Do NPs need a supervising physician in Texas?

Yes. In Texas, nurse practitioners need a supervising (delegating) physician when exercising prescriptive authority or performing delegated medical acts through a written prescriptive authority agreement between the APRN and the physician¹. This agreement governs the scope of delegation and establishes how the physician will supervise and collaborate.

The prescriptive authority agreement must include specific elements (e.g., practice settings, drug categories, consultation/referral plans) and requires at least monthly meetings to discuss patient care and document quality assurance activities¹. Additionally, the delegating physician must register the agreement with the Texas Medical Board within 30 days of signing, listing the APRN and practice locations where prescribing will occur².

Prescribing of controlled substances by APRNs is permitted only through physician delegation, with limits: Schedules III–V are restricted to 90 days (and refills require physician consultation), and Schedule II prescribing is allowed only in hospital facility-based practice or hospice plan-of-care contexts³⁴. These requirements underscore that APRN prescribing in Texas is conducted under physician supervision via formal delegation.