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Flipping the Switch on Advanced Practice Business Models – Expanding State Enforcement

The message from Big Bend Regional Medical Center was stark: The only hospital in a sparsely populated region of far West Texas notified local physicians last month that because of a nursing shortage its labor and delivery unit needed to temporarily close its doors and that women in labor should instead be sent to the next closest hospital — an hour’s drive away.”

Texas licenses certified nurse midwives, certified professional midwives, and women’s health nurse practitioners. I believe that pregnant moms, living in this medical “dessert” would welcome certified nurse midwives, birthing clinics, and women’s health practices. But substantial roadblocks exist which severely circumscribe advanced practice nurses (APNs)  from becoming health innovators and entrepreneurs. Although all APN curricula were standardized to facilitate licensure over thirty years ago (including nurse practitioner and nurse-midwife educational requirements) and that curriculum supports full practice licensure in an excess of 20 full practice states, the Texas Nursing Practice Act requires Nurse Practitioners to have written “prescriptive delegation” consent—also referred to as a collaborative agreement— from a supervising physician. In addition to the TX Board of Nursing, NPs are also regulated by the TX Board of Medicine.  Only recently that TX finally eliminated the requirement that a doctor be on-site to oversee NPs at all times, and the fight continues. The Texas mandate limits practice to areas where physicians have offices. No physician, no collaboration. Yet states like Montana and North Dakota have allowed nurse practitioners to provide independent care in underserved areas almost since the beginning of the profession (1980’s).  

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