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An evaluation of nursing program administrator perspectives on national nursing education accreditation

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An evaluation of nursing program administrator perspectives on national nursing education accreditation

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Content Running head: NURSING EDUCATION ACCREDITATION 1

AN EVALUATION OF NURSING PROGRAM ADMINSTRATOR PERSPECTIVES ON
NATIONAL NURSING EDUCATION ACCREDITATION

By

Jill Kathryn Richardson

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

May 2015

Copyright 2015 Jill Kathryn Richardson
NURSING EDUCATION ACCREDITATION 2
Acknowledgements
I would like to acknowledge the following people for their guidance and support through the
dissertation process. First and foremost, I appreciate the overall research guidance from my
committee chair, Dr. Robert Keim, as well as his patience with my alpha-ness. I would like to
thank Dr. Patricia Tobey for walking a quantitative mind through the qualitative study design
and analysis process. I am very appreciative of Barbara Sinclair and Cathy Earl for their
emotional support and introductions to integral people in the nursing education field, for which
my data collection would not have been possible. Also, I am thankful for the contributions and
moral support of my thematic teammates and fellow USC Rossier School of Education
classmates throughout the past three years. Finally, I would like to thank my family and friends
who have continued to support me and my educational endeavors, despite many missed
engagements and drive-by meetings over the years. I would not have made it this far without
you, and, for that, I am eternally grateful.

NURSING EDUCATION ACCREDITATION 3
Table of Contents

Acknowledgements 2

Chapter One: Overview of the Study 6

Background of the Problem 6

Statement of the Problem 9

Purpose of the Study 10

Importance of the Study 10

Limitations 11

Definition of Terms 12

Organization of the Study 14

Chapter Two: Literature Review 16

Introduction 16

Accreditation: Definition, Process, and Purpose 17

Definition of Accreditation 17

History of Higher Education Accreditation in the U.S. 17

Early Institutional Accreditation 17

Regional Accreditation, 1885 to 1920 19

Regional Accreditation, 1920-1950 20

History of Accreditation 1950 to Present 21

Specialized Accreditation 24

The Effects of Accreditation 26

Trend toward Learning Assessment 27

Framework for Learning Assessment 27

Benefits of Accreditation on Learning 28

Organizational Effects of Accreditation 30

Future Assessment Recommendations 31

Challenges to Student Learning Outcomes 32

Organizational Learning Challenges 32

Lack of Faculty Buy-in 33

Lack of Institutional Investment 33

Difficulty with Integration into Local Practice 34

Outcome Equity 35

Tension between Improvement and Accountability 36

Challenges with Transparency 36

Costs of Accreditation 38

Critical Assessment of Accreditation 45

Alternatives to Accreditation 49

International Accreditation in Higher Education 53

The Current State and Future of Accreditation 56

Accreditation in Nursing Education 60

History of Nursing Accreditation 60

Comparison of the ACEN and CCNE 62

Measuring Student Learning Outcomes 64

The Role of State Boards of Nursing and Changes to U.S. Healthcare 64

NURSING EDUCATION ACCREDITATION 4
Conclusion 65

Chapter Three: Methodology 67

Sample and Population 67

Instrumentation 68

Data Collection 68

Data Analysis 69

Chapter Four: Results 70

Programs 70

Participants 70

Table 1: Institution Identifier, Type of Institution, Degrees Offered, and Accrediting
Agency of Participating Nursing Programs 71

Results 71

Observation One 72

Observation Two 80

Observation Three 85

Conclusion 88

Chapter Five: Conclusions 90

Summary of Findings 90

Finding One 90

Finding Two 91

Finding Three 92

Limitations 93

Implications for Practice 94

Future Research 95

Conclusion 95

References 97

Appendix A: Interview Protocol Example 123

Appendix B: Interview Questions 124

Appendix C: Commission on Collegiate Nursing Education (CCNE) Standards 125

Appendix D: Accreditation Commission for Education in Nursing (ACEN) Standards 128

NURSING EDUCATION ACCREDITATION 5
Abstract

This study evaluates nursing school administrator perspectives on national nursing education
accreditation and their quality standards, such as first-time National Council Licensing Exam for
Registered Nurses (NCLEX-RN) pass rates. The purpose of this study was to explore California
nursing school opinions of the Commission on Collegiate Nursing Education (CCNE) and/or the
Accreditation Commission for Education in Nursing (ACEN) accreditation requirements, first-
time NCLEX-RN pass rates, in particular. These perspectives were obtained through a
qualitative, narrative study design using open-ended, structured interviews of six nursing school
administrators from programs located in California. Three surprising observations were made
from the interviews: all six agreed that accreditation was a positive thing; all six agreed that the
NCLEX is necessary and the only accurate measurement of entry-level nursing skills; and all six
programs had differing opinions and levels of knowledge about the third and new accrediting
agency. This study found that nursing administrators believed that accreditation is important for
nursing education, that the first-time NCLEX pass rates may not be the most accurate measure of
program quality, and there were varying opinions about the new, third nursing education
accrediting body. The implications of this study are that there maybe support for mandatory,
national accreditation; there are areas for improvement in the accreditation process; and there
should be a re-evaluation of first-time NCLEX pass rates used as an accreditation standard. The
study concluded that, overall, administrators are content with their nursing education
accreditation and the accreditors are successful in helping ensure a quality nursing education.

NURSING EDUCATION ACCREDITATION 6
CHAPTER ONE: OVERVIEW OF THE STUDY
Accreditation in the United States is a voluntary system of external, non-governmental
assessments developed to evaluate colleges, universities, and specialized programs for quality
assurance and quality improvement (Eaton, 2012). While it has historically been an autonomous,
non-governmental process, it has increasingly come under a great deal of scrutiny by the federal
government over the past several years. A belief that many college and university graduates are
not acquiring the skills necessary for the demands of the U.S. workforce (i.e., writing and critical
thinking) have led many to blame the accreditors for not holding institutions accountable for
successfully meeting student learning outcomes (American Council of Trustees and Alumni,
2007; Commission on the Future of Higher Education, 2006). This is particularly concerning in
specialized healthcare programs, such as nursing, where well-developed critical thinking skills
by nursing school graduates are necessary to protect the public’s health (Facione & Facione,
1994; Giddens & Gloekner, 2005).
This study will provide a general overview of U.S. regional accreditation and its role in
student learning outcomes. It will also specifically review nursing program administrators’
opinions of national nursing education accreditation and their quality standards.
Background of the Problem
In the 1980s, there began a shift toward assessment and accountability in higher education.
Concerns had emerged within the business sector that undergraduate students were academically
underprepared and lacked writing, critical thinking, and teamwork skills (Ewell, 2001). In 1991,
the U.S. Department of Education (USDOE) released a report – National Education Goals for
the Year 2000 – with one of the goals that colleges and universities be able to assess students’
communication, critical thinking, and problem solving skills (National Education Research
NURSING EDUCATION ACCREDITATION 7
Group, 1991). As a result, institutions of higher education began focusing more on assessment of
student learning outcomes as a measure of academic quality (Beno, 2004). This shift and
continued proliferation of learning assessments were driven primarily by the regional accrediting
agencies and not by governmental forces (Ikenberry & Kuh, 2008; Rhodes, 2012). Moreover,
assessment of student achievement and academic quality continues to be primary foci of regional
accreditation today (CHEA, 2012).
During the same time period, this shift toward assessment of learning outcomes was also
seen in specialized programs, such as nursing. The one nursing education accrediting agency at
the time – National League for Nursing (NLN) – emphasized critical thinking as one of the most
important skills for professional nurses (Facione & Facione, 1994). Critical thinking in nursing
was defined as “decisive, self-regulated judgment that promotes a forum in which to address
clinical and professional nursing issues in an effective method” (Facione, 1990, p. 3). In response
to the new standards created by the NLN, nursing education programs began to revise their
curricula to focus more on “what students learn and how students actively participate in the
teaching-learning process to achieve expected learning outcomes” (CCNE, 2009, p. 11).
Over the past few decades, there have been several exams created to measure critical
thinking skills. Some of theses exams included the California Critical Thinking Skills Test, the
Watson-Glaser Critical Thinking Appraisal, the Cornell Critical Thinking Test, and the Ennis-
Weir Critical Thinking Essay Test (Facione & Facione, 1994; Romeo, 2010). However, none of
these exams are currently used by either of the nursing education accrediting agencies –
Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate
Nursing Education (CCNE) – to measure student learning outcomes. The one exam that both
agencies do use to assess program quality and student learning outcomes is the National Council
NURSING EDUCATION ACCREDITATION 8
Licensure Examination (NCLEX) (ACEN, 2013b; CCNE, 2013). The NCLEX exam is
“designed to test knowledge, skills and abilities essential to the safe and effective practice of
nursing at the entry level” (National Council of State Boards of Nursing, 2014, p. 2). Though
this exam is not designed for curriculum assessment, the exam measures nursing competencies
obtained while in a training program and, therefore, indirectly measures the quality of that
training program (Morrison, 2005). In addition, because the National Council of State Boards of
Nursing (NCSBN) – the body that oversees the content of the NCLEX exam, with no influence
from either accrediting agency – considers critical thinking an essential component of nursing
education, it can be inferred that critical thinking is tested on the exam (Giddens & Gloekner,
2005). Therefore, passing the NCLEX requires a high level of critical thinking in order to
successfully answer the scenario-based questions (Wendt, 2003; Wendt & Brown, 2000).
Though the accreditors have multiple standards for assessing the quality of nursing education
programs, NCLEX pass rates have become the “gold standard” in defining program quality
(Giddens, 2009, p. 1). In addition to meeting accreditor and state boards of nursing minimum
standards, NCLEX pass rates have become “high stakes,” as they can impact the ability of
nursing programs to qualify for state funding, grants, and private donations (Giddens, 2009, p.
1). Furthermore, multiple years of low pass rates by a nursing program can lead to corrective
action or loss accreditation. For example, the State of Indiana states that a nursing program
whose NCLEX pass rates fall below the national average by one standard deviation for three
consecutive years is subject to corrective action, and failure to increase the pass rates may lead to
loss of accreditation (Indiana Professional Licensing Agency, n.d.). Plus, states like California
and Texas have similar consequences for programs that have NCLEX pass rates below 75% or
NURSING EDUCATION ACCREDITATION 9
80%, respectively, for three consecutive years (California Code of Regulations, n.d.; Texas
Administrative Code, n.d.).
The use of NCLEX pass rates as a student learning outcome measurement is critical to
nursing programs, not only for their reputation’s sake, but also for maintaining their
accreditation. However, the NCLEX pass rate is just one component of many accreditation
standards, which also includes completion rates, employment rates, program outcomes, faculty
outcomes, and clear on-going improvement efforts, and these other standards can also impact the
accreditation status of a nursing program.
Due to the emphasis placed on the NCLEX and other accreditation standards for maintaining
program viability, this study will explore nursing program administrators’ perspectives on the
nursing education accrediting agencies and meeting their standards, particularly the NCLEX.
Statement of the Problem
Meeting the minimum standard for NCLEX pass rates is a constant stressor for programs of
nursing. As a consequence, the nursing education literature has several articles that include
predictors of success or failure on the exam or in nursing school (Breckenridge, Wolf, &
Roszkowski, 2012; McGahee, Gramling, & Reid, 2010; Penprase & Harris, 2013; Romeo, 2010;
Romeo, 2013), remediation programs (Horton, Polek, & Hardie, 2012; Norton, Relf, Cox,
Farley, Lachat, Tucker, & Murray, 2006; Pennington & Spurlock, 2010), and changes in
admission criteria (Jones-Schenk & Harper, 2014; Schmidt & MacWilliams, 2011; Shaffer &
McCabe, 2013). However, there is a dearth of information on the role accreditors play in
ensuring students receive a quality education that will prepare them for success on the NCLEX
exam. As Norton, et al. (2006) stated, “Programs are challenged to develop strategies that will
secure successful NCLEX-RN outcomes” (p. 323), the accreditors are not challenged.
NURSING EDUCATION ACCREDITATION 10
Accreditors tend to be more focused on the process rather than specific learning outcomes
(Ewell, 2005).
Nursing education accreditors evaluate more than just NCLEX pass rates when they review
nursing programs. The accreditors also review how programs meet their governing body’s
mission; how the curriculum meets the campus’s mission, as well as, the standards set by the
nursing profession; whether they have adequate numbers of faculty and staff to run a successful
program; whether the governing body provides enough resources for the program to remain
viable; and how well programs assess their learning outcomes (i.e., NCLEX pass rates, among
other means) (ACEN, 2013b; CCNE, 2013). How programs meet these categories (and
subcategories) affects their standing with the accrediting agency and may also relate to success
or failure on the NCLEX exam.
Thus, the specific problem being explored in this study is whether nursing program
administrators feel the accrediting bodies and their standards, such as the NCLEX, are necessary
and/or accurately measuring their program’s educational quality.
Purpose of the Study
The purpose of this study is to explore California nursing school administrators’ perspectives
on CCNE and ACEN and their accreditation requirements, such as the NCLEX, in particular.
The evaluation will attempt to answer the following research question about nursing program
accreditation: Are there any common themes in the opinions of nursing school administrators
regarding CCNE or ACEN accreditation and their quality standards?
Importance of the Study
Consistently low NCLEX pass rates can be grounds for a nursing program to receive
corrective action by their state’s BRN or lose national accreditation altogether. In addition to
NURSING EDUCATION ACCREDITATION 11
this, maintaining high NCLEX pass rates also has a societal impact. Though the need for new
nurses leveled off in the wake of the recession starting in 2008, hiring is projected to pick up
again as the economy recovers and older nurses begin to retire; thus, the U.S. will need to
increase the nursing workforce by 20% per decade to meet the projected demand in 2030
(Auerbach, Staiger, Muench, & Buerhaus, 2013). Also expected to drive this demand are
changes in healthcare delivery as a result of the Affordable Care Act (Auerbach, Staiger,
Muench, & Buerhaus, 2013). Greater numbers of insured U.S. citizens and an expansion of
nurse-managed healthcare centers may increase the need for more nurses (Auerbach, Staiger,
Muench, & Buerhaus, 2013). Moreover, the Institute of Medicine (2010) recommended an
increase in baccalaureate-prepared (or higher) nurses from 50% to 80% of the nursing workforce
(currently dominated by associate degree-prepared nurses) by 2020.
If nursing programs and their accreditors are not successful at training students capable of
passing the NCLEX on the first attempt, they may not be meeting the nursing employment
demands of the communities in which these institutions serve. Therefore, ensuring quality
nursing programs with high NCLEX pass rates is important to guarantee nursing programs
remain open and accredited so they may continue to enroll more students, as well as meet the
demands for the growing nursing workforce.
Limitations
With regards to the sample used in the present study, selection of nursing program
administrators was dependent on those known to the researcher or introduced by someone known
to the researcher and willing to be interviewed, and thus, there may be some inherent selection
bias in the population sample that will limit the findings of this study. In addition, nursing
programs are reassessed by the accrediting agencies approximately every 10 years, so depending
NURSING EDUCATION ACCREDITATION 12
on where a program is in the cycle, it might influence an administrator’s opinion of accreditation.
For example, if a program is currently in the process of developing their self-study report, they
may feel more negatively or positively about the process than a program that is three years out
from a review.
Definition of Terms
Accreditation: A quality review process conducted by professional peers whereby an
institution or program is evaluated to determine whether it has a minimum level of academic
quality.
Accreditation Commission for Education in Nursing (ACEN): One of two specialized
accrediting bodies responsible for reviewing nursing education that offers both postsecondary
and higher degree programs. The agency was called the National League for Nursing
Accreditation Commission from 1997 to 2013, when it was renamed the ACEN.
Affordable Care Act: A law signed by President Obama in 2010 to reform healthcare
insurance industry as a means of increasing access to and affordability of health insurance and
preventive care in the U.S.
Benefits of accreditation: The advantages an institution gains by being accredited.
California Board of Registered Nursing (BRN): A state governmental agency created by law
to protect the public by overseeing the practice of registered nurses. The BRN is responsible for
enforcing and implementing the Nursing Practice Act.
Commission on Collegiate Nursing Education (CCNE): One of two specialized accrediting
bodies responsible for evaluating baccalaureate and graduate-level nursing programs, only.
Cost of accreditation: The institutional commitment in terms of budgetary spending (direct
costs) and time contributed (indirect costs) by the various campus constituencies to the
NURSING EDUCATION ACCREDITATION 13
accreditation effort.
Council for Higher Education Accreditation (CHEA): The national body coordinating efforts
for accreditation that reviews the effectiveness of accrediting bodies, both regional and
programmatic, and primarily assures the academic quality and improvement within institutions.
Gatekeeper: The role of accreditation with respect to federal funding; in order for an
institution or program to qualify for the receipt of federal funds it must be accredited by a
recognized institution.
National Council Licensure Exam (NCLEX): The national exam required by nursing program
graduates who wish to practice as a registered nurse. The exam tests the knowledge, skills, and
abilities essential to the safe and effective practice of nursing at the entry level.
National Council of State Boards of Nursing (NCSBN): The national organization that
oversees and coordinates each of the state boards of nursing. In addition, they oversee the
NCLEX exam and its question content.
National League for Nursing (NLN): The first and only accrediting body for nursing
education until 1997, when it created a separate accrediting agency, the NLN Accrediting
Commission (NLNAC). In 2013, the NLNAC was renamed the Accreditation Commission for
Education in Nursing (ACEN).
Nursing Practice Act. A California law that requires the Board of Registered Nursing to
determine the scope of practice and responsibilities of registered nurses in the state of California.
Peer Review: The concept governing accreditation whereby the actual review of the self-
study is conducted by knowledgeable professionals from like institutions in order to root the
decision in legitimacy and credibility.
Regional accreditation: Quality review at the institutional level conducted on a regional
NURSING EDUCATION ACCREDITATION 14
scope rather than on a national or state scope.
Self-study: A comprehensive review, usually lasting approximately a year and a half to two
years, resulting in a culminating document that considers every aspect of an institution or
program’s operation in order to determine whether it has adequate resources at all levels to fulfill
its clearly defined mission.
Site visit: Generally a two to three day period in which knowledgeable professionals from
peer institutions visit an institution after reviewing its self-study to ascertain the accuracy of the
self-study and identify any concerns; subsequent to the site visit the visiting team makes an
accreditation recommendation to the accrediting body after which the accrediting body
announces a formal decision.
Specialized accreditation (or programmatic accreditation): Recognition of a minimum level
of adequate quality at the level of the individual program of study without respect to the rest of
the institution as a whole.
U.S. Department of Education (USDOE): The arm of the federal government concerned with
educational quality and access nationally.
Voluntary association: An organization in which membership is optional; accrediting bodies
began as voluntary associations and, strictly speaking, continue to be so classified, however
because eligibility for federal funding is tied to accreditation many professionals question
whether accreditation is truly voluntary.
Organization of the Study
This study will include five chapters. Chapter One covers the background, statement of the
problem, the problem’s importance, as well as definitions of key terms. Chapter Two includes a
background of the literature covering U.S. regional accreditation, in addition to nursing
NURSING EDUCATION ACCREDITATION 15
education accreditation. Chapter Three includes a description of the sample population, the
research methodology, and data analysis techniques for this study. Chapter Four will discuss the
results of the data analysis and insights gleaned from the findings. Chapter Five will include a
summary of the findings, implications for practice, and possible future research.
NURSING EDUCATION ACCREDITATION 16
CHAPTER TWO: LITERATURE REVIEW
This chapter was written in collaboration with the following authors: Jill Richardson
1
,
Jennifer Barczykowski
2
, Nathan Barlow
3
, Rufus Cayetano
4
, Benedict Dimapindan
5
, Deborah
Kinley
6
, Richard May
7
, Dinesh Payroda
8
, Win Shih
9
, and Kristopher Tesoro
10
.
Introduction
Accreditation of higher education in the United States has historically been an autonomous,
non-governmental process; however, it has increasingly come under a great deal of scrutiny by
the federal government over the past several years. A belief that many college and university
graduates are not acquiring the skills necessary for the demands of the U.S. workforce (i.e.,
writing and critical thinking), have led many to blame the accreditors for not holding institutions
accountable for successfully meeting student learning outcomes (American Council of Trustees
and Alumni, 2007; Commission on the Future of Higher Education, 2006). This chapter will
review the literature covering higher education accreditation in the U.S., as well as abroad. The
goal of this section is to provide a general understanding of accreditation and context to its role
in ensuring student learning outcomes.
This chapter will also cover a breadth of information regarding higher education
accreditation to provide a general overview. The topics covered will include the definition of

