Can a Nurse Practitioner Act as an Attending at a Nonskilled Nursing Facility?

Carolyn Buppert, NP, JD

Disclosures

March 30, 2006

Question

Can a nurse practitioner act as an attending at a nonskilled nursing facility in Illinois?

Response From the Expert

Carolyn Buppert, NP, JD 
Attorney, Private Practice, Annapolis, Maryland

No. Illinois law allows a resident of a skilled nursing facility or intermediate care facility to select an attending physician. The statute uses the term "physician" and nowhere is physician defined to include nurse practitioner.

Here is the statutory language:

A resident shall be permitted to retain the services of his own personal physician at his own expense or under an individual or group plan of health insurance, or under any public or private assistance program providing such coverage. However, the facility is not liable for the negligence of any such personal physician. Every resident shall be permitted to obtain from his own physician or the physician attached to the facility complete and current information concerning his medical diagnosis, treatment and prognosis in terms and language the resident can reasonably be expected to understand.
210 IL Compiled Statutes 45/2-104 (a)
All medical treatment and procedures shall be administered as ordered by a physician. All new physician orders shall be reviewed by the facility's director of nursing or charge nurse designee within 24 hours after such orders have been issued to assure facility compliance with such orders.
210 IL Compiled Statutes 45/2-104 (b)

Illinois law defines "physician" as:

...a person licensed under the Medical Practice Act to practice medicine in all of its branches or a chiropractic physician licensed to treat human ailments without the use of drugs and without operative surgery.
225 IL Compiled Statutes 60/2(10)

Advanced practice nurses (APN) in Illinois are licensed under the Nurse Practice Act and are defined as:

...a person who: (1) is licensed as a registered professional nurse under this Act; (2) meets the requirements for licensure as an advanced practice nurse under Section 15-10; (3) except as provided in Section 15-25, has a written collaborative agreement with a collaborating physician in the diagnosis of illness and management of wellness and other conditions as appropriate to the level and area of his or her practice in accordance with Section 15-15; and (4) cares for patients (A) by using advanced diagnostic skills, the results of diagnostic tests and procedures ordered by the advanced practice nurse, a physician assistant, a dentist, a podiatrist, or a physician, and professional judgment to initiate and coordinate the care of patients; (B) by ordering diagnostic tests, prescribing medications and drugs in accordance with Section 15-20, and administering medications and drugs; and (C) by using medical, therapeutic, and corrective measures to treat illness and improve health status. Categories include certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), or certified clinical nurse specialist (CNS).
225 IL Compiled Statutes 65/15-5

Some new federal and state laws granting legal authority to perform physician services have been expanded to include other clinicians qualified to provide these services. Occasionally, "physician" is defined to include nurse practitioners. However, this is not the case with the section of Illinois code on nursing facilities.

Nevertheless, nothing in Illinois law prevents nurse practitioners from conducting evaluation and management visits in nursing facilities. Nurse practitioners may alternate with physicians in performing federally mandated visits, although a physician must conduct the comprehensive admission evaluation.

Nurse practitioners in other states who want to provide services in nursing facilities should read the state regulations applicable to nursing facilities to determine which services are restricted to physicians and which services may be delegated to other clinicians, including nurse practitioners. For example, Maryland regulations describe the services that an "attending physician" must perform, without mention of other types of healthcare providers. But the regulations go on to specifically reference a "licensed or certified professional health care practitioner" who may, like the attending physician, provide "periodic, pertinent on-site visits to residents," and may perform the monthly assessments (Maryland COMAR 10.07.02.10).

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