HB4478 102ND GENERAL ASSEMBLY

LRB102 24271 AMQ 33503 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB4478

Introduced 1/21/2022, by Rep. Debbie Meyers-Martin

SYNOPSIS AS INTRODUCED:

225 ILCS 65/50-10	was 225 ILCS 65/5-10
225 ILCS 65/50-75
225 ILCS 65/60-35

Amends the Nurse Practice Act. Provides that registered professional nursing practice is a scientific process founded on a professional body of knowledge; it is a learned profession based on the understanding of the human condition across the life span and environment and includes all nursing specialties and means the performance of any nursing act based upon professional knowledge, judgment, and skills acquired by means of completion of an approved professional nursing education program. Provides that registered professional nurses may delegate nursing interventions and tasks (rather than nursing interventions) to other registered professional nurses and licensed practical nurses based on a comprehensive nursing assessment. Provides that registered professional nurses may delegate tasks to unlicensed personnel based on a comprehensive nursing assessment. Provides that a registered professional nurse is prohibited from delegating work requiring nursing knowledge, assessment, judgment, inference, decision making (including medication administration), the development of a plan of care, and the evaluation of a plan of care to unlicensed non-nurse personnel. Removes provisions concerning delegation of nursing interventions and administration of medications in community-based or in-home care settings. Makes other changes. Effective July 1, 2022.

A BILL FOR

AN ACT concerning regulation.

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

Section 5. The Nurse Practice Act is amended by changing Sections 50-10, 50-75, and 60-35 as follows:

(225 ILCS 65/50-10) (was 225 ILCS 65/5-10)

(Section scheduled to be repealed on January 1, 2028)

Sec. 50-10. Definitions. Each of the following terms, when used in this Act, shall have the meaning ascribed to it in this Section, except where the context clearly indicates otherwise:

"Academic year" means the customary annual schedule of courses at a college, university, or approved school, customarily regarded as the school year as distinguished from the calendar year.

"Address of record" means the designated address recorded by the Department in the applicant's or licensee's application file or license file as maintained by the Department's licensure maintenance unit.

"Advanced practice registered nurse" or "APRN" means a person who has met the qualifications for a (i) certified nurse midwife (CNM); (ii) certified nurse practitioner (CNP); (iii) certified registered nurse anesthetist (CRNA); or (iv) clinical nurse specialist (CNS) and has been licensed by the Department. All advanced practice registered nurses licensed and practicing in the State of Illinois shall use the title APRN and may use specialty credentials CNM, CNP, CRNA, or CNS after their name. All advanced practice registered nurses may only practice in accordance with national certification and this Act.

"Advisory Board" means the Illinois Nursing Workforce Center Advisory Board.

"Approved program of professional nursing education" and "approved program of practical nursing education" are programs of professional or practical nursing, respectively, approved by the Department under the provisions of this Act.

"Board" means the Board of Nursing appointed by the Secretary.

"Center" means the Illinois Nursing Workforce Center.

"Collaboration" means a process involving 2 or more health care professionals working together, each contributing one's respective area of expertise to provide more comprehensive patient care.

"Competence" means an expected and measurable level of performance that integrates knowledge, skills, abilities, and judgment based on established scientific knowledge and expectations for nursing practice.

"Comprehensive nursing assessment" means the gathering of information about the patient's physiological, psychological, sociological, and spiritual status on an ongoing basis by a registered professional nurse and is the first step in implementing and guiding the nursing plan of care.

"Consultation" means the process whereby an advanced practice registered nurse seeks the advice or opinion of another health care professional.

"Credentialed" means the process of assessing and validating the qualifications of a health care professional.

"Dentist" means a person licensed to practice dentistry under the Illinois Dental Practice Act.

"Department" means the Department of Financial and Professional Regulation.

"Email address of record" means the designated email address recorded by the Department in the applicant's application file or the licensee's license file, as maintained by the Department's licensure maintenance unit.