1
Introduction; The Current State and Future of Accreditation; Accreditation in Nursing Education; Conclusion
2
Costs of Accreditation
3
History of Higher Education Accreditation in the U.S. (1885-1950)
4
Accreditation: Definition, Process, and Purpose; History of Higher Education Accreditation in the U.S. (1950 to
2
Costs of Accreditation
3
History of Higher Education Accreditation in the U.S. (1885-1950)
4
Accreditation: Definition, Process, and Purpose; History of Higher Education Accreditation in the U.S. (1950 to
Present)
5
The Effects of Accreditation
6
Critical Assessment of Accreditation
7
International Accreditation in Higher Education
8
Specialized Accreditation
9
The Effects of Accreditation
10
Alternatives to Accreditation
NURSING EDUCATION ACCREDITATION 17
accreditation and a description of the process; a history of accreditation from the 1600s until the
present time; an overview of specialized, or programmatic, accreditation; the effects of
accreditation on higher education; the costs associated with the accreditation process; criticisms
and potential alternatives to accreditation; a comparison of how accreditation is conducted
internationally; and the current state and potential future for accreditation in the U.S. Finally, the
chapter will conclude with an overview of accreditation in nursing education, including its
history in the U.S., a comparison of the current accrediting agencies, the use of the national
licensing exam as a student learning outcomes, and the role of the state boards of registered
nursing in the context of a rapidly changing healthcare system.
Accreditation: Definition, Process, and Purpose
Definition of Accreditation
Accreditation in the United States is a voluntary system of external, non-governmental
assessments developed to evaluate colleges, universities, and specialized programs for quality
assurance and quality improvement (Eaton, 2012). This definition is unique to the U.S. higher
education system, as most international systems are involuntary and government-run
(Brittingham, 2009; WASC, n.d.). However, many question the use of the descriptive
“voluntary,” since accreditation is required for any institution hoping to receive federal financial
aid (Higher Education Act, Title IV funds), and thus, is essentially an involuntary process
(American Council of Trustees and Alumni, 2007; Dill, 1998; Leef & Burris, 2002; Middaugh,
2012; Orlans, 1975).
History of Higher Education Accreditation in the U.S.
Early Institutional Accreditation
Accreditation has a long parentage among the universities and colleges of the U.S. dating
NURSING EDUCATION ACCREDITATION 18
back to the self-initiated external review of Harvard University in 1642. This external review,
performed only six years after Harvard’s founding, was intended to ascertain curricular rigor by
peers from universities in Great Britain and Europe (Brittingham, 2009; Davenport, 2000). This
type of self-study was not only the first example of peer-review in America, but also highlighted
the need for self and peer regulation in the U.S. educational system, since there was no federal
government regulation. This lack of federal government intervention in the evaluation process of
educational institutions was a primary impetus for the development of a more formal
accreditation process in U.S. higher education (Brittingham, 2009).
Though historically the federal government has not directly accredited educational
institutions, the first example of an accrediting body was through a state government. In 1784,
the state of New York established the New York Board of Regents, which was the first
regionally organized accrediting organization styled around the European ministry (Orlans,
1975). The NY Board was the first organization to define what a college is (Nevins, 1959) and
also created a set of standards required by each college or university, if they hoped to receive
state financial aid (Blauch, 1959).
In 1892, the president of Harvard University, Charles W. Eliot, organized and chaired the
Committee of Ten, which was an alliance formed among educators – comprised mostly of 100
college and university presidents – seeking standardization of educational philosophies and
practices in the U.S. through a system of peer approval (Davis, 1945; Shaw, 1993).
Additionally, around this same time period, various associations and foundations began
accrediting institutions of U.S. higher education with their own set of standards. For example,
the American Association of University Women, the Carnegie Foundation, and the Association
of American Universities would, for a variety of reasons, such as gender equality and
NURSING EDUCATION ACCREDITATION 19
professorial benefits, evaluate institutions and generate lists of approved or accredited schools
(Harcleroad, 1980; Nevins, 1959; Orlans, 1975). These associations were responding to the
desire of their member institutions to have accurate information regarding the quality of the
different colleges and universities (Orlans, 1975; Shaw, 1993).
Regional Accreditation, 1885 to 1920
When the above associations declined to broaden or continue their accrediting practices,
individual institutions began uniting together to form regional accrediting bodies that assessed
secondary schools’ adequacy of college preparation (Brittingham, 2009). Colleges were, in
turn, measured by the quality of the students they admitted based on standards at the secondary
school level and measured by the accrediting agency (Brittingham, 2009). The regional
accrediting agencies also began creating a list of approved colleges that were considered quality
destinations for graduating seniors. If institutions were members of an accrediting agency, they
were considered true colleges, while non-member institutions were not (Blauch, 1959; Davis,
1932; Ewell, 2008; Orlans, 1974; Shaw, 1993).
Regional accrediting bodies were formed in the years that followed: the New England
Association of Schools and Colleges (NEASC) in 1885; the Middle States Association of
Colleges and Secondary Schools (MSCSS) and Middle States Commission on Higher Education
(MSCHE) in 1887; the North Central Association of Colleges and Schools (NCA) and the
Southern Association of Colleges and Schools (SACS) in 1895; the Northwest Commission on
Colleges and Universities (NWCCU) in 1917; and the Western Association of Schools and
Colleges (WASC) in 1924 (Brittingham, 2009). These regional accrediting associations began
creating instruments that established unity and standardization of college entrance requirements
and college academic standards (Blauch 1959). For example, in 1901 MSCHE and MSCSS
NURSING EDUCATION ACCREDITATION 20
created the College Entrance Examination Board to standardize college entrance requirements,
and in 1909, the NCA published the first set of higher education standards (Brittingham, 2009).
Although there were functioning regional accreditation bodies in most of the states, in 1910,
the U.S. Department of Education (USDOE) created its own national list of recognized
(accredited) colleges (Blauch, 1959; Ewell, 2008; Orlans, 1975). President William Taft blocked
the publishing of the list, and the USDOE discontinued accrediting schools because of the
pressure to keep the federal government from controlling higher education directly (Blauch,
1959; Ewell, 2008; Orlans, 1975). Instead, the USDOE reestablished itself as a data repository
and comparison resource for the regional accrediting bodies (Blauch, 1959; Ewell, 2008; Orlans,
1975).
Regional Accreditation, 1920-1950
With the regional accrediting bodies in place, the ideas of what an accredited college was
became more disparate. Due to differences in school types and institutional purposes, the need
arose to apply more qualitative measures of outcomes and a focus on optimal rather than
minimum standards (Brittingham, 2009). In addition, the regional organizations began to
measure success (and, therefore, grant accreditation) on whether an institution met the standards
outlined in its own mission, rather than a predetermined set of criteria (Brittingham, 2009).
Accreditation later became a requirement for all member institutions, with self-studies and peer-
reviews undertaken by volunteers from the other member institutions (Ewell, 2008).
The legitimacy of the accrediting bodies’ ability to accredit a college or not began to be
challenged. For instance, the landmark 1938 Langer Case maintained the standing of accrediting
bodies in the U.S. when Governor William Langer of North Dakota lost his legal challenge of the
NCA’s denial of accreditation to North Dakota Agricultural College (Ewell, 2008). This ruling
NURSING EDUCATION ACCREDITATION 21
carried over to other legal cases that upheld the decision that accreditation was a credible, as well
as a voluntary process (Ewell, 2008; Fuller & Lugg, 2012; Orlans, 1974).
Eventually, additional associations were created to monitor and regulate the regional
accrediting agencies. In 1938, the Joint Commission on Accreditation was formed to validate
legitimate accrediting agencies and discredit questionable or redundant ones (Blauch, 1959).
After some changes to the mission and the membership due to the Association of American
Universities (AAU) removing itself from the accreditation business, the Joint Commission on
Accreditation changed its name to the National Commission on Accrediting (NCA) (Blauch,
1959).
In 1949, the regional accreditors met and created the National Committee of Regional
Accrediting Agencies (NCRAA), an institution run entirely separate from the NCA. Up to this
point, only four of the six regional accreditors were formally accrediting institutions of higher
education. As a result, the NCA and NCRAA requested that all regional accrediting agencies
begin formally assessing institutions of higher education, to which they all complied (Blauch,
1959).
History of Accreditation 1950 to Present
The period 1950 to 1985 has been coined the “golden era” of higher education (Bloland,
2001, p. 34) and was marked by increasing federal regulations. During this period, key
developments in the accreditation process included self-studies becoming the standard, site visits
executed by colleagues from peer institutions, and institutions visited on a cyclical basis (Ewell,
2008).
With the passage of the Veterans Readjustment Assistance Act of 1952, the U.S.
Commissioner of Education was required to publish a list of recognized accreditation
NURSING EDUCATION ACCREDITATION 22
associations (Bloland, 2001). This Act also provided for education benefits to veterans of the
Korean War directly to the students rather than to the educational institutions, increasing the
importance of accreditation as a mechanism for recognition of legitimacy (Ewell, 2008). A
more decisive event occurred in 1958 with the National Defense Education Act's (NDEA)
allocation of funding for NDEA fellowships and college loans (Weissburg, 2008). The NDEA
limited participating institutions to those that were accredited (Gaston, 2014). Additionally, in
1963, the Higher Education Facilities Act was passed, which also required that higher education
institutions receiving federal funding be accredited (Ewell, 2008).
Arguably the most striking expansion in accreditation's mission coincided with the passage
of the Higher Education Act (HEA) in 1964 (Gaston, 2014). Title IV of this Act allowed
Congress to use federal financial aid as a means to broaden access to higher education.
According to Gaston (2014), having committed to this much larger role in encouraging college
attendance, the federal government found it necessary to confirm that institutions benefitting
from federal funding were worthy of it. That same year, the NCRAA became the Federation of
Regional Accrediting Commissions of Higher Education (FRACHE), and continued to coexist
separately from the NCA (Ewell, 2008).
In 1965, the Higher Education Act was signed into law. The HEA strengthened the resources
available to higher education institutions and provided financial assistance to students enrolled at
those institutions. The law was especially important to accreditation because it forced the
USDOE to create a much larger list of institutions eligible for federal programs (Trivett, 1976).
This need to deal with increasing numbers of potentially eligible institutions led the USDOE’s
Bureau of Higher Education to create the Accreditation and Institutional Eligibility Staff (AIES)
NURSING EDUCATION ACCREDITATION 23
in 1968 (Dickey & Miller, 1972). The purpose of the AIES was to administer the federal
recognition and review process involving the accrediting agencies (Dickey & Miller, 1972).
In 1975, the NCA and FRACHE merged to form a new organization called the Council on
Postsecondary Accreditation (COPA) (Ewell, 2008). This newly created national accreditation
association encompassed several diverse types of postsecondary education, including community
colleges, liberal arts colleges, proprietary schools, graduate research programs, bible colleges,
trade and technical schools, and home-study programs (Chambers, 1983).
Since 1985, accountability had become the issue of paramount importance in the field of
education. According to Bardo (2009), key developments in the accreditation process during this
period included rising educational costs resulting in high student loan default rates, as well as
accreditation enduring increasing criticism for a number of apparent shortcomings, most
ostensibly a lack of demonstrable student learning outcomes. As a result of this criticism,
Congress, in the midst of debates on the reauthorization of the Higher Education Act of 1992,
threatened to end the role of the accrediting agencies as gatekeepers for financial aid (Ewell,
2008). As a direct consequence, Part H, Subpart 1 of the Higher Education Act amendment
involved an increased role of state governments in determining the eligibility of institutional
participation in Title IV student financial aid programs (Bloland, 2001; Ewell, 2008). This led to
the creation of State Postsecondary Review Entities (SPRE) within each state that would review
institutions identified as falling below certain criteria, such as students with high default rates on
federal student loans (Bloland, 2001). SPREs were quickly abandoned after the elections in
1994, largely due to a lack of adequate federal funding (Ewell, 2008). The HEA Reauthorization
of 1992 also created the National Advisory Committee on Institutional Quality and Integrity
NURSING EDUCATION ACCREDITATION 24
(NACIQI) to provide greater leadership for accreditation and quality assurance of higher
education (National Committee on Institutional Quality and Integrity, 2012).
For several years, the regional accrediting agencies had entertained the idea of pulling out of
COPA and forming their own national association. Based on dissatisfaction with the
organization’s inability to predict and prevent the formation of SPREs, the regional accrediting
agencies voted to terminate COPA in 1993 (Bloland, 2001). In January 1994, a special
committee generated by the COPA plan of dissolution led to the formation of the Commission on
Recognition of Postsecondary Accreditation (CORPA) to continue the work of acknowledging
accrediting agencies (Bloland, 2001).
In 1995, national leaders in accreditation formed the National Policy Board (NPB) – a
national organization overseeing accreditation (Bloland, 2001). The purpose of the NPB was to
determine ways to deal with increasing government regulation, address the increasing pressure to
develop common accreditation standards, and create a new national organization for
accreditation (Bloland, 2001). Following years of numerous, intensive meetings by members of
the NPB, a new organization – the Council for Higher Education Accreditation (CHEA) – was
formed in 1996 to replace CORPA (Bloland, 2001). Today, CHEA continues to be the primary
non-governmental agency overseeing 3000 degree-granting colleges and universities, as well 60
specialized accrediting organizations, and is the “national advocate and institutional voice for
self-regulation and academic quality through accreditation” (CHEA, 2012c, p.1).
Specialized Accreditation
Specialized, or programmatic, accreditation has been an essential part of higher education
accreditation since the Flexner Report called attention to the need for quality control in medical
education in the U.S. and Canada (Flexner, 1910). The report’s impact on ensuring a more
NURSING EDUCATION ACCREDITATION 25
standardized way to assess medical schools led to the proliferation of specialized accreditation in
the U.S.
Specialized and programmatic accreditation focuses on the specialized training and
knowledge needed for professional degrees and careers. Some examples include the
Accreditation Council for Pharmacy Education (ACPE), Accrediting Council on Education in
Journalism and Mass Communications (ACEJMC), Council on Accreditation of Nurse
Anesthesia Educational Programs (CoA-NA), Council on Social Work Education Office of
Social Work Accreditation (CSWE), and Teacher Education Accreditation Council, Inc.
(TEAC), which are just a few noted by CHEA that recognizes 60 institutional and programmatic
accrediting organizations (CHEA, 2012c). CHEA affirms that the standards and processes of the
accrediting agencies are consistent with the academic quality, improvement, and accountability
expectations that CHEA has established (CHEA, 2012c). Programmatic accreditation is granted
and monitored by national organizations rather than by regional accrediting organizations, such
as the Western Association of Schools and Colleges (WASC), Southern Association of Colleges
and Schools (SACS), North Central Association of Colleges and Schools, etc. (Adelman &
Silver, 1990; Eaton, 2009; Hagerty & Stark, 1989).
As noted by the Global University Network for Innovation (2007), institutional accreditation
has to encompass all academic programs, while programmatic accreditation supports the overall
institutional accreditation goals in addition to meeting its specific programmatic objectives; thus,
both working in complement towards overall institutional success. Coordinating institutional
accreditation efforts with programmatic accreditation, where possible, can increase cost
effectiveness, since overlaps exist between both processes; however, the review process and
NURSING EDUCATION ACCREDITATION 26
resource allocations can become complicated when dealing with multiple programs (Shibley &
Volkwein, 2002; Western Association of Schools and Colleges, 2009).
Specialized program accreditation contains institutional quality assurance of import, because
differences between individual programs within a single institution can be greater than when
compared to the entire institution. Thus, the power of program accreditation review is due to its
targeted evaluation by specialists in particular disciplines from peer institutions (Ratcliff, 1996).
Like institutional accreditation, programmatic accreditation is lacking in abundance and
quality of research. Strong faculty involvement and instruction have been linked to individual
program accreditation (Cabrera, Colbeck, & Terenzini, 2001; Daoust, Wehmeyer, & Eubank,
2006), while other studies found that programmatic accreditation does not specifically focus
enough attention on learning assessments (Hagerty & Stark, 1989). Programmatic accreditation
is important to higher education because it outlines the parameters of professional education
(Ewell, Wellman, & Paulson, 1997; Hagerty & Stark, 1989) and, thus, upholds the national
professional standards (American Accounting Association, 1977; Bardo, 2009; Floden, 1980;
Raessler, 1970). Therefore, the field of programmatic accreditation needs further empirical
research given its importance on students’ educational and professional achievement.
The Effects of Accreditation
This section of the literature review will examine the effects of accreditation, focusing
primarily on the assessment of student learning outcomes. Specifically, outcome assessment
serves two main purposes — quality improvement and external accountability (Bresciani, 2006;
Ewell, 2009). Over the years, institutions of higher education have made considerable strides
with regard to learning assessment practices and implementation. Yet despite such progress, key
challenges still remain.
NURSING EDUCATION ACCREDITATION 27
Trend toward Learning Assessment
The shift within higher education accreditation toward greater accountability and student
learning assessment began in the mid-1980s (Beno, 2004; Ewell, 2001; Wergin, 2005, 2012).
During that time, higher education was portrayed in the media as “costly, inefficient, and
insufficiently responsive to its public” (Bloland, 2001, p. 34). The impetus behind the public’s
concern stemmed from two reasons: first was the perception that students were underperforming
academically, and second was the demand of the business sector (Ewell, 2001). Employers and
business leaders expressed their need for college graduates who could demonstrate high levels of
literacy, problem solving ability, and collaborative skills in order to support the emerging
knowledge economy of the 21
st
century. In response to these concerns, institutions of higher
education started emphasizing student learning outcomes as the main process of evaluating
effectiveness (Beno, 2004).
Framework for Learning Assessment
Accreditation is widely considered to be a significant driving force behind advances in both
student learning and outcomes assessment. According to Rhodes (2012), in recent years,
accreditation has contributed to the proliferation of assessment practices, lexicon, and even
products such as e-portfolios, which are used to show evidence of student learning.
Kuh and Ikenberry (2009) surveyed provosts or chief academic officers at all regionally
accredited institutions granting undergraduate degrees and found that student assessment was
driven more by accreditation than by external pressures, such as government or employers.
Another major finding was that most institutions planned to continue their assessment of student
learning outcomes despite budgetary constraints. They also found that gaining faculty support
NURSING EDUCATION ACCREDITATION 28
and involvement remained a major challenge — an issue that will be examined in more depth
later in this section.
Additionally, college and university faculty and student affairs practitioners have stressed
how students must now acquire proficiency in a wide scope of learning outcomes to adequately
address the unique and complex challenges of today’s ever-changing, economically competitive,
and increasingly globalizing society. In 2007, the Association of American Colleges and
Universities (AACU) published a report focusing on the aims and outcomes of a 21
st
century
collegiate education, with data gathered through surveys, focus groups, and discussions with
postsecondary faculty. Emerging from the report were four “essential learning outcomes” which
include: (a) knowledge of human cultures and the physical and natural world, through study in
science and mathematics, social sciences, humanities, history, languages, and the arts; (b)
intellectual and practical skills, including inquiry and analysis, critical and creative thinking,
written and oral communication, quantitative skills, information literacy, and teamwork and
problem-solving abilities; (c) personal and social responsibility, including civic knowledge and
engagement, multicultural competence, ethics, and foundations and skills for lifelong learning;
and (d) integrative learning, including synthesis and advanced understanding across general and
specialized studies (Rhodes, 2012, p. 12). With the adoption of such frameworks or similar tools
at institutions, accreditors can be well positioned to connect teaching and learning and, as a
result, better engage faculty to improve student learning outcomes (Rhodes, 2012).
Benefits of Accreditation on Learning
Accreditation and student performance assessment have been the focus of various empirical
studies, with several pointing to benefits of the accreditation process. Ruppert (1994) conducted
case studies in 10 states – Colorado, Florida, Illinois, Kentucky, New York, South Carolina,
NURSING EDUCATION ACCREDITATION 29
Tennessee, Texas, Virginia, and Wisconsin – to evaluate different accountability programs based
on student performance indicators. The report concluded that “quality indicators appear most
useful if integrated in a planning process designed to coordinate institutional efforts to attain
state priorities” (Ruppert, 1994, p. 155).
Furthermore, research has also demonstrated how accreditation is helping shape outcomes
inside college classrooms. Specifically, Cabrera, Colbeck, and Terenzini (2001) investigated
classroom practices and their relationship with the learning gains in professional competencies
among undergraduate engineering students. The study involved 1,250 students from seven
universities. It found that the expectations of accrediting agencies may be encouraging more
widespread use of effective instructional practices by faculty.
A study by Volkwein, Lattuca, Harper, and Domingo (2007) measured changes in student
outcomes in engineering programs, following the implementation of new accreditation standards
by the Accreditation Board for Engineering and Technology (ABET). Based on the data
collected from a national sample of engineering programs, the authors noted that the new
accreditation standards were indeed a catalyst for change, finding evidence that linked the
accreditation changes to improvements in undergraduate education. Students experienced
significant gains in the application of knowledge of mathematics, science, and engineering; use
of modern engineering tools; use of experimental skills to analyze and interpret data; designing
solutions to engineering problems; teamwork and group work; effective communication;
understanding of professional and ethical obligations; understanding of the societal and global
context of engineering solutions; and recognition of the need for life-long learning. The authors
also found accreditation prompted faculty to engage in professional development-related activity.
NURSING EDUCATION ACCREDITATION 30
Thus, the study showed the effectiveness of accreditation as a mechanism for quality assurance
(Volkwein, Lattuca, Harper, & Domingo, 2007).
Organizational Effects of Accreditation
Beyond student learning outcomes, accreditation also has considerable effects on an
organizational level. Procopio (2010) noted that the process of acquiring accreditation
influences perceptions of organizational culture. According to the study, administrators are more
satisfied than staff – and especially more so than faculty – when rating organizational climate,
information flow, involvement in decisions, and utility of meetings. “These findings suggest
institutional role is an important variable to consider in any effort to affect organizational culture
through accreditation buy-in” (Procopio, 2010, p. 10). Similarly, a study by Wiedman (1992)
describes how the two-year process of reaffirming accreditation at a public university drives the
change of institutional culture.
Meanwhile, Brittingham (2009) explains that accreditation offers organizational-level
benefits for colleges and universities. The commonly acknowledged benefits include students’
access to federal financial aid funding, legitimacy in the public, consideration for foundation
grants and employer tuition credits, positive reflection among peers, and government
accountability. However, Brittingham (2009) points out that there are “not often recognized”
benefits, as well (p. 18). For example, accreditation is cost-effective, particularly when
contrasting the number of personnel to carry out quality assurance procedures here in the U.S.
versus internationally, where it’s far more government-regulated. Second, “participation in
accreditation is good professional development” because those who lead a self-study come to
learn about their institution with more breadth and depth (Brittingham, 2009, p. 19). Third, self-
regulation by institutions, if done properly, is a better system than government regulation.
NURSING EDUCATION ACCREDITATION 31
Lastly, “regional accreditation gathers a highly diverse set of institutions under a single tent,
providing conditions that support student mobility for purposes of transfer and seeking a higher
degree” (Brittingham, 2009, p. 19).
Future Assessment Recommendations
Many higher education institutions have developed plans and strategies to measure student
learning outcomes, and such assessments are already in use to improve institutional quality
(Beno, 2004). For future actions, the Council for Higher Education Accreditation (CHEA), in its
2012 Final Report, recommends to further enhance commitment to public accountability:
“Working with the academic and accreditation communities, explore the adoption and
implementation of a small set of voluntary institutional performance indicators based on
mission that can be used to signal acceptable academic effectiveness and to inform students
and the public of the value and effectiveness of accreditation and higher education. Such
indicators would be determined by individual colleges and universities, not government” (p.
7).
In addition, Brittingham (2012) outlines three developments that have the capacity to
influence accreditation and increase its ability to improve educational effectiveness. First,
accreditation is growing more focused on data and evidence, which strengthens its value as a
means of quality assurance and quality improvement. Second, “technology and open-access
education are changing our understanding of higher education” (Brittingham, 2012, p. 65).
These innovations, such as massive open online courses (MOOC), hold enormous potential to
open up higher education sources. As a result, this trend will heighten the focus on student
learning outcomes. Third, “with an increased focus on accountability – quality assurance –
accreditation is challenged to keep, and indeed strengthen, its focus on institutional and
NURSING EDUCATION ACCREDITATION 32
programmatic improvement” (Brittingham, 2012, p. 68). This becomes particularly important
amid the current period of rapid change.
Challenges to Student Learning Outcomes
Assessment is critical to the future of higher education. As noted earlier, outcome
assessment serves two main purposes – quality improvement and external accountability
(Bresciani, 2006; Ewell, 2009). The practice of assessing learning outcomes is now widely
adopted by colleges and universities since its introduction in the mid-1980s. Assessment is also
a requirement of the accreditation process. However, outcomes assessment in higher education
is still a work in progress, and there are still a fair amount of challenges (Kuh & Ewell, 2010).
Organizational Learning Challenges
Assessment, as clearly stated by the American Association for Higher Education (1992), “is
not an end in itself but a vehicle for educational improvement” (para. 1). Instead, it provides an
opportunity for continuous organizational learning and improving (Maki, 2010). Too often,
institutions assemble and report sets of mountainous data just to comply with federal or state
accountability policy or accreditation agency’s requirements. However, after the report is
submitted, the evaluation team has left, and the accreditation status confirmed, there are few
incentives to act on the findings for further improvement. The root causes of deficiencies
identified are rarely followed up and real solutions are never sought (Ewell, 2005; Wolff, 2005).
Another concern pointed out by Ewell (2005) is that accrediting agencies tend to emphasize
the process of accreditation, rather than its outcomes, once the assessment infrastructure is
established. The accreditors are satisfied with formal statements and goals of learning outcomes,
but do not query further about how, the appropriateness of, and to what degree these learning
goals are applied in the teaching and learning process. As a result, the learning process tends to
NURSING EDUCATION ACCREDITATION 33
be single-loop, where changes are reactionary and superficial, instead of double-loop, where
changes are incorporated into the deeper practices, beliefs, and norms of the institution
(Bensimon, 2005).
Lack of Faculty Buy-in
Lack of faculty buy-in and participation in the process is another hurdle in the adoption of
assessment practice (Kuh & Ewell, 2010). In a 2009 survey by the National Institute for
Learning Outcomes Assessment, two-thirds of 2,809 surveyed schools felt that more faculty
involvement in learning assessment would be helpful (Kun & Ikenberry, 2009). According to
Ewell (1993, 2002, 2005), there are several reasons that faculty is less inclined to be directly
involved in the assessment process. First, faculty views teaching and curriculum development as
their domain. Assessing their teaching performance and student learning outcomes by external
groups can be viewed as an intrusion of their professional authority and academic freedom.
Second, the extra effort and time required for engaging in outcomes assessment and the
unconvincing added value perceived by faculty can be another deterrent. Finally, the assessment
process requires a tremendous amount of work and resources. To minimize costs, administrative
staff performs the majority of the work. Thus, faculty perceives assessment as an exercise
performed by administration for external audiences, instead of embracing and involving
themselves in the process (Ewell, 1993, 2002, 2005).
Lack of Institutional Investment
Shortage of resources and institutional support is another challenge in the implementation of
assessment practice. As Beno (2004) stated, “Deciding on the most effective strategies for
teaching and for assessing learning will require experimentation, careful research, analyses, and
time” (p. 67). With continuously dwindling federal and state funding in the last two decades,
NURSING EDUCATION ACCREDITATION 34
higher education, particularly at public institutions, has been stripped of resources to support
such an endeavor. The recession in the in the early 1990s is an example of this. Budget cuts
forced many states to abandon the state assessment mandates originated in mid-1980s and
switched to process-based performance indicators as a way to gain efficiency in large public
institutions (Ewell, 2005). The 2009 National Institute for Learning Outcomes Assessment
survey shows that the majority of those institutions surveyed undercapitalized resources, tools,
and expertise for assessment work. Moreover, 20% of respondents indicated they had no
assessment staff and 65% had two or less (Kuh & Ewell, 2010; Kuh & Ikenberry, 2009).
Difficulty with Integration into Local Practice
Integrating the value and institutionalizing the practice of assessment into daily operations
can be another tall order in many institutions. In addition to redirecting resources, leadership’s
involvement and commitment, faculty’s participation, and adequate assessment personnel
contribute to the success of cultivating a sustainable assessment culture and framework on
campus (Banta, 1993; Kuh & Ewell, 2010; Lind & McDonald, 2003; Maki, 2010). Furthermore,
assessment activities, imposed by external authorities, tend to be implemented as an addition to,
rather than an integral part of, an institutional practice (Ewell, 2002). Assessment, like
accreditation, is viewed as a special process with its own funding and committee, instead of
being part of regular business operations.
Colleges also tend to adopt the institutional isomorphic approach by modeling itself after
those peers who are more legitimate or successful in dealing with similar situations and the
practice widely used to gain acceptance (DiMaggio & Powell, 1983). As reported by Ewell
(1993), institutions are prone to “second-guess” and adopt the type of assessment practice
acceptable by external agencies as a safe approach instead of adopting or customizing the one
NURSING EDUCATION ACCREDITATION 35
appropriate to the local needs and situation (Ewell, 1993). Institutional isomorphism offers a
safer and more predictable route for institutions to deal with uncertainty and competition, to
confirm to government mandates or accreditation requirements, or to abide by professional
practices (Bloland, 2001). However, the strategy of following the crowd might hinder in-depth
inquiry of a unique local situation, as well as the opportunity for innovation and creativity.
Furthermore, decision makers may be unintentionally trapped in a culture of doing what
everyone else is doing without carefully examining the unique local situation, the logic, the
appropriateness, and the limitations behind the common practice (Miles, 2012).
Lack of assessment standards and clear terminology presents another challenge in assessment
and accreditation practice (Ewell, 2001). With no consensus on vocabulary, methods, and
instrumentation, assessment practice and outcomes can have limited value. As reported by Ewell
(2005), the absence of outcome metrics makes it difficult for state authorities to aggregate
performance across multiple institutions and to communicate the outcomes to the public.
Bresciani (2006) stressed the importance of developing a conceptual definition, framework, and
common language at the institutional level.
Outcome Equity
Outcome assessment that focuses on students’ academic performance while overlooking the
equity and disparity of diverse student population, as well as the student engagement and campus
climate issues, is another area of concern. In discussing local financing of community colleges,
Dowd and Grant (2006) stressed the importance of including outcome equity in addition to
performance-based budget allocations. Outcome equity pays special attention to the equal
outcomes of educational attainment among populations of different social, economic, and racial
groups (Dowd, 2003).
NURSING EDUCATION ACCREDITATION 36
Tension between Improvement and Accountability
The tension between the twin goals of outcomes assessment, quality improvement, and
external accountability, can be another factor affecting outcome assessment practice. According
to Ewell (2009), assessment practice has evolved over the years into two contrasting paradigms.
The first paradigm – assessment for improvement – emphasizes constant evaluation and process
or outcome enhancement, while the other paradigm – assessment for accountability – requires
conformity to a set of established standards mandated by the state or accrediting agencies. The
strategies, the instrumentation, the methods for gathering evidence, the reference points, and the
way results are utilized for these two paradigms tend to be at opposite ends of the spectrum
(Ewell, 2009). For example, the improvement paradigm assessment is mainly used internally to
address deficiencies and enhance teaching and learning. It requires periodic evaluation and
formative assessment to track progress over time. On the other hand, the accountability
paradigm assessment is designed to demonstrate institutional effectiveness and performance to
