State of Illinois
91st General Assembly
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91_HB0553

 
                                               LRB9100682ACcd

 1        AN ACT concerning nursing.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5.  The Ambulatory Surgical Treatment Center  Act
 5    is amended by changing Section 6.5 as follows:

 6        (210 ILCS 5/6.5)
 7        Sec. 6.5.  Clinical privileges; advanced practice nurses.
 8    All  ambulatory  surgical  treatment  centers (ASTC) licensed
 9    under this Act shall comply with the following requirements:
10        (1)  No ASTC policy, rule, regulation, or practice of  an
11    ambulatory  surgical treatment center licensed under this Act
12    shall  be  inconsistent  with  the  provision   of   adequate
13    collaboration,   including   medical  direction  of  licensed
14    advanced practice nurses, in accordance with Section 54.5  of
15    the Medical Practice Act of 1987.
16        (2)  Operative  surgical  procedures  shall  be performed
17    only by a physician licensed to practice medicine in all  its
18    branches  under  the  Medical Practice Act of 1987, a dentist
19    licensed  under  the  Illinois  Dental  Practice  Act,  or  a
20    podiatrist licensed under the Podiatric Medical Practice  Act
21    of  1987, with medical staff membership and surgical clinical
22    privileges granted by the consulting committee of the ASTC. A
23    licensed physician, dentist, or podiatrist may be assisted by
24    a  physician  licensed  to  practice  medicine  in  all   its
25    branches,  dentist,  dental  assistant,  podiatrist, licensed
26    advanced  practice  nurse,  licensed   physician   assistant,
27    licensed registered nurse, licensed practical nurse, surgical
28    assistant,  surgical technician, or other individuals granted
29    clinical privileges to assist in surgery  by  the  consulting
30    committee of the ASTC.
31        (3)   The anesthesia service shall be under the direction
 
                            -2-                LRB9100682ACcd
 1    of  a  physician  licensed  to  practice  medicine in all its
 2    branches who has had specialized preparation or experience in
 3    the area or who has completed a residency in  anesthesiology.
 4    An  anesthesiologist,  Board  certified or Board eligible, is
 5    recommended. Anesthesia services  may  only  be  administered
 6    pursuant  to  the  order  of a physician licensed to practice
 7    medicine in all its branches, licensed dentist,  or  licensed
 8    podiatrist.
 9             (A)  The  individuals  who, with clinical privileges
10        granted by the medical staff  and  ASTC,  may  administer
11        anesthesia services are limited to the following:
12                  (i)  an anesthesiologist; or
13                  (ii)  a physician licensed to practice medicine
14             in all its branches; or
15                  (iii)  a  dentist  with authority to administer
16             anesthesia under Section 8.1 of the Illinois  Dental
17             Practice Act; or
18                  (iv)  a  licensed  certified  registered  nurse
19             anesthetist.
20             (B)  For  anesthesia  services,  an anesthesiologist
21        shall participate through  discussion  of  and  agreement
22        with  the  anesthesia  plan  and  shall remain physically
23        present and be  available  on  the  premises  during  the
24        delivery    of   anesthesia   services   for   diagnosis,
25        consultation,  and   treatment   of   emergency   medical
26        conditions.  In  the  absence  of 24-hour availability of
27        anesthesiologists with clinical privileges, an  alternate
28        policy    (requiring    participation,    presence,   and
29        availability of a physician licensed to practice medicine
30        in all its branches) shall be developed  by  the  medical
31        staff  consulting  committee  in  consultation  with  the
32        anesthesia  service  and  included  in  the medical staff
33        consulting committee policies.
34             (C)  A certified registered nurse anesthetist is not
 
                            -3-                LRB9100682ACcd
 1        required to possess prescriptive authority or  a  written
 2        collaborative   agreement  meeting  the  requirements  of
 3        Section  15-15  of  the  Nursing  and  Advanced  Practice
 4        Nursing Act to provide anesthesia services ordered  by  a
 5        licensed  physician,  dentist,  or  podiatrist.  Licensed
 6        certified registered nurse anesthetists are authorized to
 7        select,  order,  and  administer  drugs  and  apply   the
 8        appropriate   medical   devices   in   the  provision  of
 9        anesthesia services under the anesthesia plan agreed with
10        by  the  anesthesiologist  or,  in  the  absence  of   an
11        available   anesthesiologist  with  clinical  privileges,
12        agreed  with  by  the  operating   physician,   operating
13        dentist,  or  operating podiatrist in accordance with the
14        medical staff consulting committee policies of a licensed
15        ambulatory surgical treatment center.
16    (Source: P.A. 90-742, eff. 8-13-98.)

