68 Ill. Adm. Code 1305.10
ILLINOIS ADMINISTRATIVE CODE
*** THIS DOCUMENT IS CURRENT THROUGH OCTOBER 12, 2001 ***
TITLE 68. PROFESSIONS AND OCCUPATIONS
CHAPTER VII. DEPARTMENT OF PROFESSIONAL REGULATION
SUBCHAPTER B. PROFESSIONS AND OCCUPATIONS
PART 1305. NURSING AND ADVANCED PRACTICE NURSING ACT - ADVANCED
PRACTICE NURSE
68 Ill. Adm. Code 1305.10 (2001)
§ 1305.10 Definitions
"Act" means the Nursing and Advanced Practice Nursing
Act [225 ILCS 65].
"APN Board" or "Board" means the Advanced
Practice Nursing Board.
"Advanced practice nurse" or "APN" means
a person who:
is licensed as a registered professional nurse under the Act;
meets the requirements for licensure as an advanced practice
nurse under Section 15-10 of the Act;
except as provided in Section 15-25 of the Act, has a written
collaborative agreement with a collaborating physician in the
diagnosis of illness and management of wellness and other conditions
as appropriate to the level and area of his or her prac dtice
in accordance with Section 15-15 of the Act; and cares for patients:
by using advanced diagnostic skills, the results of diagnostic
tests and procedures ordered by the advanced practice nurse, a
physician assistant, a dentist, a podiatrist, or a physician,
and professional judgment to initiate and coordinate the care
of patients;
by ordering diagnostic tests, prescribing medications and drugs
in accordance with Section 15-20 of the Act, and administering
medications and drugs; and
by using medical, therapeutic, and corrective measures to treat
illness and improve health status.
Categories include Certified Nurse Midwife (CNM), Certified Nurse
Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA),
or Certified Clinical Nurse Specialist (CNS). (Section 15-5 of
the Act)
"Collaborating physician" means a physician who works
with an advanced practice nurse and provides medical direction
as documented in a written collaborative agreement required under
Section 15-15 of the Act. (Section 15-5 of the Act)
"Physician" means a person licensed to practice medicine
in all its branches under the Medical Practice Act of 1987. (Section
15-5 of the Act)
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§ 1305.15 Application for Licensure Prior to July 1, 2001
a) An applicant for licensure as an advanced practice nurse shall
file an application, prior to July 1, 2001, on forms provided
by the Department. The application shall include:
1) Current Illinois registered nurse license number.
2) Proof of current national certification, which includes completion
of an examination, from one of the following:
A) Nurse Midwife certification from:
i) the American College of Nurse Midwives (ACNM); or
ii) American College of Nurse Midwives Certification Council
(ACC);
B) Nurse Practitioner certification from:
i) American Academy of Nurse Practitioners Certification Program
as a Nurse Practitioner;
ii) American Nurses Credentialing Center as a Nurse Practitioner;
iii) The National Certification Board of Pediatric Nurse Practitioners
& Nurses as a Nurse Practitioner;
iv) The National Certification Corporation for the Obstetric,
Gynecologic and Neonatal Nursing Specialties as a Nurse Practitioner;
or
v) The Certification Board for Urologic Nurses and Associates
as a Urologic Nurse Practitioner;
C) Registered Nurse Anesthetist certification from:
i) Council on Certification of the American Association of Nurse
Anesthetists; or
ii) Council on Recertification of the American Association of
Nurse Anesthetists;
D) Clinical Nurse Specialist certification from:
i) American Nurses Credentialing Center (ANCC) as a Clinical
Nurse Specialist;
ii) American Association of Critical Care Nurses as a Clinical
Nurse Specialist;
iii) Rehabilitation Nursing Certification Board as a Certified
Rehabilitation Registered Nurse-Advanced;
iv) Oncology Nursing Certification Corporation as an Advanced
Oncology Certified Nurse (AOCN); or
v) Certification Board for Urologic Nurses and Associates as
a Urologic Clinical Nurse Specialist.
3) The Board, in addition to the certifications listed in subsection
(a)(2)(D), may review and make a recommendation to the Department
to accept a certification for a clinical nurse specialist if the
certifying body meets the following requirements:
A) is national in the scope of credentialing;
B) has no requirement for an applicant to be a member of any
organization;
C) has an examination that represents a specialty practice category;
D) has an examination that evaluates knowledge, skills and abilities
essential for the delivery of safe and effective specialty nursing
care;
E) has an examination whose content and distribution are specified
in a test plan;
F) has examination items reviewed for content validity, cultural
sensitivity and correct scoring, using an established mechanism,
both before use and periodically;
G) has an examination evaluated for psychometric performance;
H) has a passing standard established using acceptable psychometric
methods and is reevaluated periodically;
I) has examination security maintained through established procedures;
J) issues a certification based upon passing the examination;
K) has mechanisms in place for communication to boards of nursing
for timely verification of an individual's certification status,
changes in certification status and changes in the certification
program, including qualifications, test plan and scope of practice;
and
L) has an evaluation process to provide quality assurance in
its certification program.
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4) Education
A) Proof of successful completion of a post-basic advanced practice
formal education program in the area of his or her nursing specialty;
or
B) Proof of successful completion of a master's program appropriate
for certification as a Nurse Midwife, Nurse Practitioner, Clinical
Nurse Specialist or Nurse Anesthetist.
5) A complete work history since completion of an advanced practice
nursing program.
6) Proof on forms provided by the Department, from all states
in which an applicant was licensed and is currently licensed as
an advanced practice nurse, if applicable, stating:
A) The time during which the applicant was licensed in that state,
including the date of the original issuance of the license; and
B) Whether the file on the applicant contains any record of disciplinary
actions taken or pending.
