1. SUNSET SUMMIT 2017 Sunset of the Nurse Practice Act
Susan Y Swart MS, RN, CAE Executive Director

2. Process Illinois Coalition of Nursing Organizations - April 2015
Identified organizations that could take lead on various sections
Timeline developed
Messaging – Nursing Voice, Advocacy Portal, each organization would be reporting out to their members
9 organizations present at first meeting
26 organizations met on August 3rd to review the proposals

3. Organizations ANA-Illinois
IACN – Illinois Association of Colleges of Nursing   
National Hispanic Nurses Association - Illinois
IANA – Illinois Association of Nurse Anesthetists
IPHNA – Illinois Public Health Nurse Administrators
ISAPN – Illinois Society for Advanced Practice Nursing  
IOADN – Illinois Organization for Associate Degree Nursing   
IASN – Illinois Association of School Nurses               
ICCB Deans and Directors – Illinois Community College Board
IONL – Illinois Organization of Nursing Leaders              
PNAI – Philippine Nurses Association of Illinois   
INF – Illinois Nurses Foundation    
CCNBNA – Chicago Chapter of the National Black Nurses Association
Leading Age – Nursing Division
DDNA of Illinois – Development Disabilities Nurses Association of Illinois
Emergency Nurses Association – Illinois State Council
GCCHIMSS - Greater Illinois Chapter of the Health Information Management and Systems Society – Nursing Division
Illinois Homecare and Hospice Council
Illinois Ambulatory Nurse Practice Consortium (IANPC) - chapter of AAACN
International Polish Nurses Association
National Association of Indian Nurses
Chi Eta Phi
Illinois League for Nursing
Illinois Nurses Association
American Psychiatric Nurses Association (APNA) - Illinois Chapter
IAOHN - Illinois Association of Occupational Health Nurses

4. MISCELLANEOUS DPR CHANGES
Eliminates obsolete or duplicative programs and services that are no longer utilized, such as:
a registered externship permit (65/60-15),
current nursing practice update course definition (65/60-10),
long vacant position of Assistant Nursing Coordinator (65/60-50).
Makes it easier for nurses to interact with the Department during licensure through common sense updates and changes, including enhancing the Department’s e-license initiative to streamline initial licensure and renewal and allowing licensed nurses to know the results of an administrative case with greater immediacy so they may react more quickly and appropriately.
Adds uniform confidentiality provision consistent with other Acts.

5. SECTION 50-10 Definitions Address of Record & Email Address of Record
Competence
Comprehensive Nursing Assessment
Focused Nursing Assessment
Full Practice Authority
Practical Nursing
Registered Professional Nursing Practice
Postgraduate Advanced Practice Registered Nurse

6. SECTION 70-5 Grounds for disciplinary action
(b) Grounds for disciplinary action include the following: (30) physical illness, including but not limited to deterioration through the aging process or loss of motor skill, mental illness, or disability that results in the inability (6) Failing, within 90 days, to provide a response to a request for information in response to a written request made by the Department by certified or registered mail or by to the address of record. (37) Willfully failing to report an instance of suspected abuse, neglect, financial exploitation, or self-neglect of an eligible adult as defined in and required by the Adult Protective Services Act. (38) Being named as an abuser in a verified report by the Department on Aging and under the Adult Protective Services Act, and upon proof by clear and convincing evidence that the licensee abused, neglected, or financially exploited an eligible adult as defined in the Adult Protective Services Act.

7. SECTION Fund
Require an annual report to the BON and the ICN on the use of the Nursing Dedicated and Professional Fund monies. Report must include monies allocated to IDPH including persons or organizations and the respective amounts dispersed for the relative fiscal year and the state agencies administrative expenses. The report will be publicly available on IDFPR’s Center for Nursing website.
RATIONALE - The requested report will serve as a full disclosure to the nursing community on how the funds are allocated. The nursing community should be aware of how their funds are spent.

