Physician assistants and Advanced practice Nurses who are they? Susan y swart ms, rn, cae Executive director Ana-Illinois Illinois society for advanced practice nursing

Contents Overview Illinois Regulation Licensure Requirements Education Certification Written Agreements Prescriptive Authority Hospitals, Hospital Affiliates & ASTCs Scope of Practice Differences & Similarities

Physician Assistants Key facts about PAs A physician assistant is a healthcare professional who practices medicine as a part of a healthcare team with supervising physicians and other providers. In the United States, PAs are nationally certified and state licensed to practice medicine. PAs are trained using the medical model and complete these qualifications in less time than a traditional medical degree. Under the State Medical Licensing Board & State Medical Disciplinary Board PA Advisory Committee to IDPR and Medical Licensing Board # of Licensed PAs – 2950 QuickStarter has created an outline to help you get started on your presentation. Some slides include information here in the notes to provide additional topics for you to research. More key facts: Similar profession: Surgeon, Registered nurse, Occupational therapist, Advanced practice registered nurse, Physician, Speech-language pathologists, Physiotherapist

Advanced Practice Nurses Key facts about APNs An advanced practice registered nurse is a nurse with post-graduate education in nursing. APRNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing. Nationally certified and state licensed to practice advanced practice nursing. Certified in one of four specialties: Clinical Nurses Specialist – 1,016 licensees Nurse Practitioner – 8,777 licensees Nurse Midwife – 489 licensees Nurse Anesthetist – 1945 licensees Under the Board of Nursing QuickStarter has created an outline to help you get started on your presentation. Some slides include information here in the notes to provide additional topics for you to research. More key facts: Similar profession: Physician, Surgeon, Occupational therapist, Physician assistant, Registered nurse, Speech-language pathologists, Physiotherapist, Audiologists

ILLINOIS REGULATION Advance Practice Nurses Physician Assistants 225 ILCS 65/ Nurse Practice Act Article 65 – Advanced Practice Nurses TITLE 68: Professions & Occupations CHAPTER VII: IDFPR SUBCHAPTER b: Professions & Occupations PART 1300: Nurse Practice Act SUBPART A: GENERAL PROVISIONS Section 1300.10 Definitions SUBPART D: ADVANCED PRACTICE NURSE Section 1300.430 Prescriptive Authority Section 1300.440 APN Scope of Practice 225 ILCS 95/ Physician Assistant Practice Act of 1987 TITLE 68: Professions & Occupations CHAPTER VII: IDFPR SUBCHAPTER b: Professions & Occupations PART 1350: Physician Assistant Practice Act of 1987 SUBPART A: GENERAL PROVISIONS Section 1300.10 Definitions SUBPART D: ADVANCED PRACTICE NURSE Section 1300.400 - Section 1300.480 Consider talking about: Grandfather exception

Illinois Regulation others 225 ILCS 60 - Medical Practice Act TITLE 68: Professions and Occupations CHAPTER VII: Department of Financial & Professional Regulation SUBCHAPTER v: Professions and Occupations PART 1285: Medical Practice Act of 1987 720 ILCS 570 - Illinois Controlled Substance Act TITLE 77: Public Health CHAPTER XV: Department of Financial & Professional Regulation PART 3100: Illinois Controlled Substance Act 210 ILCS 85 - Illinois Hospital Licensing Act TITLE 77: Public Health CHAPTER I: DPH SUBCHAPTER b: Hospitals & Ambulatory Care Facilities PART 250: Hospital Licensing Requirements Illinois Regulation others

Illinois Regulation others 110 ILCS 330 – University of Illinois Hospital Licensing Act TITLE 77: Public Health CHAPTER I: Department of Public Health SUBCHAPTER b: Hospitals & Ambulatory Care Facilities PART 250: Hospital Licensing Requirements 210 ILCS 5 – Ambulatory Surgical Treatment Center Act TITLE 77: Public Health CHAPTER I: Department of Public Health SUBCHAPTER b: Hospitals & Ambulatory Care Facilities PART 205: Ambulatory Surgical Treatment Center Licensing Requirements Illinois Regulation others

Licensure requirements Physician Assistants Advanced Practice Nurses Passed National Certification exam National Commission on the Certification of Physician Assistants Renewal every 2 years (March of even years) Maintenance of certification not required for renewal of license RN license Graduate degree or post-master’s certificate CRNA – prior 1999, certified – current and continuous National certification Renewal every 2 years (May of even years) 50 hrs of CE Proof of National Certification Exception - Licensed since 2001 – not eligible for national certification

EDUCATION Advanced Practice Nurses Physician Assistants Graduate Degree appropriate for national certification in a clinical APN specialty Graduate Degree or post-master’s certification from a graduate level program in a clinical APN specialty Exception for CRNA completing a program prior to 1999 Based on the accredited program

