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What medical care can nurse practitioners provide in Texas?

Texas doesn't allow nurse practitioners to have a totally independent scope of practice

Nurse practitioners are mid-level providers who are a valuable part of team-oriented health care.

As the name suggests, nurse practitioners have an educational background that arises from nursing rather than medicine. Nurse practitioners (NPs) are advanced practice nurses who went to nursing school and are registered nurses (RNs) with graduate-level degrees (masters or doctorate) in a focused nursing field.

Physicians, on the other hand, are medical doctors (MDs or DOs) who are trained in medicine.

The nursing versus medicine focus of their training represents a fundamental difference in approach between NPs and physicians. Lippincott Nursing Center explains the difference, in part, as: “Nursing is concerned with health, whereas medicine focuses on cure. Also, there is a functional difference between care and healing.”

Traditionally, nurse practitioners have been part of a physician-led health care team. In a phenomenon that some describe as “scope creep,” some states have changed their laws to allow nurse practitioners to provide medical care without any physician supervision.

While there have been pushes in that direction in the Lone Star State, Texas law and Board of Nursing rules still require nurse practitioners to have physician supervision in order to provide medical care.

Texas distinguishes between a NP’s nursing/health versus medical care

Board of Nursing Rules 221.12 and 221.13 allow nurse practitioners to practice nursing and health care in a scope that’s based on the individual NP’s educational preparation, continued advanced practice experience, and the accepted scope of professional practice of the particular specialty area.

In Rule 221.12, Texas defers to national professional specialty organizations or advanced practice nursing organizations to define the acceptable scope of practice in particular specialty areas.

In contrast, when it comes to a nurse practitioner providing medical care, Texas Rule 221.13 placed additional requirements on NPs when it comes to providing medical aspects of care. The Board of Nursing’s rule makes it clear that there are different standards for NP medical care than nursing and health care, by stating, “This shall not be construed as requiring authority for nursing aspects of care.”

For NP-provided medical care, Rule 221.13 specifies that there must be “utilize mechanisms which provide authority for that care” that include physician involvement. The mechanisms may include, but aren’t limited to:

• Protocols or other written authorization that promote the exercise of professional judgment by the advanced practice nurse commensurate with the NP’s own education and experience. The rule doesn’t contemplate unlimited authority for NPs to provide medical care, but rather requires an individualized assessment by a physician and NP of the individual NP’s preparation of competence for specific medical tasks.

The protocols or written authorizations:

• Should be jointly developed by the NP and the appropriate physician(s).

• Shall be signed by the NP and the physician(s).

• Shall be reviewed and re-signed at least once a year.

• Shall be maintained in the NP’s practice setting or location.

• Shall be made available as necessary to verify authority to provide medical aspects of care.

What you can do

When receiving medical care from a physician, nurse practitioner, or physician assistant, it’s based on the patient giving informed consent. It’s certainly within a patient’s rights to be adequately informed.

When considering nurse practitioner care, a patient may want to investigate or ask questions about:

• The nurse practitioner’s specific training. Was the graduate training in person or online?

• What certification does the NP have? How many hours of advanced practice clinical training were required to obtain the certification?

• What physician signed off on the NP’s medical practice protocols or written authorizations? What’s the background of that doctor?

If you’ve been seriously injured because of inadequate or poor care by a Texas nurse practitioner, then contact a top-rated experience Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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