Tip: Distinguish between privileged and nonprivileged APPs during privileging and competence assessment
The mix of definitions of advance practice professionals (APP) often causes confusion in organizations and medical staffs as they determine which level of practitioners require privileges. Some organizations are unnecessarily offering privileges to practitioners that do not require them. In addition to the waste and inefficiency of resources in doing this, remember that you have a definitive obligation to certify competency for all privileges granted. Therefore, don’t grant privileges unless you have to.
Some of the pitfall terms that may exist in your organization might include an ill-defined "associate staff," "midlevel practitioners or staff," "specified professional staff," "clinical staff," or simply "allied health professional staff." Organizations that continue to use the term allied health professional staff are often privileging all practitioners brought into the organization by a physician regardless of level of clinical practice. If this is the case, your organization is doing unnecessary work and may actually be out of compliance with regulatory and accreditation standards. We have spent a fair amount of time trying to define what might constitute an APP. Equally important is to define what is not an APP. These would be classes of caregivers that do not require privileges and can function under a job description and competency determination through the HR department.
This second group of APPs that do not require privileges through the medical staff, but rather require competence assessment through a job description and HR standards, can be referred to as clinical assistants (CA). This term does not denote the level of advanced practice as given to the preceding group. Therefore, this group might be defined as individuals qualified by academic education and clinical experience or other training to provide patient care services in a clinical or supportive role. CAs provide services only under the supervision of a member of the medical staff. CAs provide only those clinical services that are consistent with a written scope of care approved by the medical staff and senior management of the hospital. CAs are not members of the medical staff and are not privileged through the medical staff.
Once again, the governing body periodically determines the categories of individuals eligible to serve as CAs. For example, an organization’s policy may be as simple as, “At this time, the disciplines included are surgical assistants, surgical technicians, RN first assistants, perfusionists, and dental technicians.” This short list recognizes that the most common CAs in most hospitals will be the individuals who assist at surgery, including RFNAs, surgical assistants, surgical technicians, certified operating room technicians, and so forth. That said, there are also many other CA disciplines that are common in organizations.
It is also important to standardize the terminology regarding the clinical activity allowed for nonprivileged APPs. Common terms used in the field are "scope of practice," "scope of care," "scope of services," "specified services," "duties and responsibilities," and "job description." Regardless of the terminology used, the organization must clearly understand the differences reflected in the language selected.