CONTINUING EDUCATION EXCELLENCE IN MISSOURI

Transcription

1 2012 MANUAL REVISION TASK FORCE: Mary Cunningham Michelle Jacobs, MBA, BSN, RN BC Irene Kalnins, EdD, RN N. Ellen Kisling, MSN, RN Patty Steele, MSN, RN, MBA/HC Carol Walker, BSN, RN Sara Fry, BS, MONA Continuing Education Coordinator CONTINUING EDUCATION EXCELLENCE IN MISSOURI 1

2 The Missouri Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Copyright 2013 by the Missouri Nurses Association All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Missouri Nurses Association P. O. Box Jefferson City, Missouri Printed in the United States of America v

3 TABLE OF CONTENTS List of Samples... 4 Chapter 1: Continuing Nursing Education: An Overview.. 7 Chapter 2: Structure and Function of the MONA CE Program Chapter 3: Chapter 4: Application of Adult Learning Principles to Continuing Education Activities. 25 Developing the Learning Goal (Purpose) and Instructional Objectives for Continuing Education Activities Chapter 5: Frequently Asked Questions and Answers.. 49 Chapter 6: Steps in Designing CE Activities.. 67 Chapter 7: Preparing the Provider Application & Peer Review Process 79 Chapter 8: Educational Design Process 83 Chapter 9: Provider Approval Criteria..111 Glossary References Appendices A. Provider Approval Process Checklist 201 Provider Application Checklist. 203 Approved Provider Application 205 B. Approved Provider Sample Forms, Figures & Tools Intent to Apply Form Activity Planning Guide. 223 Biographical Data & Conflict of Interest Form Educational Planning Tool Sample Sponsorship Agreement Sample Commercial Support Agreement. 237 Sample Attestation of Disclosures Sample Co Provider Agreement. 241 Approved Provider CNE Activity Form 243 Acceptable Verbs Listing Commercial Support & Sponsorship Decision Tree CNE Activity Planning Process: Awarding Contact Hours Decision Tree C. Content Integrity Standards for Industry Support in CNE Activities

4 LIST OF SAMPLES Chapter 1: Continuing Nursing Education: An Overview 1A Missouri Nurses Association Continuing Education Philosophy 13 Chapter 2: Structure and Function of the MONA CE Program 2A Continuing Education Organizational Structure 24 Chapter 4: Developing the Learning Goal (Purpose) and Instructional Objectives for Continuing Education Activities 4A Worksheet for developing purpose(s) and objectives 39 4B Bloom s Taxonomy of Cognitive Objectives 45 Chapter 6: Steps in Designing CE Activities 6A Steps in Designing CE Activities 72 Chapter 8: Educational Design Process 8A Sample Educational Planning Tool 91 8B Narrative Description of Purpose, Objectives & Content 92 8C Pilot Study Description 96 Chapter 9: Provider Approval Criteria APPROVED PROVIDER ORGANIZATIONAL OVERVIEW (OO) OO1A Multi Focused Organization 112 OO1B Single Focused Organization 113 OO2A List of Provider Unit Personnel 114 OO2B Position Description for Primary Nurse Planner 117 OO2C Position Description for Additional Nurse Planners 118 OO2D Organizational Chart for Provider Unit 119 OO2E Organizational Chart for Larger Organization 120 OO3A Data Collection & Reporting 121 OO4A Listing of Goals & Quality Outcome Measures Hospital 124 OO4B Listing of Goals & Quality Outcome Measures Association 125 4

5 APPROVED PROVIDER CRITERION 1: STRUCTURAL CAPACITY (SC) SC1A Commitment to Learner Needs 127 SC2A Commitment to Approved Provider Unit Goals 129 SC2B Commitment to Approved Provider Unit Goals 130 SC3A Primary Nurse Planner Ensuring Adherence to ANCC/MONA Criteria 133 SC4A Process to Resolve Issues within Provider Unit 135 SC4B Process to Resolve Issues within Provider Unit 137 SC5A Process Used to Ensure Adherence of all Nurse Planners 139 SC5B Process Used to Ensure Adherence of all Nurse Planners 140 SC6A Using Nurse Peer Review Leader of MONA as Resource 141 SC7A Primary Nurse Planner Advocating for Provider Unit Resources 144 APPROVED PROVIDER CRITERION 2: EDUCATIONAL DESIGN PROCESS (EDP) EDP1A Assessing the Needs of Target Audience 146 EDP2A Using Needs Assessment Data to Address Gaps 148 EDP3A Selecting Members of Activity Planning Committees 150 EDP4A Identifying Conflicts of Interest 152 EDP5A Resolving Actual & Potential Conflicts of Interest 155 EDP6A Determining Successful Completion Requirements 157 EDP7A Developing Educational Objectives 159 EDP8A Selecting Content Based on Best Available Current Evidence 160 EDP8B Selecting Content Based on Best Available Current Evidence 161 EDP9A Precautions Taken to Prevent Bias and Maintain Content Integrity 162 EDP10A Preventing Bias & Maintaining Content Integrity with Commercial Support/Sponsorship 164 EDP11A Selecting Teaching Methods for CNE Activities 166 EDP12A Using Summative Evaluation Data 169 EDP13A Using Summative Evaluation Data to Improve Nursing Practice Or Nursing Development 170 APPROVED PROVIDER CRITERION 3: QUALITY OUTCOMES (QO) QO1A Evaluating the Effectiveness of the Approved Provider Unit 172 QO2A Unit Evaluation Result Development or Improvement of a QO Measure 175 5

6 QO3A Stakeholders Participating in the Overall Unit Evaluation 177 QO4A QO4B How Stakeholder Feedback Resulted in the Development or Improvement of a QO Measure for the Approved Provider Unit Hospital 179 How Stakeholder Feedback Resulted in the Development or Improvement of a QO Measure for the Approved Provider Unit Association 180 QO5A How Unit Has Enhanced Nursing Professional Development Hospital 181 QO5B How Unit Has Enhanced Nursing Professional Development Association 182 QO5C How Unit Has Enhanced Nursing Professional Development General 183 6

7 1 CHAPTER CONTINUING NURSING EDUCATION: AN OVERVIEW Continuing nursing education (CNE) refers to those systematic professional learning experiences designed to augment the knowledge, skills and attitudes of nurses, thereby enriching the nurses contributions to quality health care and their pursuit of professional career goals (ANA 2000). Whether the educational activity is carried out in a formal classroom, attendance at a conference or symposium, reading professional journals, or participating in online activities, registered nurses (RNs) engage in CNE. Nursing professional development is a life long learning process where nurses actively participate in a learning process that assists in developing and maintaining their continuing competence, enhancing their professional practice, and supporting their achievement of their career goals. The Continuing Education: Provider Approval Manual is written to enhance the knowledge and skills of Approved CNE Providers and ensure the ongoing quality of the accreditation process in Missouri. Purpose of Continuing Education vs Staff Development According to the American Nurses Association (ANA), "the overall outcome of nursing professional development is the acquisition of knowledge, skills, and attitudes that support safety and contribute to the protection of the public and provision of quality care (ANA 2010 page 7). Professional development broadly includes academic education as well as a variety of non academic learning activities that includes preparation for certification, participation in research, reading scientific literature, nursing peer review, and participation in both continuing nursing education and staff development. A review of literature suggests that an increase use of portfolios as a means of building on the education and experiences of the nurse across their professional career may be the vehicle that assists in fostering the professional development and career satisfaction of nurses. Using a portfolio, nurses can keep track of programs attended that includes documentation of activities designed to meet the development goals of the novice or experienced nurse, continuing nursing education activities, as well as committee assignments and depth of participation in professional organizations. The purpose of CNE is different from that of staff development, and the American Nurses Credentialing Center (ANCC) Commission of Accreditation (COA) Missouri Nurses Association (MONA) criteria refer to the planning, implementation and evaluation of CNE activities. The distinguishing factor is that the knowledge, skills, or attitudes gained from CNE activities are 1) new knowledge, skills or attitudes, not part of basic nursing education and 2) transferable and able to be applied regardless of the participant's employer. Staff development activities are usually specific to participants' job roles and are based on the employing institution's policies, 7

8 procedures, equipment and resources. There may be overlap, with part of a staff development activity conveying new content knowledge transferable to other job settings, and that part may be considered CNE. According to ANCC Accreditation Program criteria, CNE contact hours can only be calculated and awarded "for those portions of the educational activity devoted to the learning experience and time spent evaluating the activity" (ANCC, 2011 p. 25). American Nurses Association Philosophy of Nursing Professional Development ANA's philosophy of nursing professional development provides the framework for the standards used by providers of CE. The following philosophical beliefs guide the development of quality CE activities and the CE Program of the Missouri Nurses Association (MONA). The Nursing Professional Development: Scope and Standards of Practice (ANA, 2010) delineates the following beliefs. Lifelong learning is the responsibility of the nurse and is essential to maintain and increase competence in nursing practice. Nursing practice is constantly being influenced by a rapidly changing health care delivery system and an ever increasing role of professional nurses in the emerging structure. Rapidly developing technology influences nursing care, including use of information technology and sophisticated equipment. As the complexity of care increases, growing legal and ethical concerns are being faced almost daily by nurses in their practice. Nursing practice is changing and will continue to change. Nurses need to continue their professional development to keep up with the rapid advances in practice. CNE and staff development activities provide an opportunity for nurses to increase their nursing knowledge and enhance their ability to keep up with trends in practice. Continuing professional nursing competence is essential to the provision of safe, quality health care to all members of society. Nursing as a profession has a mandate to provide care in a skilled, accountable manner to people anywhere on the health illness continuum and along the life span. The public has a right to expect continuing professional nursing competence throughout the career of the nurse. Knowledge gained in basic nursing education rapidly becomes obsolete. Professionalism requires accountability for continual efforts to improve knowledge and skills in order to provide state of the art care based on solid evidence. Assurance of continuing professional nursing competence must be shaped and guided by the nursing profession. The profession of nursing has developed documents for nurses in many areas of practice defining the scope, standards, guidelines and benchmarks to ensure that nurses attain and maintain continuing competence, a hallmark of professionalism and a means by which a profession is held accountable to society. Continuing professional nursing competence is definable, measurable, and can be evaluated. Standards and competencies developed by ANA and specialty nursing organizations provide an operational definition of necessary knowledge and skills. Nurses can demonstrate these 8

9 competencies through measures of achievement in professional development activities and through certification examinations. The nurse as the learner actively partners with the nursing professional development educator in the educational process and in the maintenance of the nurse's continuing professional nursing competence. Nursing professional development educators provide a climate for learning and facilitate the adult learning process. Nurses select the most effective way to meet their professional development needs, and engage with the educator in all aspects of the learning process. Nurses have primary responsibility for maintaining continuing competence, but the opportunities to do so are provided by employers, professional bodies, academic organizations, and other providers of education. The nursing professional development educator incorporates the roles of facilitator, change agent, consultant, leader, or researcher in the learning activities that support the nurse in developing and maintaining continuing nursing competence. The educator's expertise may be in a subject area as well, but the educator's value to the organization and to nurses for maintaining continuing competence lies in the role expertise that can bring about quality professional development. Self directed learning is an integral part of continuing education, staff development, and academic education. Adult learners have needs that are highly individual and immediate. Skill development in locating, interpreting and using available sources of information is a critical aspect of being a successful self directed learner. Use of adult learning principles contributes to effective professional development activities. A variety of educational options are necessary to meet the diverse needs of the nursing population, including, but not limited to, academic education, experiential learning, consultation, teaching others, professional reading, distance learning, research, and selfdirected activities. In accordance with this facet of the philosophy, the MONA CE Approver Unit reviews applications from a variety of providers, including hospitals and other acute care facilities, community health agencies, corporations, district nurses' associations, and private individuals. Each of these groups can meet some of the learning needs of the provider's constituents. Each provider needs to assess the learning needs of the nurses served. If participation in a CNE offering is to occur, the needs of the nurses have to be identified. The learning activity may be related to resolving the current knowledge or skill deficit of the nurse to ensure continuing professional nursing competence. New learning needs may emerge in relation to changes in the nurse's scope of practice and responsibilities, or in relation to organizational requirements for specific knowledge and skills. Ongoing evaluation of educational activities is essential to maintain and enhance professional development and the quality and cost effectiveness of health care. The American Nurses Credentialing Center s Commission on Accreditation (ANCC COA) criteria and MONA criteria, which derive from them, emphasize the importance of evaluation of educational activities, 9

10 revisions made to reflect participant and presenter feedback, as well as planned, systematic evaluation of all aspects of Approved Provider operations. The practice of nursing professional development is guided by principles of ethics. ANCC COA/MONA criteria ensure that participants receive full information about commercial support, and assurance that content presented is unbiased. Continuing education needs of professional nurses are influenced by many factors:...the nurse's acceptance of accountability and responsibility for his or her own practice. According to Statement 4 of the ANA Code of Ethics (2001), "The nurse maintains competence in nursing."...changes in demographic characteristics of provider and adult learner populations. Providers of CNE need to be cognizant of the characteristics of the learner. Activities for beginning professional practitioners may differ in design and scope from those for an audience of master's prepared practitioners. Needs of specialist nurses also differ from the needs of the generalist....demographic characteristics of health care consumer populations. Today's consumer is often knowledgeable about the health care system and health problems. As health educators, nurses need to understand what knowledge consumers have acquired so that this knowledge can be interpreted, enhanced, or corrected. The health care consumer's needs also change as society changes. Nurses need to effectively respond to these changes....knowledgeable consumers who recognize their right to health care and demand accountability for services rendered. Consumers are demanding quality, affordable, professional care. CNE can assist in providing society with a knowledgeable practitioner who can meet these goals. changing health care delivery methods and financing methods. The evolution of managed care requires all nurses to develop case manager/care manager skills in order to facilitate clients' progress through the health care system....a rapidly evolving body of knowledge and research applications from nursing, social, physiological, and the basic sciences. CNE provides an opportunity for nurses to apply the latest technologies to nursing care and to incorporate research findings in their own professional practice....participation of nurses in intra and interdisciplinary efforts that affect health care delivery systems. CNE activities with multiple target audiences provide opportunities for nurses to network with other health professionals. Opportunities to learn together often enhance cooperation among health professionals in meeting the needs of consumers....the numbers and variety of health personnel, health care consumer populations, and types of services provided in a given setting. The learning needs of nurses in an agency 10

11 using primary nursing in a renal dialysis unit may be quite different than the needs of nurses employing case management in an acute care facility. Therefore, providers of CNE must consider the target population's needs when designing activities....health care consumer, organizational, legislative, policy, regulatory, or professional development requirements. As the needs of the health care consumers change, nurses must be ready to assist consumers to better meet their self care needs. Organizations must often meet national and state regulatory requirements that require a skillful and knowledgeable cadre of nurses working in acute care or community settings. As these regulatory requirements change, CNE and staff development activities are needed to ensure quality staffing. The number of nurses certified by professional organizations is increasing annually. Since certification recognizes an exemplary level of skills, knowledge and abilities (ANA, 2009) there are requirements for CNE for re certification, or, as in some states for re licensure....political, social, economic, legislative and regulatory factors that influence nursing and health care throughout the world. CNE needs of nurses change with changes in society. Today, there is a greater need for nurses to know about bioterrorism, infectious diseases, and genetics and gene therapies. CNE activities can be designed to explore health concerns locally as well as globally. As these concerns change, CNE opportunities must also change. Nursing practice is affected by laws made at all levels of government. CNE opportunities can enhance the knowledge of nurses about pending or new legislative actions. CNE can also develop nurses' abilities to effect legislative changes and to influence outcomes that enhance nursing and the health care delivery system. Professional Standards The most recent standards for CE are found in the Nursing Professional Development: Scope and Standards of Practice (ANA, 2010). The standards describe the criteria on which to base quality education. The six standards of nursing practice include (1) Assessment, (2) Identification of Issues and Trends, (3) Outcomes Identification, (4) Planning (5) Implementation, and (6) Evaluation. The roles and responsibilities of CE and staff development practice are further delineated in the Scope and Standards as Educator, Facilitator, Academic Liaison, Change agent, Team Member, Consultant, Researcher, Leader, Communicator, Collaborator, Advisor and Mentor. Many factors influence the professional development of nurses, including contextual factors, learner characteristics, educational options, and the quality and cost effectiveness of health care. The growing body of nursing knowledge coupled with the expanding depth and breadth of knowledge in the medical sciences has an impact on the professional development of registered nurses. Continuing Nursing Education Outcomes Adherence to the ANA philosophy and the standards for continuing nursing education has benefits to the individual nurse, providers, and the profession itself. For the nurse, quality 11

12 programming should be available to allow for enhancement of knowledge and practice skills. For the providers of CNE, adherence to the philosophy of CNE can ensure quality programming and credibility as a provider. For the profession, adherence to the philosophy signifies acknowledgment of nurses' personal responsibility for CNE. Missouri Nurses Association CE Philosophy Based on the ANA Standards for Continuing Education, the Missouri Nurses Association, in collaboration with the CE Approver Unit Committee, has developed a philosophy of CE (Sample 1A). The Association recognizes the unique needs of nurses in both urban and rural communities, as well as the particular needs of specialists and generalists in nursing. At the same time, the Association strives to reach higher levels of knowledge for all nurses in order to improve health care for all. MONA's philosophy emphasizes that both competency in practice and life long learning are essential components of nursing practice. A major focus of the CE Program of MONA is to increase access to educational opportunities, promote inter professional continuing educational activities, enhance the continuity, quality and cost effective delivery of nursing care and assure quality educational programs for registered nurses in Missouri. According to the bylaws of MONA (2011), the CE Program is implemented by two standing committees: the CE Approver Unit and the CE Provider Unit. As outlined in the MONA Bylaws, it is the responsibility of the CE Approver Unit to: Implement a peer review process utilizing the American Nurses Credentialing Center's Commission on Accreditation criteria for approval of nursing continuing education activities. Provide a mechanism for verification of quality for continuing education programs. Encourage nurses to maintain and improve knowledge and skills for professional practice. Foster availability and accessibility of continuing education programs throughout the state. As outlined in the MONA Bylaws, it is the responsibility of the CE Provider Unit to: Advance the practice of nursing by disseminating new knowledge through MONA developed continuing education opportunities which meet the criteria established by the American Nurses Credentialing Center's Commission on Accreditation. Provide a mechanism for verification of quality for continuing education programs. Encourage nurses to maintain and improve knowledge and skills of professional practice. Foster availability and accessibility of continuing education programs throughout the state. Develop a total continuing education program for MONA. 12

13 SAMPLE 1A MISSOURI NURSES ASSOCIATION Philosophy of Continuing Education The Missouri Nurses Association believes that "Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations". The Missouri Nurses Association believes that the authority for nursing is based on a contract between society and the profession. This social contract requires accountability for current, evidenced based practice on the part of the profession and its individual practitioners. Continuing education is essential for the individual and the profession to fulfill the contract. Continuing education s end goal is the promotion, protection and improvement of the health of the society. The profession of nursing is advanced as its practitioners are enriched by the dissemination of new skills and knowledge through continuing education. The Missouri Nurses Association believes that it is essential for all registered nurses to have access to quality continuing education activities, and that national accreditation of the Provider and Approver Units is essential for achieving this goal. Accreditation is achieved through the American Nurses Credentialing Center s Commission on Accreditation (ANCC COA) Adherence to the ANA standards for quality continuing education helps ensure that educational activities will contribute to the knowledge base of the registered nurse and ultimately to the quality of care provided. Access is best assured by providing continuing education activities throughout the state. Quality is assured by requiring that providers of continuing nursing education in Missouri adhere to ANCC COA criteria. The Missouri Nurses Association believes that continued learning in nursing is a dynamic process that requires the active participation of self directed professionals. These professionals voluntarily pursue their educational goals related to their nursing practice. Voluntary participation is consistent with the accountability to the public for safe, current and competent practice. The Missouri Nurses Association believes that voluntary continuing education is an important avenue of professional growth. The Missouri Nurses Association further believes that every nurse has the right to professional self actualization which is promoted through continued learning. 13

