TNA outlines key to reviving bill to remove APRN restrictions

House Bill 2029 — this session’s effort to remove practice restrictions for advanced practice registered nurses (APRNs) in Texas — failed to gain momentum in the Legislature, despite being a high priority bill for numerous stakeholders aiming to expand APRNs’ capacity to practice. Dr. Serena Bumpus, director of practice at the Texas Nurses Association (TNA), spoke with State of Reform about why the bill failed and future efforts to remove these restrictions.

Texas nurses are currently subject to delegation agreements with physicians, in which the presiding physician has authority over which procedures APRNs may perform. These agreements prevent APRNs from providing medical services, like prescribing drugs or ordering diagnostic tests, without receiving approval from their supervising physician.

 

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Advocates say these barriers prevent APRNs from providing critical services to patients, limiting Texans’ overall access to health care. Opponents argue the bill would give too much authority to nurses who haven’t necessarily received the training that physicians have.

Sponsored by Rep. Stephanie Klick, HB 2029 would have removed these restrictions and added Texas to the 31 states who have already done so. The House Public Health Committee — chaired by Klick — held an initial hearing for the bill in March, after which it was left pending. After this, the bill didn’t budge.

Bumpus said part of the difficulty with advancing HB 2029 was due to the unique nature of this session.

“This session was actually a really tough session in general to get bills passed, just due to the pandemic and the very big snow storms that we had back in February. A lot of that shifted the focus for our legislators.”

However, Bumpus explained the primary obstacle was the legislative defense mounted by physicians. Multiple committee members sided with physician advocates on the issue, barring the legislation from advancing.

“At the end of the day, we just didn’t have enough votes to get the bill out of committee. Our physician colleagues worked really hard to kill the bill, and used their historical campaigns that they’ve used before to try and do that. And we’ve got some work to do.”

Physicians have strongly lobbied against the legislation, claiming these restrictions prevent APRNs from performing medical procedures only trained physicians should be able to perform. Speaking on behalf of his organization, Texas Medical Association President David C. Fleeger, MD, released a statement condemning the legislation in February:

“We will not stand by and watch the AANP [the American Association of Nurse Practitioners] and their supporters try to pretend that our years of medical school training and residency do not make a difference. No one has the skills and education that physicians have that qualify us to lead the patient care team. And ultimately, we have the responsibility for our patients’ health.”

According to Bumpus, one of the main impediments to removing these restrictions is misunderstanding between physicians and advocates about what the bill would do.

“We’re not asking for our APRNs to do anything outside of what they currently do already. We’re not asking for their scope to be changed at all. It’s really just asking to have the red tape removed, and that the contract requirements removed.”

She said clearing up confusion about how this bill would impact the APRN scope of practice is key to pushing it forward.

“There has been some confusion around the APRN scope of practice, and what they can and can’t do, and what this bill would allow them to do. And in all honesty, this bill is not allowing them to do anything beyond what they’re doing right now. So we have to do some education in that realm to try and clear that up.”

While Bumpus said some physician colleagues have joined TNA in supporting the legislation, there is still a lot of work to do to get opposed physicians on board. During the interim, TNA plans to continue building support through the Texans for Healthcare Access coalition — a group of over 30 stakeholder organizations that strongly supported this legislation.

Part of this work will include engaging with APRNs across the state to ensure they support the initiative. Having nurses call legislators and use their social media to promote the legislation will help build the support needed to pass the bill in the 2023 session, Bumpus said.

Drawing from the support of physician members of Texans for Healthcare Access — such as Physicians for Social Responsibility — TNA hopes to get a broader coalition of physicians on board.

“[We will be] leveraging those partnerships that we do have in that coalition to help get the message out to the other physicians who might have concerns, or sort of be on the fence.”