17        Section 10.  The Hospital Licensing  Act  is  amended  by
18    changing Section 10.7 as follows:

19        (210 ILCS 85/10.7)
20        Sec.   10.7.  Clinical   privileges;   advanced  practice
21    registered nurses.  All hospitals  licensed  under  this  Act
22    shall comply with the following requirements:
23        (1)  No hospital policy, rule, regulation, or practice of
24    a hospital licensed under this Act shall be inconsistent with
25    the  provision  of  adequate collaboration, including medical
26    direction of licensed advanced practice nurses, in accordance
27    with Section 54.5 of the Medical Practice Act of 1987.
28        (2)  Operative surgical  procedures  shall  be  performed
29    only  by a physician licensed to practice medicine in all its
30    branches under the Medical Practice Act of  1987,  a  dentist
31    licensed  under  the  Illinois  Dental  Practice  Act,  or  a
32    podiatrist  licensed under the Podiatric Medical Practice Act
 
                            -4-                LRB9100682ACcd
 1    of 1987, with medical staff membership and surgical  clinical
 2    privileges  granted  at  the hospital.  A licensed physician,
 3    dentist,  or  podiatrist  may  be  assisted  by  a  physician
 4    licensed to practice medicine in all its  branches,  dentist,
 5    dental  assistant,  podiatrist,  licensed  advanced  practice
 6    nurse,  licensed  physician  assistant,  licensed  registered
 7    nurse, licensed practical nurse, surgical assistant, surgical
 8    technician,  or other individuals granted clinical privileges
 9    to assist in surgery at the hospital.
10        (3)  The anesthesia service shall be under the  direction
11    of  a  physician  licensed  to  practice  medicine in all its
12    branches who has had specialized preparation or experience in
13    the area or who has completed a residency in  anesthesiology.
14    An  anesthesiologist,  Board  certified or Board eligible, is
15    recommended. Anesthesia services  may  only  be  administered
16    pursuant  to  the  order  of a physician licensed to practice
17    medicine in all its branches, licensed dentist,  or  licensed
18    podiatrist.
19             (A)  The  individuals  who, with clinical privileges
20        granted  at  the  hospital,  may  administer   anesthesia
21        services are limited to the following:
22                  (i)  an anesthesiologist; or
23                  (ii)  a physician licensed to practice medicine
24             in all its branches; or
25                  (iii)  a  dentist  with authority to administer
26             anesthesia under Section 8.1 of the Illinois  Dental
27             Practice Act; or
28                  (iv)  a  licensed  certified  registered  nurse
29             anesthetist.
30             (B)  For  anesthesia  services,  an anesthesiologist
31        shall participate through  discussion  of  and  agreement
32        with  the  anesthesia  plan  and  shall remain physically
33        present and be  available  on  the  premises  during  the
34        delivery    of   anesthesia   services   for   diagnosis,
 
                            -5-                LRB9100682ACcd
 1        consultation,  and   treatment   of   emergency   medical
 2        conditions.  In  the  absence  of 24-hour availability of
 3        anesthesiologists  with  medical  staff  privileges,   an
 4        alternate  policy (requiring participation, presence, and
 5        availability of a physician licensed to practice medicine
 6        in all its branches) shall be developed  by  the  medical
 7        staff  and  licensed  hospital  in  consultation with the
 8        anesthesia service.
 9             (C)  A certified registered nurse anesthetist is not
10        required to possess prescriptive authority or  a  written
11        collaborative   agreement  meeting  the  requirements  of
12        Section  15-15  of  the  Nursing  and  Advanced  Practice
13        Nursing Act to provide anesthesia services ordered  by  a
14        licensed  physician,  dentist,  or  podiatrist.  Licensed
15        certified registered nurse anesthetists are authorized to
16        select,  order,  and  administer  drugs  and  apply   the
17        appropriate   medical   devices   in   the  provision  of
18        anesthesia services under the anesthesia plan agreed with
19        by  the  anesthesiologist  or,  in  the  absence  of   an
20        available   anesthesiologist  with  clinical  privileges,
21        agreed  with  by  the  operating   physician,   operating
22        dentist,  or  operating podiatrist in accordance with the
23        hospital's alternative policy.
24    (Source: P.A. 90-742, eff. 8-13-98.)

