Position Statement on Credentialing and Practice of Advanced Practice Registered Nurses

The intent of this position statement is to assert the importance of the credentialing process to demonstrate competence of the Advanced Practice Registered professional nurse (APN) while eliminating the burden that second licensure would impose. 

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 credentialing/re-credentialing system for professional nurses.
• A master’s degree appropriate in the specialty is required for entry into advanced practice.
• It is the legal and ethical responsibility of the advanced practice registered nurse to practice competently within the scope of nursing practice. 
• The credentialing process for basic and advanced nursing practice should be under the auspices of the State Education Department and the State Board for Nursing.
• The credentialing/re-credentialing process for advanced practice registered professional nurses must be cohesive, unified and include:  formal education, clinical practice, continuing education, certification and a means of validating competence. 
• For the validation of continued competence of the advanced practice of nurses, a coordinated re-credentialing system is the preferred methodology rather than development of a second licensure system within the profession. 

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 is an umbrella term, which is used to describe a licensed registered nurse prepared at the graduate degree level either as a Clinical Nurse Specialist, Nurse Anesthetist, Nurse-Midwife, or Nurse Practitioner.

  Advanced practice registered nurses are RNs who have acquired

  advanced specialized clinical knowledge and skills to provide

  healthcare.These nurses are expected to hold a master or doctorate

  degree. They build on the practice of registered nurse by demonstrating

  a greater depthand breadth of knowledge, a greater synthesis of data,

  increased complexity of skills and interventions, and significant role

  autonomy.  Aswithin all nursing practice, the level of expertise of the

  advanced practice registered nurse increases as they journey from

  novice toexpert (Brenner, 1982).

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” (JCAHO, 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. 

Professional nurses in advanced practice roles will be able to meet the health care needs of the public when mechanisms such as direct third party reimbursement for nursing services and appropriate practice privileges are secured.  Implementation of these mechanisms often relies on the credentialing process. 

Advanced Practice Nurses can meet actual and future care needs, both in hospital and primary care settings. In primary care, walk-in centers and nurse led clinics can provide an innovative solution by which to improve public access to healthcare (Salisbury & Marino, 2002). Research has demonstrated that APNs’ treatment of undiagnosed patients with undifferentiated health problems provides the same results as GPs treatment of such patients (Horrocks, Andersen, & Salisbury, 2002).  Furthermore, when APNs act as case managers for older people’s chronic health problems, unplanned admissions are reduced and compliance to care is improved (Huws, et. al, 2008).

Conclusion

Well-educated APNs who possess master clinical education and extensive work-experience, embrace a holistic and person-centered perspective and develop a trustful relationship with patients can provide quality, cost effective care with proven successful outcomes (Fagerström, 2012).

The New York State Nurses Association recommends:

• The advance practice registered nurse is involved in any future changes to the credentialing/re-credentialing criteria and process.
• The competency of advanced practice nurses is addressed through methods such as mandatory continuing education by the state or certifying body, national nursing and/or specialty certification, peer review, practice requirements and independent record review.
• The credentialing process is unified and cohesive, as well as cost effective and manageable.
• Opposition to second licensure for advanced practice registered nurses.

This position statement replaces:

Re-Credentialing of Advanced Practice Registered Nurses

Approved by the Board of Directors 1/18-19/95.

Reviewed and revised by the expanded Council on Nursing Practice on 8/13/04

Approved by the Board of Directors on 9/15/04

Reviewed and Revised March 7, 2018

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 

Brenner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407.

Fagerström, L. (January, 2012). The impact of advanced practice nursing in healthcare: Recipe for developing countries. Ann Neurosci. 19(1): 1–2

Horrocks, S., Anderson, E., Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ. 324:819–823

Huws, D. W., Cashmore, D., Newcombe, R., G., Roberts. C,, Vincent. J,, Elwyn, G. (2008). Impact of case management by advanced practice nurses in primary care on unplanned hospital admissions: a controlled intervention study. http://www.biomedcentral.com/1472–6963/8/115. BMC Health Services Research. 8:115.

Joint Commission on Accreditation of Heahcare Organizations. (2004). Automated comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: Author.

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

Salisbury, C., Munro, J. (January, 2002) Walk-in centres in primary care: a review of the international literature. British Journal of Gerenal Practice.53–59

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