Nurse practitioners want ability to practice independently in Texas

Texas Politics

AUSTIN (Nexstar) — Nurse practitioners say they can help fill a gap in health care access across Texas if the state lifts its laws restricting their practice. The American Association of Nurse Practitioners says there are more than 20 states that allow for full or reduced practice of nurse practitioners.

Lutricia Harrison, a Houston-based family nurse practitioner, was at the Texas State Capitol Thursday to testify in support of a bill that would allow nurse practitioners, nurse midwives or clinical nurse specialists to practice independently if they have least 2,080 hours under the delegation of a physician.

The Texas Nurse Practitioners backs this bill.

“It will allow nurse practitioners to be able to practice at the full extent of our education and training to be able to see patients quicker, decrease wait times and also improve health outcomes,” Harrison said. 

In Texas, nurse practitioners work under the supervision of a physician. Under House Bill 1792, filed by Rep. Stephanie Klick, R-North Richland Hills, the scope of the practice for an advanced practice registered nurse authorized to work independently include ordering, performing and interpreting diagnostic tests; formulating primary and differential medical diagnoses and advanced assessments; and treating actual/potential health problems. They could also prescribe therapeutic and corrective measures, such as nutrition and diagnostic support services, home health care, hospice care, physical therapy, as well as prescribe and dispense certain drugs. 

They could provide referrals to other health care agencies, health care providers, community resources and serve as the primary care provider of record. 

Harrison said it would help patients get quick care for coughs, colds, runny noses, elevated blood pressures, diabetes management, physical exams, pre-sport participation physicals or immunizations.  

The Texas Medical Association, however, says it’s concerned with how the bill could impact patient safety. Dr. Lindsay Botsford, a family physician in Sugarland who serves on the Texas Medical Association’s board, pointed out the difference in training hours required for doctors compared to what’s outlined in the bill. 

“To give you some perspective, a family medicine resident goes through about 15,000 hours of training before they get out and practice,” Botsford said.  

“There’s no minimum number of patients that they would need to see during this training,” she added. “There’s no testing for quality or competence during this training and that nurse practitioner could practice in a setting completely different than where they trained after just one year of training.” 

But Harrison says the training nurse practitioners go through is enough to meet the needs of patients in the settings they’d work in. 

“Nurse practitioners are not in competition with doctors,” Harrison said. “We are not in competition with physicians. We go through training specifically for nursing and what we do, so there’s no competition or no comparison.” 

Klick expects nurse practitioners to still work with physicians under her bill.

“APRNs are well suited to help Texas solve our primary care shortage and like any medical professional, are trained to understand the extent of their training and to know when to consult when they’re beyond their training,” Klick said.

Her bill would also increase continuing education hours for APRNs to the same number of hours required by a physician. However, doctors worry certain courses offered online won’t cover the necessary bases needed for their practice. Botsford suggests lawmakers should look at other ideas that could help health care access. 

“We can talk about improving Medicaid payments to rural hospitals,” she said. “We can talk about loan repayment for primary care physicians. We can talk about increasing the funds for primary care residency education training. There are lots of solutions and we respect the idea of trying to fix the problem of access because it’s so important, but this isn’t safe for our patients and isn’t the way to do it.” 

Other state legislatures are also considering similar legislation. According to WUSF, lawmakers in Florida are discussing a bill that would also allow nurse practitioners to practice independently.

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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