Protocol · NP · Texas
Practice Protocol for Nurse Practitioners in Texas
Required. Texas law names the instrument a Prescriptive Authority Agreement (PAA), and the clinical protocol is the content that instrument carries. Below: the board that governs it, what it must contain, and the terms it has to carry.
Texas remains a restricted-practice state with no independent-practice pathway for NPs at any experience level — confirmed by AG Opinion KP-0266 (2019) and BON's own APRN Scope of Practice Decision-Making Model. A 2025 rural 10-year/20,000-hour pathway bill (S.B. 3055) died in committee, as did 2023's full-practice-authority S.B. 1700.
What a Texas Prescriptive Authority Agreement (PAA) must contain
Governed by the Texas Board of Nursing and the Texas State Board of Pharmacy. Each numbered item is a statutory requirement the Prescriptive Authority Agreement (PAA) must satisfy.
The Nurse Practitioner shall practice pursuant to a written Prescriptive Authority Agreement ("PAA") with the Physician, as required by Tex. Occ. Code §§ 157.0511–157.0514. The PAA shall state the names, addresses, and license numbers of the Nurse Practitioner and the Physician; the nature of practice and practice locations and settings of each; the categories of drugs the Nurse Practitioner may or may not prescribe; and a plan for consultation, referral, and coverage in an emergency or in the Physician's absence, including a designated alternate physician.
The number of advanced practice registered nurses and physician assistants combined for whom the Physician may serve as the physician under a PAA may not exceed seven (7) full-time-equivalent providers, except as Texas law otherwise permits for practices in a medically underserved area or a hospital or facility-based practice. The PAA shall include a quality assurance plan providing for chart review, in a number the Parties determine, and for face-to-face meetings between the Physician and the Nurse Practitioner at least monthly until the third anniversary of the date the PAA is executed, and at least quarterly thereafter.
- The Prescriptive Authority Agreement (PAA) also carries 1 scope, 1 education and 1 registration clauses, authored in the document itself.
Statutes and rules these clauses cite
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the Prescriptive Authority Agreement (PAA) has to carry, from Texas's supervision rules.
Proximity
No proximity requirement
No mileage/radius or continuous-availability standard is codified; TMB treats distance between practice sites as one factor in judging 'adequate supervision,' not a fixed rule.
Supervision ratio
Up to 7 at a time (combined across provider types)
Same combined APRN+PA cap as the `pa` entry (§ 157.0512(c)) — one physician's total roster, not 7 NPs specifically. No cap at a facility-based hospital practice or medically-underserved site (§ 157.0512(d)).
Chart review
Not codified — left to the agreement
Meeting cadence
Monthly, in person or via telehealth
At least monthly (§ 157.0512(e)(9)(B), (f)), method flexible since H.B. 278 (2019) removed the prior in-person requirement. Chart review is required as part of the agreement's QA process, with the number of charts 'determined by the physician and advanced practice registered nurse' — no fixed percentage is codified (the commonly-cited 10% figure predates the 2013 restructuring and is obsolete).
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Requires individual DEA registration only (no separate DPS registration since S.B. 195, 2015). Texas statute also requires at least 2 hours of annual CE on pain management and identifying drug-seeking behavior for APRNs with opioid-prescribing authority (§ 157.0513(a)(4)); secondary sources report a further Board of Nursing CE-hour figure for controlled-substance prescribing generally, whose exact rule citation should be confirmed.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — No Texas statute lists APRNs (NP/PMHNP/CNM/CRNA/CNS) among the professionals eligible for physician joint-ownership under Tex. Bus. Orgs. Code § 301.012 — unlike PAs (see that entry), NPs have no statutory ownership pathway into a medical PA/PLLC at all, not even a minority one. An NP may own a nursing-scope-only entity under § 301.003's same-profession rule, but full-scope prescribing practice requires a physician-owned structure.
Sources for the supervision rules (8)
- Tex. Occ. Code § 157.0511
- Tex. Occ. Code § 157.0512
- Tex. Occ. Code § 157.0513
- Tex. Bus. Orgs. Code § 301.012
- 22 Tex. Admin. Code § 221.13(d) — BON, APRN practice standards
- Texas Board of Nursing — APRN Scope of Practice Decision-Making Model
- Tex. Att'y Gen. Op. KP-0266 (2019)
- S.B. 3055 (89th Leg., 2025) — rural independent-practice pathway, died in committee
About Texas's rules
Texas has no independent-practice pathway for any APRN type (NP/PMHNP/CRNA/CNM/CNS) at any experience level — a 2025 rural 10-year/20,000-hour bill (S.B. 3055) died in committee, as did 2023's full-practice-authority S.B. 1700. No chart-review percentage is codified (the physician and provider set the number themselves) — the commonly-cited 10%/20% figures reflect a pre-2013 rule since repealed. PA is the only non-physician profession with a statutory joint-ownership pathway into a medical entity.
Other clinicians in Texas: see the state overview.