Testimony: Nurse practitioners can improve health care access

Key Takeaways:

• Advanced Practice Registered Nurses can deliver safe and cost-effective care to Texans in rural and underserved areas.
• The administrative burden imposed by physician supervision agreements does not serve patients.
• Texas risks losing APRNs trained in Texas institutions of higher education to full practice authority states.

Background:

APRNs fill a critical role in the health care ecosystem. As graduate trained practitioners, a majority of whom practice primary care, APRNs are well-equipped to provide care in areas plagued by health professional shortages. The Health Resources and Services Administration (HRSA) determines Health Professional Shortage Areas — places throughout the country where there are not enough physicians for a given geographic area, population or facility (like a correctional facility or rural health clinic).

The chart to the right shows geographic HPSAs based on county as well as the presence of facility or population-based HPSAs. There is at least one HPSA in all 254 Texas counties. These shortages are indicative of a challenging health care landscape in which Texas should ease pathways to encourage providers of all kinds to work in these medically underserved areas. APRNs can do so in a safe and cost-effective manner.

Research conducted in Veterans Affairs facilities found no significant difference in patient outcomes between those patients assigned to physicians and those assigned to APRNs. Additional research has found similar care quality between physicians, physician assistants and nurse practitioners, and that nurse practitioners deliver care at lower costs compared to physicians.

Policy Recommendations:

To ensure that patients are able to retain access to these providers, Texas should structure its regulatory environment to empower APRNs to practice to the fullest extent of their existing licensure. They are currently hamstrung by physician supervision requirements, which create an unnecessary and expensive administrative burden on the nurse without providing additional value to the patient. The supervision may be as limited as a once-monthly remote meeting and a review of a small number of patient charts, but can cost the nurse tens of thousands of dollars a year.

A total of 39 states have taken some action to ensure that APRNs can practice nursing without unnecessary administrative impediment. Texas should follow suit to ensure that underserved populations are able to benefit from this care, and that Texas-trained nurses do not leave the state for more appealing practice environments.

Read more:

• Testimony: Recommendations on prescription drug prices program
• Testimony: Address housing, nutrition needs of pregnant women
• Lege update: 12-month Medicaid for new moms, lower cost drugs

This written testimony was presented to the Senate Committee on Health and Human Services on Sept. 18, 2024.