external constituencies and to comply with pre-defined standards or expectations. The process
tends to be performed on set schedules as a summative assessment. The nature of these two
constraints can create tension and conflict within an institution. Consequently, an institution’s
assessment program is unlikely to achieve both objectives. Ewell (2009) further pointed out that,
“when institutions are presented with an intervention that is claimed to embody both
accountability and improvement, accountability wins” (p. 8).
Challenges with Transparency
Finally, for outcome assessment to be meaningful and accountable, the process and
information needs to be shared and open to the public (Ewell, 2005). Accreditation has long
been criticized for being mysterious or secretive when sharing information with stakeholders
NURSING EDUCATION ACCREDITATION 37
(Ewell, 2010). In a 2006 survey, the Council of Higher Education Accreditation (CHEA)
reported that only 18% of the 66 accreditors surveyed provided information about the results of
individual reviews publicly; less than 17% of accreditors provided a summary on student
academic achievement or program performance; and just over 33% of accreditors offered a
descriptive summary about the characteristics of accredited institutions or programs (Council of
Higher Education Accreditation, 2006). In the 2014 Inside Higher Education survey, only 9% of
the 846 college presidents indicated that it is very easy to find student outcomes data on the
institution’s website, and only half of the respondents agreed that it is appropriate for federal
government to collect and publish data on outcomes of college graduates (Jaschik & Ledgerman,
2014). With the public disclosure requirements of the No Child Left Behind Act (Linn, Baker, &
Betebenner, 2002), there is an impetus for higher education and accreditation agencies to be
more open to the public and policymakers. It is expected that further openness will contribute to
more effective and accountable institutional practices, as well as the improvement of educational
quality.
It has been three decades since the onset of the assessment movement in U.S. higher
education and a reasonable amount of progress has been made (Ewell, 2005). Systematic
assessment of student learning outcomes is now a common practice at most institutions. The
2009 National Institute for Learning Outcomes Assessment showed that more than 75% of
surveyed institutions have adopted common learning outcomes for all undergraduate students
and most institutions conducted assessments at both the instructional and program level (Kun &
Ikenberry, 2009). The 2008 survey performed by the Association of American Colleges and
Universities (AACU) also reported that 78% of the 433 surveyed institutions have a common set
NURSING EDUCATION ACCREDITATION 38
of learning outcomes for all their undergraduate students and 68% of the institutions also assess
learning outcomes at the departmental level (Hart Research Associates, 2009).
As the public concern about the performance and quality of American colleges and
universities continues to grow, it is more imperative than ever to embed assessment in the
everyday work of teaching and using assessment outcomes to further improve practice, to inform
decision makers, to communicate effectively with the public, and to be accountable for preparing
the national learners in the knowledge economy. With effort, transparency, continuous
improvement and responsiveness to society’s demands, higher education institutions may be able
to regain the trust from the public.
Costs of Accreditation
There are a variety of financial costs incurred by an institution of higher education for
obtaining and maintaining accreditation. Institutions applying for initial accreditation are
required to pay an application fee, as well as various additional fees, including any onsite
reviews, as they progress through the process (Gaston, 2014). Once accredited, institutions are
required to pay annual fees to the accrediting body, as well as fees associated with periodic
reaccreditation (Gaston, 2014).
In addition to these direct, financial costs, there are internal or indirect costs that must be
calculated, as well. These internal costs can include faculty and administrative time invested in
the assessment and self-study, volunteer service in accreditation activities, preparation of annual
or periodic filing reports, and attendance at mandatory accreditation meetings (Gaston, 2014).
Costs of initial accreditation can vary greatly from region to region; however, regardless of
the region, the costs can be substantial. It can cost an institution $23,500 to pursue initial
accreditation through the Higher Learning Commission (HLC), regardless if the pursuit is
NURSING EDUCATION ACCREDITATION 39
successful or not (Higher Learning Commission, 2012). This does not include the costs
associated with the three required on-site visits, nor does it include the dues that must be paid
during the application and candidacy period. For example, the applicant and candidacy fees for
the Southern Association of Colleges and Schools (SACS) are $12,500 (Higher Learning
Commission, 2012).
Shibley & Volkwein (2002) claim there has been limited research on the costs of
accreditation within the literature. Calculating the cost can be very complex, as institutions must
be able to evaluate both monetary and non-monetary costs of going through the accreditation
process. One of the most complex and difficult items to evaluate is time. Reidlinger and Prager
(1993) state there are two reasons why thorough, cost-based analyses of accreditation have not
been pursued. First, there is a belief that voluntary accreditation is preferable to governmental
control and that accreditation is worth the time and effort, despite the price. Second, it is difficult
to relate perceived benefits of accreditation to an actual dollar amount (Reidlinger & Prager,
1993).
The Council for Higher Education Accreditation (CHEA) began publishing an almanac in
1997 and continues to release a revised version every two years (CHEA, 2012a). This almanac
looks at macro-level accreditation practices across the U.S., reviewing data, such as number of
volunteers, number of employees, and unit operating budgets of the regional accrediting
organizations (CHEA, 2012a). However, little, if any, information is provided on overall costs
incurred by individual institutions as they go through the accreditation process.
In 1998, the North Central Association of Colleges and Schools (NCA) completed a self-
study in which they examined the perception of accreditation costs among the institutions within
that region (Lee & Crow, 1998). The study revealed some significant findings, which included
NURSING EDUCATION ACCREDITATION 40
the variance of responses among institutional type. Research and doctoral institutions were less
apt to claim that benefits outweighed costs while also responding less positively than other types
of institutions regarding the effectiveness and benefits of accreditation (Lee & Crow, 1998). The
study suggested that well-established research and doctoral institutions might already have
internal processes in place that serve the traditional function of the accreditation, in which case, a
traditional audit system could serve as an appropriate alternative to the formal process by the
regional accreditation organization (Lee & Crow, 1998). In looking at the results of all
institutional types, the self-study found that 53% of respondents felt that the benefits of
accreditation outweighed the costs; approximately 33% of respondents considered benefits of
accreditation to be equal to the costs; and the remaining 13% of the respondents believed that the
costs of accreditation outweighed the benefits (Lee & Crow, 1998). There have been similar case
studies performed by Warner (1977) on the Western Association of Schools and Colleges
(WASC) and by Pigge (1979) on the Committee on Postsecondary Accreditation (COPA). In
both studies, cost was labeled a significant concern of the accreditation process, plus budget
allocations have been impacted by accreditation results. Warner (1977) found that approximately
one-third of responding institutions had changed budget allocations based on accreditation
results; however, there was no further exploration done. The majority of respondents in the
Warner (1977) and Pigge (1979) studies believed that, despite the costs of accreditation, the
benefits outweighed the costs.
Wood (2006) developed a three-stage model for accreditation preparation, which included (a)
the release time required for the various coordinators of the accreditation review, (b) the
monetary costs of training, staff support, and materials, and (c) the accreditation team site visit.
Institutional costs are incurred at each of these stages. Willis (1994) also examined these costs,
NURSING EDUCATION ACCREDITATION 41
but made the differentiation between direct and indirect costs. Direct costs include things, such
as accreditation fees, operating expenses (specific to the accreditation process), direct payments
to individuals who participate in the process, self-study costs, travel costs, and site visit costs.
Indirect costs measure things such as personnel time. Willis (1994) identified indirect costs as
“probably many times greater than the direct costs due mainly to the personnel time required at
the institution” (p. 40). He suggested that caution be exercised when evaluating these costs, and
that they should not be underestimated. In addition, he stated that, many times, the normal tasks
that cannot be completed by individuals with accreditation responsibilities are distributed to
other individuals who are not identified as participants in the accreditation process (Willis,
1994).
Kennedy, Moore, and Thibadoux (1985) attempted to establish a methodology for
determining costs, with a particular focus on monetizing time spent on the accreditation process.
They looked at a timeframe of approximately 15 months, from the time when the initial planning
of the self-study began through the presentation of the study. They used time logs to gather data
on time spent by faculty and administrative staff. After reviewing the time logs, it was
discovered that the time spent by faculty and administrative staff accounted for 94% of the total
cost of the accreditation review, over two-thirds of which was attributed to administrative staff
(Kennedy, Moore, & Thibadoux, 1985). These figures demonstrate the fact that the time
required by both faculty and administrative staff is the most significant cost involved in the
accreditation process. It was concluded, however, that this cost was not excessive as there is a
seven-year span between each self-study review process (Kennedy, Moore, & Thibadoux, 1985).
Kells and Kirkwood (1979) conducted a study in the Middle States region, which looked at
the direct costs of participating in a self-study. Almost 50% of the respondents reportedly spent
NURSING EDUCATION ACCREDITATION 42
under $5,000 on the self-study, which was not considered excessive. It was also determined that
there was maximum number between 100 and 125 people directly involved in the self-study. The
majority of participants were faculty (41-50%), followed by staff (21-30%), and very few
students. The size of the institution was believed to have had the greatest impact on the
composition of the self-study committee (number of faculty vs. staff), as well as the cost of the
self-study itself (Kells & Kirkwood, 1979).
Doerr (1983) performed a case study to explore the direct costs of accreditation and to
examine the benefits received from accreditation when university executives wish to pursue
additional programmatic accreditations. Both financial costs and opportunity costs of
institutional accreditation granted by SACS and four programmatic accreditations cultivated by
the University of West Florida in 1981-1982 were examined. The author assigned an average
wage per hour to faculty and administrative staff, while also adding in the cost of material
supplies. It was estimated that the total direct costs of accreditation for these reviews totaled
$50,030.71. It was also projected that there would be additional costs in the following years,
particularly membership costs for the accrediting organizations and those costs associated with
preparing for additional programmatic reviews (Doerr, 1983).
Shibley and Volkwein (2002) evaluated the benefits of a joint accreditation by conducting a
case study of a public institution in the Middle States region. This institution had multiple
accrediting relationships, including both institutional and programmatic reviews. They confirmed
what Willis (1994) had suggested: “The true sense of burden arose from the time contributed to
completing the self-study process rather than from finding the financial resources to support self-
study needs” (Shibley & Volkwein, 2002, p.8). They also found that the separate accreditation
NURSING EDUCATION ACCREDITATION 43
processes had more benefits for individuals than the joint effort; however, the joint process was
less costly and the sense of burden for participants was reduced.
There have been several studies released on the expense of accreditation and its value to
institutions. Britt and Aaron (2008) distributed surveys to radiology programs without
specialized accreditation. These institutions reported that the expense of accreditation was the
primary factor in not pursuing accreditation. A secondary consideration was the time required to
go through the accreditation process. Many respondents indicated that a decrease in the expense
would allow them to consider pursuing accreditation in the future. Bitter, Stryker, and Jens
(1999) and Kren, Tatum, and Phillips (1993) looked at specialized accreditation for accounting.
Both studies found that non-accredited programs believed that accreditation costs outweighed the
benefits. Many programs claim they follow accreditation standards; however, since the programs
did not go through the accreditation process, there is no way to verify if they are actually meeting
the established accreditation standards, and, thus, are equal comparisons (accredited versus non-
accredited).
Cost is frequently used as a factor for why institutions have not pursued accreditation. In
addition to direct costs of accreditation, indirect costs such as resources, time, and energy spent
are also included. The Florida State Postsecondary Planning Commission (1995) defined costs in
a variety of ways and only sometimes included indirect costs as part of their definition. Benefits
could potentially impact up to three groups: students, departments, and the institution (Florida
State Postsecondary Planning Commission, 1995). The Commission recommended that
institutions seeking accreditation balance the direct and indirect costs of accreditation with the
potential benefits to each group before making the decision to pursue accreditation (Florida State
Postsecondary Planning Commission, 1995).
NURSING EDUCATION ACCREDITATION 44
As a result of the concerns of the higher education community and the research on the costs
associated with accreditation, both the National Advisory Committee on Institutional Quality and
Integrity (NACIQI) and the American Council on Education (ACE) published reports in 2012.
These reports called for a cost-benefit analysis of the accreditation process in an attempt to
reduce excessive and unnecessary costs (ACE, 2012; NACIQI, 2012). NACIQI recommended
that data gathering be responsive to standardized expectations and that it should only seek out
information that is useful and that cannot be found elsewhere (NACIQI, 2012). The ACE Task
Force on Accreditation called for an evaluation of required protocols, such as the self-study, the
extent and frequency of on-site visits, expanded opportunities for the use of technology, greater
reliance on existing data, and the evaluation of potential duplication of requirements imposed by
different agencies and the federal government (ACE, 2012).
Due to the limited amount of research on the cost-benefit analysis of the accreditation
process, Woolston (2012) conducted a recent study of the direct and indirect costs of
accreditation. This study consisted of distributing a survey to all regionally accredited
institutions of higher education that grant baccalaureate degrees in the U.S. It targeted four
primary areas: demographic information, direct costs, indirect costs, and an open-ended section
allowing for possible explanation for the costs. Results showed that one of the most complicated
things to calculate is the monetary value of the time spent going through the accreditation
process. Analysis of the open-ended response questions revealed that two of the biggest benefits
of going through accreditation were self-evaluation and university improvement. There were
other themes that emerged, such as: campus unity, outside review, ability to offer federal
financial aid, reputation, sharing best practices, celebration, and fear associated with not being
accredited. While it was agreed that accreditation costs are significant and excessive, many
NURSING EDUCATION ACCREDITATION 45
believe that the costs are justified and that the benefits of accreditation outweigh both the direct
and indirect costs (Woolston, 2012).
Critical Assessment of Accreditation
Accreditation has evolved from simpler days of semi-informal peer assessment into a
burgeoning industry of detailed analysis, student learning outcomes assessment, quality and
performance review, financial analysis, public attention, and all-around institutional scrutiny
(Bloland, 2001; Burke & Minassians, 2002; McLendon, Hearn, & Deaton, 2006; Zis, Boeke, &
Ewell, 2010). Public scrutiny of institutions to establish their worth, their contribution to student
learning, and a progressively regulated demand for institutional proof of success shown by
evidence and assessment has changed accreditation and created a vacuum of knowledge about
how accreditation is truly working in practice (Commission on the Future of Higher Education,
2006; Dougherty, Hare, & Natow, 2009; Leef & Burris, 2002). WASC-Accrediting Commission
for Junior and Community College’s (ACCJC) recent history has demonstrated profound
changes in practices (i.e., updated standards for accreditation and a rising rate of institutional
sanctions) and the need for more information concerning the relationship of accreditation to
institutional data (Baker, 2002). Initial data collection found that 55% of all California
community colleges have been sanctioned at least once since 2002 (Moltz, 2010).
Measures of inputs, outputs, local control versus governmental review, performance funding
versus institutional choice, rising demands, and institutional costs make difficult the task of
understanding trends and movement of regional accreditation in the U.S., but, nevertheless, have
had a great influence upon actual implementation of accreditation standards to real-world
institutions (Leef & Burris, 2002). There have been calls for increased public transparency of
accreditation findings and actions, including full publication of reports by the commission and by
NURSING EDUCATION ACCREDITATION 46
the institutions in question. For example, some institutions are sanctioned for deficiencies and
may be given a detailed list of reporting deadlines to show compliance and ongoing quality
review for those areas noted to be lacking. Some correspondence between accreditation
commissions and the institutions are public, whereas others are private. Therefore, this semi-
public nature to accreditation has been a point of contention in the literature on accountability
and assessment (Eaton, 2010; Ikenberry, 2009; Kuh, 2010).
WASC-ACCJC has been at the center of controversies during the past ten years due to its
heavy emphasis on student learning outcomes compliance (WASC, 2002; WASC-ACCJC 2011).
There is much debate on whether student learning outcomes are the best measure and appropriate
to education, whether they violate the purview of faculty members, or are truly in the best
interest of students, best practices, and learning (Eaton, 2010).
Accreditation has evoked emotional opposition since its inception and much has been
expressed in very colorful language. Accreditation has been accused of “[benefiting] the small,
weak, and uncertain” (Barzun, 1993, p. 60). It is a “pseudo-evaluative process, set up to give the
appearance of self-regulation without having to suffer the inconvenience” (Scriven, 2000, p.
272). It is a “grossly unprofessional evaluation” (Scriven, 2000, p. 271), and “it is scarcely
surprising that in large areas of accreditation, the track record on enforcement is a farce”
(Scriven, 2000, p. 272). Accreditors “[make] the accreditation process a high-wire act for
schools” (American Council of Trustees and Alumni, 2007, p. 12). The system of accreditation is
“structured in such a way as to subordinate the welfare of the educational institution as an entity
and of the general public to the interest of groups representing limited institutional or
professional concerns” (American Medical Association, 1971, F-3). It has been stated that
“accreditation standards have already fallen to the lowest common denominator” (American
NURSING EDUCATION ACCREDITATION 47
Council of Trustees and Alumni, 2007, p. 16), and accreditation is responsible for the
“homogenization of education” and the “perseverance in the status quo” (Finkin, 1973, p. 369).
“It is an impossible game with artificial counters” which ignores the student (Learned & Wood,
1938, p. 69). It is “a crazy-quilt of activities, processes and structures that is fragmented, arcane,
more historical than logical, and has outlived its usefulness” (Dickeson, 2006, p. 1). It “seeks not
only to compare apples with grapes, but both with camels and cods” (Wriston, 1960, p. 329). “As
a mechanism for the assurance of quality, the private voluntary accreditation agencies are a
failure” (Gruson, Levine, & Lustberg, 1979, p. 6). It is “to be tolerated only as a necessary evil”
(Blauch, 1959, p. 23). “While failing to protect the taxpayer and the consumer from being ripped
off by irresponsible institutions, it has also quashed educational diversity and reform” (Finn,
1975, p. 26). At the same time it constitutes a system of “sturdy walls and deep moats around...
academic city-states” (Carey, 2009, para. 28), and it is a “tissue-thin layer of regulation” (Carey,
2010, p. 166). “The word ‘accreditation’ is so misunderstood and so abused that it should be
abandoned” (Kells, 1976). According to Gillen, Bennett, and Vedder (2010), “the inmates are
running the asylum” (p. i).
The reauthorization of the Higher Education Act in 1992 came during a time of heightened
government concern over increasing default rates of student loans. Again concerned about the
lack of accountability demonstrated by accreditation, this legislation established a new
institution: the State Postsecondary Review Entity (SPRE) (Ewell, 2008). The creation of these
agencies was intended to shift the review of institutions for federal aid eligibility purposes from
regional accreditors to state governments. This direct threat to accreditation led to the dissolution
of the Council on Postsecondary Accreditation (COPA) and the proactive involvement of the
higher education community resulting in the creation of the Council for Higher Education
NURSING EDUCATION ACCREDITATION 48
Accreditation (CHEA). It was the issue of cost that ultimately led to the abandonment of the
SPREs when legislation failed to provide funding for the initiative (Ewell, 2008). The
governmental concern did not dissipate, however, and in 2006 the USDOE released a report by
the Commission on the Future of Higher Education (also called the Spellings Commission),
which criticized accreditation for being both ineffective and a barrier to innovation (Commission
on the Future of Higher Education, 2006; Eaton, 2012b; Ewell, 2008).
Other concerns are evident. It is problematic when accreditation is considered a chore to be
accomplished as quickly and painlessly as possible rather than an opportunity for genuine self-
reflection for improvement, and institutional self-assessment is ineffectual when there is faculty
resistance and a lack of administrative incentive (Bardo, 2009; Commission on Regional
Accrediting Commissions, n.d.; Driscoll & De Norriega, 2006; Rhodes, 2012; Smith & Finney,
2008; Wergin, 2012). One of the greatest stresses on accreditation is the tension between
assessment for the purpose of improvement and assessment for the purpose of accountability,
two concepts that operate in irresolvable conflict with each other (American Association for
Higher Education, 1997; Burke & Associates, 2005; Chernay, 1990; Ewell, 1984; Ewell, 2008;
Harvey, 2004; National Advisory Committee on Institutional Quality and Integrity, 2012;
Provezis, 2010; Uehling, 1987b), although some argue that the two can be effectively
coordinated for significant positive results (Brittingham, 2012; El-Khawas, 2001; Jackson,
Davis, & Jackson, 2010; Walker, 2010; Westerheijden, Stensaker, & Rosa, 2007; Wolff, 1990).
Another concern involves the way that being held to external standards undermines institutional
autonomy that is a primary source of strength in the American higher education system (Ewell,
1984).
NURSING EDUCATION ACCREDITATION 49
The Spellings Commission report detailed a new interest from the USDOE in critiquing the
status quo of regional accreditation commissions (Commission on the Future of Higher
Education, 2006). Ewell (2008) describes the report as a scathing rebuke of inability of regional
accreditors to innovate and a hindrance to quality improvement. Others have called for an
outright “end…to the accreditation monopoly” (Neal, 2008). There have been increasing calls
within the last several years, since the Spellings report in 2006, to reform or altogether replace
accreditation as it is currently known (American Council of Trustees and Alumni, 2007; Gillen,
Bennett, & Vedder, 2010; Neal, 2008). The American Council on Education (2012) convened a
task force comprised of national leaders in accreditation to explore the adequacy of the current
practice of institutional accreditation. They recognized the difficulty of reaching a consensus on
many issues, but, nevertheless, recommended strengthening and reinforcing the role of self-
regulation in improving academic excellence. The Spellings Commission report signaled federal
interest in setting the stage for new accountability measures of higher education, raising the
worst fears of some defenders of a more autonomous, peer-regulated industry (Eaton, 2003).
Accreditation’s emphasis upon value and the enhancement of individual institutions with
regional standards is now being pressed to achieve accountability roles for the entire sector of
U.S. higher education (Brittingham, 2008).
Alternatives to Accreditation
As the role of accreditation has been thrust into the public spotlight within the U.S., it is
important to review the alternatives to the current system that have been proposed in previous
years.
Generally speaking, the alternatives to accreditation that have been proposed by scholars or
administrators in the past revolved around a common theme of increased government
NURSING EDUCATION ACCREDITATION 50
involvement (either at the state or federal government level). To illustrate this notion, Orlans
(1975) described the development (at the national level) of a Committee for Identifying Useful
Postsecondary Schools that would ultimately allow for accrediting agencies to focus on a wider
range of schools. This committee was part of Orlan’s greater overall idea that there be an
increase in the amount of competition among accrediting agencies in order to further the
advancement of education (Orlans, 1975). Trivett (1976) demonstrated that there was a triangular
relationship between accrediting agencies, state governments, and federal governments. Trivett
(1976) said:
In its ideal form, the states establish minimum legal and fiscal standards, compliance with
which signifies that the institutions can enable a student to accomplish his objectives because
the institution has the means to accomplish what it claims it will do. Federal regulations are
primarily administrative in nature. Accrediting agencies provide depth to the evaluation
process in a manner not present in either the state or federal government’s evaluation of an
institution by certifying academic standards (p. 7).
Trivett’s statement speaks to the ever-present interrelationship between accreditation agencies,
state governments, and federal governments.
Harcleroad (1976, 1980) identified six different methods for accreditation in his writings;
three vouched for an expansion of responsibility for state agencies, one called for an expansion of
federal government responsibility, and the remaining two asked for a modification of the present
system (by increasing staff members or auditors) or keeping the present system in place.
Harcleroad (1980) wrote that:
A combination of the second (present system with modifications) and third options (increased
state agency responsibility without regional and national associations) seems the most likely
NURSING EDUCATION ACCREDITATION 51
plan for the near future. This possibility will become even more viable if both regional and
national associations continue refinements in their process and increase the objectivity of an
admittedly subjective activity (p. 46).
These methods proposed by Harcleroad (1980) clearly demonstrate a preference for increased
state government involvement within the accreditation process. Harcleroad (1976) also spoke
about the use of educational auditing and accountability as an internal review to increase both
external accountability and internal quality. This concept is modeled after the auditing system
developed by the Securities and Exchange Commission (SEC) that was used to accredit financial
organizations (Harcleroad, 1976).
Another example of internal and external audits was demonstrated by the proposals in the
essay produced by three scholars (Graham, Lyman, & Trow, 1995). The essay was the result of a
Mellon Foundation grant funding the study of accountability of higher education institutions to
their three major constituencies (students, government, and the public) (Bloland, 2001). This
essay emphasized the notion that accountability had both an internal and external aspect and the
authors suggested that institutions conduct internal reviews (primarily within their teaching and
research units) every five to 10 years (Bloland, 2001). Once this internal review was completed,
an external review would then be conducted in the form of an audit on the procedures of the
internal review (Bloland, 2001). Specifically, this external audit would be conducted by regional
accrediting agencies while institutional accrediting agencies were encouraged to pay close
attention to the internal processes in order to determine if the institution has the ability to learn
and address its weaknesses (Bloland, 2001). These concepts surrounding auditing were later
explored by other authors and, most recently, have been linked to discussions regarding the future
of higher education accreditation (Bernhard, 2011; Burke & Associates, 2005; Dill, Massy,
NURSING EDUCATION ACCREDITATION 52
Williams, & Cook, 1996; Ewell, 2012; Ikenberry, 2009; Western Association of Schools and
Colleges, 1998; Wolff, 2005).
In examining alternatives to accreditation, it is important to note the alternative programs that
have been established by regional accreditors as enhancements to current accreditation processes.
For example, the Higher Learning Commission (an independent commission within the NCA)
established an alternative assessment for institutions that have already been accredited: the
Academic Quality Improvement Program (AQIP). According to Spangehl (2012), this process
instilled the notion of continuous quality improvement through the processes that would
ultimately provide evidence for accreditation. An example of AQIP offering continuous
improvement for higher educational institutions would be its encouragement of institutions to
implement the use of various categories (e.g., the Helping Students Learn category allows for
institutions to continuously monitor their ongoing program and curricular design) to stimulate
organizational improvement (Spangehl, 2012).
Another example of an alternative program is the use of the Quality Enhancement Plan
(QEP) by the SACS (Jackson, Davis, & Jackson, 2010; Southern Association of Colleges and
Schools, 2007). QEP was defined as an additional accreditation requirement that would help
guide institutions to produce measurable improvement in the areas of student learning
(Jackson, Davis, & Jackson, 2010). A few common themes of student learning that have been
utilized by institutions through the use of QEP include student engagement, critical thinking,
and promoting international tolerance (Jackson, Davis, & Jackson, 2010).
This section has offered a glimpse into the alternatives to accreditation that have been
proposed and implemented in the past. It is important to note that while accreditation has been
criticized by many, the general thoughts of many are that accreditation is a critical piece of
NURSING EDUCATION ACCREDITATION 53
academia and vital to accomplishing the goal of institutional quality assurance and accountability
(Bloland, 2001).
International Accreditation in Higher Education
The U.S. has developed a unique accreditation process (Brittingham, 2009). The most
obvious difference between the U.S. and other countries is the way education is governed. In the
U.S., education is governed at the state level where other nations are often governed by a
ministry of education (Ewell, 2008; Middaugh, 2012). Dill (2007) outlined three traditional
models of accreditation. These include “the European model of central control of quality
assurance by state educational ministries, the U.S. model of decentralized quality assurance
combining limited state control with market competition, and the British model in which the
state essentially ceded responsibility for quality assurance to self-accrediting universities” (p. 3).
These models have been used in some form by other nations in South America, Africa, and Asia.
Historically, direct government regulation (the European model) of higher education has been
the most prevalent form of institutional oversight outside of the U.S. (Dickeson, 2009).
Unfortunately, the low level of autonomy historically granted to post-secondary institutions
in European countries has limited their ability to effectively compete against institutions in the
U.S. and other countries (Dewatripont, Van Pottelsberghe, & Veugelers, 2010; Jacobs & Van
der Ploeg, 2006; Sursock & Smidt, 2010). Overall, European institutions "suffer from poor
governance, are insufficiently autonomous and offer often insufficient incentives to devote time
to research" (Dewatripont, Van Pottelsberghe, & Veugelers, 2010, p. 3). Many European
countries have a “very centralized” system of higher education, such as France, Germany, Italy,
and Spain (Van der Ploeg & Veugelers, 2008). In addition, the level of governmental
intervention inhibits European universities from innovating and reacting quickly to changing
NURSING EDUCATION ACCREDITATION 54
demands (Van der Ploeg & Veugelers, 2008).
Institutions in Europe with low levels of autonomy have had little to no control in areas
including hiring faculty, managing budgets, and setting wages (Aghion, Dewatripont, Hoxby,
Mas-Colell, & Sapir, 2008). Thus, it is difficult for universities with low autonomy to attract and
retain the faculty needed to compete for top spots in global ranking indices (Aghion,
Dewatripont, Hoxby, Mas-Colell, & Sapir, 2008; Dewatripont, Van Pottelsberghe, & Veugelers,
2010; Jacobs & Van der Ploeg, 2006).
However, some European nations have conducted serious reform to their higher education
systems, including Denmark, the Netherlands, Sweden, and the United Kingdom. Not
surprisingly, universities with high autonomy in these countries have higher levels of research
performance compared to European countries with low levels of institutional autonomy
(Dewatripont, Van Pottelsberghe, & Veugelers, 2010). This sentiment is echoed by Aghion,
Dewatripont, Hoxby, Mas-Colell, and Sapir (2008), who argue that research performance (which
impacts academic prestige and rankings) is negatively impacted by less institutional autonomy.
While research on accreditation’s direct impact on student learning outcomes is sparse,
Jacobs and Van der Ploeg (2006) argue the European system of greater regulation has some
benefits. They concluded that institutions in continental Europe had better access for students
with lower socioeconomic status, better outcomes in terms of student completion, and lower
spending per student.
Due to globalization, there is an increased focus on how to assure quality of standards in
higher education across nations. Assessment frameworks are being initiated and modified to
meet these increased demands for accountability (World Bank, 2002). Recent studies have tried
to compare these assessment trends across multiple countries.
NURSING EDUCATION ACCREDITATION 55
Bernhard (2011) conducted a comparative analysis of such reforms in six countries (Austria,
Germany, Finland, the United Kingdom, the United States, and Canada). Stensaker and Harvey
(2011) identified a growing trend that nations are relying on forms of accreditation distinctly
different from the U.S. accreditation processes. Specifically, they identified the academic audit
as an increasingly used alternative in countries such as Australia and Hong Kong. Hou (2014)
examined challenges the Asia-Pacific region faces in implementing quality standards that cross
national boundaries.
Another outcome of globalization is the internationalization of the quality-assurance process
itself. Rather than each nation setting its own assessment frameworks, international accords are
attempting to bridge academic quality issues between nations (Van Damme, 2000). Student
mobility across national borders has driven this need for “international mutual accreditation
networks” (Van Damme, 2000, p. 17). There are many additional loosely or unconnected
initiatives that have formed over the last decade.
There are several organizations currently addressing higher education accreditation on an
international level. The United Nations Educational, Scientific and Cultural Organization
(UNESCO) has begun the discussion on guidelines for international best practices in higher
education (UNESCO, 2005). The International Network for Quality Assurance Agencies in
Higher Education (INQAAHE) is a network of quality assurance agencies aimed to help ensure
cross-border quality assurance measures. Public policy-led initiatives in Europe include the
establishment of the “European Standards and Guidelines for quality assurance in higher
education (ESG) in the framework of the Bologna Process”
11
(Cremonini, Epping,
Westerheijden, & Vogelsang, 2012, p. 17). The CHEA International Quality Group (CIQG) also