14 Accreditation The Missouri Nurses Association (MONA) has been accredited as a provider and approver of CNE since 1977, first by the American Nurses Association (ANA) and more recently by the American Nurses Credentialing Center Commission on Accreditation (ANCC COA). This accreditation reflects an intensive process that the respective unit must undergo to ensure that CNE activities approved and provided by MONA have met national criteria. Accreditation is one way a state nurses association can acknowledge that its CE program has met established professional standards and guidelines. MONA's recognition of the importance of accreditation as an approver and a provider of CNE is evidenced by the association's participation in the accreditation process. At a national level, the ANCC COA accredits agencies, including professional organizations, colleges, and universities, to offer educational activities for nursing CE contact hours. The American Nurses Credentialing Center s Accreditation Program is governed by members who have "expertise in continuing education, adult education, research, standards setting, and professional development" (ANCC 2011 p. 3). Provider Accreditation. MONA is accredited by the ANCC COA as both a provider and an approver of CNE. The most recent accreditation took place in February of 2008 for a six (6) year period. Provider accreditation allows MONA to offer contact hours for CE activities provided by MONA. The CE Provider Unit works with the structural units of the association to ensure quality programming that meets the established criteria set by ANA. Because of its provider accredited status, MONA can assure its constituents that CNE activities provided by the association have met the standards set by the ANCC COA. Participants attending MONA provided CNE activities should recognize that the activities are based on the identified needs of nurses, have been planned with nursing input and by nurses who have knowledge of educational design and adult learning needs, that the educational activities are directed toward registered professional nurses and have appropriate content for nursing, are offered with fiscal responsibility in mind, and have evaluative measures. Approver Accreditation. Through a separate ANCC COA approver accreditation process, the MONA CE Approver Unit approves CNE activities provided by others, including MONA districts, hospitals, and a variety of health care agencies. The most recent accreditation took place in February of 2008 for a four (4) year period. MONA is currently seeking re accreditation as an Approver for a decision early MONA accepts applications from agencies located both inside and outside of Missouri, as long as eligibility requirements are met. Applications submitted to the MONA CE Approver Unit are evaluated based on criteria established by the ANCC COA. Based on information provided by the provider, the CE Approver Unit Nurse Peer Reviewers review the prospective educational activity, determine whether that activity meets the criteria and either approves or disapproves the activity for nursing contact hours. Approval by MONA assures that the activity has met the criteria set by ANCC COA. Educational activities not submitted to the CE Approver Unit for review may provide good learning opportunities for the RN who attends the offering, but there is no assurance that the professional standards have been met. Currently, when resources are limited and many opportunities for CNE abound, the 14

15 stamp of approval for an educational activity by the professional organization that is ANCCaccredited is meaningful. The consumer can be assured that quality is built into an educational activity approved by MONA for CNE contact hours. Changes in the Accreditation Process Numerous changes have been made in the accreditation process in the past decade to reflect the dynamic nature of healthcare, and the emphasis on outcomes rather than process in all accreditation systems. After the publishing of the new ANA Scope and Standards for Nursing Professional Development (staff development and continuing education) in 2010, the ANCC COA undertook an extensive review of the criteria for accreditation. Subsequent revisions of the criteria have streamlined applications in some areas, and added requirements in others. This process has brought ANCC COA requirements closer to those of other professional CE accrediting bodies, so that an organization seeking provider accreditation from both ANCC COA and ACCME could submit a unified application. In 2012, the most recent revised ANCC COA accreditation manual became available to accredited approvers and providers of continuing education. The Missouri Nurses Association's CE Approver Unit volunteers and staff worked to make revisions in the continuing education program to comply with the new criteria. Efforts were made to notify providers of the changes occurring. This eighth (8 th ) edition of Continuing Education: Provider Approval Manual includes the new educational design criteria developed by ANCC Accreditation Program and operational criteria for the evaluation of applications reviewed by MONA CE Approver Unit. The changes are summarized below for approved providers of continuing nursing education. Organizations/individuals who submit an approved provider application after January 1, 2013 will be expected to utilize the new criteria/guidelines. Current application and sample documents are available in Appendix A & B of this manual and on the MONA website at Changes for Approved Providers Restructuring of the key elements using the new framework of Organizational Overview, Structural Capacity, Educational Design Process and Quality Outcomes (OO, SC, EDP, & QO). Certain key elements were retained in the Organizational Overview, and others incorporated into the individual criteria or removed from the application entirely. A small percentage of the criteria are new and are related to Quality Outcomes and to the Accountability of the Primary Nurse Planner. How the applicant writes to the criteria within the Provider Application will present the largest change in the guidelines. Each criterion within the provider application now require a narrative description of Provider Unit process and an example as supporting evidence that illustrates how that process is operationalized within the Approved Provider Unit. The revised criterion now include the following instruction Describe, and using an example, demonstrate the following: 15

16 ANCC developed the Content Integrity Standards for Industry Support in CNE Activities as to replace the previous ACCME Standards for Disclosure and Commercial Support. Additional eligibility requirements must be met by providers, which are reflected in updated Intent to Apply form. A new process for determining eligibility was also developed. Mission statement requirement removed. Description of Provider Unit sources of financial support and projections for the future removed. Category of evaluation identification removed Attestation forms signed by Provider Unit leadership removed. Incorporated into the eligibility/intent to apply process. The Activity Planning Guide was updated to reflect the new guidelines and assist Approved Providers in documenting all required elements for the educational activities provided within their Unit. Nurse Planner responsibilities expanded. An identified Nurse Planner (Primary Nurse Planner or another identified Nurse Planner assigned to the Provider Unit) must review all biographical data/conflict of interest forms submitted by planners and presenters to ensure appropriate qualifications and evaluation of actual or potential bias and sign each form. Disclosure requirements were revised. Disclosing the off label use of products was removed. Other disclosures such as commercial support, sponsorship, expiration date for enduring materials, etc. are now required only if applicable to the educational activity. The purpose and/or objectives must be disclosed. See Chapter 8 for complete, specific details on the new disclosure requirements. Activity Form now required to be completed and submitted with Approved Provider application for the previous 12 month period. This is the form only required during Annual Report submissions in the past. New reporting requirements were established for Providers in their communications with MONA Identification of quality outcome measures the Provider Unit collects, monitors, and evaluates specific to the Provider Unit and to Nursing Professional Development is a new requirement (OO3). The Primary Nurse Planner s commitment to learner needs, including how Provider Unit goals are revised based on data is a new requirement (SC1). How the Primary Nurse Planner is accountable for resolving issues related to providing CNE is a new requirement (SC4). How evaluation data were collected to measure change in nursing practice or nursing professional development is a new requirement (EDP13). New section of application titled, Quality & Outcomes that focuses on the impact of the structure and process of the Provider Unit and the value/benefit to nursing professional development 16

17 How the evaluation process for the Provider Unit resulted in the development or improvement of an identified quality outcome measure is a new requirement (QO2). How, over the past 12 months, the Provider Unit has enhanced nursing professional development is a new requirement (QO5). Planning Committee Structure the target audience member identification was removed; content expert(s) must now be identified New educational design criteria focused more ensuring content is based on most current available evidence (documentation should reflect quality of evidence chosen) Listing of required records to maintain has been revised Definitions in the glossary were added and revised. The responsibilities of Accredited Approvers for ensuring that providers operate according to criteria and provide quality activities are expanded, and Approved Providers will be monitored more closely throughout the period of approval. The criteria still require providers to document how they are using ANCC/MONA Accreditation Program criteria in the planning, implementation and evaluation of their nursing continuing education activities and incorporating the Nursing Professional Development: Scope and Standards of Practice (ANA, 2010). Once again sample forms were developed to ensure all required information is present. However, Approved Providers still have the option of developing their own forms to document adherence within their Unit. Approved Providers must carefully review the forms to ensure that all areas have been addressed. Responsibility for Continuing Education According to the Code of Ethics for Nurses (2001), "The nurse owes the same duties to self as to others, including the responsibility to maintain competence, and to continue personal and professional growth." (p. 18). The Standards for Professional Development (ANA, 2010) recognizes that nursing professional development is influenced by "the nurse's acceptance of accountability and responsibility for his or her own practice". A hallmark of a professional is the enhancement of one's knowledge and skill base through identifying one's own learning needs and planning ways to meet them. Based on professional standards, the Code for Nurses, and professional criteria, registered nurses have responsibility for their own CNE. Recent continuing education research has focused on the connection between quality and continuing education. As healthcare resources become leaner continuing nursing education remains vital in providing nursing staff current information, skills and resources to provide quality care for patients with higher acuity levels (Cheesman, S. 2009). Additionally, the Institute of Medicine (IOM) reports suggest that nursing continuing education move to a team approach, including physicians, nurses, pharmacists, and when applicable patients and should include current evidence based practice (Finkelman & Kenner 2009 p. 109). The CE literature has also addressed the growing role of distance education. Harrington & Walker (2003) emphasized the flexibility of on line as well as computer based information and 17

18 training. Armstrong, Gessner and Cooper (2000) reported that distance learning formats are as effective as traditional formats, and predict that the use of these methods will continue to grow. Does the employer have a responsibility for CNE of RNs? Employers expect competent, safe employees who can function with increasing independence in their roles. Too often nurses are finding that employers are less able, or less willing, to fund opportunities for the staff to attend CE activities outside of the health care agency. At one time some employers paid registration fees, lodging, and transportation so their staff could attend educational activities; however, economic limitations have decreased the willingness of employers to fund these costs. RNs are often left with the entire responsibility of paying for their CNE. RNs are also finding it difficult to negotiate time off to attend activities that will benefit their practice. These factors favor the development of flexible CNE options. Health care agencies strive for quality care for their clients. Maintaining a nursing staff that has the knowledge and skill to provide quality care must be important to these agencies. Health care agencies need to look at increasing the opportunity for staff nurses to attend CNE activities that will update and enhance practice. Whose responsibility is CNE? The primary responsibility is that of the RN. Health care employers and consumers also share a responsibility. Nurse educators play a role in encouraging selfresponsibility and life long learning. With this shared responsibility, a cadre of nursing professionals will be available who have the knowledge and skill to function safely and effectively in an ever changing health care system. Voluntary vs. Mandatory CE It is the position of the Missouri Nurses Association that voluntary participation in continuing nursing education activities is one of several methods RNs can use to maintain professional competence. The association periodically reviews its position and has continued to support the policy that participation in continuing education should be voluntary. The association opposes legislation that may establish any type of system regulating continuing education for relicensure of professional nurses in Missouri. Missouri nurses continue to be strong supporters of continuing education, as evidenced by the large number of contact hours awarded by providers of CNE their involvement in voluntary attendance at educational activities that can enhance their professional practice. Continuing Education: Provider Approval Manual Within the framework of MONA's Philosophy, the Philosophy of Continuing Education and the purpose of the CE Program, as specified by the Association's Bylaws, the CE Program serves nurses in the state by providing quality continuing nursing education activities through the CE Provider Unit and through the CE Approver Unit, both accredited by the ANCC Commission on Accreditation. Accreditation of both of these Unit s demonstrates the commitment of the Association to quality programming and assures registered nurses in the state that activities approved by MONA have met rigorous standards. 18

19 CHAPTER 2 STRUCTURE AND FUNCTION OF THE MONA CE PROGRAM The Continuing Education (CE) Program of the Missouri Nurses Association (MONA) is implemented through two structural units: the CE Approver Unit and the CE Provider Unit (see Sample 2A). Both the CE Approver Unit and the CE Provider Unit are accredited by the American Nurses Credentialing Center (ANCC) Commission on Accreditation (COA). The CE Approver Unit and CE Provider Unit are responsible for implementing the association's CE Program and making policy recommendations to the MONA Board of Directors. CE Approver Unit The MONA CE Approver Unit is administratively and operationally responsible for coordinating all aspects of the peer review approval process of continuing nursing education activities and approved providers for the Association. MONA accepts applications for approval from providers meeting the eligibility criteria. The Chief Executive Officer (CEO) of MONA, who is a Registered Nurse with a master s degree in nursing, assures that the business of the CE Programs of MONA is consistent with the overall mission, goals, and strategic plan of the Association. The CEO also assumes fiscal responsibility and coordinates the day to day management and operating procedures of the Association. The Nurse Peer Review Leader (NPRL) and CE Approver Unit Chairperson, is administratively responsible for the CE Approver Unit Committee, and is assisted by a Continuing Education Coordinator, who is a member of the MONA staff assigned to the CE program. The Continuing Education Coordinator is responsible for coordinating the office administration and various activities of the CE Approver Unit. The CE Approver Unit Committee chair and subcommittee members are volunteers appointed by the MONA Board of Directors for two year terms. The Approver Unit members are MONA members who have the academic credentials required by the ANCC Accreditation Program criteria, have expertise with staff development and continuing education in a variety of practice settings, and who represent a variety of practice areas: providers of education in baccalaureate and higher degree programs, nursing administrators, individuals involved in staff development and CE in a variety of practice settings, and clinical practitioners. The MONA Board of Directors considers geographic representation when selecting members as well as experiential and educational qualifications. The goals of the CE Approver Unit are updated during each biennium, and support the MONA Board of Directors Strategic Plan. Within the Strategic Plan the CE Approver Unit works to meet the following: Strategic Focus 2: Professional & Educational Development Promote the professional development and pursuit of lifelong learning for registered nurses in Missouri 19

20 Objective 2.2: Encourage professional development, leadership and scholarly activity through MONA events, publications and communications, as well as through the pursuit of life long professional learning opportunities. As a standing committee of the association, the CE Approver Unit is expected to: Implement a peer review process utilizing the American Nurses Credentialing Center's Commission on Accreditation criteria for approval of nursing continuing education activities Provide a mechanism for verification of quality for CNE programs Encourage nurses to maintain and improve knowledge and skills of professional practice, and Foster availability and accessibility of CNE programs throughout the state. The activities of the CE Approver Unit are carried out in meetings at MONA headquarters, meetings by conference call, communication by , subcommittee work in peer reviews of applications, webinar and face to face trainings and staff work in the MONA office. They include: Reviewing applications for CNE approval for educational activities and approved providers Establishing and/or revising criteria for approval based on ANCC COA criteria Orienting new members to the review criteria and all members to changes in criteria Making CE Approver Unit Committee policy and procedure recommendations to the MONA Board Evaluating the effectiveness of the CE Approver Unit Committee Monitoring the type, quantity and quality of approved CNE available to nurses Monitoring the adherence of Approved Providers to ANCC Accreditation criteria Fostering availability and accessibility of CNE throughout the state Encouraging the establishment of national standards for the quality and measurement of CNE in order to ensure transferability of evidence of completed work in CNE Establishing fees for the approval process, and Establishing biennial goals for the CE Approver Unit Committee. The CE Approver Unit is chaired by a volunteer who has the following qualifications and responsibilities: Qualifications: Is a Registered Nurse with a current, valid license to practice as an RN, and a master s degree or higher with either the baccalaureate or graduate degree in nursing Member in good standing of the Missouri Nurses Association 20

21 Be qualified by education and experience to guide the peer review process for the Missouri Nurses Association and coordinate the activities of the CE Approver Unit Education or experience in the field of education or adult learning and expertise with staff development and continuing education in a variety of practice settings Demonstrate knowledge of the ANCC/MONA Accreditation criteria, and Demonstrate excellent communication skills and a commitment to the organization s continuing education program mission and continuous quality improvement plan. Responsibilities: Orientation of all Nurse Peer Reviewers and key personnel in the organization to the ANCC accreditation criteria Confirming that all Nurse Peer Reviewers hold a current, valid license as an RN with a baccalaureate degree or higher in nursing Developing an ongoing evaluation plan for the CE Approver Unit Ensuring adherence to the ANCC Accreditation Program criteria in all aspects of the peer review approval process of the CE Approver Unit Serve as the CE Approver Unit Chairperson coordinating all activities of the CE Approver Unit and facilitating a minimum of two meetings per year Participate in the qualitative review process of CNE applications Collaborates with the MONA Chief Executive Officer and staff to effect the activities of the CE Approver Unit Agree to maintain strict confidentiality with information related to status of applications submitted for approval, and Serve as a resource person for providers of CNE activities The work and review of applications for approval is accomplished through a subcommittee structure. Each subcommittee consists of three members who independently review and evaluate each application. The chairperson of each subcommittee is responsible for communicating with the MONA staff the outcome of the committee's work. The CE Approver Unit has established standards to ensure quality and consistency within the committee. Inter rater reliability is one aspect of quality improvement. At various meetings of the CE Approver Unit, the members work as the committee of the whole or divide into subgroups to review an application. Total group discussion allows for review of ratings assigned by the subcommittee. Subgroup raters have an opportunity to provide the rationale for evaluation of the applicant's response to each criterion. This method of quality control and improvement has fostered strong inter rater reliability. Quarterly reviews demonstrate congruence among subcommittee members in evaluating reviewed CNE activities. New committee members are oriented to the approval process by working with the Committee Chair and Continuing Education Coordinator to ensure appropriate review of CNE activities. 21

22 CE Provider Unit Committee The MONA CE Provider Unit is designed to provide CNE programs for the Association. The Association provides a variety of CNE activities, including educational sessions at the biennial convention, advanced practice programs, and clinical sessions. Some of these CNE activities may be co provided with other associations or organizations. The Chief Executive Officer (CEO) of MONA, who is a Registered Nurse with a master s degree in nursing, assures that the business of the CE Programs of MONA is consistent with the overall mission, goals, and strategic plan of the Association. The Lead Nurse Planner (LNP) responsible for the Provider Unit and is assisted by a full time Continuing Education Coordinator who is a member of the MONA staff assigned to the CE program. The CEO and the LNP will collaborate in overseeing the Provider Unit and its functions. The CEO will collaborate with the Board of Directors to ensure the Provider Unit has the resources necessary for implementation of the program. The LNP will ensure adherence to the ANCC Accreditation Program criteria in all aspects of the planning, implementing and evaluating educational activities offered by the MONA Provider Unit. The Continuing Education Coordinator is responsible for coordinating the various activities of the CE Provider Unit. Members of the CE Provider Unit are appointed for two year terms by the MONA Board of Directors after each biennial convention. Members of the CE Provider Unit include MONA members who are active in baccalaureate or higher degree nursing education, nursing administration, are responsible for Provider Unit CNE activities, or are active in specialized, general or advanced practice nursing. The MONA Board of Directors considers experience, education, and geographic representation when selecting members. The goals of the CE Provider Unit are updated during each biennium, and support the MONA Board of Directors Strategic Plan. Within the Strategic Plan the CE Provider Unit works to meet the following goal: Strategic Focus 2: Professional & Educational Development Promote the professional development and pursuit of lifelong learning for registered nurses in Missouri Objective 2.2: Encourage professional development, leadership and scholarly activity through MONA events, publications and communications, as well as through the pursuit of life long professional learning opportunities. As a standing committee of the association, the CE Provider Unit is expected to: Remain an accredited provider of nursing continuing education in Missouri 1. Annually submit a calendar of CE events to the MONA Board 2. Plan, develop and evaluate provided activities listed on the calendar 3. Review criteria regularly to ensure compliance 4. Evaluate overall effectiveness of the CE Provider Unit Promote the programs that MONA provides for CE so it is cost effective. 22

