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Nurse Practitioners Call for Greater Independence

Relaxed rules could help medically underserved

Texas State Page February 2011

Alta Walter, a nurse practitioner in Waco, is one of the few in Texas who owns her own practice. Nurse practitioners want state restrictions relaxed so they can practice with less direct supervision from physicians. — Photo by Van Ditthavong

Nurse practitioner Alta Walter knows her patients. Often, she visits them where they live, developing relationships to the point where a simple nonverbal cue can tell her that something is wrong. She charges less than a physician, so her patients can visit her more often.

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"I use a lot of prevention and a lot of referrals [to physicians]," said Walter, 59, a nurse practitioner for a decade who specializes in geriatric patients.

A nurse practitioner is a registered nurse who has advanced education and clinical training in a health care specialty and can serve as a primary health care provider for children and adults.

Nurse practitioners are trained to provide a number of health care services, such as physical examinations, family planning services, diagnosing and treating acute and chronic illnesses, psychological counseling and health education. Nurse practitioners in Texas can prescribe medicine if they have an agreement with a physician. Under these agreements, they can prescribe certain, but not all, narcotics. They are barred from performing major surgery.

Walter is one of the few nurse practitioners in Texas who owns her own practice — Central Park Clinic in Waco. Under state rules, a physician visits Walter's clinic every couple of weeks to review a sample of her patient charts. Walter said she was lucky to find a "special doctor" who "understands what we do." Unfortunately, not all nurse practitioners in Texas are so lucky.

Texas is one of the strictest states in the country for nurse practitioners who want to open their own clinics, requiring them to find a physician with the willingness and time to follow a complex set of rules. Those rules include requiring the physician to delegate prescriptive authority, review patient charts, make on-site visits or practice within a certain geographical distance of the nurse practitioner. It's a system many nurse practitioners say is unnecessary and burdensome, especially in light of the state's considerable health access problem and the success of nurse practitioners in other states who practice without such direct physician supervision.

"It's really something that is limiting access to care and taking up physician and nurse time," said Lynda Woolbert, executive director of the Texas-based Coalition for Nurses in Advanced Practice. "There's no other state that has this type of very specific, site-based supervision."

Woolbert said she hopes to see legislative changes in which advanced practice nurses are granted diagnosing and prescribing authority solely from the state's Board of Nursing and not from a physician, such as in New Mexico.

Next: More independence for nurse practitioners? >>

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