Accrediting organization

In 1996 the National League for Nursing (NLN) approved the creation of the NLNAC as an independent entity within the organization; in 1997, with sole authority and accountability, the NLNAC began implementing the accreditation role and responsibilities. The NLNAC’s mission is to support nursing education, nursing practice, and the public through accreditation. The commission defines accreditation as “a voluntary, self-regulatory process by which non-governmental associations recognize educational institutions or programs that have been found to meet or exceed standards and criteria for educational quality” (NLNAC, 2008, p. 1).

NLNAC is governed by a 15-member Board of Commissioners composed of individuals representing nursing education (9 commissioners), service (3 commissioners), and the public sector (3 commissioners). The executive director (ED) reports directly to the Board of Commissioners. The remaining organization structure is composed of professional and administrative staff, program evaluators, and support staff. The ED or NLNAC commissioners chair delivers a formal report to NLN, the parent organization, during an NLN Board of Governors meeting annually. While NLN is the parent organization, NLNAC is a wholly owned subsidiary of NLN whose accrediting processes, finances, and administration are separate and independent of NLN to meet compliance requirements of the USDOE. The NLNAC Board of Commissioners is responsible for setting policy and making decisions related to accreditation, policy, finances, and administration (NLNAC, 2008).

Program evaluators (peer reviewers) participate as site visitors, evaluation review panel members, and appeal panel members. These individuals must meet certain criteria related to educational preparation, nursing education expertise, and professional service in addition to attending program evaluator professional development (every 4 years) in order to serve as a program evaluator. Program evaluators are expected to maintain confidentiality regarding nursing programs visited and recommendations made as a result of the self-study and site visit. They also must be from an NLNAC-accredited nursing program. NLNAC provides a detailed accreditation manual that can be downloaded easily by nursing programs (www.nlnac.org/manuals/Manual2008.htm).

NLNAC standards and criteria

There are six designated NLNAC (2008) accreditation standards, including mission and administrative capacity, faculty and staff, students, curriculum, resources, and outcomes. These standards are applicable for all types of nursing programs. The standards and criteria are reviewed every 5 years. Table 29-1 identifies the standards that are defined as “agreed-upon rules for measurement of quantity, extent, value, and quality” (NLNAC, 2008, p. 12). Each standard has specific criteria based on the type of nursing program being evaluated. For example, there are specific criteria (elements that must be addressed in the evaluation of a standard) for the clinical doctorate, master’s and postmaster’s certificate, baccalaureate, associate, diploma, and practical nursing programs. Distance education is also addressed as a criterion in each of the standards. To aid with preparation of the self-study document, NLNAC provides focus questions for each standard and criteria that facilitate adequately addressing each standard. It is an expectation that all standards will be in compliance for the nursing program to receive initial or continued accreditation. Nursing programs are expected to provide a summary of program strengths, areas in need of development, and an action plan based on the standards and criteria. NLNAC offers self-study forums for nursing programs beginning the accreditation or reaccreditation process. The focus of the forums is an overview of the accreditation process and writing a self-study. Each forum addresses in detail a specific standard that may have been identified as an area needing further nursing program development. For example, Standard 6: Outcomes was identified as an area needing development for fall 2009 and spring 2010, followed by Standard 2: Faculty and Staff (NLNAC, 2010).

NLNAC accreditation process

NLNAC follows the accreditation model discussed earlier in the chapter. A four-step process is used that includes a self-study report, an on-site visit, a review by the evaluation panel, and a final decision by the Board of Commissioners. The on-site visit is performed by site visitors composed of professional peers. The team of site visitors looks for congruence between the self-study and the actual functioning of the program. The site visitors make a recommendation to the accreditation status of the nursing program. This report is submitted to NLNAC; a copy is then sent to the nursing program administrator, who has 2 weeks to review the report and clarify any errors noted in it on a response form. The final draft of the report is sent to the site visitors and the nursing program administrator. Next, the report is reviewed by the evaluation review panel, whose role is to validate the site visit team’s report and determine that there is strong evidence to support the standards and criteria. This panel is appointed by the NLNAC Board of Commissioners and one of the commissioners serves as a member of the panel. The nursing program administrator may attend the evaluation review panel meeting in person or by conference call. The administrator is in the role of observer only, but may address the panel after deliberations are completed. A recommendation from the panel is made to the Board of Commissioners, which has the sole authority for determining accreditation status of nursing program applicants.

Initial accreditation and continuing accreditation

Nursing programs seeking initial accreditation must comply with certain policies and procedures. The chief executive officer of the college or university initiates the process and authorizes the NLNAC to begin the accreditation process. NLNAC assigns the nursing program a mentor to facilitate the self-assessment process. The nursing program applies for candidacy status by submitting state board of nursing approval documentation, specific fees, and information related to faculty, curriculum, and resources. Once candidacy status is established, the nursing program has 2 years to complete the accreditation process. The nursing program must be in compliance with all standards and criteria to receive initial accreditation or risk accreditation being denied. Initial accreditation nursing programs are reviewed in 5 years (NLNAC, 2008).

Nursing programs seeking continuing accreditation must be in compliance with all standards and criteria to receive accreditation for 8 years. If a nursing program is found to be noncompliant in one or two standards, the next review is scheduled in 2 years for all types of programs except the practical nurse program, which is reviewed in 18 months. This review can be a follow-up report or a follow-up report with a follow-up site visit. For nursing programs that are noncompliant in three or more standards, the next review, consisting of a site visit with self-study report, is in 2 years for all program types except practical nursing program, which is reviewed in 18 months.

Nursing programs facing possible denial or withdrawal have the opportunity to appeal the decision. Nursing programs have 30 days to begin the appeal process after receiving notification of the adverse accreditation decision. An appeal panel is charged with reviewing all pertinent materials, including any documentation relevant to the adverse accreditation decision and information presented at an appeal hearing where oral presentations are made by two representatives of the nursing program, including the nursing administrator. The final appeal decision is made by the appeal panel. A final decision can be affirmation of the adverse accreditation decision, continuing accreditation with an on-site visit in 8 years, or initial accreditation with an on-site visit in 5 years. All NLNAC accreditation decisions are made available to the USDOE, state boards of nursing, and the public. The NLNAC website (www.nlnac.org) provides extensive information to guide nursing programs in every aspect of the accreditation process.