Nurse Practitioner Scope of Practice: Texas

Ahh, the Lone Star State, famous for it's spirit of pride and freedom, the Alamo and the invention of Dr Pepper.  Among the lesser known facts about Texas is that it is home to nearly 10,000 nurse practitioners.  Does Texas' independent attitude extend to state laws governing NP's?

Nurse practitioners in Texas do not enjoy as many freedoms as NP's in many other states.  In fact, Texas falls at the lower end of the spectrum regarding the freedoms it offers nurse practitioners.  Let's take a look at the laws governing nurse practitioners in the Lone Star State. 

Texas' Nurse Practitioner Supervision Laws

Despite attempts from nursing organizations to advocate for independent practice laws, nurse practitioners in Texas must work under physician supervision.  In 2009 and 2011, nursing organizations lobbied to change these laws but were unsuccessful largely as a result of physician protest.  Nursing organizations plan to again request changes to nurse practitioner supervision statutes sometime in 2013.

For the time being, nurse practitioners must practice under physician supervision.  The nurse practitioner must practice within 75 miles of the supervising physician.  Physicians may not supervise more than four nurse practitioners at one time.  The supervising physician must also ramdomly review at least 10 percent of the nurse practitioner's patient charts each month.  

Texas' Nurse Practitioner Prescribing Laws

Consistent with strict supervision guidelines, nurse practitioners in Texas are allowed to prescribe only under physician supervision.  Furthermore, they may only prescribe a 30 day supply of medications and are not allowed to prescribe schedule 2 drugs such as Lortab or Adderall.  All prescriptions written by the nurse practitioner must include the supervising physician's name, address, DEA number and phone number.  

Other NP Scope of Practice Laws

Nurse practitioners in the Lone Star State are not allowed to signs death certificates or handicap parking permits.  They are, however able to sign worker's comp claims and be officially named primary care providers.

The scope of practice for nurse practitioners in Texas is limited.  In keeping with the state's attitude of independence these rules and regulations will hopefully change in the future.  For now, NP's practicing in Texas are subject to laws requiring strict physician supervision in prescribing and practice. 

Comments

I am currently going through a lot of issues - I was given a shot in a hospital and caused Cellulitis (really bad down into my bone) and also causing Deep Vein Thrombosis. I was in the hospital for a week and we are currently waiting for the swelling to go down.. I left the hospital with enough pain meds to get me to my next appointment with one of the doctors I see. The doctor that I had been seeing is a Nurse Practitioner and I am afraid that she is not going to be able to give me the medication that I need to get me to my next appointment which will be the surgeon that is going to be doing surgery? Can this nurse practitioner help me because I have two that are I believe to be controlled substances, what should I do the pain is intolerable majority of the time and It is so bad that I am unable to sleep longer than 3 hours at a time. Any advise

Jessica

Can FNPs legally work in acute care or ICU in Texas?

Heather

I realize this is an older blog, but has the 10% chart review changed for Texas? Is this still a requirement in 2016 ? Thank you.

TJ

Why don't the nurse practitioners in the state of Texas get together and Sue state for the right to work instead of being forced into extortion by the doctors in the state of Texas with the state of texas acting as the enforcer

Jimmy

who can help me find some documentation to clarify if NP's can order therapy/nursing services or sign POC's for home health?

michelle

I went to see a Dermatologist an M.D. The nurse practitioner did the initial consultation, make a diagnosis without taking any specimens and wrote a prescription without the M.D. being in the office, she wasn't even in the country at the time. How is this legal?

bruce ford

Hi Katie,

I've found the answer. The Texas State Board of Pharmacy requires the DEA and DPS for the nurse practitioner and the DEA number for the delegating physician to be included on a prescription for any controlled substance. 

Erin Tolbert

I will look into this and see if I can find you an answer!

Erin Tolbert

In Texas if I have my own DEA number, DPS number on my script along with my prescribing physicians name. Do I have to also put my supervising physicians DEA on controlled substance scripts such as codeine???

Katie

Do physicians register to be TMA to be supervising or collaborative physicians?

mike

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