The ability of a healthcare provider to perform specific patient care services is governed by a rigorous system of authorization. This formal process, known as clinical privileging, has become a requirement for advanced nursing professionals who practice with a high degree of autonomy. Clinical privileges represent the institutional authorization that permits a nurse to deliver care, ensuring that every procedure performed within a facility meets standards of safety and quality. Understanding this requirement is fundamental for Advanced Practice Registered Nurses (APRNs) seeking to practice in hospitals and other organized healthcare settings, as it dictates the precise boundaries of their daily work. This article clarifies how clinical privileging for nurses is established, maintained, and enforced.
Defining Clinical Privileges for Nurses
Clinical privileges are the specific activities, procedures, and medical services that a healthcare organization permits a practitioner to perform. This authorization is granted only after a thorough review of the nurse’s competence, education, training, and experience within a particular specialty. Unlike a license, which is issued by a state board, privileges are facility-specific; a nurse must apply for and be granted privileges at every institution where they intend to practice. The scope of these authorized services is delineated by the facility’s governing body and medical staff bylaws to ensure patient safety and alignment with the institution’s available resources.
The process confirms that the nurse is not only legally authorized to practice but is also currently competent to perform complex procedures in that specific institutional setting. If the facility does not have the necessary equipment, staff, or support, the privilege for a procedure will not be granted, even if the nurse has the training. Clinical privileges represent a precise, location-based determination of a nurse’s practice authority. This authorization must be reviewed and renewed periodically to ensure ongoing adherence to the institution’s standards.
Clinical Privileges Versus Scope of Practice and Licensure
Clinical privileges are often confused with two other distinct professional requirements: licensure and scope of practice. Licensure is the foundational authorization granted by a state board of nursing, confirming that an individual has met the minimum competency requirements to practice as an RN or an APRN. This license grants the right to practice within a jurisdiction but does not specify what procedures can be performed in a single facility. It is the initial, mandatory step that allows a nurse to enter the profession.
Scope of practice is defined by state law and regulatory bodies, outlining the maximum permissible activities a nurse can legally perform based on their educational preparation and role. This legal framework establishes the outer limits of a nurse’s permissible actions, such as whether an APRN can independently prescribe controlled substances.
Clinical privileges, however, function as the practical, facility-level authorization, which may be narrower than the full scope of practice allowed by the state. A nurse’s scope of practice defines what they may do, while clinical privileges define what the facility authorizes them to do within its walls.
The facility’s privileging process acts as a localized filter on the broader state scope of practice. For example, a state may permit a Certified Registered Nurse Anesthetist (CRNA) to perform all types of regional anesthesia, but a small community hospital may only grant privileges for general anesthesia and moderate sedation due to limited resources. The nurse must always operate within the bounds of their state-defined scope of practice, but they are further restricted to the specific privileges granted by the institution where they are practicing. The distinction lies in the granting authority: the state grants the license and defines the scope, and the healthcare organization grants the privileges.
Which Nursing Roles Require Privileging
Formal clinical privileging is primarily required for Advanced Practice Registered Nurses (APRNs) and other nursing roles that function with significant independent autonomy. The four recognized APRN roles—Nurse Practitioners, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, and Clinical Nurse Specialists—almost universally require formal privileging in organized healthcare settings. These roles involve advanced clinical decision-making, diagnosis, treatment, and performance of procedures that necessitate institutional oversight. The institution must verify the advanced education and specialized certification that supports the requested level of practice.
The specific list of procedures and services an APRN is approved to perform is formally known as the Delineation of Privileges. This document is tailored to the individual, listing core privileges standard for the role and specific non-core privileges for specialized skills. Some non-APRN roles, such as the Registered Nurse First Assist (RNFA), may also require formal privileging. Conversely, the practice of standard Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) is generally covered by their job description and does not typically require the formal, individualized clinical privileging process.
The Formal Credentialing and Privileging Process
Obtaining clinical privileges is a multistep process that begins with credentialing, which verifies the nurse’s foundational qualifications.
Application Submission
The nurse provides an extensive packet of documents detailing their education, training, work history, and certifications. The application includes a written request for the specific privileges they wish to exercise. It also requires information on malpractice insurance, disciplinary actions, and a comprehensive list of procedures performed to demonstrate experience.
Verification of Credentials
This step, often called Primary Source Verification (PSV), requires the healthcare organization to contact original sources—such as the state board of nursing, educational institutions, and certification bodies—to directly confirm the validity of all licenses, degrees, and board certifications. This is a necessary step to confirm the integrity of the nurse’s professional background and ensure compliance with accrediting bodies like The Joint Commission.
Review, Recommendation, and Approval
A medical staff committee or a dedicated credentialing committee, which includes peer practitioners, reviews the verified information. The committee evaluates the nurse’s current competence for the requested privileges, assessing evidence of training and experience against the facility’s criteria for each specific procedure requested. The committee then forwards a recommendation regarding the granting of privileges to the facility’s leadership. The facility’s governing body, such as the hospital board of directors, makes the ultimate decision on whether to approve the committee’s recommendation.
Once privileges are granted, the nurse is subject to Monitoring and Reappointment. This ongoing evaluation involves Ongoing Professional Practice Evaluation (OPPE), where the facility systematically reviews the nurse’s clinical performance, outcomes, and procedure volumes. Clinical privileges are typically granted for a specific period, often two years, requiring the nurse to undergo a full reappointment process to demonstrate continued competence before renewal.
Institutional Oversight and Liability
The clinical privileging process is a tool for institutional oversight, linking a nurse’s practice to the healthcare facility’s responsibility for patient safety and quality of care. By vetting a nurse’s qualifications and limiting their practice to demonstrated competencies, the institution manages its legal and regulatory exposure. The facility’s governing body is ultimately accountable for the quality of care delivered, making the rigor of the privileging process a measure of its commitment to safe practice.
Regulatory compliance is a significant driver, with accrediting organizations setting stringent standards for credentialing and privileging. Clinical privileges are closely tied to the National Practitioner Data Bank (NPDB), a federal clearinghouse that flags practitioners with histories of adverse actions. Any denial or restriction of a nurse’s clinical privileges lasting more than 30 days and related to professional competence must be reported to the NPDB. This reporting emphasizes the seriousness of the privileging decision and reinforces accountability.