23 The CE Provider Unit is chaired by a volunteer who has the following qualifications and responsibilities: Qualifications: Is a registered nurse with a current, valid license to practice as an RN, and a master s degree or higher with either the baccalaureate or graduate degree in nursing, Member in good standing of the Missouri Nurses Association Be qualified by education and experience to guide the development of each activity provided by the Missouri Nurses Association and coordinate the activities of the CE Provider Unit Education or experience in the field of education or adult learning and expertise with staff development and continuing education in a variety of practice settings Demonstrate knowledge of the ANCC/MONA Accreditation criteria, and Demonstrate excellent communication skills and a commitment to the organization s continuing education program mission and continuous quality improvement plan. Responsibilities: Orientation of all Nurse Planners and key personnel in the organization to the ANCC Accreditation criteria Confirming that all Nurse Planners hold a current, valid license as an RN with a baccalaureate degree or higher in nursing Ensuring that: o A Nurse Planner who understands the accreditation criteria actively participates in the planning, implementation, and evaluation of each educational activity. o All educational activity planning committees have a minimum of a Nurse Planner and one other planner involved in the planning process. o The Nurse Planner reviews the completed biographical/conflict of interest forms from each planner and presenter to ensure appropriate qualifications and evaluation of actual or potential conflicts of interest. Developing an ongoing evaluation plan for the CE Provider Unit, and Maintenance of required records in accordance with the accreditation criteria. 23

24 SAMPLE 2A Continuing Education Organizational Structure Missouri Nurses Association Continuing Education Organizational Structure MONA Membership MONA Board of Directors Chief Executive Officer Continuing Education Coordinator CE Provider Unit Chairperson CE Provider Unit Committee CE Approver Unit Chairperson CE Approver Unit Committee Volunteer Subcommittee Volunteer Subcommittee Volunteer Subcommittee 24

25 3 CHAPTER APPLICATION OF ADULT LEARNING PRINCIPLES TO CONTINUING EDUCATION ACTIVITIES When planning activities for registered nurses, providers need to keep in mind that the target population is made up of adult learners. Adult learners have unique needs that make their participation in continuing nursing education (CNE) a challenge for CNE providers. According to Merriam (1984), "what is known about adults, their tasks, concerns, and experiences, provides educators with guidelines in planning meaningful experiences" (p. 23). This chapter explores some of the characteristics of adult learners, the cognitive aspects of learning, adult learning theory, and barriers to participation. Suggestions for providers of CNE are also proposed. Characteristics of Adult Learners Adults typically make a commitment to learning when their learning goals are perceived as immediately useful and realistic and are important and relevant to their personal, professional and career needs (Billings & Hallstead, 2009 p. 207). They manage their personal and professional lives, often enroll in academic courses, and face new challenges in developing new work roles and new relationships. Many adults seek job related education because of job obsolescence and job competition. Increasingly, many RNs seek a BSN, MSN or doctoral education to increase their job opportunities in an increasingly competitive health care market. Aslanian and Brickell (1980) suggest that adults participate in learning activities in order to cope with change. Many times events in adults' lives are powerful influences for their participation in CNE. An RN who has just taken a position in a neonatal intensive care nursery may seek out educational activities focusing on nursing care of high risk infants. A new nurse manager may participate in workshops to enhance management skills. Critical care courses provide opportunity for RNs relatively new to critical care nursing to gain confidence in their developing knowledge and skills. Unmet needs also stimulate participation in CNE activities. According to Redman (1988), learning takes place "when an individual identifies a need for knowledge or gaining ability to do something" (p. 15). A need must exist or learning is not likely to take place. Assessing the learning needs of potential participants of CNE activities is critical. Input from the target population can identify those areas of nursing practice where deficits in knowledge exist. Based on those identified gaps in knowledge, need based activities can be developed. Adults are like other learners: Their motivation and reasons for learning are quite varied. According to Houle (1961), adults may be goal oriented, activity oriented or learning oriented. Those individuals who are goal oriented participate in learning activities in order to achieve a specific purpose. Perhaps an RN attends a gerontology program to prepare for a certification examination. Another nurse might attend a program on faculty development in order to 25

26 prepare for a staff development position in her hospital. Activity oriented learners might participate in CNE because of the networking and social interaction that takes place at conferences, workshops and conventions. The actual programming is secondary to the opportunity to talk with others working in similar settings. However, activity oriented learners may attend a CNE program to escape boredom or loneliness. Whereas, learning oriented learners attend activities either to learn new information that might be applicable to their job, to keep up with changes in their practice, or to enhance professionalism. Learning oriented learners pursue learning for its own sake. Providers of CNE might keep Houle's three types of learners in mind when designing activities. Allowing time for networking and socializing during breaks and at a luncheon or dinner, appeals to those activity oriented learners. The content of the program will be of interest particularly to the goal oriented and learning oriented participants. Adults like to be in control of their learning. Self managed or self directed learning (SDL) opportunities are often less threatening than formal classes taken for credit. The following event line illustrates several learning modalities for adults, ranging from least stressful to those most stressful. Low stress High stress SDL TV Non credit Competency Formal Course Course Based Experience Class SDL allows learners to pace themselves during the learning activity. The learner can choose if and when to participate. Staff development personnel may find that RNs might be more willing to complete a SDL activity rather than attend a CNE program on the same topic. Research has shown that nurses spend on average 200 to 300 hours per year on independent learning projects (Emblen & Gray, 1990). Budget constraints, advances in technology, and staffing shortages are factors leading staff development educators to advocate self paced learning that presents essential information in a brief, compartmentalized format (O'Very, 1999). Online courses and non credit courses are options open to adult learners and may have relevance for CNE and staff development providers. Some telecommunication courses may provide an opportunity for staff to learn by viewing a program at their facility. Telecommunication courses can also be cost effective. Adult learners find competency based learning opportunities to be less stressful than taking a course where a grade is earned. In competency based learning, learning continues until the knowledge or skill is learned. In a competency based learning situation, the learner is not in competition with others in a class. Learning is complete when the individual has met the objectives of the learning activity. 26

27 Knowles (1972) characterized the adult learner as one who uses past experiences as a resource for learning, is self directed, tends to want to apply new knowledge immediately, and is oriented toward problem centered learning rather than subject centered learning. The role of the faculty is to be a facilitator in the learning process. According to Knowles' view of adults, these learners expect respect for their individuality, want to participate in defining goals, planning and conducting learning activities, and want to be involved in evaluation of their learning. Therefore, as much as possible, faculty need to involve the learner in the CNE planning, learning process, and evaluation. Cognitive Attributes Adult cognition, the thinking process, can be considered from two aspects: cognitive psychology and cognitive development. Both aspects should be considered when designing educational activities for registered nurses. Cognitive psychology. From a cognitive psychology perspective, the process of learning is not different in adults than in children or adolescents. According to cognitive theory, information is encoded and stored in schema. Schemas are representations of visual and schematic information. When a nurse learns about the factors that affect a person's blood pressure, this information is stored in a schema as declarative knowledge. Procedural schema also exists. When a nurse learns how to take a blood pressure, the procedure is represented in memory. Included in this procedure are all the components of taking a blood pressure, including how to position the cuff, where to place the stethoscope, and how to listen for and interpret the Korotkoff sounds representing flow through the vessels. A novice will spend time practicing the skill until it becomes automatized. An expert nurse who has automatized taking a blood pressure does not even think about the steps in the procedure. Declarative schema can be added to and expanded relatively easily; however, procedural knowledge is difficult to change once the skill becomes automatic. While a student nurse is learning to take a blood pressure, the procedural knowledge can be modified. However, once taking a blood pressure becomes an automatic skill, it is difficult to correct the procedure if the student is taking blood pressures incorrectly. Besides encoding or storing information, the information also needs to be retrieved. In the retrieval process, the individual scans information in memory, trying to connect the new situation with what is already known. For example, a nurse may be familiar with caring for patients with an autoimmune disease such as rheumatoid arthritis. When assigned a patient with scleroderma, another autoimmune disease, the nurse scans his or her memory to seek information about the disorder. If none is found, information about autoimmune diseases may be retrieved to help the nurse in the care planning. Some adults may have difficulty in both encoding and retrieving information. Retrieval is easier in recognition situations rather than in recall. If learning has taken place, a true false question on an evaluation tool is easier for an adult learner to respond to correctly than if the nurse is asked to write an essay about what was learned. A true false or multiple choice question 27

28 facilitates recall since words in the question may trigger retrieval pathways. An essay question forces the learner to search his or her memory for the correct information. Timed tests are generally more difficult for adult learners than for adolescents. The speed for memory tasks tends to slow down in adults. Self directed learning activities compensate for this slow down by allowing adults to pace themselves in their learning. Flavell (1985) suggested that the most important adult cognitive changes are probably the result of life experiences, including programmed and everyday experiences of living. In her work with novice/expert nurses, Benner (1984) found that expert nurses are more likely to use past experiences to guide their actions than are novice nurses. Both Flavell and Benner support the importance of past experience in learning and decision making. Cognitive development. Several developmental theories are applicable to adult learning; however, most of these theories were developed based on observations of adolescents and young adults. According to Perry's theory of cognitive development (1970), individuals move through several stages of development: duality, relativism, and commitment. Children and adolescents are often at a dualistic stage where they see the world as right or wrong, black or white. Adults, on the other hand, tend to be in a relativistic stage where they view knowledge in a contextual sense. For example, confusion in an older adult newly admitted to an extended care facility may be perceived by the nurse as a response to sleep medication or the unfamiliarity of the environment. Whereas, the emergency department nurse might have a different perspective about confusion in a child who has recently fallen from a tree. Both of these nurses are taking contextual information into consideration. Adults tend to search for relationships between ideas and the meaningfulness of information. It is important for CE and staff development educators to keep in mind that adults generally want to apply the knowledge they acquire. Unless they are part of the shuttle nurse corps, participants are less likely to be excited about a program on nursing in a space shuttle and more excited about a program about case management that is going to be instituted in the near future. Adult Learning Theory Learning can be looked at from the viewpoint of the behaviorists, humanists (Maslow, 1943; Carl Rogers, 1951), social learning theorists (Bandura, 1976), cognitivists (Ausubel, 1968; Anderson, 1982; Gagné, 1985), or from a transformation perspective (Mezirow, 1991). The behaviorist focuses on observable behavior. From a behaviorist viewpoint, learning is affected by the environment and not by characteristics of the learner. Reinforcement is one component of behavioral learning theory. If nurses are rewarded for attending CNE (through merit pay or career ladder), the behavior of attending CNE activities will be reinforced. The behaviorists provided educators with the concepts of goals and objectives to guide learning activities. The behaviorist perspective is also evident in programmed instruction, computer assistedinstruction, and competency based learning. Bevis' early work on curriculum (1972) guided nurse educators in developing sound curricula and providing a framework for evaluation. The 28

29 use of behavioral objectives in ANA's criteria for developing CNE activities has its beginnings in behavioral psychology. The humanist's perspective considers the human potential for growth. Individuals have a natural tendency to learn, and when there is an encouraging environment, learning will occur. Learning is fostered when the learner is able to share in the decision making process and in self evaluation. Participants like to have input into the type of programs offered by their agency or organization. Programming based on a needs assessment of the RN staff is more likely to be well attended than programs based on what the CNE or staff development personnel perceived as the needs of the staff. The National League for Nursing has described a curriculum revolution occurring in nursing education that focuses on a humanistic approach to learning (Bevis & Watson, 1989). From this humanistic view, students and faculty share the responsibility for learning and work collaboratively in enhancing the learning process. Social learning theory considers context in the learning process (Bandura, 1976). From this theoretical perspective, learning occurs by observing others and is often acquired vicariously. Learning is enhanced where there is peer interaction. Small group activities can facilitate learning as participants share experiences or reflect on the content presented in a more formal lecture. Bandura's theory suggests that faculty should expose students to a wide range of learning alternatives so they can decide for themselves which learning strategy is most effective. According to social learning theory, students should not be required to perform in order to demonstrate that learning has taken place. Mezirow's theory of perspective transformation is especially applicable to the adult learner. According to Mezirow (1991), learning is not always adding on to what is already known. Instead, learning can take place as knowledge is transformed into a new perspective. Learning becomes emancipatory when the learner has interest in one's own knowledge and gains insight through self reflection. Perhaps an RN is quite knowledgeable about caring for the physical needs of terminally ill patients. While attending an activity on meeting the psychosocial and physical needs of AIDS patients, the nurse may use the new information to provide new meaning to the information he or she already has about caring for a dying patient. Barriers to Participation A variety of barriers face individuals seeking CNE opportunities, including institutional barriers, situational barriers and dispositional barriers (Aslanian, 1980; Cross, 1988). All three of these barriers can influence whether RNs seek opportunities to continue their education. Providers of CNE need to consider ways to minimize these obstacles. Institutional barriers. At times, the location and timing of an activity may influence participation. If a critical care course is taught at the hospital immediately after the day shift, more nurses might participate than if they had to travel to a location across town for an evening program. Once the nurse is home, she or he may find it difficult to break away from family responsibilities and may be less likely to go out to attend a program later in the evening. 29

30 Accessible parking is also important to adults. Is parking available at the conference center, or, as on many college campuses and some health care centers, must the participant park at some distance from the location and be shuttled by bus to the conference site? Registration can also serve as a barrier to participation especially if the nurse has to expend a great deal of time and energy to register for an activity. Mail in registration or registration through phone, fax or online can minimize this barrier. Institutional barriers may also exist when educational activities offered are not of interest to the nurse. An ER Flight nurse has different learning needs than the nurse working in an inpatient psychiatric setting. While some programs may be of interest to both nurses, each nurse will have unique learning needs. Situational barriers. Cost and time are two major situational barriers faced by adults seeking CE. What is the program going to cost the individual participant? From the provider's point of view, activities need to be cost effective; however, programs with exceptionally high costs may be out of reach for many potential participants. Since many employers no longer provide funds for CE activities, nurses may find it difficult to secure the financial resources to attend an activity. Out of town programs will cost more because of extra expenses for travel and lodging. A four day program in Milwaukee might cost an RN in southwest Missouri over $2000: registration fees $500; lodging $300 $150/night; travel $650 by plane or car, and $400 for meals not included in the conference. At times, nurses have to take vacation time, use their days off, or take an unpaid day off to attend educational activities. This lost income impacts on willingness to attend some activities. Because many workshops are two or more days in length, finding the time to go to a conference can be difficult. Their class and clinical schedules frequently limit nurse educators, especially if no one is available to substitute for them. Staff nurses also may be limited by inflexible schedules and unavailability of replacements. Responsibilities at home or work often are seen as situational barriers. Parents with small children often find it difficult to get away from childcare responsibilities. Those with older children are involved in carpooling and attending their children's school or sports activities. For many nurses, finding time to attend CE activities can be difficult. Dispositional barriers. Some adults feel they are too old to learn and lack confidence in their ability to gain new knowledge. Staff development and CE opportunities often are more acceptable to adults than formal graded classroom activities. CE providers need to consider activities where small group activities or case studies are used as part of the learning strategy. Making the educational activity meaningful to adults is an important way to enhance CE participation. 30

31 Motivational Techniques Various motivational techniques can be used to promote learning. The environment can help focus the learner's attention on what is to be learned by developing a business like setting, while at the same time maintaining an atmosphere of warmth and acceptance. A variety of techniques can be used to capture the attention of the learner, including the use of handouts and appropriate audiovisual aids. Internal motivation is recognized as having a stronger effect on knowledge retention than external motivational factors. Internal motivation is often high in adult learners, particularly those who are goal or learning oriented. Since participants are aware of an activity s objectives through announcements and brochures, the learner is able to determine whether the activity meets his or her individual learning needs. Learning is enhanced since the learner will derive feelings of satisfaction from meeting personal needs. External motivation can also be fostered at CNE activities. A packet of handouts, objectives, speaker information, and evaluation tools given to the participant at the beginning of the educational activity can support external motivation. The certificate of attendance provides a tangible item in recognition of participation. Instructional Strategies A variety of instructional techniques may be used in CNE activities, including presentation, interaction, and individualized techniques (Hughes, 1992). The choice of instructional method depends on several factors, including the characteristics of the learner, the content to be learned, and the setting. Each instructional technique has its unique advantages and disadvantages. Presentation techniques. The lecture is a formal presentation that allows communication from the lecturer to a group of participants. Lectures are often used to present a body of knowledge to a large number of people. Although a time effective teaching technique, lectures tend to limit participation by the learner and especially limit opportunity to ask questions. Panel discussions can often be used effectively to present information from a group of experts. Panel discussion often provides opportunity for panelists to present differing views, thus stimulating reflection in the learner. It is important for continuing educators to define the role of the panelists and the discussion process to prevent take over by dominant panelists or to direct panelists regarding their specific objectives. Demonstrations are most effective in helping learners gain procedural or skill related knowledge. If demonstration is a part of the CNE activity's teaching strategy, there must be an opportunity for the learner to practice the skill and receive immediate feedback. Demonstration is best used with small groups where all the participants can see and hear the demonstrator and have adequate time to practice the skill. Interactive techniques. Teaching methods that are interactive allow participants to engage in dialog and discussion with other students and the instructor. Role play is one interactive 31

32 technique that allows participants to assume roles and practice skills in a lifelike situation. Roleplay is often an advantageous way to learn new interpersonal skills such as assertiveness or handling conflict and confrontation. Role play provides stimulus for discussion, allows time to practice new skills in a non threatening environment, and encourages reflection on personal attitudes. Class discussion is most meaningful when participants actively engage in dialog with others in the group. Discussion is best suited for a group that numbers less than 25 and where the seating arrangement allows eye contact among all participants. It is important for the discussion leader to keep the discussion focused on the topic, encourage all members of the group to participate, and encourage sharing of ideas and opinions. Individualized techniques. Student contracts and individualized instruction are two types of individualized techniques. Learning contracts are developed by the instructor and student to determine the content/skill to be learned, objectives of the learning experience, and evaluation methods. Although not often employed in CNE activities, contract learning may be suited to selected staff development activities. Individual instruction activities such as independent study or learner paced, programmed instruction, and mastery skills labs may be used as effective teaching methods. These techniques tend to encourage students to assume more responsibility for their own learning and enable learners to gain knowledge at their own pace. Learner paced activities can be timeconsuming for the CNE educator, especially in the initial design of the activity. When determining the appropriate teaching method, the CNE faculty must consider the outcomes expected based on the learning objectives. The teaching method must also be congruent with the learners' needs, the setting, size of the audience and time frame available. Role of the Educator and Learner in the Learning Process According to Billings & Hallsted (2009), the role of the teacher or faculty member is to "create a relaxed, psychologically safe environment while developing a climate of trust and mutual respect that will facilitate student empowerment (p. 207). The following concepts can be used by adult educators to facilitate the teaching learning process: Good rapport between the teacher and the student is important in the learning situation. An attitude of trust and friendliness should develop between the teacher and the learner. The teacher must communicate effectively. The teacher must be knowledgeable about the learner's needs and level of understanding regarding the topic. The teacher should give credence to the concept that the highest state of creativity is in self fulfillment. 32

