Position Statement

Licensure and Credentialing of Advanced Practice Registered Nurses

The intent of this position statement is to assert the importance of the licensure and credentialing process, define the independent clinical practice and the competence assessment process for the Advanced Practice Registered Nurse (APRN).

Definitions

APRN Definition:

Completed an accredited graduate-level education program
Maintains continued advanced competence
Acquired advanced clinical knowledge and skills
Practice builds upon the RN competencies
Educationally prepared to assume responsibility and accountability for health promotion and/or maintenance and assessment, diagnosis, management of patient problems, including pharmacologic and non-pharmacologic interventions
Has sufficient clinical experience

Position

The following concepts constitute the New York State Nurses Association’s position on this issue:

The nursing profession must be integrally involved in the coordination and control of any licensure/credentialing/re-credentialing system for professional registered nurses (RNs).
RN licensure is required to practice as an APRN.
A master’s degree appropriate in the specialty is required for entry into advanced practice.
It is the legal and ethical responsibility of the APRN to practice competently within the scope of nursing practice.
The credentialing process for advanced nursing practice should be under the auspices of the State Education Department and the State Board for Nursing.
The APRN credentialing/re-credentialing process must be cohesive, unified and include: formal education, specialty clinical certification, continuing education, clinical practice experience, and a means of validating clinical competence.
A coordinated credentialing/re-credentialing system is the preferred methodology for the validation of continued clinical competence of the APRN

Background

Statutory, regulatory, and credentialing requirements are critical elements that affect advanced practice nurses in this dynamic healthcare climate. The challenge that faces the profession is to ensure public protection through balanced solutions, to prevent over regulation and burdensome requirements (CNS, 2003).

Advanced Practice Registered Nurse describes a licensed registered nurse prepared at the graduate degree level as a Clinical Nurse Specialist, Nurse Anesthetist, or Nurse Practitioner. APRNs have acquired advanced specialized clinical knowledge and skills to provide safe and effective healthcare.

Licensure is intended to protect the public from unsafe practitioners by determining and testing for a basic level of safety (CNS, 2003). Subsequently, after obtaining licensure a registered professional nurse has a legal and ethical commitment to perform competently within their scope of practice and ensure that all educational and practice requirements are met. It is a professional responsibility to engage in professional networking, peer review, utilization of standards of care and clinical practice guidelines, and the evaluation of outcomes of care.

Credentialing is the “process of obtaining, verifying and assessing the qualifications of a health care practitioner to provide patient care, treatment, and services in or for a health care organization” (TJC, 2004). The nursing profession must continue to address the development of specialty certification and advanced practice credentialing including re-credentialing. Re-credentialing of nurses in advanced practice roles is the process of validating the continuing competency of these professional nurses. It is an ongoing process which includes initial education, licensure, re-registration, advanced education, specialty certification and a commitment to lifelong learning and competence.

APRNs will be able to meet the complex health care needs of the public when effective, direct reimbursement mechanisms for APRN nursing services and appropriate autonomous practice privileges are secured. Implementation of these mechanisms relies on the licensure and credentialing process, and state, federal, and professional organization regulations.

Recommendations

The New York State Nurses Association recommends:

APRNs effectively participate in the development, review, and approval of future changes to the credentialing/re-credentialing criteria and process.
APRNs clinical competency be addressed through methods such as mandatory continuing education defined by the state and/or certifying body, national nursing and/or specialty certification; peer review; clinical practice requirements; and independent record review.
The credentialing and competence assessment process is unified, cohesive, and cost effective.
Second licensure for APRN practice will not be required.

This position statement replaces Re-Credentialing of Advanced Practice Registered Nurses.

Approved by the Board of Directors on January 18-19, 1995 , Reviewed and revised by the expanded Council on Nursing Practice on August 13, 2004, Approved by the Board of Directors on September 15, 2004, Reviewed/revised by Council on Nursing Practice December 18, 2009, Approved by the Board of Directors on January 13, 2010.

Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.

References

American Nurses Association. (2004). Nursing: Scope and standards of practice. Washington, DC: Author.

The Joint Commission. (2009). Automated comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: Author.

Regulatory credentialing of clinical nurse specialist. (2003). Clinical Nurse Specialist, 17(3), 163-169.

Sheehy, C. M., & McCarthy, M. (1998). Advance practice nursing: Emphasizing common roles. Philadelphia, PA: F.A. Davis Company.

For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.