CERTIFICATION Physician Assistants Advanced Practice Nurses 100 hrs of CME every two years 50 Category I 50 Category II or combination of both Pass recertification exam every 10 years (2014) Graduate of an accredited program in the clinical specialty Recertification Every 4 -5 years Continuing Education (# of hours varies by specialty) 75 – 100 hrs Or reexamination

Written agreements (NOT REQUIRED IN HOSPITALS, HOSPITAL AFFILIATES, or AMBULATORY SURGICAL TREATMENT FACILITIES) Physician Assistants Written Supervisory Agreement (WSA) Advanced Practice Nurses Written Collaborative Agreement (WCA) Services the supervising physician (SP) is authorized to and generally provides Must specify which procedures require the presence of the SP Physical presence of SP not required Joint formulation/approval of orders or guidelines Supervision/consultation at least once a month Copy of WSA available upon request Notify all SP of other WSAs Describe the relationship between the APN & collaborating physician (CP) – employment relationship not required Categories of care, treatments or procedures Personal presence of CP not required exception for CRNA Consultation includes in person, telecommunications or electronic Cannot restrict the categories of patients, limit third party payors, government plans or geographic area or practice location CRNA – joint anesthesia plan 90 day waiver

Prescriptive Authority Physician Assistants Advanced Practice Nurses Delegation of prescriptive authority - filed by SP – initiation and termination Written Guidelines signed by the PA and SP Prescribe, select, order, administer, store, accept samples, dispense OTC, legend drugs, medical gases, controlled substances, botanical and herbal remedies Mid-level provider controlled substance license & DEA # Name of SP on all prescriptions Prescriptions reviewed periodically by SP Schedule II – Oral, topical, transdermal Routinely prescribed by the SP Specific drugs identified 30 day supply, continuation after prior approval of SP Discuss condition of patients who receive monthly prescriptions Meet the educational requirements of Section 303.05 of the IL Controlled Substance Act Delegation of prescriptive authority - filed by CP – initiation and termination Prescribe, select, order, administer, store, accept samples, dispense OTC, legend drugs, medical gases, controlled substances, botanical and herbal remedies Mid-level provider controlled substance license & DEA # Name of CP on all prescriptions Prescriptions reviewed periodically by CP Schedule II – Oral, topical, transdermal Routinely prescribed by the CP Specific drugs identified 30 day supply, continuation after prior approval of CP Discuss condition of patients who receive monthly prescriptions Meet the educational requirements of Section 303.05 of the IL Controlled Substance Act

Hospitals, Hospital Affiliates, or ambulatory surgical treatment centers Physician Assistants Advanced Practice Nurses Clinical Privileges Medical staff or consulting medical staff committee – periodically review the services select, order, and administer medications, including controlled substances, to provide delineated care Discharge medication in name of PA and attending/discharging physician Mid-level provider controlled substance license not needed Clinical Privileges Medical staff or consulting medical staff committee – periodically review the services select, order, and administer medications, including controlled substances, to provide delineated care Discharge medication in name of APN and attending/discharging physician Mid-level provider controlled substance license not needed in hospital or ASTC Hospital Affiliates - NP, CNS, CNMs only May prescribe with mid-level controlled substance license & DEA # Same restrictions as with prescribing authority in other settings Hospital files delegated prescriptive authority form with IDFPR

SCOPE Physician Assistants Advanced Practice Nurses Medical/surgical services delegated by SP Within the PA’s skills Within current scope of practice of SP Must specify which procedures require the presence of the SP Physical presence of SP not required Provided under the supervision & direction of the SP Joint formulation/approval of orders or guidelines Supervision/consultation at least once a month Copy of WSA available upon request Notify all SP of other WSAs Advanced assessment & diagnosis Ordering diagnostic and therapeutic tests and procedures Ordering treatments and medical devices Providing palliative and end-of-life care Counseling, education and advocacy Delegated prescriptive authority Delegation to other health care personnel

Difference & similarities APNs – can bill in their name PAs- employer must bill for the services provided APNs – collaborating physician PAs – supervising physician Ratio for PAs – 5 max

Everything changes…. Sunsets Physician Assistants SB 1585 Remove supervisory requirement, change to collaborative agreement Remove ratio restrictions Advanced Practice Nurses SB 642 Remove collaborative agreement requirement after 4000 hrs of practice

Sources of information Illinois Health & Hospital Association www.team-iha.org Illinois Society for Advanced Practice Nursing www.isapn.org Illinois Academy of Physician Assistants www.illinoispa.org Illinois Department of Professional Regulation www.idfpr.com