NAPNAP Position Statement on Credentialing and Privileging for Nurse Practitioners

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• Acknowledgment
• References

The National Association of Pediatric Nurse Practitioners (NAPNAP) recommends that all nurse practitioners (NPs) obtain the credentialing^∗ necessary to perform services to the full extent of their knowledge, training, experience, and skills. Through credentialing and privileging,^† individual NPs are able to demonstrate competencies consistent with their role and responsibilities. When the competencies needed exceed those provided by NP graduate educational programs, appropriately mentored education and experience are necessary to support the NP's request for credentialing and privileging. These two distinct but related processes are essential for NPs to fully function within a variety of health care settings; they are mandated by a variety of regulatory bodies, including The Joint Commission (TJC), the Accreditation Association for Ambulatory Health, the National Committee for Quality Assurance, and many managed care organizations (Madgic & Hravnak, 2005).

The regulation of professional nursing practice is accomplished by licensure, certification, and professional standards of practice. The legal authority to practice as an NP within a particular state is granted by the state's nurse practice act through licensure or recognition as an advanced practice nurse. Certification is a common prerequisite for advanced practice recognition or licensure, and it defines the functional scope and population for NP practice. Certification in a specialized area validates the clinician's minimum level of competence and demonstrates that the NP has achieved a higher level of competence in that area, for example, in pediatrics (NAPNAP, 2006a). Professional standards of practice are delineated by professional organizations to further define professional competency for NPs. Credentialing and privileging provide additional safeguards to the public by establishing an NP's competency to practice in a specific setting.

The credentialing and privileging process is accomplished through a series of activities designed to collect, verify, and evaluate data relevant to the practitioner's professional performance. This process includes obtaining verification of current licensing, letters obtained from colleagues to verify level of competence, and proof that the individual has the ability to perform the requested clinical activities. These data are the foundation for objective, evidence-based decisions regarding appointment to membership on the medical staff and for recommendations to grant or deny initial and renewed privileges. In the course of the credentialing and privileging process, an overview of each applicant's licensure, education, training, current competence, and physical ability to perform patient care responsibilities is established. Health care delivery systems must fulfill their obligation of ensuring that all practitioners who work within their system are clinically competent to carry out their tasks. The systems also must provide these individuals with appropriate authority to direct hospital staff, write orders, and interpret diagnostic information.

NAPNAP supports:

It is important for both health care consumers and professionals that decisions about credentialing and privileging be made objectively, transparently, equitably, and accurately and that they be based on data and reasonable criteria. It is imperative that policies and procedures define credentialing and privileging processes and that the role of credentialed and privileged providers in delivering specialty care be defined. In this way it will be possible to recognize competent practitioners from all health care disciplines.

NAPNAP is an organization whose mission is promoting optimal health for children through leadership, practice, advocacy, education, and research.

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The National Association of Pediatric Nurse Practitioners would like to acknowledge the contributions of the following NAPNAP members and individuals from the NAPNAP Professional Issues Committee: Andrea Kline Tilford, MS, RN, CPNP-AC/PC, FCCM, Professional Issues Chair; Terry Buford, PhD, RN, CPNP-PC; Kristin Hittle, MSN, RN, CPNP, CCRN; Nancy Laterra-Ferraro, MSN, RN, CPNP; Melissa Reider-Demer, MSN, RN, CPNP-PC; Katherine Rossiter, EJD, MSN, APRN-NP, CPNP-PC, CDE; Jo Ann Serota, MSN, RN, CPNP; and Heather Keesing, MSN, RN, APRN (Staff).

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References 

1. Kleinpell R, Hravnak M, Hinch B, Llewellyn J. Developing an advanced practice nursing credentialing model for acute care facilities. Nursing Administration Quarterly. 2008;32(4):279–287
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2. Madgic K, Hravnak M. Credentialing for nurse practitioners. AACN Advanced Critical Care. 2005;16(1):15–22
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3. National Association of Pediatric Nurse Practitioners . NAPNAP position statement on certification. Journal of Pediatric Health Care. 2006;20:39A–40A
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4. National Association of Pediatric Nurse Practitioners . NAPNAP position statement on continuing education. Journal of Pediatric Health Care. 2006;20:47A
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5. The Joint Commission. (2009a). 2009 Standards FAQs. Retrieved from http://www.jointcommission.org/AccreditationPrograms/Hospitals/Standards/09_FAQs/default.htm
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6. The Joint Commission. (2009b). 2010 Standards (2010 Pre-publication version): Medical staff privileging and appointment: Standards MS 06.01.07, #8 and MS 07.01.01, #3. Retrieved from http://www.jointcommission.org/NR/rdonlyres/FC01E2E0-A0CB-4A71-AF0B-137AA77D1BD6/0/AllChapters_HAP.pdf
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• ∗ Credentialing is a process in which education, licensure, and certification are verified using primary sources (Kleinpell, Hravnak, Hinch, & Llewellyn, 2008). Credentialing begins with the four core requirements of TJC: current licensure; relevant education, training, or experience; current competence; and the ability to perform the activities for which privileges are requested (TJC, 2009a). This process is used by institutions, agencies, and organizations to formally grant authority to designated professionals to act as licensed providers within that health care delivery system.
• † Privileging is the process of determining a health care professional's current skill and competence to order and/or perform specific diagnostic or therapeutic procedures. Privileges are granted based on several factors, including the state nurse practice act, collaborating relationships, professional experience, and the specific facility's mission, resources, and regulations. TJC clearly states that review of NP applications for medical staff membership and privileges must follow a specific path with a review process similar to that for physicians (TJC, 2009a).