Generally, CNMs and NPs are credentialed first as registered nurses and then as advanced practice nurses (in the CNM or NP role), whereas PAs have only one credentialing mechanism. APCs may be educated and also credentialed for practice with a population (e.g., primary care, women’s health) and/or a specialty (e.g., abortion care) focus.

The credentialing process is based on a set of essential elements that aligns government authority with regulatory and professional responsibilities. These essential elements of professional regulation and credentialing include the following:

While there is no uniform federal law that grants a professional license to practice, there are commonalities across states and each of the health professions. State legislatures and state licensing boards exercise legal authority in defining, enforcing, and advancing scope of practice for APCs. NP, CNM, and PA educators and professional organizations play a critical role in complementing state legislative and regulatory authority. State licensing boards rely on the professional organizations to assess and define professional practice, standards of practice (including ethical standards), and basic and advanced competencies that are the foundation for safe and effective care. State licensing boards may then codify these foundational elements for safe practice.

State licensing boards also look to state health-professional education and training programs to identify how practice standards and competencies are situated within the curriculum and clinical training. Furthermore, most state licensing boards have processes for determining how to incorporate practice advancement into existing regulations.

In all cases, the individual practitioner is accountable to the patient and the profession to practice according to legal/professional ethical standards and to adhere to professional performance criteria established and enforced by the regulatory and professional bodies.