25        Section 15.  The Medical Practice Act of 1987 is  amended
26    by changing Section 54.5 as follows:

27        (225 ILCS 60/54.5)
28        Sec. 54.5.  Physician delegation of authority.
29        (a)  Physicians  licensed to practice medicine in all its
30    branches may delegate care and treatment responsibilities  to
31    a physician assistant under guidelines in accordance with the
32    requirements  of   the  Physician  Assistant  Practice Act of
 
                            -6-                LRB9100682ACcd
 1    1987.  A physician licensed to practice medicine in  all  its
 2    branches may enter into supervising physician agreements with
 3    no more than 2 physician assistants.
 4        (b)  A physician licensed to practice medicine in all its
 5    branches  in active clinical practice may collaborate with an
 6    advanced practice nurse in accordance with  the  requirements
 7    of Title 15 of the Nursing and Advanced Practice Nursing Act.
 8    Collaboration   is  for  the  purpose  of  providing  medical
 9    direction, and no employment  relationship  is  required.   A
10    written   collaborative   agreement   shall  conform  to  the
11    requirements of Sections 15-15 and 15-20 of the  Nursing  and
12    Advanced  Practice  Nursing  Act.   The written collaborative
13    agreement shall be for services the  collaborating  physician
14    generally  provides  to  his  or  her  patients in the normal
15    course of  clinical  medical  practice.    Physician  medical
16    direction  shall  be  adequate  with respect to collaboration
17    with certified nurse practitioners, certified nurse midwives,
18    and clinical nurse specialists if a collaborating physician:
19             (1)  participates in the joint formulation and joint
20        approval  of  orders  or  guidelines  with  the  advanced
21        practice nurse and periodically reviews such  orders  and
22        the  services  provided  patients  under  such  orders in
23        accordance with accepted standards  of  medical  practice
24        and advanced practice nursing practice;
25             (2)  is  on  site  at  least once a month to provide
26        medical direction and consultation; and
27             (3)  is  available  through  telecommunications  for
28        consultation  on  medical  problems,  complications,   or
29        emergencies or patient referral.
30        (b-5)  An   anesthesiologist  or  physician  licensed  to
31    practice medicine in all its branches may collaborate with  a
32    certified  registered  nurse  anesthetist  in accordance with
33    Section 15-25 of the Nursing and  Advanced  Practice  Nursing
34    Act.   Medical  direction  for  a  certified registered nurse
 
                            -7-                LRB9100682ACcd
 1    anesthetist shall be adequate if:
 2             (1) an anesthesiologist or a physician  participates
 3        in  the joint formulation and joint approval of orders or
 4        guidelines and periodically reviews such orders  and  the
 5        services provided patients under such orders; and
 6             (2)  for  anesthesia  services, the anesthesiologist
 7        or  physician  participates  through  discussion  of  and
 8        agreement with the  anesthesia  plan  and  is  physically
 9        present and available on the premises during the delivery
10        of  anesthesia  services for diagnosis, consultation, and
11        treatment of  emergency  medical  conditions.  Anesthesia
12        services  in  a hospital shall be conducted in accordance
13        with Section 10.7 of the Hospital Licensing Act and in an
14        ambulatory surgical treatment center in  accordance  with
15        Section  6.5  of the Ambulatory Surgical Treatment Center
16        Act.
17        (b-10)  The anesthesiologist or operating physician  must
18    agree  with  the  anesthesia  plan  prior  to the delivery of
19    services.
20        (c)  The supervising physician shall have access  to  the
21    medical  records  of  all  patients  attended  by a physician
22    assistant.  The collaborating physician shall have access  to
23    the  medical  records  of  all  patients  attended  to  by an
24    advanced practice nurse.
25        (d)  Nothing in this Act shall be construed to limit  the
26    delegation  of  tasks  or  duties  by a physician licensed to
27    practice medicine in all its branches to a licensed practical
28    nurse, a registered professional nurse, or other personnel.
29        (e)  A physician shall not be  liable  for  the  acts  or
30    omissions of a physician assistant or advanced practice nurse
31    solely  on the basis of having signed a supervision agreement
32    or guidelines or  a  collaborative  agreement,  an  order,  a
33    standing medical order, a standing delegation order, or other
34    order  or  guideline  authorizing  a  physician  assistant or
 
                            -8-                LRB9100682ACcd
 1    advanced practice nurse to perform acts, unless the physician
 2    has reason to believe the  physician  assistant  or  advanced
 3    practice  nurse  lacked  the competency to perform the act or
 4    acts or commits willful and wanton misconduct.
 5    (Source: P.A. 90-742, eff. 8-13-98.)

