As an RN with 17 years of experience, I have seen the business of caring change a great deal (Editorial, "Unintended Consequences," April). I began my career in 1991 in a 100-bed specialty hospital that served both privately insured patients and those receiving Medicare benefits. We were not accredited initially. It wasn't necessary for funding.

When the hospital's administration decided to obtain accreditation, we were given a list of changes that needed to occur. I inquired how these changes would improve the quality of care we provided and was told they might not, but that we should comply nevertheless.

How much extra work was added onto each department as we sought to comply with a standard that might not even improve outcomes? And no one asks why we're doing it. I used to question these "improvements" but was repeatedly told they were necessary if we were to meet and comply with the accreditation agency's requirements. In one case, we had to implement a particular policy that not one bedside nurse agreed with!!

Kellyann Curnayn, RN

Lake Mary, FL

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