33 The teacher should be perceived as a facilitator who guides and enables the adult in the learning process. Consideration should be given to the learner's own motives for attending an educational activity. The following concepts should be considered when designing activities for adults. The learning process is dynamic and interactive. A spirit of trust and support should exist in the learning environment. Learning must be problem centered and relevant to the learner. Learning must be experience centered. Experiences must be developed that are meaningful to the learner and taught using the learner's vocabulary. Acquired knowledge should have immediate application. The learning atmosphere should encourage problem solving. The learning process should involve a variety of learning experiences to meet the needs of a diverse population. The activity should have a flexible structure in order to provide learning experiences acceptable to adults. Retention of information is enhanced by fostering the intent to learn and assisting the learner in finding meaning in the material learned. Learning can be enhanced by showing the relationship between previous knowledge and new information, by spreading learning over a period of time, and by organizing information in logical patterns. Learning is enhanced by providing the learner with encouragement and reinforcement in a non threatening learning environment. The learner also assumes responsibility for the learning process. The learner has the responsibility for the success or failure of the learning situation. The learner must have immediate feedback about progress toward the goals of the activity. The learner should be an active rather than a passive listener or viewer. Goal setting by the learner is important as motivation for learning. Successful goal achievement enhances further educational efforts. The following is an example of how adult learning principles are used in designing a 150 minute educational activity on up to date information on immunization. 1. Build on the learner's positive experience. Participants have a body of knowledge regarding immunology and immunization. This program is designed to build on that foundation and provide new information for those nurses who provide immunizations and counsel patients about immunization. 33

34 2. Encourage the sharing of experience. The discussion during and at the end of the activity will allow participants to discuss the content presented and ask questions. This sharing will reinforce new knowledge obtained in the educational activity and strengthen an interactive experience. 3. Help the learner develop problem solving skills. Comparing new information with prior knowledge can enhance problem solving skills. Participants have an opportunity to consider how changes in the recommendations for use of various vaccines affects their practice. 4. Provide real life situations as examples, or have the learner provide them. The presenter has an opportunity to use case studies to enhance learning. For example, the presenter might describe a situation where a child develops Lyme disease. Information about preventing Lyme disease can be shared with the audience. Participants can also share information about vaccines they feel are important for health care workers to receive. 5. Allow sufficient time for learning. This activity is scheduled for 150 minutes with a 10 minute break in the middle of the activity. The allotted time should be sufficient to introduce new content, apply the content in a structured situation and to review new knowledge learned. Handouts will reinforce the material presented and can be used later by the participants as reference material. 6. Provide a variety of learning methods. While a lecture format will be used, time is allotted for small group comparison of several liability insurance packages. Discussion and audiovisual materials also provide variety in the learning process. 7. Present information that can be used now. This program focuses on a problem area nurses face in their community health or primary care centers. The content of this activity is immediately applicable by the participants when they return to their work setting. The following is another example of how adult learning principles are reflected in the teaching methods for a hands on workshop for nurse educators and staff development personnel on using presentation software to create effective classroom teaching tools. 1. Build Confidence during Hands on Learning Experiences The workshop faculty will share information about how to use various presentation software programs. Participants will have an opportunity to practice creating a short presentation during the workshop. While the participants are using the computers to create their programs, the presenter and several assistants will circulate in the room to help the participants. Participants will receive instant feedback on their efforts, thus enhancing their confidence in using this new teaching tool. 2. Encourage Sharing of Experience During the workshop, the participants will be able to share information about various teaching aids they already use and what they have found useful and what students have found most beneficial to their learning. The participants can use this information as they develop their presentation software program. 34

35 3. Provide Reinforcement After the participants have created their software program, each participant will have an opportunity to show the program to all the participants. This will offer a chance for comments and critique of each participant's effort. The workshop faculty will be able to provide constructive comments and reinforce the content presented during the didactic portion of the workshop. 4. Provide Goal Setting In order to enhance goal setting and achievement, each participant will be asked to send e mail to the workshop faculty stating when they will use the presentation software in a classroom setting. Summary It is important for continuing educators and staff developers to understand their target population the adult learner. Consideration of the characteristics, developmental and cognitive aspects of the adult learner can enhance the educators' ability to meet the needs of these individuals. Faculty can enhance learning by serving as a role model, resource person, and colleague to foster self direction in the learner. The use of small group activities and discussion groups can allow learners to engage more actively in the learning process, and increases the opportunity for the learner to share past experiences. Educators need to look at how they view the learner. Educators also need to have knowledge of adult characteristics, cognitive development, and principles of learning in order to plan meaningful experiences for participants in their CNE activities. 35

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37 4 CHAPTER DEVELOPING THE LEARNING GOAL (PURPOSE) AND INSTRUCTIONAL OBJECTIVES FOR CONTINUING EDUCATION ACTIVITIES Bevis' work (1972) on curriculum development ingrained in nurse educators and staff developers the use of purposes/goals and objectives when designing educational experiences. The statement of purpose "describes why and for whom an educational program has been designed" (ANA, 2000, p. 25). Educational objectives are "a statement of the learner outcome(s) of an educational activity that is/are measurable and achievable within the designated time frame" (ANA, 2000 p. 24). The importance of objectives is found in the ANCC Accreditation Program criteria for approval of various educational activities for registered nurses. The criteria for designing educational activities for registered nurses include evidence of the development of instructional objectives. Identifying a Purpose for Continuing Nursing Education Activities Prior to developing objectives for an educational activity, an overall purpose should be identified. Purposes are based on needs of the organization, group or individual. Purpose statements for educational activities are often derived from the problem or the identified educational need identified and should be congruent with the content and objectives. When developing the purpose the nurse planner should consider how the learning activity will contribute to the nurses learning needs and their pursuit of educational goals. For example, based on a needs assessment, including a survey of the 15 area flight nurses and an audit of CNE activities related to their needs, it became evident that a greater percentage of airlifted patients were children, but no CNE provider in the region had offered an activity on pediatric trauma in the past two years. A search of the literature and review of the standards for flight nurses indicates a need for specific programming for this specialized group of nurses. The problem statement for this situation is that flight nurses do not have the opportunity to attend continuing education opportunities on pediatric trauma in their region. Based on the problem, the Education Department of the regional air ambulance service determined a need for an annual two day educational activity for flight nurses, planning the first year's activity on the topic of pediatric trauma. The purpose of the two day program evolved from the problem: Purpose: The purpose of this educational activity is to provide an opportunity for flight nurses to enhance their knowledge and skill in caring for pediatric trauma patients requiring flight services. 37

38 In another example, an Advanced Practice Nursing special interest group received many questions from APRN's about anticipated changes in legislation affecting prescriptive authority. The education subcommittee sees the problem as lack of opportunity to learn about and discuss implications of the new legislation. They decide to devote the monthly meeting's educational session to this topic, and state: The purpose of this educational activity is to assist APRN's in understanding the content of new legislation and implications for practice. An activity may have a single purpose, as in the above example, or more than one; in a conference lasting several days, for example, the planners may have a different purpose for each day. Stating a Theme It is not necessary for providers of continuing education activities to include a theme in the information provided in the CNE application. However, themes are sometimes used in educational activities that extend over several days or weeks, such as a critical care course or association convention. Themes are statements reflecting recurring, unifying ideas that are evident throughout the educational activity. A course or convention program may have several themes that would be included in each session, such as the theoretical basis for the information presented, an update of the latest treatment, or an emphasis on application of information in a clinical setting. For example, a convention for nurse educators might have a theme of "Distance Learning Today and Tomorrow". Sessions would address theoretical aspects of self directed learning, innovations in methods, successful examples with different learner populations, impact on practice, and soon. Objectives Once the purpose has been developed, statements can be designed that describe what will be accomplished by the learner at the end of the educational activity. These statements are measurable, derived from and consistent with the purpose/s, are specific and are observable. These statements are objectives. Objectives are stated in behavioral terms and are written to clarify expected accomplishments of the learner. They should be written to demonstrate the behavior that will be evident in the participant at the end of the educational activity. The Purpose Objective Worksheet in Sample 4A can help to facilitate the writing of the purpose statements, and behavioral objectives for an educational activity. 38

39 Sample 4A Worksheet for developing purpose(s) and objectives Objective Worksheet State the need or deficit identified for the educational activity: State the Purpose of the CNE activity: Objectives for the Purpose By the end of the educational activity, the RN will: a. b. c. Behavioral objectives are statements that describe the behavior the learner is expected to exhibit as a result of one or more learning experiences. The focus is on the learner's behavior and learner outcome as a result of the learning experience rather than the material covered. Learning is seen as a change in behavior. Therefore, it becomes very important to select behaviors appropriate to a given situation and then to state the behaviors in measurable terms. This gives direction to the learner's experiences and provides an activity that can be evaluated or measured, thus guiding the nursing educator to be clear and precise in communicating one's intent or answer the question, "What is expected from the learner as a result of the learning experience?" What are the learner outcomes? Robert Mager (1962) identified four basic elements of objectives: 1. Description of the learner, e.g., "the learner who completes this course or class will be able to list three low sodium foods from memory." 2. Description of the behavior the learner will exhibit to demonstrate he or she has attained competence, e.g., "upon completion of the course the learner will be able to correctly identify presenting symptoms of patients with parotid tumors." 3. Description of conditions under which the learner will demonstrate competence. Specific restrictions may or may not be imposed. When specific restrictions are 39

40 imposed, the restrictions should be critical to the skills learned. Restrictions can include time limits, situational confinements, or use of certain materials, e.g., "upon completion of this course, the learner will be able to identify correctly, within 30 seconds of each strip presentation, a total of six arrhythmias." It is important to insure that the objective can be obtained in the time frame allotted and that you have allowed enough time for each participant. 4. Statement of standards of performance expected to indicate excellence, e.g., "upon completion of this course the learner will be able to demonstrate correctly the placement of EKG leads when preparing a patient for an EKG." There are several steps in writing objectives. The first step is to select behavioral terms or verbs to indicate the expected behavioral change from the educational experience. This verb or behavioral term must be measurable and precise with few interpretations, e.g., define, compare, design, analyze, describe, and demonstrate. Some words commonly found in objectives that are not measurable and have many interpretations include: understand, know, appreciate, realize, see, learn, and believe. Secondly, the objectives should contain only one verb or behavioral term. Multiple behavioral terms should not be included in one objective. When multiple behavioral terms are included in one objective, it is difficult to evaluate or measure the outcome for the learner since the learner may demonstrate one behavior but not the other. Incorrect: Upon completion of the course the learner will be able to list and compare the effects of commonly inhaled street drugs. (Two verbs are being measured: list and compare.) Correct: Upon completion of the course, the learner will be able to list those illicit drugs that are typically inhaled. Upon completion of the course, the learner will be able to compare the symptoms of illicit drug inhalation. The third step is to write the objective as a statement, not as a list of topics or content areas. Incorrect: Value nurses role in assessing patients who have abused drugs. (May be more appropriate as a goal or theme. What will the learners be able to demonstrate, relate, describe if they value nurses' role in assessing these patients?) Appreciate the importance of determining pulmonary complications associated with illicit drug use. (Appreciation is not measurable. What behaviors will the participants demonstrate if they "appreciate" the importance of these complications?) Correct: Upon completion of the course, the learner will be able to identify the pulmonary complications associated with illicit drug use. 40

41 Upon completion of the course, the learner will be able to analyze the symptoms to determine which drug might be contributing to the pulmonary symptoms. Fourth, the objective should be written according to expected behavior or changes in the learner as a result of the educational experience, not what the teacher is to teach. Incorrect: To teach nurses about pulmonary complications with illicit drug use. Correct: Upon completion of this course, the learner will be able to identify presenting symptoms of patients who have used one or more illicit drugs. The fifth and last step involves identifying the appropriate behavioral level of the objective. This can be done by determining whether the behavioral objectives are elementary or advanced. Behavioral objectives that are written at an elementary level are considered lower level. Lower level objectives are very specific and easily achieved. It is expected that all learners will master the knowledge or skill indicated and the skill or knowledge serves as a prerequisite to further learning. Example of a lower level objective: Upon completion of the course, the learner will be able to list three of four commonly used illicit drugs. Advanced level behavioral objectives are those that depend on the individual's ability to use information in analysis or synthesis. All learners are not expected to fully achieve the objectives but would be able to show as much progress as possible toward achieving the objective. Advanced behavioral objectives are often very general and the standard of performance may be difficult to define. Rather than asking for one specific response, several different responses may be possible. Example: Upon completion of the educational activity, the learner will be able to: 1. Describe the treatment of patients who have pulmonary complications related to illicit drug use. 2. Discuss the complications frequently seen with illicit drug use. Bloom (1956), Krathwohl (1964), and Simpson (1972) have developed categories for the various domains of objectives: cognitive, psychomotor, and affective. Each domain identifies increasingly more complex levels of behavior. Since each category builds on the one that precedes it, one can assume that an objective written at an advanced level or category involves or includes all behaviors found at the lower, more elementary, level. Cognitive Domain. Six behavioral levels comprise the cognitive domain: knowledge, comprehension, application, analysis, synthesis, and evaluation. The knowledge level involves remembering previously learned material and the recall of specific information. Typical verbs used to describe the learner's knowledge include: define, describe, list, recite, name, outline, 41

42 select, state, make, record, trace and recall. An example of an objective at this level would be to "list the factors that influence intensive care unit survival for elderly patients," or "state the reason for hospitalization." The comprehension level implies understanding of information, or the ability to grasp meaning, translate and interpret information, and estimate future events. Typical verbs for comprehending behavior include: compare, distinguish, extrapolate, interpret, translate, contrast, infer, predict, and summarize. Examples of comprehension objectives include "restate the concept in your own words," and "compare the similarities and differences in the nursing roles." At the application level, the learner is able to use knowledge in new and concrete situations. Learning outcomes are at a higher level than comprehension. Appropriate verbs at this level include: apply, classify, demonstrate, examine, relate, solve, use, produce, prepare, and modify. At the application level, the learner might "demonstrate how to comfort a grieving client, " or "use nursing diagnoses when developing a nursing care plan for an Alzheimer patient." Analysis involves looking at a whole and examining the parts of the whole. This behavior includes identifying the parts, analyzing relationships between and among the parts and looking at the organization of the structure. Typical verbs include: analyze, explain, group, infer, order, separate, distinguish, and develop. An example: "explain the differences in ICU treatment by survivors and nonsurvivors," or "distinguish between facts and inferences." At the synthesis level, the learner is able to put parts together to make a whole. Learning outcomes often stress creativity or use of information to do something new and different. Synthesis verbs include: arrange, combine, create, develop, integrate, organize, plan, produce, and specify. The learner might "design a nursing unit appropriate for Alzheimer's patients," or "develop a philosophy for a staff development department." Evaluation involves judging the value of materials and methods based on definite criteria. Evaluation verbs include: appraise, assess, critique, grade, judge, measure, rank, and recommend. Behaviors might include "select the best example of a nursing care plan," or "critique the article on 'use of objectives for learning'." Sample 4B illustrates how Bloom's taxonomy of cognitive objectives can be used in developing objectives for continuing education activities. Psychomotor domain. Seven behaviors are a part of the psychomotor domain: perception, set, guided response, mechanism, complex overt response, adaptation, and origination. Perception involves the use of the sensory system to guide physical activity. Several learning activities are associated with perception: identification of a stimulus, selection of a response and carrying out the response. Learner activities might include "distinguishing between a hungry cry and a painful cry in an infant," or "recognizing a malfunctioning infusion pump." Verbs for perception might include: choose, describe, distinguish, select, or relate. 42

43 Set involves preparation for action. This preparation includes mental readiness, physical readiness, and willingness to respond to environmental clues. Typical set verbs include: proceed, respond, start, and volunteer. Examples include "responds appropriately to the client's behavior," and "shows a desire to teach a patient." With guided response, the learner begins to perform complex skills. The learner carries out the skill according to set criteria. Typical verbs for guided response include: assemble, build, fasten, measure, dissect, or construct. The learner might "apply a dressing on a patient with second degree burns," or "dispose of syringes and needles safely in the home environment." At the fourth level, mechanism, the learner is able to demonstrate a skill with confidence and proficiency. Using similar verbs as with guided responses, the learner might "operate a complex piece of equipment with confidence," or "proficiently administer flu immunizations to clients in a clinic." Complex overt response, the fifth psychomotor level, involves skillfully performing a complex task. At this level of behavior, the learner performs proficiently. An example includes "demonstrate skill in admitting a postoperative open heart patient to the intensive care unit." At the sixth psychomotor level, adaptation, the learner is able to modify knowledge and skills according to the need identified. The learner would be able to adapt, alter, rearrange, or revise. The learner could "adapt the colostomy irrigation technique for a person without indoor plumbing" or "modify teaching aids according to the client's individual learning needs." The seventh and highest level, origination, involves creative behaviors and include arranging, composing, designing, and creating. The learner might "design a portfolio of teaching aids to assist patients with pregnancy induced medical problems," or "construct a model that might explain the sliding filament theory of muscle contraction." Affective Domain. The affective domain has five levels: receiving, responding, valuing, organization, and characterization by a value or value complex. At the receiving level, the learner becomes sensitive to certain phenomena and stimuli. Receiving involves awareness or consciousness without assessing the nature or qualities of the stimulus. Receiving also implies a willingness to receive, e.g., the willingness to tolerate a given stimulus and not to avoid a situation. Also implied is controlled or selective attention. Verbs that can be applied to the receiving level include: ask, choose, follow, hold, identify, and select. Examples of behaviors include: "listens attentively to the confused patient," and "identifies two views on death espoused by others." Responding, the second level, is concerned with doing something with the information gained in receiving and attending. The learner might help, answer, discuss, show, select, or present. The learner might "demonstrate willingness to comply with safety regulations," or "seek opportunities to care for complex patients." Responding involves consenting and willingness to act; the learner finds satisfaction in responding. 43

44 Valuing is an abstract concept of worth. In valuing, the learner accepts and demonstrates one's beliefs, one's willingness to pursue or seek out a value, and one's commitment to a belief. The learner might explain, justify, share, differentiate, or propose. The learner might "assume responsibility to communicate information to the staff," or "justify one's position on flexible staffing." Organization involves organizing values into a system, determining interrelationships among various values and establishing dominant or pervasive values. Organization involves beginning to build a value system by conceptualizing a value and bringing together values into ordered relationships. Verbs describing behavior at this level might include adhere, defend, explain, and integrate. The learner might "justify a nursing care plan designed to balance a client's levels of activity and rest" or "defend one's response to a new policy." 44

45 Sample 4B Bloom's Taxonomy of Cognitive Objectives Area of Taxonomy Definition What the Participant Does Knowledge Comprehension Application Analysis Synthesis Evaluation Recalling of specific bits of information Understanding of information; the ability to grasp meaning, translate and interpret information. Use knowledge in new and concrete situations. Examining the parts of the whole; analyzing relationships; looking at organization. Putting together the parts into a whole; use of information to create something new and different. Involves judging the value of materials and methods. Define "primary care." Name the nurse who developed... List the steps in the nursing process. State the reason for hospitalization. Compare Orem's definition of nursing with Roy's definition of nursing. Predict the learning outcome if behavioral objectives are used. Interpret the laboratory values for the patient described in the case study. Apply knowledge of Pathophysiology to explain why potassium may be administered to a diabetic in ketoacidosis. Demonstrate how to comfort a grieving family. Explain the impact managed care has had on health care economics. Distinguish between fact and inference. Describe the order in which treatment should be instituted for a cardiac patient. Design a nursing system appropriate for case management. Create a new job description for a case manager. Specify the activities that need to be carried out in order to produce a continuing education program. Rank the programs according to their benefit to the learner. Select the best examples of behavioral objectives. Evaluate the effectiveness of the care. At the fifth and highest affective level, characterization by a value or value complex, the learner demonstrates integration of a value into his/her life style. The learner responds consistently and predictably. Verbs describing this behavior include: display, practice, act, and 45

