Could Rule Change Improve Rural Health Care in Texas?

by Mary Kuhlman

AUSTIN, Texas – There are more than 300 medically under-served communities in Texas that some groups say could be better served by a change in regulations.

Advanced Practice Registered Nurses, known as APRNs, are fully trained to treat and diagnose acute and chronic illnesses, and practice full primary care. But rules in Texas restrict them from providing care to the full extent of their education and training.

Elizabeth Ellis is a doctorate-level nurse practitioner who owns and operates the B.I.S. Community Clinic in Bedias. She explains a supervisory rule limits the scope of practice of APRNs because it requires them to have a contract with a collaborating physician.

“Texas is a large state with very large health care needs, and rural health needs,” says Ellis. “We need to get with the future and provide independent practice to our highly qualified and highly trained nurse practitioners that have experience. “

Texas ranks 46th among states for the number of physicians practicing in rural areas. AARP, the Texas Association of Business and the Texas Public Policy Foundation are among the groups that support expanding nurse practitioners’ scope of practice.

Research from the Journal of Nurse Practitioners shows that health outcomes for patients cared for by nurse practitioners is the same or better of that of a physician. And Ellis argues costly supervisory contracts can hamper patient care.

“We’re having to pay them and in my case divert funds away from my clinic that could be utilized towards providing additional equipment or services in my clinic so that I can pay for a physician to be my collaborating provider,” says Ellis.

Some physicians organizations argue that doctors have more extensive training and experience in patient care, and say rules are needed to ensure safety. But Ellis counters changing the regulations would not end collaboration between medical professionals.

“We all have our certain limitations and scope so if you’re a good practitioner you know where your limitations are and you’re always going to reach out to your colleague and to ensure the appropriate treatment plan for your patient when you need to,” says Ellis.

More than 20 other states allow nurse practitioners to work to the full scope of their training without a supervisory contract, and the Department of Veterans Affairs also extended full practice authority.