Finding a Collaborating Physician in Texas
The role of nurse practitioners (NPs) continues to evolve, and so does the importance of establishing strong collaborative relationships with physicians.
From demystifying legal requirements to fostering positive and collaborative working relationships, Zivian Health empowers nurse practitioners to navigate the process with confidence, ultimately elevating the standard of care for the communities they serve.
For nurse practitioners embarking on this journey, the quest for a suitable collaborating physician can be challenging. In this post, we provide insights and practical tips for NPs navigating the landscape of finding a collaborating physician in Texas.
Below, we outline Texas state regulations and things to consider while trying to find a collaborating doctor in the Lone Star state.
Note: State regulations and requirements are subject to change. Always check with your state medical or nursing board to confirm the most up-to-date information.
Overview: The Importance of Collaboration in Texas
Texas has specific regulations governing the collaboration between nurse practitioners and physicians. According to the Texas Occupations Code, a nurse practitioner must have a delegated prescriptive authority agreement with a physician to practice.
This agreement outlines the scope of collaboration, including the approval of certain advanced practices and medication prescription privileges. Nurse practitioners must familiarize themselves with these regulations to navigate the process effectively.
What Is the State Practice Environment for NPs in Texas?
Is a collaboration required?
Yes, a collaboration is required for NPs in the state of Texas.
Delegation Authority & Process
Is an agreement required?
Yes, a “prescriptive authority agreement is required in order for an APRN to prescribe. A “protocol” or other written authorization is required for medical acts.
Instead of multiple documents, protocols can be included in one document with the prescriptive authority agreement.
What form of agreement is required and what are the requirements for the substance of the agreement? Is use of a state template required?
To learn more about the required components of a collaboration agreement or prescriptive authority agreement in Texas, contact our team today!
Where must the agreement be stored?
An APRN who is part of a prescriptive authority agreement must keep a copy of the agreement within their practice setting until two years after the official termination date of the agreement.
Does the agreement need to be filed with the state?
No, it does not need to be filed with the state.
Are there additional requirements after the initial filing of the agreement?
Physicians are required to register all PAs and APRNs that they supervise prior to the delegates beginning to work. If there is a change to the scope of the delegation, physicians must notify the Texas Board of Nursing within 30 days of this change.
Who must sign the agreement?
The APRN, delegating physician, and alternate physician (if applicable).
How often must the agreement be reviewed and/or reauthorized?
The agreement must be reviewed and signed annually by all parties.
Are there any required qualifications for the collaborating provider?
No, there are no specific requirements.
Is an alternate collaborating physician required?
No, an alternate collaborating physician is not required, but it is permitted.
Collaboration Requirements
Are there ratios/limits on the number of NPs that a collaborator may supervise or enter into collaboration agreements?
1:7 NPs and PA “full-time equivalents” at any one time.
Note: there is an option for higher ratio if treating a medically underserved population or if in a facility-based practice within a hospital.
Is there an express requirement to review a certain number/percentage of charts?
There are no restrictions.
Is there a requirement to meet and, if so, how often and how?
Monthly meetings are required and must be documented.
Are there proximity requirements? (e.g., between the NP/collaborator or practice site)
There are no restrictions.
Are there location-specific requirements (e.g., that collaborator must go to practice site at some frequency)?
There are no restrictions.
Is remote supervision allowed/are there limitations on remote supervision?
There are no restrictions.
Prescription Requirements & Controlled Substance Prescribing
What are the prescription requirements?
Prescriptions written by nurse practitioners must include:
The patient's name and address.
The name, strength, and quantity of the drug to be dispensed.
Directions to the patient regarding taking of the drug and the dosage
The intended use of the drug, if appropriate.
The name, address, and telephone number of the physician with whom the APRN has a prescriptive authority agreement or facility-based protocols or other written authorization.
Address and telephone number of the site at which the prescription drug order was issued.
The date of issuance.
The number of refills permitted.
The name, prescription authorization number, and original signature of the APRN who authorized the prescription drug order.
The United States Drug Enforcement Administration numbers of the APRN and the delegating physician, if the prescription drug order is for a controlled substance.
What are the requirements for controlled substance prescribing?
APRNs may prescribe schedule II drugs in the following situations:
In a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who meets one or more of these criteria:
Has been admitted to the hospital for an intended length of stay of 24 hours or greater
Is receiving services in the emergency department of the hospital
As part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
APRNs must consult with the delegating physician for refills of a prescription for controlled substances after the initial 90-day supply and every 90 days thereafter as long as the patient continues to receive a prescription for controlled substances. Consultation is also required when prescribing controlled substances for children under the age of two years. In both cases, the consultation must be documented in the patient’s medical record.
Find a Collaborating Physician in Texas with Zivian
Zivian Health helps nurse practitioners connect with physicians within their specialty in a secure online collaboration software. Our mission is to simplify and streamline compliant collaborations to empower NPs and expand access to health care.
We’ll match you with a collaborating physician in a matter of days. Plus, you’ll have access to our easy-to-use platform to track all of your state requirements, including meetings, chart reviews, and licensure.
Get started with Zivian today by contacting us here.
