OJIN probes the sensitive and important issue of accreditation of schools of nursing. Dr. Barnum rightly places accreditation within a paradigm that includes licensure and certification. She also offers vital distinctions about purpose (assure safety versus assure quality) and scope (individual versus institutional). The discussants, Dr. Collins and Dr. Ryan, place accreditation in the context of a social agenda of cost containment, managed care, and accountability in higher education and health care. As they lay out their conceptual grid, I am reminded of an old McDonald's commercial where a father comforts a preschool child who is feeling displaced by a new baby. The dad reminds the little boy that he has been around the block several times. Dr. Barnum speaks of this experience factor especially around licensure as identifying "hot" or "wedge" issues. In the decade of the nineties, accreditation has assumed center stage. It is hot!

There is concern about the value of accreditation. There is debate about whether accreditation should be public or a private sector endeavor. There are efforts to relate accreditation to quality assurance, reimbursement, eligibility for financial aid, academic progression, or comparative advantage in the student, patient, or job market. Some commentators explain the loss of confidence in accreditations as another sign that twentieth century structures are collapsing under their own weight. Modern writers insist that accreditation should not be driven by process (credentials of accreditors or faculty, the format of the curriculum, or admissions and progression standards). They argue that it is the end, the product or the outcome that counts.

Cognizant of these debates, Dr. Ryan asks what needs to be "done to" accreditation so that it fits into a technological or information society? Dr. Collins wants marketplace accountability. She asks whether accreditation as we know it meets the standards of efficiency or cost containment?

If health and education become commercial enterprises, I wonder how the "customer" -- the patient, the employer, or the student will sort through the hype and select the school or the health care environment that is best for them. Will private accreditation become a consumer's guide to quality health care and professional education? Let us hear your opinion -- please make your ideas known to the editor of OJIN. Write a manuscript or letter to the editor about this important issue.

Keywords: Accreditation Schools, Nursing, United States

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