Evidence-Based Review and Discussion Points.

Abstract

Across acute care settings, acute care nurse practitioners (ACNPs) provide care to acutely and critically ill patients. In accordance with reductions in residency hours for physicians, there has been a proportional growth in the numbers of ACNPs who are needed to provide health care to high acuity patients. Despite the prevalence of ACNPs, there has been limited exploration into how this cohort of advanced practice nurses are credentialed or privileged to perform invasive procedures.To gain insight on how credentialing and privileging of ACNPs occur across hospitals statewide, the authors contacted all of the hospitals in California. Medical credentialing coordinators were interviewed by telephone and asked 7 questions that included hospital and ACNP demographic characteristics, a description of the credentialing and privileging processes, as well as details on the invasive procedures performed by ACNPs.In total, the authors were able to gather data from 74% (n = 246) of all the hospitals in California. Of these participating hospitals, fewer than half (48%) employed ACNPs and the majority (60%) of hospitals that privileged ACNPs for invasive procedures were teaching hospitals. The results of this study highlight that credentialing and privileging of ACNPs for invasive procedures typically involves proctored observations by a supervising physician and the number of proctored observations varies by hospital and procedure.Fatmata Jalloh, acnp-bc, cns, ccrn, lead author on this EBR article provides additional information about the study. She says that the study was designed to answer the prevailing question, “How are ACNPs credentialed and privileged to perform invasive procedures across hospitals in California?”According to Jalloh, this study grew out of need to understand the best practices for credentialing and privileging ACNPs who are expected to perform invasive procedures on acutely or critically ill patients. “We were the first group of nurse practitioners at our hospital that requested the privilege of performing invasive procedures and the medical credentialing coordinator had difficulty deciding on what was needed to privilege an ACNP to independently perform these procedures,“ she says.Jalloh points out that initially calls were made to affiliate hospitals about the credentialing and privileging processes for ACNPs. However, the lack of standardization among these hospitals prompted her and coauthors to conduct a statewide investigation to gain insight on variations in the credentialing and privileging process among hospitals across California.Jalloh encourages readers of the American Journal of Critical Care to consider the quality and safety implications that result from a lack of standardization of the credentialing and privileging processes. She hopes that her research sheds light on the inconsistencies in the credentialing and privileging processes for ACNPs and highlights the urgency for an evidence-based framework to standardize these processes, which may enhance the quality of patient outcomes.The study findings confirm that credentialing and privileging ACNPs to perform invasive procedures varies by hospital and type of invasive procedure. Jalloh explains that it is important for standardization of credentialing and privileging process for ACNPs and other advanced practice nurses performing invasive procedures. “Doing an invasive procedure a couple of times does not necessarily make an ACNP proficient at performing the procedure,” she adds.This feature briefly describes the personal journey and background story of the EBR article’s investigators, discussing the circumstances that led them to undertake the line of inquiry represented in the research article featured in this issue.Fatmata Jalloh, acnp-bc, cns, ccrn, is an acute care nurse practitioner at the Keck Medical Center of the University of Southern California in Los Angeles, California. She has been a registered nurse for more than a decade and is a board-certified advanced practice nurse who specializes in cardiology, internal medicine, and critical care.This project grew out of a need to identify how local hospitals credentialed and privileged ACNPs to perform invasive procedures. “We subsequently decided to publish our work because we thought it might be useful to other advanced practice nurses and hospital administrators,” comments Jalloh. She notes that her research received an unanticipated positive response from several of the medical credentialing coordinators who were genuinely interested in using the results to inform modifications to their credentialing and privileging processes.Regarding challenges faced during research, Jalloh says, “The main lesson that I learned was to identify your team members at the beginning of the project rather than bringing them on board after initiating the study.” She says collaboration with advanced practice nurses, a graduate nursing student, a trauma surgery fellow, and her medical director provided the requisite clinical and research expertise to successfully carry out the study procedures and generate the data needed to answer her research question.