Associate Degree nursing education is in considerable turmoil and conflict over the issue of accreditation. The problem, of course, is not should we be accredited, but by whom? Three contenders for the honor are: (1) the state board of nursing, (2) the regional accrediting association, and (3) the National League for Nursing. The Nurse Training Act of 1964 brought the problem clearly into focus when the Commissioner of Education named the League as the recognized body for the accreditation of nursing programs under the portion of the law which requires that programs receiving funds be accredited. At the time this decision was made, no more than four or five Associate Degree (AD) programs were accredited by the League. However, the League moved rapidly, as had been agreed upon, to make tentative approval procedures available at reasonable cost so that programs might qualify for participation under Public Law 88581.
Dr. Francis Keppel stated in a letter, November, 1964, to Dr. Edmund Gleazer, Executive Director of the American Association of Junior Colleges, that "at present no single accrediting body or group of accrediting bodies is satisfactorily meeting the national need for accreditation of AD nursing programs. " In approving the League as the recognized body for accreditation, he reserved the right to approve additional accrediting bodies for AD nursing programs at a later date. He indicated to Dr. Gleazer that the action he was taking was designed to make possible the initiation of programs under the Nurse Training Act without delay, and to provide time for resolving the accreditation issues facing the junior college.
With this decision the issue of accreditation of AD nursing programs became a reality for those of us in leadership roles in AD nursing education - a reality we have not dealt with prior to this time. It is interesting to try to determine why we have not, and to assess the course of action available to us at this time. Ideas and opinions concerning the issue of accreditation are as varied as the people with whom one discusses the problem. Each of us has a different bias, and many of us have relatively superficial knowledge of the complex problem of accrediting procedures for higher education in our country.
Dr. William Selden's book, Accreditation - A Struggle Over Higher Standards In Education, was very helpful in giving me some perspective on the subject of accreditation itself. He says that his own interest in the area of accreditation has led him to realize that accrediting is a manifestation in higher education of our form of civil government and political control and that just as there is struggle for control and influence in civil government, so there is struggle for control and influence in higher education. Accreditation provides the focus for this struggle. This is the essence of what is going on in relation to AD nursing education at the present time. What we need is the wisdom to strip away the politics of the struggle, which every agency interested in having this right is engaging in, and look to our needs so that we may determine what will best serve our programs.
Dr. Seiden describes accreditation as the process whereby an organization or agency recognizes the college or university or program of studies as having met certain predetermined qualifications or standards. We need to ask ourselves which organization or agency will offer us the most effective process of systematic review through which the quality of our programs will be evaluated and from which will come motivation and guidance for further growth.
In nursing, the term accreditation has been synonymous with "accreditation by the National League for Nursing." Associate Degree nursing programs, however, from their inception did not move in great numbers to seek League approval. Some of the reasons why they did not seek this approval are easy to identify. First, the structure of the League did not accommodate to the AD program in a way that met its needs effectively. Placing the program in the same department with diploma schools has not provided an environment for growth. The cost of departmental membership and the cost of the accreditation survey itself have been prohibitive for some junior colleges. The policies and processes of accreditation have been somewhat less than desirable in some instances. In the environment of the junior college this new program felt free to question old methods, to look to other agencies as potential, appropriate accreditors. This, I believe, was an appropriate part of the growing process of a totally new approach to nursing education.
In addition, the AD program has had the advantage of more than ten years of research and study in the Cooperative Research Project, followed by the Sealantic Project, and then the fourstate Kellogg Project, which has provided motivation and assistance to many of the programs in their initial growth and continued development. Until recently the number of these programs has been small, with growth relatively controlled. AU of this has tended to make the need for accreditation somewhat obscure. Perhaps, it seemed, accreditation of the college alone was sufficient if the program had state approval.
Certainly another influential factor is the attitude of junior college administrators, many of whom are inclined to steer clear of accreditation of special programs by specialized accrediting bodies. Some administrators are adamant on this point Their attitude is expressed clearly by Dr. Tom Merson in his article, "Crisis In Accreditation," in the Junior College Journal, February, 1965. Three sentences in the article succinctly express their attitude. Dr. Merson said: "These colleges have been trying to avoid some of the accreditation pitfalls in which senior colleges and universities have become entrapped, particularly the pitfall of special accreditation." He further states "the expense and the work load imposed on the institution by multiple accreditation can severely tax its resources," and ". . . at least two regional accrediting associations now review AD nursing programs as part of their general accreditation process and it is this approach which must be encouraged."
Dr. Merson presents the view of perhaps many junior college administrators. They seem to think that opening the door to one national professional accrediting group may be akin to opening Pandora's box. They support the idea of making changes in regional accrediting procedures to provide for the review of nursing programa. They are interested, also, in educating Congress so that future legislation will be worded "appropriately," and in making an effort to amend the present legislation to make program accreditation for participation under the Nurse Training Act unnecessary. This failing, they will attempt to have another agency identified at the state or regional level as the appropriate accrediting group for junior college nursing programs.
In the midst of this controversy, two pertinent factors seem rather obvious at this time. (1) The decision as to where responsibility for accreditation of AD nursing programs will lie is not going to be influenced by the deans, directors, chairmen, and faculty of of these programs in a measurable way. (2) The deans, directors, chairmen, and faculty of these programs have no majority opinion which they are committed to follow. Associate Degree nursing educators have no avenue at this time at the regional or national level, or even at the state level, to make themselves felt in a meaningful way in relation to accreditation. This does not mean we could not have, nor should not have, but that at the present time we do not have an effective voice on the subject of accreditation at these levels.
