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

1. 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)

2. REGULATING PEOPLE AND PLACES credentialing examination accreditation licensure certification registration interstate compact

3. 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)

4. 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)

5. 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

6. Benefits of Accreditation • Facilitates access to a comparable standard on a state/national scope • Enhances community confidence • Fulfills state/federal requirements • Provides consideration used as a basis for determining eligibility for federal assistance

7. Benefits of Accreditation • State-of-the-art, professionally based standards • Evaluation of compliance against benchmarks • Symbol of quality that reflects commitment to meeting certain performance standards

8. 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

9. 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

10. 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

11. Limitations of AccreditationWhat 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

12. 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

13. 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

14. 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

15. 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

16. 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?

17. 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.

18. 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.

19. 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

20. 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)

21. Vision for Regulation in The 21st Century: A credential issued or accepted by the state of residence that is recognized nationally and enforced locally

22. 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?