"Focused nursing assessment" means an appraisal of an individual's status and current situation, contributing to the comprehensive nursing assessment performed by the registered professional nurse or advanced practice registered nurse or the assessment by the physician assistant, physician, dentist, podiatric physician, or other licensed health care professional, as determined by the Department, supporting ongoing data collection, and deciding who needs to be informed of the information and when to inform.

"Full practice authority" means the authority of an advanced practice registered nurse licensed in Illinois and certified as a nurse practitioner, clinical nurse specialist, or nurse midwife to practice without a written collaborative agreement and:

(1) to be fully accountable to patients for the quality of advanced nursing care rendered;

(2) to be fully accountable for recognizing limits of knowledge and experience and for planning for the management of situations beyond the advanced practice registered nurse's expertise; the full practice authority for advanced practice registered nurses includes accepting referrals from, consulting with, collaborating with, or referring to other health care professionals as warranted by the needs of the patient; and

(3) to possess the authority to prescribe medications, including Schedule II through V controlled substances, as provided in Section 65-43.

"Hospital affiliate" means a corporation, partnership, joint venture, limited liability company, or similar organization, other than a hospital, that is devoted primarily to the provision, management, or support of health care services and that directly or indirectly controls, is controlled by, or is under common control of the hospital. For the purposes of this definition, "control" means having at least an equal or a majority ownership or membership interest. A hospital affiliate shall be 100% owned or controlled by any combination of hospitals, their parent corporations, or physicians licensed to practice medicine in all its branches in Illinois. "Hospital affiliate" does not include a health maintenance organization regulated under the Health Maintenance Organization Act.

"Impaired nurse" means a nurse licensed under this Act who is unable to practice with reasonable skill and safety because of a physical or mental disability as evidenced by a written determination or written consent based on clinical evidence, including loss of motor skills, abuse of drugs or alcohol, or a psychiatric disorder, of sufficient degree to diminish his or her ability to deliver competent patient care.

"License-pending advanced practice registered nurse" means a registered professional nurse who has completed all requirements for licensure as an advanced practice registered nurse except the certification examination and has applied to take the next available certification exam and received a temporary permit from the Department.

"License-pending registered nurse" means a person who has passed the Department-approved registered nurse licensure exam and has applied for a license from the Department. A license-pending registered nurse shall use the title "RN lic pend" on all documentation related to nursing practice.

"Nursing intervention" means any treatment based on clinical nursing judgment or knowledge that a nurse performs. An individual or entity shall not mandate that a registered professional nurse delegate nursing interventions if the registered professional nurse determines it is inappropriate to do so. A nurse shall not be subject to disciplinary or any other adverse action for refusing to delegate a nursing intervention based on patient safety.

"Physician" means a person licensed to practice medicine in all its branches under the Medical Practice Act of 1987.

"Podiatric physician" means a person licensed to practice podiatry under the Podiatric Medical Practice Act of 1987.

"Practical nurse" or "licensed practical nurse" means a person who is licensed as a practical nurse under this Act and practices practical nursing as defined in this Act. Only a practical nurse licensed under this Act is entitled to use the title "licensed practical nurse" and the abbreviation "L.P.N.".

"Practical nursing" means the performance of nursing interventions requiring the nursing knowledge, judgment, and skill acquired by means of completion of an approved practical nursing education program. Practical nursing includes assisting in the nursing process under the guidance of a registered professional nurse or an advanced practice registered nurse. The practical nurse may work under the direction of a licensed physician, dentist, podiatric physician, or other health care professional determined by the Department.

"Privileged" means the authorization granted by the governing body of a healthcare facility, agency, or organization to provide specific patient care services within well-defined limits, based on qualifications reviewed in the credentialing process.

"Registered Nurse" or "Registered Professional Nurse" means a person who is licensed as a professional nurse under this Act and practices nursing as defined in this Act. Only a registered nurse licensed under this Act is entitled to use the titles "registered nurse" and "registered professional nurse" and the abbreviation, "R.N.".

