Bill Text: IL SB1908 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Nurse Practice Act. Provides that a certified nurse midwife with full practice authority may enter into a written collaborative agreement with an advanced practice registered nurse. Provides that an advanced practice registered nurse certified as a nurse midwife may enter into a written collaborative agreement with an advanced practice registered nurse with full practice authority who is certified as a nurse midwife or a physician. Provides that, for an advanced practice registered nurse certified as a nurse midwife, the clinical experience shall be in collaboration with a certified nurse midwife with full practice authority. Makes conforming changes in provisions concerning written collaborative agreements, prescriptive authority under a written collaborative agreement, and full practice authority.

Sponsorship: Partisan Bill (Democrat 1)

Status: (Introduced - Dead) 2025-03-21 - Rule 3-9(a) / Re-referred to Assignments [SB1908 Detail]

Download: Illinois-2025-SB1908-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1908 Introduced 2/6/2025, by Sen. Lakesia Collins SYNOPSIS AS INTRODUCED:
225 ILCS 65/50-10 was 225 ILCS 65/5-10
225 ILCS 65/65-35 was 225 ILCS 65/15-15
225 ILCS 65/65-40 was 225 ILCS 65/15-20
225 ILCS 65/65-43
Amends the Nurse Practice Act. Provides that a certified nurse midwife with full practice authority may enter into a written collaborative agreement with an advanced practice registered nurse. Provides that an advanced practice registered nurse certified as a nurse midwife may enter into a written collaborative agreement with an advanced practice registered nurse with full practice authority who is certified as a nurse midwife or a physician. Provides that, for an advanced practice registered nurse certified as a nurse midwife, the clinical experience shall be in collaboration with a certified nurse midwife with full practice authority. Makes conforming changes in provisions concerning written collaborative agreements, prescriptive authority under a written collaborative agreement, and full practice authority.
LRB104 08797 AAS 18852 b
A BILL FOR
SB1908 LRB104 08797 AAS 18852 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Nurse Practice Act is amended by changing
Sections 50-10, 65-35, 65-40, and 65-43 as follows:
(225 ILCS 65/50-10) (was 225 ILCS 65/5-10)
(Section scheduled to be repealed on January 1, 2028)
Sec. 50-10. Definitions. Each of the following terms, when
used in this Act, shall have the meaning ascribed to it in this
Section, except where the context clearly indicates otherwise:
"Academic year" means the customary annual schedule of
courses at a college, university, or approved school,
customarily regarded as the school year as distinguished from
the calendar year.
"Address of record" means the designated address recorded
by the Department in the applicant's or licensee's application
file or license file as maintained by the Department's
licensure maintenance unit.
"Advanced practice registered nurse" or "APRN" means a
person who has met the qualifications for a (i) certified
nurse midwife (CNM); (ii) certified nurse practitioner (CNP);
(iii) certified registered nurse anesthetist (CRNA); or (iv)
clinical nurse specialist (CNS) and has been licensed by the

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Department. All advanced practice registered nurses licensed
and practicing in the State of Illinois shall use the title
APRN and may use specialty credentials CNM, CNP, CRNA, or CNS
after their name. All advanced practice registered nurses may
only practice in accordance with national certification and
this Act.
"Advisory Board" means the Illinois Nursing Workforce
Center Advisory Board.
"Approved program of professional nursing education" and
"approved program of practical nursing education" are programs
of professional or practical nursing, respectively, approved
by the Department under the provisions of this Act.
"Board" means the Board of Nursing appointed by the
Secretary.
"Center" means the Illinois Nursing Workforce Center.
"Collaboration" means a process involving 2 or more health
care professionals working together, each contributing one's
respective area of expertise to provide more comprehensive
patient care.
"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.
"Comprehensive nursing assessment" means the gathering of
information about the patient's physiological, psychological,
sociological, and spiritual status on an ongoing basis by a

