Illinois General Assembly - Full Text of HB4478
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Full Text of HB4478  102nd General Assembly

HB4478 102ND GENERAL ASSEMBLY

  
  

 


 
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.


LRB102 24271 AMQ 33503 b

 

 

A BILL FOR

 

HB4478LRB102 24271 AMQ 33503 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Nurse Practice Act is amended by changing
5Sections 50-10, 50-75, and 60-35 as follows:
 
6    (225 ILCS 65/50-10)   (was 225 ILCS 65/5-10)
7    (Section scheduled to be repealed on January 1, 2028)
8    Sec. 50-10. Definitions. Each of the following terms, when
9used in this Act, shall have the meaning ascribed to it in this
10Section, except where the context clearly indicates otherwise:
11    "Academic year" means the customary annual schedule of
12courses at a college, university, or approved school,
13customarily regarded as the school year as distinguished from
14the calendar year.
15    "Address of record" means the designated address recorded
16by the Department in the applicant's or licensee's application
17file or license file as maintained by the Department's
18licensure maintenance unit.
19    "Advanced practice registered nurse" or "APRN" means a
20person who has met the qualifications for a (i) certified
21nurse midwife (CNM); (ii) certified nurse practitioner (CNP);
22(iii) certified registered nurse anesthetist (CRNA); or (iv)
23clinical nurse specialist (CNS) and has been licensed by the

 

 

HB4478- 2 -LRB102 24271 AMQ 33503 b

1Department. All advanced practice registered nurses licensed
2and practicing in the State of Illinois shall use the title
3APRN and may use specialty credentials CNM, CNP, CRNA, or CNS
4after their name. All advanced practice registered nurses may
5only practice in accordance with national certification and
6this Act.
7    "Advisory Board" means the Illinois Nursing Workforce
8Center Advisory Board.
9    "Approved program of professional nursing education" and
10"approved program of practical nursing education" are programs
11of professional or practical nursing, respectively, approved
12by the Department under the provisions of this Act.
13    "Board" means the Board of Nursing appointed by the
14Secretary.
15    "Center" means the Illinois Nursing Workforce Center.
16    "Collaboration" means a process involving 2 or more health
17care professionals working together, each contributing one's
18respective area of expertise to provide more comprehensive
19patient care.
20    "Competence" means an expected and measurable level of
21performance that integrates knowledge, skills, abilities, and
22judgment based on established scientific knowledge and
23expectations for nursing practice.
24    "Comprehensive nursing assessment" means the gathering of
25information about the patient's physiological, psychological,
26sociological, and spiritual status on an ongoing basis by a

 

 

HB4478- 3 -LRB102 24271 AMQ 33503 b

1registered professional nurse and is the first step in
2implementing and guiding the nursing plan of care.
3    "Consultation" means the process whereby an advanced
4practice registered nurse seeks the advice or opinion of
5another health care professional.
6    "Credentialed" means the process of assessing and
7validating the qualifications of a health care professional.
8    "Dentist" means a person licensed to practice dentistry
9under the Illinois Dental Practice Act.
10    "Department" means the Department of Financial and
11Professional Regulation.
12    "Email address of record" means the designated email
13address recorded by the Department in the applicant's
14application file or the licensee's license file, as maintained
15by the Department's licensure maintenance unit.
16    "Focused nursing assessment" means an appraisal of an
17individual's status and current situation, contributing to the
18comprehensive nursing assessment performed by the registered
19professional nurse or advanced practice registered nurse or
20the assessment by the physician assistant, physician, dentist,
21podiatric physician, or other licensed health care
22professional, as determined by the Department, supporting
23ongoing data collection, and deciding who needs to be informed
24of the information and when to inform.
25    "Full practice authority" means the authority of an
26advanced practice registered nurse licensed in Illinois and

 

 

HB4478- 4 -LRB102 24271 AMQ 33503 b

1certified as a nurse practitioner, clinical nurse specialist,
2or nurse midwife to practice without a written collaborative
3agreement and:
4        (1) to be fully accountable to patients for the
5    quality of advanced nursing care rendered;
6        (2) to be fully accountable for recognizing limits of
7    knowledge and experience and for planning for the
8    management of situations beyond the advanced practice
9    registered nurse's expertise; the full practice authority
10    for advanced practice registered nurses includes accepting
11    referrals from, consulting with, collaborating with, or
12    referring to other health care professionals as warranted
13    by the needs of the patient; and
14        (3) to possess the authority to prescribe medications,
15    including Schedule II through V controlled substances, as
16    provided in Section 65-43.
17    "Hospital affiliate" means a corporation, partnership,
18joint venture, limited liability company, or similar
19organization, other than a hospital, that is devoted primarily
20to the provision, management, or support of health care
21services and that directly or indirectly controls, is
22controlled by, or is under common control of the hospital. For
23the purposes of this definition, "control" means having at
24least an equal or a majority ownership or membership interest.
25A hospital affiliate shall be 100% owned or controlled by any
26combination of hospitals, their parent corporations, or

