AbstractsMedical & Health Science

Exploration of the Practices of Credentialing of Nurse Practitioners in Acute Care Hospital Settings

by Carla M. Hronek




Institution: University of Kansas
Department: Nursing
Degree: PhD
Year: 2014
Keywords: Nursing
Record ID: 2026168
Full text PDF: http://hdl.handle.net/1808/14502


Abstract

Abstract The nursing shortage, physician shortage, advancing age of the population, and concerns about equalizing access to health care have supported the movement of the Nurse Practitioner (NP) role into the acute care hospital setting (ACHS). Expansion of the role has resulted in efforts by regulatory and accreditation bodies to require standardized processes to ensure that credentialing and privileging supports the role of the NP in the acute care hospital setting. Historically credentialing processes have been developed with the physician role as the template. However, it is not clear that those processes support the role of the NP in the acute care setting. The purpose of the study is to understand and describe the processes by which Nurse Practitioners are credentialed and granted privileges to practice within the acute care hospital setting. A qualitative multi-sited case study approach was used to identify the rules and norms of the credentialing process of Nurse Practitioners. From three acute care hospitals, a purposeful sample of NPs (n=9) and other members of the credentialing bodies (n=3) were interviewed, a demographic survey completed, and documents defining structure collected. Analysis of the data included development of themes across the interviews and cross-case analysis for the three sites. Three major areas were identified that gave rise to specific themes: a) required activities that Nurse Practitioners must complete to receive organizational approval to practice in the advanced role; b) nurse practitioner perceptions of the credentialing process; and c) enhancement of the credentialing process for the Nurse Practitioner. Themes within the area of required activities that Nurse Practitioners must complete to receive organizational approval to practice in the advanced role are: a) required information for acute care credentialing; b) importance of timeliness of completing the process; c) steps for adding and maintaining competencies; d) people involved in the process; and e) common barriers to the credentialing process. Nurse practitioner perceptions of the credentialing process themes are: a) emotional responses of NPs to the credentialing process; b) fit of the credentialing process with the intended role of the NP; and c) involvement of the right people in the credentialing process. Themes within the area of enhancement of the credentialing process for the Nurse Practitioner are: a) reduction of barriers in the NP credentialing process; and b) external factors impacting the NP credentialing process. Cross-case analysis revealed these differences among the sites. Employed NPs and those not employed by the ACHS enter the credentialing process at the same point at two of the study sites. The human resources department is the entry point for employed NPs at the third site, while NPs not employed by the ACHS enter through the medical staff office. The same two sites have implemented a nurse credentialing committee as the first review of the completed application. The third site did not have a nurse…