8. SECTION 75-15 Illinois Nursing Workforce Center Advisory Board
Appointed by the Secretary of the Department
SECTION Powers and Duties of the Advisory Board
Determine operational policy
Establish committees, as needed
Recommend adoption and revision of rules
Implement the major function of the board
Seek and accept non-state funds for carrying out the policy of the center
DELETED
(2) administer grants, scholarships, internships, and other programs, as defined by rule, including the administration of programs, as determined by law, that further those goals set forth in Section of this Article, in consultation with other State agencies, as provided by law;

9. LPN & RN Education Remove reference to correspondence course
RATIONALE – outdated terminology
Remove the word “written” throughout the act when referencing the application process
Nurse administrator of the program oversees academic and clinical areas of the program.
ADDITIONAL WORK NEEDED -
Include that simulation can be included in the theoretical and clinical instruction and that it cannot be more than 30% of clinical instruction.
Recommend that ratio of students to faculty in clinical areas be 8 to 1 or 12 to 1 when preceptors are used. Previous language 10 to 1
Copies of the feasibility study will be provided to the board of nursing
RATIONALE – Summaries are insufficient, risk of data being misrepresented

10. RN Education Accreditation of all RN programs in the state
beginning December 31, 2022, obtaining programmatic accreditation by a national accrediting body for nursing education that is recognized by the United States Department of Education and approved by the Board of Nursing.
The Board of Nursing shall be notified within 30 days should the program lose its accreditation. The Board shall determine a process for warnings and adopt rules for reaccreditation.
RATIONALE – Program accreditation ensures quality and review of curriculum and the program by a national organization. Students from accredited programs are able to continue their education in a seamless manner and have more options for transfer to other educational opportunities.
Remove the need for full routine site visits; the need for site visits will be determined by the Nursing Coordinator or upon recommendation of the board. Site visits will be used to determine compliance with the Act.

11. LPN & RN Education OUR ASK -
Apply to take the examination for a license within 6 months (currently there is no timeframe legislated)
Successfully complete the examination within 12 months after graduation (currently a student has 3 years from application to pass the NCLEX)
Must enroll in and successfully complete a Board-approved licensure examination preparatory course.
May sit for the (NCLEX-PN) or (NCLEX-RN) or (Currently unlimited). a maximum of 6 times
LANGUAGE – All applicants have 3 years after the date of application to complete the application process. If the process has not been completed within 3 years after the date of application, the application shall be denied, the fee forfeited, and the applicant must reapply and meet the requirements in effect at the time of reapplication.

12. SECTION 50-13 Address of record; email address of record
All applicants and licensees shall: (1) provide a valid address and address to the Department, which shall serve as the address of record and address of record, respectively, at the time of application for licensure or renewal of a license; and (2) inform the Department of any change of address of record or address of record within 14 days after such change either through the Department's website or by contacting the Department's licensure maintenance unit.

13. SECTION 50-50 Prohibited acts
(18) Be deemed a supervisor when delegating nursing interventions or guiding the practice of a licensed practical nurse as authorized under this act;

14. SECTION 50-55 Department powers and duties
Determine fitness and qualifications of applicants
Issue licenses
Adopt rules in consultation with the Board of Nursing
Prescribe rules for method of examination of candidates
Prescribe rules defining what constitutes an approved program
Conduct hearings
Prepare and maintain a list of approved programs
Act upon the recommendations of the Board of Nursing and the Illinois Nursing Workforce Center Advisory Board

15. SECTION 55-30. LPN Scope of Practice
Practice as a licensed practical nurse means a scope of nursing practice, with or without compensation, under the guidance of a registered professional nurse, an advanced practice nurse, or the direction of a physician assistant, physician, dentist, or podiatric physician or other healthcare professionals as determined by the department, and includes, but is not limited to, all of the following:
Conducting a focused nursing assessment and collaborating on the ongoing health assessment of the patient.
“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, advanced practice registered nurse, or the assessment by the physician, dentist, podiatric physician or other healthcare professionals as determined by the department, supporting ongoing data collection, and deciding who needs to be informed of the information and when to inform

16. RN Practice/Delegation
INTENT OF THE PROPOSALS -
align RN scope of practice in Illinois with the ANA Scope and Standards of Practice (2015)
Include the ANA Code of Ethics in the RN scope of practice
Delegation decisions are the sole purview of the RN or APN who is delegating.
The RN or APN who wishes to delegate must use the principals of the
“5 rights of delegation” to determine if delegation is appropriate.
Systems need to be built that support the RN’s delegation decisions.