11
The Bologna Process is an intergovernmental agreement of 29 European governments that wanted to reform the
European higher education system and develop equivalent national systems, created in 1999 (Keeling, 2006).
NURSING EDUCATION ACCREDITATION 56
provides a forum to discuss quality assurance issues in an international context (CHEA, 2014).
In conclusion, the U.S. system of accreditation has served as a model for higher education
assessment worldwide. Nonetheless, there are considerable differences in how other nations
govern quality assurance. While internationalization of the higher education accreditation
process will continue to increase, the precise frameworks used to achieve cross-national quality
standards remains undetermined. For the immediate future, nations will continue to use their own
frameworks for accreditation. Though, international accreditation processes may eventually
supersede these existing frameworks.
The Current State and Future of Accreditation
Accreditation in higher education is at a crossroads. Since the Spellings Commission report
was released in 2006, which called for more government oversight of accreditation to ensure
public accountability, the government and critics have begun scrutinizing a system that had been
nongovernmental and autonomous for several decades (Eaton, 2012). The U.S. Congress is
currently in the process of reauthorizing the Higher Education Act (HEA), and it is expected that
they will address accreditation head-on. All the while, CHEA and other accreditation supporters
have been attempting to convince Congress, the academy, and the public at-large of
accreditation’s current and future relevance in quality higher education.
In anticipation of the HEA’s reauthorization, NACIQI was charged with providing the U.S.
Secretary of Education with recommendations on recognition, accreditation, and student aid
eligibility (NACIQI, 2012). The committee advised that accrediting bodies should continue their
gatekeeping role for student aid eligibility, but also recommended some changes to the
accreditation process. These changes included more communication and collaboration between
accreditors, states, and the federal government to avoid overlapping responsibilities; moving
NURSING EDUCATION ACCREDITATION 57
away from regional accreditation and toward sector or mission-focused accreditation; creating an
expedited review process and developing more gradations in accreditation decisions; developing
more cost-effective data collection and consistent definitions and metrics; and making
accreditation reports publically available (NACIQI, 2012).
However, two members of the committee did not agree with the recommendations and
submitted a motion to include the Alternative to the NACIQI Draft Final Report, which
suggested eliminating accreditors’ gatekeeping role; creating a simple, cost-effective system of
quality assurance that would revoke financial aid to campuses not financially secure; eliminating
the current accreditation process altogether as means of reducing institutional expenditures;
breaking the regional accreditation monopoly; and developing a user-friendly, expedited
alternative for the re-accreditation process (NACIQI, 2012). The motion failed to pass, and the
alternative view was not included in NACIQI’s final report. As a result, Hank Brown, the
former U.S. Senator from Colorado and founding member of the American Council of Trustees
and Alumni, drafted a report seeking accreditation reform and reiterating the alternatives
suggested above, because accreditation had “failed to protect consumers and taxpayers” (Brown,
2013, p. 1).
The same year the final NACIQI report was released, the American Council of Education’s
(ACE) Task Force on Accreditation released its own report that identified challenges and
potential solutions for accreditation (ACE, 2012). The task force made six recommendations: a)
increase transparency and communication, b) increase the focus on student success and
institutional quality, c) take immediate and noticeable action against failing institutions, d) adopt
a more expedited process for institutions with a history of good performance, e) create common
definitions and a more collaborative process between accreditors, and f) increase cost-
NURSING EDUCATION ACCREDITATION 58
effectiveness (ACE, 2012). They also suggested that higher education “address perceived
deficiencies decisively and effectively, not defensively or reluctantly” (ACE, 2012, p. 8).
President Obama has also recently spoken out regarding accountability and accreditation in
higher education. In his 2013 State of the Union address, Obama asked Congress to “change the
Higher Education Act, so that affordability and value are included in determining which colleges
receive certain types of federal aid” (Obama, 2013a, para 39). The address was followed by The
President’s Plan for a Strong Middle Class and a Strong America, which suggested achieving
the above change to the HEA:
Either by incorporating measures of value and affordability into the existing accreditation
system or by establishing a new, alternative system of accreditation that would provide
pathways for higher education models and colleges to receive federal student aid based on
performance and results (Obama, 2013b, p. 5).
Furthermore, in August 2013, President Obama called for a performance-based rating system
that would connect institutional performance with financial aid distributions (Obama, 2013c).
Though accreditation was not specifically mentioned in his plan, it is not clear if the intention is
to replace accreditation with this new rating system or utilize both systems simultaneously
(Eaton, 2013b).
In November 2014, Senator Tom Harkin introduced legislation offering his version of the
Higher Education Act renewal (Field, 2014). In December 2014, NACIQI released its
recommendations for changes to higher education accreditation while the legislature mulls over
Harkin’s legislation and the HEA renewal (Inside Higher Ed, 2014). NACIQI recommended:
conversion of all accrediting agencies from regional to national; allowing for alternative
accrediting bodies; establishing common definitions across agencies; focusing more on wellness
NURSING EDUCATION ACCREDITATION 59
and affordability of institutions than on strict criteria compliance; allowing agencies to create
varying approval tiers; requiring self-certified data on key metrics; and providing differential
access to Title IV funds, eliminating the “all or nothing” system (Inside Higher Ed, 2014).
The President’s actions over the last year have CHEA and other supporters of
nongovernmental accreditation concerned. Calling it the “most fundamental challenge that
accreditation has confronted to date,” Eaton (2012) has expressed concern over the
standardization and increasingly regulatory nature of the federal government’s influence on
accreditation. Astin (2014) also stated that if the U.S. government creates its own process for
quality control, the U.S. higher education system is “in for big trouble” (para. 9), like the
government-controlled, Chinese higher education system. Plus, some higher education
organizations, such as the ACE and the National Association of Independent Universities and
Colleges, have concerns that Obama’s performance-based rating system will “create improper
incentives for institutions, undermine the value of higher education and cut off access to
institutions that serve low-income and underprivileged students” (Lederman, Stratford, &
Jaschik, 2014, para 5).
Though many agree there will be an inevitable increase in federal oversight after the
reauthorization of the HEA, supporters of the accreditation process have offered
recommendations for minimizing the effect. Gaston (2014) provides six categories of
suggestions, which include stages for implementation: consensus and alignment; credibility;
efficiency; agility and creativity; decisiveness and transparency; and a shared vision. The
categories maintain the aspects of accreditation that have worked well and that are strived for
around the world, – nongovernmental, peer review – as well as addressing the areas receiving the
most criticism. Eaton (2013a) added that accreditors and institutions must push for streamlining
NURSING EDUCATION ACCREDITATION 60
of the federal review of accreditors as a means to reduce federal oversight; better communicate
the accomplishments of accreditation and how quality peer-review benefits students; and
anticipate any further actions the federal government may take.
While the HEA undergoes the process of reauthorization, the future of accreditation remains
uncertain. There have been many reports and opinion pieces on how accreditation should change
and/or remain the same, much of them with overlapping themes. Only time will tell if the
accreditors, states, and the federal government reach an acceptable and functional common
ground that ensures the quality of U.S. higher education into the future.
Accreditation in Nursing Education
Similar to regional accreditation, nursing education accreditation is technically voluntary.
Though national accreditation of nursing programs is not linked to Title IV federal funding, it is
linked to the ability of program graduates to register for the national licensing exam that is
required to practice in each state. This section will explore the history of nursing accreditation in
the U.S., a comparison of the two federally recognized nursing education accreditors, the
accreditors’ use of the national licensing exam pass rates as measurements of learning outcomes,
the role of state boards of registered nursing in accreditation, and how recent changes in the U.S.
healthcare system may affect nursing program accreditors in the future.
History of Nursing Accreditation
Standardization of nursing curriculum has been around for several decades. In 1893, the
American Society of Superintendents of Training Schools for Nurses was founded to create
universal guidelines for nurse training (ACEN, 2013a; Kalisch & Kalisch, 1978), and in 1917,
the National League of Nursing Education published the Standard Curriculum of Schools of
Nursing (ACEN, 2013a; Kalisch & Kalisch, 1978). The National League for Nursing (NLN)
NURSING EDUCATION ACCREDITATION 61
was formed as the first accrediting body of nursing education, and the USDOE included it on its
list of recognized accrediting agencies in 1952 (ACEN, 2013a; Bellack, Gelman, O’Neil, &
Thomsen, 1999). The NLN accredited all types of nursing education, including baccalaureate
and graduate degree programs, associate degree programs, practical nursing programs, and
diploma programs (ACEN, 2013a). During the reauthorization of the Higher Education Act of
1992, new guidelines for accrediting agency recognition were mandated, and in 1995, the
USDOE cited the NLN for not complying with the new mandates, which included required
accreditation standards; inspections; institutional and programmatic monitoring; protocol for
systematic review; administrative staff; finances; evaluator training; and a system to control
inconsistent application of published standards (Bellack, Gelman, O’Neil, & Thomsen, 1999;
Overbay & Aaltonen, 2001). While the NLN struggled to meet the new USDOE requirements,
they developed an independent agency called the NLN Accrediting Commission (NLNAC) in
1997 (Bellack, Gelman, O’Neil, & Thomsen, 1999), which was renamed the Accreditation
Commission for Education in Nursing (ACEN) in 2013 (ACEN, 2013a).
Concurrently with the NLN reorganization, concerns about nursing accreditation began to
emerge. Not unlike the criticisms of the regional accrediting agencies, there were questions
about the benefits of accreditation relative to the costs (CCNE, 2009), as well as concerns
brought up by the National Task Force of Health Professions Education Accreditation about the
process being “complex and inefficient, focusing more on rigid compliance with arcane rules
than on improving the quality of educational programs that graduate new health professionals”
(UCSF, 1999, para 4). The task force added that part of the problem was the volume of health
professional accrediting agencies, all with varying criteria (UCSF, 1999). In addition to these
concerns, higher education was moving towards assessment of student learning outcomes, and so
NURSING EDUCATION ACCREDITATION 62
too was nursing education. Many in nursing education felt that accreditation needed to be altered
to reflect these emerging issues and new trends (CCNE, 2009). As a result, members of the
American Association of Colleges of Nursing (AACN) began exploring the potential of creating
a new accrediting body that would serve as an umbrella agency for all the subspecialty
accreditors (i.e., midwifery, anesthesia, nurse practitioner) and focus entirely on baccalaureate
and graduate-level nursing programs; and in 1996, the Commission on Collegiate Nursing
Education (CCNE) was formed (Bellack, Gelman, O’Neil, & Thomsen, 1999; CCNE, 2009).
In September 2013, the NLN announced the creation of a third national accrediting agency
for nursing education – the Commission for Nursing Education Accreditation (CNEA) (NLN,
n.d.). The impetus for this decision was the NLN’s move to Washington D.C. and subsequent
reorganization (NLN, n.d.). The NLN plans to operate both the CNEA and the ACEN as
separate entities, with the CNEA being a division within the NLN and the ACEN being a wholly
owned subsidiary (NLN, n.d.). The CNEA will accredit all types of nursing education programs,
including associate, bachelors, masters, and doctor of nursing practice degree programs, as well
as vocational and diploma programs. However, the CNEA will be classified as a USDOE
category two agency, which means it will only accredit programs not acting as gatekeepers for
HEA Title IV financial aid (NLN, n.d.). The CNEA is currently under development, and it will
not begin accrediting nursing programs until late 2015.
Comparison of the ACEN and CCNE
For almost half a century, the NLN was the only accrediting body of nursing education in the
U.S. until the CCNE began accrediting programs in 1998, giving nursing programs a choice of
accrediting agencies. Though their overall missions are the same – ensuring a quality nursing
education as a means of ensuring quality patient care (ACEN, 2013; CCNE, 2013; UCSF, 1999)
NURSING EDUCATION ACCREDITATION 63
– there are some subtle differences in how the ACEN and CCNE approach accreditation
requirements. The ACEN has six standards that measure “quantity, extent, value, and quality”
(ACEN, 2013a, p. 10). These six standards include (a) mission and administrative capacity – a
nursing program’s mission reflects the core values of the governing organization and it has the
administrative ability to effectively run a nursing program, (b) faculty and staff – there are
sufficient numbers of qualified faculty and staff to achieve learning outcomes and support the
program, (c) students – policies and student services ensure successful achievement of learning
outcomes, (d) curriculum – courses help the achievement of student learning outcomes and
ensure safe healthcare practice, (e) resources – enough financial, physical, and educational
resources to ensure achievement of learning outcomes, and (f) outcomes – program assessments
show that students are meeting learning outcomes (ACEN, 2013b).
The CCNE has four standards that “serve as the basis to evaluate the quality of the
educational program offered and to hold the nursing program(s) accountable to the educational
community, the nursing profession, and the public” (CCNE, 2013, p. 5). The four standards
include (a) program quality: mission and governance – the goals and mission align with the
governing organization, the nursing profession, and community in which it serves, (b) program
quality: institutional commitment and resources – the governing organization shows an ongoing
commitment and support to the nursing program, (c) program quality: curriculum and teaching-
learning practices – the curriculum is created to align with the goals and mission of governing
organization, the nursing profession, and community in which it serves, and that teaching-
learning practices promote achievement of learning outcomes, and (d) program effectiveness:
assessment and achievement of program outcomes – the program is able to fulfill its goals and
mission by showing it successfully achieves the learning outcomes (CCNE, 2013).
NURSING EDUCATION ACCREDITATION 64
Measuring Student Learning Outcomes
As is evident by the descriptions of each agency’s standards, there is a primary focus on
student learning outcomes. Plus, in the ACEN’s standard #6 and the CCNE’s standard #4, one
means they discuss for measuring student learning outcomes is through the pass rates on the
national licensing exam – the National Council Licensure Examination for Registered Nurses
(NCLEX-RN) (ACEN, 2013; CCNE, 2013). Unlike knowledge-based exams, the NCLEX
examines how potential nurses use skills gained in their training programs to critically think and
make appropriate nursing judgments (Kaplan, n.d.). It was designed to protect the public by
ensuring that licensed nurses have a minimal level of competence (Morrison, 2005). However,
the NCLEX was not designed for curriculum assessment; though, it is reasonable to consider that
since the exam measures nursing competencies obtained while in a training program, it therefore
indirectly measures the quality of that training program (Morrison, 2005).
The Role of State Boards of Nursing and Changes to U.S. Healthcare
The NCLEX is administered through each state’s Board of Registered Nursing (BRN). For
example, in the state of California, a potential examinee must have graduated from a BRN-
approved nursing program to be eligible to sit for the exam (California Board of Registered
Nursing, 2013). Though most of California’s BRN-approved nursing programs are also
nationally accredited, not all of them are, as it is not currently a national or state requirement
(except for the state of Minnesota) (NCSBN, 2012). However, in 2011, the National Council of
State Boards of Nursing (NCSBN) recommended requiring accreditation of all prelicensure
nursing programs by 2020, because it “ensures that national standards are achieved at each level
of education, thus promoting articulation to the next level” (NCSBN, 2012, p. 1). The NCSBN
reached this conclusion after the industry-altering report – The Future of Nursing: Leading
NURSING EDUCATION ACCREDITATION 65
Change, Advancing Health – by the Institute of Medicine (2010), which called for increasing the
number and advanced roles of nurses in healthcare in response to the Affordable Care Act of
2010. The IOM (2010) report included accreditation agency involvement in four of its eight
recommendations: (a) they should be involved in creating nurse residency programs that support
nurses’ transition into practice, (b) they should require nursing programs to create more defined
and easier pathways to higher degree attainment, (c) they should monitor each nursing program
to ensure that at least 10% of their graduates advance into master’s or doctoral degree programs
within five years, and (d) they should require demonstrated competencies that show
compassionate care across the lifespan (IOM, 2010).
Nursing accreditation has been relatively dynamic over the past 15 years. Creating
competition and allowing choice between nursing education accreditors should ultimately benefit
the nursing programs. Though, the imminent changes to the U.S. healthcare system due to the
influx of newly insured patients from Affordable Care Act and the IOM-recommend increase of
baccalaureate-prepared nurses from 50% to 80% by 2020 (IOM, 2010) will challenge nursing
programs and accreditors alike. The role accreditors will play in aiding nursing programs to
increase not just nursing program graduates, but graduates that successfully pass the national
licensure exam and safely begin nursing practice is yet to be determined.
Conclusion
This chapter provided an overview of regional higher education accreditation in the U.S. It
reviewed its long history with and effects on institutions of higher education. It discussed its
past and continued struggles to prove its legitimacy in quality assurance, particularly with regard
to student learning outcomes, while others offer alternatives to the current system. Plus, the
NURSING EDUCATION ACCREDITATION 66
chapter reviewed accreditation’s current state of uncertainty while awaiting the reauthorizing of
the Higher Education Act.
Furthermore, this chapter concluded with a summary of nursing education accreditation. It
discussed the history, development, and comparison of two nursing education-accrediting
agencies, the ACEN and CCNE. It also reviewed the agencies’ use of NCLEX pass rates as a
measurable student learning outcome, as well as potential changes to the nursing profession and,
thus, to the accrediting agencies, as a result of the Affordable Care Act of 2010.
The remainder of this report will focus on the opinions of nursing programs regarding
accreditation standards, as measured by first-time NCLEX pass rates, in particular.

