An Alliance for Accreditation of Nursing Higher Education
As the AACN Task Force on Nursing Accreditation engaged in discussions to prepare its report and recommendations, a variety of questions emerged from individuals reviewing the task force's proposal to establish an alliance of multiple organizations to accredit nursing higher education programs. Answers to the most frequently asked questions follow.
What is the objective of accreditation?
Accreditation is a voluntary, privately managed process of peer evaluation of post-secondary education institutions and programs. Being accredited imparts to the public, potential students, educational institutions, government agencies, lenders, and others that the institution or program meets an established standard of quality. In order for students, programs, or institutions to be eligible for federal support under the Higher Education Act of 1965 or the Nurse Education Act (Title VIII of the Public Health Service Act), a program or institution must be accredited by an agency recognized by the U.S. Department of Education (DOE) and be recognized in the published list of accrediting agencies. Thus, accrediting agencies play a critically important role as gatekeepers for access to federal funds.
There are two types of accreditation: institutional (as performed by various regional agencies, and by the National League for Nursing (NLN) for schools, such as hospital diploma programs, not within a higher education institution), and specialized or programmatic (such as performed by NLN and specialty nursing organizations for nursing schools within higher education institutions).
All regional accrediting bodies have had, for a number of years, recognition status from the DOE. Baccalaureate and graduate-degree nursing programs already meet DOE criteria due to their position within regionally accredited institutions.
How is nursing education currently accredited?
A variety of organizations currently conduct specialized accreditation of nursing education, including the National League for Nursing (for all levels of nursing education, including practical, hospital diploma, as well as associate-, baccalaureate-, and master's-degree programs), the American Association of Nurse Anesthetists (for nurse anesthesia education), the American College of Nurse-Midwives (for pre-accreditation and accreditation of nurse-midwifery programs), and the American Nurses Association (for continuing education). In addition, programs in institutions of higher education are reviewed by regional accrediting agencies, as well as by state agencies such as boards of education or state boards of nursing charged with approval of nursing education programs.
Moreover, a variety of other nursing organizations have expressed interest in creating additional accreditation review processes for oversight of graduate-level nursing education, such as nurse practitioner programs.
Why was the alliance model chosen?
Several models were discussed and considered by the AACN Task Force on Nursing Accreditation in preparing its recommendations to the Association's membership. It was the panel's conclusion that an alliance model will provide the best vehicle to bring together the various groups involved in accreditation or standard setting for baccalaureate and graduate nursing education. In particular, an alliance model affords the opportunity to streamline accreditation for schools of nursing, eliminate redundancies, reduce overall costs to nursing schools, assure representation of specialty practice areas, and involve faculty from across all program and school types. The clear concerns of the higher education community that specialized accreditation is becoming burdensome and duplicative can be addressed through an alliance that brings together -- in a uniform and coordinated process -- the multiple interests that have a role in setting the standards for nursing education.
An alliance model will allow the development of common processes, common data sets, and commonly accepted standards and norms for education.
In addition, an alliance model is consistent with the current goals of the newly formed entity, the Council for Higher Education Accreditation, and its long-term expectations for the reform of specialized and regional accreditation.
Since institutions with baccalaureate and graduate programs already have regional accreditation, why is specialized accreditation necessary?
Regional agencies accredit only the overall institution -- the college or university -- not individual programs. Accreditation of specialized programs is a crucial level of review to assure the public and employers, among other stakeholders, of the quality of an educational program and its graduates.
How will AACN's structure and function be changed?
The proposal approved by AACN members calls for creation of a new alliance of multiple organizations. The mission, structure, and organization of AACN would not change.
However, to form a new entity for accreditation of baccalaureate and graduate nursing programs, possibly a subsidiary organization of AACN -- such as a council on accreditation -- may be needed as the AACN voice in the alliance. The primary mission of AACN is to develop and implement standards for baccalaureate and graduate nursing education and the alliance initiative furthers that goal.
Was the AACN proposal a response to the Department of Education's review of the accreditation authority of the National League for Nursing?
In June 1995, the National League for Nursing applied to DOE for renewal of its recognition to accredit practical, diploma, associate, baccalaureate, and graduate nursing programs. That application is currently under review by the Secretary of Education.
However, for a number of years, AACN's Board of Directors has received concerns from nursing educators and policymakers in higher education regarding the current processes in place for accreditation in general, and for nursing and other specialized accreditation in particular. Indeed, as early as 1989, the AACN Board of Directors commissioned a special report by staff on the issues surrounding specialized accreditation, and since that time, has continued to receive numerous requests for further investigation of accreditation issues.
In October 1995, as part of the Association's strategic plan, the Board established the AACN Task Force on Nursing Accreditation to explore the fiscal, professional, regulatory, and statutory aspects of specialized accreditation, and to present a report and recommendation to the membership on what role, if any, AACN should play in the accreditation of baccalaureate and graduate nursing programs. The task force evolved out of the need to respond to an array of growing concerns in nursing and higher education -- among them, the proliferation and lack of coordination of specialized accreditation within nursing and other professions, the rapidly expanding number of nurse practitioner education programs, and the increasing dissatisfaction of university and college presidents with the accreditation process as a whole.
