Credentialing and Clinical Privileges

Credentialing from advanced practice registered nurses (APRNs) perspective is defined as “furnishing the documentation necessary to be authorized by a regulatory body or institution to engage in certain activities and use a certain title” (Hanson, 2014). Credentialing is also define from a local institutional process that consider specific documentations for APRN before they assume the practice role as APRN within their facility. In health care system, credentialing ensures individuals meet required standards of practice and is prepared to perform those duties implied by the credentials. National certification and education are considered as part of credentialing for APRN to acquire basic level of competence to practice. (Hanson, 2014)

been restricted on what they can and can’t do including signing certain documents and orders they can prescribe. With the Affordable Care Act the demand for primary care providers is growing (Gadbois, Miller, Tyler, & Intrator, 2015). This means that the need for APRNs is rising and the need change is approaching. In the primary care setting, there is a variety of medical staff working including medical assistance, LPNs, and RNs. This can become more for the APRN when delegating medication administration. When the APRN cannot delegate medication administration the quality of patient care is sacrificed and is not productive in providing care to the patients.

While uncertainty about the role of an Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) persists, what research has found about the role is that AG-ACNP’s provide advanced nursing care to those who are acutely, critically or chronically ill in both traditional and nontraditional healthcare settings (Kleinpell et al., 2012). Standard of scope differs between all types of scopes and nurse practitioners alike. The scope of practice (SOP) for an Acute Care Nurse Practitioner (ACNP) is not based on practice setting, but rather what type of care the patient will need, for example, someone who needs ventilator management in either the home or hospital environment (Kleinpell et al., 2012).

The APRN Consensus Model was released in July of 2008 to define advanced practice registered nurse, identify the titles to be used by APRNs, and define specialty area of practice. The Consensus Model also describes population foci, suggests a process for recognition of new APRN roles, and recommends requirements for implementation (American Nurses Association [ANA], 2010). The APRN regulatory model helps uniform scope of practice of APRN across the United States, which benefit individual APRN, enhance patient outcomes, and improve the quality of care. Consensus Model consists of Licensure, Accreditation, Certification, and Education. The Education criteria in LACE Consensus Model relate to all APRN programs regardless of master’s or doctoral

Poghosyan and Knutson conducted a survey of 278 APRNs to better understand their independence and role in New York State primary care settings. Forty two percent of the APRNs surveyed stated they have their own patient panel and do not share panel with physicians and two thirds are able to review the outcome measures of the care they deliver. The study found that despite the restrictions on APRNs they freely apply their clinical knowledge

Many studies exist which highlight the benefits of APRN full practice authority. One study from Duke University, by Conover and Richard (2015), contained this strong statement regarding APRN practice, “studies vary in their methodological rigor, each has concluded that APRN practice outcomes are equivalent or better to those of physicians” (pg. 4). The study goes on to say that three cost effective benefits to full practice authority APRNs are: lower training costs, lower compensation and limited use of expensive resources or procedures. The study also discusses how full practice laws would increase access to care by decreasing primary care provider shortages (pg. 6).

In 2008, the coalition of members from the Alliance for Advanced Practice Credentialing and the National Council of State Boards of Nursing (NCSBN) created the Consensus Model for Advanced Practicing Registered Nurses (APRN’s). This model creates a framework for APRN’s in licensing, accreditation, certification, and education in the United States (Alleman & Houle, 2013). The establishment of this Consensus Model has developed a bases for the ARNP’s comprehensive knowledge base, ability for clinical reasoning, cultural, and ethical competencies, establishing a model of practice for ARNPs in which to follow. These concepts will be further discussed in this paper.

While the demand of healthcare need increasers the United States facing a physician shortage. In recent years the number of nurse practitioners (NPs) and physician assistants (PAs) has significantly increased and they are taking the part in providing healthcare cervices to the majority of patients. I believe nurse practitioners and physician assistants can practice independently from doctors and be free of oversight. Expanding the scope of NPs and PAs is essential to overcome the healthcare crisis we are facing; it will increase patient satisfaction and stabilizing the healthcare economy.

The success of NPs depends on practicing evidence-based care with competency in assessment, diagnosing, managing patients, and maintaining a caring practice. The nursing component of the NP role continues to be challenged from within nursing, as well as by large national physician organizations. NPs are extensions of nursing practice who are guided by nursing theory. The transformation from nurse to the advanced practice role of NP involves development of advanced knowledge and skills for listening, knowing, being with patients, connecting patients to their communities, promoting health,

Three issues or trends I see that are important with regard to credentialing are reimbursement, malpractice and education. Within each issue are opportunities for the advance practice nurse (APN) to grow in knowledge and participate in change. It is important to understand why each one effects credentialing for the APN.

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

As the young and rapidly-aging population continues to increase, the demands of primary, acute and chronic disease management will also increase. As a result, more health care professionals who provide primary care will be needed to meet these demands. Thus, the emergence of Advanced Practice Registered Nurse (APRN) evolve. APRN is a nurse who has completed a graduate degree and has acquired advanced knowledge and skills. APRNs are grounded with theory, concepts and principles that enable them to assess, diagnose, treat and manage their patients. APRNs can work in conjunction with other health care professionals or independently. APRNs improve access to health care by providing care in the rural and underserved areas. APRNs also reduce the cost to health care (Joel, 2013).

This is a very interesting post regarding the IOM report for advanced practice nurses in the future. You state “that more autonomy with APRNs will be very beneficial.” One of the key recommendations of the IOM report is for “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression” (IOM, 2011). By allowing APRNs to have more autonomy, there will a higher chance of the population to have more access to the health care system. There is a high rate of physician shortage and by allowing the APRNs to have more autonomy, this will help bridge the gap of available providers for patient care. The APRNs can work collaboratively with the physician and other

The issue that can create an impact in the practice of the APRNs it is not uniform. One of the main problems in the nursing career is the different type of practice from each state. According to Timmons (2016), each state has their own rules and their regulations for the APRNs. This is the biggest issues in providing the real care to our patients. According to Yee, Boukus, Cross, and Samuel (2013), the clinical role of NPs is governed largely by state scope-of-practice (SOP) laws that determine the range of services NPs can provide and the extent to which they can practice independently. The curriculum and the training are kind of the same almost in every state; nevertheless, the scope of practice is controversial. To benefit the patient’s

HealthCare Issue: With the rapidly growing elder population, the considerable economic burden on healthcare followed by more outpatient office visits, these factors have resulted in an unprecedented strain on the healthcare system. Particularly concerning, is the projected supply of and demand for the healthcare workforce (Administration on Aging, 2016, Anderson, 2014). In response to these pressures, the healthcare industry strives to search for cost effective approaches through redesigning and reducing its work force by increasing the utilization of MAs (Anderson, 2014). Currently medical assistants (MAs) and Advanced Practice Registered Nurses (APRNs) work closely together in various clinical settings delivering quality healthcare to the public. However, the role of the MA presents a unique challenge to the APRN in that APRNs are limited in their ability to effectively and efficiently delegate to MAs (New Hampshire MA Taskforce, 2011). Therefore, APRNs will not be deployed in various clinic settings, thus, confining a physician’s means to expand healthcare access to his/her patients. Clinic workflows and staffing structures can result in situations where an APRN is formally or informally relied upon to delegate to and supervise CMAs (New Hampshire MA Taskforce, 2011). With this in mind, much more attention should be focused on future proposed changes concerning the legal relationship between MAs and APRNs. Current Arkansas jurisdictions allows APRNs to delegate limited