NURSING EDUCATION ACCREDITATION 67
CHAPTER THREE: METHODOLOGY
The purpose of this study was to explore California nursing school administrator perspectives
on CCNE and ACEN accreditation requirements, particularly first-time NCLEX-RN pass rates.
The evaluation will attempt to answer the following research question about nursing program
accreditation: Are there any common themes in the opinions of nursing school administrators
regarding CCNE or ACEN accreditation and their quality standards?
The method used to answer this research question was a qualitative, narrative design
where the nursing school administrators were asked to provide their opinions and stories of
their experiences with nursing school accreditation and NCLEX pass rates (Creswell, 2009).
The analysis of the interview responses included these stories retold by the researcher
combined with researcher’s view of accreditation (Creswell, 2009).
Sample and Population
A convenience sample of those nursing program administrators willing to be interviewed
and provide information on their opinions of accreditation and their quality standards, such as
NCLEX success, was used. A former supervisor introduced the researcher to contacts in
several of the nursing programs. The researcher also used personal contacts for introductions
in other nursing programs. Nine nursing programs were contacted for interviews – two did
not respond to the requests and one had a lengthy approval process that did not fit within the
research timeframe. The final sample consisted of six nursing programs that included two
four-year public institutions, two two-year community colleges, one private institution, and
one for-profit institution. (See Table 1 in Chapter Four for a complete list.)