 6        Section 20.  The Nursing and  Advanced  Practice  Nursing
 7    Act  is  amended  by  changing  Sections  10-25, 15-5, 15-10,
 8    15-15, 15-30, and 15-35 and by adding 15-25 as follows:

 9        (225 ILCS 65/10-25)
10        Sec. 10-25. Board.
11        (a)  The Director shall  appoint  the  Board  of  Nursing
12    which,  beginning  January  1, 2000, shall be composed of 7 9
13    registered professional nurses, 2 licensed  practical  nurses
14    and  one  public member who shall also be a voting member and
15    who is not a licensed health care  provider.  Two  registered
16    nurses  shall  hold at least a master's degree in nursing and
17    be  educators   in   professional   nursing   programs,   one
18    representing    baccalaureate    nursing    education,    one
19    representing   associate   degree   nursing   education;  one
20    registered nurse shall hold at least a bachelor's degree with
21    a major in nursing and be an educator in a licensed practical
22    nursing program; one registered nurse shall hold  a  master's
23    degree  in  nursing   and  shall  represent  nursing  service
24    administration;  2 registered nurses shall represent clinical
25    nursing practice, one of whom shall have at least a  master's
26    degree  in nursing; and, until January  1, 2000, 2 registered
27    nurses shall represent advanced specialty practice.  Each  of
28    the  11 nurses shall have had a minimum of 5 years experience
29    in nursing, 3 of which shall be in the area they represent on
30    the Board and be actively engaged in the area of nursing they
31    represent at the time of appointment and during their  tenure
32    on  the  Board.   Members  shall be appointed for a term of 3
 
                            -9-                LRB9100682ACcd
 1    years.  No member shall be eligible for appointment  to  more
 2    than  2  consecutive  terms  and  any  appointment  to fill a
 3    vacancy shall be for the unexpired portion of the  term.   In
 4    making   Board   appointments,   the   Director   shall  give
 5    consideration  to  recommendations   submitted   by   nursing
 6    organizations.     Consideration  shall  be  given  to  equal
 7    geographic representation.  The Board  shall  receive  actual
 8    and  necessary  expenses incurred in the performance of their
 9    duties.
10        In making the initial appointments,  the  Director  shall
11    appoint  all  new  members for terms of 2, 3, and 4 years and
12    such terms  shall  be  staggered  as  follows:   3  shall  be
13    appointed  for  terms  of  2  years; 3 shall be appointed for
14    terms of 3 years; and 3 shall be appointed  for  terms  of  4
15    years.
16        The  Director  may  remove  any  member  of the Board for
17    misconduct, incapacity, or neglect  of  duty.   The  Director
18    shall reduce to writing any causes for removal.
19        The  Board shall meet annually to elect a chairperson and
20    vice chairperson.  The Board may  hold  such  other  meetings
21    during  the year as may be necessary to conduct its business.
22    Six voting members of the Board shall constitute a quorum  at
23    any  meeting.   Any  action taken by the Board must be on the
24    affirmative vote of 6 members.  Voting by proxy shall not  be
25    permitted.
26        The Board shall submit an annual report to the Director.
27        The members of the Board shall be immune from suit in any
28    action  based upon any disciplinary proceedings or other acts
29    performed in good faith as members of the Board.
30        (b)  The Board is authorized to:
31             (1)  recommend the adoption and, from time to  time,
32        the revision of such rules that may be necessary to carry
33        out the provisions of this Act;
34             (2)  conduct  hearings  and disciplinary conferences
 
                            -10-               LRB9100682ACcd
 1        upon charges calling for  discipline  of  a  licensee  as
 2        provided in Section 10-45;
 3             (3)  report  to the Department, upon completion of a
 4        hearing, the disciplinary actions recommended to be taken
 5        against persons violating this Act;
 6             (4)  recommend the  approval,  denial  of  approval,
 7        withdrawal   of   approval,   or  discipline  of  nursing
 8        education programs;
 9             (5)  participate in a national organization of state
10        boards of nursing; and
11             (6)  recommend a list of the  registered  nurses  to
12        serve  as  Nursing  Act Coordinator and Assistant Nursing
13        Act Coordinator, respectively.
14    (Source: P.A. 90-61, eff. 12-30-97; 90-742, eff. 8-13-98.)

