Credentialing, Accreditation, Certification, Registration, and Licensure: What does it all mean?

Donna Nowakowski, MS, RN

Associate Executive Director of Nursing National Council of State Boards of Nursing (NCSBN)

examinatio

n

credentialing

licensure

registration certification

accreditation

REGULATING PEOPLE

AND PLACES

interstate compact

So What Is Accreditation?

Recognition of an institution of learning as maintaining prescribed standards requisite for its graduates to gain admission to other reputable institutions of higher learning or to achieve credentials for professional practice . . . (American Heritage Dictionary)

Official authorization or status granted by an agency other than a state board of nursing. . . . (NCSBN)

More Definitions

Recognition of an agency, institution or program that a set of established standards has been met. Not used to identify a practitioner. (Schoon and Smith)

Ensure schools continuously examine, improve, report growth, achievement (BC)

Voluntary method of self-regulation (AEE)

Who Gets Accredited? Accreditation services are provided for the following types of organizations:

Health care facilities

Colleges, universities, educational programs

Certification programs

Examinations

Government agencies i.e. state insurance and banking authorities

Benefits of Accreditation

Facilitates access to a comparable standard on a state/national scope

Enhances community confidence

Fulfills state/federal requirementsProvides consideration used as a basis for determining eligibility for federal assistance

Benefits of Accreditation

State-of-the-art, professionally based standardsEvaluation of compliance against benchmarksSymbol of quality that reflects commitment to meeting certain performance standards

Benefits of Accreditation

Verifies institution or program meets established standards

Assists prospective clients identify acceptable institutions

Assists institutions in determining the acceptability of transfer credits

Establishes criteria for professional certification and licensure

Benefits of Accreditation

Identifies institutions and programs for payment, investment of funds

Creates goals for self-improvement Stimulates raising of standards

Involves staff in institutional evaluation and planning

Limitations of AccreditationWhat the Critics Say . . .

Voluntary, peer-reviewed process

Expensive (question cost/benefit ratio)

Erosion of federal/state oversight

Diminished public accountability

Lack of public access to meaningful information

Limitations of Accreditation What the Critics Say . . .

Flawed evaluation/survey protocols

Reviewer variability

Emphasis on structure/process rather than outcomes

Public limited in standard development and standard access

Lack of meaningful enforcement

Key Elements of Accreditation

Standard development, including field testing

Scoring and decision rules

Surveyor selection and education

Survey process

Report generation

Accreditation decisions

Public disclosure

Key Elements (Cont’d)

Appeal mechanisms

Public input

Progress report on deficiencies

Performance measures and data

Random audits

Ongoing compliance with standards

Critical event response

Regulatory Safeguards When Deeming Accreditors

Access to past, current, and future standards

Annual report (compliance)

Accredited institution data & information

Aggregate trend data

Periodic reapplication of deemed status

Regulatory Safeguards When Deeming Accreditors (Cont’d)

Random surveys/audits/evaluations

Complaint investigations

Consider baseline initial evaluation

Criteria for response to accreditation decisions

Maintain authority in statute, rule

Necessary Accreditation Questions

To what extent are goals met?

Are clients/students attaining desired outcomes?

Do you meet needs of all students, patients, clients?

Do standards guide practice?

What are your outcomes?

Accreditation of Health Care

Since 1965, Social Security Act provides that accredited hospitals are deemed to meet the requirements of Medicare conditions of participation i.e., These hospitals are not subject to routine State Agency surveys to assess compliance with Medicare CoPs.

Accreditation of Health Care

The Secretary can to survey accredited hospitals on a selective sample basis (random validation survey) To respond to allegations of complaints or significant deficiencies The Act requires an evaluation of the JCAHO accreditation process in an annual report to Congress.

Implementation Example: CLIA

Comparable inspections

Electronic data, reports

Notification of accreditation status and deficiencies

Informed of standards changes

Schedules provided for validations

6 year deemed status approval

How Boards of Nursing Use Accreditation

Nursing education program approval (10 states)Coordinates visits with accreditation agency (28 states)Serves as accreditor recognized by DoE (5 states)Required accreditation of certifying exam programs for APRNs (NCSBN)

Vision for Regulation in The 21st Century:

A credential issued or accepted by the state of residence that is recognized nationally and enforced locally

Future Questions????

Who will be the regulatory agent of accountability?Should processes of licensure, accreditation, credentialing, certification be linked in order to improve accountability?What are the assurances that accreditation works?