7) The fee required in Section 1305.25 of this Part.
b) A nurse practitioner applying for licensure as an advanced
practice nurse pursuant to Section 15-10(c) of the Act shall file
an application, before July 1, 2001, on forms provided by the
Department. The application shall include:
1) Current Illinois registered nurse license number;
2) Education
A) Proof of successful completion of a post-basic advanced practice
formal education program in the area of his or her nursing specialty;
or
B) Proof of successful completion of a master's or higher program
appropriate for certification as a nurse practitioner;
3) Proof of practice for at least 10 years as a nurse practitioner;
4) A complete work history since completion of an advanced practice
nursing education program;
5) Proof on forms provided by the Department, from all states
in which an applicant was licensed and is currently licensed as
an advanced practice nurse, if applicable, stating:
A) The time during which the applicant was licensed in that state,
including the date of the original issuance of the license; and
B) Whether the file on the applicant contains any record of disciplinary
actions taken or pending;
6) The fee required in Section 1305.25 of this Part.
c) When the accuracy of any submitted documentation or the relevance
or sufficiency of the course work or experience is questioned
by the Department or the Board because of lack of information,
discrepancies or conflicts in information given, or a need for
clarification, the applicant seeking licensure shall be requested
to:
1) Provide information as may be necessary; and/or
2) Appear for an interview before the Board to explain the relevance
or sufficiency, clarify information or clear up any discrepancies
or conflicts in information.
d) An advanced practice nurse license will be issued when the
applicant meets the requirements set forth in this Section and
the Act or the applicant will be notified for the reasons for
denial.
e) "Post-basic advanced practice formal education program"
means an integrated course of study that includes concurrent advanced
clinical nursing practice and theory.
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§ 1305.20 Application for Licensure Beginning July 1,
2001
a) An applicant for licensure as an advanced practice nurse shall
file an application on forms provided by the Department. The application
shall include:
1) Current Illinois registered nurse license number.
2) Proof of current national certification, which includes completion
of an examination, from one of the following:
A) Nurse Midwife certification from:
i) the American College of Nurse Midwives (ACNM); or
ii) the American College of Nurse Midwives Certification Council.
B) Nurse Practitioner certification from:
i) American Academy of Nurse Practitioners Certification Program
as a Nurse Practitioner;
ii) American Nurses Credentialing Center as a Nurse Practitioner;
iii) The National Certification Board of Pediatric Nurse Practitioners
& Nurses as a Nurse Practitioner;
iv) The National Certification Corporation for the Obstetric,
Gynecologic and Neonatal Nursing Specialties as a Nurse Practitioner;
or
v) The Certification Board for Urologic Nurses and Associates
as a Urologic Nurse Practitioner.
C) Registered Nurse Anesthetist certification from:
i) Council on Certification of the American Association of Nurse
Anesthetists; or
ii) Council on Recertification of the American Association of
Nurse Anesthetists.
D) Clinical Nurse Specialist certification from:
i) American Nurses Credentialing Center (ANCC) as a Clinical
Nurse Specialist;
ii) American Association of Critical Care Nurses as a Clinical
Nurse Specialist;
iii) Rehabilitation Nursing Certification Board as a Certified
Rehabilitation Registered Nurse-Advanced;
iv) Oncology Nursing Certification Corporation as an Advanced
Oncology Nurse (AOCN); or
v) Certification Board for Urologic Nurses and Associates as
Urologic Clinical Nurse Specialist.
3) Proof of successful completion of a master's program or higher
appropriate for certification as a Nurse Midwife, Nurse Practitioner,
Clinical Nurse Specialist or Nurse Anesthetist.
4) A complete work history since completion of an advanced practice
nursing program.
5) Proof on forms provided by the Department, from all states
in which an applicant was licensed and is currently licensed as
an advanced practice nurse, if applicable, stating:
A) The time during which the applicant was licensed in that state,
including the date of the original issuance of the license; and
B) Whether the file on the applicant contains any record of disciplinary
actions taken or pending.
6) The fee required in Section 1305.25 of this Part.
b) When the accuracy of any submitted documentation or the relevance
or sufficiency of the course work or experience is questioned
by the Department or the Board because of lack of information,
discrepancies or conflicts in information given, or a need for
clarification, the applicant seeking licensure shall be requested
to:
1) Provide information as may be necessary; and/or
2) Appear for an interview before the Board to explain the relevance
or sufficiency, clarify information or clear up any discrepancies
or conflicts in information.
c) An advanced practice nurse license may be issued when the
applicant meets the requirements set forth in this Section.
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§ 1305.25 Fees
The following fees shall be paid to the Department and are not
refundable:
a) Application Fees. The fee for application for a license as
an advanced practice nurse is $ 125.
b) Renewal Fees. The fee for the renewal of a license shall be
calculated at the rate of $ 40 per year.
c) General Fees.
1) The fee for the restoration of a license other than from inactive
status is $ 20 plus payment of all lapsed renewal fees.
2) The fee for the issuance of a duplicate license, for the issuance
of a replacement license for a license that has been lost or destroyed,
or for the issuance of a license with a change of name or address
other than during the renewal period, is $ 20. No fee is required
for name and address changes on Department records when no duplicate
license is issued.
3) The fee for a certification of a licensee's record for any
purpose is $ 20.
4) The fee for a wall certificate showing licensure shall be
the actual cost of producing the certificate.
5) The fee for a roster of persons licensed as advanced practice
nurses in this State shall be the actual cost of producing the
roster.
6) The fee for processing a fingerprint card by the State Police
is the cost of processing, which shall be made payable to the
State Police Services Fund and shall be remitted to the State
Police for deposit into the Fund.
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§ 1305.30 Written Collaborative Agreements
a) A written collaborative agreement shall describe the working
relationship of the advanced practice nurse with the collaborating
physician and shall authorize the categories of care, treatment,
or procedures to be performed by the advanced practice nurse.
