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table of contents | references | test
By Sheila A. Ryan, PhD, RN, FAAN
Article originally published August 20, 1997
Introduction
Dr. Barnum raises several compelling issues in her piece on "Licensure, Certification, and Accreditation" while positing questions as to their future relevance to the profession as they stand
today. Licensure, she asserts, is a state regulatory function to guarantee the "MINIMUM" safety
of the entering professional. I always thought rather simplistically about these events as:
- licensure tests minimum safety for the entering professional;
- credentialing measures advanced knowledge and skills;
- accreditation verifies the program's quality and integrity to prepare the student
appropriately and according to national standards.
Questions for Tomorrow
Two interesting sets of questions for future relevance include:
- Will we continue to require measures for quality to produce minimum or advanced
competency? Are there other measures we should be considering?
The answer to this set of questions of course will be "absolutely." Fifty years ago, outcome
measures were not understood. Quality improvement has brought them to the fore. Nursing and
other disciplines will need to successfully complete competency examinations in one's practice
discipline (beyond the counting of curriculum inputs or process).
- Who will be the regulatory agent of accountability? the state? the federal government? the
professions? the public stakeholders? And should the processes of licensure, accreditation and
credentialing be linked in order to improve accountability?
Actually, Barnum makes a case that states really are serving in this capacity nominally. The
licensure exam is already national; the passing score is national; and states recognize reciprocity
with each other across state boundaries now. States serve primarily as a register of record. As
competency outcome measures for individuals become the norm, states may actually have a role
to play in sanctioning schools within their state boundaries who do not meet or "produce" these
competencies. They could impose additional requirements or practice restrictions as well for the
graduate who cannot demonstrate minimum competency in all other desired areas.
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