dding a nurse practitioner (NP) or physician assistant (PA) to your Texas practice offers a way to share the workload and expand patient care. Before hiring, it helps to understand the responsibilities that come with the working relationship.
Building the supervision framework
The first step is to define each provider’s duties and your responsibilities as the supervising physician. Delegation gives them authority to perform certain medical tasks, while supervision covers your ongoing oversight of that work.
An NP does not need physician delegation for nursing duties within their licensed scope of practice. Medical acts, however, require written approval, such as a protocol that you both agree to and sign. The duties it covers must fit the nurse’s education and the limits of their license.
A PA provides delegated medical services under continuous physician supervision, but you do not have to stay on-site at all times. When you are away, you and the PA must be able to reach each other easily by phone or a similar device. You remain responsible for overseeing their care, so being available is only part of your role.
Establishing prescriptive authority
If the provider’s role includes prescribing or ordering drugs and devices, that authority needs separate attention. In most office practices, Texas law requires a written prescriptive authority agreement before an NP or PA takes on that responsibility.
Alongside that agreement, you must register the delegation with the Texas Medical Board. An NP also needs approval from the Texas Board of Nursing to prescribe, so your authorization alone does not satisfy all the requirements.
Allocating liability among the parties
When a patient suffers harm, the provider who treated them is not necessarily the only party facing a claim. You can also face liability if negligent delegation or poor supervision helped cause the injury. The employing practice can be liable for an employee’s negligence when it occurs within the scope of their employment, even without a separate failure in oversight.
Clear written responsibilities help prevent gaps in care, but they do not decide who is legally at fault. Assigning a task to an NP or PA does not remove your own duties under Texas law, so the working arrangement must support those obligations in daily practice.
Sustaining compliance over time
Once the agreements are in place, keeping them current becomes part of running the practice. That includes tracking each provider’s license and prescribing status, along with completing and documenting the required chart reviews and meetings. You and the provider must also review, sign and date the prescriptive authority agreement at least annually.
When delegated duties change, the written terms and board records need to reflect the new arrangement. If a supervising physician leaves, appropriate replacement coverage must be in place before the provider continues services that require it, rather than waiting until the next scheduled review.