(Section 15-15(b) of the Act)
b) The agreement shall be defined to promote the exercise of
professional judgment by the advanced practice nurse commensurate
with his or her education and experience. The services to be provided
by the advanced practice nurse shall be services that the collaborating
physician generally provides to his or her patients in the normal
course of his or her clinical medical practice. The agreement
need not describe the exact steps that an advanced practice nurse
must take with respect to each specific condition, disease, or
symptom, but must specify which authorized procedures require
a physician's presence as the procedures are being performed.
The collaborative relationship under an agreement shall not be
construed to require the personal presence of a physician at all
times at the place where services are rendered. Methods of communication
shall be available for consultation with the collaborating physician
in person or by telecommunications in accordance with established
written guidelines as set forth in the written agreement. (Section
15-15(b) of the Act)
c) A copy of the signed, written collaborative agreement must
be available to the Department upon request from both the advanced
practice nurse and the collaborating physician and shall be annually
updated. An advanced practice nurse shall inform each collaborating
physician of all collaborative agreements he or she has signed
and provide a copy of these to any collaborating physician, upon
request. (Section 15-15(d) of the Act)
d) Pursuant to Section 15-25 of the Act, a certified registered
nurse anesthetist is not required to possess prescriptive authority
or a written collaborative agreement to provide anesthesia services
ordered by a licensed physician, dentist or podiatrist. However,
a certified registered nurse anesthetist may be delegated limited
prescriptive authority under Section 15-20 of the Act in a written
collaborative agreement.
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§ 1305.35 Medical Direction
a) Physician medical direction shall be adequate with respect
to collaboration with Certified Nurse Practitioners, Certified
Nurse Midwives, and Clinical Nurse Specialists if a collaborating
physician:
1) participates in the joint formulation and joint approval of
orders or guidelines with the advanced practice nurse and periodically
reviews those orders and the services provided patients under
those orders in accordance with accepted standards of medical
practice and advanced practice nursing practice;
2) is on site at least once a month to provide medical direction
and consultation. On site is defined in the collaborative agreement;
and
3) is available through telecommunications for consultation on
medical problems, complications, or emergencies or patient referral.
[225 ILCS 60/54.5(b)]
b) Medical direction for a certified registered nurse anesthetist
shall be in accordance with Section 54.5(b-5) of the Medical Practice
Act [225 ILCS 60/54.5(b-5)].
c) In the absence of the collaborating physician, another physician
shall be available for consultation.
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§ 1305.40 Prescriptive Authority
a) A collaborating physician who delegates limited prescriptive
authority to an advanced practice nurse shall include that delegation
in the written collaborative agreement. The prescriptive authority
may include prescription and dispensing of legend drugs and legend
controlled substances categorized as Schedule III, IV, or V controlled
substances, as defined in the Illinois Controlled Substances Act
[720 ILCS 570]. The authority to prescribe Schedule II controlled
substances may not be delegated by the collaborating physician.
b) An APN who has been given controlled substances prescriptive
authority shall be required to obtain an Illinois mid-level practitioner
controlled substance license in accordance with 77 Ill. Adm. Code
3100. The physician shall file a notice of delegation of prescriptive
authority with the Department. The delegation of authority form
shall be submitted to the Department prior to the issuance of
a controlled substance license.
c) The APN may only prescribe and dispense within the scope of
practice of the collaborating physician.
d) All prescriptions written and signed by an advanced practice
nurse shall indicate the name of the collaborating physician.
The collaborating physician's signature is not required. The advanced
practice nurse shall sign his/her own name.
e) An APN may receive and dispense samples per the collaborative
agreement.
f) Medication orders shall be reviewed periodically by the collaborating
physician.
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§ 1305.45 Delivery of Anesthesia Services by a Certified
Registered Nurse Anesthetist
a) A licensed certified registered nurse anesthetist may provide
anesthesia services pursuant to the order of a licensed physician,
licensed dentist, or licensed podiatrist in a licensed hospital,
a licensed ambulatory surgical treatment center, or the office
of a licensed physician, the office of a licensed dentist, or
the office of a licensed podiatrist. For anesthesia services,
an anesthesiologist, physician, dentist, or podiatrist shall participate
through discussion of and agreement with the anesthesia plan and
shall remain physically present and be available on the premises
during the delivery of anesthesia services for diagnosis, consultation,
and treatment of emergency medical conditions, unless hospital
policy adopted pursuant to Section 10.7(3)(B) of the Hospital
Licensing Act [210 ILCS 85/10.7(3)(B)] or ambulatory surgical
treatment center policy adopted pursuant to Section 6.5(3)(B)
of the Ambulatory Surgical Treatment Center Act [210 ILCS 5/6.5(3)(B)]
provides otherwise. (Section 15-25(a) of the Act)
b) A certified registered nurse anesthetist who provides anesthesia
services in a hospital shall do so in accordance with Section
10.7 of the Hospital Licensing Act and, in an ambulatory surgical
treatment center, in accordance with Section 6.5 of the Ambulatory
Surgical Treatment Center Act. (Section 15-25(b) of the Act)
c) A certified registered nurse anesthetist is not required to
possess prescriptive authority or a written collaborative agreement
meeting the requirements of Section 15-15 of the Act to provide
anesthesia services ordered by a licensed physician, dentist,
or podiatrist. Certified registered nurse anesthetists are authorized
to select, order, and administer drugs and apply the appropriate
medical devices in the provision of anesthesia services under
the anesthesia plan agreed with by the anesthesiologist or the
physician in accordance with hospital alternative policy or the
medical staff consulting committee policies of a licensed ambulatory
surgical treatment center. In a physician's office, dentist's
office, or podiatrist's office, the anesthesiologist, operating
physician, operating dentist, or operating podiatrist shall agree
with the anesthesia plan, in accordance with the written practice
agreement. (Section 15-25(d) of the Act)
d) A certified registered nurse anesthetist may be delegated
limited prescriptive authority under Section 15-20 of the Act
in a written collaborative agreement meeting the requirements
of Section 15-15 of the Act. (Section 15-25(e) of the Act)
e) In a physician's office, the certified registered nurse anesthetist
may only provide anesthesia services if the physician has training
and experience in the delivery of anesthesia services to patients.
