Purpose: This study aimed to explore, in depth, the changes in nurses’ perceptions and organizational culture following repeated experiences with healthcare accreditation. Methods: A qualitative content analysis design was employed to explore nurses’ perceptions of healthcare accreditation. In-depth semi-structured interviews were conducted with 14 nurses from a spine and joint specialty hospital in Seoul who had experienced both the third and fourth accreditation cycles. Data were collected from July 9 to July 30, 2025. To enhance analytical depth, the Balanced Scorecard (BSC) framework was adopted as an interpretive lens, encompassing four perspectives: financial, customer, internal process, and learning and growth. Results: Twenty themes were identified and organized into four thematic clusters aligned with the BSC framework (1) ‘The Hospital’s Reputation built on Nurses Burnout’, (2) ‘The Gap between Accreditation Standards and Clinical Realities’, (3) ‘The Need for Process Improvement and Link between Accreditation and Practice’, (4) ‘Fostering a Collaborative Culture and Strengthening Leadership Competence’ Conclusion: From the BSC perspective, healthcare accreditation positively influenced clinical standardization (internal process), hospital reputation (customer), and professional development (learning and growth), but imposed significant resource imbalances (financial) on frontline nurses. To enhance future accreditation effectiveness, policies should establish fair compensation and support systems, apply flexible evaluation criteria reflecting hospital size and resources, and integrate patient and staff satisfaction indicators into the evaluation framework.