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In Face of Severe Health Care Workforce Shortages, Coalition Asks to Remove Barriers to APRN Care

Coalition of Almost 40 Organizations Urge Lawmakers to Modernize APRN Regulations. Removing Contract Requirements Would Expand Access for All Texans

AUSTIN – Texans for Healthcare Access – a diverse coalition of organizations representing consumers, businesses, and health care stakeholders – is urging lawmakers to modernize the state’s licensing laws on Advanced Practice Registered Nurses (APRN) as part of their efforts to address the state’s critical health care workforce shortage.

In Texas, APRNs face a lifetime requirement that they must have a delegation agreement with a physician before they can practice to the full extent of their education, training, and experience.

Governor Greg Abbott waived the contractual delegation requirement to expand access to APRNs during the COVID pandemic.

Here are the facts:

Studies have shown that APRNs are more likely than physicians to practice in rural and medically underserved areas. In states that eliminate delegation agreements, APRNs are even more likely to work in rural areas. As of 2020, 73% of nurse practitioners in Texas specialized in primary care.

Psychiatric mental health nurse practitioners, who are specially trained to diagnose and treat mental illnesses and disorders, are a crucial part of addressing our state’s mental health workforce shortage and caring for underserved populations. In fact, a new study shows that psychiatric mental health nurse practitioners are helping to offset workforce shortages and now represent one in three mental health care providers for Medicare patients.

APRNs are the only independently licensed professionals in the state of Texas who are required to maintain a lifetime contract with a member of another profession in order to go into business, which deters nurses from moving to Texas to practice and drives Texas-educated APRNs out of Texas looking for work elsewhere. More than half the country, the Department of Veteran Affairs, and all branches of the U.S. military have already done away with these types of lifetime mandates.

Organizations across the state committed to improving access to care continue the effort, with the Convenient Care Association and Texas 2036 counting as two of the latest entities joining THCA in our effort to expand access to quality health care.

A 2022 Texas Nurse Practitioners member survey found that nearly 55% of nurse practitioners say delegation requirements prevented them from expanding or creating their own practice to care for more patients. Over half of nurse practitioners surveyed, 51%, said they would consider moving or practicing in another state with full practice authority for APRNs, and a staggering 71.73% said they would consider practicing telehealth to patients outside of Texas in states that do not have such onerous regulations.

“The need for health care professionals is skyrocketing across the country, with other states seeking every advantage they can to attract Texas-born and Texas-educated APRNs to care for their patients. Texas is competing for quality health care providers and states like Florida and New Mexico have made their workforce climate attractive to high-quality APRNs.”

  • Glenn Hamer, Texas Association of Business (TAB) CEO

“At a time when patients across Texas, especially in our rural communities, are struggling to find health care, this outdated and unnecessary regulation is standing between patients who need care and quality providers. Texas is the largest remaining state to still require delegation agreements for APRNs.”

  • Cindy Weston, President of Texas Nurse Practitioners (TNP)

"Currently, APRNs in Texas may practice and see patients, but must do so under the delegation of a licensed physician. In past sessions, several bills have been filed to permit Advanced Practice Registered Nurses to practice with independent authority, allowing these practitioners to fully exercise the licenses for which they are trained. This policy change would alter little in the actual manner in which APRNs care for their patients, would remove a cumbersome and costly hurdle to practice, and is a critical step towards increasing access to care in underserved areas of the state."

  • Tom Aldred, Executive Director of Texas Conservative Coalition Research Institute (TCCRI)

"Shortages in primary care providers afflict Texans everywhere, with rural areas bearing the brunt. Reasonable measures to allow medical professionals to practice to the fullest extent of their licensure should be a feature in an 'all hands on deck' approach to solving the primary care crisis."

  • Emily Dove, Policy Advisor for Texas 2036

“In Texas, primary care physicians are in short supply, especially in rural areas. Many patients have long waits for needed services. And as the population ages, the shortages continue to grow. Advanced Practice Registered Nurses can fill the gaps if they are allowed. Older Texans would benefit by ending the unnecessary restrictions on APRNs that prevent them from contributing to the full extent of their capabilities.”

  • Tina Tran, AARP Texas Director

“The Texas Nurses Association’s research shows that allowing APRNs to practice to the full extent of their licensure can lower the cost of care, increase access to care, and increase choices available to medical consumers in Texas. Eliminating regulatory barriers to practice will help the state improve care for Texans, especially in underserved and rural service areas.”

  • Jack Frazee, Director of Government Affairs and General Counsel for the Texas Nurses Association

“Changing this law would change nothing in terms of scope of practice, in-person oversight, or collaboration; it would only expand quality health care access to more patients, including in our underserved communities. Requiring an APRN to have an agreement with a physician is an unnecessary barrier, as the physician is not required to see a patient or provide any in-person, hands-on care. The APRN and physician are only required to have one phone call a month.”

  • Linda Cole, President of Texas Clinical Nurse Specialists

“Texas has one of the more severe mental health workforce shortages in the country. Failing to reduce burdensome and unnecessary red tape limits the extent to which psychiatric APRNs can help address sizable gaps in the mental health care system.”

  • Greg Hansch, Executive Director of National Alliance on Mental Illness (NAMI) Texas

“Before the COVID-19 pandemic, Texas faced a shortage in its long-term care workforce and other settings that threatened quality care and patient safety. The pandemic has exacerbated the threat and it’s critical the Texas Legislature acts now to strengthen the workforce and ensure access to care for senior Texans. Advanced Practice Registered Nurses are key to improving care.”

  • Alyse Meyer, VP of Advocacy for LeadingAge Texas

“By removing these unnecessary barriers, Texas has an opportunity to align with the majority of states in increasing access to safe and quality APRN care.”

  • Nicole Livanos, Director of State Affairs, National Council of State Boards of Nursing

“Timely access to quality care impacts patient outcomes and affordability of health care overall. Adoption of this legislation will be a win-win for patients, APRNs, physicians and the entire state of Texas.”

  • Viola Hebert, representative for the Texas Silver-Haired Legislature

Texans for Healthcare Access is a coalition of organizations representing consumers, business, and a broad range of health care stakeholders. These groups have joined forces to remove unnecessary barriers to care and allow Advanced Practice Registered Nurses to provide more access and more options for Texas patients. Learn more here.


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