Accreditation, unlike the RN/LPN testing in licensure and RN certification, evaluates and judges institutions rather than individuals. Most accreditation programs testify to the institution's achievement, rather than merely guaranteeing safety. Accreditation, like nurse certification, is voluntary — but not quite. For example, if a service institution wants to collect Medicaid bills, it will have to have accreditation. Hence, while accreditation is "voluntary," an institution might go broke for the privilege of not volunteering. Similarly, in nursing master's education, most programs will not admit a nurse who graduated from an unaccredited program, even if the program was licensed by the state.

In nursing practice, we have long been familiar with Joint Commission on Accreditation of Hospitals, later revised to Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the change corresponding to the broadening of the accrediting target from merely hospitals to other health care delivery systems.

In nursing, our chief accrediting body over the years has been the National League for Nursing (NLN).

The NLN parent organization accredits (through independent arms) both home health organizations under the Community Health Accreditation Program (CHAP) and nursing education through the NLN Accrediting Commission (NAC). We'll look at the home health accreditation process first.

Acquiring of deemed status for this new accrediting function brought NLN into direct competition with JCAHO (there is no monopoly on the coveted deemed status). JCAHO's deemed status allowed them to accredit home health care programs long before the NLN developed itscompetitor, CHAP. The League's argument for creating the competitive organ was that a nursing organization was better prepared to do this sort of accreditation than an organization in which nursing held little clout, certainly true of JCAHO, which has always preserved power (in the form of full membership) in the hands of physicians and administrators — in spite of active participation of nurses atlower levels of JCAHO.

After a long struggle, NLN (or technically, the independent arm) achieved deemed status. The competition between the two organizations (CHAP and JCAHO) was inevitable, but JCAHO is now recognizing CHAP accreditation for home health care components in integrated systems that come under the JCAHO purview.