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Employed advanced practice nurses and physician assistants

Credentialing Resource Center Connection , April 9, 2009

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Anne Roberts, CPMSM, CPCS, is the director of medical affairs at Children's Medical Center of Dallas, where she oversees the medical administration, graduate medical education, and medical staff services departments.

Dear credentialing colleague:

I received a question this week from a chief medical officer facing a common concern. The question was “Can an employed advanced practice nurse (APN) or physician assistant (PA) begin providing patient care while their credentialing and privileging  application is pending?”

The Joint Commission requires that any APNs or PAs that function as licensed independent practitioners (LIPs) be credentialed and privileged through the medical staff process. If the APNs or PAs are not functioning as LIPs, the Joint Commission allows organizations to have an equivalent process as outlined in the standard HR.01.02.05. As APNs and PAs are required to be fully credentialed and privileged prior to beginning their practice, an APN or PA should not function in the role of an LIP until such time that their credentials and privileges have been approved by the board. 

The credentialing and privileging process can be cumbersome and sometimes can take longer than initially anticipated. Hospitals that employ their APNs and PAs have the option to allow their employees to function under a different scope of practice while their credentialing and privileging application is pending. An employee’s job description would need to reflect what that employee can perform while their application is pending and what level of supervision is required. For example, since they are unable to practice as a fully privileged APN or PA, they would need to have assigned a preceptor who is responsible for countersigning all notes and other documentation until the employee is fully credentialed.

Having a clearly defined job description is essential to ensuring compliance. Below is an example of steps that we have implemented to allow our employees to participate in unit- based training while their credentialing and privileging application is pending:

• Employee must have a completed credentialing application, collaborative practice agreement, documentation of professional liability insurance, and sponsoring physician (preceptor) agreements prior to attending new employee orientation
• All employment screening must be completed prior to attending new employee orientation (background screening, primary source verification of required licenses and certifications, drug screening, immunization documentation, etc.)
• Employee must sign the job description which makes clear they are allowed to function in a completely supervised manner with a preceptor until such time that their privileges are approved by the board. The job description clearly delineates what they can do and what must be countersigned during this initial period

Allowing employees to begin their employment benefits the organization by allowing the employee to obtain unit-based training while their credentials application and privileging approval are pending.

Remember, clear, effective communication is the key to success!

That's all for this week.

All the best,

Anne Roberts, CPMSM, CPCS

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