46 serve. A learner at this level might "display professional behaviors at all times," or "display ethical behavior consistent with the ANA Code of Ethics." Verb List for Writing Measurable Behavioral Objectives KNOWLEDGE COMPREHENSION APPLICATION ANALYSIS SYNTHESIS EVALUATION arrange associate apply analyze arrange appraise cite classify change appraise assemble assess define convert choose breakdown categorize attach describe compute compute calculate collect choose duplicate defend demonstrate categorize combine compare identify describe discover compare comply conclude label discuss dramatize contrast compose contrast list distinguish employ criticize construct critique match estimate illustrate debate create defend memorize explain interpret diagram design describe name express manipulate differentiate develop discriminate order extend modify discriminate devise estimate outline generalize operate distinguish explain evaluate read identify practice examine formulate explain recall indicate predict experiment generate grade recite infer prepare identify integrate judge recognize locate produce illustrate manage justify record paraphrase propose infer organize interpret relate predict relate inspect plan measure repeat recognize schedule inventory prepare predict report rewrite show model rearrange rank reproduce review sketch outline reconstruct rate restate select solve question relate relate select summarize translate relate reorganize score specify translate use select revise select state utilize separate rewrite summarize tabulate write subdivide setup support test summarize test synthesize value tell write Use of Cognitive, Psychomotor, and Affective Domains in Continuing Nursing Education In continuing nursing education activities, all three domains are used, with emphasis placed on the cognitive domain. Psychomotor domains are especially valuable in those educational activities where skills are to be learned. The affective domain is often neglected in CNE activities, however, this domain is the essence of caring. Since the three domains are 46

47 interdependent, objectives often contain components of several domains: "Upon completion of this course, the learner will be able to differentiate between the rights of a dying patient and the rights and responsibilities of the hospital." Continuing education activities will use several learning domains to guide the participant's learning experiences. 47

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49 5 CHAPTER FREQUENTLY ASKED QUESTIONS AND ANSWERS The following questions reflect those frequently asked by providers of continuing nursing education (CNE). Many of the answers given here are further described elsewhere in this manual. GENERAL Q. Who is eligible to apply for MONA approval for CNE activities? A. Any provider whose headquarters is located in the State of Missouri and who does not meet the definition of a commercial interest is eligible to seek approval of appropriate CNE activities or apply for Approved Provider status. Applications from providers whose headquarters are in another state are accepted only if the state nurses association in the provider's state is not accredited as an approver of CNE by the American Nurses Credentialing Center (ANCC) Commission on Accreditation (COA). Q. What address do I mail our application copies to and also to whom do I make the check payable? A. Please make all checks payable to the Missouri Nurses Association. If you are using regular mail to send your application, use the following address: P.O. Box , Jefferson City, MO If you are using FedEx or UPS services to send your application, use the following address: 1904 Bubba Lane, Jefferson City, MO Q. How long is the approval period? A. If you are applying for approval of an individual educational activity, the approval period is two years. If you are applying for provider approval, the approval period is three years. Q. Are all educational activities of a staff development/continuing education department appropriate for CNE credit? What's the difference between continuing education, inservice, and staff development? A. No, not all educational activities are suitable for CNE credit. For example, in service educational activities are those learning experiences designed to help nurses acquire, maintain or increase their competence in fulfilling their responsibilities to deliver quality health care (ANA, 2000) and do not always qualify as CNE. For example, the following activities are not appropriate for CNE contact hours: Recertification courses where little or no new information is presented, 49

50 Orientation that focuses on facility policies and procedures, or documentation systems Basic Life Support courses, and In service education on the use of a specific piece of equipment Sometimes it is difficult to distinguish between CNE, in service, basic knowledge and staff development. According to the Scope and Standards of Practice for Nursing Professional Development (2000), nursing professional development activities exist in the overlapping areas of continuing nursing education, staff development, and academic education. The concepts of continuing competence and lifelong learning are central to all nursing professional activities (p 4). "Continuing education refers to systematic professional learning, experiences designed to augment the knowledge, skills, and attitudes of nurses and therefore enrich the nurses' contributions to quality health care and their pursuit of professional career goals (ANA, 2010). Staff development is the systematic process of assessment, planning, development, and evaluation that enhances the performance or professional development of health care providers and their continuing competence. Staff development activities, which generally are provided by nurses' employers and focus on competence assessment and development, include continuing education, orientation, and in service educational activities" (ANA, 2010). Educational activities for CNE build on and expand the basic knowledge acquired in nursing educational programs, provide new information relevant to nursing practice, and relate to the process and content of professional nursing. An educational activity for CNE might be developed for RNs who are involved in caring for patients with multiple organ failure, and would qualify as CNE; an activity teaching nurses how to use a new care path developed by the employer would be in service, and would not qualify for CNE. Q. My agency wants to provide an educational activity that may conflict with MONA's philosophy. Can we still receive approval for the educational activity? A. MONA will not review any application submitted for approval if the activity is in conflict with the Missouri Nurses Association's philosophy. Q. What should I do if my agency decides not to pursue contact hour approval once an application has already been submitted? A. An application can be withdrawn by the applicant at any time in the review process prior to the time a decision is made by the MONA CE Approver Unit Committee review team. If the application is withdrawn during pre review (prior to submission to the Approver Unit Nurse Peer Reviewers), the application and fee will be returned minus administrative costs. Once the review is initiated (e.g., the application is sent to the reviewers) the fee is non refundable. The withdrawn application will be returned to the provider. 50

51 Q. My agency is planning to offer continuing education programs and will be seeking MONA contact hours for our educational activities. How can we get help in preparing the application? A. The Provider Approval Manual, is designed to assist Approved Providers in meeting the educational design criteria for provider approval. If, after reading the manual, further assistance or clarification is needed, the prospective provider should contact the Missouri Nurses Association where a CE staff member is available. Members of the CE Approver Unit may also be available to meet with providers in their area of the state to assist in designing appropriate educational activities and to guide the provider in application preparation. Q. Must a provider whose majority of CE activities include internet activities/enduring materials or other learner paced activities that target a nationwide audience apply to ANCC? A. Yes. Q. Can providers who target a nationwide audience and are already approved continue with their approval until its expiration date? A. Yes. Q. We would like to distribute a list of participant names and contact info to all who attend at our upcoming conference. Is this permitted? A. Since the names of participants and their contact info is confidential information, it is permitted only if you secure approval before the conference from the individuals whose names are on the list. The registration form might include a question asking for this approval and providing an "opt out" checkbox for those who wish to deny permission. DISCLOSURES Q. When a speaker cancels at the last minute may we substitute another presenter, even if the required documents are not in hand? A. Yes, as long as the provider has ensured that evaluation of conflict of interest and resolution (if required) have been met and all required disclosures are provided to learners/participants. Q. Are electronic signatures acceptable when completing the MONA Biographical Data and Conflict of Interest form? A. Yes Q. Our MONA Region offers educational activities at each of our monthly meetings. Should we apply for approval for each educational activity or would provider approval be more appropriate? A. If the region plans to offer a number of educational activities over a three year period, it may be more cost effective and time efficient to submit an application and receive provider approval. This allows the region to offer educational activities during a three 51

52 year period and award nursing contact hours to participants rather than individual applications for each activity provided. Or the region can submit an application for each educational activity individually using the criteria for approval of an educational activity if they are offering only a few activities. CONTACT HOURS Q. What is the difference between a contact hour and CEU? Are they the same? A. A contact hour and a CEU are not the same. The ANCC COA uses the "contact hour" as the unit of measure for approved nursing education activities. A contact hour is defined as a unit of measure that describes 60 minutes (1.0 hours) of an organized learning activity that is either didactic or clinical experience. Contact hours may be awarded to participants for those portions of the educational activity devoted to the learning experience and time spent evaluating the activity. (ANCC COA, 2012, p 25). One contact hour = 60 minutes. Activities must be a minimum of 60 minutes in length. The International Association for Continuing Education and Training is an international organization that allows agencies such as colleges, universities, and professional agencies to award a Continuing Education Unit (CEU) for their educational programs. Criteria for awarding CEU provider status include evidence of responsible providership, capable direction, and qualified instruction. One CEU represents ten contact hours of participation (600 minutes) in an organized continuing education experience; 0.1 CEU is equal to 60 minutes (ANCC COA, 1991; ANCC COA, 1996). Staff development departments in a large health care or educational setting might be approved to offer both CEUs and contact hours. Since the CEU and contact hour are different units of measure, staff developers need to review their math when determining the amount of the unit to award participants. For example, if a program were 360 minutes long, the CEUs awarded would be 360 minutes or 6 hours 10 hours/ceu, or 0.6 CEUs. The contact hours awarded would be 360 minutes 60 minutes/contact hour, or 6.0 contact hours. It is important to note that the terms CEU and contact hour are not interchangeable. Q. Can nurses who participate in pilot testing receive ANCC contact hours? A. Yes. Individuals acting as learners for the purpose of a pilot test may receive contact hours for that educational activity when the appropriate number of contact hours has been determined. Pilot testing is important in demonstrating the effectiveness of the teaching or learning materials used in the educational activity and in determining the number of contact hours awarded. The approved agency must maintain records of the data used in deciding the number of contact hours to be awarded for participating in an activity. Q. Can contact hours be awarded to participants of ACLS, PALS, BLS, and BLS instructor courses? A. For initial certification, ANCC contact hours can be awarded for advanced skilled courses such as ACLS and PALS. As of June 1, 2011, ANCC contact hours cannot be awarded to 52

53 nurses attending these courses in order to renew their certification in the subject area unless new material is added to course. Contact hours may be awarded for new content only. Contact hours may not be awarded for BLS and other basic courses (either initial or renewal), since they do not meet the definition of continuing nursing education. Contact hours can be awarded for Instructor courses including BLS, ACLS, PALS or similar courses. Q. How are contact hours for poster sessions (such as at a convention or multi day CNE event) calculated? A. Contact hours may be awarded for poster sessions using a logical and defensible method. Options may include but are not limited to having the learner attest to time spent viewing posters; pilot testing the number of posters that can be viewed within a time period and sign off sheet or similar for poster presenters to validate that the learner actually viewed the poster; or pilot testing the number of posters that can be viewed within a time period and submission of an evaluation form for each individual poster, contact hours commensurate with time viewed. The approach chosen depends on poster location, conference schedule, and objectives of the poster session. Simply assigning time in the conference schedule is not sufficient. Q. In my agency, we usually only have time for a 30 minute program. Can we offer continuing education contact hours for these short educational activities? A. No, contact hours can only be awarded by MONA to educational activities 60 minutes or more in length. Programs of less than 60 minutes cannot be awarded contact hours. Q. If there is a single educational design; does that mean that pilot testing is no longer required for provider directed, learner paced activities? A. The criteria do not require a pilot test specifically, but do require a method for calculating the contact hours be identified (ANCC COA, 2012, p. 25). Q. Our agency provides contact hours to those nurses who view a videotape of a program or conference. Is this appropriate? A. It is appropriate to use videotapes or audiotapes and award contact hours only if the provider meets the educational design criteria. Nurses who attend the actual program or conference may receive a certificate specifying the number of contact hours obtained. However, it is not appropriate to award contact hours to individuals who only view a tape of the educational activity. If an agency provides a videotape of an educational activity for staff to review, a learner paced activity should be developed with a pilot study and posttest questions if contact hours are to be awarded. Q. Can contact hours be awarded if the individual only attends a portion of an educational activity? A. The provider determines whether partial credit can be awarded for an educational activity and should have internal policies in place to make a sound decision when these 53

54 situations occur. If the educational activity is designed to have individual sessions each with its own objectives, contact hours may be awarded only for those sessions attended. If a specific number of contact hours are awarded for attending an entire educational activity, the provider of the educational activity needs to determine if partial contact hours should be awarded, again, based on the provider's own policies and criteria for verifying participation and successful completion of an educational activity. Generally, participants who are absent for a portion of the formal presentation should be held to the same standard as those who attend the entire educational activity. Q. We did not give a certificate of attendance nor contact hours to the speaker in our one day conference? Was this correct? A. A registered participant in the educational activity who presents or facilitates a portion of the total learning experience (e.g., a speaker or faculty member) should not be awarded credit for the portion of the educational activity that he or she presents. If; however, the remainder of the educational activity constitutes a learning experience for the speaker, credit for that portion of the educational activity may be awarded based on the provider's internal policies and criteria for verifying completion of an educational activity. It is inappropriate for the speaker to receive contact hours for their presentations because they are considered the expert on the topic. Going back to the definition, continuing education builds upon the nurse s knowledge. If the speaker does not have the knowledge, then they would not have been selected to present. Q. The criterion asks the applicant to identify the number of contact hours to be awarded, with supporting documentation. What supporting documentation are they looking for? A. The educational objectives and the level and amount of content to be provided dictate the amount of time that will be required when the learners and presenters interact in real time, as in a course, seminar, or videoconference. Each topic area should have a designated time frame. The time allotments for content for each objective should be sufficient to facilitate achievement of the objectives by the learner. Indicating the time allotted for each objective will satisfy this supporting documentation. Whether the applicant is using the Educational Planning Tool or a narrative description of objectives, content, and time frame, they must indicate the time allotted for each of the objectives. Too often, adequate time is not allotted for the speaker to cover the content and help the learner achieve the objectives. Q. When calculating the number of contact hours I find that the number is two digits past the decimal point, or more e.g., What is the number of contact hours I should use? A. You can either award contact hours in the hundredths (i.e., two digits past the decimal point) or round down to 1.6. Do not round up. 54

55 Q. How do you calculate contact hours for online or home study programs? A. These hours must be calculated in a logical and defensible manner. One approach often used is the pilot study. Another approach sometimes used with written materials online is a recognized formula using data such as word count and level of reading and level of technical difficulty. Q. Should a certificate be given to all participants attending a CNE activity even if all of the participants are not RNs? A. If the provider chooses to do so, certificates verifying attendance and the number of contact hours awarded can be given to all participants who meet the criteria for successful completion, whether the participants are RNs or individuals from other disciplines. Participants should be aware that the contact hours are specific to registered nurses and those other disciplines such as nursing home administration or speech pathology may or may not recognize the contact hours awarded by MONA or a MONA Approved Provider. EDUCATIONAL DESIGN Q. Can only the Primary Nurse Planner plan education? A. No, the Primary Nurse Planner is responsible for ensuring overall adherence of the Provider Unit to accreditation criteria. However, for every educational activity awarding contact hours, there must be at least one Nurse Planner and one other planner to plan e ach educational activity. The Nurse Planner is knowledgeable about the CNE process and is responsible for adherence to ANCC criteria. One planner needs to have appropriate subject matter expertise for the educational activity being offered. There is no limit to the number of additional individuals who may help plan the activity. Q. May we use previously developed content and award CNE credit to our nurses? A. Content previously developed may be incorporated into educational activities for continuing nursing education credit within the following guidelines: The Nurse Planner and Planning Committee must: Conduct an independent needs assessment of the target audience Identify previously developed educational content that meets the learning needs of the target audience Develop new learning objectives independent of any prior objectives for the content or possess evidence why previously developed learning objectives did not require modification. Possess evidence the previously developed content is current, evidence based, meets current standards or practice guidelines Provide evidence of revisions/deletions/additions required for the previously developed content OR evidence stating why previously developed content did not require any revisions/deletions/additions. Ensure the previously developed content is objective and unbiased; and excludes any promotional influence. Verify that the previously developed content meets the definition of "continuing education" as described by the ANCC's Accreditation Program. 55

56 The Nurse Planner and Planning Committee may not provide a previously developed educational activity and award continuing nursing education credit without complying with these guidelines. Failure to adhere to these guidelines may result in loss of accreditation/approval status. Q. There is a requirement for the nurse planner to "have education or experience in the field of education or adult learning". What kind of experience do you mean? A. These are examples and are certainly NOT comprehensive: Engagement on several CNE planning committees, Academic education focused on education (Masters in Education, for example), or participation in a training session for Nurse Planners Q. A number of speakers for our convention have submitted resumes. May we submit these resumes instead of the MONA Biographical Data Form included in the education activity application? A. All applicants are required to use the MONA Combination Biographical Data & Conflict of Interest Form when documenting the education, expertise and potential relationships posing a conflict of interest for planners and presenters participation in an educational activity. Resumes are not accepted with the application documentation. Information from the resume must be summarized on the combination form to demonstrate the planner or presenter s qualifications. Q. My agency does not have registered nurses on planning committees for CNE activities. Can we still apply to MONA for CNE approval? A. No. The Missouri Nurses Association CE Approver Unit will not review any application submitted for approval if there are no registered nurses serve on the planning committee. According to the criteria, there must be at least one RN with a minimum of a baccalaureate degree in nursing on the planning committee identified as the Nurse Planner and at least one other who has appropriate subject matter expertise for the educational activity being offered. Q. Can an RN who has a bachelor's degree in social work serve as the "Nurse Planner" for CNE activities in our organization? A. Registered nurses that hold a current, valid license as an RN and a baccalaureate degree or higher in nursing may serve as the Nurse Planner, or Primary Nurse Planner within a Provider Unit, who is responsible for planning, developing, implementing, and evaluating a provider's continuing education activities (ANCC COA, 2012). At least one of the RNs on the planning committee for an educational activity must have a baccalaureate or higher degree in nursing. This requirement means that the RN must have a baccalaureate degree in nursing (typically a BSN), master's degree in nursing (may be an MS, MSN, or MA with a major in nursing), or a doctorate in nursing (typically a PhD, DNP or Doctorate in Nursing Science). An RN who has an associate degree in nursing or is a graduate of a diploma 56

57 school of nursing and does not have a baccalaureate or higher degree in nursing would not qualify as the "Nurse Planner" for purposes of an Approved Provider. Q. The criterion states Describe the teaching/learning strategies to be used in the activity, including resources, materials, delivery methods, and learner feedback is confusing. Haven t I already done this if I am using the Educational Planning Tool? A. Yes. If the applicant has completed the Educational Planning Tool then the areas of teaching/learning strategies, resources, materials, delivery methods, and learner feedback have been addressed. There are certain areas that have been included within the application that primarily address provider directed, learner paced activities. This criterion is one of those areas. If the applicant is submitting a provider directed, learnerpaced activity for approval, they would need to elaborate on these five areas more than with an activity that involves participant attendance. Q. A program we are planning will have a mixed target population: Registered Nurses, physicians, social workers, and hospital administrators. How do we address the target audience for this program? A. Multidisciplinary partnerships are encouraged, with the planners representing each discipline articulating specific learning needs. For example, a multidisciplinary conference on spinal cord injury was planned by nurses, social workers, and therapists and all agreed on a need to know about advances in research. The keynote presentations were planned to focus on research and advances in knowledge, with breakout sessions for PT/OT, nurses, and social workers incorporating the advances into their own practice. If there are no specific breakout sessions for registered nurses then it is the responsibility of the nurse planner to ensure during the planning meetings the topics and content is appropriate for nursing continuing education. For example, the topic could be a general topic focused on the Institute of Medicine Report on Patient Safety. This topic is very appropriate for a multidisciplinary audience. ACCREDITATION/APPROVAL STATEMENT Q. How will participants know that an educational activity has been awarded contact hours approved by the Missouri Nurses Association? A. The following statement must be used on the certificates of attendance and on all written materials related to the educational activities of the Approved Provider: (Name of Approved Provider) is an approved provider of continuing nursing education by the Missouri Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Q. What is the appropriate way to list the approval statement and the contact hours on the certificate? We typically list these items in the same sentence. Is that still appropriate? 57

