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.
A number of legislative attempts have been made to relax the rules governing nurse practitioners in Texas, but have yet to make it out of the legislature. The main opposition to such change is the Texas Medical Association, which supports the current rules, said Susan Bailey, the association's president. "We feel that it's important that [nurse practitioners] work as part of a team, supervised by physicians," Bailey said. "We understand there is a shortage of caregivers in Texas ... and we don't think that expanding prescribing authority for nurse practitioners is the way to address the shortage issue. We think it's a patient safety issue."
Thirty-five states and the District of Columbia allow nurse practitioners to work within their scope of training to prescribe and make diagnoses with high levels of autonomy — some allowing nurse practitioners to work fully independent of a physician, said Sandy McCoy, president of Texas Nurse Practitioners. With the overwhelming majority of Texas counties federally designated as completely or partially medically underserved, McCoy said, relaxing nurse practitioner rules could go far in filling the need for more primary care practitioners while reducing health care costs.
"The vast majority of Texas counties have some or all of their populations facing access-to-care problems," said Amanda Fredriksen, director of advocacy at AARP Texas. "We think that allowing advanced practice registered nurses to practice to the full extent of their training would help address that. We've got this whole cadre of health care professionals that we're not making the best use of."
A study published in the Journal of the American Medical Association in 2000 found no significant difference in health outcomes between patients treated by nurse practitioners and those cared for by physicians.
Susan Haynes, who works in a senior health clinic in the city of Round Rock, said that as a nurse practitioner she's able to spend more time getting to know and educating her patients. "Nurse practitioners treat people; doctors treat diseases," she said.
"I think if you turned us loose, you would see more of us setting out as entrepreneurs to start our own clinics," Haynes said.
Women's health nurse practitioner Connie Ryan, who founded Central Family Practice in Austin in 1998, said she hopes things change in Texas, so that more nurse practitioners are allowed to practice in areas that lack primary medical care. She said that while working collaboratively with a physician is important to her, being supervised by a physician is not necessary.
"I understand that physicians do not want to give up what they feel is their turf and their control over an increasingly uncontrollable medical environment," Ryan said. "But I also understand that nurse practitioners are capable of giving good, safe care within their scopes of practice."
Also of interest: State-by-state guide of nurse practitioners. >>
Kim Krisberg is a freelance writer based in Austin, Texas.