17. RN Practice
“Comprehensive Nursing Assessment” means the gathering of information about the patient’s physiological, psychological, sociological and spiritual status by a Registered Professional Nurse and is the first step in implementing and guiding the nursing plan of care. "Registered professional nursing practice" means a scientific process founded on a professional body of knowledge, which 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.

18. SECTION 60-35 RN Scope of Practice
RN Scope of nursing practice is the protection, promotion and optimization of health and abilities, prevention of illness and injury, 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 includes but is not limited to, all of the following:
Collecting pertinent data and information relative to the patient’s health or the situation through the comprehensive nursing assessment.
Analyzing the assessment data to determine actual or potential diagnoses, problems and issues.
Identifying expected outcomes for a plan individualized to the patient or the situation that prescribes strategies to attain expected, measurable outcomes.
Implementing the identified plan, coordinating care delivery, employing strategies to promote healthy and safe environments, and administering or delegating medication administration according to Sec Delegation by the Registered Professional Nurse.
Evaluating progress toward attainment of goals and outcomes.

19. SECTION 60-35 RN Scope of Practice
Delegating and assigning nursing interventions to implement the plan of care.
Providing health education and counseling.
Advocating for the patient.
Practicing ethically according to the ANA Code of Ethics
Practicing in a manner that recognizes cultural diversity.
Communicating effectively in all areas of practice.
Collaborating with health care consumer and other key stakeholders in the conduct of nursing practice.
Participating in continuous professional development
Teaching the theory and practice of nursing to nursing students.
Leading within the professional practice setting and the profession.
Contributing to quality nursing practice.
Integrating evidence and research findings into practice.
Utilizing appropriate resources to plan, provide and sustain evidence-based nursing services that are safe and effective.
Participating in development of policies, procedures, and systems to support patient safety.
RATIONALE -This revision would make the law and the professional standards congruent and enhance the legal RN scope of practice

20. SECTION 50-75 Nursing delegation by the Registered Professional Nurse
“Delegation” means transferring to a specific individual the authority to perform a specific nursing intervention in a specific situation. “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 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.

21. “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. “Stability” means a registered professional nurse has determined that the individual’s clinical status and nursing care needs are consistent. “Predictability of outcomes” means a registered professional 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.

22. The stability and condition of the patient, The potential for harm,
(b) This Section authorizes a registered professional nurse to:
Delegate nursing interventions based on overall patient assessment that includes, but is not limited to
The stability and condition of the patient,
The potential for harm,
The complexity of the nursing intervention to be delegated,
Predictability of outcomes, and
Competency of the individual to whom the nursing intervention is delegated.
Delegate medication administration to other licensed nurses
In community-based or in home-care settings may delegate the administration of medication (limited to oral or subcutaneous dosage, topical or transdermal application) to unlicensed personnel, if all the conditions for delegation set forth in this section are met; or
Refuse to delegate, stop, or rescind a previously authorized delegation.
In community-based or in home care settings the registered professional nurse delegates, guides, and evaluates the implementation of nursing interventions as a component of patient care coordination after completion of the comprehensive patient assessment. Care coordination may occur in person or by telecommunication, or by electronic communications.

23. (c) This Section prohibits the following:
An individual or entity from mandating a professional registered nurse delegate nursing interventions if the RN 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.
The delegation of medication administration to unlicensed persons in any institutional facility 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.
A registered professional nurse from delegating nursing judgment, the comprehensive patient assessment, the development of the plan of care, and the evaluation of care to licensed or unlicensed personnel.
A licensed practical nurse or unlicensed personnel who has been delegated a nursing intervention from re- delegating a nursing intervention.

24. ARTICLE 50/SECTION 65. ADVANCED PRACTICE REGISTERED NURSES
Change APN to APRN throughout the act and other laws
RATIONALE – consistency across states and to align with the APRN consensus model

25. FOR THOSE PRACTICING AS A CRNA
Remove language that references the requirement of physical presence by physicians during the delivery of anesthesia services. Specifically, remove where this language below appears in the Nurse Practice Act or related Acts:
“and remain physically present and available on the premises during the delivery of anesthesia services.”

