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Give level playing Field to Advanced Practice Nurses by Bill Hammond - Articles - Nurses Arena Forum

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Give level playing Field to Advanced Practice Nurses by Bill Hammond by katty : December 04, 2016, 01:08:47 PM
Each day thousands of Texas patients see their health care provider for services ranging from the common cold or flu to delivering a new baby to geriatric care to mental health services. And for more and more Texans, it is highly trained and specialized nurses who provide this level of personalized care.

Advanced Practice Nurses, or APRNs, perform many of the same duties as a physician, which is good news for our state’s health care provider shortage. The bad news for patients is that our current regulatory climate is restricting the ability of APRNs to practice to the full extent of their licensure and training.



Lawmakers have long recognized APRNs, which include nurse practitioners, nurse midwives, certified nurse anesthetists, and clinical nurse specialists, play a crucial role in addressing our state’s growing and changing health care needs. To that end, the state funds several programs to train these specialized nurses and to license and regulate them. After APRNs complete undergraduate and graduate classroom training, graduate specialty clinical training, and complete their state licensure, there’s one last hurdle Texas throws in their way: a “delegation agreement.”

When advanced practice nursing was relatively new, the Legislature made doctors delegate their authority to APRNs. Fifty years later, Texas has robust educational, licensure, and regulatory frameworks, and this delegation is no longer necessary. Indeed, the U.S. military, federal agencies and many other states have ended this practice.

Today in Texas, the delegation is merely a physician’s signature on a page that says the APRN can practice. The physician is not required to provide care for the APRN’s patients or even be in the same city as the APRN.

In fact, Texas allows many physicians to delegate to numbers of APRNs, further proof there is no meaningful supervision occurring. In many cases, the most substantial interaction between some physicians and APRNs is that the APRN has to pay the doctor simply for the privilege of being able to practice to the full extent of his or her education and licensure. A 2016 study of Texas APRNs found that some were forced to pay their delegating physician up to $120,000 every year.

The reality is our state does not have enough health care providers to meet our population’s needs. Texas ranks 47th among the 50 states in primary care access. And while Texas is busy worrying about whether APRNs should have to pay doctors to practice, other states like New Mexico are happily recruiting our Texas-trained APRNs to come to them. Why wouldn’t an APRN go to a different state where their competitors aren’t allowed to deny them the right to practice?

For everyone involved, this means higher costs. When there is a shortage of providers, people end up seeking treatment from more expensive alternatives, like emergency rooms. That not only costs more to patients, but it causes the entire cost of health care to go up. That means higher costs to employers as well.

We know that APRNs are fully capable of doing many of the things a primary care physician can do, because so much of what they do is routine. APRNs should have the ability to stay home in Texas and do the job they have been trained to do.

This once well-meaning regulatory requirement has more than outlived its purpose and today serves as a costly hindrance to patient-centric care from the now proven advanced practice nursing industry. It’s time for Texas to end this nonsensical and unfair regulatory regime. Like most Texans, I want to see our state provide a level playing field and cut the unnecessary red tape. Let’s do the right thing for Texas patients and put an end to delegation agreement requirements.

Bill Hammond is president and CEO of the Texas Association of Business.

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