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Instrumentation
This study used structured, open-ended questions to interview the nursing school
administrators. The interviews allowed opportunities for participants to explain a situation
using their own perspective (Stringer, 2007). Using the research question as a guide, the
interview questions were generated using the following guidelines: (a) questions were open-
ended, (b) questions were neutrally worded, (c) questions were worded clearly, and (d) only
one question was asked at a time (McNamara, 2009). A pilot test was then performed on the
questions using a small group of nursing faculty, chosen because of their similar interest and
experience with nursing accreditation (Turner, 2010) and personally known to the researcher.
The pilot test identified limitations that required refinement of the interview questions and
study design before interviewing the nursing program administrators (Kvale, 2007).
Data Collection
Data were obtained through voice recordings and field notes of interviews of the nursing
school administrators involved in accreditation. Using Creswell’s (2007) interview protocol,
the interviewer introduced herself, the administrators were told the purpose of the interview
and how the interview data would be used, and then they were provided with their rights and
informed consent to participate (see Appendix A for the interview protocol). Each
administrator was asked the same open-ended questions, which allowed him/her to provide as
much or as little detail as they felt comfortable providing (see Appendix B for the list of
interview questions). Additional probing questions were asked to obtain deeper and more
detailed answers to the questions (Turner, 2010). The goal of the interviews was to obtain
nursing school administrators’ opinions of the accreditation process and its quality standards
through an “informal conversation” (Stringer, 2007, p. 69).
NURSING EDUCATION ACCREDITATION 69
Data Analysis
Data were obtained through qualitative analysis of the interview responses. The question
responses were transcribed from the voice recordings and field notes, and then the text was
coded to identify similarities and differences between and/or unexpected opinions of the
directors regarding accreditation, their standards, and the BRN. Coding is a way of organizing
text into segments, then assigning labels to the segments of text and grouping the text by each
label, referred to as themes (Creswell, 2009). Five themes were identified in this study: (a)
national and state standards, (b) self-assessment and reflection, (c) accreditation staff, (d)
importance of the NCLEX, and (e) choice of accrediting agencies. These five themes bring
greater meaning to the data collected.

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CHAPTER FOUR: RESULTS

The focus of this study was to explore California nursing school administrators’ perspectives
on CCNE and ACEN accreditation standard requirements, such as first-time NCLEX-RN pass
rates. The evaluation attempted to answer the following research question about nursing
program accreditation: Are there any common themes in the opinions of nursing school
administrators regarding CCNE or ACEN accreditation and their quality standards?
Programs
Six nursing programs located in California agreed to be interviewed for this study. Each
program was assured anonymity and, thus, assigned a pseudonym. School A and School B were
located in public, four-year institutions offering bachelors (BSN) and masters (MSN) degrees in
nursing, and in School B’s case, also offering a doctoral (DNP) degree; School C and School D
were located in public, two-year institutions offering an associate degree in nursing (ADN);
School E was a private, non-profit institution offering BSN, MSN, and DNP degrees; and School
F was located in a private, for-profit institution offering BSN degrees (see Table 1).
Participants
An administrator or faculty member of the nursing program was interviewed at each site. At
School A, the interviewee was a professor emerita and former director of the school. At School
B, the interviewee was an associate professor and coordinator of the pre-licensure nursing
program. At School C, the interviewee was the assistant dean for the college. At School D, the
interviewee was the associate dean for the division. At School E, the interviewee was the
department chair. Moreover, at School F, the interviewee was the dean of the school.

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Table 1
Institution Identifier, Type of Institution, Degrees Offered, and Accrediting Agency of
Participating Nursing Programs

Institution Type Degrees Agency
A

Public, Four-Year BSN, MSN CCNE
B

Public, Four-Year BSN, MSN, DNP CCNE
C

Public, Two-Year ADN ACEN
D

Public, Two-Year ADN None
E

Private, Non-Profit BSN, MSN, DNP CCNE
F For-Profit BSN CCNE
Note. BSN = Bachelor of Science in Nursing; MSN = Master of Science in Nursing; DNP = Doctor of Nursing
Practice; ADN = Associate Degree in Nursing; CCNE = Commission on Collegiate Nursing Education; ACEN =
Accreditation Commission for Education in Nursing

Results
In answering the research question, common themes did emerged in the opinions of nursing
administrators regarding nursing education accreditation and their quality standards, like the
NCLEX. Three surprising observations were made during the interviews with administrators of
six California nursing programs: (a) all six programs agreed that accreditation of some kind was
a positive thing, (b) all six programs agreed that the NCLEX is necessary and the only accurate
measurement of entry-level nursing skills, and (c) all six programs had differing opinions and
levels of knowledge about the third and new accrediting agency, the Commission on Nursing
Education Accreditation (CNEA). Qualitative analysis of the interview transcripts revealed five
commons themes of their opinions regarding nursing accreditation: (a) national and state
standards, (b) self-assessment and reflection, (c) accreditation staff, (d) importance of the
NCLEX, and (e) choice of accrediting agencies. Below is a discussion, including original
NURSING EDUCATION ACCREDITATION 72
insights, using themes one, two, and three to address observation one, theme four to address
observation two, and theme five to address observation three.
Observation One
All six nursing program administrators interviewed agreed that accreditation was important
to nursing education. Three themes from the interviews provided support for its importance.
The first are the national and statewide standards that accreditation provides for the nursing
profession. The second theme is the continual program evaluation and improvement plans
required by accrediting agencies that ensure ongoing nursing program quality. Furthermore, the
support and guidance provided by accrediting agency staff to ensure high standards and
educational quality is the third theme.
Theme one: National and state standards. All administrators had a similar reason for why
accreditation and/or state nursing board approval are important – maintaining nursing standards
across a national and state level. Both national accrediting agencies, CCNE and ACEN, have
four and six national standards respectively (see Appendices D and E for a list of each standard)
for nursing programs, which require measurement of student learning outcomes, including
NCLEX pass rates, in standards number 4 and 6, respectively. School A administrator stated that
these student learning outcome standards are important for evaluating “quality and consistency
of programs in terms of national standards” (School A, personal communication, October 9,
2014) and ensuring the nursing profession is uniform from state to state, “that we have standards
– from New York to California – people understand that the…rigor of the education and the
expectations of that education, that they’re there” (School B, personal communication, October
8, 2014). Plus, “the standard that looks at curriculum is CCNE’s way of ensuring your students
are successful on the [NCLEX]” (School F, personal communication, October 14, 2014). The
NURSING EDUCATION ACCREDITATION 73
standards determined by accrediting agencies are important for nursing education because they
provide consistent requirements on a national scale that help ensure their students are successful
on the NCLEX exam.
Furthermore, three administrators emphasized the importance of following “the essentials” –
The Essentials of Baccalaureate Education for Professional Nursing Practice – created by the
American Association of Colleges of Nursing (2008), a national organization for baccalaureate
and graduate-level nursing programs, which also oversees the CCNE. The essentials serve to
“transform baccalaureate nursing education by providing the curricular elements and framework
for building the baccalaureate nursing curriculum for the 21
st
century” (AACN, 2008, p. 3).
There are nine essentials, which include (a) liberal education for baccalaureate generalist nursing
practice, (b) basic organizational and systems leadership for quality care and patient safety, (c)
schedule for evidence-based practice, (d) information management and application of patient
care technology, (e) health care policy, finance, and regulatory environments, (f)
interprofessional communication and collaboration for improving patient health outcomes, (g)
clinical prevention and population health, (h) professionalism and professional values, and (i)
baccalaureate generalist nursing practice (AACN, 2008, pp. 3-4). As the School B administrator
(personal communication, October 8, 2014) remarked, “We use the essentials as our framework
for our student learning outcomes.” The School F administrator (personal communication,
October 14, 2014) added, “I see CCNE and the BSN essentials…as the guidelines so that
everyone is on the same playing field.” Plus, the School E administrator (personal
communication, October 14, 2014) stated, “The [BRN], they don’t ask for the essentials per se,
but if you don’t stick to those essentials, you’re not going to meet what’s necessary.” The
essentials, though not created by the accreditors, are important to nursing education as they
NURSING EDUCATION ACCREDITATION 74
provide a national framework for the BSN degree that fulfills the accreditation standards, and
they ensure a consistent, quality education nationwide.
On the state level, the California Board of Registered Nursing (BRN) approves all nursing
programs operating within the state. BRN approval is required for a nursing program to operate;
however, national nursing accreditation is currently optional. The BRN oversees and enforces
the regulations for nursing education and safe practice within the state, upholding the Nursing
Practice Act (BRN, 2013c). In addition, the BRN manages the NCLEX exam for the state and
dictates which nursing school graduates may or may not sit for the exam, as well as monitors the
first-time NCLEX pass rates for each nursing program (BRN, 2013a). As the School B
administrator stated (personal communication, October 8, 2014), BRN program approval “shows
that they are in a program that meets the minimal guidelines for the State of California, they are
eligible to take the licensing exam.” The administrators interviewed believed that the national
accrediting bodies and the California BRN served similar, but complimentary roles. “The BRN
focuses more on curriculum,” including “the content and where it’s taught” (School C, personal
communication, October 9, 2014). According to the School D administrator, the BRN “has a lot
of standards we need to meet. Basically, their standards are similar to the national standards”
(personal communication, October 8, 2014).
Though accreditation is voluntary, BRN approval is required, ensuring standards within each
of the states, upholding the laws for safe nursing practice, and determining who can take the
NCLEX. There is some overlap of requirements between accreditors and the BRN, but
ultimately each serve complimentary roles in nursing education.
All three elements – national accreditation, the BSN essentials, and the state-level BRN –
have important roles in maintaining the standards of nursing education across programs and
NURSING EDUCATION ACCREDITATION 75
across states. These standards, both national and statewide, not only require the establishment
and assessment of student learning outcomes for each program, but also help to ensure successful
first-time pass rates on the NCLEX.
Theme two: Self-assessment and reflection. Another aspect that supports accreditation’s
importance to nursing education was the required, periodic program evaluation that ensures
continual program improvement. Whether the national accrediting agencies, the BRN, or the
university/college that houses the nursing program, they require some form of programmatic
assessment. All nursing administrators interviewed expressed the importance of these required
assessments to keep them ever mindful of their program quality, to bring their faculty together in
a collaborative manner, and for constant program improvement.
The national accrediting agencies require self-studies every 10 years or sooner, depending on
a program’s status with the agency, as well as annual and mid-cycle continuous improvement
progress reporting (ACEN, 2013a; CCNE, 2012). The BRN requires a continuing approval self-
study report every five years, also with annual reporting (BRN, 2012). Moreover, the
colleges/universities require each department to prepare a program review ranging from annually
in some community colleges to six or more years in the four-year institutions (School A,
personal communication, October 9, 2014; School C, personal communication, October 9, 2014;
School D, personal communication, October 9, 2014). These periodic reports “give [the
programs] focus…[and]…make [the programs] look at everything” (School C, personal
communication, October 9, 2014); “look for ways to improve” (School A, personal
communication, October 9, 2014); and “keep everyone on top of their game” (School E, personal
communication, October 14, 2014). As the School F administrator (personal communication,
October 14, 2014) stated, “Going through that process is going to help you see where you might
NURSING EDUCATION ACCREDITATION 76
have some deficiencies in your curriculum or deficiencies with your faculty…that helps you to
reflect when [the accrediting agency] bring[s] this to your attention.”
Another positive aspect of required self-assessment is the collaboration of faculty and
administrators during the review process. It encourages everyone to get involved in writing the
self-study or program review, it requires them to really think about things, and helps them to
truly learn all about the program in which they are employed (School C, personal
communication, October 9, 2014). It helps faculty and administrators work more closely as a
team as they prepare the final report (School D, personal communication, October 9, 2014).
For programs with deficiencies, they are required to complete a success or action plan for
correcting any issues (California Code of Regulations, n.d.). For example, if a nursing
program’s NCLEX pass rates drop below 80% for national accreditors (ACEN, 2013b; CCNE,
2012) or 75% for BSN regulations (California Code of Regulations, n.d.) for three consecutive
years, the program will be placed on probation, and they must write a plan for any changes they
will make (i.e., to the curriculum, faculty, or student remediation) to increase their pass rates in
subsequent years (California Code of Regulations, n.d.; School B, personal communication,
October 8, 2014). After the program submits its success plan, they will be “reevaluated every six
months to a year” (School F, personal communication, October 14, 2014). As the School F
administrator (personal communication, October 14, 2014) added, “If you don’t have someone
that you’re reporting to you might continue to be lax about it.”
Being held accountable by accrediting agencies and the BRN constantly “forces [programs]
to collect data, to look at data, and to look for ways to improve” (School A, personal
communication, October 9, 2014). Reflecting on maintaining or improving nursing programs in
NURSING EDUCATION ACCREDITATION 77
a regulated manner is important for ensuring nursing programs provide a quality education that
produces safe nurses and leads to successful first-time pass rates on the NCLEX.
Theme three: Accreditation staff. The final aspect of accreditation’s importance in nursing
education is their supportive staff that helps ensure standards and educational quality. Both the
national accrediting agencies and the California BRN have limited numbers of staff to advise all
the accredited and approved programs in the nation and the state of California, respectively.
Despite this, the majority of the interviewees had a very positive relationship with the agency
and BRN staff, with the exception of a few suggestions for process improvement.
Five administrators expressed how helpful and responsive the staff has been guiding them
through the accreditation and re-evaluation process. “They are very helpful if you ever have to
call and talk with them, if you have any concerns or need additional information or assistance in
meeting the requirements” (School A, personal communication, October 9, 2014). The School D
(personal communication, October 9, 2014) administrator added, “I could call them up, email
them, and they’ll be on board with me to try and figure out things.” The School E administrator
(personal communication, October 14, 2014) added, “The educational consultants are excellent,
they could not have been more helpful.” “I think that they help you and they guide you by
keeping the standards high” (School F, personal communication, October 14, 2014). In addition,
one of the sites mentioned not only how well they train their own staff, but that they provide
workshops to train nursing program staff, as well (School A, personal communication, October
9, 2014).
On the other hand, three of the administrators felt there were a couple things the agency and
the BRN staff could improve upon. The first being more consistent between and among
accreditation site visitor evaluations. Site visitors are volunteers from various nursing education
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programs across the country who have received on-site evaluator training (ACEN, n.d.; CCNE,
2012) and who, sometimes, bring their “own agendas” (School B, personal communication,
October 8, 2014) to the site visit. “Some are just different. Like, one will want it this way, and
then you have a new one later and she wants it this way” (School D, personal communication,
October 9, 2014). Another suggestion was that the accreditation staff needs to provide more
clarity on the standards. “They need to be clearer in what they really want, and I think a little
more concise” (School C, personal communication, October 9, 2014). Furthermore, another site
stated that the accreditors ask for information that is difficult to obtain without clear guidance on
how to obtain it (School D, personal communication, October 9, 2014). For example, in addition
to obtaining percentages of students employed, accreditors want satisfaction surveys from both
the graduate/employee and the employers (ACEN, 2013b; CCNE, 2012), “They want to know
what the employee [and] what the employers think” (School D, personal communication,
October 9, 2014). However, as School C (personal communication, October 8, 2014) mentions,
“Employers do not keep track of where a student comes from when they hire them. So we
have to do it by calling them, or we actually ask [the students] where they work on their
survey, but that’s six months out. Some of them aren’t even hired until nine months out
now.”
Thus, providing some guidance or developing some process on the best means to obtain
employee/employer satisfaction data would be helpful to the programs.
Having a positive and productive relationship with the accreditation and BRN staff is critical
for obtaining and keeping a program’s accreditation and approval status. They are helpful at
guiding programs through the proper curriculum in the proper sequence and hiring appropriately
trained faculty to teach the curriculum effectively and at ensuring the programs’ students are
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ultimately successful on the NCLEX exam. The majority of the nursing administrators had
extremely positive sentiments and experiences with the accreditation and the BRN staff, though
there were some areas where they felt accreditation staff could improve: more consistency
among how the evaluators assess each program, plus, more clarity on the standards and how to
go about obtaining the required information.
All of the nursing program administrators interviewed felt that accreditation was important
for nursing education and the profession. This was surprising to the researcher due to the general
dissatisfaction by the Obama Administration, as well as others in the government and in
academia, with non-governmental accreditation and its seeming inability to ensure educational
quality (Brown, 2013; Commission on the Future of Higher Education, 2006; Obama, 2013a;
Obama, 2013b; Obama, 2013c). There have also been concerns over the rising costs to maintain
accreditation throughout the years (ACE, 2012; NACIQI, 2012), and, considering that
accreditation is voluntary and that programs need only be BRN approved to legally operate, it
was surprising that the nursing programs felt that both oversight agencies are necessary and
worth the added expense to ensure the standards. Despite this, the administrators’ believed that
the quality of the nursing profession hinges on maintaining a certain minimum national and
statewide standard of excellence in nursing education, making accreditors’ role an important
component in ensuring successful NCLEX pass rates and, thus, knowledgeable and safe
practicing nurses to meet growing market demands. They also believed that periodic self-
assessment required by the accreditors was important for maintaining the quality of their
programs, creating a more collaborative environment with their faculty, and ensuring continual
program improvement. Finally, and even though they had suggestions for improvement, the
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administrators felt the support and guidance provided by the accreditation staff had been
invaluable to successfully meeting and maintaining the accreditation standards.
Observation Two
All six nursing program administrators agreed that the NCLEX is a necessary and accurate
measure of safe, entry-level nursing skills, despite some negative opinions about use of the first-
time pass rates as an accreditation and BRN standard. Interviews with the administrators
revealed theme four: the importance of the NCLEX, which includes the opinions of the NCLEX
in general, the use of first-time pass rates as a student learning outcome, and predictors of
success on the exam.
Theme four: Importance of the NCLEX. The first-time NCLEX pass rates are
accreditation student learning outcome standards for CCNE and ACEN, as well as the BRN
(ACEN, 2013b; BRN, 2013a, CCNE, 2012) and have become the “gold standard” in defining
nursing program quality (Giddens, 2009, p. 1), which influence “important decisions about
overall program quality, admission and progression policies, curricula, and teaching and learning
practices (Taylor, Collette, & Reyes, 2014, p. 363).” Thus, it was no surprise that many of the
administrators had strong opinions, both positive and negative, of the importance of the NCLEX
in general, the use of first-time pass rates as a student learning outcome, and predictors of
success on the exam.
Four of the sites interviewed had some negative opinions or concerns about the NCLEX,
particularly the use of the first-time pass rate to evaluate nursing programs. One person bluntly
said, “I hate first-time pass rates” (School B, personal communication, October 8, 2014).
Another stated, “To me, the first-time pass rate is not the be all and end all” (School A, personal
communication, October 8, 2014). School E (personal communication, October 14, 2014) said
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she warns her students that approximately 15% of them will not pass the first time, “Some
people just don’t test well the first time. I don’t want students to feel bad” (School E, personal
communication, October 8, 2014). Another interviewee felt the NCLEX should not be used as an
outcome, “It’s something you want your students to do and to achieve, but it’s not a curriculum
that can be built on teaching to the test, because there’s so much more in nursing” (School B,
personal communication, October 8, 2014). Another school reiterated that sentiment, stating, “I
don’t even think we need to be…regulated on the pass rates…because that’s what we are striving
for” (School C, personal communication, October 9, 2014).
Current research by Taylor, Loftin, and Reyes (2014) reinforces these negative sentiments
about use of first-time NCLEX pass rates when they write,
“By continuing to rely on a simple percentage of success on the first attempt as an indicator
of quality nursing programs, the profession is missing the opportunity to understand the
complexity of the NCLEX-RN testing experience. In addition, persistent use of this metric
also perpetuates unintended negative consequences for graduates who fail on the first and the
programs from which they graduate (p. 338).”
The authors added that their research showed no evidence that students who failed the first
attempt, but past during subsequent attempts were any less safe as practicing nurses than those
students who passed the NCLEX during the first attempt (Taylor, Loftin, & Reyes, 2014).
Despite the unfavorable opinions of the first-time NCLEX pass rates, the administrators
agreed it is the only and most effective way to measure whether a student learned the appropriate
knowledge and skills to be a safe, practicing nurse.
There’re a lot of people who are saying it’s okay if we [take the NCLEX] two times…I
don’t mind that. We have to have some stop-gate especially if programs aren’t really
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making sure that those that are being educated are at the ability to reasonably pass the
exam…(School E, personal communication, October 14, 2014).
The School D administrator (personal communication, October 9, 2014) added, “The goal is to
pass the NCLEX and become a licensed nurse and practice. The only way we can [measure] it is
with a test.”
Due to the importance placed on the NCLEX, ensuring student success on the exam is
critical. All administrators interviewed agreed it is the responsibility of the program, and not the
accrediting agency, to ensure successful first-time pass rates on the NCLEX. There were three
important areas discussed in the interviews where they could most effectively achieve this: the
curriculum, third-party testing services, and admissions requirements.
Though the accrediting agencies, the BSN essentials, and the BRN dictate the types of
courses that need to be covered, the specific content of the curriculum via textbooks and course
materials can vary by program. In order for nursing program students to be successful on the
NCLEX, the curriculum “has to match up with your competencies…then your curriculum should
be based on the NCLEX test map…it really follows the nursing process” (School E, personal
communication, October 14, 2014). The literature supports curriculum alignment with the
NCSBN NCLEX-RN Detailed Test Plan (2013) for better preparing students to pass the NCLEX
on the first attempt (Carr, 2011; Davis, 2011). The Test Plans “serve as blue prints to outline the
content to be tested [on the NCLEX] (NCSBN, 2013, para 1).”
Three of the programs mentioned their use of third-party testing services that align with their
curriculum to increase the likelihood of their students passing the NCLEX. Third-party testing
services include ATI Nursing Education, Kaplan Nursing, and Health Educational Systems, Inc.
(HESI) and provide course-specific testing to track students’ performance throughout the
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program, provide remediation, and offer NCLEX test preparation (Assessment Technologies,
Inc., 2014a; Elsevier, 2014; Kaplan Nursing, n.d.a.). For example, ATI has the Content Mastery
Series that provides review and remediation of NCLEX content-specific topics and includes case
studies and critical thinking exercises. Scoring at least a 65% on the ATI practice exams equates
to at least a 90% chance of passing the NCLEX the first time (Holstein, Zangrilli, & Taboas,
2006). “We use ATI Content Mastery…throughout the program” (School C, personal
communication, October 9, 2014). “We use Kaplan to help our students…they use it in class, so
they…get used to the NCLEX, and it looks just like the NCLEX” (School D, personal
communication, October 8, 2014). The third party testing is also used to predict which students
will not pass the NCLEX. “If you gave a computerized predictor test using a program, such as
ATI [or HESI], you need a certain benchmark to be predictive [of doing] well on [the] NCLEX”
(School E, personal communication, October 14, 2014). “Those that had…a level one
competency or below [on the ATI exams] throughout, especially [in Medical-Surgical] courses
did not pass [the NCLEX]” (School C personal communication, October 9, 2014). Research on
the HESI Exit Exam (E
2
) showed that it is “highly predictive of NCLEX-RN success (Langford
& Young, 2013, p. S9)” with a predictive accuracy of 98.3% (Langford & Young, 2013).
However, two program administrators felt that predicting a student’s success or failure on the
NCLEX can be determined before they are admitted into the program. The School D
administrator (personal communication, October 9, 2014) felt, “The criteria to get it into the
program will really determine who is going to make it or not.” “The predominant area [of
predictors for NCLEX success are] the entrance [requirements]. [The research] very clearly
shows that the students that have risk factors…will not do well in progression, as well as [on] the
NCLEX…”(School E, personal communication, October 14, 2014). The School D administrator
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(personal communication, October 9, 2014) added, “They started doing studies. They found out
anyone with a 2.0 [GPA] will not pass nursing school, and if they do, they will not pass the
NCLEX.” Supporting these ideas, research by Breckenridge, Wolf, and Roszkowski (2012)
showed that a predictive instrument – the Risk Assessment Profile and Strategies for Success
Instrument – were able to significantly predict first-time pass rates on the NCLEX based on three
risk factors: poverty or non-poverty, GPA of science courses, and if the student had to repeat any
science courses.
There are many schools admitting students without ensuring their predictive ability to pass
the exam with the use of an admissions entrance exam, such as the Test of Essential Academic
Skills (TEAS) (Assessment Technologies, Inc., 2014b) or the NLN Pre-Admissions Exam (PAX)
(NLN, n.d.). Research by Crow, Handley, Morrison, and Shelton (2004) found a positive
relationship between nursing admissions entrance exam scores and success or failure on the
NCLEX. “If there is no way they have a chance to pass the [NCLEX], I call that a social
injustice” (School E, personal communication, October 14, 2014). The School D administrator
(personal communication, October 9, 2014) added, “Just weed out the ones who would never
pass.”
All nursing program administrators felt that the NCLEX was the only true and objective way
to measure a nursing student’s ability to be a safe, entry-level nurse. This was surprising to the
researcher, as nursing requires hands-on, real-time skills, not directly measured by the NCLEX,
and the researcher thought more administrators would suggest clinical skills testing with direct
patient (or simulated patient) care, such as objective structured clinical examination (Mitchell,
Henderson, Groves, Dalton, & Nulty, 2009). However, admittedly, this kind of testing is
difficult to measure truly objectively (Cant, McKenna, & Cooper, 2012). Until a more practical
NURSING EDUCATION ACCREDITATION 85
exam can be developed, the NCLEX is the best way to measure a nursing student’s critical
thinking in nursing-based scenarios. However, whether or not the accreditors and/or the BRN
should only look at the first-time NCLEX pass rate appears to be up for debate (Taylor, Loftin,
& Reyes, 2014). Regardless, the onus is on the nursing programs to ensure successful students
whether by providing a solid curriculum that aligns with the NCLEX test content, determining
ahead of time if certain students are inherently capable of passing nursing courses, as well as the
NCLEX exam, and/or either providing remediation or not admitting them in the first place.
Observation Three
The third observation was that all six programs had varying levels of knowledge and few
common opinions regarding the advent of a third accreditation agency for nursing education.
Interviews with the administrators revealed the fifth theme: choice of accrediting agencies. The
addition of a third choice of accreditors would seem like a positive thing, though the varying
opinions of the administrators might imply otherwise.
Theme five: Choice of accrediting agencies. Nursing programs in the U.S. will have a third
choice of nursing education accreditation within the next year or two. In 2013, the National
League for Nursing (NLN) created a third accrediting body – the Commission on Nursing
Education Accreditation (CNEA) – that is set to begin accrediting programs in 2015-2016 (NLN,
n.d.a). When asked how CNEA might affect the future of nursing accreditation, all the
interviewees had varying knowledge of its existence – from no knowledge to being on a planning
committee for it – and varying strengths of opinions on what changes, if any, this will have on
nursing accreditation.
Having a choice of accrediting agencies seems like a positive thing, and for two of the
nursing programs, that was the case. However, the remainder were either unsure of how it will
NURSING EDUCATION ACCREDITATION 86
benefit them or felt negatively about the lack of “unity” (School F, personal communication,
October 14, 2014) in nursing education. The positive comments about CNEA were that, “It will
give everyone a choice” (School C, personal communication, October 9, 2014) and “If it
becomes mandatory, then you have a choice of where to go” (School E, personal
communication, October 14, 2014). The School E administrator (personal communication,
October 14, 2014) added, “The NLN is a very classy organization…very professional. That’s the
draw for some people.” Moreover, both school administrators agreed that when people see how
the CNEA pilot works out over the next year that they will want to switch to CNEA (School C,
personal communication, October 9, 2014; School E, personal communication, October 14,
2014).
The rest of the administrators were vaguely aware or unaware of CNEA’s creation and how it
will compare to CCNE and ACEN. “I don’t know much about it” (School A, personal
communication, October 9, 2014); I don’t know [what the impact will be]” (School F, personal
communication, October 14, 2014); “They’re simpler and less money, maybe?” (School D,
personal communication, October 9, 2014); “It maybe a bit more organized and their validity
will be better, hopefully” (School B, personal communication, October 8, 2014). Two of the
programs felt that adding an additional accrediting agency was not a good idea. Their comments
included, “It’s very political” (School D, personal communication, October 9, 2014); “I think it
will just be confusing for most people” and “It’s going to be redundant” (School F, personal
communication, October 14, 2014). Both administrators felt there should just be one accrediting
agency, “I think it should just be one body, so when [accreditation] is required we all just go to
one place” (School D, personal communication, October 9, 2014), because, “How many different
ways can you ask the same question?” (School F, personal communication, October 14, 2014).
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Though, one of the biggest concerns for the CNEA, and accreditation in general, is the cost
of the accreditation process. “Everyone is wondering how much [CNEA] is going to cost
because…neither one of those institutions [NLN and CCNE] are real financially solvent. That’s
why they charge so much money” (School C, personal communication, October 9, 2014). Since
accreditation is not mandatory, many of the community college programs have been dropping
their accreditation due to the required costs (School C, personal communication, October 9,
2014; School D, personal communication, October 9, 2014). The School D administrator
(personal communication, October 9, 2014) stated, “Since we are so financially strapped for
money, I’m not going to go looking for money so I can be [accredited]…The BRN is free.”
All six administrators had varying levels of knowledge and differing opinions regarding the
addition of the CNEA. This was surprising to the researcher, as the new agency was announced
over a year ago, and the only two administrators who had clear knowledge of the program were
directly affiliated with the NLN is some capacity (i.e., committee membership). This implies
that the NLN has not marketed the CNEA properly (whether intentionally or otherwise), which
aligns with the complaints that other national accrediting agencies are not promoting themselves
and their positive attributes well enough (Eaton, 2013a). It is not clear at this point whether
having a choice of three accrediting agencies will benefit nursing education. After CNEA rolls
out in a couple years, it will be interesting to see if the negative reaction to a third accrediting
body was just “fear of the unknown” or whether it was justified. However, until the total cost of
CNEA accreditation is made public, it is unclear whether programs will make the switch in
droves (due to lower costs), whether programs will remain with their current agencies (due to
greater or the same costs), or, in the case of community colleges, whether they will continue to
drop accreditation altogether.
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Conclusion
Three surprising observations with five common themes did emerged in the opinions of
nursing administrators regarding nursing education accreditation and their quality standards,
particularly the NCLEX. The first observation was that all nursing administrators agreed that
accreditation is important for nursing education and the nursing profession. This was reinforced
by three themes that emerged from interviews with the administrator. The first that accreditation
is important for ensuring national and state standards for nursing education. The second that
accreditor-required self-assessments are important for maintaining quality of the nursing
education, enhancing the faculty collaborative process, and ensuring ongoing program
improvement. Finally, the help and support of the accreditation staff is important for ensuring
programs successfully meet all the accreditation requirements. All three themes collectively help
to ensure that nursing students are ultimately successful in passing the NCLEX exam.
The second observation was that all six nursing programs agreed that the NCLEX is a
necessary and accurate measure of safe, entry-level nursing skills. Interviews with nursing
administrators revealed the fourth theme, which is the importance of the NCLEX exam. Though
there were some negative opinions of the use of the first-time NCLEX pass rate, they all agreed
is was the most effective way to measure a nursing student’s knowledge and determine their
readiness for entry into safe nursing practice. Plus, there was agreement that the nursing
programs, and not the accreditors, were responsible for ensuring successful NCLEX pass rates
through proper curriculum, use of third party testing services, and/or admissions requirements.
Finally, the third observation was that all six administrators had varying levels of knowledge
and few common opinions regarding the new accreditation agency for nursing education. From
the interviews, the fifth theme regarding the choice of accrediting agencies emerged. Varying
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levels of knowledge and differing opinions about how the addition of the CNEA will impact on
nursing accreditation makes for an unclear picture on the future of the CNEA and whether
having an additional choice of accreditors will be beneficial to nursing education.

