Nurse practitioners have limited scope of practice in Texas

There is a national movement among nurse practitioners to expand their scope of practice. Lobbying and professional organizations for nurse practitioners contend that they provide care that is equal to or better than that provided by physicians.

Nurse practitioners are mid-level providers and advanced practice registered nurses (APRN). A nurse practitioner must be a registered nurse (RN) who has completed additional training to obtain a master’s or doctoral nursing degree from an accredited program. Some of these programs are offered entirely online. Nurse practitioners also must pass a national certification exam.

The scope of practice of nurse practitioners varies from state to state. So far 24 states and Washington, DC have granted nurse practitioners full practice authority. Despite intense lobbying, the rules and regulations of the Texas Board of Nursing applicable to nurse practitioners limits their scope of practice.

While I believe that nurse practitioners are an important part of the health care team, my experience leads me to believe that it’s a good idea for them to continue to be supervised by physicians.

Scope of practice for nurse practitioners in Texas

In Texas, the scope of practice for nurse practitioners is defined as the activities that a nurse practitioner performs and delivery of patient care. In other words, there’s not a blanket approach and an individual with a nurse practitioner degree won’t be qualified to practice in every medical field in Texas.

Texas Board of Nursing Rule 211.12 defines the scope of practice for nurse practitioners:

“The advanced practice nurse provides a broad range of health services, the scope of which shall be based upon educational preparation, continued advanced practice experience and the accepted scope of professional practice of the particular specialty area. Advanced practice nurses practice in a variety of settings and, according to their practice specialty and role, they provide a broad range of health care services to a variety of patient populations.

(1) The scope of practice of a particular specialty area shall be defined by national professional specialty organizations or advanced practice nursing organizations recognized by the Board. The advanced practice nurse may perform only those functions which are within that scope of practice and which are consistent with the Nursing Practice Act, Board rules, and other laws and regulations of the State of Texas.

(2) The advanced practice nurse’s scope of practice shall be in addition to the scope of practice permitted a registered nurse and does not prohibit the advanced practice nurse from practicing in those areas deemed to be within the scope of practice of a registered nurse.

The rule makes it clear that a nurse practitioner’s scope of practice must match his or her education, training, preparation and experience.”

Rule 221.13 adds that, “The advanced practice nurse shall practice within the advanced specialty and role appropriate to his/her advanced educational preparation.”

Certified Nurse Practitioner Specialties

The highlighted areas of Rule 211.12 deal with specialty areas of practice for nurse practitioners. There are currently only eight nurse practitioner degrees:

• Family Nursing

• Adult–Gerontology Acute Care

• Adult–Gerontology Primary Care

• Pediatric Nursing

• Neonatal Nursing

• Women’s Health

• Emergency Nursing

• Psychiatric–Mental Health Nursing

Nurse practitioners practicing without training and certification in the above areas, but practicing within the specialties, may be in violation of Texas rules and regulations.

You’ll notice that the short list above leaves many specializations without certification for nurse practitioners, including: allergy and immunology, cardiology, dermatology, gastroenterology, general surgery, hematology, infectious disease, nephrology, neurology, neurosurgery, oncology, orthopedics, pain medicine, plastic surgery, radiology, urology, sleep medicine, sports medicine and vascular surgery.

Nurse practitioners expanding their scope of practice into these medical specialties may be in violation Texas rules and regulations. At a minimum, it will be more challenging for the nurse practitioner and his or her employer to demonstrate the educational and professional development necessary to provide safe patient care in the specialty areas.

Rule 221.13 provides that, “The advanced practice nurse shall retain professional accountability for advanced practice nursing care.” An employer who hires and enables a nurse practitioner to practice outside his or her educational preparation, training, experience may also be responsible for patient injury.

If you’ve been seriously injured because of poor care from a nurse practitioner in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys 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 for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.