Privilege v. scope of practice: How to handle AHPs

"Simply put, any individual allowed to access patients must undergo some type of credentialing," says Cairns. The level of medical and legal risk to the patient and the organization usually determines the extent of credentialing.

For example, a sales representative for a new medical device wouldn't undergo the same process as a practitioner. Organizations must outline in a policy the credentialing processes for each of the above listed practitioner groups.

Remember, in order for a practitioner to hold privileges, he or she must be permitted by law and the organization to practice independently.

Therefore, if the state authorizes the practitioner to practice independently, the organization is not bound to do so as well. The governing body holds the responsibility to evaluate the organization's scope of services and determine which practitioners may care for patients and what level of supervision it will permit. So the organization doesn't have to grant these individuals clinical privileges; a scope of practice or job description would suffice.

"The nurse practitioners at our facility caused us to take another look at our AHP privileging policy," says Marijo DeMott, coordinator of medical staff services at St. Alexius Medical Center, in Bismark, ND. "They currently work under contract and are supervised by a physician, but they want to practice independently because North Dakota law allows it."

But if the state and organization consider practitioners licensed independent practitioners (LIP) and they practice without supervision, then the facility should credential and privilege them through the medical staff process, Cairns says.

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