New Bills Offer Practice Freedom to Physician Assistants and delegation rules for Nurses in Illinois

Posted By American Med Spa Association, Thursday, February 21, 2019

A new bill introduced in Illinois seeks to provide physician assistants (PAs) the ability to practice independently from a physician instead of under their supervision. The House version of the bill is sponsored by Representative  Jay Hoffman and LaToya Greenwood and is known as House Bill 3355 (HB 3355). You can review the text of HB 3355 in full here  it has initially been referred to the House Rules Committee for further consideration. The Senate has an identical bill is sponsored by Senator  Antonio Munoz known as Senate Bill 1725 (SB 1725). SB 1725 is initially referred to the Assignments Committee. Below references to HB 3355 include SB 1725.
Currently, PAs must practice subject to written supervision agreement with a physician. This supervision agreement authorizes the PAs scope of practice, their ability to prescribe, and what level of supervision is needed. HB 3355 would allow a PA to provide medical services independent of a physician. A PA may still enter into a collaborative practice agreement with a physician. To be sufficient a collaborative agreement must 1) promote the exercise of professional judgement by the PA in line with their education and experience 2) the PA provides services based on the agreement with the physician3) and there are methods of communication to consult, collaborate, or refer either in person or by telecommunication. There is no requirement that this agreement be signed or in writing. HB 3355 also makes clear that an employment relationship isn’t required by this collaboration and even goes on to state that a PA practicing in a health professional shortage area with a score of 12 or more must own their own medical practice. Under HB 3355, the PAs scope of practice is now determined by their training and education. A PA will still need to enter a collaborative agreement to be delegated prescriptive authority.
The national trend has been moving towards allowing PAs to practice as independent healthcare providers and not dependent on the supervision of physicians. In that regard, both SB 1725 and HB 3355 are right in line with that trend and if passed would make Illinois PAs independent health care providers able to provide services within their scope of practice. We will be monitoring both SB 1725 and HB 3355 as they work their way through Illinois’ legislative process this year.  
A separate bill introduced in the Senate would change the practice of registered nurses (RN) in Illinois. Known as Senate Bill 2151 (SB 2151) and sponsored by   Michael Hastings, it is currently with the Senate Assignment Committee. SB 2151 makes it clear that the practice of registered nursing is a scientific process based on a professional body of knowledge. Professional nursing includes 1) assessment of healthcare needs with nursing diagnosis and evaluation; 2) promoting maintenance and restoration of health; 3) counseling, education m, and advocating for and with patients; 4) administering medications and treatments as prescribed; 5) coordinating nursing care; 6) delegating and supervising assisting individuals; and 7) teaching student nurses. SB 2151 also makes clear that RNs may only delegate “tasks” to unlicensed assistants. “Tasks” in this case do not require nursing knowledge, judgment, or decision making. RNs would still be able to delegate nursing interventions and the administration of medication to other nurses.
If passed SB 2151 would be a somewhat unusual law. Most states do not clearly define what a nurse may delegate to an unlicensed assistant. Often, states will have more specific admin rules or advisory statements from the board of nursing that provide guidance in this area. But, it would be uncommon to see it explicitly stated in a statute. We will be monitoring both SB 2151 as it works its way through Illinois’s legislative process this year.