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CHAPTER FIVE: CONCLUSIONS

Summary of Findings
There were three main findings identified during this study. Each is discussed below with
support from the current literature.
Finding One
Despite all the negative press about higher education accreditation in the U.S. – their inability
to ensure a quality education and the enormous amount of time and resources required for
accreditation – the first finding was that all the nursing program administrators agreed
accreditation was important to nursing education, and that the self assessment process was a
valuable use of their time. The administrators felt accreditation ensured standards for nursing
education and the nursing profession within and between all the U.S. states. They felt the self-
assessment process kept them on their toes and provided an avenue for more faculty
collaboration around the quality of the program for which they worked. Plus, they felt the staff
support provided by the accreditors ensured they successfully met the accreditation standards.
All the above aspects of nursing accreditation collectively helping to ensure successful pass rates
on the NCLEX exam and providing more licensed nurses to meet the need of the increasing
nursing workforce.
This finding is counter to many of the critiques in the literature and the federal government
regarding regional accreditation. The primary concern is accreditation’s lack of transparency
with its constituents, as well as the general public (Eaton, 2010; Ikenberry, 2009; Kuh, 2010;
NACIQI, 2012). Other concerns include a lack of violation enforcement (Scriven, 2000); the
accreditation process benefits the accrediting agencies at the expense of institutional and general
NURSING EDUCATION ACCREDITATION 91
public welfare (American Medical Association, 1971); accreditation has diluted the standards to
the bare minimum (American Council of Trustees and Alumni, 2007); the regional accreditors
are a monopoly (Neal, 2008); and the process is fractured, outdated, and no longer useful
(Dickeson, 2006).
The federal government has been accreditation’s worst critic over the past decade. The
USDOE report released by the Spellings Commission stated that accreditation is an ineffective
process that stifles innovation in higher education (Commission on the Future of Higher
Education, 2006). More recently, the Obama Administration has spoken out about accreditation
and asked for accreditation to be reevaluated during the renewal of the Higher Education Act,
with a focus on affordability and value in higher education (Obama, 2013b). In addition, Obama
(2013c) has called for a performance-based rating system that links campus performance with
financial aid allocations that may or may not replace regional accreditation once the Higher
Education Act renewal is finalized.
Perhaps it is a difference in perception between national, specialized accreditation and
regional accreditation, but none of the administrators interviewed expressed any of the above
concerns when speaking of specialized nursing education accreditation. This is particularly
surprising, as the accrediting agencies and the state BRNs overlap standards and requirements,
and the researcher felt the burden of meeting the requirements of both entities would lead to at
least some negative opinions of the accrediting agencies. This was not found to be the case.
Finding Two
The second finding was that many of the administrators interviewed did not believe
accreditors and the state BRNs should be using first-time NCLEX pass rates as a way to measure
student learning outcomes and program quality. Though all the administrators believed the
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NCLEX is currently the most effective way to assess a student’s knowledge of safe nursing
practice, the topic of first-time pass rates brought up some negative emotions.
The belief that accreditors should not focus so heavily on first-time pass rates has been
reinforced by recent literature (Giddens, 2009; Taylor, Loftin, & Reyes, 2014). Taylor, Loftin,
and Reyes (2014) wrote that programs are forced to rely an exam that uses basic statistical
analyses to evaluate program quality and inform potentially life-altering decisions. The high
stakes nature of the NCLEX (Giddens, 2009) can have negative consequences to the programs
and the students. These include a reduction of the curriculum by removal of topics not tested on
the NCLEX, instructors altering their teaching styles to teach to the test, over-concern with exam
preparation, disparities among disadvantaged students, test anxiety, reduction in instructor
morale, and manipulation of student retention data, plus altered admissions policies to increase
overall scores (Blazer, 2011). Moreover, Taylor, Loftin, and Reyes (2014) found no empirical
evidence to support the idea that students who pass the NCLEX the first time are safer nurses in
practice than those who passed the second time.
The nursing program administrators echoed the sentiments of current nursing researchers
who are calling for a change in accreditation and BRN evaluation policy. Therefore, it might be
time for accrediting agencies and the BRNs to reevaluate the evidence that supports (or not) the
use of first-time NCLEX pass rates as an outcome measurement.
Finding Three
The third finding was the nursing program administrators’ mixed opinions about the addition
of a third accrediting body for nursing education. Their opinions ranged from believing it will be
a good thing for nursing education to neutral or not knowing the impact to feeling as though a
third agency is entirely unnecessary.
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These varied opinions align with the literature, as well. Neal (2008) criticizes regional
accreditors as holding monopolies on the non-governmental, self-evaluation process (Neal, 2008)
and that choice of accrediting agencies is actually good thing for higher education. While logic
might imply that having a choice of accreditors would benefit nursing programs, Gaston (as cited
in Fain, 2014) believes the addition of new accreditors will lead to greater inefficiencies and
more confusion, as they currently use different standards and terminology. He adds that regional
accreditors would benefit from better collaboration to create a more consistent and clear national
process (Gaston, as cited in Fain, 2014).
While uncertainly swirls around the future of regional accreditation, there is also much
uncertainty around the level of impact a third, national nursing accrediting agency will have on
nursing education at this point. It could create an additional choice that will benefit nursing
programs with more efficient processes and/or lower rates, as the accrediting agencies compete
for business. However, it could also just add another layer to an already complicated and heavily
scrutinized system, which could create more confusion. The direction nursing education
accreditation eventually takes will not be clear until the third agency begins accrediting programs
in a year or two.
Limitations
There were two limitations to this study that are described below. There were only two
representatives for each of the public four-year and the public two-year institutions, and only one
representative for each of the private non-profit and the for-profit institutions. Thus, it was
difficult to determine any differences that may have existed between different types of
institutions. However, responses were similar enough across all types of institutions,
strengthening the results. In addition, the administrators interviewed were either known to the
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researcher or introduced by someone known to the researcher, which may have affected the
responses to the interview questions. Though, making the interviewees and their campus names
anonymous controlled this potential bias.
Implications for Practice
There are three implications for practice that developed over the course of this study. The
first is potential support for mandatory national accreditation of nursing programs. The NCSBN
has recommended requiring national accreditation of all U.S. prelicensure nursing programs by
2020 (NCSBN, 2011). Since all six administrators interviewed felt national accreditation was
important for nursing education and that the accreditors played a complementary role to the state
board of nursing, it implies that there would be support behind this move.
The second implication is improvements to the accreditation program evaluation process. As
some of the administrators mentioned, there are inconstancies between how different site
evaluators assess programs, potentially bringing their own agendas or biases to the process. In
addition, they ask for information that can be difficult to attain, such as employee/employer
satisfaction data. Therefore, the accrediting agencies should reevaluate their site evaluator
training and procedures, as well as develop mechanisms or list of best practices that allow for
easier data collection of the items that are difficult to attain.
The third implication is the use of first-time NCLEX pass rates as an accreditation and BRN
quality standard. The administrators interviewed had negative opinions of the use of first-time
rates. The high stakes nature of the first-time pass rate can cause test anxiety in nursing students
and potentially impact the accreditation status of the nursing program; plus, there is no evidence
that students who pass the NCLEX on the second attempt are less safe than those who pass the
first time (Taylor, Loftin, & Reyes, 2014). Thus, accrediting agencies and the state boards of
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nursing should reevaluate the use of the first-time NCLEX pass rates as an outcome measure and
quality standard.
Future Research
There are two ideas for future research that emerged from this study. The first is exploring
the implications of mandating national accreditation would have on the programs that are not
currently accredited, such as some community college nursing programs. Of the programs in
California that are not accredited, most do not go through the accreditation process due to lack of
funding for membership and site visit fees. Requiring these programs to be accredited will
impact them financially, and potentially significantly; thus, researching the nationwide financial
impact of mandating accreditation would have on smaller colleges needs to be explored.
The second idea for future research is the evaluation of the use of the first-time NCLEX pass
rate as a measure of program quality. There needs to be more research on whether there are
significant differences between students who pass the first time and those that pass the second
(or more) time, and whether there are significant differences between nursing programs with
higher first-time pass rates and those with lower first-time pass rates. Moreover, whether the
benefits of requiring first-time NCLEX pass rates outweighs the consequences of high stakes
testing needs to be explored further.
Conclusion
Despite all the criticism of the accreditation process and calls to reassess its utility in the U.S.
higher education system, there are instances where accreditation appears to be functioning in the
manner it was intended: ensuring a quality education for students. While there are certainly
some programs that are struggling, nursing education accreditation successfully upholds the
standards of the nursing profession across all states. Accreditors’ use of the NCLEX pass rates
NURSING EDUCATION ACCREDITATION 96
to measure outcomes, as well as program quality, is the appropriate choice; however, the use of
first-time pass rates needs to be evaluated. Further, providing for more choice in nursing
education accreditation seems like a positive thing in theory, though the reality of its impact to
nursing education will not felt for two or more years.
The bottom line is that nursing program administrators are content with their current
accreditors and how their programs are being evaluated. In addition, they find value in the
overlap between accrediting agencies and the state BRN, even with the added expense, and feel
both provide the support their programs need to meet accreditation requirements and the
framework required to produce students successful on the NCLEX.
NURSING EDUCATION ACCREDITATION 97
References
Aghion, P., Dewatripont, M., Hoxby, C. M., Mas-Colell, A., & Sapir, A. (2008). Higher
aspirations: An agenda for reforming European Universities. Brussels: Bruegel.
Accreditation Commission for Education in Nursing. (2013a). ACEN Accreditation Manual.
Retrieved from http://acenursing.org/accreditation-manual/
Accreditation Commission for Education in Nursing. (2013b). Section III, 2013 Standards and
Procedures. Retrieved from
http://www.acenursing.net/manuals/SC2013_BACCALAUREATE.pdf
Accreditation Commission for Education in Nursing. (n.d.). Becoming an ACEN program
evaluator. Retrieved from http://www.acenursing.org/becoming-an-acen-program-
evaluator/
Adelman, C., & Silver, H. (1990). Accreditation: The American experience. London, England:
Council for National Academic Awards.
American Accounting Association, Committee on Consequences of Accreditation. (1977).
Report of the Committee on Consequences of Accreditation, 52, 165, 167-177.
American Association of Colleges of Nursing. (2008). The Essentials of Baccalaureate
Education for Professional Nursing Practice. Retrieved from
http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf
American Association for Higher Education. (1997). Assessing impact: Evidence and action.
Washington, DC: American Association for Higher Education.
American Association for Higher Education. (1992). 9 principles of good practice for assessing
student learning. North Kansas City, MO: American Association for Higher Education.
American Council on Education. (2012). Assuring academic quality in the 21st century: Self-
NURSING EDUCATION ACCREDITATION 98
regulation in a new era: A report of the ACE National Task Force on institutional
accreditation. Washington, DC: American Council on Education. Retrieved from
http://www.acenet.edu/AM/Template.cfm?Section=Government_Relations_and_
Public_Policy&Template=/CM/ContentDisplay.cfm&ContentID=45275
American Council of Trustees and Alumni. (2007). Why accreditation doesn’t work and what
policymakers can do about it. Washington, DC: American Council of Trustees and
Alumni. Retrieved from
https://www.goacta.org/publications/downloads/Accreditation2007Final.pdf
American Medical Association. (1971). Accreditation of health educational programs. Part I:
Staff working papers. Washington, DC: American Medical Association.
Assessment Technologies, Inc. (2014a). ATI Nursing Education. Retrieved from
http://www.atitesting.com
Assessment Technologies, Inc. (2014b). Test of Essential Academic Skills (TEAS). Retrieved
from https://www.atitesting.com/Solutions/pre-program/TEAS.aspx
Association of American Colleges and Universities (2007). College Learning for the New Global
Century. Washington, DC: Association of American Colleges and Universities. Retrieved
from: http://www.aacu.org/leap/documents/GlobalCentury_final.pdf
Astin, A.W. (2014, February 18). Accreditation and autonomy. Inside Higher Ed. Retrieved from
http://www.insidehighered.com/views/2014/02/18/accreditation-helps-limit-government-
intrusion-us-higher-education-essay
Auerbach, D.I., Staiger, D.O., Muench, U., & Buerhaus, P.I. (2013). The nursing workforce in an
era of health care reform. The New England Journal of Medicine, 368, 1470-1472.
Baker, R. L. (2002). Evaluating quality and effectiveness: Regional accreditation principles and
NURSING EDUCATION ACCREDITATION 99
practices. The Journal of Academic Librarianship, 28(1), 3-7.
Banta, T. W. (1993). Summary and conclusion: Are we making a difference? In T. W. Banta
(Ed.), Making a difference: Outcomes of a decade of assessment in higher education (pp.
357-376). San Francisco, CA: Jossey-Bass.
Bardo, J. W. (2009). The impact of the changing climate for accreditation on the individual
college or university: Five trends and their implications. New Directions for Higher
Education, 145, 47-58.
Barzun, J. (1993). The American university: How it runs, where it is going. Chicago, IL:
University of Chicago Press.
Bellack, J.P., Gelman, S.B, O’Neil, E.H, & Thomsen, C.L. (1999). Response of baccalaureate
and graduate programs to the emergence of choice in nursing accreditation. Journal of
Nursing Education, 38(2), 53-62.
Beno, B. A. (2004). The role of student learning outcomes in accreditation quality review. New
Directions for Community College, 236, 65-72.
Bensimon, E. M. (2005). Closing the achievement gap in higher education: An organizational
learning perspective. New Directions for Higher Education, 131, 99-111.
Bernhard, A. (2011). Quality assurance in an international higher education area: A
case study approach and comparative analysis. Wiesbaden, Germany: VS Verlag
für Sozialwissenschaften.
Bitter, M. E., Stryker, J. P, & Jens, W. G. (1999). A preliminary investigation of the choice to
obtain AACSB accounting accreditation. Accounting Educators’ Journal, XI, 1-15.
Blauch, L. E. (1959). Accreditation in higher education. Washington, DC: United States
Government Printing Office.
NURSING EDUCATION ACCREDITATION 100
Blazer, C. (2011). Unintended consequences of high-stakes testing. Miami-Dade County Public
Schools. Retrieved from http://files.eric.ed.gov/fulltext/ED536512.pdf
Bloland, H. G. (2001). Creating the Council for Higher Education Accreditation (CHEA).
Phoenix, AZ: Oryx Press.
Breckenridge, D.M., Wolf, Z.R., & Roszkowski, M.J. (2012). Risk Assessment Profile and
Strategies for Success instrument: Determining prelicensure nursing students’ risk for
academic success. Journal for Nursing Education, 51(3), 160-166.
Bresciani, M. J. (2006). Outcomes-based academic and co-curricular program review: A
compilation of institutional good practice. Sterling, VA: Stylus.
Britt, B., & Aaron, L. (2008). Nonprogrammatic accreditation: Programs and attitudes.
Radiologic Technology, 80(2), 123-129.
Brittingham, B. (2008, September/October). An uneasy partnership: Accreditation and the
federal government. Change, 32-38.
Brittingham, B. (2009). Accreditation in the United States: How did we get to where we are?
New Directions for Higher Education , 145, 7-27.
Brittingham, B. (2012). Higher education, accreditation, and change, change, change: What’s
teacher education to do? In M. LaCelle-Peterson & D. Rigden (Eds.), Inquiry, evidence,
and excellence: The promise and practice of quality assurance (59-75). Washington, DC:
Teacher Education Accreditation Council.
Brittingham, B. (2012). Higher education, accreditation, and change, change, change: What’s
teacher education to do? In M. LaCelle-Peterson & D. Rigden (Eds.), Inquiry, evidence,
and excellence: The promise and practice of quality assurance (59-75). Washington, DC:
Teacher Education Accreditation Council. Retrieved from http://www.teac.org/wp-
NURSING EDUCATION ACCREDITATION 101
content/uploads/2012/03/Festschrift-Book.pdf
Brown, H. (2013, September). Protecting Students and Taxpayers: The Federal Government’s
Failed Regulatory Approach and Steps for Reform. American Enterprise Institute, Center
on Higher Education Reform. Retrieved from http://www.aei.org/files/2013/09/27/-
protecting-students-and-taxpayers_164758132385.pdf
Burke, J. C. & Associates. (2005). Achieving accountability in higher education: Balancing
public, academic, and market demands. San Francisco, CA: Jossey- Bass.
Burke, J. C. & Minassians, H. P. (2002). The new accountability: From regulation to results.
New Directions for Institutional Research, 2002(116), 5-19.
Cabrera, A. F., Colbeck, C. L., & Terenzini, P. T. (2001). Developing performance indicators for
assessing classroom teaching practices and student learning: The case of engineering.
Research in Higher Education, 42(3), 327-352.
California Board of Registered Nursing. (2012). Guidelines for approval visits. Retrieved from
http://coadn.org/north/files/resource/91.pdf
California Board of Registered Nursing. (2013a). Licensure by examination. Retrieved from
http://www.rn.ca.gov/applicants/lic-exam.shtml
California Board of Registered Nursing. (2013b). NCLEX pass rates. Retrieved from
http://www.rn.ca.gov/schools/passrates.shtml
California Board of Registered Nursing. (2013c). What is the Board of Registered Nursing?
Retrieved from http://www.rn.ca.gov/about_us/whatisbrn.shtml
California Code of Regulations, Title 16, Division 14, Article 3, §1432 (n.d.).
Cant, R., McKenna, L., & Cooper, S. (2013). Assessing preregistration nursing students’ clinical
competence: A systematic review of objective measures. International Journal of
NURSING EDUCATION ACCREDITATION 102
Nursing Practice, 19, 163-176.
Carey, K. (2009, September/October). College for $99 a month. Washington Monthly. Retrieved
from http://www.washingtonmonthly.com
Carey, K. (2010). Death of a university. In K. Carey & M. Schneider (Eds.), Accountability in
American higher education. New York, NY: Palgrave Macmillan.
Carr, S.M. (2011). NCLEX-RN pass rate peril: One school’s journey through curriculum
revision, standardized testing, and attitudinal change. Nursing Education Perspectives,
32(6), 384-388.
Chernay, G. (1990). Accreditation and the role of the Council on Postsecondary Accreditation.
Washington, DC: Council on Postsecondary Accreditation.
Chambers, C. M. (1983). Council on Postsecondary Education. In K.E. Young, C.M.
Chambers, & H.R. Kells (Eds), Understanding Accreditation. San Francisco: Jossey-
Bass.
Commission on Collegiate Nursing Education. (2009). Achieving Excellence in Accreditation:
The 10 Years of CCNE. Retrieved from http://www.aacn.nche.edu/ccne-
accreditation/CCNEHistory.pdf
Commission on Collegiate Nursing Education. (2012). Procedures for accreditation of
baccalaureate and graduate degree nursing programs. Retrieved from
http://www.aacn.nche.edu/ccne-accreditation/procedures.pdf
Commission on Collegiate Nursing Education. (2013). Standards for Accreditation of
Baccalaureate and Graduate Nursing Programs. Retrieved from
http://www.aacn.nche.edu/ccne-accreditation/Standards-Amended-2013.pdf
NURSING EDUCATION ACCREDITATION 103
Commission on the Future of Higher Education (Spellings Commission Report) (2006). US
Department of Education. Retrieved from
http://www2.ed.gov/about/bdscomm/list/hiedfuture/reports.html.
Council for Higher Education Accreditation (2006). CHEA survey of recognized accrediting
organizations: Providing information to the public. Washington, DC: Author.
Council for Higher Education Accreditation. (2010). Quality review 2009: CHEA almanac of
external quality review. Washington, DC: Council for Higher Education Accreditation.
Council for Higher Education Accreditation. (2012a, November 15). The CHEA almanac online.
Retrieved from http://www.chea.org/news/NR_2012.11.15_Online_Almanac.htm
Council for Higher Education Accreditation. (2012b). The CHEA initiative final report.
Washington, DC: Council for Higher Education Accreditation. Retrieved from:
http://www.chea.org/pdf/TheCHEAInitiative_Final_Report8.pdf
Council for Higher Education Accreditation. (2012c). CHEA At-a-Glance. Retrieved from
http://www.chea.org/pdf/chea-at-a-glance_2012.pdf
Council for Higher Education Accreditation. (2014a). 2013-2014 Directory of CHEA-
Recognized Organizations. Retrieved from
http://www.chea.org/pdf/2013-2014_Directory_of_CHEA_Recognized_
Organizations.pdf
Council for Higher Education Accreditation. (2014b). International Quality Group. Retrieved
from http://www.cheainternational.org
Council of Regional Accrediting Commissions. (n.d.). A guide for institutions and evaluators.
Retrieved from http://www.sacscoc.org/pdf/handbooks/GuideForInstitutions.pdf
Cremonini, L., Epping, E., Westerheijden, D., & Vogelsang, K. (2012). Impact of Quality
NURSING EDUCATION ACCREDITATION 104
Assurance on Cross-Border Higher Education. Enschede, Netherlands: Center for Higher
Education Policy Studies.
Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods
approaches (3
rd
Ed.). Thousand Oaks, CA: Sage Publications, Inc.
Crow, C.S., Handley, M., Morrison, R.S., & Shelton, M.M. (2004). Requirements and
interventions used by BSN programs to promote and predict NCLEX-RN success: A
national study. Journal of Professional Nursing, 20(3), 174-186.
Daoust, M. P., Wehmeyer, W., & Eubank, E. (2006). Valuing an MBA: Authentic outcome
measurement made easy. Unpublished manuscript. Retrieved from
http://www.momentumbusinessgroup.com/resourcesValuingMBA.pdf
Davis, B.W. (2011). A conceptual model to support curriculum review, revision, and design in
an associate degree nursing program. Nursing Education Perspectives, 32(6) 389-394.
Dewatripont, M., Sapir, A., Van Pottelsberghe, B., & Veugelers, R. (2010). Boosting
innovation in Europe. Bruegel Policy Contribution 2010/06.
Dickeson, R. C. (2006). The need for accreditation reform. Issue paper (The Secretary of
Education’s Commission on the Future of Higher Education). Washington, DC.
Retrieved from http://www2.ed.gov/about/bdscomm/list/hiedfuture/reports/dickeson.pdf
Dickey, F., & Miller, J. (1972). Federal involvement in nongovernmental accreditation.
Educational Record, 53(2), 139
Dill, D.D. (2007, June). Quality assurance in higher education: Practices and issues. The
University of North Carolina, Chapel Hill, Department of Public Policy. Retrieved from
http://www.unc.edu/ppaq/docs/Encyclopedia_Final.pdf
Dill, D. D., Massy, W. F., Williams, P. R., & Cook, C. M. (1996, September/October).
NURSING EDUCATION ACCREDITATION 105
Accreditation and academic quality assurance: Can we get there from here? Change
28(5), 16-24.
DiMaggio, P. J., & Powell, W. W. (1983). The iron cage revisited: Institutional isomorphism and
collective rationality in organizational fields. American Sociological Review, 48(2), 147-
160.
Doerr, A. H. (1983). Accreditation: Academic boon or bane. Contemporary Education, 55(1), 6-
8.
Dougherty, K. J., Hare, R., & Natow, R. S. (2009). Performance accountability systems for
community colleges: Lessons for the voluntary framework of accountability for
community colleges. Community College Research Center. Columbia University, NYC:
Teachers College.
Dowd, A. C. (2003). From access to outcome equity: Revitalizing the democratic mission of the
community college. Annals of the American Academy of Political and Social Science,
586, 92-119.
Dowd, A. C., & Grant, J. L. (2006). Equity and efficiency of community college appropriations:
The role of local financing. The Review of Higher Education, 29(2), 167-194.
Driscoll, A., & De Noriega, D. C. (2006). Taking ownership of accreditation: Assessment
processes that promote institutional improvement and faculty engagement. Sterling,
VA: Stylus Publishing.
Eaton, J. S. (2003). Is accreditation accountable? The continuing conversation between
accreditation and the federal government. Washington, DC: Council for Higher
Education Accreditation.
NURSING EDUCATION ACCREDITATION 106
Eaton, J. S. (2009). Accreditation in the United States. New Directions for Higher Education,
145, 79-86. doi:10.1002/he.337
Eaton, J. S. (2010). Accreditation and the federal future of higher education. Academe,
96(5), 21-24.
Eaton, J. S. (2012, August). An Overview of U.S. Accreditation. Council for Higher Education
Accreditation: Washington DC.
Eaton, J. S. (2012b). What future for accreditation: The challenge and opportunity of the
accreditation – federal government relationship. In M. LaCelle-Peterson & D. Rigden
(Eds.), Inquiry, evidence, and excellence: The promise and practice of quality assurance
(77-88). Washington, DC: Teacher Education Accreditation Council. Retrieved from
http://www.teac.org/wp- content/uploads/2012/03/Festschrift-Book.pdf
Eaton, J.S. (2012, April-June). The future of accreditation: Can the collegial model flourish in
the context of the government’s assertiveness and the impact of nationalization and
technology? How? Society for College and University Planning. 8-15.
Eaton, J.S. (2013a, June 13). Accreditation and the next reauthorization of the Higher Education
Act. Inside Accreditation with the President of CHEA, 9(3). Retrieved from
http://www.chea.org/ia/IA_2013.05.31.html
Eaton, J.S. (2013b, November-December). The changing role of accreditation: Should it matter
to governing boards? Trustee. Retrieved from
http://agb.org/trusteeship/2013/11/changing-role-accreditation-should-it-matter-
governing-boards
El-Khawas, E. (2001). Accreditation in the USA: Origins, developments and future prospects.
Paris, France: International Institute for Educational Planning.
NURSING EDUCATION ACCREDITATION 107
Elsevier Student Life. (2014). Take control with HESI. Retrieved from
https://evolve.elsevier.com/studentlife/hesi.html
Ewell, P. T. (1984). The self-regarding institution: Information for excellence. Boulder, CO:
National Center for Higher Education Management Systems.
Ewell, P. T. (1993). The role of states and accreditors in shaping assessment practice. In T. W.
Banta (Ed.), Making a difference: Outcomes of a decade of assessment in higher
education (pp. 339-356). San Francisco, CA: Jossey-Bass.
Ewell, P. T. (2001). Accreditation and student learning outcomes: A proposed point of
departure. Washington, DC: Council for Higher Education Accreditation. Retrieved from
http://www.chea.org/award/StudentLearningOutcomes2001.pdf
Ewell, P. T. (2002). An emerging scholarship: A brief history of assessment. In T. W. Banta
(Ed.), Building a scholarship of assessment (pp. 3-25). San Francisco, CA: Jossey-Bass.
Ewell, P. T. (2005). Can assessment serve accountability? It depends on the question. In J. C.
Burke (Ed.), Achieving accountability in higher education: Balancing public, academic,
and market demands (pp. 78-105). San Francisco, CA: Jossey-Bass.
Ewell, P. T. (2008). U.S. accreditation and the future of quality assurance: A tenth anniversary
report from the Council for Higher Education Accreditation. Washington, DC: Council
for Higher Education Accreditation.
Ewell, P. T. (2010). Twenty years of quality assurance in higher education: What’s happened
what’s different? Quality in higher education, 16(2), 173-175.
Ewell, P. T. (2012). Disciplining peer review: Addressing some deficiencies in U.S.
accreditation practices. In M. LaCelle-Peterson & D. Rigden (Eds.), Inquiry, evidence,
and excellence: The promise and practice of quality assurance (89-105). Washington,
NURSING EDUCATION ACCREDITATION 108
DC: Teacher Education Accreditation Council. Retrieved from http://www.teac.org/wp-
content/uploads/2012/03/Festschrift-Book.pdf
Ewell, P. T., Wellman, J. V., & Paulson, K. (1997). Refashioning accountability: Toward a
coordinated system of quality assurance for higher education. Denver, CO: Education
Commission of the States.
Facione, P.A. (1990). Critical thinking: A statement of expert consensus for purposes of
educational assessment and instruction: The Delphi Report. Millbrae, CA: The California
Academy Press.
Facione, N.C. & Facione, P.A. (1994). The California Critical Thinking Skills Test and the
National League for Nursing accreditation requirement for critical thinking. Millbrae,
CA: The California Academic Press.
Fain, P. (2014, February 19). Tough love for accreditors. Inside Higher Ed. Retrieved from
https://www.insidehighered.com/news/2014/02/19/book-explores-how-make-
accreditation-more-effective
Field, K. (2014, November 21). Senate Democrats’ bill to renew Higher Education Act: Many
ideas, little hope of passing. The Chronicle of Higher Education. Retrieved from
http://chronicle.com/article/Senate-Democrats-Bill-to/150175/
Finkin, M. W. (1973). Federal reliance on voluntary accreditation: The power to recognize as the
power to regulate. Journal of Law and Education, 2(3), 339-375.
Finn, Jr. C. E. (1975, Winter). Washington in academe we trust: Federalism and the universities:
The balance shifts. Change, 7(10), 24-29, 63.
Floden, R. E. (1980). Flexner, accreditation, and evaluation. Educational Evaluation and Policy
Analysis, 2(2), 35-46. doi:10.3102/01623737002002035
NURSING EDUCATION ACCREDITATION 109
Florida State Postsecondary Education Planning Commission. (1995). A review of specialized
accreditation. Tallahassee, FL: Florida State Postsecondary Education Planning
Commission.
Gaston, P. L. (2013). Higher Education Accreditation: How it's changing, why it
must. Stylus Publishing, LLC.
Giddens, J.F. (2009). Changing paradigms and challenging assumptions: Redefining quality and
NCLEX pass rates. Journal of Nursing Education, 48(3), 23-24.
Giddens, J.F. & Gloekner, G.W. (2005). The relationship of critical thinking to performance on
the NCLEX-RN. Journal of Nursing Education, 44, 85-89.
Gillen, A., Bennett, D. L, & Vedder, R. (2010). The inmates running the asylum? An analysis of
higher education accreditation. Washington, DC: Center for College Affordability and
Productivity. Retrieved from
http://www.centerforcollegeaffordability.org/uploads/Accreditation.pdf
Global University Network for Innovation. (2007). Higher education in the world 2007:
Accreditation for quality assurance: What is at stake? New York, NY: Palgrave
Macmillan.
Graham, P. A., Lyman, R. W., & Trow, M. (1995). Accountability of colleges and
universities: An essay. New York, NY: Columbia University.
Gruson, E. S., Levine, D. O, & Lustberg, L. S. Issues in accreditation, eligibility and institutional
quality. Cambridge, MA: Sloan Commission on Government and Higher Education.
Hagerty, B. M. K., & Stark, J. S. (1989). Comparing educational accreditation standards in
selected professional fields. The Journal of Higher Education, 60(1), 1-20.
Harcleroad, F. F. (1976). Educational auditing and accountability. Washington, DC: The
NURSING EDUCATION ACCREDITATION 110
Council on Postsecondary Accreditation.
Harcleroad, F. F. (1980). Accreditation: History, process, and problems. Washington, DC:
American Association for Higher Education.
Hart Research Associates. (2009). Learning and assessment: Trends in undergraduate education
(A survey among members of the Association of American College and Universities).
Washington, DC: Author. Retrieved from
https://www.aacu.org/membership/documents/2009MemberSurvey_Part1.pdf
Harvey, L. (2004). The power of accreditation: Views of academics. Journal of Higher
Education Policy and Management, 26(2), 207-223.
Higher Learning Commission. (2012). Seeking accreditation. Chicago, IL: Higher Learning
Commission of the North Central Association. Retrieved from
http://www.ncahlc.org/Information-for-Institutions/obtaining-accreditation.html
Holstein, B.L., Zangrilli, B.F., & Taboas, P. (2006). Standardized testing tools to support quality
educational outcomes. Quality Management in Health Care, 15(4), 300-308
Horton, C., Polek, C., & Hardie, T.L. (2012). The relationship between enhanced remediation
and NCLEX success. Teaching and Learning in Nursing, 7(4), 146-151.
Ikenberry, S. O. (2009). Where do we take accreditation? Washington, DC: Council for Higher
Education Accreditation.
Indiana Professional Licensing Agency. (n.d.). Nursing education and nursing program
information. Retrieved from http://www.in.gov/pla/2490.htm
Inside Higher Ed, Quick Takes. (2014, December 12). Accreditation panel issues Higher Ed Act
suggestions. Inside Higher Ed. Retrieved from
https://www.insidehighered.com/quicktakes/2014/12/12/accreditation-panel-issues-
NURSING EDUCATION ACCREDITATION 111
higher-ed-act-suggestions
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health.
Retrieved from http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-
advancing-health.aspx
Jackson, R. S., Davis, J. H., & Jackson, F. R. (2010). Redesigning regional accreditation: The
impact on institutional planning. Planning for Higher Education, 38(4), 9-19.
Jacobs, B. & Van der Ploeg, F. (2006, July). How to reform higher education in Europe.
Economic Policy, 535-592.
Jaschik, S., & Ledgerman, D. (2014). The 2014 Inside Higher Ed survey of college & university
presidents. Washington, DC: Inside Higher Ed.
Jones-Schenk, J. & Harper, M.G. (2014). Emotional intelligence: An admission criterion
alternative to cumulative grade point averages for prelicensure students. Nurse Education
Today, 30(14), 413-420.
Kalisch, P.A. & Kalisch, B.J. (1978). The advance of American nursing. Boston: Little, Brown.
Kaplan Nursing. (n.d.a). Kaplan Nursing integrated testing + NCLEX-RN review. Retrieved
from http://www.kaptest.com/nursing/educators/rn-programs
Kaplan Nursing. (n.d.b). The NCLEX-RN Exam. Retrieved from
http://www.kaptest.com/NCLEX/Learn-About-NCLEX/About-NCLEX-RN/nclex-rn-
exam.html
Keeling, R. (2006). The Bologna Process and the Lisbon Research Agenda: The European
Commission’s expanding role in higher education discourse. European Journal of
Education, 41(2), 203-223.
Kells, H. R. (1976) The reform of regional accreditation agencies. Educational Record 57(1), 24-
NURSING EDUCATION ACCREDITATION 112
28.
Kells, H. R., & Kirkwood, R. (1979). Institutional self-evaluation processes. The Educational
Record, 60(1), 25-45.
Kennedy, V. C., Moore, F. I., & Thibadoux, G. M. (1985). Determining the costs of self- study
for accreditation: A method and a rationale. Journal of Allied Health,14(2), 175-182.
Kren, L., Tatum, K. W., & Phillips, L. C. (1993). Separate accreditation of accounting programs:
An empirical investigation. Issues in Accounting Education, 8(2), 260- 272.
Kuh, G. D. (2010). Risky business: Promises and pitfalls of institutional transparency.
Change: The Magazine of Higher Learning, 39(5), 30-35.
Kuh, G. D., & Ewell, P. T. (2010). The state of learning outcomes assessment in the United
States. Higher education management and policy, 22(1), 1-20.
Kuh, G., & Ikenberry, S. (2009). More than you think, less than we need: Learning outcomes
assessment in American higher education. Champaign, IL: National Institute for Learning
Outcomes Assessment. Retrieved from
http://www.learningoutcomeassessment.org/documents/niloafullreportfinal2.pdf
Kvale, S. (2007). Doing interviews. Thousand Oaks, CA: Sage.
Langford, R. & Young, A. (2013). Predicting NCLEX-RN success with the HESI Exit Exam:
Eighth validity study. Journal of Professional Nursing, 29(2S), S5-S9.
Learned, W. S., & Wood, B. D. (1938). The student and his knowledge: A report to the Carnegie
Foundation on the results of the high school and college examinations of 1928, 1930, and
1932. New York, NY: The Carnegie Foundation for the Advancement of Teaching.
Lederman, D., Stratford, M., & Jaschik, S. (2014, February 7). Rating (and berating) the ratings.
Inside Higher Ed. Retrieved from
NURSING EDUCATION ACCREDITATION 113
http://www.insidehighered.com/news/2014/02/07/colleges-and-analysts-respond-obama-
ratings-proposal
Lee, M. B., & Crow, S. D. (1998). Effective collaboration for the twenty-first century: The
Commission and its stakeholders (Report and Recommendations of the Committee on
Organizational Effectiveness and Future Directions). Chicago, IL: North Central
Association of Colleges and Schools.
Leef, G. C., & Burris, R. D. (2002). Can college accreditation live up to its promise?
Washington, DC: American Council of Trustees and Alumni. Retrieved from
https://www.goacta.org/publications/downloads/CanAccreditationFulfillPromise.pdf
Lind, C. J., & McDonald, M. (2003). Creating and assessment culture: a case study of success
and struggles. In S. E. Van Kollenburg (Ed.), A collection of papers on selfstudy and
institutional improvement, 3. Promoting student learning and effective teaching, pp.21-
23. (ERIC Document Reproduction Service No. ED 476 673). Retrieved from
http://files.eric.ed.gov/fulltext/ED476673.pdf#page=22
Linn, R.L., Baker, E.L., & Betebenner, D.W. (2002). Accountability systems: Implications of
requirements of the No Child Left Behind Act of 2001. Educational Researcher, 31(6), 3-
16.
Maki, P. L. (2010). Assessing for learning: Building a sustainable commitment across the
institution (2nd ed.). Sterling, VA: StylusPublishing.
McGahee, T.W., Gramling, L., & Reid, T.F. (2010). NCLEX-RN success: Are there predictors.
Southern Online Journal of Nursing Research, 10(4), 208-221.
McLendon, M. K., Hearn, J. C., & Deaton, R. (2006). Called to account: Analyzing the origins
and spread of state performance-accountability policies for higher education. Educational
NURSING EDUCATION ACCREDITATION 114
Evaluation and Policy Analysis, 28(1), 1-24.
McNamara, C. (2009). General guidelines for conducting research interviews. Retrieved from
http://managementhelp.org/businessresearch/interviews.htm
Middaugh, M. F. (2012). Introduction to themed PHE issue on accreditation in higher education.
Planning for Higher Education, 40(3), 6-7
Middle States Commission on Higher Education (2009, March). Becoming Accredited,
Handbook for applicants and candidates for accreditation.
Miles, J. A. (2012). Jossey-Bass business and management reader: Management and
organization theory. Hoboken, NJ: Wiley
Mitchell, M.L., Henderson, A., Groves, M., Dalton, M., & Nulty, D. (2009). The objective
structured clinical examination (OSCE): Optimising its value in the undergraduate
nursing curriculum. Nurse Education Today, 29(4), 398-404.
Moltz, D. (2010). Redefining community college success. Inside Higher Ed. Retrieved from
http://www.insidehighered.com/news/2011/06/06/u_s_panel_drafts_and_debates_measur
es_to_gauge_community_college_success.
Morrison, S. (2005). Improving NCLEX-RN pass rates through internal and external curriculum
evaluation. In M.H. Oermann & K.T. Heinrich (Eds.), Annual review of nursing
education (pp. 77-94). New York, NY: Springer Publishing Company.
National Advisory Committee on Institutional Quality and Integrity. (2012). Higher education
accreditation reauthorization policy recommendations. Retrieved from
http://www2.ed.gov/about/bdscomm/list/naciqi-dir/naciqi_draft_final_report.pdf
National Council of State Boards of Nursing. (2012, August). A preferred future for prelicensure
program approval: Part II. Strategies for moving forward. Retrieved from
NURSING EDUCATION ACCREDITATION 115
https://www.ncsbn.org/A_Preferred_Future_for_Prelicensure_Program_PartII_wAppendi
ces.pdf
National Council of State Boards of Nursing. (2013). Test Plans. Retrieved from
https://www.ncsbn.org/1287.htm
National Council of State Boards of Nursing. (2014). 2014 NCLEX examination candidate
bulletin. Retrieved from https://www.ncsbn.org/2014_NCLEX_Candidate_Bulletin.pdf
National Education Resource Group. (1991). National education goals for the year 2000. U.S.
Department of Education, Office of Educational Research and Statistics.
National League for Nursing. (n.d.a). NLN Commission for Nursing Education Accreditation
(CNEA): Frequently asked questions. Retrieved from http://www.nln.org/aboutnln/C-
NEA_FAQs.htm
National League for Nursing. (n.d.b). Testing services: About the NLN pre-admissions exam
(PAX). http://www.nln.org/testingservices/ns/ns_gs_pax.htm
Neal, A. D. (2008). Dis-accreditation. Academic Questions, 21(4), 431-445.
Nevins, J. F. (1959). A study of the organization and operation of voluntary accrediting
agencies. Washington, DC: The Catholic University of American Press.
Norton, C.K., Relf, M.V., Cox, C.W., Farley, J., Lachat, M., Tucker, M., & Murray, J. (2006).
Ensuring NCLEX-RN success for first-time test-takers. Journal of Professional Nursing,
22(5), 322-326.
Obama, B. (2013a, February 12). State of the Union Address. The White House. Retrieved from
http://www.whitehouse.gov/the-press-office/2013/02/12/president-barack-obamas-state-
union-address
Obama, B. (2013b, February 12). The President’s Plan for a Strong Middle Class and a Strong
NURSING EDUCATION ACCREDITATION 116
America. The White House. Retrieved from
http://www.whitehouse.gov/sites/default/files/uploads/sotu_2013_blueprint_embargo.pdf
Obama, B. (2013c, August 22). Fact Sheet on the President’s Plan to Make College More
Affordable: A Better Bargain for the Middle Class. The White House. Retrieved from
http://www.whitehouse.gov/the-press-office/2013/08/22/fact-sheet-president-s-plan-
make-college-more-affordable-better-bargain-
Orlans, H. O. (1975). Private accreditation and public eligibility. Lexington, MA: D.C.
Heath and Company.
Overbay, J.D. & Aaltonen, P.M. (2001). A comparison of NLNAC and CCNE accreditation.
Nurse Educator, 26(1), 17-22.
Pennington, T.D. & Spurlock, D. (2010). A systematic review of the effectiveness of remediation
interventions to improve NCLEX-RN pass rates. Journal of Nursing Education, 49(9),
485-492.
Penprase, B.B. & Harris, M.A. (2013). Accelerated second-degree nursing students: Predictors of
graduation and NCLEX-RN first-time pass rates. Nurse Educator, 38(1), 26.
Pigge, F. L. (1979). Opinions about accreditation and interagency cooperation: The results of a
nationwide survey of COPA institutions. Washington, DC: Committee on Postsecondary
Education.
Procopio, C. H. (2010). Differing administrator, faculty, and staff perceptions of organizational
culture as related to external accreditation. Academic Leadership Journal, 8(2), 1-15.
Provezis, S. J. (2010). Regional accreditation and learning outcomes assessment: Mapping the
territory (Doctoral dissertation, University of Illinois at Urbana- Champaign).
NURSING EDUCATION ACCREDITATION 117
Raessler, K. R. (1970). An analysis of state requirements for college or university accreditation
in music education. Journal of Research in Music Education, 18(3), 223-233.
Ratcliff, J. L. (1996). Assessment, accreditation, and evaluation of higher education in the US.
Quality in Higher Education, 2(1), 5-19.
Reidlinger, C. R., & Prager, C. (1993). Cost-benefit analyses of accreditation. New Directions
for Community Colleges, 83, 39-47.
Rhodes, T. L. (2012). Show me the learning: Value, accreditation, and the quality of the degree.
Planning for Higher Education, 40(3), 6-7.
Romeo, E.M. (2010). Quantitative research on critical thinking and predicting nursing students’
NCLEX-RN performance. Journal of Nursing Education, 49(7), 378-386.
Romeo, E.M. (2013). The predictive ability of critical thinking, nursing GPA, and SAT scores on
first-time NCLEX performance. Nursing Education Perspectives, 34(4), 248.
Salkind, N.J. (2011). Statistics for people who (think they) hate statistics (4
th
Ed.). Thousand
Oaks, CA: Sage Publishing, Inc.
Schermerhorn, J. W., Reisch, J. S., & Griffith, P. J. (1980). Educator perceptions of
accreditation. Journal of Allied Health 9(3), 176-182.
Schmidt, B. & MacWilliams, B. (2011). Admission criteria for undergraduate nursing programs:
As systematic review. Nurse Educator, 36(4), 171.
Shaffer, C. & McCabe, S. (2013). Evaluating the predictive ability of preadmission academic
criteria: High-stakes assessment. Teaching and Learning in Nursing, 8(4), 157-161.
Shibley, L. R., & Volkwein, J. F. (2002, June). Comparing the costs and benefits of re-
accreditation processes. Paper presented at the annual meeting of the Association for
Institutional Research, Toronto, Ontario, Canada.
NURSING EDUCATION ACCREDITATION 118
Scriven, M. (2000). Evaluation ideologies. In D. L. Stufflebeam, G. F. Madaus, & T. Kellaghan
(Eds.), Evaluation models (250-278). Boston, MA: Kluwer Academic Publishers.
Smith, V. B., & Finney, J. E. (2008, May/June). Redesigning regional accreditation: An
interview with Ralph A. Wolff. Change,18-24.
Spangehl, S. D. (2012). AQIP and accreditation: Improving quality and performance.
Planning for Higher Education, 40(3), 6-7.
Southern Association of Colleges and Schools. (2007). The Quality Enhancement Plan.
Retrieved from http://www.sacscoc.org/pdf/081705/QEP%20Handbook.pdf
Stensaker, B., & Harvey, L. (2006). Old wine in new bottles? A comparison of public and private
accreditation schemes in higher education. Higher Education Policy, 19, 65-85.
Stringer, E.T. (2007). Action research (3
rd
Ed.). Thousand Oaks, CA: Sage Publications, Inc.
Sursock, A. & Smidt, H. (2010). Trends 2010: A decade of change in European
higher education. Brussels: European University Association.
Taylor, H., Loftin, C., & Reyes, H. (2014). First-time NCLEX-RN pass rate: Measure of program
quality or something else? Journal of Nursing Education, 53(6), 336-341.
Texas Administrative Code, Title 22, Part 11, Chapter 215, Rule §215.4(c)(3)(B).
Trivett, D. A. (1976). Accreditation and institutional eligibility. Washington, DC:
American Association for Higher Education.
Turner, D.W. (2010). Qualitative interview design: A practical guide for novice investigators.
The Qualitative Review, 15(3), 754-760.
Uehling, B. S. (1987). Accreditation and the institution. North Central Association Quarterly,
62(2), 350-360.
UNESCO (2005). Guidelines for Quality Provision in Cross-border Higher Education. Paris:
NURSING EDUCATION ACCREDITATION 119
UNESCO.
University of California-San Francisco, Center for Health and Community. (2009, June 30).
Health Professions Accreditation System “Obsolete” and Needs to Be Changed,
According to Task Force Report. Retrieved from
http://www.chc.ucsf.edu/archives/healthprofessionsobsolete.htm
Van Damme, D. (2000). Internationalization and quality assurance: Towards worldwide
accreditation? European Journal for Education Law and Policy, 4, 1-20.
Van der Ploeg, F. & Veugelers, R., (2008). Towards evidence-based reform of European
universities. CESifo Economic Studies, 54(2), 99‒120.
Volkwein, J. F., Lattuca, L. R., Harper, B. J., & Domingo, R. J. (2007). Measuring the impact of
professional accreditation on student experiences and learning outcomes. Research in
Higher Education, 48(2), 251-282.
Walker, J. J. (2010). A contribution to the self-study of the postsecondary accreditation protocol:
A critical reflection to assist the Western Association of Schools and Colleges. Paper
presented at the WASC Postsecondary Summit, Temecula, CA.
Warner, W. K. (1977). Accreditation influences on senior institutions of higher education in the
Western accrediting region: An assessment. Oakland, CA: Western Association of
Schools and Colleges.
Weissburg, P. (2008). Shifting alliances in the accreditation of higher education: self-regulatory
organizations. Dissertation Abstracts International, 70(2). ProQuest ID 250811630.
Wendt, A. (2003). The NCLEX-RN examination charting the course of nursing practice. Nurse
Educator, 28, 276-280.
NURSING EDUCATION ACCREDITATION 120
Wendt, A. & Brown, P. (2000). The NCLEX examination. Preparing for future nursing practice.
Nurse Educator, 25, 297-300.
Wergin, J. F. (2005). Waking up to the importance of accreditation. Change, 37(3) 35-41.
Wergin, J. F. (2012). Five essential tensions in accreditation. In M. LaCelle-Peterson & D.
Rigden (Eds.), Inquiry, evidence, and excellence: The promise and practice of quality
assurance (27-38). Washington, DC: Teacher Education Accreditation Council.
Western Association of Schools and Colleges. (1998). Eight perspectives on how to focus
the accreditation process on educational effectiveness. Oakland, CA: Accrediting
Commission for Senior Colleges and Universities.
Western Association of Schools and Colleges. (2002). Guide to using evidence
in the accreditation process: A resource to support institutions and evaluation
teams. Retrieved from www.wascweb.org/senior/Evidence_Guide.pdf
Western Association of Schools and Colleges. (n.d.). Purposes of WASC accreditation. Retrieved
from http://www.wascsenior.org/about/purposeofaccreditation
Western Association of Schools and Colleges’ Accrediting Commission for Community and
Junior Colleges. (2011). Retrieved from http://www.accjc.org.
Wergin, J. F. (2012). Five essential tensions in accreditation. In M. LaCelle-Peterson & D.
Rigden (Eds.), Inquiry, evidence, and excellence: The promise and practice of quality
assurance (27-38). Washington, DC: Teacher Education Accreditation Council.
Retrieved from http://www.teac.org/wp- content/uploads/2012/03/Festschrift-Book.pdf
Westerheijden, D. F., Stensaker, B., & Rosa, M. J. (2007). Quality assurance in higher education:
Trends in regulation, translation and transformation. Dordrecht, The Netherlands:
Springer.
NURSING EDUCATION ACCREDITATION 121
Wiedman, D. (1992). Effects on academic culture of shifts from oral to written traditions: The
case of university accreditation. Human Organization, 51(4), 398-407.
Willis, C. R. (1994). The cost of accreditation to educational institutions. Journal of Allied
Health, 23, 39-41.
Wolff, R. A. (1990, June 27-30). Assessment 1990: Accreditation and renewal. Paper presented
at The Fifth AAHE Conference on Assessment in Higher Education, Washington, DC.
Wolff, R. A. (2005). Accountability and accreditation: Can reforms match increasing demands?.
In J. C. Burke (Ed.), Achieving accountability in higher education: Balancing public,
academic, and market demands (pp. 78-105). San Francisco, CA: Jossey-Bass.
Wood, A. L. (2006). Demystifying accreditation: Action plans for a national or regional
accreditation. Innovative Higher Education, 31(1), 43-62. doi: 10.1007/s10755- 006-
9008-6
Woolston, P. J. (2012). The costs of institutional accreditation: A study of direct and indirect
costs. (Order No. 3542492, University of Southern California). ProQuest Dissertations
and Theses, 313. Retrieved from
http://search.proquest.com/docview/1152182950?accountid=14749. (1152182950).
World Bank (2002). Constructing knowledge societies: New challenges for tertiary education.
Washington, DC: World Bank.
Wriston, H. M. (1960). The futility of accrediting. The Journal of Higher Education, 31(6), 327-
329.
Yung-chi Hou, A. (2014). Quality in cross-border higher education and challenges for the
internationalization of national quality assurance agencies in the Asia-Pacific region: the
Taiwanese experience. Studies in Higher Education, 39(1). 135-152.
NURSING EDUCATION ACCREDITATION 122
Zis, S., Boeke, M., & Ewell, P. (2010). State policies on the assessment of student learning
outcomes: Results of a fifty-state inventory. Boulder, CO: National
Center for Higher Education Management Systems (NCHEMS).

