The Legislative Journey to Independent Practice
In most other states, Advance Practice Registered Nurses (APRNs) already have full practice authority to diagnose, treat, and prescribe. Currently, there are 24 states and the District of Columbia that don't require any physician involvement for APRNs to diagnose, treat or prescribe. In addition to those, eight states allow APRNs to diagnose and treat independently but require physician involvement to prescribe.
There was strong support this year, within the Illinois legislature to grant APRNs with full independent practice. Instead of voting against physicians, legislators asked that the Illinois State Medical Society (ISMS) draft an alternative. The Illinois Society for Advanced Practice Nursing bill as introduced would have granted full independent practice and full prescriptive authority, after completing additional clinical training under the supervision of either another APRN or physician.
After numerous negotiating sessions and intense advocacy from physicians, an agreement was reached. This agreement was passed by the Legislature, signed into law by Governor Rauner, and will take effect on January 1, 2018.
Below is a summary of the language that was eventually accepted by the APRNs:
- 1.Maintains the requirement that APRNs have a written collaborative agreement, unless the APRN receives substantial post-graduate training under the direct supervision of a physician (4,000 clinical training and 250 hours in additional educational/training components). The physician then must sign a written attestation confirming that the training was completed.
- 2.Does not change current practice within a hospital setting; APRNs must still be recommended for credentialing by the hospital medical staff.
- 3.Requires APRNs to maintain a formalized relationship with a physician that must be noted in the state's prescription monitoring program (PMP) if that APRN wishes to prescribe schedule II opioids and benzodiazepines. The opioids to be prescribed must be specifically noted in the PMP and APRNs and the consulting physician must meet at least monthly to discuss the patient's care.
- 4.Says APRNs are prohibited from administering opiates via injection. APRNs are also prohibited from performing operative surgery.
- 5.Prohibits APRNs from advertising as "Dr.," which is extremely misleading to patients. APRNs who have doctorate degrees must tell patients that they are not medical doctors or physicians.
- 6.Makes clear that nurse anesthetists are NOT included in the agreement; nothing changes as to how nurse anesthetists currently practice.
ISA has worked closely with ISMS on scope of practice issues and greatly appreciates that anesthesia services have been uniquely identified in the medical practice acts. While ISA has traditionally been opposed to the independent practice of non-physician providers, we've conceded that mainstream support exists for APRNs in Illinois. ISA will vigilantly advocate that anesthesia services are not the same as primary health care. We believe that the Anesthesia Care Team model provides excellent access to quality care for our patients.