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registered professional nurse and is the first step in
implementing and guiding the nursing plan of care.
"Consultation" means the process whereby an advanced
practice registered nurse seeks the advice or opinion of
another health care professional.
"Credentialed" means the process of assessing and
validating the qualifications of a health care professional.
"Dentist" means a person licensed to practice dentistry
under the Illinois Dental Practice Act.
"Department" means the Department of Financial and
Professional Regulation.
"Email address of record" means the designated email
address recorded by the Department in the applicant's
application file or the licensee's license file, as maintained
by the Department's licensure maintenance unit.
"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 or advanced practice registered nurse or
the assessment by the physician assistant, physician, dentist,
podiatric physician, or other licensed health care
professional, as determined by the Department, supporting
ongoing data collection, and deciding who needs to be informed
of the information and when to inform.
"Full practice authority" means the authority of an
advanced practice registered nurse licensed in Illinois and

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certified as a nurse practitioner, clinical nurse specialist,
or nurse midwife to practice without a written collaborative
agreement and:
(1) to be fully accountable to patients for the
quality of advanced nursing care rendered;
(2) to be fully accountable for recognizing limits of
knowledge and experience and for planning for the
management of situations beyond the advanced practice
registered nurse's expertise; the full practice authority
for advanced practice registered nurses includes accepting
referrals from, consulting with, collaborating with, or
referring to other health care professionals as warranted
by the needs of the patient; and
(3) to possess the authority to prescribe medications,
including Schedule II through V controlled substances, as
provided in Section 65-43.
"Full practice authority-pending advanced practice
registered nurse" means an advanced practice registered nurse
licensed in Illinois and certified as a nurse practitioner,
clinical nurse specialist, or nurse midwife who has provided a
notarized attestation of completion of at least 250 hours of
continuing education or training in the advanced practice
registered nurse's area of certification and at least 4,000
hours of clinical experience after first attaining national
certification and who has submitted an application to the
Department to be granted full practice authority.

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"Hospital affiliate" means a corporation, partnership,
joint venture, limited liability company, or similar
organization, other than a hospital, that is devoted primarily
to the provision, management, or support of health care
services and that directly or indirectly controls, is
controlled by, or is under common control of the hospital. For
the purposes of this definition, "control" means having at
least an equal or a majority ownership or membership interest.
A hospital affiliate shall be 100% owned or controlled by any
combination of hospitals, their parent corporations, or
physicians licensed to practice medicine in all its branches
in Illinois. "Hospital affiliate" does not include a health
maintenance organization regulated under the Health
Maintenance Organization Act.
"Impaired nurse" means a nurse licensed under this Act who
is unable to practice with reasonable skill and safety because
of a physical or mental disability as evidenced by a written
determination or written consent based on clinical evidence,
including loss of motor skills, abuse of drugs or alcohol, or a
psychiatric disorder, of sufficient degree to diminish his or
her ability to deliver competent patient care.
"License-pending advanced practice registered nurse" means
a registered professional nurse who has completed all
requirements for licensure as an advanced practice registered
nurse except the certification examination and has applied to
take the next available certification exam and received a

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temporary permit from the Department.
"License-pending registered nurse" means a person who has
passed the Department-approved registered nurse licensure exam
and has applied for a license from the Department. A
license-pending registered nurse shall use the title "RN lic
pend" on all documentation related to nursing practice.
"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 professional nurse determines it is inappropriate
to do so. A nurse shall not be subject to disciplinary or any
other adverse action for refusing to delegate a nursing
intervention based on patient safety.
"Physician" means a person licensed to practice medicine
in all its branches under the Medical Practice Act of 1987.
"Podiatric physician" means a person licensed to practice
podiatry under the Podiatric Medical Practice Act of 1987.
"Practical nurse" or "licensed practical nurse" means a
person who is licensed as a practical nurse under this Act and
practices practical nursing as defined in this Act. Only a
practical nurse licensed under this Act is entitled to use the
title "licensed practical nurse" and the abbreviation
"L.P.N.".
"Practical nursing" means the performance of nursing
interventions requiring the nursing knowledge, judgment, and

