In summary, accreditation is a means to recognize an educational institution for standards that qualify the graduate for higher or more specialized education or for professional practice through a process of periodic self-examination and peer review that focuses on quality improvement. There is a renewed call for a balance of the interests of the institutions, the professions and the public. Reducing the proliferation, duplication and cost of accreditation will require new structures that can also increase effectiveness and quality outcomes. Reducing barriers to innovation among health professions education must be a priority.

These issues are not unique to the nursing profession nor will they be resolved with a simplistic competition from a new agency (AACN). While competition may ultimately serve as a catalyst to stimulate transformation in the accreditation industry, collaboration of limited resources in an already too costly process would provide ample opportunities for emerging partnership models. Even collaboration would not in itself offer assurances for the quality improvement and accountability being called for from employers and the public. This issue demands a response bigger than current practices.

The NLN continues to have public and employer membership representation; a commitment to improvement, and plans for improvement are underway to implement an integrated, automated, electronic information system. NLN delivers specialized nursing accreditation more effectively than state, institutional, or regional bodies or administrators can deliver, but must continue to do so with a more efficient, quality improvement approach.

Barnum asks "What is gained (with accreditation) versus what is lost (without accreditation)?" With the massive health reform underway and the need for major transformation in the education of all health providers, health care employers, professionals and the public will need better measures of quality improvement in the preparation of the nation's practitioners for tomorrow ... through improved and responsive accreditation, licensure and credentialing. We can't afford to go without, especially now, nor should we transfer the process to other self-serving regulators. There are several improvements needed, and we should be about providing them.