THE CENTER FOR NURSING EXCELLENCE 
1620 TREMONT STREET BOSTON, MA 02120
APPLICATION FOR PRIVILEGES
FOR FIRST TIME APPLICANTS
STATEMENT:
Professional nurses employed by outside agencies who wish to perform nursing activities* at Brigham and
Women’s Hospital (BWH) must apply for access to the hospital and receive authorization to practice granted
through the credentialing and privileging process.
OVERVIEW:
All RNs employed by outside agencies who wish to perform nursing activities* at Brigham and Women’s Hospital
no matter the setting must meet appointment requirements and qualifications for their specific job categories and
perform within the standards of nursing practice applicable to all nurses. Nursing credentials and standards of
nursing practice are determined in accordance with, but not limited to, the following established criteria: licensure
requirements by the Massachusetts Board of Registration in Nursing; scope of nursing practice as defined by the
Nurse Practice Act; nursing specialty certification standards; Joint Commission requirements for patient care;
approved protocols and practice guidelines specified in special privileges; departmental job/position descriptions;
and any other nursing standards required by the clinical discipline of nursing in carrying out its mission,
philosophy and objectives for the care of patients at the Brigham and Women’s Hospital.
PROCEDURE:
Qualified nurses who wish to practice nursing, or participate in clinical, administrative, educational and research
activities at BWH must submit documents for review by the Center for Nursing Excellence. Outside agencies who
employ RNs requesting access to the BWH may include, but are not limited to, affiliating schools and colleges of
nursing, non BWH physicians' offices, non BWH neighborhood health centers, community organizations, health
insurance/ payor organizations, home health care agencies, and institutions conducting research. It is the
responsibility of the employing agency to verify the credentials of the applicants they endorse for access to
BWH and to provide notification that it has conducted or has ensured that a “National County Background
Check” no more than one year prior to the date on which services are scheduled to begin and that these
background checks have returned “no record” results.
*Such activities may include, but are not limited to direct patient care, patient and family teaching, review of patient information and
medical records, assessment or interview of patients for any purpose, instruction and supervision of students in clinical areas,
participation in research, education and consultation, and performing any other nursing activities involving the patients and/ or their
families
REQUIREMENTS FOR APPLICATION AND REAPPLICATION:
All material listed below must be submitted with the completed application in order for the applicant to be
considered. The process of review and the granting of privileges will be delayed or may be denied if material is
missing. Please note that failure to submit reapplication material at least 6 weeks prior to expiration will
automatically terminate access to BWH.
1. Proof of current RN license in the Commonwealth of Massachusetts
2. Proof of current employment by the agency or organization with which BWH has a formal relationship and
endorsement by the employing agency or organization to practice or perform specific activities requested at
BWH.
3. Copy of current curriculum vitae (CV) or resume.
4. Copy of current BLS certification.
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5. Compliance with minimum health standards as required by BWH Employee Health Service, including
documentation of immunizations.
6. A copy of professional liability insurance coverage showing individual coverage limits of at least $1million. If
covered under a group policy, applicant’s name must be listed with an indication that the limits are
individually applied.
7. After obtaining computer access, applicants must complete Annual Compliance training in our learning
management online system, HealthStream.
8. Notification that a “National County Background Check” and equivalent criminal background checks in the
applicant’s state of residence have been done no more than one year to the date on which services are
requested to begin and have returned “no record” results.
9. Nurses employed by BWH or any Partners HealthCare facility who seek access as an employee of an outside
agency must not have disciplinary or performance issues in place or pending at the time of their application.
APPLICATION AND APPROVAL PROCEDURE:
1. The professional nurse will electronically submit the appropriate application (see descriptions below) for
nursing staff privileges to the Nursing Credentialing Team. Please note that to maintain privileges, the
“Application for Renewal of Privileges” must be approved yearly. Applications and materials can be obtained
from the Center for Nursing Excellence Website.
a) Credentialing And Staff Privileges For Professional Nurses Employed By Outside Agencies: This
is the original application that is completed by any individual wishing to obtain Nursing privileges at
Brigham and Women’s Hospital for the purposes of Nursing research, case management, School of
Nursing faculty or any other reason for needing to access patients or patient’s records. Approval is
granted by Nursing Leadership for the remainder of the current calendar year until the applicant’s
birthday on the following calendar year.
b) Application for Renewal Of Privileges: This is a one page application that is required to ensure
uninterrupted access to patient or patient’s records. It should be submitted 4weeks prior to the
applicants’ birthday annually. This is completed on the year following the original application approved
above (a).
c) Privileges Request for BWH Staff in the Role of Visiting Faculty: This is completed by any BWH
staff nurse who is also employed by a School of Nursing in the role of “Faculty Advisor” for Precepted
Students who are completing a practicum assignment.
d) Request For Building Access For Visiting Faculty: This is completed by College Faculty who are
teaching a didactic course on the BWH Campus and need access to a classroom.
