Exploration of the Practices of Credentialing of Nurse Practitioners in Acute Care Hospital Settings

Abstract

Abstract The nursing shortage, physician shortage, advancing age of the population, and concerns about equalizing access to health care have supported the movement of the Nurse Practitioner (NP) role into the acute care hospital setting (ACHS). Expansion of the role has resulted in efforts by regulatory and accreditation bodies to require standardized processes to ensure that credentialing and privileging supports the role of the NP in the acute care hospital setting. Historically credentialing processes have been developed with the physician role as the template. However, it is not clear that those processes support the role of the NP in the acute care setting. The purpose of the study is to understand and describe the processes by which Nurse Practitioners are credentialed and granted privileges to practice within the acute care hospital setting. A qualitative multi-sited case study approach was used to identify the rules and norms of the credentialing process of Nurse Practitioners. From three acute care hospitals, a purposeful sample of NPs (n=9) and other members of the credentialing bodies (n=3) were interviewed, a demographic survey completed, and documents defining structure collected. Analysis of the data included development of themes across the interviews and cross-case analysis for the three sites. Three major areas were identified that gave rise to specific themes: a) required activities that Nurse Practitioners must complete to receive organizational approval to practice in the advanced role; b) nurse practitioner perceptions of the credentialing process; and c) enhancement of the credentialing process for the Nurse Practitioner. Themes within the area of required activities that Nurse Practitioners must complete to receive organizational approval to practice in the advanced role are: a) required information for acute care credentialing; b) importance of timeliness of completing the process; c) steps for adding and maintaining competencies; d) people involved in the process; and e) common barriers to the credentialing process. Nurse practitioner perceptions of the credentialing process themes are: a) emotional responses of NPs to the credentialing process; b) fit of the credentialing process with the intended role of the NP; and c) involvement of the right people in the credentialing process. Themes within the area of enhancement of the credentialing process for the Nurse Practitioner are: a) reduction of barriers in the NP credentialing process; and b) external factors impacting the NP credentialing process. Cross-case analysis revealed these differences among the sites. Employed NPs and those not employed by the ACHS enter the credentialing process at the same point at two of the study sites. The human resources department is the entry point for employed NPs at the third site, while NPs not employed by the ACHS enter through the medical staff office. The same two sites have implemented a nurse credentialing committee as the first review of the completed application. The third site did not have a nurse credentialing committee at the time of the interviews. The governing body at Site One and Two is the final decision making body for credentialing. Site Three uses the governing body for NPs not employed by the ACHS and the human resources department for approval of employed NPs. The required documents for proof of education, licensure, and competency and other credentialing structures are similar across all three sites. Structure and content of the credentialing process for all three sites were similar. However, variation and barriers were identified by the participants. Findings from this study include opportunities to further standardize and enhance the credentialing process for NPs. Opportunities for standardization and enhancement include: a) communicate needed information about the credentialing process-during the NP educational experience; b) determine consistencies for core competencies and specialty competencies validation across disciplines; c) clearly define methods for obtaining and verifying new psychomotor competencies; d) advocate that the right people, not just functional groups, are involved in the credentialing process within the acute care setting; e) include a contact person for NP credentialing; f) automate and streamline required paperwork, remove confusing language, focus privileging forms on the specialty education of the NP; and g) promote the value of a central verification organization (CVO) to include NP credentialing to the national organizations that represent advance practice nurses. Continued refinement of the credentialing process as well as the implementation of strategies listed above that will enhance the process and may assist in reducing some of the barriers and frustrations identified in this study.