15        (225 ILCS 65/15-5)
16        Sec. 15-5.  Definitions. As used in this Title:
17        "APN Board" means the Advanced Practice Nursing Board.
18        "Advanced practice nurse" or "APN" means  a  person  who:
19    (1)   is  licensed  as  a registered professional nurse under
20    this Act;   (2)  meets the requirements for licensure  as  an
21    advanced  practice  nurse under Section 15-10;  (3) except as
22    provided  in  Section  15-25,  has  a  written  collaborative
23    agreement with a collaborating physician in the diagnosis  of
24    illness  and  management  of wellness and other conditions as
25    appropriate to the level and area of his or her  practice  in
26    accordance  with  Section  15-15; and  (4) cares for patients
27    (A) by using  advanced  diagnostic  skills,  the  results  of
28    diagnostic  tests  and  procedures  ordered  by  the advanced
29    practice  nurse,  a  physician  assistant,   a   dentist,   a
30    podiatrist,  or  a  physician,  and  professional judgment to
31    initiate and coordinate the care of patients; (B) by ordering
32    diagnostic  tests,  prescribing  medications  and  drugs   in
33    accordance  with Section 15-20, and administering medications
 
                            -11-               LRB9100682ACcd
 1    and drugs;   and  (C)  by  using  medical,  therapeutic,  and
 2    corrective  measures  to  treat  illness  and  improve health
 3    status. Categories include  certified  nurse  midwife  (CNM),
 4    certified  nurse  practitioner  (CNP),  certified  registered
 5    nurse   anesthetist   (CRNA),  or  certified  clinical  nurse
 6    specialist (CNS).
 7        "Collaborating physician" means  a  physician  who  works
 8    with   an   advanced  practice  nurse  and  provides  medical
 9    direction as documented in a written collaborative  agreement
10    required under Section 15-15.
11        "Licensed  hospital"  means a hospital licensed under the
12    Hospital Licensing Act or organized under the  University  of
13    Illinois Hospital Act.
14        "Physician"  means a person licensed to practice medicine
15    in all its branches under the Medical Practice Act of 1987.
16    (Source: P.A. 90-742, eff. 8-13-98.)

17        (225 ILCS 65/15-10)
18        Sec. 15-10.   Advanced  practice  nurse;  qualifications;
19    roster.
20        (a)  A  person  shall  be  qualified  for licensure as an
21    advanced practice nurse if that person:
22             (1)  has applied in writing in  form  and  substance
23        satisfactory  to  the  Department  and has not violated a
24        provision of this Act or the  rules  adopted  under  this
25        Act.  The  Department  may  take  into  consideration any
26        felony conviction of the applicant but a conviction shall
27        not operate as an absolute bar to licensure;
28             (2)  holds  a  current  license  to  practice  as  a
29        registered nurse in Illinois;
30             (3)  has  successfully  completed  requirements   to
31        practice  as, and holds a current, national certification
32        as, a nurse midwife, clinical nurse specialist, or  nurse
33        practitioner,  or  certified registered nurse anesthetist
 
                            -12-               LRB9100682ACcd
 1        from  the  appropriate  national   certifying   body   as
 2        determined by rule of the Department;
 3             (4)  has paid the required fees as set by rule; and
 4             (5)  has   successfully   completed   a   post-basic
 5        advanced practice formal education program in the area of
 6        his or her nursing specialty.
 7        (b)  In   addition   to   meeting   the  requirements  of
 8    subsection (a), except item (5) of that subsection, beginning
 9    July 1, 2001 or 12 months after the adoption of  final  rules
10    to  implement  this  Section, whichever is sooner, applicants
11    for  initial  licensure  shall   have   a   graduate   degree
12    appropriate for national certification in a clinical advanced
13    practice nursing specialty.
14        (c)  The   Department  shall  provide  by  rule  for  APN
15    licensure of registered professional nurses who (1) apply for
16    licensure before July 1, 2001  and  (2)  submit  evidence  of
17    completion  of  a program described in item (5) of subsection
18    (a) or in subsection (b) and  evidence  of  practice  for  at
19    least 10 years as a nurse practitioner.
20        (d)  The  Department  shall maintain a separate roster of
21    advanced practice nurses licensed under this Title and  their
22    licenses  shall  indicate "Registered Nurse/Advanced Practice
23    Nurse".
24    (Source: P.A. 90-742, eff. 8-13-98.)

