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OP-ED: Set APRNs free

Bill Hammond
CEO of Texas Employers for Insurance Reform and former CEO of the Texas Association of Business

The Texas Legislature begins its session in January, and already bills are being filed at the State Capitol. Many of those bills will deal with health care due to the ongoing pandemic facing this state and this country. A significant issue for many Texans is access to health care because we still face a shortage of doctors, especially in rural areas.

For more and more Texans, the provider they see are highly trained and specialized nurses. Advanced practice nurses (or APRNs) perform many of the same duties as physicians, which is good news for our state’s health care provider shortage. The bad news for patients is that our current regulatory climate is restricting APRNs’ ability to practice to the full extent of their licensure and training.

Lawmakers have long recognized that APRNs, including nurse practitioners, nurse midwives, certified nurse anesthetists, and clinical nurse specialists, play a crucial role in addressing our state’s growing and changing health care needs. To that end, the state funds several programs to train these specialized nurses and to license and regulate them. After an APRN completes undergraduate and graduate classroom training, graduate specialty clinical training, and completes their state licensure, there is one last hurdle Texas throws in their way: a “delegation agreement.”

When advanced practice nursing was relatively new, the legislature made doctors delegate their authority to APRNs. Fifty years later, Texas has robust educational, licensure, and regulatory frameworks, and this delegation is no longer necessary. Indeed, the US military, federal agencies, and many other states have ended this practice.

Today in Texas, the delegation is merely a physician’s signature on a page that says the APRN can practice. The physician is not required to provide care for the APRN’s patients or even be in the same city as the APRN. In fact, Texas allows many physicians to delegate to numbers of APRNs, further proof there is no meaningful supervision occurring. In many cases, the most substantial interaction between some physicians and APRNs is that the APRN must pay the doctor simply for the privilege of being able to practice to the full extent of their education and licensure. And it is not cheap. Some pay over 100-thousand dollars.

The reality is our state does not have enough health care providers to meet our population’s needs. Texas ranks 45th among the 50 states in our supply of primary care physicians. And while Texas is busy worrying about whether APRNs should have to pay doctors to practice, other states are happily recruiting our Texas-trained APRNs to come to them. Why wouldn’t an APRN go to a different state where their competitors are not allowed to deny them the right to practice?

For everyone involved, this means higher costs. When there is a shortage of providers, people seek treatment from more expensive alternatives, like emergency rooms. That not only costs more to patients, but it causes the entire cost of health care to go up. That means higher costs to employers as well.

We know that APRNs are fully capable of doing many of the things a primary care physician can do because so much of what they do is routine. APRNs should have the ability to stay home in Texas and do the job they are trained to do.

This once well-meaning regulatory requirement has more than outlived its purpose. Today, it is a costly hindrance to patient-centric care from the now-proven advanced practice nursing industry. Let us do the right thing for Texas patients and put an end to delegation agreement requirements in the 2021 Legislative Session.

Bill Hammond is the CEO of Texas Employers for Insurance Reform and former CEO of the Texas Association of Business