Such training and experience shall be documented in the written
practice agreement.
1) The training and experience requirements may be met in the
manner specified in either subsection (e)(1)(A) or (B).
A) The physician maintaining clinical privileges to administer
anesthesia services in a hospital licensed in accordance with
the Hospital Licensing Act or an ambulatory surgical treatment
center licensed in accordance with the Ambulatory Surgical Treatment
Center Act [210 ILCS 5]; or
B) Completion of continuing medical education:
i) For conscious sedation only, the physician shall complete
a minimum of 8 hours of continuing medical education (CME) within
each 3 year license renewal period in delivery of anesthesia,
including the administration of conscious sedation. The physician
will be required to complete 4 of the 8 hours of CME for the July
2002 renewal period.
ii) For deep sedation, regional anesthesia and/or general anesthesia,
a physician shall complete a minimum of 34 hours of continuing
medical education in the delivery of anesthesia services within
each 3 year license renewal period. The physician will be required
to complete 16 of the 34 hours of CME for the July 2002 renewal
period. Fullfillment of this requirement shall satisfy the requirement
of subsection (e)(1)(B)(i) above.
iii) A continuing medical education program shall be conducted
by a university, professional association, or hospital as a formal
CME program under 68 Ill. Adm. Code 1285.110(b)(2).
2) In addition, the physician and any certified registered nurse
anesthetist shall maintain current Advanced Cardiac Life Support
(ACLS) certification. (For practice agreements entered into prior
to November 1, 2001, the physician and CRNA shall obtain ACLS
certification no later than November 1, 2001.)
f) In a dentist's office, the certified registered nurse anesthetist
may only provide those services the dentist is authorized to provide
pursuant to the Illinois Dental Practice Act [225 ILCS 25] and
rules (68 Ill. Adm. Code 1220). Licensed dentists are required
to hold permits to administer anesthesia pursuant to 68 Ill. Adm.
Code 1220: Subpart D.
g) In a podiatrist's office, the certified registered nurse anesthetist
may only provide those services the podiatrist is authorized to
provide pursuant to the Podiatric Medical Practice Act of 1987
[225 ILCS 100] and rules (68 Ill. Adm. Code 1360). Podiatrists
may not administer general anesthetics.
h) A CRNA providing anesthesia services in a physician, dental
or podiatrist office shall do so with the active participation,
approval, presence and availability of the physician, dentist
or podiatrist as well as in accordance with Standards 1-11 of
the "Standards for Office Based Anesthesia Practice",
American Association of Nurse Anesthetists, 222 South Prospect
Avenue, Park Ridge, Illinois 60068 (1999), which are hereby incorporated
by reference, with no later editions or amendments. If there is
a conflict between the Nursing and Advanced Practice Nursing Act
or this Part and the Standards for Office Based Anesthesia Practice
of the American Association of Nurse Anesthetists, the Act and
this Part shall prevail.
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§ 1305.50 Practice Agreement for Certified Registered
Nurse Anesthetist
A certified registered nurse anesthetist who provides anesthesia
services in a physician office, dental office, or podiatric office
shall enter into a written practice agreement with an anesthesiologist
or the physician licensed to practice medicine in all its branches,
the dentist, or the podiatrist performing the procedure. The agreement
shall describe the working relationship of the certified registered
nurse anesthetist and anesthesiologist, physician, dentist, or
podiatrist and shall authorize the categories of care, treatment,
or procedures to be performed by the certified registered nurse
anesthetist. In a dentist's office, the certified registered nurse
anesthetist may only provide those services the dentist is authorized
to provide pursuant to the Illinois Dental Practice Act and rules
(68 Ill. Adm. Code 1220). In a podiatrist's office, the certified
registered nurse anesthetist may only provide those services the
podiatrist is authorized to provide pursuant to the Podiatric
Medical Practice Act of 1987 and rules (68 Ill. Adm. Code 1360).
For anesthesia services, an anesthesiologist, physician, dentist,
or podiatrist shall participate through discussion of and agreement
with the anesthesia plan and shall remain physically present and
be available on the premises for diagnosis, consultation and treatment
of emergency medical conditions. (Section 15-25(c) of the Act)
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§ 1305.60 Renewals
a) Every license issued under the Act shall expire on May 31
of each even numbered year. The first renewal of an advanced practice
nurse license is 2002. The holder of a license may renew such
license during the month preceding the expiration date by paying
the required fee. A licensee's registered nurse license shall
be renewed in order to renew the advanced practice nurse license.
b) It is the responsibility of each licensee to notify the Department
of any change of address. Failure to receive a renewal form from
the Department shall not constitute an excuse for failure to pay
the renewal fee.
c) Practice on a license that has expired is the unlicensed practice
of advanced practice nursing and shall be grounds for discipline
pursuant to Section 15-50 of the Act.
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§ 1305.70 Advertising
a) Advertising shall contain all information necessary to make
the communication informative and not misleading. Advertising
shall identify the type of license held by the licensee whose
services are being promoted. The form of advertising shall be
designed to communicate the information to the public in a direct,
dignified and readily comprehensible manner.
b) If an advertisement is communicated to the public over television
or radio, it shall be prerecorded and approved for broadcast by
the advanced practice nurse and a recording of the actual transmission,
including videotape, shall be retained for at least 3 years by
the advanced practice nurse.
c) Advertising shall otherwise comply with Section 15-40 of the
Act.
