Eliminating Physician Oversight for APRNs in Texas

The recent passage of the Affordable Care Act (ACA) and the effort to provide healthcare for every American is expected to create a large influx of citizens seeking primary care providers. The current demand for primary care services has already burdened most states with a projection of more than 16 million individuals gaining health coverage by 2016, with a projection in Texas of more than 4.2 million (Schiff, 2012).

Advanced practice registered nurses (APRNs) possess the training, experience and expertise in providing primary care services and can be part of the solution in solving shortages, but face unnecessary restrictions in Texas. Advanced Practice Registered Nurses (APRNs) are nurses possessing masters, post-masters or doctoral level education. An APRN holds national certification and in Texas is licensed by the state Board of Nursing (BON) (CNAP, 2013). A wealth of evidence suggests that APRNs have the skills and expertise to perform many of the primary care services that physicians perform with an equal or higher patient satisfaction rate (Humphries, 2007). The Institute of Medicine (IOM) has criticized states laws that prevented APRNs from practicing to the full extent of their training (2011). Therefore, removing these restrictions, will permit APRNs in Texas is a practical solution to help meet this shortage. In addition, APRNs will also enhance health delivery efficiency and provide economic benefit as well for Texas by creating nearly 100,000 permanent jobs for the state of Texas (Perryman, 2013). Action needs to be taken to remove restrictions that are preventing or delaying APRNs from caring for Texans.

As the population of Texas grows, this problem will only be compounded to a system that is already inadequate and overloaded. The laws and regulations concerning APRNs scope of practice varies by state, with 16 states permitting full practice authority, without physician oversight. This permits APRNs to practice to the full extent of their training. The remaining states (34) require some degree of physician oversight and involvement. States with only minimal restrictions have not reported any increased threat to patient safety (Texas Public Policy Foundation, 2013). Texas is one of the remaining states with a high level of oversight. Recent research indicates that APNs who live in states that allow full practice authority give more care (IOM, 2011). By removing these unnecessary restrictions, more NPs will be able to meet the healthcare needs of Texans.

Texas Public Policy Foundation (2013) reports that of Texas’s 254 counties, only 23 have an adequate number of healthcare professionals to serve their populations. In addition almost 90% of rural Texas counties are considered partially or completely underserved. Twenty-five Texas counties have no physicians at all and it is estimated that 20% of Texans (3.3 million) do not have access to a primary care provider. As the provisions of our national healthcare law go into effect we can expect this to worsen with an anticipated shortage of 44,000 to 46,000 primary care providers nationally by 2025. The severe PCP shortage has also been affected by a shrinking medical school enrollment and a decrease in the number of students choosing primary care as a specialty (Texas Public Policy Foundation, 2013).

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