25        (225 ILCS 65/15-15)
26        Sec. 15-15.  Written collaborative agreements.
27        (a)  Except as provided in Section 15-25, no person shall
28    engage in the practice of advanced  practice  nursing  except
29    when  licensed  under  this  Title  and pursuant to a written
30    collaborative agreement with a collaborating physician.
31        (b)  A written collaborative agreement shall describe the
32    working relationship of the advanced practice nurse with  the
33    collaborating physician and shall authorize the categories of
 
                            -13-               LRB9100682ACcd
 1    care,  treatment,  or  procedures  to  be  performed  by  the
 2    advanced  practice  nurse.  Collaboration does not require an
 3    employment relationship between the  collaborating  physician
 4    and   advanced   practice  nurse.   Collaboration  means  the
 5    relationship under which an  advanced  practice  nurse  works
 6    with a collaborating physician in an active clinical practice
 7    to  deliver  health  care services in accordance with (i) the
 8    advanced practice nurse's training, education, and experience
 9    and  (ii)  medical  direction  as  documented  in  a  jointly
10    developed written collaborative agreement.
11        The agreement shall be defined to promote the exercise of
12    professional  judgment  by  the   advanced   practice   nurse
13    commensurate  with  his  or her education and experience. The
14    services to be provided by the advanced practice nurse  shall
15    be   services  that  the  collaborating  physician  generally
16    provides to his or her patients in the normal course  of  his
17    or  her  clinical  medical  practice.  The agreement need not
18    describe the exact steps that an advanced practice nurse must
19    take with respect to each  specific  condition,  disease,  or
20    symptom  but must specify which authorized procedures require
21    a physician's presence as the procedures are being performed.
22    The collaborative relationship under an agreement  shall  not
23    be construed to require the personal presence of a  physician
24    at  all  times  at  the  place  where  services are rendered.
25    Methods of communication shall be available for  consultation
26    with   the   collaborating   physician   in   person   or  by
27    telecommunications in  accordance  with  established  written
28    guidelines as set forth in the written agreement.
29        (c)  Physician medical direction under an agreement shall
30    be adequate if a collaborating physician:
31             (1)  participates in the joint formulation and joint
32        approval  of  orders or guidelines with the APN and he or
33        she periodically reviews such  orders  and  the  services
34        provided  patients  under  such orders in accordance with
 
                            -14-               LRB9100682ACcd
 1        accepted  standards  of  medical  practice  and  advanced
 2        practice nursing practice;
 3             (2)  is on site at least once  a  month  to  provide
 4        medical direction and consultation; and
 5             (3)  is  available  through  telecommunications  for
 6        consultation   on  medical  problems,  complications,  or
 7        emergencies or patient referral.
 8        (d)  A  copy  of  the   signed,   written   collaborative
 9    agreement  must  be  available to the Department upon request
10    from both the advanced practice nurse and  the  collaborating
11    physician   and  shall  be  annually  updated.   An  advanced
12    practice nurse shall inform each collaborating  physician  of
13    all collaborative agreements he or she has signed and provide
14    a copy of these to any collaborating physician, upon request.
15    (Source: P.A. 90-742, eff. 8-13-98.)

16        (225 ILCS 65/15-25 new)
17        Sec. 15-25.  Certified registered nurse anesthetists.
18        (a)  A  licensed  certified  registered nurse anesthetist
19    may provide anesthesia services pursuant to the  order  of  a
20    licensed  physician, licensed dentist, or licensed podiatrist
21    in  a  licensed  hospital,  a  licensed  ambulatory  surgical
22    treatment center, or the office of a licensed physician,  the
23    office  of  a  licensed  dentist, or the office of a licensed
24    podiatrist.  For anesthesia  services,  an  anesthesiologist,
25    physician,  dentist,  or podiatrist shall participate through
26    discussion of and agreement  with  the  anesthesia  plan  and
27    shall  remain  physically  present  and  be  available on the
28    premises during  the  delivery  of  anesthesia  services  for
29    diagnosis,  consultation,  and treatment of emergency medical
30    conditions, unless hospital policy adopted pursuant to clause
31    (B) of subdivision  (3)  of  Section  10.7  of  the  Hospital
32    Licensing  Act or ambulatory surgical treatment center policy
33    adopted pursuant to clause (B) of subdivision (3) of  Section
 
