Credentialing for nurse practitioners: an update

Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services

The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs.

Reviewing and reflecting on practice: the midwives experiences of credentialling

RESEARCH QUESTION

What are the experiences of midwives working in midwifery-led models of care in NSW who undertake the credentialling process?

BACKGROUND

In 2005, the NSW Health Department issued a directive requiring midwives who worked in midwifery-led models of care to undergo a process known as credentialling. Credentialling involved a four-step process: self-assessment, face-to-face panel review of midwifery practice, assessment of emergency management skills and discussion of a case study from practice.

METHOD

A descriptive exploratory study examined the experiences of the midwives who undertook the credentialling process in NSW. Data were collected through in-depth, semi-structured interviews with 12 midwives who had experienced credentialling and analysed using descriptive and thematic analysis.

FINDINGS

The themes were preparing for credentialling; doing credentialling; achieving credentialling; valuing credentialling; and, improving credentialling. Initially, the midwives were self-focused in their understanding and impressions of the value of credentialling. There were a number of contentions including seeing credentialling as another 'hoop to jump through' or a need to 'tick the box' and not as a framework for practice. Some viewed it as a necessary move to increase professionalism and facilitate practice review. Others felt they were being unfairly targeted as not all midwives were expected to undertake it. The midwives were cognisant of the need for a process that encouraged responsibility for ongoing professional development and continuing competence and believed the process would be useful in promoting deeper reflection on practice.

IMPLICATIONS FOR PRACTICE

Credentialling was recognised as being valuable for all midwives to undertake as it encourages both a review of, and reflection on, practice. The process has further developed into Midwifery Practice Review (MPR) and is administered by the national professional association for midwifery.

Vascular neurology nurse practitioner provision of telemedicine consultations

Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP) in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS) scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2 +/- 9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0 +/- 9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.

Developing an advanced practice nursing credentialing model for acute care facilities

Credentialing of advanced practice registered nurses (APRNs) in acute care settings is an essential practice, but care must be taken to ensure that full utilization of the scope of practice and capacity of APRNs is attained. The process of credentialing and privileging involves the verification of required education, licensure, and certification to practice as an APRN along with the recognition of the scope of the individual APRN's practice based on training, education, and practice setting. Nursing administrators are challenged with ensuring that APRNs are credentialed and privileged and that appropriate mechanisms exist within the institution for promoting recognition of the scope of practice of APRNs. This article reviews concepts related to the process of credentialing and privileging for APRNs, with special considerations to acute care settings. Important considerations are highlighted to ensure that the credentialing process for APRNs promotes practice within their scope of practice.