"Registered professional nursing practice" means a scientific process founded on a professional body of knowledge that includes, but is not limited to, the protection, promotion, and optimization of health and abilities, prevention of illness and injury, development and implementation of the nursing plan of care, facilitation of nursing interventions to alleviate suffering, care coordination, and advocacy in the care of individuals, families, groups, communities, and populations. "Registered professional nursing practice" does not include the act of medical diagnosis or prescription of medical therapeutic or corrective measures. Registered professional nursing practice is a scientific process founded on a professional body of knowledge; it is a learned profession based on the understanding of the human condition across the life span and environment and includes all nursing specialties and means the performance of any nursing act based upon professional knowledge, judgment, and skills acquired by means of completion of an approved professional nursing education program. A registered professional nurse provides holistic nursing care through the nursing process to individuals, groups, families, or communities, that includes, but is not limited to: (1) the assessment of health care needs, nursing diagnosis, planning, implementation, and nursing evaluation; (2) the promotion, maintenance, and restoration of health; (3) counseling, patient education, health education, and patient advocacy; (4) the administration of medications and treatments as prescribed by a physician licensed to practice medicine in all of its branches, a licensed dentist, a licensed podiatric physician, or a licensed optometrist or as prescribed by a physician assistant or by an advanced practice nurse; (5) the coordination and management of the nursing plan of care; (6) the delegation to and supervision of individuals who assist the registered professional nurse implementing the plan of care; and (7) teaching nursing students.

"Professional assistance program for nurses" means a professional assistance program that meets criteria established by the Board of Nursing and approved by the Secretary, which provides a non-disciplinary treatment approach for nurses licensed under this Act whose ability to practice is compromised by alcohol or chemical substance addiction.

"Secretary" means the Secretary of Financial and Professional Regulation.

"Unencumbered license" means a license issued in good standing.

"Written collaborative agreement" means a written agreement between an advanced practice registered nurse and a collaborating physician, dentist, or podiatric physician pursuant to Section 65-35.

(Source: P.A. 99-173, eff. 7-29-15; 99-330, eff. 1-1-16; 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)

(225 ILCS 65/50-75)

(Section scheduled to be repealed on January 1, 2028)

Sec. 50-75. Nursing delegation by a registered professional nurse.

(a) For the purposes of this Section:

"Delegation" means transferring to a specific individual the authority to perform a specific nursing intervention or task in a specific situation.

"Predictability of outcomes" means that a registered professional nurse or advanced practice registered nurse has determined that the patient's or individual's clinical status is stable and expected to improve or the patient's or individual's deteriorating condition is expected to follow a known or expected course.

"Stability" means a registered professional nurse or advanced practice registered nurse has determined that the individual's clinical status and nursing care needs are consistent.

"Task" means work not requiring nursing knowledge, judgment, or decision making, as defined by the Department by rule.

(b) This Section authorizes a registered professional nurse to:

(1) delegate nursing interventions and tasks to other registered professional nurses and , licensed practical nurses based on the comprehensive nursing assessment that includes, but is not limited to:

(A) the stability and condition of the patient;

(B) the potential for harm;

(C) the complexity of the nursing intervention or task to be delegated;

(D) the predictability of outcomes; and

(E) the competency of the individual to whom the nursing intervention or task is delegated;

(2) delegate tasks to , and other unlicensed personnel based on the comprehensive nursing assessment that includes, but is not limited to:

(A) the stability and condition of the patient;

(B) the potential for harm;

(C) the complexity of the task nursing intervention to be delegated;

(D) the predictability of outcomes; and

(E) competency of the individual to whom the task nursing intervention is delegated;

(3) (2) delegate medication administration to other licensed nurses; or

(3) in community-based or in-home care settings, delegate the administration of medication (limited to oral or subcutaneous dosage and topical or transdermal application) to unlicensed personnel, if all the conditions for delegation set forth in this Section are met;

(4) refuse to delegate, stop, or rescind a previously authorized delegation. ; or

(5) in community-based or in-home care settings, delegate, guide, and evaluate the implementation of nursing interventions as a component of patient care coordination after completion of the comprehensive patient assessment based on analysis of the comprehensive nursing assessment data; care coordination in in-home care and school settings may occur in person, by telecommunication, or by electronic communication.