At the same time, two significant developments are taking place in the growth of AD nursing programs. First, there is a great proliferation of programs, and secondly, there is a critical shortage of administrators and faculty for these programs. If we could be sure that the quality of administration and faculty found in the first programs could be maintained as these programs grow in number, we could take a much more relaxed attitude toward accreditation. We could take our time in making a decision about the process of systematic review that will serve us best. But it seems to me that time is of the essence. Now is the time when many apparently weak programs are being instituted without adequate guidance and support.
Statistics from the National League for Nursing show that when the academic preparation of faculty in sixty programs operating in 1961 was compared with the academic preparation of faculty in twenty-one programs opened since 1961, there was a decline in caliber. Whereas 70 percent of the full-time faculty in long-established programs held master's or higher degrees, 64 percent of the faculty in newly established programs held similar degrees. Of even greater importance is the fact that in the older programs, 30 percent of the faculty held less than a master's degree whereas 36 percent of the faculty in newly established programs held lesser degrees. If this trend in the quality of faculty preparation continues without the quality control associated with accreditation, the concept of AD nursing education and the safety of patient care may be in jeopardy.
Statistics regarding state board examinations for the year 1961-1962 show that 6 percent of the graduates of accredited AD programs (by the National League for Nursing) and 21 percent of the graduates of non accredited programs failed to pass these examinations. In 1963-1964 the graduates of nonaccredited AD programs had the highest proportion of failures on state board examinations (25 percent). This is a definite change from statistics of earlier years.
It seems to me that we are faced with two problems: (1) How to provide some assurance of quality control in AD nursing programs, which we do not have at the present time, and (2) how, as a group, to make ourselves felt in relation to the accreditation decision. The agencies that may assist us in controling the quality of these programs are the state boards of nursing or the state departments of education, regional associations, the National League for Nursing, or a compromise solution which might prove to be better than any of these. In terms of the state boards of nursing and/or departments of education, Dr. Keppel's statement of last October, when the decision was made to recognize the League as the appropriate accrediting body for nursing, has merit here. He said ". . . the procedures and standards for licensing of nurses and approval of programs of nurse education in the several states varies so widely that it does not seem feasible at this time to identify state accrediting or approval agencies for the purpose of the Act." In accepting either of these state agencies, we would be putting accreditation in the hands of a governmental agency instead of in a voluntary agency. These boards seem to be exerting far too little control in the rapid expansion of AD nursing programs, and it is to the state level one must look for control in the opening of new programs. In many states, they have authority for minimal standards only.
Should we look to the regional associations for this kind of systematic review? There are several factors to be considered here. Regional accreditation would not provide us national guidance, although the examination for licensure is given nationally. The process of identifying criteria for the review of these programs and of setting up a mechanism within the regional body for carrying out such a procedure would be time-consuming and expensive, and would vary from region to region. At the present time some of the regional bodies do not seem interested in moving toward specialized accreditation of programs. Can and will the regional body establish a procedure for approving or disapproving a program within a college which is not attached to the overall accreditation procedure for the college? If it can, will the procedure have meaning in terms of assuring quality if it has no bearing or direct relationship to the overall accreditation of the college itself?
Should we look to the National League for Nursing? They have been effective in accreditation. They have established criteria for reviewing AD nursing programs arrived at by the AD nursing programs themselves. We would have within this framework a survey by qualified peers, and a review of this survey by our peers. Would, however, the cost continue to remain prohibitive for junior colleges?
Or should we look for a compromise solution and hope to find, thereby, a better solution? The League is now establishing a department for AD nursing programs. We will have an opportunity here for agency membership and participation on a national level, something we have not had. Within this department high-level conferences on the subject of accreditation could be called to determine what we need and how to get it. We are a new program; we have sought new answers to problems in the past. Perhaps a compromise solution would involve both a national professional body and the regional association in a way which would be acceptable to each of them and to us. The processes and procedure with which we are unhappy could be changed. It would be unfortunate in AD nursing education to take away from institutions who wish to submit voluntarily for review, on the basis of established criteria on a national level, the prerogative to do so.
Dr. Selden's book has a prologue and an epilogue. In the prologue, Edward Tyler, Chairman of the Department of Modern Languages, becomes president of fictitious Enfield University. He is an academic man with little orientation to the political world of administration. One of the first issues confronting him in his new presidency is a letter from a national professional association indicating that the accreditation of Enfield University is in jeopardy. President Tyler was quite agitated by what he considered the impertinence of an outside organization in dictating how a university should be operated. His first impulse was to send a letter expressing his annoyance with such proceedings. Before he did this, he recalled a quotation from Voltaire, "It is said that God is always on the side of the heaviest battalions," and he wisely decided to find out on which side were the heaviest battalions.
In the epilogue, President Tyler comes to the conclusion that the letter he meant to write should never be written. After much study of the problem he was no less happy; in fact, he was even in disagreement with the written report sent to Enfield University, for he came to know that accreditation is indeed a fallible, finite method of evaluating and judging institutions or programs of study, using often only broad and gross measures. But he became convinced that it was a necessary tool and rather than simply be critical, he must move to share actively in the responsibility of finding a better way. This is what I think we must do now. We must find a better way for accrediting AD nursing programs. We must find the side with the heaviest battalions. We have won a battle by moving part of our basic education in nursing into the junior college, into an educational setting. Let us be sure that we do not lose the war by failing to guide our destiny in these programs toward the highest quality education it is possible for us to achieve.
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