Driving APRN Policy: A Legislative Success James LaVelle Dickens, DNP, FNP-C, FAANP Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013

1. James LaVelle Dickens, DNP, FNP-C, FAANP

2.  Texas ranks 47th in the country in the supply
of primary care physicians
 Out of the 254 counties in Texas, 185 are
designated as medically underserved

3.  Historically, policies limited APRNs scope of
practice and restricted APRNs ability to
address the primary care shortage
 Primary care shortages will continue and the
aging population is on the rise

4.  The number of primary care providers per
100,000 rural population is significantly less
than in metropolitan areas

5. 0
2000
4000
6000
8000
10000
12000
2001 2011
Number of APRNs

6. Senate Bill 406
“Texas Team”
Action Coalition
The Future of
Nursing: Leading
Change,
Advancing Health

7.  June 14, 2013 Senate Bill (SB) 406 was signed
into law by Governor Rick Perry
 SB 406 - first piece of legislation in over a
decade that significantly broadens APRN
scope of practice

8.  October 2010 - Institute of Medicine (IOM)
report released, The Future of Nursing:
Leading Change, Advancing Health
 IOM Recommendation – remove barriers that
prevent APRNs from practicing to the fullest
extent of their education and experience

9.  The Future of Nursing: Campaign for Action
was created under the Robert Wood Johnston
Foundation
 Texas based action coalition was “born” and
named “The Texas Team; Advancing Health
through Nursing”

10.  The Texas Team worked to increase access to
care for Texans through expanded scope of
practice for Advanced Practice Registered
Nurses (APRNs)
 And employed specific strategies to achieve a
successful inter-professional collaboration.

11.  November 2011, “The Texas Team” convened
the APRN Roundtable
 Texas Nurses Association, Coalition for
Nurses in Advanced Practice, APRN specialty
organizations were represented at the
roundtable

12.  APRN Roundtable - strategies were identified
by the groups to achieve consensus on scope
of practice expansion

13.  May 2012 – APRN groups testified to
legislative committee
 Intent to move forward with legislative
change in Prescriptive Authority model

14.  Dr. Ray Perryman issued report regarding the
economic benefit in greater utilization of
APRNs

15.  Senator Jane Nelson, Chair of Senate Health
and Human Services Committee
 Representative Lois Kolkhorst, Chair of the
Public Health Committee
 Legislators encouraged collaboration between
nursing and medicine

16.  Negotiations began on new model
 Texas Nurses Association
 Coalition for Nurses in Advanced Practice
 Texas Nurse Practitioners
 Texas Medical Association
 Texas Academy of Family Physicians
 Texas Academy of Physician Assistants
 Senator Jane Nelson and staff
 Representative Lois Kolkhorst and staff

19.  SB 406 was filed on February 26, 2013
 Signed by Governor on June 14, 2013
 Effective November 1, 2013

20.  Eliminates the requirement for onsite
physician supervision
 Allows physicians to delegate drug and
durable medical devise prescribing authority
to an APRN or PA

21.  Increases the number of APRNs or PAs to
whom a physician can delegate prescriptive
authority from 4 to 7
 Improved coordination between the Texas
Medical Board and the Board of Nursing

22.  Allows physicians to delegate prescribing
authority to APRNs and PAs for Schedule II
controlled substances in hospital and hospice
settings

23.  Outcomes
 Lessons learned
 Moving Forward

24.  Peck, J. L., Addressing the Texas Health Care Crisis: Effective Use of Advanced Practice
Registered Nurses. The Journal for Nurse Practitioners. 2013; 9 (2):116-120.
 Tovar, S. APRNs Achieve First Expansion of Prescriptive Authority in a Decade. Texas
Nurses Association. The Nursing Voice. July 2013