Texas NPs are putting plans in place to increase access to nurse practitioners in the state. In preparation for plans to introduce a bill in 2011, the Texas Coalition for Nurses in Advanced Practice (CNAP) contacted local media to convey their goals and explain the barriers to practice that NPs experience.

In an article carrying the headline "Diagnosis: Turf War," The Texas Tribune described the plight of Prudie Orr, a psychiatric NP who has not practiced since 2009 because she's been unable to find a physician willing to collaborate. "I have to go hat in hand to these folks to see if they will grant me the privilege of making a living," Orr told the newspaper.

Texas holds its legislative sessions in odd years, and the next session starts in January 2011. "In order to maximize our chances of success in 2011, we have to get a jump start on helping people understand the issues," said CNAP executive director Lynda Woolbert, NP. "We want Texas law for NPs to be consistent with the model legislation adopted by the National Council of State Boards of Nursing."

Woolbert said that 90% of Texas counties are designated in whole or in part as medically underserved, and 25 counties have no physicians.

"Greater reliance on NPs will lead to much greater access to safe, cost-effective and comprehensive high-quality healthcare," she said. "There are more than 7,900 nurse practitioners offering a broad range of services, including performing physical exams, ordering diagnostic tests, and managing acute and chronic illnesses."

All advanced practice nursing organizations in the state are making efforts to ensure that NPs visit legislators in their home districts to talk with them about the need for statutory changes that would expand NP diagnostic and prescriptive authority. Current law in Texas requires that a physician delegate "medical acts" to NPs. It further hinders efficient practice by limiting physicians to delegating prescriptive authority in only certain sites.

"Texas law is convoluted, cumbersome and must be modernized to meet current and future demands on the healthcare system," Woolbert said. "Getting rid of the delegated, site-based requirement for prescriptive authority is the only no-cost solution being proposed to help Texas's primary care provider shortage.

We will have much more to report in 2011."