with physicians and other health care providers. Texas has more than 18,000 licensed APRNs today. They perform many of the same functions physicians perform, without compromising quality of service, but more cost-effectively. This vast field of expertise is not being fully utilized to provide health care services for Texans.

Those who oppose SB 751 and HB 1885 argue that APRNs do not have as much education and training as doctors. They follow up with statements like “extending full practice authority to APRNs is a public safety concern.” To that end, hundreds of studies conducted over the past forty years – highly rated on strength of evidence – have repeatedly found advanced practice registered nurses’ care to be equivalent, and in some cases superior, to that provided by physicians. This should not be a conversation about hours, this is about competency.

Texas is home to a rapidly expanding, aging population making chronic disease and health disparities an increasing concern. Yet fewer medical school graduates are choosing primary care practice. In 2009, 9 percent of medical school graduates chose primary care. To provide quality, affordable access to health care, we must have an adequate primary care workforce. Conveniently, 80 percent of our APRNs work in a primary care setting.

By eliminating the outdated requirements for physician delegation of diagnosing and prescribing, this legislation will help Texas resolve its health care delivery crisis and ensure citizens statewide have access to high-quality health care when they need it.