Stop APRN Scope Expansion

TMA Testimony by Dara Grieger, MD

House Committee on Public Health
in Opposition to House Bill 1792

April 4, 2019

Good afternoon, Chairman Sheffield and members of the committee. I am Dr. Dara Grieger. In three months I will complete a second residency in general preventive medicine at The University of Texas Rio Grande Valley. Today, I’m representing myself and the nearly 53,000 members of the Texas Medical Association in OPPOSTION to House Bill 1792.

Before going to medical school, I was a nurse practitioner. I graduated from the Vanderbilt Bridge program in 1995. I went to this program because I had wanted to become a physician, but my undergraduate grades were not quite strong enough to gain admission to medical school. Several people told me being a nurse practitioner was basically like being a doctor, so I pursued that path. The program consisted of three semesters of registered nurse-level instruction and three semesters of nurse practitioner-level instruction. 

As part of the program, I had several structured clinical experiences in pediatrics, adult medicine, and family medicine. These clinical experiences involved working two to three days a week for a semester with approved nurse practitioner faculty who were well known to the school. Students would see selected patients and do a history and physical exam, then present the patient to the nurse practitioner and propose a treatment plan. We then would see the patient together with the faculty nurse practitioner, who would confirm our history and exam findings and finalize the treatment plan. If we made any errors, the faculty nurse practitioner corrected us, and we were expected to accept the correction gracefully. We also were expected to continue studying and show improvement over the course of the semester.  

This stands in stark contrast to the exploding world of online nurse practitioner education today. Online schools often require students to find their own preceptors. Often, the clinical experiences are merely shadowing at best. It is not unusual for a student not to show up for clinical hours and merely have the paperwork signed. And if the student receives negative feedback, often the school merely lets the student find another site. There is little clinical training. The former nurse practitioner in me is appalled and embarrassed by the poor quality of education in these online schools. I believe patients deserve better. They deserve to have a nurse practitioner who has been through a rigorous training program and who has hands-on patient experience with faculty overseeing his or her work in a clinical setting.  

But even the nurse practitioners who graduate from the strongest programs are not equipped to practice independently. The role was never intended to be an independent role. This became obvious to me during medical school. Medical school was a very humbling experience as I learned the depth of what I did not know as a nurse practitioner. Many times I realized I had inadvertently provided improper treatment for a patient simply out of ignorance. I came to realize, for example, the reason I struggled to understand how to interpret lab data as a nurse practitioner was that I hadn’t gained the in-depth knowledge of normal physiology and abnormal pathophysiology required to understand the “why” behind the lab tests. 

As a physician I have worked closely with nurse practitioners who were excellent, valuable members of the health care team. These nurse practitioners embraced the traditional role of working as part of a physician-led team. 

Members, I thank you for the opportunity to testify today. I am happy to answer any questions you have.

86th Texas Legislature Letters and Testimonies

TMA Legislative main page

Last Updated On

April 03, 2019