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Appendix A
Interview Protocol Example

Institution ID: __________ Interviewee initials: ________________
Appointment date/time: ___________________
Start time: _______________ End time: _______________
Description of the location:

Interview
Introduce myself: I am at doctoral student at USC’s Rossier School of Education collecting data
to perform qualitative research on nursing program accreditation as part of my dissertation.

Set the mood: The purpose of this study is to obtain nursing school directors’ and/or faculty’s
opinions regarding nursing education accreditation requirements and student learning outcomes.

Explain terms: The information I am collecting will be used in partial fulfillment of my doctoral
dissertation. Any identifying information (i.e., names of people, names of schools/universities)
will be excluded from the write-up. I will be recording the interview to ensure the accuracy of
your responses. As indicated in the consent form, the recordings and field notes collected will be
stored in a safe a place and destroyed after three years. The interview should last approximately
40-50 minutes.

Explain rights: You have the right to end this interview at any time. You have the right to ask
me to turn the recorder off at any time. You have the right to review the transcripts of this
interview. Have you read the consent form and agree to its terms?

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Appendix B
Interview Questions

1. Do you think CCNE/ACEN accreditation is important for nursing education?
a. Why or why not?

2. Do you think there are alternative quality review processes other than accreditation?
a. If so, what are some examples?
b. If not, why?

3. Given the role of the CA BRN, in what ways do you think CCNE/ACEN and the BRN
overlap duties?
a. In what ways do they complement each other?

4. What role do you think CCNE/ACEN plays in helping your school achieve its student
learning outcomes (SLOs)?

5. Do you have any suggestions for how CCNE/ACEN can help your school better achieve
or maintain its SLOs? If so, please provide any examples.

6. What role, if any, do CCNE/ACEN and its requirements play in ensuring successful first-
time NCLEX pass rates for your graduates?

7. Do you have any suggestions for how CCNE/ACEN can help your school increase or
maintain its first-time NCLEX pass rates?

8. In what ways do you feel the use of the NCLEX first-time pass rates as one measurement
of student learning outcomes for accreditation reporting is or is not effective?
a. What do you believe may be more accurate measures of SLOs?

9. What kind of impact, if any, do you think the NLN’s new accrediting agency – the
Commission on Nursing Education Accreditation – will have on nursing education?

10. Do you have any other thoughts or opinions about CCNE/ACEN accreditation or SLOs
you would like to add?

11. Is there anything I haven’t asked about nursing accreditation that you think is important?

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Appendix C
Commission on Collegiate Nursing Education (CCNE) Accreditation Standards

Standard I. Program Quality: Mission and Governance
Key Elements
I-A. The mission, goals, and expected program outcomes are:
• Congruent with those of the parent institution; and

• Consistent with relevant professional nursing standards and guidelines for the
preparation of nursing professionals.

I-B. The mission, goals, and expected student outcomes are reviewed periodically and
revised as appropriate, to reflect:
• Professional nursing standards and guidelines; and

• The needs and expectations of the community interest.

I-C. Expected faculty outcomes are clearly identified by the nursing unit, are written and
communicated to the faculty, and are congruent with institutional expectations.
I-D. Faculty and students participate in the practice of governance.
I-E. Documents and publications are accurate. A process is used to notify constituents
about changes in documents and publications.
I-F. Academic policies of the parent institution and the nursing program are congruent
and support achievement of the mission, goals, and expected student outcomes.
These policies are:
• Fair and equitable;

• Published and accessible, and

• Reviewed and revised as necessary to foster program improvement.

Standard II. Program Quality: Institutional Commitment and Resources
Key Elements
II-A. Fiscal and physical resources are sufficient to enable the program to fulfill its
mission, goals, and expected outcomes. Adequacy of resources is reviewed
periodically and resources are modified as needed.
II-B. Academic support services are sufficient to ensure quality and are evaluated on a
regular basis to meet program and student needs.
II-C. The chief nurse administrator:
• Is a registered nurse (RN);
• Holds a graduate degree in nursing;
• Holds a doctoral degree if the nursing unit offers a graduate program in nursing;
• Is academically and experientially qualified to accomplish the mission, goals, and
expected program outcomes;
• Is vested with the administrative authority to accomplish the mission, goals, and
expected program outcomes; and
• Provides effective leadership to the nursing unit in achieving its mission, goals,
and expected program outcomes.
II-D. Faculty are:
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• Sufficient in number to accomplish the mission, goals, and expected program
outcomes;
• Academically prepared for the areas in which they teach; and
• Experientially prepared for the areas in which they teach.
II-E. Preceptors, when used by the program as an extension of faculty, are academically
and experientially qualified for their role in assisting in the achievement of the
mission, goals, and expected student outcomes.
II-F. The parent institution and program provide and support an environment that
encourages faculty teaching, scholarship, service, and practice in keeping with the
mission, goals, and expected faculty outcomes.

Standard III. Program Quality: Curriculum and Teaching-Learning Practices
Key Elements:
IIIA. The curriculum is developed, implemented, and revised to reflect clear statements
of expected student outcomes that are congruent with the program’s mission and
goals, and with the roles for which the program is preparing its graduates.
IIIB. Curricula are developed, implemented, and revised to reflect relevant professional
nursing standards and guidelines, which are clearly evident within the curriculum
and within the expected student outcomes (individual and aggregate).
• Baccalaureate program curricula incorporate The Essentials of Baccalaureate
Education for Professional Nursing Practice.

• Master’s program curricula incorporate professional standards and guidelines as
appropriate.

o All master’s degree programs incorporate The Essentials of Master’s
Education in Nursing and additional relevant professional standards and
guidelines as identified by the program.

o All master’s degree programs that prepare nurse practitioners incorporate
Criteria for Evaluation of Nurse Practitioner Programs.

• Graduate-entry program curricula incorporate The Essentials of Baccalaureate
Education for Professional Nursing Practice and appropriate graduate program
standards and guidelines.

• DNP program curricula incorporate professional standards and guidelines as
appropriate.

o All DNP programs incorporate The Essentials of Doctoral Education for
Advanced Nursing Practice and additional relevant professional standards
and guidelines if identified by the program.

o All DNP programs that prepare nurse practitioners incorporate Criteria for
Evaluation of Nurse Practitioner Programs.

• Post-graduate APRN certificate programs that prepare nurse practitioners
incorporate Criteria for Evaluation of Nurse Practitioner Programs.

III-C. The curriculum is logically structured to achieve expected students outcomes.
• Baccalaureate curricula build upon a foundation of the arts, sciences, and
humanities.

• Master’s curricula build on a foundation comparable to baccalaureate level
nursing knowledge.

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• DNP curricula build on a baccalaureate and/or master’s foundation, depending on
the level of entry of the student.

• Post-graduate APRN certificate programs build on graduate level nursing
competencies and knowledge base.

III-D. Teaching-learning practices and environments support the achievement of
expected student outcomes.
III-E. The curriculum includes planned clinical practice experiences that:
• Enable students to integrate new knowledge and demonstrate attainment of
program outcomes; and
• Are evaluated by faculty.
III-F. The curriculum and teaching-learning practices consider the needs and
expectations of the identified community interest.
III-G. Individual student performance is evaluated by the faculty and reflects
achievement of expected student outcomes. Evaluation policies and procedures for
individual student performance are defined and consistently applied.
III-H. Curriculum and teaching-learning practices are evaluated at regularly scheduled
intervals to foster ongoing improvement.

Standard IV. Program Effectiveness: Assessment and Achievement of Program Outcomes
Key Elements:
IV-A. A systematic process is used to determine program effectiveness.
IV-B. Program completion rates demonstrate program effectiveness.
IV-C. Licensure and certification pass rates demonstrate program effectiveness.
IV-D. Employment rates demonstrate program effectiveness.
IV-E. Program outcomes demonstrate program effectiveness.
IV-F. Faculty outcomes, individually and in the aggregate, demonstrate program
effectiveness.
IV-G. The program defines and reviews formal complaints according to established
policies.
IV-H. Data analysis is used to foster ongoing program improvement.

Source: Commission on Collegiate Nursing Education. (2013). Standards for Accreditation of
Baccalaureate and Graduate Nursing Programs. Retrieved from
http://www.aacn.nche.edu/ccne-accreditation/Standards-Amended-2013.pdf
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Appendix D
Accreditation Commission for Education in Nursing (ACEN) Accreditation Standards

Standard 1. Mission and Administrative Capacity
1.1 The mission/philosophy and program outcomes of the nursing education unit are
congruent with the core values and mission/goals of the governing organization.
1.2 The governing organization and nursing education unit ensure representation of the
nurse administrator and nursing faculty in governance activities; opportunities exist
for student representation in governance activities.
1.3 Communities of interest have input into program processes and decision-making.
1.4 Partnerships that exist promote excellence in nursing education, enhance the
profession, and benefit the community.
1.5 The nursing education unit is administered by a nurse who holds a graduate degree
with a major in nursing and is doctorally prepared.
1.6 The nurse administrator is experientially qualified, meets governing organization
and state requirements, and is oriented and mentored to the role.
1.7 When present, nursing faculty who coordinate or lead program options/tracks are
academically and experientially qualified.
1.8 The nurse administrator has authority and responsibility for the development and
administration of the program and has adequate time and resources to fulfill the role
responsibilities.
1.9 The nurse administrator has the authority to prepare and administer the program
budget with faculty input.
1.10 Policies for nursing faculty and staff are comprehensive, provide for the welfare of
faculty and staff, and are consistent with those of the governing organization;
differences are justified by the goals and outcomes of the nursing education unit.
1.11 Distance education, when utilized, is congruent with the mission of the governing
organization and the mission/philosophy of the nursing education unit.

Standard 2. Faculty and Staff
2.1 Full-time faculty hold a minimum of a graduate degree with a major in nursing; a
minimum of 25% of the full-time faculty also hold an earned doctorate or are
currently enrolled in doctoral study. Full- and part-time faculty include those
individuals teaching and/or evaluating students in classroom, clinical, or laboratory
settings.
2.2 Part-time faculty hold a minimum of a graduate degree with a major in nursing.
2.3 Faculty (full- and part-time) credentials meet governing organization and state
requirements.
2.4 Preceptors, when utilized, are academically and experientially qualified, oriented,
mentored, and monitored, and have clearly documented roles and responsibilities.
2.5 The number of full-time faculty is sufficient to ensure that the student learning
outcomes and program outcomes are achieved.
2.6 Faculty (full- and part-time) maintain expertise in their areas of responsibility, and
their performance reflects scholarship and evidence-based teaching and clinical
practices.
NURSING EDUCATION ACCREDITATION 129
2.7 The number, utilization, and credentials of staff and non-nurse faculty within the
nursing education unit are sufficient to achieve the program goals and outcomes.
2.8 Faculty (full- and part-time) are oriented and mentored in their areas of
responsibility.
2.9 Systematic assessment of faculty (full- and part-time) performance demonstrates
competencies that are consistent with program goals and outcomes.
2.10 Faculty (full- and part-time) engage in ongoing development and receive support
for instructional and distance technologies.
Standard 3. Students
3.1
Policies for nursing students are congruent with those of the governing
organization, publicly accessible, non-discriminatory, and consistently applied;
differences are justified by the student learning outcomes and program outcomes.
3.2 Public information is accurate, clear, consistent, and accessible, including the
program’s accreditation status and the ACEN contact information.
3.3 Changes in policies, procedures, and program information are clearly and
consistently communicated to students in a timely manner.
3.4 Student services are commensurate with the needs of nursing students, including
those receiving instruction using alternative methods of delivery.
3.5 Student educational records are in compliance with the policies of the governing
organization and state and federal guidelines.
3.6 Compliance with the Higher Education Reauthorization Act Title IV eligibility and
certification requirements is maintained, including default rates and the results of
financial or compliance audits.
3.6.1 A written, comprehensive student loan repayment program addressing student
loan information, counseling, monitoring, and cooperation with lenders is
available.
3.6.2 Students are informed of their ethical responsibilities regarding financial
assistance.
3.6.3 Financial aid records are maintained in compliance with the policies of the
governing organization, state, and federal guidelines.
3.7 Records reflect that program complaints and grievances receive due process and
include evidence of resolution.
3.8 Orientation to technology is provided, and technological support is available to
students.
3.9 Information related to technology requirements and policies specific to distance
education are accurate, clear, consistent, and accessible.

Standard 4. Curriculum
4.1 The curriculum incorporates established professional standards, guidelines, and
competencies, and has clearly articulated student learning outcomes and program
outcomes consistent with contemporary practice.
4.2 The student learning outcomes are used to organize the curriculum, guide the
delivery of instruction, direct learning activities, and evaluate student progress.
4.3 The curriculum is developed by the faculty and regularly reviewed to ensure
integrity, rigor, and currency.
NURSING EDUCATION ACCREDITATION 130
4.4 The curriculum includes general education courses that enhance professional
nursing knowledge and practice.
4.5 The curriculum includes cultural, ethnic, and socially diverse concepts and may also
include experiences from regional, national, or global perspectives.
4.6 The curriculum and instructional processes reflect educational theory,
interprofessional collaboration, research, and current standards of practice.
4.7 Evaluation methodologies are varied, reflect established professional and practice
competencies, and measure the achievement of the student learning outcomes.
4.8 The length of time and the credit hours required for program completion are
congruent with the attainment of identified student learning outcomes and program
outcomes and consistent with the policies of the governing organization, state and
national standards, and best practices.
4.9 Practice learning environments support the achievement of student learning
outcomes and program outcomes.
4.10 Students participate in clinical experiences that are evidence-based and reflect
contemporary practice and nationally established patient health and safety goals.
4.11 Written agreements for clinical practice agencies are current, specify expectations
for all parties, and ensure the protection of students.
4.12 Learning activities, instructional materials, and evaluation methods are appropriate
for all delivery formats and consistent with the student learning outcomes.

Standard 5. Resources
5.1 Fiscal resources are sustainable, sufficient to ensure the achievement of the student
learning outcomes and program outcomes, and commensurate with the resources of
the governing organization.
5.2 Physical resources are sufficient to ensure the achievement of the nursing education
unit outcomes, and meet the needs of the faculty, staff, and students.
5.3 Learning resources and technology are selected with faculty input and are
comprehensive, current, and accessible to faculty and students.
5.4 Fiscal, physical, technological, and learning resources are sufficient to meet the
needs of the faculty and students engaged in alternative methods of delivery.

Standard 6. Outcomes
6.1 The systematic plan for evaluation of the nursing education unit emphasizes the
ongoing assessment and evaluation of each of the following:
• Student learning outcomes;
• Program outcomes;
• Role-specific graduate competencies; and
• The ACEN Standards.
The systematic plan of evaluation contains specific, measurable expected levels of
achievement; frequency of assessment; appropriate assessment methods; and a mum
of three years of data for each component within the plan
6.2 Evaluation findings are aggregated and trended by program option, location, and
date of completion and are sufficient to inform program decision-making for the
maintenance and improvement of the student learning outcomes and the program
outcomes.
NURSING EDUCATION ACCREDITATION 131
6.3 Evaluation findings are shared with communities of interest.
6.4 The program demonstrates evidence of achievement in meeting the program
outcomes.
6.4.1 Performance on licensure exam: The program's three-year mean for the
licensure exam pass rate will be at or above the national mean for the same
three-year period.
6.4.2 Program completion: Expected levels of achievement for program completion
are determined by the faculty and reflect student demographics and program
options.
6.4.3 Graduate program satisfaction: Qualitative and quantitative measures address
graduates six to twelve months post-graduation.
6.4.4 Employer program satisfaction: Qualitative and quantitative measures address
employer satisfaction with graduate preparation for entry-level positions six to
twelve months post-graduation.
6.4.5 Job placement rates: Expected levels of achievement are determined by the
faculty and are addressed through quantified measures six to twelve months
post-graduation.

Source: Accreditation Commission for Education in Nursing. (2013). Accreditation Manual:
Section III – Standards and Criteria Glossary. Retrieved from
http://www.acenursing.net/manuals/SC2013.pdf

Abstract (if available)

Abstract This study evaluates nursing school administrator perspectives on national nursing education accreditation and their quality standards, such as first-time National Council Licensing Exam for Registered Nurses (NCLEX-RN) pass rates. The purpose of this study was to explore California nursing school opinions of the Commission on Collegiate Nursing Education (CCNE) and/or the Accreditation Commission for Education in Nursing (ACEN) accreditation requirements, first-time NCLEX-RN pass rates, in particular. These perspectives were obtained through a qualitative, narrative study design using open-ended, structured interviews of six nursing school administrators from programs located in California. Three surprising observations were made from the interviews: all six agreed that accreditation was a positive thing

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Asset Metadata

Creator Richardson, Jill Kathryn (author)

Core Title An evaluation of nursing program administrator perspectives on national nursing education accreditation

School Rossier School of Education

Degree Doctor of Education

Degree Program Education (Leadership)

Publication Date 02/19/2015

Defense Date 01/20/2015

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag board of nursing,National Council Licensing Exam,NCLEX,nursing education,nursing education accreditation,OAI-PMH Harvest

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Keim, Robert G. (committee chair), Tobey, Patricia Elaine (committee member), Woolston, Paul J. (committee member)

Creator Email jillkrichardson@yahoo.com,jkrichar@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-534465

Unique identifier UC11298491

Identifier etd-Richardson-3199.pdf (filename),usctheses-c3-534465 (legacy record id)

Legacy Identifier etd-Richardson-3199.pdf

Dmrecord 534465

Document Type Dissertation

Format application/pdf (imt)

Rights Richardson, Jill Kathryn

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA