Texans for Healthcare Access

Allow Advanced Practice Registered Nurses to care for Texans.

Desk with Stethoscope
 The Issue

Advanced Practice Registered Nurses (APRNs) are masters or doctorate level health care providers who are subject to specific occupational licensing barriers which limit access to care for patients and drive up the cost of health care in Texas.


Texas has a critical shortage of primary care providers, with 432 Primary Care Health Professional Shortage Areas (HPSAs) in urban, suburban, and rural areas across the state.  APRNs are quality, cost-effective providers who can help address this shortage if Texas passes legislation to remove barriers standing in the way of APRNs and their patients.

The Problem

To practice in Texas, APRNs are required to enter into a contract, or what’s called a “delegation agreement,” with a physician. In many cases, the delegation is simply a physician's signature that says the APRN can practice. Some APRNs actually have to pay thousands of dollars a year for this agreement.


More states are opting to cut the red tape, eliminate delegation agreements, and give patients full and direct access to the quality care APRNs provide. Currently 22 states, the District of Columbia, the Department of Defense, and the U.S. Department of Veteran Affairs do not require these agreements. Meanwhile, lawmakers in New Mexico and Arizona are recruiting Texas-trained APRNs to their states, where APRNs face fewer regulatory burdens and lower practice costs.

The Solution

The Coalition for Health Care Access urges all Texas legislators to join us in supporting legislation, which will keep more APRNs in Texas and remove the requirement for unnecessary, expensive, and many times unfair pay-to-play delegation agreements between APRNs and physicians. This is zero-risk, zero-cost solution that will put patients first, and ensure that more Texans can access the vital care they need.

May 1, 2020

As Texas reopens today, a broad group of business, healthcare, and consumer organizations -- including TCCRI, Texas Association of Business, AARP-Texas, Americans for Prosperity-Texas, Texas Business Leadership Council, Center for Public Policy Priorities, Texas Nurses...

March 6, 2020

On March, 6, several hundred nurse practitioners (NPs) from across the state gathered at the Texas Capitol to discuss hot topics in healthcare and issues regarding full practice authority for Texas NPs. The headliner for the event was a Texas Tribune moderated panel wi...

November 7, 2019

This week, nurse practitioners were front and center of the Texas Tribune's live panel in Canyon, Texas: "A Conversation on Rural Healthcare. Panelists included Holly Jeffreys, a nurse practitioner and founder of three rural clinics in the Texas Panhandle; State Repres...

May 24, 2019

Texans for Healthcare Access today applauded Texas lawmakers for passing HB 278 by Rep. Tom Oliverson, MD, which allows nurse practitioners and their delegating physician to use technology for required monthly meetings, removing an outdated mandate that they meet in pe...

May 17, 2019

Our ongoing efforts to free nurse practitioners from the delegation agreement mandate has passed a new milestone. For the first time since we have been fighting this antiquated requirement, our cause was heard before the Senate. 

S.B. 2438, by Senator José Rodríguez of...

May 1, 2019

This week, Jessica Boston of the Texas Association of Business, one of the key members of the Coalition for Healthcare Access, was featured in the The Marshall News Messengers in an Oped on how outdated regulations of advanced practice registered nurses (APRNs) are har...

April 27, 2019

Texas Railroad Commission Chairman Christi Craddick recently hosted a Rural Issues Workshop in Austin to facilitate an open discussion centered around rural issues in our state, and the important role of nurse practitioners in these communities was a key focal point (w...

April 16, 2019

Today, TribTalk featured an Oped from nurse practitioner and clinic owner Lutricia Harrison in support of H.B. 1792, legislation that would remove outdated and costly regulations standing in the way of nurse practitioners and their patients.

A nurse practitioner for 14...

April 4, 2019

On Thursday, April 4, the Texas legislature held a public hearing for H.B. 1792 by Representative Stephanie Klick, legislation that would allow nurse practitioners, clinical nurse specialists, and certified nurse midwives to practice without a state-mandated delegation...

March 15, 2019

A recent article in the Fort Worth Star Telegram highlights a big problem plaguing Texas: Texas has a growing and aging population, but this population growth continues to outpace that rate at which Texas adds physicians to the workforce.

Here are the facts:

  • Texas ra...

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