During its deliberations, the task force remained apprised of the DOE review of the National League for Nursing's accreditation authority, and AACN will continue to closely monitor the review's status. However, regardless of the outcome of the DOE review, AACN will continue to pursue development of the new alliance and accreditation entity as an efficient and effective approach for the accreditation of baccalaureate and graduate nursing programs.
How will the alliance be implemented?
In its discussions, the AACN Task Force on Nursing Accreditation agreed that any new conceptualization of accreditation for the profession must include collaboration with specialty organizations in order to coordinate the review process, develop uniform standards, avoid redundancies, and decrease the costs that nursing programs incur during accreditation reviews.
AACN will assume the leadership in contacting other organizations involved in, or currently proposing to be involved in, the accreditation of specialty graduate programs in nursing for the purpose of exploring the creation of an alliance organization. A steering committee will be established to to determine what kinds of organizational structure, governance, and bylaws may be necessary. The specific roles, responsibilities, and financial expectations of each member organization will be determined. Each organization will need to obtain the approval and commitment of its own membership.
The alliance would be autonomous in conducting all aspects of its evaluation and accreditation affairs, including the establishment of standards, policies, and procedures, as well as selecting its own members, officers, committee members, evaluators, and consultants. The public interest also would be represented by elected public members.
How many programs will be accredited each year?
Discussions with expert consultants in other accrediting organizations indicate that, once the new AACN-established accreditation entity is fully operational, it could expect to review 75 schools of nursing each year. This would mean that it would take approximately 5-1/2 years for all current AACN-member schools to be reviewed.
Will the new AACN accrediting entity seek Department of Education approval?
The accreditation entity established by AACN will seek recognition as an accrediting authority through the U.S. Department of Education (DOE). However, eligibility for approval by the DOE will depend upon the ability of the entity to show that it serves a federal "gatekeeping" function to assure quality in nursing programs eligible for federal funding.
If the accreditation entity is deemed eligible to apply for DOE approval, it is anticipated that approval would be granted as this recognition has been granted to other accrediting bodies in nursing. At this time, for example, a number of nursing organizations have established recognition from DOE, including the American Association of Nurse Anesthetists, American College of Nurse-Midwives, and the National Association of Nurse Practitioners in Reproductive Health.
How will faculty be involved in the accreditation process?
Accreditation must assure a peer review process. Given that the curriculum is the responsibility of faculty, involvement of faculty in the new alliance would occur through a variety of mechanisms, including participation on standards committees, peer review teams, and appeals panels. The alliance will be structured to assure that the faculty role is central to the development of high-quality and well-defined criteria and processes for accreditation.
Why are associate-degree programs not included in the newly proposed alliance organization?
The mission of AACN is to advance the quality of baccalaureate and graduate-degree education in nursing, and it is with this objective that AACN is pursuing establishment of the alliance. However, there is every reason to expect that the newly created alliance would seek opportunities to consult and collaborate with associate-degree programs, particularly because of the need to maintain seamless bridge programs between associate- and higher-degree nursing education. Once an alliance is established, numerous organizational alternatives are possible.
Is the timetable realistic?
The AACN Task Force on Accreditation has consulted with an expert in accreditation of a health-related discipline who is knowledgeable about DOE criteria and the newly-created Council on Higher Education Accreditation. Although much work remains to be accomplished, it is reasonable to expect that accreditation services of baccalaureate and graduate-degree nursing programs through the AACN-established entity would be operational in 1998. Towards this goal, AACN will commit to the employment of a project director/consultant and will seek the involvement of member schools to identify appropriate faculty consultants to establish the various committees and standard-setting operations.
How will the alliance affect programs scheduled for accreditation by the National League for Nursing in the next two to three years?
AACN recognizes the concerns of institutions that are currently in a timeline for an upcoming accreditation review. Any new accreditation process must assist schools that have recently achieved accreditation, and those that would be seeking accreditation in the near future, to not incur a penalty as a result of the establishment of the new process. A variety of options are being explored. It is expected that programs in good standing would receive a grandfathered status to encourage early entry to the new alliance. Those institutions seeking membership in the alliance could submit a pre-accreditation application. A form of "pre-accreditation status" could be granted to those schools submitting the necessary documentation. Schedules for actual accreditation site visits will provide for a phased-in approach until all schools can be visited and reviewed in a timely and orderly manner.
How will work be organized to be completed within the projected time line?
A steering committee with several task forces will be appointed within the month following the AACN membership's approval of the alliance proposal. AACN's Board of Directors will move quickly to hire a full-time project director/consultant to oversee and coordinate the various start-up activities.
Last updated: November 6, 1996
CONTACT: Robert J. Rosseter
(202) 463-6930, x231