 

 

HB4478- 5 -LRB102 24271 AMQ 33503 b

1physicians licensed to practice medicine in all its branches
2in Illinois. "Hospital affiliate" does not include a health
3maintenance organization regulated under the Health
4Maintenance Organization Act.
5    "Impaired nurse" means a nurse licensed under this Act who
6is unable to practice with reasonable skill and safety because
7of a physical or mental disability as evidenced by a written
8determination or written consent based on clinical evidence,
9including loss of motor skills, abuse of drugs or alcohol, or a
10psychiatric disorder, of sufficient degree to diminish his or
11her ability to deliver competent patient care.
12    "License-pending advanced practice registered nurse" means
13a registered professional nurse who has completed all
14requirements for licensure as an advanced practice registered
15nurse except the certification examination and has applied to
16take the next available certification exam and received a
17temporary permit from the Department.
18    "License-pending registered nurse" means a person who has
19passed the Department-approved registered nurse licensure exam
20and has applied for a license from the Department. A
21license-pending registered nurse shall use the title "RN lic
22pend" on all documentation related to nursing practice.
23    "Nursing intervention" means any treatment based on
24clinical nursing judgment or knowledge that a nurse performs.
25An individual or entity shall not mandate that a registered
26professional nurse delegate nursing interventions if the

 

 

HB4478- 6 -LRB102 24271 AMQ 33503 b

1registered professional nurse determines it is inappropriate
2to do so. A nurse shall not be subject to disciplinary or any
3other adverse action for refusing to delegate a nursing
4intervention based on patient safety.
5    "Physician" means a person licensed to practice medicine
6in all its branches under the Medical Practice Act of 1987.
7    "Podiatric physician" means a person licensed to practice
8podiatry under the Podiatric Medical Practice Act of 1987.
9    "Practical nurse" or "licensed practical nurse" means a
10person who is licensed as a practical nurse under this Act and
11practices practical nursing as defined in this Act. Only a
12practical nurse licensed under this Act is entitled to use the
13title "licensed practical nurse" and the abbreviation
14"L.P.N.".
15    "Practical nursing" means the performance of nursing
16interventions requiring the nursing knowledge, judgment, and
17skill acquired by means of completion of an approved practical
18nursing education program. Practical nursing includes
19assisting in the nursing process under the guidance of a
20registered professional nurse or an advanced practice
21registered nurse. The practical nurse may work under the
22direction of a licensed physician, dentist, podiatric
23physician, or other health care professional determined by the
24Department.
25    "Privileged" means the authorization granted by the
26governing body of a healthcare facility, agency, or

 

 

HB4478- 7 -LRB102 24271 AMQ 33503 b

1organization to provide specific patient care services within
2well-defined limits, based on qualifications reviewed in the
3credentialing process.
4    "Registered Nurse" or "Registered Professional Nurse"
5means a person who is licensed as a professional nurse under
6this Act and practices nursing as defined in this Act. Only a
7registered nurse licensed under this Act is entitled to use
8the titles "registered nurse" and "registered professional
9nurse" and the abbreviation, "R.N.".
10    "Registered professional nursing practice" means a
11scientific process founded on a professional body of knowledge
12that includes, but is not limited to, the protection,
13promotion, and optimization of health and abilities,
14prevention of illness and injury, development and
15implementation of the nursing plan of care, facilitation of
16nursing interventions to alleviate suffering, care
17coordination, and advocacy in the care of individuals,
18families, groups, communities, and populations. "Registered
19professional nursing practice" does not include the act of
20medical diagnosis or prescription of medical therapeutic or
21corrective measures. Registered professional nursing practice
22is a scientific process founded on a professional body of
23knowledge; it is a learned profession based on the
24understanding of the human condition across the life span and
25environment and includes all nursing specialties and means the
26performance of any nursing act based upon professional

 

 