(c) This Section prohibits the following:

(1) An individual or entity from mandating that a registered professional nurse delegate nursing interventions if the registered professional nurse determines it is inappropriate to do so. Nurses shall not be subject to disciplinary or any other adverse action for refusing to delegate a nursing intervention based on patient safety.

(2) The delegation of medication administration to unlicensed personnel in any institutional or long-term facility, including, but not limited to, those facilities licensed by the Hospital Licensing Act, the University of Illinois Hospital Act, State-operated mental health hospitals, or State-operated developmental centers, except as authorized under Article 80 of this Act or otherwise specifically authorized by law.

(2.5) A registered professional nurse from delegating work requiring nursing knowledge, assessment, judgment, inference, decision making (including medication administration), the development of a plan of care, and evaluation of a plan of care to unlicensed non-nurse personnel.

(3) A registered professional nurse from delegating nursing judgment, the comprehensive patient assessment, the development of a plan of care, and the evaluation of care to licensed or unlicensed personnel.

(4) A licensed practical nurse or unlicensed personnel who has been delegated a nursing intervention or task from re-delegating a nursing intervention or task.

(5) Unlicensed personnel who have been delegated tasks from re-delegating the tasks

(d) A registered professional nurse may delegate tasks to other licensed and unlicensed persons.

(Source: P.A. 100-513, eff. 1-1-18; 100-1160, eff. 6-1-19.)

(225 ILCS 65/60-35)

(Section scheduled to be repealed on January 1, 2028)

Sec. 60-35. RN scope of practice. The RN scope of nursing practice is the protection, promotion, and optimization of health and abilities, the prevention of illness and injury, the development and implementation of the nursing plan of care, the facilitation of nursing interventions to alleviate suffering, care coordination, and advocacy in the care of individuals, families, groups, communities, and populations. Practice as a registered professional nurse means this full scope of nursing, with or without compensation, that incorporates caring for all patients in all settings, through nursing standards of practice and professional performance for coordination of care, and may include, but is not limited to, all of the following:

(1) Collecting pertinent data and information relative to the patient's health or the situation on an ongoing basis through the comprehensive nursing assessment.

(2) Analyzing comprehensive nursing assessment data to determine actual or potential diagnoses, problems, and issues.

(3) Identifying expected outcomes for a plan individualized to the patient or the situation that prescribes strategies to attain expected, measurable outcomes.

(4) Implementing the identified plan, coordinating care delivery, employing strategies to promote healthy and safe environments, and administering or delegating medication administration according to Section 50-75 of this Act.

(5) Evaluating patient progress toward attainment of goals and outcomes.

(6) Delegating nursing interventions and tasks to licensed nurses to implement the plan of care.

(6.5) Delegating tasks to unlicensed personnel to implement the plan of care.

(7) Providing health education and counseling.

(7.5) Advocating for the patient.

(8) Practicing ethically according to the American Nurses Association Code of Ethics.

(9) Practicing in a manner that recognizes cultural diversity.

(10) Communicating effectively in all areas of practice.

(11) Collaborating with patients and other key stakeholders in the conduct of nursing practice.

(12) Participating in continuous professional development.

(13) Teaching the theory and practice of nursing to student nurses.

(14) Leading within the professional practice setting and the profession.

(15) Contributing to quality nursing practice.

(16) Integrating evidence and research findings into practice.

(17) Utilizing appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe and effective.

(Source: P.A. 100-513, eff. 1-1-18.)

Section 99. Effective date. This Act takes effect July 1, 2022.