Role specialization in organizations and work systems

Nurse Role Specialization

Credentialing Issues

Becoming credentialed as a nurse practitioner (NP) for a hospital clinic is a process that demands a lot from recent graduates. Depending on the hospital, recent NP hires may or may not have restricted privileges until full credentialing has been completed, or may even be barred completely from practicing until the process is done. The credentialing process includes completing a criminal background check, submitting official transcripts documenting completion of an advanced nursing academic program, professional references, and completing the regulatory paperwork required by the state boards and federal agencies. Delays and inefficiencies in the credentialing process can prevent a newly hired NP from getting full privileges.

Waiting for a DEA number took up to three months, yet hospitals expect NPs to contribute in a meaningful way. Without privileges to write prescriptions the NP cannot function autonomously and delays in patient care occurs. Thus the credentialing process takes too long, is inefficient, and creates friction between staff and new NPs from the very beginning. Probably the most important issue to address is to streamline the internal credentialing process in hospitals, followed by making the credentialing process quicker. This would create a more favorable work environment for all concerned.

The two issues of length of the credentialing process and hospital inefficiencies can be addressed on an individual level to some extent. In the absence of privileges or only partial privileges, the new NP can become proactive about sitting down and explaining the situation fully to colleagues to ensure that they realize the impositions will be only temporary. The nursing profession should lobby legislatures at both the state and federal level to shorten the time it takes to become fully credentialed. The American Nurses Association has testified before federal agencies with the claim that state control over the licensure process has put limits on NP practice growth and independence (Federal Trade Commission, 2003). The Institute of Medicine (2000) has long held that patient safety and care quality are pressing issues in health care today and improving the efficiency of the credentialing process within hospitals would be one way to pursue these goals.

Expanding NP Scope of Practice

My state of residence debated whether to participate in Medicaid expansion under the Patient Protection and Affordable Care Act of 2010 and one of the issues was the impact on the state budget. I wrote my state representative and explained that one way to control costs of Medicaid is to give NPs the authority to diagnose, treat, and write prescriptions without physician involvement. I have not heard back, but the legislature did decide to expand Medicaid coverage under ACA.