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What the nurses want

Thursday, Mar 26, 2020

* From Sue Clark, who lobbies for the American Nurses Association Illinois…


Wanted to make sure you saw this. Governor Pritzker has most of this, and for that ANA-Illinois and nurses across Illinois are grateful. This letter highlights other issues needing to be addressed, in our opinoin.


What she sent was a letter from the US Secretary of Health and Human Services asking governors to immediately extend the capacity of their health care workforce to address the pandemic, with specific suggestions. Click here to read it.

* I asked Sue what other issues need addressing in Illinois. She sent me this…

COVID Nurse Workforce Issues.

1. Allow health Care professionals licensed in other states to practice across state lines.

    a. The Governor, per Executive Order, allowed this practice around the border, which will help with direct patient care immediately around the border of Illinois.
    b. Telehealth-need to allow telehealth from licensed healthcare professionals throughout the US.
    c. Neither of these strategies would be needed for nurses, had Illinois joined the Nurse Licensure Compact.

2. Waive statutory and regulatory standards not necessary for standards of care: specific to Advanced Practice Registered Nurses (APRNs)*. Remove all barriers for access to care by APRNs. Other states have done this.

    a. The Illinois Nurse Practice Act requires APRN scope of practice be linked directly to their national certification. If this requirement is waived, it allows more flexibility in providing care. Care for which APRNs are educated to provide in all settings.
    b. Eliminate the requirement for Written Collaborative Agreements, (WCA), which requires physicians to determine what care an APRN may provide, including prescribing limitations. Would allow more flexibility and efficiency.
    c. For CRNAs, waive the mandate for ‘physical presence’ of anesthesiologist, physician, podiatrist, or dentist. Elective surgeries have been cancelled so some hospitals are hiring CRNAs as RNs. The ‘physical presence’ requirement is causing confusion regarding liability issues. CRNAs are better utilized to provide lifesaving services such as intubation, ventilator management and insertions of arterial lines and other procedures. While we know RNs are and will be in demand, CRNAs are educated and proficient in these life saving measures that RNs are not.

3. Many Illinois pharmacists will not fill a prescription signed by an APRN. The law does not require a physician name or signature for APRNs prescriptions. Patients are being asked to return at a later time to allow for an unnecessary name of a physician. This needs to stop.

*APRNs in Illinois in order to be licensed must have at least a Masters Degree, obtain and maintain national certification in their specialty. For instance, a Nurse Practitioner is one category of APRN (the others are CRNA (Certified Registered Nurse Anesthetists), CNS (Clinical Nurse Specialists) and CNM (Certified Nurse Midwives)

There are subspecialties especially for Nurse Practitioners, like pediatric, adult, family, mental health, emergency, etc, etc. The NPA (Nurse Practice Act) requires APRNs to practice within the certification specialty. What we are asking is to allow all APRNs to practice wherever there is need for increased access to APRN care. Flexibility during this time.

Written Collaborative Agreement (WCA): is a written agreement between a physician and APRN. In the agreement the physician must delegate whatever care the physician wants to allow. Nursing has tried to eliminate this for many years, as APRNs are well educated and practice within the scope of practice. In 2017, APRNs to meet specific requirements my obtain full authority to practice without a WCA. One stipulation is that an APRN must work 4000 hours with a WCA.

* TL/DR? Probably. But I mistakenly tweeted last year that Sue had been murdered, so I figure I owe her one.

Anyway, she ended with this…

Ok, so I gave you too much information!

The bottom line:

Request to:

    1) Remove all barriers for access to APRN care, including but not limited to eliminating the WCA mandate and remove limitations on scope of practice. And, includes removing the requirement for physical presence of any other healthcare provider when anesthesia care is administered by a CRNA.

    2) Require the acceptance of prescriptions written by an APRN, as authorized by the Nurse Practice Act.

- Posted by Rich Miller        

  1. - ??? - Thursday, Mar 26, 20 @ 12:37 pm:

    “But I mistakenly tweeted last year that Sue had been murdered so I figure I owe her one.”

    Lol. Yeah…probably.

  2. - Sayitaintso - Thursday, Mar 26, 20 @ 1:13 pm:

    ??? - Exactly. Then again I’ve always liked Rich’s sense of fair play.

  3. - socialist state - Thursday, Mar 26, 20 @ 1:21 pm:

    WOAH. Allowing nurses to administer anesthesia is a really big deal and not the kind of thing that should ever be considered in an EO. Crazy

  4. - Norseman - Thursday, Mar 26, 20 @ 1:26 pm:

    Curious as to what ISMS has to say about this. They aren’t too progressive as far as loosening nurses ties to docs.

  5. - Anyone Remember - Thursday, Mar 26, 20 @ 2:01 pm:

    social state -
    CRNAs were used by the Army in Korea. It is still an Army Occupation Code (AOC) in the Army Nursing Corps. Get over it.

  6. - Rural Survivor - Thursday, Mar 26, 20 @ 2:26 pm:

    The doctors need to realize that outside of the metropolitan areas of this state exists an urgent need for nurse practitioners. This makes sense for underserved areas of the state now and after this emergency has passed.

  7. - All this - Friday, Mar 27, 20 @ 8:03 am:

    What is frightening is that with so many people losing their employers’ insurance they will go bankrupt or default on their payments to the hospital should they get treated. Then the hospital itself might go bankrupt and not pay medical providers. This is really a mess.

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* Pritzker thanks Abbott Labs - "Our rate of rise is looking less and less exponential" - Praises local groups for pitching in - Shoutout to #SpritzersWithPritzker - Dr. Ezike: "If you think you don't have a case in your zip code that's probably not actually the case" - Pritzker defends pending minimum wage hike - Still no date for IDES fix - Could come back in the fall - More testing in African-American areas - Curve not bending down yet - Will be posting PPE contracts online - Following Gov. Baker's lead on contact tracing - Dr. Ezike outlines DHS DD center readiness - Addresses federal halt to funding drive-through testing - "I think everybody needs to think seriously about canceling large summer events" - Plans to pursue workshare program
* 1,344 new cases, 66 additional deaths
* Ted E. Leverenz
* COVID-19 roundup
* Worst case scenario: "Illinois could lose more than $28 billion between calendar years 2020 and 2023"
* Today's heroes: Tony and Lisa Yuscius
* Question of the day
* The testing situation
* Still no word on when gig workers can access Illinois unemployment insurance
* *** UPDATED x1 *** National stockpile runs dry as feds stop supporting drive-through sites
* 6.6 million new jobless claims
* Open thread
* *** UPDATED x1 - 50 at Shapiro, 29 at Ludeman *** Several Murray Developmental Center residents, 1 staff test positive
* Yesterday's stories

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