58 A. NO. In years past, approved activities could alter the approval statement on their certificates to also include the number of contact hours awarded to the participant. For example: the current educational activity approval statement reads, "This continuing nursing education activity was approved by the Missouri Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation." Several providers would alter the statement to read "This continuing nursing education activity was approved for contact hours by the Missouri Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation." to include the number of contact hours. The ANCC COA will no longer allow this alteration to the approval statement. From this point forward, please list the approval statement separate from the number of contact hours awarded to participants. You are still required to indicate the number of contact hours awarded for attending the activity and include the approval statement, but they can no longer be included in the same sentence. The approval statement must stand alone. In other words it must start and end on a line separate from other text. Approval statements must be exactly as written in the manual. No additional statements may be attached to the approval statement. If a provider would like to say that another agency has approved the activity, do so with a separate statement. Formal complaints can be, have been, and continue to be, lodged against organizations where incorrect statements are used. As the Accreditation Program processes and decisions become more outcome focused and evidence based, the presence of complaints in an organization's file may, in the near future, result in additional requirements or documentation at the time of re accreditation. Q. It is not clear to me if the rules regarding the approval statement say that it needs to be on a separate line or just a self contained sentence. A. The approval statement must be both a self contained sentence and be on a separate line from any other statements or text. Q. Must the "pending approval" statement stand alone, or can it be on the same line as other information? A. The pending approval statement must stand alone. This statement applies only to the individual education activity approval process. CONFLICT OF INTEREST Q. Under the current criteria, it is a requirement to have our planners and presenters disclose any conflicts by completing a conflict of interest form. What does this form look like? A. We do have a copy of the form located in the 8th edition of the CE Provider Approval Manual. If you do not have access to the manual you may also view form on our website at You may also contact the MONA office and request a copy of the form. Conflict of interest is addressed on the combination Biographical Data & 58

59 Conflict of Interest form. Both planners and presenters must complete this form and disclose any relevant conflicts of interest for each activity they participate in. Blanket statements and forms signed annually are no longer accepted. Q. Our agency s Nurse Planner is married to a pharmaceutical executive whose company sometimes provides educational grants for our CNE program. Does this disqualify her from involvement in planning at those times? A. The purpose of the more detailed guidelines for disclosure, sponsorship and commercial support is to ensure independence in educational content. You must be able to show that each individual in a position to control the content of an educational activity, i.e. planners and presenters, disclose any financial interest in a commercial entity. ANCC COA interprets this as including financial relationships of a family member. The Nurse Planner is not disqualified, but must 1. Disclose the potential conflict of interest in the Conflict of Interest form, which is part of the activity file, and 2. Disclose the potential conflict of interest to learners of any such relationship either present, or within the past 12 months. Q. What are the requirements for electronic signatures (on disclosure statements, COI statements, etc.)? A. Signatures, electronic or original, are not required. However, if a signature is not used, then documentation that you received the disclosure information from the source of the information will be needed. For example, if the form was faxed, you would need to save the cover sheet with the person's name and phone number on it. You need to use a method that makes you comfortable that documentation has been secured, and which provides verifiable proof after the fact. It is acceptable to use a single form to meet the requirements of multiple accrediting bodies. The individual requirements for each accrediting body must be met by the form. Q. If there is no conflict of interest; do we need to disclose it? A. The provider must secure from presenters and planners a statement regarding conflict of interest on a conflict of interest form whether there is a conflict or not. The presence or lack thereof must be disclosed to the learners. COMMERCIAL SUPPORT/SPONSORSHIP Q. What is the difference between a co sponsor and co provider? A. Co Providership is the planning, developing, and implementing an educational activity by two or more organizations or agencies. ANCC Accreditation criterion requires that the Nurse Planner of the approved organization be fully responsible for the particular aspects of the process to assure adherence to all the ANCC criteria. A written coprovider agreement is completed. Sponsorship is support (monetary or in kind') furnished to the provider of the educational activity. Sponsorship must be acknowledged to learners. A written agreement is completed and signed by both organizations. When an educational activity 59

60 is supported by more than one entity, each entity is a co sponsor. Sponsors and cosponsors do NOT participate in planning, developing and implementing the educational activity. Q. Will other states accept MONA contact hours for re licensure? A. Usually, but not necessarily. MONA s approval is recognized by all other states that are accredited as an approver, as well as by some states requiring mandatory continuing education for licensure renewal. If the state is a mandatory continuing education state then check with that state s board of nursing. It is always best to contact the state's board of nursing or other professional licensing body when one's intent is to attend an educational activity to use the contact hours for re licensure. The ANCC and MONA voluntary recognition systems are not related to mandatory continuing education requirements. States that require continuing education for re licensure may have in place additional requirements that are not a part of the ANCC or MONA CE approval process. Q. The activity is not receiving commercial support and therefore has no conflict of interest, do I have to respond to that criterion within the education activity application and provide a copy of the conflict of interest form? A. Yes. Disclosing conflict of interest in the activity is not limited to activities that have received commercial support or sponsorship. The MONA combination Biographical Data & Conflict of Interest Form or similar form must be obtained from all planners and presenters and potential or perceived conflicts of interest disclosed for all activities regardless of the presence of commercial support or sponsorship. Q. Our annual perinatal conference is always generously sponsored by a large formula manufacturer. They pay all the speakers directly. They provide attractive conference bags with their logo, and their excellent print materials are part of the handout packet. They also display product information in the main classroom. Is this appropriate under the new criteria? A. You will need to review the new guidelines carefully. You must have a written agreement with each entity providing commercial support or sponsorship, signed by both parties, that follows the ANCC Accreditation guidelines. The provider or coprovider, not the commercial entity, must pay speakers or authors from an unrestricted educational grant. You must take care to keep educational content separate from product advertising; items with company ads or logos cannot be handed out where you register participants and hand out the educational packet, but rather at a separate table. Likewise, commercial advertising or logos can be present in an exhibit room, but not in the room where presentations occur. The presence of commercial support or sponsorship must be disclosed to participants in print or written form or by an announcement prior to the start of the activity. Q. What is a commercial interest company? A. Commercial product companies include: 60

61 Any entity either producing, marketing, re selling, or distributing health care goods or services consumed by, or used on, patients or An entity that is owned or controlled by an entity that produces, markets, re sells, or distributes health care goods or services consumed by, or used on, patients. Exceptions are made for non profit or government organizations and non health care related companies. Q. Can the sponsor logo be used on the certificate of completion? A. No. Q. Can a commercial supporter require that only their clients be given credit for an activity? A. No. Q. Is paying for food considered to be commercial support? A. Yes. Q. The activity I am submitting is not receiving commercial support so how do I need to respond to the criterion? Could I just say not applicable? A. No. You should include a statement indicating, This activity is not receiving commercial support. Simply saying not applicable would not satisfy the criteria. Q. Our Oncology Nursing Society chapter often invites expert nurses who are on the speakers panel of drug manufacturers. What should we do to maintain compliance with ANCC COA criteria for disclosure and commercial support? A. The speaker must disclose the relationship on the combination Biographical Data & Conflict of Interest form, and you must inform learners either in print or by verbal announcement prior to the activity. You must also keep written documentation that verbal disclosure occurred. Slides and handouts must be free from company logos and advertising. According to criteria, presentations must give a balanced view of therapeutic options, and use of generic names of drugs is preferred; if trade names are used, trade names from several companies should be used. Q. I am trying to respond to the criterion related to commercial support. We are not holding exhibits or receiving money from pharmaceutical companies, therefore we are not receiving commercial support for the activity. However, the activity is being sponsored by another company. How do I respond to the criterion? A. You would respond first that there was no commercial support received for the activity. And secondly would indicate that yes, there was sponsorship received for the activity. If you are receiving funds, supplies or in kind services from an outside agency and that agency is not participating in the planning, developing, and implementing of the educational activity, then you are receiving sponsorship. This sponsorship must be acknowledged to learners and a written agreement is completed between the agencies. 61

62 Q. Our nurse planner is married to a man who works full time for a major pharmaceutical company. He owns stock and receives salary. When our nurse planner completes her disclosure, must we publish (disclose to the audience) this info for EVERY program we do of which she is a part or only those when this pharmaceutical company is financially supporting and/or exhibiting at? A. You will only need to disclose this information when it could cause or could cause the perception that a bias in the continuing education being planned or implemented. In other words, if the activity is related to a product or service of the pharmaceutical company, then this would need to be disclosed. An alternative might be that you train a second nurse planner who would direct the planning committees addressing the educational activities where there might be a relationship with the pharmaceutical company. Q: Must we limit the promotional activities of companies that are not considered commercial entities? A. Yes. Promotional activities should never occur within educational activities regardless of the nature of the company wishing to promote themselves or their product(s). Example #1: A speaker has written a book related to the topic that s/he is addressing in the presentation. Acknowledgement of the speaker's expertise in the area may be made but the speaker may NOT encourage the learners to buy the book in order to learn more' or for any reason. Additionally, if there is to be a 'book signing', it should NOT be mentioned before, during or subsequent to the educational activity and it should occur in an area OTHER THAN the education area. Example #2: A not for profit healthcare entity agrees to sponsor education. They wish to include an invitation to practice' at their hospital in the educational material provided to the learner. RECORD KEEPING While the not for profit healthcare entity does not meet the definition of "commercial entity", the scenario in question mixes educational activity with promotional activity. This is not allowed. The sponsor must be acknowledged but that acknowledgement cannot result in a promotion of the sponsor. Learners should not feel "pressured" or marketed to by the sponsor of the program or should not receive promotional information because they participated in a CNE activity. Q. Recordkeeping no longer requires participant addresses but does require "unique identifier information". What are examples of this identifier? A. Identifier information might be the last four digits of the participants social security number (never the full number, license number or credit card number), birth date OR address. Some organizations have a system that automatically generates a unique identifier number for a new learner. It is a way to track an individual participant that 62

63 conceals the identity of the participant from office staff, other participants, or others. Only the Nurse Planner or his/her designee has the key to identify which Unique Identifier Code matches with each participant. Q. Our MONA district does not have an office. Our CNE documents travel from one officer to the next officer at the end of the biennium. We don't have a system for record keeping. What can we do? A. All providers of CNE must have a system for record filing, storage, retrieval, and retention, and a system to ensure record security and confidentiality. It is important for your district to develop an appropriate record keeping system. Perhaps the district could purchase storage boxes and file folders to organize a filing system. The district should develop a written policy and procedure describing the filing system and rotation of the files. It is also important to maintain these records for at least six years. APPROVED PROVDIERS Q. My agency recently received provider approval. Several area nursing organizations have asked us to approve their programs for contact hours. Is this acceptable? A. No. An organization with provider approval can only issue contact hours for educational activities designed by that organization. Provider approval does not allow the Approved Provider to review applications for educational activities and award contact hours. Nor can an Approved Provider award contact hours for educational activities provided by the agency if no member of the Approved Provider Unit has participated on the planning committee. If contact hours are to be awarded for an educational activity, a nurse member of the Approved Provider must be on the planning committee. Key points for providers to remember are that Providers provide but not approve activities. Providers can only provide activities in which the Approved Provider s Primary Nurse Planner(s) assume(s) an active role in the entire process of planning, implementing, delivering and evaluating continuing nursing education activities (ANCC COA, 2012, p. 73). If an educational activity is offered by two or more organizations (i.e. co provided), the Approved Provider or organization awarded provider approval by MONA may grant contact hours for the co provided activity. However, the provider must have submitted a co provider policy within their provider application to MONA and that policy must be followed whenever co providing occurs. It is also imperative that the educational activity is planned and implemented with the direct involvement of at least one of the nurse members of the agency's Approved Provider Unit. Q. Must a member of the CE Unit in my agency be involved in all planning committees if we award contact hours? A. Yes. In order to award contact hours for educational activities provided by an Approved Provider Unit, the Nurse Planner(s) of the Unit must be involved in the planning communication or each planning committee meeting for each educational activity receiving contact hours. The individual must be an RN with a minimum of a 63

64 baccalaureate degree in nursing. However, planning may take place by telephone, mail, e mail, as well as face to face meetings. Q. Our agency offers workshops, seminars, and lecture series. We also offer learnerpaced activities. In our application for provider approval, can we submit examples of three on site educational activities? A. Since the 1996 criteria, there is a single educational design, even though provider paced and learner paced activities are planned and implemented differently. If the Approved Provider offers provider directed, provider paced and provider directed, learner paced learning activities, they should submit a sample of each type. Q. When submitting an Approved Provider application with three samples, it seems that the three samples have the same narrative. Is this appropriate? A. When submitting an application for provider approval, the provider should individualize each of the samples submitted. If the narrative for the educational activity is written generically, this may indicate to the reviewers that the provider does not fully understand concepts affecting educational design. The responses to the statements on the application should demonstrate the uniqueness of each individual educational activity. Q. Comments from the MONA reviewers on our last provider application indicated our evaluation of the overall provider program was weak. How can we enhance this aspect of our application? A. Under the current criteria, the emphasis is on continual quality improvement of the Approved Provider's activities and operations. A plan for evaluation indicates that the provider has a systematic method for evaluating its goals, operations, resources, and activities, involving the participation of faculty, planners, and learners. According to Phillips (1994), there are seven steps in developing an evaluation plan: 1) Define the purpose of evaluation; 2) Identify resources and limitations; 3) Decide what is to be evaluated and when; 4) Decide specifically what it is you want to know; 5) Decide how to do it; 6) Draft a plan; and 7) Review and test the plan. The information found in Chapter 10, Provider Approval Criteria (under Approved Provider Criterion 3, Quality Outcomes (QO), QO1) may be helpful in developing a stronger evaluation plan. Q. My agency has received provider approval through the Missouri Nurses Association. We are in the process of merging with another agency. How does this affect our approved provider status? A. The review of the application and the awarding of the Approved Provider status were effective for your agency prior to any merger. Approved Provider status does not transfer to the newly merged, created agency. If an organization wants to continue to have Approved Provider status within the newly formed organization, the MONA CE staff should be contacted for guidance regarding what the organization needs to do to remain an Approved Provider. 64

65 Q. When a hospital is approved, but is part of a larger organization system, can they offer programs for the entire system under their name? A. The Approved Provider can use their approved status only for those activities their provider unit plans, implements and evaluates. However, this provider can co provide with other hospitals (either within the hospital system or without). Q. May our agency submit a co provided sample as one of the three samples required in the provider application? A. Approved Provider applicants may submit co provided samples as long as the applicant is the primary provider of the educational activity. Q. Can a first time provider applicant submit a co provided activity as one of the three sample activities? A. No. Q. Please explain the new rule regarding the boundary for Approved Providers. A. An organization with a majority of CE activities targeted to nurses from states within their region (see map) OR from within the region where the activity is to be provided or a state contiguous to it. May apply to an approver to become an Approved Provider or may apply to ANCC to become an Accredited Provider, or may continue to apply for individual activity approval from an Accredited Approver. An organization with a majority of CE activities targeted to an audience of nurses from outside the states of their HHS region (see map below) or states contiguous to that region must apply to ANCC to become an Accredited Provider. Q. What is the reason for this rule? A. There have been incidences of providers being denied by one approver who then go to a series of other approvers until they find one that will approve their activity. These come to our attention through complaints from participants. It is therefore more efficient and protects the participants if ANCC reviews and accredits all of the providers reaching the larger audiences, so that they can be monitored more closely. 65

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67 6 CHAPTER STEPS IN DESIGNING CE ACTIVITIES Developing successful continuing nursing education (CNE) activities is facilitated when the planning process is well organized. Sample 6A illustrates the steps used to design CNE activities. Although the steps are listed sequentially, planners may find that several steps can be taken simultaneously. Step One: Identify the Need for a CNE Activity Assessment of nurses learning needs provides the nurse planner with objective data to guide the planning and development of a CNE activity. The nurse s learning needs must be assessed on an on going basis to guide the development of educational activities that support the target audiences identified and perceived learning needs as well as their professional growth. A variety of sources of information should be explored that can provide information about the learning needs of the target population. A needs assessment is a vital source of information. A survey of the target population is one way to assess CNE activity needs. Feedback from previous programs or activities may also provide input into CNE needs. Recommendations from accrediting agencies or professional groups may also be a source of CNE programming. The Provider Unit should monitor relevant nursing literature, examine current research findings applicable to nursing practice, and consider standards of practice in other parts of the country. If articles in the nursing practice journals are discussing use of minimum nursing data sets and the health care organization is not using this information, the agency may choose to offer an educational activity on this topic. An on going review of the literature can provide information on potential CNE programs. This information can be cross validated with surveys of the staff, or of the membership in the case of a district or other professional organization. Other sources of information regarding topics appropriate for CNE may include professional practice issues, health care concerns, or major health problems occurring locally or regionally. Quality assurance/ improvement recommendations may also serve as a basis for CNE activities. Step Two: Identify the Target Population It is important to determine the target population for the CNE activity. For CNE activities receiving MONA approval for contact hours, the target population must be registered nurses (RNs). However, it is appropriate for the target population to include other health care providers, as long as the goals and objectives of the CNE activity are designed to meet the needs of RNs. Planners of CNE should consider the educational level, the experience of potential participants, and the practice setting of nurses identified as the target population. An activity relevant to critical care may be very inappropriate for a group of nurses working in a long term geriatric setting. Similarly, an activity on new techniques to enhance bladder control may be appropriate 67

68 for nursing working in rehabilitation, but might not be appropriate for emergency department nurses. Consideration of the educational background of the target population is also important. A target population comprised primarily of advanced practice nurses has a different knowledge base than a group of new graduates working in hospital settings. If the population includes nurses with mixed educational and experiential backgrounds, the planners of CNE need to design the objectives, content and learning methods with this information in mind. Speakers will need to be aware of the characteristics of the target population so they may design their presentation appropriately. Step Three: Assemble a Planning Committee At this point, if not assembled earlier, a planning committee should be formed to assist in the development of the CNE activity. The planning committee should include members of the target population (e.g., someone who is going to use the information presented at the CNE activity/ a member of the group for which the educational activity has been designed). One or more of the members of the planning committee should be familiar with ANCC Accreditation Program criteria and qualified by education and/or experience to guide the program development and implementation of the activity (ANCC COA, 2011). The number of members of a planning committee is not mandated and will not affect the approval process; however, the size is important to ensure efficient development. If you are planning a large symposium or conference you want your planning committee to be enough to complete and assists with the tasks. The planning committee must include the Nurse Planner of the Approved Provider Unit (in the case of approved providers) or an RN with a minimum of a baccalaureate in nursing (in the case of providers of educational activities). Content "experts" can provide input into the level of objectives needed based on the target population. If the activity is planned for a multidisciplinary audience, representation from the other targeted disciplines should be present on the planning committee. As soon as the planning committee is formed, each member should be requested to complete 1) a bio form and 2) a conflict of interest form, so that eventually all record keeping requirements will be met. Written minutes of planning meetings or summaries of conference calls provide documentation of the planning process, and help planners stay on track. One of the most important practical tasks of the planners of a single activity is to establish at least a tentative date for the activity, and a timeline for accomplishing each of the following steps in order to meet the educational design criteria for Approved Providers and document the required records for an activity. The scope and complexity of the activity largely determines the length of the planning cycle; planning for a large multi day conference may begin more than a year in advance, while planning for a one day activity on a single topic may be accomplished over two or three months. 68

