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.

Recent Posts



Texas Tribune Says APRN Bill has Broad Support

Photo: Bob Daemmrich for The Texas Tribune. In an article covering the press conference announcement of APRN full practice bills HB 1415/SB 681, Mariana Alfaro of the Texas Tribune talks about what this legislation would mean for APRNs and their patients in Texas. "Nurse practitioners are often the primary health providers in many rural and low-income Texas communities," said Alfaro. "Under current regulations, the physicians they contract with don’t need to be in the same city as the nurse or see the patients the nurse treats. Experts say the contracts drive up clinic prices or push nurses to other states." Alfaro noted that while this is not the first time APRN have fought this legislative

HB 1415 / SB 681 Press Conference

(Photo: Madlin Mekelburg via Twitter) On February 9th, Representative Stephanie Klick and Representative Donna Howard announced HB 1415/SB 681, a full practice authority bill that would remove outdated and costly barriers to Advanced Practice Registered Nurses (APRNs) and allow these health care providers to practice to the full extent of their training and education. “We need every single health care provider in this state and we need them operating to the full extent of their training and education,” Klick said. “HB 1415 is about patient access, it's about expanding options for care in rural and underserved areas, it's about patient choice and high-quality, cost-effective care.” See organi


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