Nurse Practitioner Credentialing and Scope of Practice

Introduction to NP Credentialing Challenges

Becoming credentialed as a nurse practitioner (NP) for a hospital clinic is a process that demands a great deal from recent graduates. Depending on the hospital, recently hired NPs may have restricted privileges until full credentialing is completed, or may be barred entirely from practicing until the process is finished. The credentialing process includes completing a criminal background check, submitting official transcripts documenting completion of an advanced nursing academic program, providing professional references, and completing the regulatory paperwork required by state boards and federal agencies. Delays and inefficiencies in the credentialing process can prevent a newly hired NP from obtaining full privileges and meaningfully contributing to patient care from the outset.

Inefficiencies in the Hospital Credentialing Process

Waiting for a DEA number can take up to three months, yet hospitals expect NPs to contribute in a meaningful way from the start. Without the privilege to write prescriptions, the NP cannot function autonomously, and delays in patient care result. The credentialing process is therefore too long, inefficient, and creates friction between staff and new NPs from the very beginning. Probably the most important issue to address is streamlining the internal credentialing process within hospitals, followed by making the overall credentialing timeline shorter. Both changes would create a more favorable work environment for all concerned.

Strategies to Address Credentialing Delays

The two issues of credentialing length and hospital inefficiency can be addressed on an individual level to some extent. In the absence of full or partial privileges, the new NP can be proactive by sitting down with colleagues to explain the situation fully, ensuring they understand that any imposed limitations will be temporary. At a broader level, the nursing profession should lobby legislatures at both the state and federal levels to shorten the time required to achieve full credentialing.

Expanding NP Scope of Practice

The American Nurses Association has testified before federal agencies, arguing that state control over the licensure process has placed limits on NP practice growth and independence (Federal Trade Commission, 2003). The Institute of Medicine (2000) has long maintained that patient safety and care quality are pressing issues in health care, and improving the efficiency of the credentialing process within hospitals would be one concrete way to pursue these goals.

The debate over whether to participate in Medicaid expansion under the Patient Protection and Affordable Care Act of 2010 included discussion of its impact on state budgets. One argument for controlling the costs associated with Medicaid expansion is to grant NPs the authority to diagnose, treat, and write prescriptions without physician involvement. In 2012, only 18 states gave full practice privileges to NPs, while another 32 required physician involvement (Cassidy, 2013). As Medicaid expands to include millions of previously uninsured Americans, the demand for primary care will grow substantially.

As an NP providing primary care services in a hospital setting but unable to write prescriptions without a physician's approval, the ability to deliver high-quality, cost-efficient care without delays is significantly impaired. The only viable solution is to engage in a campaign to convince state representatives to confer full practice privileges to NPs. This will require a coordinated letter-writing campaign and the engagement of professional organizations that have already adopted a similar position at the local level (ANA, 2013).

Conclusion

Addressing credentialing inefficiencies and expanding NP scope of practice are interrelated reforms essential to improving primary care access and patient safety. Both individual advocacy — such as transparent communication with hospital colleagues — and systemic efforts, including lobbying professional associations and state legislatures, are necessary to reduce barriers that prevent NPs from practicing to the full extent of their training and education. Legislative engagement and institutional reform must work in concert to create a more functional and equitable environment for nurse practitioners and the patients they serve.