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skill acquired by means of completion of an approved practical
nursing education program. Practical nursing includes
assisting in the nursing process under the guidance of a
registered professional nurse or an advanced practice
registered nurse. The practical nurse may work under the
direction of a licensed physician, dentist, podiatric
physician, or other health care professional determined by the
Department.
"Privileged" means the authorization granted by the
governing body of a healthcare facility, agency, or
organization to provide specific patient care services within
well-defined limits, based on qualifications reviewed in the
credentialing process.
"Registered Nurse" or "Registered Professional Nurse"
means a person who is licensed as a professional nurse under
this Act and practices nursing as defined in this Act. Only a
registered nurse licensed under this Act is entitled to use
the titles "registered nurse" and "registered professional
nurse" and the abbreviation, "R.N.".
"Registered professional nursing practice" means a
scientific process founded on a professional body of knowledge
that 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

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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.
"Professional assistance program for nurses" means a
professional assistance program that meets criteria
established by the Board of Nursing and approved by the
Secretary, which provides a non-disciplinary treatment
approach for nurses licensed under this Act whose ability to
practice is compromised by alcohol or chemical substance
addiction.
"Secretary" means the Secretary of Financial and
Professional Regulation.
"Unencumbered license" means a license issued in good
standing.
"Written collaborative agreement" means a written
agreement between an advanced practice registered nurse and a
collaborating physician, dentist, certified nurse midwife with
full practice authority, or podiatric physician pursuant to
Section 65-35.
(Source: P.A. 103-154, eff. 6-30-23; 103-686, eff. 1-1-25.)
(225 ILCS 65/65-35) (was 225 ILCS 65/15-15)
(Section scheduled to be repealed on January 1, 2028)
Sec. 65-35. Written collaborative agreements.

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(a) A written collaborative agreement is required for all
advanced practice registered nurses engaged in clinical
practice prior to meeting the requirements of Section 65-43,
except for advanced practice registered nurses who are
privileged to practice in a hospital, hospital affiliate, or
ambulatory surgical treatment center.
(a-5) If an advanced practice registered nurse engages in
clinical practice outside of a hospital, hospital affiliate,
or ambulatory surgical treatment center in which he or she is
privileged to practice, the advanced practice registered nurse
must have a written collaborative agreement, except as set
forth in Section 65-43.
(b) A written collaborative agreement shall describe the
relationship of the advanced practice registered nurse with
the collaborating physician or certified nurse midwife with
full practice authority and shall describe the categories of
care, treatment, or procedures to be provided by the advanced
practice registered nurse. A collaborative agreement with a
podiatric physician must be in accordance with subsection
(c-5) or (c-15) of this Section. A collaborative agreement
with a dentist must be in accordance with subsection (c-10) of
this Section. A collaborative agreement with a podiatric
physician must be in accordance with subsection (c-5) of this
Section. A collaborative agreement between an advanced
practice registered nurse certified as a certified nurse
midwife and a certified nurse midwife with full practice

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authority must be in accordance with subsection (c-20) of this
Section. Collaboration does not require an employment
relationship between the collaborating physician or certified
nurse midwife with full practice authority and the advanced
practice registered nurse.
The collaborative relationship under an agreement shall
not be construed to require the personal presence of a
collaborating physician or certified nurse midwife with full
practice authority at the place where services are rendered.
Methods of communication shall be available for consultation
with the collaborating physician or certified nurse midwife
with full practice authority in person or by
telecommunications or electronic communications as set forth
in the written agreement.
(b-5) Absent an employment relationship, a written
collaborative agreement may not (1) restrict the categories of
patients of an advanced practice registered nurse within the
scope of the advanced practice registered nurses training and
experience, (2) limit third party payors or government health
programs, such as the medical assistance program or Medicare
with which the advanced practice registered nurse contracts,
or (3) limit the geographic area or practice location of the
advanced practice registered nurse in this State.
(c) In the case of anesthesia services provided by a
certified registered nurse anesthetist, an anesthesiologist, a
physician, a dentist, or a podiatric physician must

