Ask a Professor: The Fight for Full Practice Authority in Illinois

“NPs are the ones going to the front lines when needed. We fill those gaps when otherwise there would be no providers.”

Dr. Julie Koklys, DNP, Assistant Professor at the Lewis University’s College of Nursing and Health Sciences

The US is headed towards a healthcare crunch, with Baby Boomers retiring faster than medical schools can graduate an adequate number of physicians. The need for qualified healthcare professionals is acute and increasing. Nurse practitioners (NPs) could play a prominent role in meeting that need. 

“Nurse practitioners are provided with an education and a certification within their scope of practice and population focus that provides them with the knowledge and skills to provide safe, quality, and cost-effective care straight out of school,” says Dr. Julie Koklys, an assistant professor at Lewis University’s College of Nursing and Health Sciences.

“Like any profession, there’s a learning curve. But nurse practitioners have completed hundreds of hours of clinical experience from their education, both undergraduate and graduate, and from their nursing background, prior to ever stepping foot into their role as an NP.”

Despite Americans having ranked nursing as the most trusted profession for 18 years in a row, some state governments don’t trust NPs as much as they should. Several states, including Illinois, are classified as reduced practice environments: jurisdictions where NPs are not allowed to practice to the full extent of their education, licensure, training, and ability.

Meet the Expert: Dr. Julie Koklys, DNP, APRN, FNP-BC

Dr. Julie Koklys, DNP, APRN, FNP-BC, is an assistant professor at Lewis University’s College of Nursing and Health Sciences. She received her MS in family health nursing and nursing education from the University of South Florida and her DNP from Lewis University. 

Her DNP research was titled “Nurse Practitioner Perceived Readiness for Full Practice Authority.” Dr. Koklys currently serves on the Government Relations Committee for the Illinois Society for Advanced Practice Nursing (ISAPN).

Dr. Koklys graciously shared her thoughts on NP practice authority within her state in August 2020 and again in December 2023.

What is NP Full Practice Authority?

In states like Illinois, the law hasn’t fully caught up to the facts. Nurse practitioners are rigorously trained and highly competent, with studies showing that NPs can provide equal or better care than physicians. Research also suggests that they can provide equal or better patient outcomes at a lower cost, too. These benefits, however, are limited when full practice authority (FPA)—the ability of NPs to practice, unencumbered, to the full extent of their training—is not realized in their jurisdiction. 

“In other states, you can graduate, and then you can practice independently,” Dr. Koklys says. “But, I use that term independently carefully:  We know our resources. We know our referral sources. We know the colleagues that we can rely on if we have questions. We know as nurse practitioners when it’s time to seek out external sources. We don’t ever operate in a vacuum.”

The Challenges of NP Reduced Practice Laws in Illinois

A problem arises when legislation requires NPs to ask for help and confirmation when they don’t need it. What’s known as a “supervisory requirement” or “collaborative agreement” is the crux of one of the primary impediments to FPA. While they vary in their precise wording, these restrictions generally include the stipulation that an NP needs the approval of a physician to perform certain tasks. In some states, the ability to practice as an NP depends upon such an agreement.

Largely a product of a bygone era, these supervisory requirements fail to consider the rigorous education and training that modern NPs undergo. They ultimately undermine the ability of NPs to fully meet the needs of the healthcare crunch. When an NP needs a physician signature or phone call to approve what they already know how to do, the care process is slowed down and cost savings can drop significantly. 

When a supervising physician retires or relocates, the corresponding NP needs to halt a portion of their practice until a replacement can be found. The financial cost to an NP of maintaining a collaborative agreement can be a serious barrier to providing care in rural areas. In these and other cases, the legislative burden on the NP inevitably gets passed onto the patient.

“I work for a clinic in the Chicagoland area that treats very specific conditions,” Dr. Koklys says. “Under my collaborative practice agreement, there are restrictions on the medications I can utilize for patients.  For example, I cannot provide my patients with certain controlled migraine medications. So if I determine a diagnosis of migraine during the course of a visit and they would benefit from one of these controlled medications, I have to charge them for my visit, then send them to another provider, where they would likely be charged for a secondary visit.  This is a barrier for both patients and providers.”

Supervisory requirements and collaborative agreements can be a significant nuisance in major metropolitan areas. In rural areas, they become a major problem. Illinois is home to some 76,000 farms that cover over 28 million acres and comprise nearly 80 percent of the state’s total land area. Data shows that NPs are far more likely than physicians to practice in rural areas. NPs providing care in these rural areas may be the closest healthcare provider within reachable distance for some patients; making them dependent upon the approval of a distant physician makes a hard job harder and sometimes impossible.

Moving Toward NP Full Practice Authority in Illinois

Like many other states, Illinois is inching itself towards full practice authority. In September 2017, an amendment to the Nurse Practice Act was signed into law, allowing some NPs to practice without entering into a written collaborative agreement with a physician. 

To qualify, NPs need to first meet educational and training standards, including national certification, 4,000 hours of clinical experience in collaboration with a physician, and 250 hours of continuing education. In some ways, these requirements are redundant forms of the training and experience an NP has already accrued through the educational process. 