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§ 1305.75 Mandatory Reporting of Impaired Advanced Practice
Nurses by Health Care Institutions
a) Section 15-55 of the Act requires that the chief administrator
or executive officer of any health care institution licensed by
the Department of Public Health report to the APN Board concerning
impaired advanced practice nurses. All instances in which a person
licensed under the Act is impaired by reason of age, drug or alcohol
abuse, or physical or mental impairment, is under supervision,
and where appropriate, is in a program of rehabilitation, must
be reported to the APN Board. The reports must contain sufficient
current information to enable the APN Board to evaluate the impairment
and determine the appropriateness of the supervision or the program
of rehabilitation. If the Board finds the supervision or treatment
plan submitted by the institution is not sufficient to meet the
needs of the individual, the Board may direct the facility to
work with the Department to revise the plan or treatment to meet
the specific objections.
b) Contents of Reports. Reports of impaired persons shall be
submitted in writing on forms provided by the Department that
shall include but not be limited to the following information:
1) The name, address, telephone number and title of the person
making the report;
2) The name, address, telephone number and type of health care
institution where the maker of the report is employed;
3) The name, address, telephone number and professional license
number of the person who is the subject of the report;
4) A means of identification used by the institution of any patient
or patients whose treatment is a subject of the report, provided,
however, no medical records may be revealed without the written
consent of the patient or patients; and further provide that the
APN Board may require disclosure of the name, address, and telephone
number of any patient if it deems the information necessary to
an evaluation of the impairment or a determination of the appropriateness
of the supervision or program of rehabilitation;
5) The nature of the impairment and brief description of the
facts that gave rise to the issuance of the report, including
the dates of any occurrences deemed to necessitate the filing
of the report;
6) The terms and conditions of the supervision under which the
subject of the report is conducting his activities or practice,
including the date supervision commenced; the term of the supervision;
the name, address and telephone number of the person in charge
of the subject's supervision; and a written consent executed by
the subject of the report authorizing the APN Board, or designated
representative of the APN Board, to contact the person in charge
of the subject's supervision for information, including written
documentation, in order to evaluate the progress of the subject's
supervision pursuant to subsection (g)(2);
7) If the subject of the report is in a program of rehabilitation,
the name, address, and telephone number of the program and the
name and position of any individual in charge of the program;
and
8) Any other information deemed by the reporting person to be
of assistance to the APN Board in evaluating the report, including,
but not limited to, the following items: drug screens being used
and their status; relapses and actions taken; attendance at work;
observations of recovery status and level of cooperation in recovery;
other psychopathology or known related physical and mental illnesses;
involvement of the family and others in treatment or supervision;
and a copy of the aftercare agreement.
c) Reports of impaired persons shall be submitted to the APN
Board in a timely manner. The initial report shall be submitted
on forms provided by the Department within 60 days after it is
determined that a report is necessary under the Act and this Section.
Periodic reports (which evidence written documentation of the
progress of supervision or rehabilitation) shall be submitted
to the APN Board every 6 months, commencing with the time of the
filing of the initial report. A copy of each report shall be sent
by the person making the report to the impaired person.
d) Confidentiality
1) The contents of any report shall be strictly confidential,
except as otherwise provided in this subsection (d), and exempt
from public disclosure, but may be reviewed by:
A) Members of the APN Board or their designees;
B) The APN Board's designated attorneys;
C) Administrative personnel assigned to open mail containing
reports, to process and distribute the reports to authorized persons,
and to communicate with senders of reports; and
D) The person who is the subject of the report, his attorney
or his authorized representative (as evidenced by a written authorization
signed by the person who is the subject of the report).
2) The reports may also be handled or processed by other designated
persons in a limited manner necessary to implement reports required
under this Act by computer, word processing equipment or other
mechanical means. The data record shall be limited to the name
and address of the originator of the report, the date the initial
report was received, the date of the most recent report and the
professional license number of the subject of the report.
3) The contents of the confidential reports relating to impaired
persons shall not be used or made available in any other administrative
proceedings before the Department of Professional Regulation or
any other department; however, violations of the treatment or
supervision plan will result in a review of the person's status
by the Board or its designees for possible discipline or revision
in the treatment or supervision plan. Reports shall not be disclosed,
made available or subject to subpoena or discovery proceedings
in any civil or criminal court proceedings.
e) Upon a determination by the Board that a report or reports
on an impaired person no longer require review and consideration,
the Board shall notify the maker of the reports to cease sending
the reports and the Board and Department records shall be purged
of information contained in the reports. Such determinations shall
be based on, but not limited to: the type of rehabilitation program,
length of supervision, occurrence of any relapses and present
status of license.
f) Whenever any chief administrative or chief executive officer
of any health care institution who makes a report or provides
other information to the Board, or assists the Board concerning
an impaired person, acts in good faith and not in a willful and
wanton manner, that chief administrative or chief executive officer,
and the health care institution employing him, shall not, as a
result of such actions, be subject to criminal prosecution or
civil damages (Section 15-55(c) of the Act).
g) Definitions
1) "Impaired" means the inability to practice advanced
practice nursing with reasonable skill and safety due to physical
or mental disabilities, as evidenced by a written evaluation or
clinical evidence that reveals a deterioration of the advanced
practice nurse's ability to deliver competent care, due to problems
related to aging, loss of motor skill, abuse of drugs or alcohol,
or mental illness.
2) "Under supervision" means that the performance of
the impaired person's clinical privileges and status of the person's
impairment is being observed and monitored under the authority
of a written directive issued in accordance with a health care
institution's or medical staff's bylaws or rules and regulations.
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§
1305.80 Fines
Fines, not to exceed $ 5000 for each violation, shall be primarily
used in cases not involving patient care. In addition, fines may
be imposed in conjunction with other forms of disciplinary actions,
but they shall not be the exclusive disposition of any disciplinary
action arising out of conduct resulting in death or injury of
a patient.
§ 1305.85 Public Access to Records and Meetings
a) All investigative procedures, information arising out of the
investigation of complaints, and informal conferences shall be
confidential. All other proceedings and documents beginning with
the filing of a formal complaint shall be open to the public.
b) All meetings of the APN Board shall also be open to the public
in accordance with the Open Meetings Act.