26. Definitions
“Full Practice Authority” means an APN who has met the requirements of Section XX of this Act and who may petition the Department to practice without a written collaborative agreement while maintaining collaborative, consultative and referral networks with other healthcare professionals.
“Postgraduate advanced practice registered nurse” means a licensed advanced practice nurse (APRN) who has been initially licensed in Illinois after the effective date of this Act, and meets the qualifications for licensure as a Certified Nurse Practitioner, Certified Nurse Midwife or Certified Clinical Nurse Specialist and has obtained a written collaborative agreement with a physician.
“Post graduate APRN Practice” means the practice of a postgraduate APRN until completing hours of clinical practice outside a hospital, hospital affiliate, or ASTC with a written collaborative agreement with a physician, or completion of 3000 hours of practice as privileged in a hospital, hospital affiliate or ASTC.

27. SECTION 65-XX FULL PRACTICE AUTHORITY
(a) "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 be fully accountable:
to patients for the quality of advanced nursing care rendered,
for recognizing limits of knowledge and experience, and
for planning for the management of situations beyond the advanced practice registered nurse's expertise.
"Full practice authority“ includes accepting referrals from, consulting with, collaborating with, or referring to other health care professionals as warranted by the needs of the patient and possessing the authority to prescribe all medications and orders for, administration of, storage of, acceptance of samples of, and dispensing over the counter medications, legend drugs, medical gases, and controlled substances categorized as any Schedule II through V controlled substances, as defined in Article II of the Illinois Controlled Substances Act, and other preparations, including, but not limited to, botanical and herbal remedies.

28. SECTION 65-XX FULL PRACTICE AUTHORITY
(b) Full practice Authority as an advanced practice registered nurse shall be accorded if (1) The advanced practice nurse has been licensed as an APRN and in practice for more than 3000 hours prior to the effective date of this Act, or (2) A postgraduate advanced practice registered nurse has met 3000 hours of practice with a written collaborative agreement with a physician or privileged to practice in a hospital, hospital affiliate or ASTC. (c) An advanced practice registered nurse with full practice authority shall: (1) Shall hold a controlled substances license for prescribing schedule II-V drugs. (2) Meet the education requirement under Section of the Controlled Substance Act.

29. SECTION 65-XX POSTGRADUATE APRN PRACTICE
(a) Postgraduate APRN who is licensed and certified as Certified Nurse Practitioner, Certified Nurse Midwife, or Certified Clinical Nurse Specialist shall be required to practice with a written collaborative agreement with a physician, according to the following Sections in this Act until hours of clinical practice is complete:
Section Written Collaborative Agreement
Section Written Collaborative Agreement: Temporary Practice.
Section Written Collaborative Agreement: Prescriptive Authority
Section Hospital, Hospital Affiliate, or ASTC

30. SECTION 65-35 WRITTEN COLLABORATIVE AGREEMENTS
(a) A written collaborative agreement is required for advanced practice registered nurses engaged in clinical practice, except for advanced practice registered nurses who are privileged to practice in a hospital, hospital affiliate, or ambulatory surgical treatment center or an APRN who has met the requirements in Sec. 65- XX. Full practice authority.

31. SECTION 65-45 ADVANCED PRACTICE NURSING IN HOSPITALS, HOSPITAL AFFILIATES, OR ASTC
(a) An advanced practice registered nurse with full practice authority may be privileged to provide healthcare services as described in Section (a-3) An APRN with full practice authority may be privileged to complete discharge prescriptions under the APRN’s name. (6) An APRN with full practice authority may be privileged to prescribe controlled substances categorized as Schedule II through V controlled substances

32. SECTION 65-60 CONTINUING EDUCATION
Increase pharmacology continuing education requirements
Total hours will not change 50 hours CE per renewal cycle
20 hours must be pharmacology with 10 of those hours specific to Schedule II
RATIONALE – To circumvent issues that may occur due to continued conversations in Springfield related to the use of schedule II gateway drugs that may lead to substance abuse (heroin overdose).

33. Next Steps HOUSE HB 313 – NPA minus APRN HB 312 – APRN bill
Representative Sara Feigenholtz
COMMITTEE –
Health Care Licenses
HB 313 shelled and passed out of committee –
On 2rd reading during continued negotiations
SENATE
SB 625 – NPA minus APRN
Senator Iris Martinez
SB 642 – APRN bill
Senator Heather Steans
Licensed Activities & Pensions
Passed out of committee – on 3rd reading during continued negotiations