Austin Advanced Practice Nurses

CNAP Interim Report - May 17, 2012

Posted almost 7 years ago by Glenda Velji

Call To Action

[Note: Underlined phrases link to additional information.  If you have difficulty, visit the CNAP Home page directly,]
The Coalition for Nurses in Advanced Practice, in conjunction with other nursing organizations and the Texas Team, announced at a press conference on May 14, 2012, a legislative initiative to take forward to the 83rd Legislature when the session begins in January 2013. Simultaneously, the Texas Team unveiled an economic study done by a well-acclaimed economist, Ray Perryman, which examines the impact of greater utilizing advanced practice nurses as recommended by the Institute of Medicine’s (IOM) report,
The Future of Nursing: Leading Change, Advancing Health.
The Perryman Report estimates that the medical cost savings resulting from the efficiencies created by greater utilization of APRNs by removing some of the existing legal barriers would yield a broader economic impact that includes over $8 Billion in gross product and over 97,000 new jobs, annually; an estimate that he assures is conservative.  The overall economic stimulus is over $16 Billion, plus there is a gain to state and local sales tax revenue of over $480 Million and $230 Million, respectively.  This is great information to share with your legislators.  Please take time to look at the report.  Note the appendices where the data is broken down by counties.  It really drives the point home, when you can tell your Senator and Representative how changing the law can improve the economy and job creation in his/her area and can back it up with the facts.
CNAP’s proposed 2013 Legislative Initiative would eliminate delegation and the current overly complex site-based restrictions.  Under this collaborative model, an APRN would be credentialed by the Board of Nursing (same as current law) and must secure and maintain a collaborative prescriptive authority agreement with a physician, or physician group, for the purpose of referrals and consultation. Currently, Texas is among the most restrictive of states (15) which require physician delegation and certain specific acts of supervision. On the opposite end of the spectrum, the laws of 18 states plus the District of Columbia provide for independent practice, which allows APRNs to practice to the full extent of their education and certification (as suggested by the IOM report).  Our 2013 Legislative Initiative would move Texas into the middle category with 17 other states that currently provide for collaborative prescriptive authority agreements.  A map demonstrating the comparison of states is available on the CNAP Web site.
CNAP has worked diligently with its member organizations and related stakeholder groups for many months to develop a legislative initiative that will have consensus among all nursing groups and other important allies.  With little to no progress made in the last two legislative sessions when only independent prescriptive authority was sought, it is felt by nursing advocacy groups and our allies that this collaborative agreement approach is more advisable at this time.
Press coverage following the Monday press conference was extensive and provided a very nice backdrop for the legislative hearing the next morning.  (To review the press coverage, click here.)  The day after the hearing, HHSC Commissioner Tom Suehs, Representative Garnet Coleman (D-HD 147, Houston) and our own lobbyist Kathy Hutto were interviewed by KUHF-FM, Houston’s Public Radio Station. To listen to that interview, click here.
When the House Public Health Committee met May 15, 2012, in Houston at the UT School of Public Health, it considered interim charges related to: (1) state changes in Medicaid funding and service delivery; and, (2) a lengthy multi-faceted charge that includes workforce, access to care issues and the phrase we all hate, “physician extenders”.  It reads as follows.
                Examine the adequacy of the primary care workforce in Texas and assess the impact of an aging population, the passage of the Patient Protection and Affordable Care Act, and state and federal funding reductions to graduate medical education and physician loan repayment programs. Study the potential impact of medical school innovations, new practice models, alternative reimbursement strategies, expanded roles for physician extenders, and greater utilization of telemedicine. Make recommendations to increase patient access to primary care and address geographic disparities.
The 2013 Legislative Initiative and the Perryman Report were presented to the committee during testimony by Commander James Dickens, a Dallas FNP with the Office of the Assistant Secretary for Health representing the Texas Team.  Marty Strong, a PNP in private practice in Richardson testified on behalf of CNAP and TNP.  As she described her clinic and the Medicaid/CHIP population she serves as well as the recent problems she has encountered upon the unexpected death of her delegating physician, Marty made a strong case for why the laws in Texas need to be changed.  Both faced some tough questions, but represented their profession well.  Concerns continue to be expressed about physician liability, the appropriateness of allowing APRNs and PAs to prescribe Schedule II drugs, and whether the BON is the appropriate place for APRNs to be regulated if they are functioning without delegation. 
Prior to this panel, though, the committee heard presentations from officials with certain state agencies (HHSC, TMB, BON, Higher Education Coordinating Board, and the Statewide Health Coordinating Council), followed by officials of the state’s medical schools. There was also a panel representing the interests of physicians (TMA, TAFP, White Glove Health, and a first year physician in residency).
For over eight hours, the committee listened earnestly and asked many questions of each of the panels.  Then they heard public testimony.  Cyndee Malowitz, ANP, GNP and FNP, described the care she provides at Bay Area Quick Care in Corpus Christi and the challenges she finds practicing in Texas after practicing in New Mexico where she had independent prescriptive authority.  She too did a great job!
At the end of the hearing, it was clear there is a great deal of interest in greater funding for medical schools and graduate medical education to improve the shortage of primary care physicians.  However, the interest in better utilizing APRNs to address provider shortages appears to have made progress, but we still have a lot of work to do.  With the Perryman Report, we are well positioned to do that work, but need your help to spread the message.


CNAP and all APRNs must remain diligent in efforts to improve legislative understanding and willingness to forge change.  The imposing crisis in access and affordability of safe patient care may create just the tipping point needed to advance such change.  Here is what you can do to make a difference:

1. Contribute to CNAP now so we can continue our advocacy and educational efforts. (Click here)  Remember: Only about a third of CNAP’s revenue comes from our member organizations, and a much smaller portion comes from sale of educational products, but over half comes from individuals.  WE rely on YOU to continue our efforts on your behalf.

2. Contribute to the Texas RN/APN PAC. (Click here)

3. During the next eight months before the beginning of the legislative session, contact your state representative and senator to visit with them in your home district about the health care you give and the importance of changing the law to allow APRNs to better practice to the full extent of their education. (Click here to find your state senator, and click here to find your state representative.)

4.  Remember to vote.  Early voting has started and the Primary is on May 29th, the day after the Memorial Day holiday.  Many of our friends and supporters are in tough races and need our support.  If we want them to be there for us next session, we must be there for them now!