PNP Credentialing and Privileging

Requirements for Pediatric Nurse Practitioners

PNPs who want to provide direct clinical services within inpatient settings must meet the requirements established by the institution in which they wish to practice.  Although, the specific requirements for PNP credentialing and privileging tend to vary from institution to institution, a rigorous and systematic procedure is always essential to building a quality professional staff.  The goal of credentialing and privileging for both the practitioner and the health care organization should be the desire to achieve the highest quality of care with the best utilization of personnel resources.

Credentialing

Credentialing is a process for validating professional licensure, clinical experience, educational preparation and certification for specialty practice.  Credentialing is a relatively straightforward administrative process involving the collection and verification of information about your PNP education, former practice experience, references, specialty certification, licensure and certification history, professional associations, and professional liability history.  The requirements may include, but are not limited to, the following:

1.            Curriculum vitae

2.            Current RN and APRN (where available) license in state of practice

3.            Graduation from an approved PNP program

4.            Certification by an appropriate national certification body such as the PNCB or ANCC

5.            State specialty certification to practice as a PNP

6.            Letters of recommendation (2 or 3) from professional colleagues; one or more of whom may be a nurse practitioner or physician with clinical privileges at the institution of application

7.            Job description or outline of specific clinical services to be provided

8.            Health clearance release form

9.            Malpractice coverage policy

10.            Recent BLS, NRP, PALS or ACLS certification, as appropriate

11.            Listing of continuing education credits

12.            Listing of professional association memberships

Depending on the institution, the application packet can be obtained through the nursing or the medical staff affairs office.  The process can take as long as 2-3 months, so it is important to gather and submit the information in a timely manner.  There may be a non-refundable application processing fee payable to the institution.  It may be possible to negotiate with your employer to reimburse this fee.  Credentials are renewed periodically according to the bylaws of the institution.

Privileging

Privileging is the process through which the health care institution grants a practitioner specific authority to perform designated clinical services in the facility. The privileges that are granted must address the uniqueness of PNP practice while ensuring one common standard of patient care (Brassard & Smolenski, 2011).

To read NAPNAP’s Position Statement on Credentialing and Privileging for Nurse Practitioners

go to http://www.napnap.org/PNPResources/Practice/PositionStatements.aspx

 

Ongoing Professional Practice Evaluation (OPPE) is a measure of health care provider performance to evaluate competency on an ongoing basis in order to allow steps to improve performance in a more timely fashion.

Focused Professional Practice Evaluation (FPPE) is a focused evaluation of health care provider competency in two specific scenarios: initial credentialing application and when there is concern in regard the competency or ability of the health care provider to provide care. This includes circumstances in which a health care provider is requesting new privileges that were not previously requested or granted.   FPPE is applicable to health care providers that are not new to the organization.

Both OPPE and FPPE are used to begin, continue, suspend, revoke, or limit clinical privileges.

Uniqueness of NP practice will vary from state to state and be defined by nurse practice acts.  Variation in prescriptive authority, reimbursement, and practice requirements necessitating physician supervision, physician collaboration, or allowing independent practice must be incorporated into the privileging requirements for NPs.  In preparing to make a formal request for clinical privileges, you should give thoughtful consideration to the following:

Patient Care Services:  Determine what direct patient care services will you perform and devise a detailed outline of these.  The following general categories of services may be considered: performing admission and discharge physical examinations, diagnosing and treating health deviations, ordering diagnostic tests and interpreting results, prescribing medications including narcotics with appropriate privileges, consulting subspecialists, performing invasive procedures, and providing anticipatory guidance to patients and families about the care and management of various health conditions.

Demonstrating Procedural Competence:  This process verifies within a health care system that a provider is trained and capable of performing a diagnostic or treatment procedure.  In order have the privilege of performing procedures you must show initial competency maintenance of this competency.  For initial competency, a provider is frequently required to successfully perform a procedure with a currently privileged provider within the organization, typically 3 times to establish independent privileging (Ritz and Smith, n.d).

With each re-credentialing period providers must demonstrate ongoing competence through documentation of recent successful procedures or practice in simulation settings.  Any adverse events associated with procedural competence must be reported and ongoing education should be documented related to performance of procedures.  No national standards exist currently pertaining to the maintenance of procedural competence.  As a result, the number of successful procedures and simulation attempts needed to maintain competence will vary from system to system. NPs performing procedures should maintain a procedure log either in hard copy or web based application to document procedures that have been performed.

Supporting Documents: Assemble your documents indicating education, experience, and certifications.  Obtain letters of support from faculty, mentors, or NP colleagues who can attest to your competence as an NP in the area of practice for which privileges are being sought.  These documents serve to substantiate, beyond any doubt, that you are competent to practice and possesses the required education, expertise, and certifications.

 

References

Brassard, A. & Smolenski, M. (2011). Removing barriers to advanced practice registered nurse care: hospital privileges. Insight on the Issue, 55,1-12.

Ritz, S. & Smith, G. (n. d.) Evaluating procedural skills competency – moving beyond see one, do one, teach one.  [Power Point slides]. Retrieved from: www.fmdrl.org/index.cfm?event=c.getAttachment&riid=980