HB4478- 8 -LRB102 24271 AMQ 33503 b

1knowledge, judgment, and skills acquired by means of
2completion of an approved professional nursing education
3program. A registered professional nurse provides holistic
4nursing care through the nursing process to individuals,
5groups, families, or communities, that includes, but is not
6limited to: (1) the assessment of health care needs, nursing
7diagnosis, planning, implementation, and nursing evaluation;
8(2) the promotion, maintenance, and restoration of health; (3)
9counseling, patient education, health education, and patient
10advocacy; (4) the administration of medications and treatments
11as prescribed by a physician licensed to practice medicine in
12all of its branches, a licensed dentist, a licensed podiatric
13physician, or a licensed optometrist or as prescribed by a
14physician assistant or by an advanced practice nurse; (5) the
15coordination and management of the nursing plan of care; (6)
16the delegation to and supervision of individuals who assist
17the registered professional nurse implementing the plan of
18care; and (7) teaching nursing students.
19    "Professional assistance program for nurses" means a
20professional assistance program that meets criteria
21established by the Board of Nursing and approved by the
22Secretary, which provides a non-disciplinary treatment
23approach for nurses licensed under this Act whose ability to
24practice is compromised by alcohol or chemical substance
25addiction.
26    "Secretary" means the Secretary of Financial and

 

 

HB4478- 9 -LRB102 24271 AMQ 33503 b

1Professional Regulation.
2    "Unencumbered license" means a license issued in good
3standing.
4    "Written collaborative agreement" means a written
5agreement between an advanced practice registered nurse and a
6collaborating physician, dentist, or podiatric physician
7pursuant to Section 65-35.
8(Source: P.A. 99-173, eff. 7-29-15; 99-330, eff. 1-1-16;
999-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
 
10    (225 ILCS 65/50-75)
11    (Section scheduled to be repealed on January 1, 2028)
12    Sec. 50-75. Nursing delegation by a registered
13professional nurse.
14    (a) For the purposes of this Section:
15    "Delegation" means transferring to a specific individual
16the authority to perform a specific nursing intervention or
17task in a specific situation.
18    "Predictability of outcomes" means that a registered
19professional nurse or advanced practice registered nurse has
20determined that the patient's or individual's clinical status
21is stable and expected to improve or the patient's or
22individual's deteriorating condition is expected to follow a
23known or expected course.
24    "Stability" means a registered professional nurse or
25advanced practice registered nurse has determined that the

 

 

HB4478- 10 -LRB102 24271 AMQ 33503 b

1individual's clinical status and nursing care needs are
2consistent.
3    "Task" means work not requiring nursing knowledge,
4judgment, or decision making, as defined by the Department by
5rule.
6    (b) This Section authorizes a registered professional
7nurse to:
8        (1) delegate nursing interventions and tasks to other
9    registered professional nurses and , licensed practical
10    nurses based on the comprehensive nursing assessment that
11    includes, but is not limited to:
12            (A) the stability and condition of the patient;
13            (B) the potential for harm;
14            (C) the complexity of the nursing intervention or
15        task to be delegated;
16            (D) the predictability of outcomes; and
17            (E) the competency of the individual to whom the
18        nursing intervention or task is delegated;
19        (2) delegate tasks to , and other unlicensed personnel
20    based on the comprehensive nursing assessment that
21    includes, but is not limited to:
22            (A) the stability and condition of the patient;
23            (B) the potential for harm;
24            (C) the complexity of the task nursing
25        intervention to be delegated;
26            (D) the predictability of outcomes; and

 

 

HB4478- 11 -LRB102 24271 AMQ 33503 b

1            (E) competency of the individual to whom the task
2        nursing intervention is delegated;
3        (3) (2) delegate medication administration to other
4    licensed nurses; or
5        (3) in community-based or in-home care settings,
6    delegate the administration of medication (limited to oral
7    or subcutaneous dosage and topical or transdermal
8    application) to unlicensed personnel, if all the
9    conditions for delegation set forth in this Section are
10    met;
11        (4) refuse to delegate, stop, or rescind a previously
12    authorized delegation. ; or
13        (5) in community-based or in-home care settings,
14    delegate, guide, and evaluate the implementation of
15    nursing interventions as a component of patient care
16    coordination after completion of the comprehensive patient
17    assessment based on analysis of the comprehensive nursing
18    assessment data; care coordination in in-home care and
19    school settings may occur in person, by telecommunication,
20    or by electronic communication.
21    (c) This Section prohibits the following:
22        (1) An individual or entity from mandating that a
23    registered professional nurse delegate nursing
24    interventions if the registered professional nurse
25    determines it is inappropriate to do so. Nurses shall not
26    be subject to disciplinary or any other adverse action for

