Hospital privileges specify which clinical activities a practitioner may perform at that hospital. For an APRN, they are a separate question from having an active state credential or accepting a job offer.
A useful application starts with the actual work proposed. Ask for the privilege request form and the relevant bylaws or policies early, so the responsibilities in the job description can be compared with the privileges being requested.
Understand the hospital's decision process
For hospitals subject to the federal medical-staff condition of participation, 42 CFR 482.22 permits eligible nonphysician practitioners to be included on the medical staff in accordance with state law and the governing body's determination.
The regulation also requires bylaws to contain criteria for granting individual privileges and a process for applying those criteria. It does not mean that every APRN automatically receives every privilege associated with a job title.
Ask the medical staff office how APRNs are categorized, who reviews requests and what approval is needed before clinical work begins.
Distinguish verification from permission
Credentialing examines qualifications. Privileging addresses the activities that may be performed.
HRSA's separate health-center framework illustrates the distinction: credential review includes verification of qualifications, while privilege review addresses current clinical competence and the services the practitioner may provide. That framework is a health-center example, not a substitute for hospital rules.
For a hospital application, find out which evidence supports each requested privilege. Depending on the request, ask whether the organization wants training records, references, documented experience or a supervised assessment.
Review the requested privilege list
Read each item rather than signing a broad list because it is commonly used in the department. Identify activities outside your preparation or recent practice and discuss them with the responsible clinical leader.
Ask how the hospital handles an activity that requires additional training. Clarify whether there is a defined supervised pathway and what evidence is needed before the privilege changes.
For privileges involving a particular patient group, compare the request with your APRN role and population preparation.
Confirm the sites and effective dates
A health system can include separately certified hospitals. Obtain confirmation of where your privileges apply and when they become effective.
Ask whether an outpatient location, another hospital or a remote service requires a separate process. Do not use an employee badge or access to the electronic record as evidence that every requested clinical activity has been approved.
Keep the final privilege notice, restrictions and renewal date with your professional records.
Plan for changes after appointment
Ask how competence is reviewed over time, how privileges are renewed and how a practitioner requests an additional activity. Learn the process for responding when a privilege is limited or questioned.
When changing jobs, maintain your own record of relevant education and experience. A new organization's review may require information that your former employer holds.
Coordinate this process with payer enrollment and state authorization. Each has its own purpose, responsible office and approval record.
Sources
- 42 CFR 482.22: Medical staff (accessed 2026-09-17).
- HRSA: Health Center Program clinical staffing (accessed 2026-09-17).