Practice Agreement · RN
Registered Nurse Practice Agreement in Texas
Texas law does not require a Registered Nurse to hold a named agreement with a physician. Practices still use one to define the working relationship; here is what it covers and what the state does require.
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 Registered Nurse practice agreement covers in Texas
Governed by the Texas Board of Nursing. Each numbered item is a statutory requirement the agreement must satisfy.
The Registered Nurse ("RN") shall practice under the orders, standing medical orders, or standing delegation orders of the Physician, consistent with the Texas Nursing Practice Act, Tex. Occ. Code Chapter 301, and Tex. Occ. Code Chapter 157, Subchapter A. Unlike the Prescriptive Authority Agreement required of Advanced Practice Registered Nurses and Physician Assistants, Texas law does not require such an agreement for this Registered Nurse's general scope of practice; the Physician shall instead be available to the Registered Nurse for consultation regarding clinical and patient care issues arising under any order or delegation.
- The agreement on file also carries 2 scope, 2 education, 2 registration clauses, generated in the document itself.
Statutes and rules cited
- 22 Tex. Admin. Code § 295.13regulation
Texas Medical Board / Texas State Board of Pharmacy rule governing drug therapy management by a pharmacist under a physician's written protocol, including required protocol contents and physician oversight duties.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.
Proximity
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · 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.
Legal sources for these 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.