Nurse Practitioner Scope of Practice: Texas

Ahh, the Lone Star State, famous for it’s spirit of pride and freedom, the Alamo and the invention of Dr Pepper.  Among the lesser known facts about Texas is that it is home to nearly 10,000 nurse practitioners.  Does Texas’ independent attitude extend to state laws governing NP’s?

Nurse practitioners in Texas do not enjoy as many freedoms as NP’s in many other states.  In fact, Texas falls at the lower end of the spectrum regarding the freedoms it offers nurse practitioners.  Let’s take a look at the laws governing nurse practitioners in the Lone Star State.

Texas’ Nurse Practitioner Supervision Laws

Despite attempts from nursing organizations to advocate for independent practice laws, nurse practitioners in Texas must work under physician supervision.  In 2009 and 2011, nursing organizations lobbied to change these laws but were unsuccessful largely as a result of physician protest.  Nursing organizations plan to again request changes to nurse practitioner supervision statutes sometime in 2013.

For the time being, nurse practitioners must practice under physician supervision.  The nurse practitioner must practice within 75 miles of the supervising physician.  Physicians may not supervise more than four nurse practitioners at one time.  The supervising physician must also ramdomly review at least 10 percent of the nurse practitioner’s patient charts each month.

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Texas’ Nurse Practitioner Prescribing Laws

Consistent with strict supervision guidelines, nurse practitioners in Texas are allowed to prescribe only under physician supervision.  Furthermore, they may only prescribe a 30 day supply of medications and are not allowed to prescribe schedule 2 drugs such as Lortab or Adderall.  All prescriptions written by the nurse practitioner must include the supervising physician’s name, address, DEA number and phone number.

Other NP Scope of Practice Laws

Nurse practitioners in the Lone Star State are not allowed to signs death certificates or handicap parking permits.  They are, however able to sign worker’s comp claims and be officially named primary care providers.

The scope of practice for nurse practitioners in Texas is limited.  In keeping with the state’s attitude of independence these rules and regulations will hopefully change in the future.  For now, NP’s practicing in Texas are subject to laws requiring strict physician supervision in prescribing and practice.

30 thoughts on “Nurse Practitioner Scope of Practice: Texas”

  1. Hi Rachel,

    The DEA is a national license so you shouldn’t have to have your supervising physician listed.  To prescribe medications legally in Texas though, you need to work under a supervising physician and have their name listed along with yours on the prescription.  In other words, having your DEA license isn’t the only thing you need to prescribe.

  2. Thank you for your reply Erin. I see that you keep saying at NP’s must practice under physician supervision in Texas. Is this the same thing as saying they must have a collaborating physician? Or saying that they need to have prescriptive authority? NP’s in TX need prescriptive authority to prescribe medication, correct? And if the NP wants to prescribe controlled substances they also need a DEA and DPS, correct?

  3. Hi Rachel,

    Yes, a supervising physician and a collaborating physician are essentially the same thing.  Each state has different laws regarding the relationships between NP’s and MD’s and defines the role of the supervising or collaborating physician in the NP’s practice differently.  

    To prescribe medications in Texas your supervising/collaborating physician will need to give you prescriptive authority.  All this involves is a statement in your collaborative practice agreement stating the NP is allowed to prescribe medication.  

    And yes, you do need a DEA number to prescribe medications.  I was not aware of the DPS but after doing a little research you do need this to prescribe controlled substances as well.

  4. You only need the DPS and DEA to prescribe controlled substances. Your prescriptive authority for dangerous drugs comes from the BON in addition to your collaborating physician. However, you also need a collaborating physician to cover your prescriptive authority for both dangerous drugs and controlled substances.

  5. First, become an RN. You can do an Associate’s Degree first and begin wniorkg if you want, but you will need a BSN to get to your goal. Both ASN (sometimes called ADN) and BSN are options for becoming an RN. An RN is someone who has gotten a nursing degree and has passed the NCLEX exam.Once you have your BSN, you apply to a Nurse Practioner graduate degree program.