§ 1305.90 Refusal to Issue a Nurse License based on Criminal
History Record
a) For purposes of this Part, criminal history record information
is defined as information collected by criminal justice agencies
(defined in 20 ILCS 2630) on individuals consisting of identifiable
descriptions and notations of arrests, detention, indictments,
information, or other formal criminal charges, and any disposition
arising therefrom, sentencing, correctional supervision and release.
The individual records must contain both information sufficient
to identify the subject of the record and notations regarding
any formal criminal justice transaction involving the identified
individual.
b) In determining whether an applicant for a nurse license is
unfit for licensure because of criminal history record information,
the Department shall consider the following standards:
1) Whether the crime was one of armed violence [720 ILCS 5/Art.
33A] or moral turpitude. Moral turpitude consists of:
A) Crimes involving dishonesty, false statement or some other
element of deceit, untruthfulness or falsification (including,
but not limited to, perjury, inducement of perjury, false statement,
criminal fraud, embezzlement, false pretense, forgery, counterfeiting
and theft).
B) Drug offenses, including, but not limited to, violations of
the Illinois Controlled Substances Act [720 ILCS 570] and Federal
Drug Enforcement Laws, 21 USC 801 et seq.
C) Sex offenses, including, but not limited to, all crimes listed
in Article 11 of the Criminal Code of 1961 [720 ILCS 5/Art. XI].
2) Whether the crime is related to the nursing profession.
3) Whether more than 10 years have elapsed since the date of
completion of imposed sentence.
4) Whether the conviction was from a city ordinance violation
or a conviction for which a jail sentence was not imposed.
5) Whether the applicant has been sufficiently rehabilitated
to warrant the public trust. The Department shall consider, but
not be bound by, the following in considering whether an applicant
has been presumed to be rehabilitated:
A) Completion of probation;
B) Completion of parole supervision; or
C) If no parole was granted, a period of 10 years has elapsed
after final discharge or release from any term of imprisonment
without any subsequent conviction.
c) If any one of the following factors exists, this outweighs
the presumption of rehabilitation as defined in subsection (c)
above:
1) Lack of compliance with terms of punishment (i.e., failure
to pay fines or make restitution, violation of the terms of probation
or parole);
2) Unwillingness to undergo, or lack of cooperation in, medical
or psychiatric treatment/counseling;
3) Falsification of an application for licensure with the Department;
4) Failure to furnish to the Department additional information
or failure to appear for an interview or meeting with the Department
in relation to the applicant's application for licensure.
d) The following criminal history records shall not be considered
in connection with an application for licensure:
1) Juvenile adjudications;
2) Records of arrest not followed by a conviction;
3) Convictions overturned by a higher court;
4) Convictions that have been the subject of a pardon or expungement.
e) Notification of denial, revocation, suspension, or intent
to refuse to renew; request for hearing
1) If the determination is made that the applicant or licensee
is unfit for licensure, the Department shall send notice of denial,
revocation, suspension, or intent to refuse to renew by certified
mail, return receipt requested, to the applicant or licensee at
the address stated on the applicant's or licensee's last known
address or by personal delivery to the applicant or licensee.
All such notices will include a statement of the reason for the
Department's action.
2) An applicant or licensee may request a hearing to contest
the Department's action pursuant to 68 Ill. Adm. Code 1110. The
request shall be in writing, and must be received by the Department
not later than 20 days after the date the Department mailed or
personally delivered the notice of its action to the applicant
or licensee.
3) After receipt of a request for hearing and prior to any such
hearing, the Department shall schedule an informal conference
with the applicant or licensee in an attempt to resolve issues
in controversy consensually. The Department shall notify the applicant
or licensee of the informal conference at least 20 days prior
to the hearing. Failure by the applicant or licensee to attend
the informal conference shall act as a withdrawal of the applicant's
or licensee's request for a hearing.
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§ 1305.95 Granting Variances
a) The Director may grant variances from this Part in individual
cases where he finds that:
1) the provision from which the variance is granted is not statutorily
mandated;
2) no party will be injured by the granting of the variance;
and
3) the rule from which the variance is granted would, in the
particular case, be unreasonable or unnecessarily burdensome.
b) The Director shall notify the APN Board of the granting of
a variance, and the reasons for the variance, at the next meeting
of the APN Board.
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§ 1305.EXHIBIT A Sample Written Collaborative Agreement
ADVANCED PRACTICE NURSING WRITTEN COLLABORATIVE AGREEMENT
A. ADVANCED PRACTICE NURSE INFORMATION
1. NAME:
2. ILLINOIS RN LICENSE NUMBER:
ILLINOIS APN LICENSE NUMBER:
ILLINOIS MID-LEVEL PRACTIONER LICENSE NUMBER:
FEDERAL MID-LEVEL PRACTITIONER DEA NUMBER:
3. AREAS OF CERTIFICATION:
4. CERTIFYING ORGANIZATION:
5. CERTIFICATION EXPIRATION DATE:
6. CERTIFICATION NUMBER:
7. PRACTICE SITES: See Attachment A.
8. CONTACT NUMBER:
FACSIMILE NUMBER:
EMERGENCY CONTACT NUMBERS:
(e.g., pager, answering service)
9. ATTACHMENTS:
Copy of Certification/Recertification
Copies of RN & APN License
Copy of Certificate of Insurance
Copy of Mid-Level Practitioner License
B. COLLABORATING PHYSICIAN INFORMATION
1. NAME:
2. ILLINOIS LICENSE NUMBER:
3. PRACTICE AREA OR CONCENTRATION:
4. BOARD CERTIFICATION (if any):
5. CERTIFYING ORGANIZATION:
6. PRACTICE SITES: See Attachment A.
7. CONTACT NUMBER:
FACSIMILE NUMBER:
EMERGENCY CONTACT NUMBERS:
(e.g., pager, answering service)
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C. ADVANCED PRACTICE NURSE COLLABORATING PHYSICIAN WORKING RELATIONSHIP
1. SCOPE OF PRACTICE
Under this agreement, the advanced practice nurse will work with
the collaborating physician in an active practice to deliver health
care services to . This includes, but is not limited to, the diagnosis,
treatment and management of acute and chronic health problems;
ordering, interpreting and performing laboratory and radiology
tests; prescribing medications, including controlled substances,
to the extent delegated; receiving and dispensing stock and sample
medications; performing other therapeutic or corrective measures
as indicated.