69 Step Four: Develop a Purpose(s) and Objectives When designing CNE activities, the process may be facilitated by developing an overall purpose and objectives. The purpose defines the overall learning goal. A purpose statement is like an umbrella, encompassing the entire activity. The purpose tells the prospective participant the general focus/goal of the CNE activity. The following are examples of purpose statements. This conference is designed to enhance nurses' knowledge about caring for individuals with a variety of genetic diseases. The purpose of this program is to increase the staff nurses' ability to incorporate research into nursing practice. Themes may be developed for CNE activities with multiple sessions. A theme is a unifying thread that ties together all of the sessions in a program. Each session in a program should reflect the overall theme of the educational activity. The following is an example of a theme statement. The theme of this program is research utilization in practice. For a recent advanced practice workshop co provided by the MONA, the overall purposes for the three day conferences were as follows: Purposes: Update APRN's clinical skills and knowledge applicable to advanced nursing practice. Present current and future trends which impact on advanced nursing practice. Facilitate networking with nurses in various specialties of advanced nursing practice. These purposes set the stage for the twenty clinical and concurrent sessions. The first two goals guided the selection of topics for the sessions. The exhibit area, breaks and luncheons provided the networking opportunities the program planners desired in this CNE activity. Objectives indicate the knowledge to be gained by the learner by attending the activity. Objectives must be written in behavioral terms and should describe what the nurse will know, do, or feel after attending the CNE activity. Ultimately, objectives guide the presenters in developing content for their presentations and serve as a basis for evaluation. The purpose, goals and objectives for the research conference might look like this: 69

70 Purpose: To increase the staff nurses' ability to incorporate research into clinical practice. Theme: Research utilization in practice. Objectives: By the end of the activity the nurse will: Describe how clinical nursing research can improve patient care. Discuss recent research applicable to care of patients with special needs. Discuss the role of the staff nurse in clinical nursing research. Describe ways staff nurses can facilitate utilization of clinical nursing research. For a program with many speakers that might extend over several days, a theme could be developed, and each day could well have a distinct purpose or several purposes. In shorter CNE activities, particularly 60 minute or one day activities, the educational activity should still have an overall purpose and objectives. Step Five: Develop the Content for the CE Activity Based on the objectives, the content for the CNE activity can be developed. The planning committee should determine what the learner must know or do in order to meet the objective. One way of developing the content is to elaborate on the primary objective by writing subobjectives or performance criteria. For example, if the MONA CE Approver Unit offered a program for CNE providers, one of the program's objectives and performance criteria might be as follows: 70

71 Objective: By the end of the program, the participant will be able to: 1. Demonstrate the steps of designing a continuing nursing educational activity. Performance criteria: The learner will be able to: 1. Identify the need for an activity. 2. Identify the target population. 3. Select members of a planning committee. 4. Develop the activity's purpose and objectives. 5. Develop the content for the activity. 6. Identify appropriate teaching and learning strategies congruent with the activity's objectives and content. 7. Select appropriate faculty/presenters. 8. Develop a time frame for the activity. 9. Plan the activity's evaluation and method for verifying participation in the activity. 10. Establish a budget for the activity. 11. Prepare the MONA application 12. Prepare a marketing plan. 13. Confirm final arrangements. The presenter/s can use the performance criteria to guide content development. Thus the learner gains knowledge from the content presented and will be able to meet the original objective: To demonstrate the steps of designing a CNE activity. The next step is deciding how this can best be accomplished; for example, each learner could do this individually, using a situation provided by the presenters, or the planning committee could design a small group activity where learners would participate in group work to design a CNE activity. Step Six: Identify Appropriate Teaching Strategies An educational activity can be presented in a variety of formats, including lecture, discussion, a question and answer session, small group activity, hands on practice, or learner paced methods using print, audiovisual or electronic delivery methods. It is important that the planning committee and speaker(s) identify the best format for the CNE activity being planned. The determination of the appropriate teaching strategy should take into consideration the needs of adult learners and be congruent with the objectives, content and target audience. Selection of the teaching strategy early in the planning process will help later when a site is chosen for the CNE activity. A large room with comfortable chairs can be used effectively for a lecture. However, a discussion format may work best in a small room with tables and chairs in a circular arrangement. If the learner is expected to complete or demonstrate a skill the provider must ensure adequate time and space are provided to accommodate this strategy. The potential use of audiovisual materials needs to be considered by CNE activity planners. The room size and teaching method may impact on the type of media used in the activity. Audiovisual materials must be clearly visible to all participants, and if a computer presentation 71

72 SAMPLE 6A Steps in Designing CE Activities Steps in Designing CNE Activities Identify the Need for a CE Activity Identify the Target Audience Assemble a Planning Committee Develop Objectives Develop the Content for the CE Activity Identify Appropriate Teaching Strategies Select the Faculty Develop the Time Frame for the CE Activity Plan Early for Evaluation Determine a Budget for the CE Activity Make Arrangements for Facilities Prepare the Activity Documentation Market the CE Activity Final Arrangements After the CE Activity is Over 72

73 projector is going to be used, it will be important to adjust the lighting of the room to best project the computer image. Step Seven: Select the Faculty Selection of the presenter is a very important role of the planning committee. The presenter should be selected because of their knowledge of the topic and teaching skills. It would be difficult for a person to present a talk on quality assurance if the individual had little knowledge about the topic. An advanced practice nurse who has a successful collaborative practice with a physician might be a good speaker to address "Issues Affecting Collaborative Practice." Besides knowledge in the content area, it is important to select speakers who can effectively share their knowledge with others. A person might be very knowledgeable, but may have ineffective presentation skills. A planning committee needs to consider the risk of selecting a speaker who mumbles, rambles, or tends to drift away from the objectives. The best recommendation is often from a colleague or planning committee member who has heard the speaker at another venue. As soon as the presenters are selected, the presenters should be given the purpose and objectives of the CNE activity and be apprised of the specific objectives they are to address. The planning committee should share information with the presenter regarding target audience, the type of room where the activity will be offered, and the audiovisual equipment that will be available. This information may help the speaker decide which teaching learning strategy and necessary AV resources should be utilized. Along with a bio form and Conflict of interest form, a letter of agreement detailing the date, time, place, and objectives to be addressed, plus agreed upon honorarium, per diem and lodging, should be sent to each speaker, providing a deadline by which the speaker must return the bio form, Conflict of Interest form, AV requests, content outline or description, and any handouts to be duplicated. Step Eight: Develop the Time Frame for the CNE Activity Once the purpose, objectives and presenters have been identified, it is possible to develop the time frame for the CNE activity. Be sure to allow time for registration of participants at the beginning of the activity. Plan for some time at the beginning of the activity to welcome participants and to cover housekeeping tasks, such as announcing times for breaks, any changes in the agenda, and the information that ANCC Accreditation Program criteria require to be disclosed prior to the activity, either in printed materials or by verbal announcement: Disclosures always required 1) Purpose and/or educational objectives, 2) Successful completion requirements, and 3) Presence or absence of conflict of interest for planners, presenters faculty, authors, and content reviewers. Disclosures required, if applicable 1) Commercial support, 2) Sponsorship, 3) Non Endorsement of products, and 4) Expiration of Enduring Materials (ANCC, 2011). 73

74 In planning the timetable, be sure to allow enough time for each of the speakers to cover the objectives. Too often, given a short amount of time and several objectives to cover, the speaker may only be able to cover a topic superficially. If the intent of the activity is to provide in depth information about a topic, allow sufficient time for the speaker to develop the content and accomplish the objectives. Step Nine: Plan Early for Evaluation The evaluation presented to the participants at the conclusion of the CNE activity can be developed once the objectives and speakers have been identified. If using a self report type of evaluation tool, be sure to allow the participants an opportunity to indicate whether each of the objectives of the CNE activity has been met and to evaluate the effectiveness of each of the speakers individually. For some educational activities, a test of knowledge or demonstration of a psychomotor or cognitive skill may be the most appropriate way to evaluate whether the objectives have been met. Learner satisfaction is important to providers or CNE, and the evaluation tool may also include appraisal of the physical facilities, meals or breaks, and location. If the CNE activity is relatively short and there is only one speaker, one evaluation may be adequate. However, if the activity is a program or conference with a keynote speaker and several speakers in concurrent sessions, one evaluation may be needed for the overall conference and keynote speaker, while individual evaluations will be needed for the concurrent sessions. The completion and submission of a session evaluation form is often required to receive contact hours for that session in large conferences where participants have the option of attending a variable number of sessions. In these situations, providers have developed many formats that can be quickly and easily tallied electronically to add up 1) each participant's contact hours 2) responses to the objectives for each session, 3) responses to each presenter's effectiveness, and 4) responses dealing with satisfaction with the overall conference. Step Ten: Determine a Budget for the CE Activity Use a budget planning sheet to estimate the cost of the CNE activity. Costs will include facilities, meals, marketing strategies, honoraria for speakers, faculty travel and lodging, duplication of materials, cost of name tags, speaker ribbons, folders and other items needed to orchestrate the CNE activity. If your organization requires reimbursement for indirect costs, such as staff time or general overhead, be sure to include that in your budget planning. The costs provide the basis for calculating the fees that participants will be charged, and for determining how many enrollees are necessary to, at a minimum, cover all costs. Although cancellation of an activity is disappointing to planners and registered participants, it may be necessary to avoid a large financial loss to the organization providing the activity. A cancellation should lead to careful evaluation and analysis of all the factors that may have contributed to a lack of response by the target audience, and the Approved Provider Unit or activity provider may be strengthened as a result. 74

75 If the activity will have commercial support or sponsorship, you must have a written agreement with each commercial entity and/or sponsor that provides details of the support and is signed by both the provider's or Approved Provider Unit's representative, and that of the commercial entity or sponsor. Financial support can in no way influence the independence of educational content. Review the ANCC s Content Integrity Standards for Industry Support in Continuing Nursing Educational Activities found in Appendix C very carefully to ensure compliance. Step Eleven: Make Arrangements for Facilities Early in CNE activity planning it is important to confirm the location of the CNE activity and make arrangements for meals, breaks, registration tables, needed audiovisual equipment, and other items related to the site of the CNE activity. Meals and breaks also need to be planned. Someone should be assigned to handle communications with personnel at the site of the CNE activity. Someone from the agency providing the activity is often needed to communicate with hotel/venue staff about adjustments in room temperature or resolve audiovisual problems that might occur. If there are exhibits by commercial entities, they must be in a location separate from where the educational content will be presented, so space needs may be increased. "Exhibits, promotion and sales must be separated from the educational activity" (ANCC, 2011). Breaks and meal function set ups can feature the names of sponsors or commercial entities/vendors only if they are served outside the location where educational content will be presented. Step Twelve: Prepare the MONA Application Once the preceding steps have been accomplished, it is possible to prepare an application for MONA approval to award contact hours for the CNE activity. It is important to remember that the application is the only information the CE Approver Unit will have about the CNE activity and your ability to provide a quality CNE activity. The CE review team assumes that your application is representative of your best work. If an agency plans to offer several CNE activities throughout the year, it may be cost effective to apply for Provider Approval. Provider Approval denotes recognition of the agency s capacity to award contact hours for continuing education activities planned, implemented, and evaluated by the provider. Provider approval extends over a three year period. Provider approval is the best approval mechanism for those agencies or providers who will be offering a number of CNE activities over a three year period. The planning committee can obtain the guidelines, application, and evaluation criteria from the Missouri Nurses Association. Information on how to prepare an application is found throughout this manual. The information is designed to assist new and renewing Approved Provider applicants in preparing a successful application. Allow enough time to prepare your application so that it can be sent and postmarked by the established deadlines: 45 days prior to an individual educational activity, and, for 75

76 Approved Providers, by November 1 for the January to December cycle or by May 1 for the July to June cycle. Late applications will not be reviewed. Step Thirteen: Market the CE Activity At least 14 to 16 weeks prior to the CNE activity, design a brochure or flyer to aid in marketing the CNE activity. Explore a variety of printing services that might be available to assist the committee. A well designed brochure can attract the interest of potential participants. Desktop publishing capabilities are readily available on personal computers and can be used to develop attractive brochures. Use of color in the ink or paper can help enhance the attractiveness of a brochure. Approved Providers of CNE must use the following statement on the certificate of attendance, promotional materials and on all written materials related to the educational activities they offer: (Name of Approved Provider) is an approved provider of continuing nursing education by the Missouri Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. It is inappropriate to state on the brochure that MONA approval has been requested or that the activity and/or contact hours are approved by MONA. Approved Providers should always use the provider approval statement they were issued after approval was achieved. This statement should be included on all communications related to continuing nursing education activities where contact hours will be awarded. Step Fourteen: Final Arrangements Confirm out of town presenters' travel plans and ensure that a planner or staff member will provide hospitality, such as transportation from the airport to lodging, and transportation to the conference site. Arrange for registration activities. Make signs, duplicate handouts and prepare packets, write nametags, and prepare a list of those pre registered. Certificates of attendance should also be prepared in advance. At registration, sign in participants and hand out folders, packets or other materials. If there are give away items or handout materials furnished by commercial entities with their logos or advertisements, those must be picked up by participants in an area separate from the registration area. Determine when the evaluations will be handed out and how they will be collected at the end of the activity or program. Distribute certificates of attendance to those present at the conclusion of the CNE activity. Step Fifteen: After the CNE Activity is Over Summarize the evaluations at the conclusion of the CNE activity. Be sure to send out thank you notes to the presenters and provide evaluation information to each of the speakers. The evaluations can also be used to help plan future CNE activities. Ensure that the activity file contains all elements required by ANCC/MONA Accreditation 76

77 Program criteria, and store it in a safe, confidential manner. Complete the paper or electronic record of each participant and their number of contact hours earned, so that the information can be retrieved if a duplicate certificate is needed. Pay the expenses, and finally, review evaluation and other data with the planning committee. Minutes or a summary of a conference call are helpful when you begin the planning process again, and help the provider or approved provider continually improve the quality of activities by ensuring that evaluation data are fully utilized. 77

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79 CHAPTER 7 PREPARING THE PROVIDER APPLICATION & PEER REVIEW PROCESS The Approved Provider application and supporting documentation along with the appropriate review fee must be submitted by November 1st (for a January December calendar) or May 1st (for a July June calendar). Approved Provider applications received later than 10 days after the deadline will not be accepted for that cycle, without prior arrangements with the MONA Office. Provider approval is granted for a three year period. Organizations may seek provider approval as a single agency or system provider. SINGLE AGENCY PROVIDER: A single agency provider may be part of a larger corporate system. However, the single agency/hospital is only providing continuing education for the agency/hospital named in the application. A single agency/hospital provider does not act as the provider of continuing education for multiple agencies/hospitals. SYSTEM PROVIDER: A system provider is a multi agency/hospital health care system providing health care services through a number of agencies/hospitals. The system is a corporation with a central administration providing services to all of the agencies/hospitals within the corporate structure. A system provider has in place at the corporate level a centralized staff development and/or continuing education department for planning and implementing a system wide continuing education program. All agencies/hospitals in system must be named in application and remain unchanged throughout approval period. The Provider Approval Manual, 8th ed. provides step by step instructions on completing the Approved Provider application as well a detailed chapter on the educational design process and the planning of activities to assist Approved Providers with adherence to the accreditation guidelines during their approval period. ELECTRONIC SUBMISSIONS: Approved Provider applications may be completed and submitted electronically; however, if submitting the application electronically, the application and supporting documentation must be collated into one Word or Adobe.pdf file, not to exceed 5 MB in size, and each of the sample activities into separate Word or Adobe pdf files (a total of four separate Word or Adobe.pdf files). Electronic applications must be submitted on a flash drive to the MONA office by the deadlines listed above. HARD COPY/PAPER SUBMISSIONS: If submitting hard copies of the Approved Provider application for review, a total of three (3) copies of the application and all supporting documentation must be submitted by the deadlines listed above. Each of the three packets must be a complete Approved Provider application, containing the application checklist, completed application, supporting documentation, and documentation for three sample activities. 79

80 Over the years, the CE Approver Unit Committee members have reviewed hundreds of applications and have identified those characteristics that facilitate and those that hinder the review process. From these observations, the CE Approver Unit Committee has developed the following suggestions for preparing an application that will facilitate the review process. Complete the application in full by responding to each criterion listed. Do not leave any criterion blank. Blank responses will not be accepted. The reviewers are evaluating the overall strength of the Approved Provider Unit and their educational design process. The review team can do this only with the information provided in the application. Applications must be typed, in English and either bound in secure manner, i.e. stapled, secured with a clip or placed in a binder or folder if copies are to be mailed OR collated together as one file (Word or Adobe.pdf) not to exceed 5MB in size if submitting electronically. It is very important that the application be organized in a manner to facilitate the review process. Be sure all documentation is clearly reproduced. Handwritten information and poorly reproduced copies are more difficult to read. The appearance and organization of the application will have an impact on the reviewer. An application that appears "thrown together" gives a negative impression. Misspelled words, incorrect use of grammar, and incomplete sentences all portray a negative image of the provider. Follow the order of the guidelines and criteria when preparing the application. When the information in the application does not correspond with the numbering, guidelines and criteria, the reviewers spend an incredible amount of time searching through the information trying to decide which criterion the information is addressing. This slows the review process and increases the chance of reviewer oversight of information. Page numbering the entire document is also required. On page 7 of the application packet, you will find an Application Checklist that must be completed and submitted with the application packet. This document asks applicants to provide the page number where the response to each criterion can be located. However, parenthetical references are also crucial. When referencing a piece of supporting documentation in the narrative, the applicant must provide a directional reference to where that evidence can be located and a corresponding page number. An example of a directional reference in a narrative is as follows, Please see the sample certificate of attendance in Appendix A, page 28. The entire application is numbered from beginning to end and supporting documents such as a sample certificate can be located easily, by page number. Large provider applications are difficult to navigate through. Page numbering and completion of the Application Checklist is a must to ensure the reviewers don t miss any important elements of the application. Sample forms, figures and tools have been developed to assist applicants and are available in Appendix B of the Provider Approval Manual, 8th ed. and on the MONA website at MONA does not require that applicants use the sample forms; however, any forms designed must contain the same, required information if they are to be used and submitted with the application to ensure the accreditation criteria are met. 80

81 PEER REVIEW PROCESS The review process begins with the determination of the applicant s eligibility for approval. Applicants seeking Provider Approval must complete and submit an intent to apply form along with the $ intent to apply fee to the MONA Office six (6) months prior to the application cycle deadline e.g. December 1st for July cycle; June 1st for the January cycle. Applicants must meet eligibility requirements to proceed forward with the full Provider Application. The intentto apply fee is non refundable if the organization submits an intent to apply form and decides not to proceed with the submission of the full Approved Provider application. The intent toapply fee will be credited toward the provider application review fee for organizations that proceed forward with the full Provider Application. The Nurse Peer Review Leader reviews the intent to apply forms received for each approval cycle and determines the applicant s eligibility. Eligible applicants will receive notification that they can proceed with submission of the full provider application and are provided with a deadline. As mentioned earlier, Approved Provider applications may be completed and submitted electronically and in hard copy. Applicants have flexibility in determining what method works best for their organization; however, electronic submissions are encouraged. Also new this year is the Application Checklist within the application packet. This checklist provides a listing of elements that must be addressed/included in the Approved Provider application packet(s). Applicants will place a check in the box indicating that the item was addressed and then provide the corresponding page number where the criterion was addressed within the submission. A copy of this Application Checklist including page numbers must be included in the final application submission. The application review process begins when the application is received in the MONA office. MONA staff conducts a quantitative review of the application, scanning the application for completeness and identifying any missing information. The purpose of this review is to identify gaps in the material submitted. Review by the staff does not assure subsequent passage of the application by the CE Approver Unit subcommittee. Next, the application is sent to a subcommittee of CE Approver Unit Committee members/nurse Peer Reviewers. Each subcommittee member independently reviews the application utilizing the MONA educational design criteria for approval. Each response to the criteria is thoroughly reviewed and rated. Review sheets are sent by the subcommittee members to the subcommittee chair who summarizes the subcommittee's decision. When the subcommittee's decision is received by the MONA office, an and/or letter is sent to the applicant, giving the subcommittee's decision and sharing any comments made by the subcommittee for strengthening the educational design of the proposed offering(s) or the administrative structure of the proposed Approved Provider. If minor areas of improvement are noted during the review process, the applicant is given a period of time to respond and provide additional information to show adherence to the criteria. Once any additional information requested is received and approved by the review committee, the application is approved. A letter is then sent to the application notifying them that their application has been approved. 81

