Expanding Access to High-Quality Healthcare using Advanced Pract

Texas needs to develop a more efficient regulatory model when it comes to Advanced Practice Registered Nurses (APRNs). Currently, Texas law grants APRNs prescriptive authority under a site-based model first enacted in 1989 that included sites serving medically underserved populations. In the decades since, amendments added physician primary practice sites, then facility based practices and, finally, alternate practice sites. Each site has its own set of restrictions – for some sites it is the number of APRN FTEs, for others it is the geographical distance from the physician, number of hours open, number of charts that must be reviewed, where the charts must be reviewed, etc., etc. The result is a hopelessly complex model with multiple restrictions which have little to do with quality of care and actually reduce access to care, e.g., the time a physician spends traveling from site to site to provide on-site supervision is time not spent seeing patients; the APRN who wants to practice in an underserved area must find a physician in that area willing to comply with the numerous restrictions required.


Texas cannot maintain the current site-based model and expect APRNs to effectively contribute to Texas’ need for more providers – particularly primary care providers. Current Texas law allows a medical doctor to “oversee” up to 4 APRNs as long as the doctor’s primary practice is within a 75-mile radius and a retrospective review of a random 10% of the APRNs patient charts is completed each month. Does this sound like supervision? APRNs are free to work independently up to 90% of the time but required to have an agreement that takes a physician out of the office reducing patient load. In addition, the APRN must pay an exorbitant fee not reflective of the service the physicians provide. These physicians do not see the patients in the APRN’s practice nor do they oversee any aspect of that APRN’s practice.


These restrictions do nothing but increase cost for the state and for patients, limits patient choice, and prevents the full deployment of APRNs into the healthcare workforce.



112 votes
114 up votes
2 down votes
Idea No. 106