Setting the Standard: Accrediting Transition to Practice Programs

Nurse Leader Insider, July 26, 2018

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Mandy Pokorny, MHA, BSN, RN

Editor’s Note: This is an excerpt from Nurse Residency Program Builder, Second Edition

We have come a long way since the 2010 IOM’s recommendation to implement Nurse Residency Programs (NRP). To date, about half of hospitals nationally have established NRPs, yet no regulations or requirements exist for accreditation or for nurse residency programs to operate under a standardized model (Spector et al., 2015). Although this fact does offer NRPs an increased sense of autonomy and innovation to meet IOM recommendations, it also leads to significant variability among programs. Inconsistencies exist with regard to length of program, curriculum topics, university affiliations, personnel, eligibility requirements, program expectations, and institutional support (Franquiz & Seckman, 2016). Such variability has led to “questions regarding the fidelity of nurse residency, conclusion validity, and the generalizability of reported outcomes” (p. 310). National accreditation of NRPs serves to reduce variability and to demonstrate quality and standardization across programs.

Once you have a well-established transition to practice program in place, in order to take your program to the next level, the next logical step to consider is accreditation.

Accreditation will allow your organization’s NRP to do the following:

  • Validate excellence and share evidence of best practices
  • Demonstrate program quality
  • Establish that the program aligns with national standards
  • Grant recognition to the robustness of the program, encouraging long-term program sustainability and value
  • Demonstrate organizational excellence and program commitment to stakeholders
  • Recruit high-quality licensed nurses seeking high-quality and accredited NRPs
  • Develop of a nursing workforce who delivers safe care and achieves quality outcomes

If your preliminary assessment deems you ready to move forward, the first step in exploring accreditation is to select the appropriate accrediting organization.

Accrediting Bodies and Eligibility
There are two organizations that accredit NRPs: the American Nurses Credentialing Center (ANCC) and the Commission on Collegiate Nursing Education (CCNE). A third organization—Accreditation Commission for Education in Nursing (ACEN)—is currently developing standards for accreditation as well.

The Accreditation Process

Although they vary to some degree, all agencies involve a similar accreditation process that includes the following:

  • An established set of program standards and criteria based on best practice and determined by the 2010 IOM’s recommendations
  • A set of eligibility criteria in order to apply
  • An application form
  • A comprehensive description of the program and how it meets the accrediting body’s program standards and criteria
  • An on-site visit or virtual visit with a team of appraisers from the accrediting body
  • Continued monitoring and data collection requirements
  • An application fee and continued maintenance charges

It can be daunting to determine which accrediting agency to select, and the previous section provides insight into the history and the basics of each. It still remains unclear as to “who” (the academic or industry side of the nursing profession) should own the transition to practice experience. As a result, both academic and industry accrediting agencies have developed NRP accreditation standards and criteria. Of the three accrediting bodies, two (CCNE and ACEN) represent the academic side of the transition experience and one (ANCC) represents the practice or industry side. The ACEN and CCNE’s primary role is to accredit academic nursing programs. Where the ACEN accredits all types and all levels of nursing programs (including practical nursing and associate-degree nursing programs), CCNE accredits bachelor’s degree and higher programs, with a greater emphasis on theoretical and professional standards. The ANCC grants industry accreditation for organizational programs such as Magnet Recognition Program®, Pathway to Excellence®, and individual nurses through national certifications.
Determining organizational readiness
Before deciding on an accrediting body, consider performing a preliminary assessment of the program with your leadership team (Lavigne & Cosme, 2018):
What do we know about NRP accreditation?

  •  What is the current state of our NRP?
  • Do we have established and standard processes and procedures within our NRP?
  • Do we have outcomes data?
  • Can we allocate adequate financial and human resources toward this initiative?
  • Preparing for accreditation

Once you have determined organizational readiness, dig into the practice standards. Each accrediting agency’s standards align with the IOM’s recommendations, but they vary. Complete a formal gap analysis to identify gaps where your program does not clearly meet the practice standards and criteria.

If your team is not already developed, the next step is to identify your team. Many residencies utilize a steering committee to run their program and make changes. This is a good venue for engaging stakeholders in the accreditation standards and process. Consider stakeholders at every level of the program, including program leadership, clinical managers, former nurse residents, preceptors, and professional development staff. It is also wise to identify a point person to lead the accreditation process (this is most commonly the program director).

Determine the scope of your steering committee. Actions of the steering committee should include items such as the following:
•    Oversight of the NRP activities
•    Assuming accountability for program outcomes
•    Guiding the accreditation process
•    Assisting with the gap analysis
•    Participating in writing accreditation application
•    Being an active champion and ambassador for the NRP

Tips, Tricks, and Pitfalls to Avoid
The accreditation process can be a challenging and rewarding experience for NRP teams. It’s important to keep in mind that this process is not a punitive one. Accreditation is an opportunity for your program to shine, to share the good work that the program is doing to support newly licensed nurses, and to benchmark your organization against others as they meet national standards.

A few things to remember during the process include the following:

  • Avoid relying too heavily on a single point person. It takes a team to run an NRP and a team to become accredited.
  • Give yourself adequate time to complete the process. Appraisers and accrediting bodies can tell when an application seems hurried or forced.
  •  When writing your comprehensive document, if using more than one author, ensure that there is a common “voice” across the document.
  • Fill your program gaps before you apply. Completing a formal gap analysis early on allows for program improvement prior to applying. It’s much easier to fix any issues before applying than it is to address them under the pressure of a deadline.
  • Engage your stakeholders early and often. Keep all stakeholders (including your nurse residents) apprised of the intent to apply and the accreditation process.
  •  Prepare your stakeholders for the site visit. Ensure that your team is comfortable with the standards, knows what to expect during the visit, and understands the goals of the visit.
  •  After you become accredited, celebrate your success!

As NRPs evolve and mature, so will accrediting bodies and standards. Joining the accreditation community keeps programs current in practice. NRP accreditation benefits healthcare organizations through improved patient care, our transitioning nurses through a high-quality program, and the entire profession through standardization. Accreditation is a worthwhile endeavor and should be seriously considered for any formalized residency program.

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