If applicable, the advanced practice nurse shall maintain allied
health personnel privileges at the following hospitals for the
designated services: Hospitals: This written collaborative agreement
shall be reviewed and updated annually. A copy of this written
collaborative agreement shall remain on file at all sites where
the advanced practice nurse renders service and shall be provided
to the Illinois Department of Professional Regulation upon request.
Any joint orders or guidelines are set forth or referenced in
Attachment B.
2. MEDICAL DIRECTION
Physician medical direction shall be adequate with respect to
collaboration with Certified Nurse Practitioners, Certified Nurse
Midwives, and Certified Clinical Nurse Specialists if a collaborating
physician:
(A) participates in the joint formulation and joint approval
of orders or guidelines with the advanced practice nurse and periodically
reviews those orders and the services provided patients under
those orders in accordance with accepted standards of medical
practice and advanced practice nursing practice;
(B) is on site at least once a month to provide medical direction
and consultation; and
(C) is available through telecommunications for consultation
on medical problems, complications, or emergencies or patient
referral. (See 225 ILCS 60/54.5(6).)
The written collaborative agreement shall be for services the
collaborating physician generally provided to his or her patients
in the normal course of clinical practice. Medical direction for
a Certified Registered Nurse Anesthetist shall be adequate if:
(A) an anesthesiologist or a physician participates in the joint
formulation and joint approval of orders or guidelines and periodically
reviews those orders and the services provided patients under
those orders; and
(B) for anesthesia services, the anesthesiologist or physician
participates through discussion of and agreement with the anesthesia
plan and is physically present and available on the premises during
the delivery of anesthesia services for diagnosis, consultation,
and treatment of emergency medical conditions. Anesthesia services
in a hospital shall be conducted in accordance with Section 10.7
of the Hospital Licensing Act and in an ambulatory surgical treatment
center in accordance with Section 6.5 of the Ambulatory Surgical
Treatment Center Act. (See 225 ILCS 60/54.5(b-5).)
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3. COMMUNICATION, CONSULTATION AND REFERRAL
The advanced practice nurse shall consult with the collaborating
physician by telecommunication or in person as needed. In the
absence of the designated collaborating physician, another physician
shall be available for consultation.
The advanced practice nurse shall inform each collaborating physician
of all written collaborative agreements he or she has signed with
other physicians, and provide a copy of these to any collaborating
physician upon request.
4. DELEGATION OF PRESCRIPTIVE AUTHORITY
As the collaborating physician, any prescriptive authority delegated
to the advanced practice nurse is set forth in Attachment C.
NOTE: ADVANCED PRACTICE NURSE MAY ONLY PRESCRIBE CONTROLLED SUBSTANCES
UPON RECEIPT OF AN ILLINOIS MID-LEVEL PRACTITIONER CONTROLLED
SUBSTANCE LICENSE.
WE THE UNDERSIGNED AGREE TO THE TERMS AND CONDITIONS OF THIS
WRITTEN COLLABORATIVE AGREEMENT.
-------------------------- --------------------------------------
Collaborating Physician Advanced Practice Nurse
Signature/Date Signature/Date
---------------------------- ----------------------------------
(Physician's Typed Name) (Advanced Practice Nurse's Typed Name)
ATTACHMENT A PRACTICE SITES ATTACHMENT B JOINT ORDERS OR GUIDELINES
ATTACHMENT C DELEGATION OF PRESCRIPTIVE AUTHORITY
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§ 1305.EXHIBIT B Sample Written Practice Agreement for
Office Based Anesthesia Services
WRITTEN PRACTICE AGREEMENT FOR OFFICE-BASED ANESTHESIA SERVICES
[A WRITTEN PRACTICE AGREEMENT IS REQUIRED AT A MINIMUM FOR A
CERTIFIED REGISTERED NURSE ANESTHETIST TO PRACTICE IN AN OFFICE
OF A LICENSED PHYSICIAN, LICENSED DENTIST OR LICENSED PODIATRIST.
A WRITTEN COLLABORATIVE AGREEMENT MAY ALSO BE USED IN THESE SETTINGS.
HOWEVER, A CERTIFIED REGISTERED NURSE ANESTHETIST IS NOT REQUIRED
TO POSSESS PRESCRIPTIVE AUTHORITY OR A WRITTEN COLLABORATIVE AGREEMENT
TO PROVIDE ANESTHESIA SERVICES ORDERED BY A LICENSED PHYSICIAN,
DENTIST OR PODIATRIST.]
A. CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) INFORMATION
1. Name:
2. Certification/Recertification #:
3. Illinois RN License #:
4. Illinois APN License #:
5. Contact Number:
Facsimile Number:
Emergency Contact Numbers:
(e.g., pager, answering service)
6. Attachments:
Copy of CRNA Certification/Recertification
Copies of RN & APN License
Copy of Certificate of Insurance
7. ACLS Certification:
B. ANESTHESIOLOGIST, PHYSICIAN, DENTIST OR PODIATRIST INFORMATION
1. Name:
2. Illinois License #:
3. Practice Area or Concentration: March 1
4. Board Certification (if any):
5. Certifying Organization:
6. ACLS Certification:
7. Continuing Medical Education (CME):
8 hours of CME for conscious sedation:
34 hours of CME for general anesthesia, deep conscious sedation
and regional
anesthesia, including conscious sedation:
OR
Clinical privileges to provide anesthesia services:
Hospital:
Ambulatory Surgical Treatment Center:
8. Practice Site:
9. Contact Number:
Facsimile Number:
Emergency Contact Numbers:
(e.g., pager, answering service)
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C. WORKING RELATIONSHIP OF THE PARTIES
Under this agreement, the CRNA will deliver anesthesia services
to designated patients in an active practice working with the
anesthesiologist, physician, dentist or podiatrist pursuant to
a mutually agreed upon anesthesia plan.
