Bill Would Strengthen Nurses' Prescriptive Power

A long-awaited agreement between physicians, nurses and state legislators to increase the prescriptive power of advanced practice nurses could improve Texans’ access to care, health care leaders said Wednesday.

“Physicians, nurse practitioners, and physician assistants are natural partners in the delivery of appropriate and compassionate patient care," Dr. Michael Speer, president of the Texas Medical Association — the state's largest physician organization — said in a statement.

The legislation, filed by Rep. Lois Kolkhorst, R-Brenham, chairwoman of the House Public Health Committee, and Sen. Jane Nelson, R-Flower Mound, chairwoman of the Senate Health and Human Services Committee, will eliminate on-site physician supervision requirements to allow doctors to delegate the authority to prescribe and order medical devices to advanced practitioner nurses; increase the number of advanced practice nurses a physician can supervise from four to seven; and improve coordination between the Texas Medical Board and the Board of Nursing and Physician Assistants. It will also allow physicians to delegate authority to advanced practice nurses to prescribe Schedule II controlled substances, which are classified as having a higher potential for abuse, in hospitals and hospice settings.

The "scope of practice" compromise comes after years of disagreement between physicians and advanced practitioner nurses on how nurses’ prescriptive authority should be tied to physicians. (The Tribune reported on the conflict in 2010.) Although advanced practice nurses receive extensive training, physicians argued at the time that the training was only a fraction of the medical training physicians receive, and might leave the nurses less prepared. Advanced practice nurses argued that the power of physicians to dictate their prescriptive authority and collect fees left them with a lack of control over their livelihood.

"Texas is famous for solving tough challenges in its own way,” Kolkhorst said of Wednesday's agreement. “Members of the House and Senate sat down with stakeholders at all levels to find a workable solution. Hopefully we’ll see a policy shift that expands care to more Texans in a way that’s both safe and sensible.”

Nelson added that the proposed legislation is only part of her greater vision to expand access to health services in Texas this session. She has also proposed legislation to increase the number of primary care physicians in Texas and increase funding for residency slots.

"We need to allow our most highly trained nurses and physician assistants to deliver care that can be responsibly and safely delegated to them by our physicians,” she said in a statement. “Our success in expanding access to care this session depends on the success of all three objectives.”