Dr. Barnum has given us an excellent overview of the collective processes that control the preparation and practice of nursing in her article, Licensure, Certification, and Accreditation. Separate and distinct regulations, some mandated and others "elective," drive the parameters of nursing education. There is often an interrelationship between and among the regulatory bodies governing nursing education. State boards of nursing regulate nursing as they approve and monitor programs of nursing so that they meet minimum standards of education. Programs of nursing ultimately prepare graduates of programs to practice in state jurisdictions. Graduates obtain licensure after qualifying through NCLEX examination. Renewal/approval of nursing programs by state boards is based on annual reports, NCLEX examination results, self study, survey visits, or other criteria established by the board. State boards give the nursing program the opportunity to open its doors, to function, and to offer a program which meets minimum requirements to prepare graduates for safe practice.

If we have state regulatory bodies that monitor nursing education programs, why is there a need for an accrediting agency? It is because regulatory bodies differ from state to state. Their focus is on meeting minimum criteria for program delivery. Minimum standards vary from state to state. Although most states use the state board to regulate and approve nursing programs (National Council of State Boards of Nursing, June 1997), there are in fact four distinct methods of approval and monitoring of programs in states and jurisdictions.

New York State is an example of a jurisdiction where a state agency other than the State Board for Nursing approves and monitors nursing programs; Mississippi and Puerto Rico do the same. This can lead to fragmentation of regulation oversight and may ultimately have an influence on the quality of nursing programs in the state. New York State has had an additional stress on the regulation and quality management of its nursing programs. Philosophical changes in the role of the government brought on by a new Republican governor, along with severe economic conditions and large decreases in the state budget, have severely impeded the ability of the state agency to regulate nursing programs. This can be seen in the mediocre performance of graduates on the NCLEX examination. Concerns about the quality of graduates extends to the quality of nursing practice and also the quality of students entering graduate programs of nursing. The consumer or student also has a right to expect a certain level of quality and preparation in nursing programs. Since there is such a variety of methods of approval by states, consistency is not assured. The standards of an accrediting agency need to be higher than minimal requirements.

Another example illustrating the need for an accreditation agency that demands more than minimal standards includes the increasing number of programs preparing graduate level nurse practitioners. The explosion in the number of these programs is directly related to managed care and the focus on primary care. Some programs have started with little or no resources, limited faculty expertise, limited experience with graduate program development, and no knowledge of graduate program evaluation.