Institutional Privileging of the Nurse Practitioner for Advanced Procedural Skills In the Pediatric Critical Care Setting

This national cross-sectional descriptive survey examines how pediatric intensive care units' (PICUs) nurse practitioners (NPs) are currently assessed for competency and granted clinical privileges related to advanced procedural skills. The variations in credentialing of NPs can generate confusion for NPs and colleagues, potential liability for acute care institutions, and decreased focus on pertinent areas of education for advance practice nursing programs. Seventy PICU NPs were contacted to participate with 50% response rate to the online survey. The respondents were very experienced (50% with 5+ years' experience); most (86%) had acute care or dual certification. The majority of the responses indicated that PICU NP's are performing procedural skills at least 6 times annually and were required to apply for specific procedural privileges related to the skill. The most common method for skill competency was observation of skill (60%) and the mean number required was 5. Most respondents (74%) felt their current process was appropriate, but 60% supported the development of best practices for procedural skill competency. There was concern expressed about the ambiguous nature of the credentialing/privileging process and over regulation of NP practice. Only one respondent reported using simulation training as a measure of competency. The lack of simulation as a training tool for psychomotor skills was an unanticipated finding and deserves further study. This study increases the fount of knowledge about the current practice amongst institutional procedural privileging for NPs in the PICU. The findings may also have implications for all NPs performing procedures in any acute care setting.