  6. hi,
    we don’t need the DPS or DEA no to prescribe medications other than controlled substances,right???we just need prescriptive authority,right??

  7. In many states a podiatrist can supervise an NP. However, I wasn’t able to find this specific information for Texas. I would contact the Texas Board of Nursing to check.

  8. I just want to clarify, We must bill the NP as the rendering provider and the MD as the supervising provider on all claims?

  9. Please change the “Midlevel” name. It is very derogatory. In most other progressive states we are called APPs (Advanced Practice Professionals/Providers).
    We need to advance from the physician names for us and start recognizing that we are not “physicain extenders” or “Midlevels”.
    We are NPs

  10. It depends. You must be careful to follow patint privacy laws (HIPAA). Patients should all be asked if it is acceptable to have an NP who is not employed by the clinic/ hospital in the room and/or look at their medicl information. 

  11. In Texas if I have my own DEA number, DPS number on my script along with my prescribing physicians name. Do I have to also put my supervising physicians DEA on controlled substance scripts such as codeine???

  12. Hi Katie,

    I’ve found the answer. The Texas State Board of Pharmacy requires the DEA and DPS for the nurse practitioner and the DEA number for the delegating physician to be included on a prescription for any controlled substance. 

  13. I went to see a Dermatologist an M.D. The nurse practitioner did the initial consultation, make a diagnosis without taking any specimens and wrote a prescription without the M.D. being in the office, she wasn’t even in the country at the time. How is this legal?

    1. I would guess the NP was working within her scope of practice. If an NP or MD feel confident in their visual DX they would usually try the usual Rx for that. The MD May have been the one in that practice to usually do biopsies or scrapings and being unavailable the NP may have made a visual Dx and if that treatment failed on the return visit some lab might have been ordered. I’m a Pediatrician and have worked with a Pediatric Nurse Practitioner for the past 18 years. I trust her diagnostic skills and she doesn’t hesitate to ask my opinion which she rarely needs to do. We are in a very rural area and do not have ready access to specialists due to distance. We do what we can and refer to specialists 2 hours away when needed.

  14. who can help me find some documentation to clarify if NP’s can order therapy/nursing services or sign POC’s for home health?

  15. Why don’t the nurse practitioners in the state of Texas get together and Sue state for the right to work instead of being forced into extortion by the doctors in the state of Texas with the state of texas acting as the enforcer

  16. I realize this is an older blog, but has the 10% chart review changed for Texas? Is this still a requirement in 2016 ? Thank you.

  17. I am currently going through a lot of issues – I was given a shot in a hospital and caused Cellulitis (really bad down into my bone) and also causing Deep Vein Thrombosis. I was in the hospital for a week and we are currently waiting for the swelling to go down.. I left the hospital with enough pain meds to get me to my next appointment with one of the doctors I see. The doctor that I had been seeing is a Nurse Practitioner and I am afraid that she is not going to be able to give me the medication that I need to get me to my next appointment which will be the surgeon that is going to be doing surgery? Can this nurse practitioner help me because I have two that are I believe to be controlled substances, what should I do the pain is intolerable majority of the time and It is so bad that I am unable to sleep longer than 3 hours at a time. Any advise

  18. Can a NP work independently under telemed. For example Jane Doe NP independently owns her company/ Office and uses telemed for the physician in Texas?

  19. I want to life coach as a NP. I have had years of training and will be getting certified in anxiety. So many people are affected right now with mental health and need advocates with resources. If I am in the state of Texas and choose NOT to prescribe, work from home, strictly telemedicine synchronous visits….do I still have to get a physician to sign off on my charting? I plan on doing evaluations for ADHD/dep/anxiety and doing followups to help patients along their journey. This will be cash pay. Otherwise I may have to obtain a license in another state. I just don’t agree with paying a physician thousands of dollars monthly to look at charts that I obviously have enough experience with and NOT prescribing, referring to resources if needing prescriptions etc…
    Please advise.

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