1. A licensed certified registered nurse anesthetist may provide
anesthesia services pursuant to the order of a licensed physician,
licensed dentist, or licensed podiatrist in the office of a licensed
physician, the office of a licensed dentist, or the office of
a licensed podiatrist. For anesthesia services, an anesthesiologist,
physician, dentist, or podiatrist shall participate through discussion
of and agreement with the anesthesia plan and shall remain physically
present and be available on the premises during the delivery of
anesthesia services for diagnosis, consultation, and treatment
of emergency medical conditions. (See 225 ILCS 65/15-25(a).)
2. A certified registered nurse anesthetist is not required to
possess prescriptive authority or a written collaborative agreement
meeting the requirements of Section 15-15 of the Act to provide
anesthesia services ordered by a licensed physician, dentist,
or podiatrist. (See 225 ILCS 65/15-25(d).) Certified registered
nurse anesthetists are authorized to select, order, and administer
drugs and apply the appropriate medical devices in the provision
of anesthesia services under the anesthesia plan agreed with by
the anesthesiologist, physician, dentist or podiatrist. In a physician's
office, dentist's office, or podiatrist's office, the anesthesiologist,
operating physician, operating dentist, or operating podiatrist
shall agree with the anesthesia plan, in accordance with the written
practice agreement. (See 225 ILCS 65/15-25(d).)
3. In a physician's office, the certified registered nurse anesthetist
may only provide anesthesia services if the physician has training
and experience in the delivery of anesthesia services to patients.
(See 68 Ill. Adm. Code 1305.50(e)).
4. In a dentist's office, the Certified Registered Nurse Anesthetist
may only provide those services the dentist is authorized to provide
pursuant to the Illinois Dental Practice Act and rules. Licensed
dentists are required to hold permits to administer anesthesia
pursuant 68 Ill. Adm. Code 1220: Subpart D.
5. In a podiatrist's office, the certified registered nurse anesthetist
may only provide those services the podiatrist is authorized to
provide pursuant to the Podiatric Medical Practice Act of 1987
and rules. Podiatrists may not administer general anesthetics.
(See 68 Ill. Adm. Code 1305.45(f).)
6. A CRNA providing anesthesia services in a physician, dental
or podiatrist office shall do so with the active participation,
approval, presence and availability of the physician, dentist
or podiatrist as well as in accordance with Standards 1-11 of
the "Standards for Office Based Anesthesia Practice",
American Association of Nurse Anesthetists, 222 South Prospect
Avenue, Park Ridge, Illinois 60068 (1999), which are hereby incorporated
by reference, with no later editions or amendments. If there is
a conflict between the Nursing and Advanced Practice Nursing Act
or this Part and the Standards for Office Based Anesthesia Practice
of the American Association of Nurse Anesthetists, the Act and
this Part shall prevail.
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D. CATEGORIES OF CARE, TREATMENT OR PROCEDURES TO BE PERFORMED
A licensed Certified Registered Nurse Anesthetist may provide
anesthesia services pursuant to the order of a licensed physician,
licensed dentist, or licensed podiatrist in the office of a licensed
physician, the office of a licensed dentist, or the office of
a licensed podiatrist. For anesthesia services, an anesthesiologist,
physician, dentist, or podiatrist shall participate through discussion
of and agreement with the anesthesia plan and shall remain physically
present and be available on the premises during the delivery of
anesthesia services for diagnosis, consultation, and treatment
of emergency medical conditions. (See 225 ILCS 65/15-25(a).)
A Certified Registered Nurse Anesthetist is not required to possess
prescriptive authority or a written collaborative agreement meeting
the requirements of Section 15-15 of the Act to provide anesthesia
services ordered by a licensed physician, dentist, or podiatrist.
(See 225 ILCS 65/15-25(d).) Certified registered nurse anesthetists
are authorized to select, order, and administer drugs and apply
the appropriate medical devices in the provision of anesthesia
services under the anesthesia plan agreed with by the anesthesiologist,
physician, dentist or podiatrist. In a physician's office, dentist's
office, or podiatrist's office, the anesthesiologist, operating
physician, operating dentist, or operating podiatrist shall agree
with the anesthesia plan, in accordance with the written practice
agreement. (See 225 ILCS 65/15-25(d).)
In a physician's office, the certified registered nurse anesthetist
may only provide anesthesia services if the physician has training
and experience in the delivery of anesthesia services to patients.
(See 68 Ill. Adm. Code 1305.45(e).)
In a dentist's office, the Certified Registered Nurse Anesthetist
may only provide those services the dentist is authorized to provide
pursuant to the Illinois Dental Practice Act and rules. Licensed
dentists are required to hold permits to administer anesthesia
pursuant 68 Ill. Adm. Code 1220: Subpart D. In a podiatrist's
office, the Certified Registered Nurse Anesthetist may only provide
those services the podiatrist is authorized to provide pursuant
to the Podiatric Medical Practice Act of 1987 and rules. Podiatrists
may not administer general anesthetics. (See 68 Ill. Adm. Code
1305.45(e).)
The anesthesia service that the CRNA may provide in the anesthesiologist's,
physician's, dentist's or podiatrist's office setting shall be
set forth in the attached pages.
Signature of CRNA/Date
CRNA's Typed Name
Signature of Anesthesiologist, Physician, Dentist or Podiatrist/Date
Anesthesiologist's, Physician's, Dentist's or Podiatrist's Typed
Name
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