Texas Nurse Practitioners Fight for Full Practice Authority
By: Portia Wofford
Nurse Practitioners (NP) are more likely to work in rural and underserved areas than physicians. According to a study by the University of Michigan, the demand for physicians in rural areas is being filled by nurse practitioners.
However, in states like Texas, restrictions on their practice limit nurses' ability to serve patients. Nurses aren't allowed to use the full extent of their education, experience, and credentialing.
To give people the level of healthcare they deserve, Texas NPs are fighting for full practice authority (FPA).
Current Scope of Limitations
Currently, the scope of practice for NP, in Texas is limited.
- NPs must practice under the supervision of a physician within a 75-mile radius.
- Physicians can’t supervise more than four nurse practitioners at one time and must review at least 10% of the NP's patient charts randomly each month.
- NPs can only prescribe under a physician's supervision and under strict guidelines.
- NPs can’t prescribe schedule two drugs — Adderall, Norco, etc.
- All prescriptions written by the nurse practitioner must include the supervising physician's name, address, DEA number, and phone number.
- NPs are not allowed to sign death certificates or handicap permits
Nurse Practitioners fight back
Proposed House Bill 1792 would allow nurse practitioners with at least 2,080 hours under the delegation of a physician to practice independently. In an interview with NBC affiliate KXAN, Lutricia Harrison, a Houston-based nurse practitioner, stated that allowing NPs to practice at the full extent of their education will give patients quicker access to healthcare, decrease wait times, and improve health outcomes.
Under House Bill 1792, the scope to practice independently would include
- Ordering, performing and interpreting diagnostic tests
- Formulating primary and differential medical diagnoses and advanced assessments
- Treating actual or potential health problems
- Prescribing therapeutic and corrective measures
- Prescribing and dispensing certain drugs
After practicing for 14 years as a nurse and five as a nurse practitioner, Onissa S. Mitchell, MSN RN APRN FNP-C, says allowing NPs to have full practice authority would open access to healthcare.
"With the number of NPs in practice, this move would provide additional resources to patients and take some of the stress off physicians. This allows NPs the power to provide patient-centered care — at a more cost-effective rate — without compromising the quality of care,” she says.
Mitchell feels limited in her ability to care for patients. She wants to operate her own clinic, without the strict requirement of employing a physician to "supervise" her.
Mitchell gave some actionable steps that NPs and others can take to help the cause.
- Stay abreast of evidence-based practices to ensure appropriate knowledge and skills are maintained for optimal patient health outcomes
- Get involved in local and national NP organizations
- Send correspondence to local and state representatives requesting their support for FPA.
- Lobby local, state, and federal lawmakers and advocate for legislative change.
Portia Wofford is a nurse, millennial strategist, healthcare writer, entrepreneur, and micro-influencer. Chosen as a brand ambassador or collaborative partner for various organizations, Wofford strives to empower nurses by offering nurses resources for career development--while providing organizations with tools to close generational gaps within their nursing staff. Follow her on Instagram and Twitter for her latest.