House Tentatively Approves "Scope-of-Practice" Bill

Advanced practice nurses and physician assistants under the supervision of a physician may soon have broader authority to prescribe controlled substances, after the House gave preliminary approval on Tuesday to a so-called scope-of-practice bill.

The “scope-of-practice” compromise has “been worked on for years and years and years,” said state Rep. Lois Kolkhorst, R-Brenham, calling Senate Bill 406 one of her highest priorities this session. 

SB 406, by state Sen. Jane Nelson, R-Flower Mound, and sponsored by Kolkhorst, will eliminate the requirement for on-site physician supervision to allow doctors to delegate the authority to prescribe and order medical devices to advanced practitioner nurses and physician assistants. It will increase the number of advanced practice nurses a physician can supervise from four to seven. And it will 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 and physician assistants to prescribe Schedule II controlled substances, which are classified as having a higher potential for abuse, in hospitals and hospice settings.

While describing the bill on the House floor, Kolkhorst said that medical associations have been in conflict about how to change Texas' "scope-of-practice" laws for more than a decade. She thanked physician and nurse associations, and other lawmakers for reaching a compromise.

“We’re really trying to promote the concept of team-based care,” said Dan Finch, director of legislative affairs for the Texas Medical Association. He explained that the bill would allow physicians to delegate more or less authority to each nurse under his or her supervision, allowing medical groups to use each nurse’s expertise and level of experience more efficiently. “It really is a historic agreement,” he said.

The "scope-of-practice" compromise comes after years of disagreement between physicians and advanced practice nurses on how nurses’ prescriptive authority should be tied to physicians. Although advanced practice nurses receive extensive training, physicians had argued that the training was only a fraction of the medical training physicians receive, and nurses might be 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.

“It’s supposed to be a collaborative relationship and not a supervisory relationship,” David Williams, spokesperson for the association of Texas Nurse Practitioners said, explaining that the “scope-of-practice” compromise would allow doctors to delegate authority to nurses to prescribe drugs and treat patients rather than require the on-site supervision of a physician. To ensure patient safety, the bill calls for periodic face-to-face meetings between nurses and physicians. “Any prudent provider would make sure to create some safeguards and some tracking mechanisms to make sure that patient safety is first and foremost,” he said.

"This bill allows highly trained medical professionals to practice to the top of their training," Nelson said in a statement, "increasing patient access to qualified health care providers at a time when we are working to address critical shortages in our medical workforce."

The House made some changes to the bill, and if it receives final approval on the floor tomorrow, the House and Senate must conference before it will be sent to the governor. If Gov. Rick Perry signs the bill, it will take effect Nov. 1.