Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2026

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Mary Jean Schumann, DNP, MBA, RN, CPNP-PC, FAAN

Keywords

East Texas; Full Practice Authority; Healthcare Policy; Healthcare Professional Shortages; Access to Healthcare

Abstract

Background: Texas is one of many states that faces healthcare professional shortages which ultimately results in poor healthcare system performance. The lack of access to healthcare providers is an ongoing challenge that is expected to continue through 2036. One solution to the healthcare access challenge is passing full practice authority (FPA) for advanced practice registered nurses (APRNs) in the state of Texas.

Objectives: This policy analysis was undertaken to evaluate current APRN practice restrictions in Texas and explore policy reforms to address healthcare workforce shortages. Specific objectives included examining primary care health needs in East Texas, workforce needs for primary care nurse practitioners, physician assistants, and physicians, reviewing policy trends in FPA states, and proposing policy recommendations to expand APRN practice authority.

Methods: Bardach’s Eightfold Path framework was utilized to conduct a policy analysis of APRN practice authority in Texas. Data sources included state and national workforce reports, legislative records, and peer-reviewed literature. The policy analysis evaluated workforce distribution, access to care indicators, Texas legislative history, and a multistate legislative review.

Results: The East Texas region has the highest shortage of primary care physicians at 51% unmet demand. Further analysis of the 23 East Texas counties of interest showed that nurse practitioners represent a substantial component of the primary care workforce across East Texas, particularly in rural communities where physician supply is limited. These findings highlight the critical role nurse practitioners play in maintaining access to primary care services in underserved areas of the state. The multistate review revealed that eleven of the twenty-seven states that have passed FPA did so with transition-to-practice (TTP) hours in place. These findings informed development of policy recommendations for the state. Texas continues to experience legislative barriers to FPA adoption despite repeated proposals spanning nearly two decades. The legislative history outlined a complex political landscape in which further legislative education is needed. A total of 60 legislators in both the House and Senate were contacted, with meetings held among 23 legislative teams. Majority of the 23 legislators supported FPA; however, there is still opposition. Concerns centered on the variation in clinical training and education.

Conclusion: The recommendation to modernize Texas laws through adoption of FPA, with a structured 2,080 transition-to-practice period, would support improved healthcare access and workforce efficiency. With a surplus of nurse practitioners (NPs) in Texas, NPs are the most stable and scalable healthcare workforce. Continued legislative engagement and stakeholder education are recommended.

Implications: Adoption of FPA in the state of Texas would strengthen the healthcare workforce, improve access to healthcare, and create more opportunities for APRNs.

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