 

 

HB4478- 12 -LRB102 24271 AMQ 33503 b

1    refusing to delegate a nursing intervention based on
2    patient safety.
3        (2) The delegation of medication administration to
4    unlicensed personnel in any institutional or long-term
5    facility, including, but not limited to, those facilities
6    licensed by the Hospital Licensing Act, the University of
7    Illinois Hospital Act, State-operated mental health
8    hospitals, or State-operated developmental centers, except
9    as authorized under Article 80 of this Act or otherwise
10    specifically authorized by law.
11        (2.5) A registered professional nurse from delegating
12    work requiring nursing knowledge, assessment, judgment,
13    inference, decision making (including medication
14    administration), the development of a plan of care, and
15    evaluation of a plan of care to unlicensed non-nurse
16    personnel.
17        (3) A registered professional nurse from delegating
18    nursing judgment, the comprehensive patient assessment,
19    the development of a plan of care, and the evaluation of
20    care to licensed or unlicensed personnel.
21        (4) A licensed practical nurse or unlicensed personnel
22    who has been delegated a nursing intervention or task from
23    re-delegating a nursing intervention or task.
24        (5) Unlicensed personnel who have been delegated tasks
25    from re-delegating the tasks
26    (d) A registered professional nurse may delegate tasks to

 

 

HB4478- 13 -LRB102 24271 AMQ 33503 b

1other licensed and unlicensed persons.
2(Source: P.A. 100-513, eff. 1-1-18; 100-1160, eff. 6-1-19.)
 
3    (225 ILCS 65/60-35)
4    (Section scheduled to be repealed on January 1, 2028)
5    Sec. 60-35. RN scope of practice. The RN scope of nursing
6practice is the protection, promotion, and optimization of
7health and abilities, the prevention of illness and injury,
8the development and implementation of the nursing plan of
9care, the facilitation of nursing interventions to alleviate
10suffering, care coordination, and advocacy in the care of
11individuals, families, groups, communities, and populations.
12Practice as a registered professional nurse means this full
13scope of nursing, with or without compensation, that
14incorporates caring for all patients in all settings, through
15nursing standards of practice and professional performance for
16coordination of care, and may include, but is not limited to,
17all of the following:
18        (1) Collecting pertinent data and information relative
19    to the patient's health or the situation on an ongoing
20    basis through the comprehensive nursing assessment.
21        (2) Analyzing comprehensive nursing assessment data to
22    determine actual or potential diagnoses, problems, and
23    issues.
24        (3) Identifying expected outcomes for a plan
25    individualized to the patient or the situation that

 

 

HB4478- 14 -LRB102 24271 AMQ 33503 b

1    prescribes strategies to attain expected, measurable
2    outcomes.
3        (4) Implementing the identified plan, coordinating
4    care delivery, employing strategies to promote healthy and
5    safe environments, and administering or delegating
6    medication administration according to Section 50-75 of
7    this Act.
8        (5) Evaluating patient progress toward attainment of
9    goals and outcomes.
10        (6) Delegating nursing interventions and tasks to
11    licensed nurses to implement the plan of care.
12        (6.5) Delegating tasks to unlicensed personnel to
13    implement the plan of care.
14        (7) Providing health education and counseling.
15        (7.5) Advocating for the patient.
16        (8) Practicing ethically according to the American
17    Nurses Association Code of Ethics.
18        (9) Practicing in a manner that recognizes cultural
19    diversity.
20        (10) Communicating effectively in all areas of
21    practice.
22        (11) Collaborating with patients and other key
23    stakeholders in the conduct of nursing practice.
24        (12) Participating in continuous professional
25    development.
26        (13) Teaching the theory and practice of nursing to

 

 

HB4478- 15 -LRB102 24271 AMQ 33503 b

1    student nurses.
2        (14) Leading within the professional practice setting
3    and the profession.
4        (15) Contributing to quality nursing practice.
5        (16) Integrating evidence and research findings into
6    practice.
7        (17) Utilizing appropriate resources to plan, provide,
8    and sustain evidence-based nursing services that are safe
9    and effective.
10(Source: P.A. 100-513, eff. 1-1-18.)
 
11    Section 99. Effective date. This Act takes effect July 1,
122022.