There is a serious doctor shortage in Texas. Nationwide, the state ranks near the bottom when it comes to doctor-patient ratios, and that’s only expected to get worse as more people gain access to insurance with the Affordable Care Act. For decades, nurse practitioners have argued they can help fill the gaps in primary care – if only there were fewer restrictions. Now, legislation giving nurses more autonomy has been signed into law.
When Sandy McCoy first began as a nurse practitioner twenty years ago, she had to turn to her supervising physician for just about everything.
“I would see a patient and if they needed a prescription I’d have to hunt the physician down to have him sign the prescription,” she says. “And you can imagine that delayed the time and how many patients I could see per day.”
McCoy, who is a nurse practitioner at Baylor University Medical Center in Dallas and President of the Texas Nurse Practitioners Association, says back then every nurse practitioner had a supervising doctor, who not only signed each prescription but also looked over every patient chart. The relationship between nurse practitioners and doctors is still too demanding, McCoy says. Nurse practitioners and physician assistants are allowed to see patients, but the doctor they have an agreement with can't be located farther than 75 miles away. And, that doctor has to visit, in person, every 10 days.
“It’s really been a hindrance for some of our nurse practitioners in our rural clinics and some of the medically underserved areas,” McCoy says.They have difficulty trying to get physicians to collaborate with them because of the commitment where they have to come to their office and sign 10% of patient charts.”
Dozens of nurses pay their supervising physician, sometimes thousands of dollars a month, so they can see patients who might not have access to a doctor.
The bill approved this month, which the governor is expected to sign, will make treating patients easier for nurse practitioners and physician assistants. Nurses will have more autonomy to prescribe certain drugs in hospitals, and will be required to meet with their supervising physician less often.
Still, McCoy wishes the new legislation went further.
“This was a great step,” McCoy says. “But we will not quit here. We want to continue on to get full prescriptive authority so we have no restrictions to take care of patients except the restrictions we have on ourselves with our own scope of practice and knowing when we need to collaborate.” She notes that nurse practitioners and physicians in 18 states, plus the District of Columbia, have independence or full practice authority.
Both the Texas Nurse Practitioners Association and the Texas Medical Association, which represents physicians, supported the bill proposed by Senator Jane Nelson (R, Flower Mound). Doctors and nurse practitioners agree collaboration is necessary to keep patients safe. It’s how much, and how often that’s the question. The goal for both groups is to spend less time in meetings reviewing charts, and more in the office treating patients.
- Nurse practitioners and physician assistants can now be supervised by a doctor located anywhere in the state. Before, they were required to be within 75 miles of the supervising doctor.
- Increases the number of nurse practitioners and physician assistants a doctor can oversee from four to seven.
- Allows physicians to delegate authority to nurse practitioners and physician assistants to prescribe Schedule II controlled substances (e.g. Codeine, Morphine) in hospitals and hospice.