Wondering where all of the nurses are? As our population ages and more providers leave the bedside and other patient care roles in COVID-19's wake, everyone is forced to face the reality of a nationwide shortage of nurses. It's a reality that isn’t expected to get better anytime soon.
Contract nurses are costly, but necessary
Hospitals and healthcare facilities have long turned to contract labor, including traveling nurses, to meet their needs for qualified nursing staff. But the pandemic affected even those organizations that previously had little trouble recruiting and retaining nurses. What was formerly an affordable temporary solution to handle high volumes of patients is becoming untenable cost-wise for most. In fact, contract travel nurses accounted for 23% of total nurse hours in January 2022 and nearly 40% of the labor expenses for nurses. The American Hospital Association cites data showing a 213% increase in hourly rates charged to hospitals by staffing companies for travel nurses in January 2022 compared to pre-pandemic levels in January 2019.
But that's not the only effect nurse contractors have had on hospitals' resources and financial health. Medical staff services departments (MSSD) face huge spikes in credentialing workloads to get those nurses up and running. Yet they too are experiencing staffing and resource issues, being forced to do more with less. For many, the answer has been delegated credentialing to a qualified credentials verification organization.
Regardless, credentialing is about patient safety, and clearly defined contract nurse credentialing policies and workflows help to ensure safety by validating that only competent providers are administering patient care. In addition to mitigating risk, an effective and comprehensive nurse credentialing process also helps track and manage requested privileges, link to ICD/CPT codes, and appropriately bill for services.
What is contract nurse credentialing?
Provider credentialing is focused on vetting physicians' and nurses’ backgrounds through primary source verification of facts and documents: licenses, education, references, certifications, and much more. Credentialing is a prerequisite to privileging, which assesses experiences and current competency levels to ensure a licensed independent practitioner is qualified for their role(s) and to practice in a hospital setting. Therefore, the terms credentialing and privileging are closely associated and often used together.
States set their own laws for nurse licensure and practice. On top of that, there is wide variability in the tasks nurses perform, and therefore differences in whether and how they are credentialed and/or privileged. For example, a certified nurse (CN) provides general patient care and works under registered nurses, while a registered nurse (RN) provides a higher level of patient care and coordination and works under a doctor. Each state has its own regulatory board for licensing nurses.
According to The Greeley Company, advance practice registered nurses (APRNs) (i.e., certified nurse-midwives, nurse practitioners, clinical nurse specialists, and nurse anesthetists) who "are providing a medical level of care and/or perform surgical procedures" are credentialed and privileged. The organization also notes that certain elements related to the privileging process must be applied regardless of whether the APRNs are employed by the organization. Both groups need to be credentialed and privileged in the same way that a physician employed or under contract with the hospital must be.
What are the ANA and ANCC?
The American Nurses Association (ANA) is the premier organization representing the interests of the nation's four million registered nurses. ANA, founded in 1896, is at the forefront of improving the quality of healthcare for all.
The American Nurses Credentialing Center (ANCC) is a subsidiary of the ANA. ANCC's internationally renowned credentialing programs certify and recognize individual nurses in specialty practice areas. ANCC recognizes healthcare organizations that promote nursing excellence and quality patient outcomes while providing safe, positive work environments. In addition, ANCC accredits healthcare organizations that provide and approve continuing nursing education and accredits transition to practice programs and prepares nurses for new practice roles.
Who credentials contract nurses?
Typically the contract company or locum tenens agency that a healthcare systems partners with conducts their own credentialing process for nurses, and in fact some are accredited like their hospital counterparts. However, it's best practice for hospitals to independently credential contract nurses for assignments at each new hospital. This is due to the fact that each facility has its own requisites.
For example, an agency won't be familiar with a healthcare organization's bylaws and medical staff policies and procedures regarding:
- What your hospital considers a red or pink flag when conducting primary source verification
- Which nurse types require privileges, whether temporary or not
- Organizational protocols about what tasks a contract nurse will perform
Further, no matter which party supplies the nursing resource, the hospital is ultimately responsible for that nurse's activities within their system. If contract nurses aren't vetted expertly through credentialing, hospitals are exposed to incredible risk. With so many temporary faces, it can quickly become a MSSD and/or HR nightmare ensuring each contractor meets the necessary nurse credentialing standards. In a worst case scenario, a contract nurse could harm or cause a patient's death and the hospital could be liable for negligent credentialing.
Nurse credentialing can get complicated quickly
Amid the increase in nurse contract companies in decades past, The Joint Commission created a certification program specifically designed to help hospitals identify staffing services which could provide qualified nursing contractors. Similarly, National Committee for Quality Assurance (NCQA) certification enables organizations to implement industry best practices for verifying practitioner credentials and demonstrate the quality of their services to clients.
Still, meeting the unique needs of each facility can be difficult because of the wide variations in procedures and quality requirements. This leads to a high need for each medical facility or hospital to create and enforce strict standardization of nurse contractor credentialing. Some facts about contract nurses include:
- Travel nurses have varying backgrounds and education levels: Some 47% of travel nurses have a bachelor’s degree, 38% having an associate’s degree, 7% have a master’s degree, and 5% have a diploma, demonstrating that travel nurses can accept short-term contracts without requiring long years of study.
- More than 50% of contract nurses remain in a position for less than a year, and 25% stay in it for one to two years. Most travel nurses only work with 13-week contracts, and they tend to jump from one role to another with breaks between contracts.
- Many hold nursing licenses in multiple states simultaneously, which can complicate the process of nurse credentialing and create an undue burden of verification on hospitals and medical facilities.
The future of contract nurse credentialing
For healthcare organizations that can afford the use of temporary nursing labor, the solution offers flexibility and customization to get through tough times. It can also optimize nurse-patient ratios, which can help strengthen nurse morale, improve safety, and support high-quality patient care. And it is these benefits that are driving facilities to take initiative by partnering with third-party services that take out the pains of nurse credentialing on their behalf.
Nurse credentialing solutions, such as those offered by symplr, oversee the complicated process of obtaining, verifying, and assessing the qualifications of nurses. By reviewing and documenting evidence of current licensure, education, training, and other qualifications, nurse credentialing services help remove the burden of processing from overworked HR departments, reduce liability and risk, and streamline the staffing process. If your facility is ready for a cost-effective way to gain the flexibility and benefits of supplementary staffing, without absorbing unnecessary safety liability and risk, then a third-party nurse credentialing service is your solution!