Understanding advanced practice nurses and their scope of practice and accountability in Texas

The Texas Board of Nursing recognizes a special category of registered nurses called “Advanced Practice Nurses.” The Board grants licensure based on a nurse’s completion of an advanced educational program acceptable to the Board.

What are advanced practice nurses?

Texas Board of Nursing Rule 221.1 notes that advanced practice nurses include nurse practitioners, nurse midwives, nurse anesthetists (certified registered nurse anesthetists or CRNAs), and clinical nurse specialists.

Nationally, there’s been a robust debate on the scope of practice boundaries for advanced practice nurses.

To simplify the matter, many advanced practice nurses believe that they should have the same licensure and scope of practice as physicians in similar fields. Half of the U.S. states have agreed, enacting full practice authority licensure laws. These laws allow nurse practitioners and advanced practice nurses authority to evaluate, diagnose, order and interpret diagnostic tests, prescribe medications, and form and manage treatment plans without physician supervision.

Others, like Texas, still require advanced practice nurses to have physician supervision of the medical aspects of their care.

Do advanced practice nurses provide medical care?

Advanced practice nurses are, as the name suggests, registered nurses with advanced training in the field of nursing. Yet, the scope of practice of advanced practice nurses includes some elements of medical care, which is in the physician field of medicine.

Texas Board of Nursing Rule 221.13(d) says, “When providing medical aspects of care, advanced practice nurses shall utilize mechanisms which provide authority for the care.” (emphasis added). The authority for the care can come through protocols or other written authorization developed with the input, agreement, and supervision of a physician.

Are advanced practice nurses accountable for medical malpractice in Texas?

Yes, advanced practice nurses, including CRNAs and nurse practitioners, can be sued for medical malpractice in Texas courts.

Texas Board of Nursing Rule 221.13(e) is clear that, “The advanced practice nurse shall retain professional accountability for advanced practice nursing care.”

According to a recent study of closed claims by a major professional liability insurance carrier, medical malpractice claims against nurse practitioners have increased sharply since 2017.

The study found the most common medical malpractice claims against nurse practitioners include allegations of:

• Misdiagnosis or improper diagnosis (40% of all claims)

• Medication errors (34%)

• Treatment and management of care (18% of all claims)

The study also identified the most common injuries in medical malpractice claims against nurse practitioners:

• Death (31% of all claims)

• Loss of a vital organ or organ function (13% of all claims)

• Cancer (12% of all claims)

If you’ve been seriously injured because of poor care from an advanced practice nurse, nurse practitioner, or nurse anesthetist/CRNA in Texas, then contact a top-rated and rated, experienced Texas medical malpractice attorney for a free strategy session about your potential case.

Article by

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.