NURSE PRACTICE ACT MIDWIVES
HB2688 amends the Illinois Nurse Practice Act to expand and clarify the practice authority of advanced practice registered nurses (APRNs), with a particular focus on certified nurse midwives and out-of-hospital birth services. The bill defines and updates a number of nursing-related terms, including “full practice authority,” “maternity care desert,” and “license-pending” categories, and it revises the rules governing collaborative agreements between APRNs and physicians, dentists, or podiatric physicians.
A major feature of the bill is the creation of new provisions allowing certified nurse midwives to provide out-of-hospital birth services in licensed birth centers without a written collaborative agreement if they have clinical privileges from the birth center’s clinical director. It also allows nurse midwives to provide such services in certain shortage areas or maternity care deserts under specified collaborative arrangements. The bill further limits what collaborative agreements may restrict, including patient categories, payor participation, and practice location, and it adds liability protections for collaborating physicians. It also preserves and clarifies existing rules for anesthesia services provided by certified registered nurse anesthetists, including requirements for collaboration and physician presence in certain settings.
The bill’s impact on state law is to modify the Nurse Practice Act by changing Sections 50-10 and 65-35 and adding new Sections 65-44 and 65-70. These changes affect APRNs, collaborating physicians, hospitals, birth centers, dental offices, and other health care settings by expanding where and how APRNs may practice, especially in maternal health and out-of-hospital birth contexts. It also creates a statutory definition of “maternity care desert,” which can be used to determine where expanded midwifery services are permitted.
The general sentiment around the bill appears strongly favorable. The House passed it unanimously, 114-0, and the Senate motion also received overwhelming support, 56-1. The bill’s findings section frames the measure as a response to a maternal health crisis and emphasizes access to out-of-hospital services as a needed part of the solution, suggesting broad legislative support for expanding maternal care access.
The main points of contention are the scope of APRN independence and the role of physician oversight. The bill limits the ability of collaborative agreements to restrict APRN practice and reduces physician liability tied solely to signing such agreements, which may concern some medical professionals or regulators who favor tighter supervision. At the same time, the bill preserves physician responsibility for their own acts and maintains certain collaboration and presence requirements in anesthesia and other settings, reflecting a compromise between expanding nursing practice and retaining physician involvement in higher-risk care.
HB2688 amends the Illinois Nurse Practice Act, updating statutory definitions and adding new provisions that expand APRN authority, especially for certified nurse midwives. It creates new rules for out-of-hospital birth services, modifies collaborative agreement requirements, and adds physician liability protections, affecting licensing, scope of practice, and regulatory oversight by the Department of Financial and Professional Regulation. The bill also impacts hospitals, birth centers, shortage-area providers, and patients seeking maternity care, particularly in underserved areas.
The bill appears to have broad bipartisan support and little visible opposition in recorded votes. It passed the House 114-0 and later advanced in the Senate 56-1, indicating strong legislative approval. The bill’s findings and structure suggest a policy goal of improving maternal health access, which likely contributed to the favorable sentiment.
The central policy tension is between expanding APRN autonomy and preserving physician oversight. Supporters appear to favor allowing certified nurse midwives and other APRNs more flexibility to practice in out-of-hospital and underserved settings, while the bill still retains collaboration requirements in many circumstances. Potential critics would likely focus on the reduced restrictions in collaborative agreements, the ability of nurse midwives to provide home birth services in certain settings, and the new limits on physician liability tied to those agreements.