2. The nurse and the employing agency will be notified regarding disposition of the request for privileges. A copy
of the application is kept on file in the Center for Nursing Excellence.
3. Privileges for faculty are granted contingent upon successful completion of Nursing Department Clinical
Instructor and unit-based orientation.
4. Initial privileges will be granted and active until applicants date of birth of the following calendar year.
5. The applicant will need to complete and submit an “Application for Renewal of Privileges” one month before
their birthday of the following year to remain active. Failure to timely submit a renewal application will
automatically terminate access to BWH. Application is available
http://www.brighamandwomens.org/Patients_Visitors/pcs/nursing/nursinged/
6. If the application is not approved or is pending, the applicant may not begin any activities at BWH until
approval of their application is granted.
7. Staff privileges will automatically be rescinded when a nurse terminates from his/her employing agency. The
agency is responsible for notifying The Center for Nursing Excellence and returning the BWH ID badge.
Should withdrawal of privileges be necessary at any other time, the nurse and agency will be notified in
writing.
8. If the professional nurse requires access to BWH for multiple agencies, an application for each agency must be
approved and current status must be maintained.
Updated June 23, 2015
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RESPONSIBILITIES OF APPLICANT:
While practicing at BWH, the nurse with access shall:
1. Practice within the scope of professional nursing as defined by the Massachusetts Board of Registration in
Nursing and in accordance with BWH-approved privileges and practice guidelines.
2. Adhere to BWH policies and standards of practice, including but not limited to patient confidentiality,
professional conduct, and safety practices.
3. Wear a BWH identification badge at all times when performing authorized functions while on hospital
premises.
4. Provide relevant patient information to BWH registered nurse assigned to the patient in a timely manner.
5. Inform the patient’s nurse when visiting the patient about the nature and purpose of the visit and the activities
to be performed. If the visit includes instruction, reinforcement of teaching, consultation, explanation of
procedures, research or anything related to ongoing nursing care, information must be shared with the nurse
caring for the patient and recorded in the patient's medical record.
6. Adhere to BWH policy, procedure and standards when providing and documenting care.
7. Request renewal of privileges at least thirty (30) days before expiration in order to ensure uninterrupted access.
Failure to meet or submit proof that annual mandatory requirements have been met will automatically
terminate access to BWH. http://www.brighamandwomens.org/Patients_Visitors/pcs/nursing/nursinged/
Instructions for Completing Application:
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Please be sure to type responses in gray shaded area, print, and obtain required signatures.
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When ALL documents are complete and ready for submission, you must arrange an appointment for
your application to be reviewed with:
Linda Evans, PhD, RN
Program Director
BWH Center for Nursing Excellence
617-525-7789 (levans3@partners.org)
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Be sure to electronically attach your Curriculum Vitae / Resume, and three professional letters of
reference.
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Please note: Incomplete applications will not be accepted. Application checklist can be found
on the next page.
Updated June 23, 2015
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INSTRUCTIONS
Please complete all items
APPLICATION CHECKLIST:
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Application: Submission of complete application is required. Incomplete applications or hand-written
applications cannot be processed. Please be sure to include:
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Copy of Malpractice Insurance Policy showing individual coverage limits of at least $1 million and
expiration date.
Current resume or CV
3 signed professional reference letters, if you are a BWH/Partners employee one must be from your
immediate supervisor.
A copy of a government issued photo ID (Click here for a list of acceptable IDs)
A copy of your current Massachusetts Nursing license
A copy of your current BLS certification
Confidentiality Form
Non- BWH Employees: Please fill out the following forms if you are not a current employee at Brigham and
Women’s Hospital. These forms are required in order to gain computer access.
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HealthCare Clearance Form signed by Health Care Provider-PLEASE DO NOT SEND YOUR
MEDICAL RECORDS
Clinical Students and Instructors POI Form
Attestation of Outside Employment
Clinical Instructor/ Faculty applicants only: If this is your first time as Faculty at BWH, you will be required
to schedule a Faculty Orientation. Please note that during orientation, all applicants must pass a Med/ Math Test.
Click here to view the Faculty Orientation dates. Please register for an orientation date by emailing
BWHNurisngCredentialing@partners.org. Upon completion of Faculty Orientation, Clinical Leadership on the
Unit will contact you directly to coordinate your clinical unit based orientation.
If you have any further questions please contact us at BWHNursingCredentialing@partners.org
Updated June 23, 2015