Delegation Agreement · RN
Texas Standing Delegation Order for Registered Nurses
Recognized but not required in every case. The Standing Delegation Order is the written instrument Texas law names for a Registered Nurse working with a physician. Below: the board that governs it, what it contains when one is used, and the supervision rules that apply either way.
RNs (general licensure, not an APRN) are not subject to physician supervision in Texas — 22 Tex. Admin. Code § 217.11 imposes a 'directed, supervised' scope only on LVNs, by contrast with RNs' unsupervised practice. Nonsurgical medical-cosmetic procedures (Botox, fillers, energy-device treatments) are separately classified as the practice of medicine requiring physician delegation (22 Tex. Admin. Code §§ 169.25–.29, eff. Jan. 9, 2025) regardless of RN licensure.
What a voluntary Registered Nurse agreement covers in Texas
Texas requires no written agreement for registered nurses. These are the clauses a practice includes when it chooses to put one in writing. The Texas Board of Nursing governs registered nurses here.
Physician prepares the standing delegation order as written instructions for a patient population with specific diseases, disorders, health problems or sets of symptoms, setting the conditions under which Registered Nurse may act before the patient is examined by a physician.
- The Standing Delegation Order also carries 1 scope and 1 education clauses, authored in the document itself.
Statutes and rules these clauses cite
- Texas Board of Nursing Position Statement 15.5, Nurses with Responsibility for Initiating Physician Standing Orders (rev. 01/2024)board guidance
Applies to LVNs and RNs; quotes the Texas Medical Board definitions of standing delegation orders and standing medical orders (22 Tex. Admin. Code §169.1), states only a physician may issue them (APRNs only in school settings under the Education Code), and bars RNs and LVNs from TMB-defined protocols.
What Texas does require
The supervision and prescribing rules that apply to registered nurses regardless of any agreement.
Proximity
Not codified
Supervision ratio
Not codified — no cap on file
Chart review
Not codified
Meeting cadence
Not codified
Prescriptive authority
No agreement needed to prescribe · no controlled-substance authority
RNs do not have prescriptive authority in Texas under any circumstance; prescribing requires APRN or PA licensure plus a Prescriptive Authority Agreement, or physician/dentist/podiatrist licensure.
Written agreement
Not required
Unconditional — general RN licensure is never subject to physician supervision or a Prescriptive Authority Agreement in Texas, unlike the APRN/PA categories above. This doesn't extend to delegated medical-cosmetic procedures — see notes.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — An RN may own a nursing-scope entity (e.g., a home-health or staffing business) under Tex. Bus. Orgs. Code § 301.003's same-profession rule. Non-clinical businesses fall outside that restriction entirely.
For medical-aesthetics (med-spa) businesses performing nonsurgical medical-cosmetic procedures, 22 Tex. Admin. Code §§ 169.25–.29 (eff. Jan. 9, 2025, replacing former § 193.17) classifies those procedures as the practice of medicine requiring physician delegation, on-site signage naming the delegating physician, and staff ID badges — the RN may not own the clinical entity performing them; the common workaround (secondary-sourced, law-firm guidance) is an MSO structure where the RN owns the business/management side and a physician-owned PLLC holds the clinical entity. Separately, H.B. 3749 ('Jenifer's Law,' 89th Leg., eff. Sept. 1, 2025) newly restricts who may administer elective IV therapy to physicians, PAs, APRNs, and RNs, with prescribing/ordering still requiring physician delegation to PAs/APRNs — directly relevant to RN-staffed IV-hydration/med-spa businesses.
Sources for the supervision rules (4)
- 22 Tex. Admin. Code § 217.11 — Standards of Nursing Practice
- Tex. Bus. Orgs. Code § 301.003
- 22 Tex. Admin. Code §§ 169.25–169.29 — Texas Medical Board, Nonsurgical Medical Cosmetic Procedures (eff. Jan. 9, 2025)
- H.B. 3749 (89th Leg., 2025) — 'Jenifer's Law,' IV therapy administration
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.