                            -15-               LRB9100682ACcd
 1    6.5  of the Ambulatory Surgical Treatment Center Act provides
 2    otherwise.
 3        (b)  A  certified  registered   nurse   anesthetist   who
 4    provides  anesthesia  services  in  a hospital shall do so in
 5    accordance with Section 10.7 of the  Hospital  Licensing  Act
 6    and,   in   an   ambulatory  surgical  treatment  center,  in
 7    accordance  with  Section  6.5  of  the  Ambulatory  Surgical
 8    Treatment Center Act.
 9        (c)  A  certified  registered   nurse   anesthetist   who
10    provides  anesthesia  services  in a physician office, dental
11    office, or  podiatric  office  shall  enter  into  a  written
12    practice  agreement with an anesthesiologist or the physician
13    licensed to  practice  medicine  in  all  its  branches,  the
14    dentist,  or  the  podiatrist  performing  the procedure. The
15    agreement shall describe  the  working  relationship  of  the
16    certified  registered nurse anesthetist and anesthesiologist,
17    physician, dentist, or podiatrist  and  shall  authorize  the
18    categories  of care, treatment, or procedures to be performed
19    by  the  certified  registered  nurse  anesthetist.    In   a
20    dentist's  office, the certified registered nurse anesthetist
21    may only provide those services the dentist is authorized  to
22    provide  pursuant  to  the  Illinois  Dental Practice Act and
23    rules. In a podiatrist's  office,  the  certified  registered
24    nurse  anesthetist    may  only  provide  those  services the
25    podiatrist is authorized to provide pursuant to the Podiatric
26    Medical Practice  Act  of  1987  and  rules.  For  anesthesia
27    services,   an   anesthesiologist,   physician,  dentist,  or
28    podiatrist  shall  participate  through  discussion  of   and
29    agreement   with   the   anesthesia  plan  and  shall  remain
30    physically present and be available on  the  premises  during
31    the   delivery   of   anesthesia   services   for  diagnosis,
32    consultation, and treatment of emergency medical conditions.
33        (d)  A certified  registered  nurse  anesthetist  is  not
34    required  to  possess  prescriptive  authority  or  a written
 
                            -16-               LRB9100682ACcd
 1    collaborative agreement meeting the requirements  of  Section
 2    15-15  to  provide  anesthesia services ordered by a licensed
 3    physician,  dentist,  or  podiatrist.   Certified  registered
 4    nurse anesthetists  are  authorized  to  select,  order,  and
 5    administer drugs and apply the appropriate medical devices in
 6    the  provision  of  anesthesia  services under the anesthesia
 7    plan agreed with by the anesthesiologist or the physician  in
 8    accordance  with  hospital alternative policy  or the medical
 9    staff consulting committee policies of a licensed  ambulatory
10    surgical   treatment   center.    In  a  physician's  office,
11    dentist's    office,    or    podiatrist's    office,     the
12    anesthesiologist,  operating physician, operating dentist, or
13    operating podiatrist shall agree with the anesthesia plan, in
14    accordance with the written practice agreement.
15        (e)  A certified  registered  nurse  anesthetist  may  be
16    delegated  limited prescriptive authority under Section 15-20
17    in a written collaborative agreement meeting the requirements
18    of Section 15-15.

19        (225 ILCS 65/15-30)
20        Sec. 15-30.  Title.
21        (a)  No  person  shall  use  any  words,   abbreviations,
22    figures,  letters,  title,  sign,  card, or device tending to
23    imply that he or she is an advanced practice nurse, including
24    but not limited to using the titles  or  initials   "Advanced
25    Practice  Nurse", "Certified Nurse Midwife", "Certified Nurse
26    Practitioner",  "Certified  Registered  Nurse   Anesthetist",
27    "Clinical  Nurse  Specialist",  "A.P.N.", "C.N.M.", "C.N.P.",
28    "C.R.N.A.", "C.N.S.", or similar titles or initials, with the
29    intention of indicating  practice  as  an  advanced  practice
30    nurse  without  meeting  the  requirements  of  this Act.  No
31    advanced practice nurse shall use  the  title  of  doctor  or
32    associate  with his or her name or any other term to indicate
33    to other persons that he or she is qualified to engage in the
 
