@Eric_Eklund ,

Does your site natively inherit permissions for all the list and libraries? 

I would expect your statement to be true if your library is not inheriting permissions from the site itself. Otherwise, "Design" at the site level should be enough. The user would still need access to the list or library to see the workflows actions available there.

Here is the minimum permissions list needed for O365 https://help.nintex.com/en-US/o365/#o365/O365WorkFlow/Admin/Minimumpermissionsworkflow.htm

Thank you @eharris04,

Yes the site inherits permissions from the list.

According to the permissions link you posted users will need Full Control to publish so I will have to give this user full control because they will be publishing workflows.