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participate through discussion of and agreement with the
anesthesia plan and remain physically present and available on
the premises during the delivery of anesthesia services for
diagnosis, consultation, and treatment of emergency medical
conditions.
(c-5) A certified registered nurse anesthetist, who
provides anesthesia services outside of a hospital or
ambulatory surgical treatment center shall enter into a
written collaborative agreement with an anesthesiologist or
the physician licensed to practice medicine in all its
branches or the podiatric physician performing the procedure.
Outside of a hospital or ambulatory surgical treatment center,
the certified registered nurse anesthetist may provide only
those services that the collaborating podiatric physician is
authorized to provide pursuant to the Podiatric Medical
Practice Act of 1987 and rules adopted thereunder. A certified
registered nurse anesthetist may select, order, and administer
medication, including controlled substances, and apply
appropriate medical devices for delivery of anesthesia
services under the anesthesia plan agreed with by the
anesthesiologist or the operating physician or operating
podiatric physician.
(c-10) A certified registered nurse anesthetist who
provides anesthesia services in a dental office shall enter
into a written collaborative agreement with an
anesthesiologist or the physician licensed to practice

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medicine in all its branches or the operating dentist
performing the procedure. The agreement shall describe the
working relationship of the certified registered nurse
anesthetist and dentist and shall authorize the categories of
care, treatment, or procedures to be performed by the
certified registered nurse anesthetist. In a collaborating
dentist's office, the certified registered nurse anesthetist
may only provide those services that the operating dentist
with the appropriate permit is authorized to provide pursuant
to the Illinois Dental Practice Act and rules adopted
thereunder. For anesthesia services, an anesthesiologist,
physician, or operating dentist 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. A
certified registered nurse anesthetist may select, order, and
administer medication, including controlled substances, and
apply appropriate medical devices for delivery of anesthesia
services under the anesthesia plan agreed with by the
operating dentist.
(c-15) An advanced practice registered nurse who had a
written collaborative agreement with a podiatric physician
immediately before the effective date of Public Act 100-513
may continue in that collaborative relationship or enter into
a new written collaborative relationship with a podiatric

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physician under the requirements of this Section and Section
65-40, as those Sections existed immediately before the
amendment of those Sections by Public Act 100-513 with regard
to a written collaborative agreement between an advanced
practice registered nurse and a podiatric physician.
(c-20) An advanced practice registered nurse certified as
a certified nurse midwife may enter into a written
collaborative agreement with a certified nurse midwife with
full practice authority or a physician.
(d) A copy of the signed, written collaborative agreement
must be available to the Department upon request from both the
advanced practice registered nurse and the collaborating
physician, dentist, certified nurse midwife with full practice
authority, or podiatric physician.
(e) Nothing in this Act shall be construed to limit the
delegation of tasks or duties by a physician to a licensed
practical nurse, a registered professional nurse, or other
persons in accordance with Section 54.2 of the Medical
Practice Act of 1987. Nothing in this Act shall be construed to
limit the method of delegation that may be authorized by any
means, including, but not limited to, oral, written,
electronic, standing orders, protocols, guidelines, or verbal
orders.
(e-5) Nothing in this Act shall be construed to authorize
an advanced practice registered nurse to provide health care
services required by law or rule to be performed by a

