Nelson is the highest-ranking Republican in the Texas Senate. The tenth woman ever elected to the Texas Senate, she was the first Republican woman ever appointed chair of a standing committee and now holds the distinction of being longest-serving chair of the Senate Health and Human Services Committee in Texas history. In 2015, she was appointed chair of the Senate Finance Committee, being the first woman to hold the position in the history of the Texas Senate. She also serves as chair of the Sunset Advisory Commission.