In signing the law, which passed unanimously in the state’s two legislative chambers, the state’s then-governor, Bruce Rauner, cited the importance of reducing restrictions to practice for NPs and how it could increase the access, affordability, and quality of healthcare across the state. Illinois has attempted to smooth out the transitional process further by providing the state’s NPs with an application packet to help them apply for independent practice. 

But, even in full effect, restrictions remain: NPs can only prescribe certain narcotics (such as opioids) when in consultation with a physician and reported under the state’s Prescription Monitoring Program

“We made some headway in 2017,” says Dr. Koklys, who also serves as the Government Relations Chair for the Illinois Society for Advanced Practice Nursing (ISAPN). “Until that point, Illinois NPs had to have a collaborative agreement with a physician indefinitely. So this was an initial step in the right direction. We still have some restrictions, and more work to do.”

Dr. Koklys and the ISAPN, along with other professional organizations like the American Association of Nurse Practitioners (AANP), are the spearheads for several advocacy issues within the profession. When the issue of providing telehealth was brought to the ISAPN board, the board took the issue to its lobbyists, who in turn took it to the state government in Springfield. The governor then put forth an emergency order stating that telehealth was a service that could be provided. The ISAPN took that information and disseminated it amongst the NP community. This sort of direct action, ultimately in service of better patient outcomes, is one of the main functions of professional organizations like the ISAPN. 

“If you don’t have your finger on the pulse, then you don’t know what the problems are, and you don’t know how to help,” Dr. Koklys says. “Becoming a member of local, national, or specialty-based professional organizations is critical for NPs and NP students alike.”

In the wake of the Covid-19 pandemic, several reduced and restricted practice states have temporarily granted NPs full practice authority. Illinois is not one of them. But recent history shows that when the public needs cost-effective quality care, the answer is often NPs. States like Illinois would do well to empower them.

“NPs are the ones going to the front lines when needed,” Dr. Koklys says. “We fill those gaps when otherwise there would be no providers.”

Update: NP Practice in Illinois in 2024

So much can change in four years’ time. Even as the public health emergency (PHE) related to Covid-19 recedes, Illinois NPs are still taking stock of its effects. Many nurses and APRNs have retired or left the nursing workforce after the pandemic, after experiencing record levels of burnout. 

“There have also been some major financial repercussions from the pandemic,” Dr. Koklys says. “And that’s brought stringent changes into our organizations. The workforce is smaller, with fewer providers and fewer assistants to see more and more patients. Many times, we’re asked to do the same if not more than we were doing before, but with less support.” 

During the pandemic, many states, including Illinois, waived some of the restrictions on NP practice. For many in the nursing community, such waivers were met with optimism: if NPs could be relied on to provide high-quality care in an emergency related to a pandemic, why shouldn’t they be relied upon in an emergency related to a lack of healthcare access? The rolling back of many pandemic-era waivers has muted that optimism. 

One of the positives of the pandemic, however, has been the widespread adoption of telehealth services. Even outside of the pandemic, NPs providing telehealth services can reach patients in rural and underserved areas. It’s a net gain for patients and providers both. 

“Telehealth is not going away,” Dr. Koklys says. “We’ll continue to see patients and NPs use telehealth as appropriate.”

Unfortunately, there have been relatively few changes to the practice landscape for NPs in Illinois. Some bright spots exist: in 2023, laws were passed that removed the requirement for APRNs to consult with a physician when prescribing benzodiazepines if the prescription is for less than 120 days. That change may look small on paper, but it’s hugely important for NPs working in mental health, pain management, and even primary care. 

The major barrier NPs face in providing care in Illinois remains in the form of requiring NPs to enter into a collaborative agreement with a physician. The educational and experiential requirements (4,000 hours of clinical experience and 250 hours of continuing education) translate to roughly two years of full-time work. That extra barrier can lead to gaps in patient care, increased patient costs, and reduced patient access. 

NPs in Illinois are still working hard in their fight for full practice authority. The IASPN continues to push for more progressive legislation. The state’s Nursing Practice Act sunsets in 2027, offering new opportunities for a major overhaul. And, in the meantime, the evidence supporting full practice authority only continues to grow. 

“There’s nothing research-based or evidence-based that says that these four thousand supervised hours do anything different for us, or for the patients, or for our outcomes,” Dr. Koklys says. “But we do know we’re lacking in primary care providers. Eventually, there will come a time where if Illinois wants patients to have access to care, they’re going to have to get rid of some of these restrictions on NP practice.”

Matt Zbrog

Matt Zbrog


Matt Zbrog is a writer and researcher from Southern California, and he believes nurse practitioners (NP) are an indispensable component of America’s current and future healthcare workforce. Since 2018, he’s written extensively about the work and advocacy of NPs, with a particular focus on the rapid growth of specialization programs, residencies, fellowships, and professional organizations. As part of an ongoing series on state practice authority, he’s worked with NP leaders, educators, and advocates from across the country to elevate policy discussions that empower NPs. His articles have featured interviews with the leadership of the American Association of Nurse Practitioners (AANP), the National Association of Pediatric Nurse Practitioners (NAPNAP), and many other professional nursing associations.