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physician. The scope of practice of an advanced practice
registered nurse does not include operative surgery. Nothing
in this Section shall be construed to preclude an advanced
practice registered nurse from assisting in surgery.
(f) An advanced practice registered nurse shall inform
each collaborating physician, dentist, certified nurse midwife
with full practice authority, or podiatric physician of all
collaborative agreements he or she has signed and provide a
copy of these to any collaborating physician, dentist,
certified nurse midwife with full practice authority, or
podiatric physician upon request.
(g) (Blank).
(Source: P.A. 100-513, eff. 1-1-18; 100-577, eff. 1-26-18;
100-1096, eff. 8-26-18; 101-13, eff. 6-12-19.)
(225 ILCS 65/65-40) (was 225 ILCS 65/15-20)
(Section scheduled to be repealed on January 1, 2028)
Sec. 65-40. Written collaborative agreement; prescriptive
authority.
(a) A collaborating physician or certified nurse midwife
with full practice authority may, but is not required to,
delegate prescriptive authority to an advanced practice
registered nurse as part of a written collaborative agreement.
This authority may, but is not required to, include
prescription of, selection of, orders for, administration of,
storage of, acceptance of samples of, and dispensing over the

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counter medications, legend drugs, medical gases, and
controlled substances categorized as any Schedule III 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.
The collaborating physician must have a valid current Illinois
controlled substance license and federal registration to
delegate authority to prescribe delegated controlled
substances.
(b) To prescribe controlled substances under this Section,
an advanced practice registered nurse must obtain a mid-level
practitioner controlled substance license. Medication orders
shall be reviewed periodically by the collaborating physician.
(c) The collaborating physician or certified nurse midwife
with full practice authority shall file with the Department
and the Prescription Monitoring Program notice of delegation
of prescriptive authority and termination of such delegation,
in accordance with rules of the Department. Upon receipt of
this notice delegating authority to prescribe any Schedule III
through V controlled substances, the licensed advanced
practice registered nurse shall be eligible to register for a
mid-level practitioner controlled substance license under
Section 303.05 of the Illinois Controlled Substances Act.
(d) In addition to the requirements of subsections (a),
(b), and (c) of this Section, a collaborating physician or
certified nurse midwife with full practice authority may, but

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is not required to, delegate authority to an advanced practice
registered nurse to prescribe any Schedule II controlled
substances, if all of the following conditions apply:
(1) Specific Schedule II controlled substances by oral
dosage or topical or transdermal application may be
delegated, provided that the delegated Schedule II
controlled substances are routinely prescribed by the
collaborating physician or certified nurse midwife with
full practice authority. This delegation must identify the
specific Schedule II controlled substances by either brand
name or generic name. Schedule II controlled substances to
be delivered by injection or other route of administration
may not be delegated.
(2) Any delegation must be controlled substances that
the collaborating physician or certified nurse midwife
with full practice authority prescribes.
(3) Any prescription must be limited to no more than a
30-day supply, with any continuation authorized only after
prior approval of the collaborating physician or certified
nurse midwife with full practice authority.
(4) The advanced practice registered nurse must
discuss the condition of any patients for whom a
controlled substance is prescribed monthly with the
delegating physician or certified nurse midwife with full
practice authority.
(5) The advanced practice registered nurse meets the

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education requirements of Section 303.05 of the Illinois
Controlled Substances Act.
(e) Nothing in this Act shall be construed to limit the
delegation of tasks or duties by a physician to a licensed
practical nurse, a registered professional nurse, or other
persons. Nothing in this Act shall be construed to limit the
method of delegation that may be authorized by any means,
including, but not limited to, oral, written, electronic,
standing orders, protocols, guidelines, or verbal orders.
(f) Nothing in this Section shall be construed to apply to
any medication authority including Schedule II controlled
substances of an advanced practice registered nurse for care
provided in a hospital, hospital affiliate, or ambulatory
surgical treatment center pursuant to Section 65-45.
(g) (Blank).
(h) Nothing in this Section shall be construed to prohibit
generic substitution.
(i) Nothing in this Section shall be construed to apply to
an advanced practice registered nurse who meets the
requirements of Section 65-43.
(Source: P.A. 100-513, eff. 1-1-18; 101-81, eff. 7-12-19.)
(225 ILCS 65/65-43)
(Section scheduled to be repealed on January 1, 2028)
Sec. 65-43. Full practice authority.
(a) An Illinois-licensed advanced practice registered