                            -17-               LRB9100682ACcd
 1    general practice of medicine.
 2        (b)  An advanced practice nurse shall  verbally  identify
 3    himself  or  herself  as an advanced practice nurse including
 4    specialty certification to each patient.
 5        (c)  Nothing in this Act shall be construed to relieve  a
 6    physician  of  professional  or  legal responsibility for the
 7    care and treatment of persons attended by him or  her  or  to
 8    relieve  an  advanced  practice  nurse of the professional or
 9    legal responsibility for the care and  treatment  of  persons
10    attended by him or her.
11    (Source: P.A. 90-742, eff. 8-13-98.)

12        (225 ILCS 65/15-35)
13        Sec. 15-35.  Advanced Practice Nursing Board.
14        (a)  There  is  hereby  established  an Advanced Practice
15    Nursing Board, hereinafter referred to as  the  "APN  Board".
16    The  APN  Board  shall review and make recommendations to the
17    Department  regarding  matters  relating  to  licensure   and
18    discipline  of advanced practice nurses.  The APN Board shall
19    be composed of 9 members to be appointed by the  Governor,  4
20    of whom shall be advanced practice nurses and 3 of whom shall
21    be  collaborating physicians licensed to practice medicine in
22    all its branches.  The 4 advanced practice nurses shall  have
23    collaborative   agreements,   except   that   any   certified
24    registered  nurse  anesthetist  is  not  required  to  have a
25    collaborative  agreement.   The  3  physicians   shall   have
26    collaborative  agreements, except that an anesthesiologist is
27    not required to have a collaborative  agreement.   In  making
28    appointments  to  the  APN Board, the Governor shall give due
29    consideration to recommendations  by  statewide  professional
30    associations  or societies representing nurses and physicians
31    in  Illinois.   Two  members,  not  employed  or  having  any
32    material interest in any health care field,  shall  represent
33    the  public.   The  chairperson  of  the APN Board shall be a
 
                            -18-               LRB9100682ACcd
 1    member elected by a majority vote of the APN Board.  The  APN
 2    Board  shall  meet and report to the Department quarterly and
 3    as advanced practice nurse issues arise.
 4        Initial appointments to  the  APN  Board  shall  be  made
 5    within  90  days  after the effective date of this amendatory
 6    Act of 1998.  The terms of office of  each  of  the  original
 7    members  shall  be at staggered intervals.  One physician and
 8    one advanced practice nurse shall serve one-year terms.   One
 9    physician  and one advanced practice nurse shall serve 2-year
10    terms.  One physician and one advanced practice  nurse  shall
11    serve  3-year  terms.  One  advanced  practice  nurse and the
12    public members shall serve 4-year terms.  Upon the expiration
13    of the term of an initial member, his or her successor  shall
14    be  appointed  for  a  term of 4 years. No member shall serve
15    more than 2 consecutive terms, excluding initial  appointment
16    terms.   An  appointment  to  fill a vacancy shall be for the
17    unexpired portion of the term.   Members  of  the  APN  Board
18    shall   be  reimbursed  for  all  authorized  legitimate  and
19    necessary expenses incurred in attending the meetings of  the
20    APN  Board.   A  majority  of the APN Board members appointed
21    shall constitute a quorum.  A vacancy in  the  membership  of
22    the  APN  Board  shall  not  impair  the right of a quorum to
23    perform all of the duties of the APN Board.  A member of  the
24    APN  Board  shall have no liability in an action based upon a
25    disciplinary proceeding or other activity performed  in  good
26    faith as a member of the APN Board.
27        (b)  Complaints  received  concerning  advanced  practice
28    nurses  shall  be  reviewed  by  the  APN  Board.  Complaints
29    received  concerning  collaborating   physicians   shall   be
30    reviewed by the Medical Disciplinary Board.
31    (Source: P.A. 90-742, eff. 8-13-98.)

32        (225 ILCS 65/15-100 rep.)
33        Section  25.  The  Nursing  and Advanced Practice Nursing
 
                            -19-               LRB9100682ACcd
 1    Act is amended by repealing Section 15-100.

 2        Section 99.  Effective date.  This Act takes effect  upon
 3    becoming law.

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