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nurse certified as a nurse practitioner, nurse midwife, or
clinical nurse specialist shall be deemed by law to possess
the ability to practice without a written collaborative
agreement as set forth in this Section.
(b) An advanced practice registered nurse certified as a
nurse midwife, clinical nurse specialist, or nurse
practitioner who files with the Department a notarized
attestation of completion of at least 250 hours of continuing
education or training and at least 4,000 hours of clinical
experience after first attaining national certification shall
not require a written collaborative agreement. Documentation
of successful completion shall be provided to the Department
upon request.
Continuing education or training hours required by
subsection (b) shall be in the advanced practice registered
nurse's area of certification as set forth by Department rule.
The clinical experience must be in the advanced practice
registered nurse's area of certification. The clinical
experience shall be in collaboration with a physician or
physicians. For an advanced practice registered nurse
certified as a nurse midwife, the clinical experience shall be
in collaboration with a certified nurse midwife with full
practice authority. Completion of the clinical experience must
be attested to by the collaborating physician or physicians,
collaborating certified nurse midwife with full practice
authority, or employer and the advanced practice registered

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nurse. If the collaborating physician or physicians,
collaborating certified nurse midwife with full practice
authority, or employer is unable to attest to the completion
of the clinical experience, the Department may accept other
evidence of clinical experience as established by rule.
(c) The scope of practice of an advanced practice
registered nurse with full practice authority includes:
(1) all matters included in subsection (c) of Section
65-30 of this Act;
(2) practicing without a written collaborative
agreement in all practice settings consistent with
national certification, except in the case of an advanced
practice registered nurse with full practice authority who
is certified as a nurse midwife, who may enter into a
written collaborative agreement with a licensed certified
nurse midwife pursuant to Section 65-35;
(3) authority to prescribe both legend drugs and
Schedule II through V controlled substances; this
authority includes prescription of, selection of, orders
for, administration of, storage of, acceptance of samples
of, and dispensing over the counter medications, legend
drugs, 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;

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(4) prescribing Schedule II narcotic drugs, such as
opioids, only in a consultation relationship with a
physician; this consultation relationship shall be
recorded in the Prescription Monitoring Program website,
pursuant to Section 316 of the Illinois Controlled
Substances Act, by the physician and advanced practice
registered nurse with full practice authority and is not
required to be filed with the Department; the specific
Schedule II narcotic drug must be identified by either
brand name or generic name; the specific Schedule II
narcotic drug, such as an opioid, may be administered by
oral dosage or topical or transdermal application;
delivery by injection or other route of administration is
not permitted; at least monthly, the advanced practice
registered nurse and the physician must discuss the
condition of any patients for whom an opioid is
prescribed; nothing in this subsection shall be construed
to require a prescription by an advanced practice
registered nurse with full practice authority to require a
physician name;
(4.5) prescribing up to a 120-day supply of
benzodiazepines without a consultation relationship with a
physician; thereafter, continued prescription of
benzodiazepines shall require a consultation with a
physician; nothing in this subsection shall be construed
to require a prescription by an advanced practice

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registered nurse with full practice authority to require a
physician name;
(5) authority to obtain an Illinois controlled
substance license and a federal Drug Enforcement
Administration number; and
(6) use of only local anesthetic.
The scope of practice of an advanced practice registered
nurse does not include operative surgery. Nothing in this
Section shall be construed to preclude an advanced practice
registered nurse from assisting in surgery.
(d) The Department may adopt rules necessary to administer
this Section, including, but not limited to, requiring the
completion of forms and the payment of fees.
(e) Nothing in this Act shall be construed to authorize an
advanced practice registered nurse with full practice
authority to provide health care services required by law or
rule to be performed by a physician.
(Source: P.A. 102-75, eff. 1-1-22; 103-60, eff. 1-1-24.)