82 Sixty days are required to process each Approved Provider application. Although the time may seem excessive to the applicant, many variables impact on the review process. One unknown is the length of time the application, review sheets, and letters are in the e/mail. A request for additional information also delays the application process. The time it takes MONA staff, subcommittee members, and subcommittee chair to process each activity is also a variable. Since all of the committee members are volunteers, the committee must apportion adequate time to review the applications. They often must fit the review process in with other professional responsibilities. Complex, incomplete, or poorly written applications tend to be more time consuming and require a longer time to review than a well prepared application. Please feel free to contact the MONA Office if you have any questions about the application submission and/or peer review process. 82

83 8 CHAPTER EDUCATIONAL DESIGN PROCESS This chapter outlines the process of developing and/or evaluating individual educational activities according to ANCC/MONA Accreditation Program criteria. The educational design expectations described in this chapter and applicable at the individual activity level are fundamental to high quality continuing nursing education (CNE). Accordingly, applicants must ensure that these expectations are met and that the ANCC/MONA Accreditation criteria for are applied in such a manner as to ensure the applicant s Approved Provider Unit provides educational activities that meet these criteria. ANCC s/mona s Accreditation criteria specify a comprehensive set of educational design criteria to ensure that educational activities are effectively planned, implemented, and evaluated according to educational standards and adult learning principles. CNE involves systematic professional learning experiences designed to augment the knowledge, skills, and attitudes of nurses, and therefore enrich nurses contributions to quality healthcare... (ANA, 2010, p. 43). The knowledge, skills, or attitudes gained from CNE activities can be applied regardless of the activity participant s employer. In contrast, staff development activities are typically designed to enhance performance in participants current job roles and are based on a specific facilities/organization s policies and procedures, equipment, and resources. When staff development learning activities convey new content knowledge that would be transferable to other job settings, the organization may be able to award contact hours. Some in service programs, based on their content, may include new, transferable knowledge. Staff development departments may offer both CNE activities and in service activities. For instance, orientation programs are typically facility specific or organization specific. Contact hours may not be awarded for the employer specific content. Contact hours may not be awarded for review or refresher courses that focus on functioning in a particular facility or reinforcing basic knowledge. However, contact hours may be awarded for refresher courses that provide nurses reentering the job market with advanced knowledge or a new skill set required to function in the role as an RN. Types of activities: Provider directed, provider paced: The provider controls all aspects of the learning activity. The provider determines the learning objectives based on a needs assessment, the content of the learning activity, the method by which it is presented, and evaluation methods. (Examples include live activities and live Webinars.) Provider directed, learner paced: The provider controls the content of the learning activity, including the learning objectives based on a needs assessment, the content of the learning activity, the method by which it is presented, and the evaluation methods. The learner determines the pace at which the learner engages in the learning activity. (Examples include print articles, online courses, e books, and self learning modules/independent studies.) A 83

84 Educational activities must meet the following guidelines in order to be eligible for awarding of continuing education credit (contact hours): Content must be beyond basic knowledge Content must be generalizable regardless of employer of the nurse Content must enhance professional development or performance of the nurse Determination of whether to award continuing education credit may be dependent on the learner, for example: If the course is the same course repeated every year for nurses, the nurse has taken the course previously, and no new content is included, it should not be classified as continuing education If the class is being offered to a new nurse and the content is new and is generalizable knowledge, it can be classified as continuing education If the class is being repeated to nurses who have taken the course previously and a portion is new and updated information, the new information can be classified as continuing education Content must be: Evidence based or based on the best available evidence Presented without promotion or bias An educational activity may include content that is eligible for continuing education credit and content that is not eligible for continuing education credit. In that circumstance, continuing education credit may be awarded for the content that is eligible. A decision tree has been developed to assist providers with the process of determining continuing nursing education and awarding of contact hours. That decision tree can be found in Appendix B. The fundamental basis for all CNE activities is the educational design process. This chapter outlines the required components of an individual education activity in accordance with ANCC/MONA accreditation criteria. Applicants for Approved Provider status are required to have an established and implemented method (i.e. policies and procedures) for defining how the Approved Provider operates, to demonstrate how they will be adhering to the requirements and how they will ensure adherence for the three year approval period. These Policies & Procedures do not need to be submitted with the application; however, should be maintained by the agency or organization requesting provider approval and subject to review by the CE Approver Unit. Assessment of Learner Needs CNE activities are developed in response to, and with consideration for, the unique educational needs of the target audience. Each educational activity is based on a needs assessment that may be conducted using a variety of methods that may include but are not limited to: Surveying stakeholders, target audience members, subject matter experts, or similar Requesting input from stakeholders such as learners, managers, or subject matter experts 84

85 Reviewing quality studies and/or performance improvement activities to identify opportunities for improvement Reviewing evaluations of previous educational activities Reviewing trends in literature, law, and healthcare Sources of supporting evidence for needs assessment data may include but are not limited to: Annual employee survey data Literature review Outcome data Survey results from stakeholders Quality data Requests (via phone, in person, or by e mail) Written evaluation summary requests If an evaluation of a previous educational activity asks "What future continuing education activities are needed?" then suggestions from the responses can help identify a need for the current activity. Nurses may state their needs or interest in a program through staff meetings or informal conversations. Quality assurance audits may show a need for an activity. The nature and number of incident reports in an agency may reveal problems that might be addressed by a continuing education activity. Changes in the health care problems in the hospital, community, or region may indicate a need for a continuing education activity. If new technology such as gene therapy or recombinant DNA drug treatment is being implemented, it may be important to educate the nursing staff regarding these new treatment trends. Regulatory agencies and professional organizations may also identify learning needs of nurses. If a needs survey is carried out, the provider of the education activity should indicate when the needs assessment was completed, how many nurses were surveyed, how the assessment was distributed, and how many nurses responded. The results of the survey should be summarized. Whatever the needs assessment methodology, it is important for the provider to show there is a need for the target population to learn more about the topic to be presented. If there is no need, there is no reason to present the educational activity. When educational activities are planned that are multidisciplinary in nature, the provider should identify the common knowledge of each of the groups attending the activity. Often, the core of information provided at an educational activity can be used by the various disciplines attending in various ways. Providers should be aware of the knowledge base of the individuals attending the educational activity. Nurses graduating from today's educational programs often have quite different knowledge and skills than graduates ten or twenty years ago. Providers should take into consideration the differences in the participants' knowledge base and experience when planning CNE activities. The needs assessment can also identify unique educational needs which can be the rationale for changes made within the Unit. For instance, the reason for choosing provider directed, learner paced rather than a provider directed, provider paced program, for providing an 85

86 activity over several weeks after work instead of an all day seminar, or for an activity provided at a conference center rather than at the work site, or vice versa. Population centers, highway access, and facility availability are all considerations in responding to unique educational needs. The time the program is scheduled can also reflect responsiveness to unique educational needs. A program scheduled from 5:00 a.m. to 9:00 a.m. may have a limited audience. However, the time may be very appropriate if the program is designed as an "EARLY BIRD" conference for the night shift that works from 11:00 p.m. to 7:00 a.m. If a program is scheduled for a morning and afternoon, the starting time should take into consideration whether participants will be traveling to the educational activity the night before or the morning of the activity. A starting time between 8:30 and 9:00 a.m., rather than 7:30 am would better meet the needs of those individuals traveling to the site in the morning. On the other hand, the needs assessment may show that the target audience members prefer to acquire knowledge and skills through a learner paced activity rather than through an activity that requires them to take time from their practice and travel to a site where the provider has chosen the scheduling and location for an educational activity. Assessment data is evaluated by the Nurse Planner and Planning Committee and is used to validate the need for each educational activity. Assessment data is used to identify and validate a gap in knowledge, skills, or practice that the educational activity is designed to improve or meet. Data is then used to formulate the objectives for the educational activity. The purpose and objectives address current needs of the learners in the target audience related to their practice or professional development. The faculty/presenters/authors, if applicable, work with the Nurse Planner and Planning Committee to develop objectives, content, and teaching methods for the target audience of nurses, including advanced practice and specialty nurses. Planning Educational Activities Planning Committees must have a minimum of one Nurse Planner and one other planner to plan each educational activity. It is the Primary Nurse Planner s responsibility to ensure that a qualified Nurse Planner is actively involved in all aspects of planning, implementation, and evaluation of each CNE activity. This Nurse Planner is knowledgeable about the CNE process and is responsible for adherence to the ANCC/MONA Accreditation criteria. One planner also needs to have appropriate subject matter expertise for the educational activity being offered. The process of how an activity is planned, organized and provided ensures the delivery of highquality activities and the overall success of the activity. The content, knowledge, and skills needed to ensure the delivery of high quality activities is the responsibility of the Approved Provider Unit. The Primary Nurse Planner must document the expertise and the role of each person involved in the planning of an educational activity. The Planning Committee will examine the education and experience of the planners for appropriate expertise. The information should show how the committee member contributes to the Planning Committee. A committee member may have some content experience or experience planning programs. For example, a group of diabetic nurse educators may want to plan an activity focusing on nursing care of diabetic patients and new therapeutic interventions. At least one of the planning committee members should have previous experience in planning 86

87 educational activities. That activity might have been a continuing education program, an inservice program, or previous programming activities with the group of diabetic educators. While formal education or experience in nursing education is not critical, it is desirable to have planners who are involved in nursing education since they can be a valuable resource in developing the educational design of the program. One or more members of the planning committee should have some knowledge about caring for diabetic patients. The Nurse Planner is responsible for ensuring completion and review of Biographical Data/Conflict of Interest forms by each Planning Committee member, each faculty/presenter/author and each content expert to ensure appropriate qualifications and evaluation of actual or potential bias. Faculty/presenters/authors must have documented qualifications that demonstrate their education and/or experience in the content area they are developing or presenting. Expertise in subject matter may be evaluated based on characteristics such as education, professional achievements and credentials, work experience, honors, awards, professional publications, or similar. The qualifications must address how the individual is knowledgeable about the topic and how the individual gained that expertise. Please remember the following two elements related to the biographical data/conflict of interest form: The Nurse Planner is responsible for reviewing each biographical data/conflict of interest form submitted to ensure proper completion, qualifications, and evaluation of actual or potential relevant relationships to impart bias, and signing the bottom of each form. The Nurse Planner must have another individual who is involved in the planning review and sign off on their biographical data/conflict of interest form rather than signing and co signing their own form. The MONA CE Approver Unit recommends the MONA Combination Biographical Data and Conflict of Interest Form (found in Appendix B) or another concise form to obtain and present the required information so that reviewers are not required to make a subjective judgment regarding expertise from many pages of accomplishments that may be unrelated to the educational activity. If the MONA form is not utilized, the Nurse Planner must ensure that the form used contains all of the required, pertinent information requested on the MONA developed form, including a signature line for the Nurse Planner to show that the form has been reviewed and approved. The review committee is looking at the knowledge and expertise the committee members have for this particular educational activity. The Planning Committee, during the planning process, may also identify an individual(s) who function as content reviewer(s). The purpose of a content reviewer is to evaluate an educational activity during the planning process or after it has been planned but prior to delivery to learners, for quality of content, potential bias, and any other aspects of the activity that may require evaluation. Content reviewers must also complete Biographical/Conflict of Interest forms that are reviewed by the Nurse Planner. The Nurse Planner is responsible for evaluating actual or potential conflicts of interest and applying the resolution process to an actual or potential conflict of interest, if present. 87

88 One planner needs to have appropriate subject matter expertise for the educational activity being offered. If additional individuals, such as faculty, presenters, or authors, will be creating or delivering content for the educational activity, Planning Committee members must identify the needed qualifications of the individuals chosen. The qualifications identified for faculty/presenters/authors for the educational offering may include but are not limited to: Content expertise Demonstrated comfort with teaching methodology (e.g., Web based) Presentation skills Familiarity with target audience During the planning phase, the Planning Committee is responsible for determining how participants will successfully complete the learning activity. The committee also evaluates whether the activity has or will have sponsorship or commercial support and, if so, how content integrity will be maintained, including what/how precautions should be taken to prevent bias in the educational content, and the methods that will be used to ensure full disclosure to activity participants. When non nurses are a part of the activity, it is important to ensure that there is a mechanism for relating the information to nursing practice. A nurse member of the planning committee can be assigned to work with the non nurse presenter to ensure a relationship between the content presented and the role of the nurse. At the educational activity, an RN moderator or session leader can tie together the content presented with the role of the RN. Periodically the MONA CE Approver Unit reviewers have noticed that LPNs are listed as faculty/presenters/ authors in educational activities for registered nurses. It must be clear to the reviewers what knowledge or expertise the LPN has that is not a part of the knowledge of RNs. Even though an LPN is working in a diabetic clinic where new diagnostic tests are being used, she/he may not be the most appropriate person to address this topic at an educational activity where RNs are the primary target audience. The content and methodological expertise, if relevant, of the faculty/presenters/authors must be documented with the MONA combination biographical data and conflict of interest form that summarizes qualifications to present/develop the particular content. Design Principles The educational design process incorporates measurable educational objectives, best available evidence, and appropriate teaching methods. Once a gap in knowledge, skills, and/or practice has been identified through the needs assessment findings, thereby validating the need for the educational activity, the purpose can be developed. Gaps are identified to indicate the difference between where learners currently are in their knowledge, skill, and/or practice and where they need to be in order to achieve the desired outcome. Needs assessment and gap analysis are used widely in both educational and practice venues to support the value of an educational initiative. Criteria require that providers identify the target audience for each proposed learning activity and document evidence of the gap that 88

89 exists prior to the educational activity. This also provides the foundation for determining and planning to measure the outcomes of the education. The purpose should be written as an outcome statement related to the learner at the conclusion of the activity (i.e., The purpose of this activity is to enable the learner to... ). The purpose(s) are statement(s) of intent that describe how this activity will enrich the nurse's contributions to quality health care and his or her pursuit of professional career goals. Activities intended to assist the participant to acquire, maintain, and/or increase the level of competence in fulfilling his or her assigned responsibilities specific to the expectations of the employer are considered in service education or orientation and do not qualify as continuing education. The purpose statement reflects the overall reason a particular educational activity is offered. Purpose statements arise from the needs of the target audience. If the needs assessment has indicated that the nurses desire information about new therapeutic interventions being used with diabetic patients, the purpose might be to "increase the nurses' knowledge about current treatment interventions in the care of diabetics." Next are educational objectives, which are derived from the overall purpose of the activity. Educational objectives are written statements that describe learner oriented outcomes that may be expected as a result of participation in the educational activity. These statements describe knowledge, skills, and/or practice changes that should occur upon successful completion of the educational activity. Specific objectives for the learning activity are developed collaboratively by the planners and faculty/presenters/authors (if applicable) and must relate to the purpose of the activity. It is critical that the objectives provide the structure for the activity. Learner oriented outcomes are expressed in measurable terms, identify observable actions, and specify one action or outcome per objective. The number of objectives should be sufficient to accomplish the intended purpose of the activity. Each objective should have one measurable action verb and specify what the learner will know or do once the objective has been completed (the outcome of attaining the objective). For an educational activity lasting 8 hours or less, with a single focus and purpose, it is appropriate to have objectives that flow from the purpose and reflect the learner s progression through the activity. For an educational activity lasting more than 8 hours, or with multiple tracks or purposes, objectives should be specific to each session in that track. Objectives should be written in cognitive, affective, or psychomotor terms. Verbs used to describe learner behavior are action verbs and measurable. Using the phrase "By the end of the educational activity, the participant will be able to..." can help the developers of the objectives to write appropriate statements. While there are no rules for the number of objectives required per session or program, thoughtful consideration should be given by the planners to ensure that the number of objectives reflects appropriately the purpose of the program and addresses the knowledge gap identified. Content for the educational activity must be congruent with each objective. Descriptions of content should not be a restatement of the objectives. Outline or briefly summarize the content to support/accomplish the stated objectives. The content area column on the educational planning tool must include enough information to demonstrate how the objective will be met. Content should be selected based on the most current available evidence. 89

90 Documentation should support quality of evidence chosen for content. Examples include but are not limited to evidence based practice, literature/peer reviewed journals, clinical guidelines, best practices, and content experts/expert opinion. Following development of objectives and selection of content, teaching learning strategies are determined. The methods, strategies, and materials to be used by faculty/presenters/authors to cover each educational objective are identified. These must be congruent with both objectives and content. Faculty/presenters/authors participate in planning, and there is documentation of involvement in the planning of their own presentations. An active role in planning a presentation can range from development of objectives, content outline, or teaching methods to providing input in these areas. Likewise, the presentation and teaching/learning materials can be prepared by the faculty/presenter/author or prepared by the planners with input from the faculty /presenter/author. When planners are centralized and faculty/presenters/authors are in various locations, planning may include options for learners to achieve the objectives and the presenter may select from those options for the presentation. In most situations, the faculty/presenters/authors are responsible for developing the content of the presentation and choosing appropriate audiovisual materials, or for authoring the text and developing delivery methods for print, electronic or other forms of learner paced methods. In order for the presenter to do this, he or she would need to know 1) the purpose of the activity 2) the target audience 3) the desired outcome 4) the objectives to be achieved, and 5) the time allotted to the presentation, or delivery method selected by planners. The presenter/faculty may also participate in developing evaluation criteria to measure the effectiveness of the presentation. The results of the evaluation are important since the information provides feedback that can be used when planning future presentations. There are situations when one objective might be covered by more than one presenter. For example, if one speaker is discussing how advances in biotechnology impact on the care of diabetics, another presenter later in the program may also cover content that could meet this objective. In this case, list the objective and content for each speaker. Even though the objective may be listed more than once, the content would be specific for each speaker. Sample 8A provides a sample showing the objectives, content, time frame, faculty/presenters/authors and teaching methods for an educational activity. Sample 8B provides a sample narrative description of the purpose, objectives and related content. 90

91 SAMPLE 8A Objectives The participant will: EDUCATIONAL PLANNING TOOL Hypertensive Disorders in Pregnancy Content (topics) Time Frame Faculty/Presenter Teaching Method 1. List the criteria for diagnosis of hypertensive disease in pregnancy A. Hypertension in pregnancy 1. Diagnosing hypertension (1) 2. Pathophysiology (2) 3. Risk factors 4. Prevention strategies 70 minutes Barb Smith lecture PowerPoint presentation case studies 2. Describe the pathophysiology of hypertensive disease in pregnancy. B. Management of mother and baby 1. Hypertensive mother a. nursing assessment b. impact on body systems (3) 70 minutes hands on skills or return demo interactive exercise 3. Distinguish between normal physiological adaptations of pregnancy and pathophysiologic symptoms of preeclampsia. c. nursing interventions (4) d. medical interventions other (describe): 4. Discuss nursing interventions for the pregnant hypertensive patient. 2. Infant a. nursing assessments b. impact on infant physiology (5) 5. Describe the impact of gestational hypertension on the fetus. C. Q/A 10 minutes 91

92 SAMPLE 8B In 2012, several oncology nurses noted that staff oncologists were implementing new or revised orders for patients with breast, colon and rectal cancer. Investigation by the clinical educator showed that the physicians were basing the new orders on recent updates to National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines. The clinical educator polled the oncology staff nurses and of 42 surveyed, 100% were interested in an educational module on the new NCCN updates. 39 of the nurses surveyed preferred to complete the education via the learning management system, as a self paced computer based learning module. A planning committee consisting of the clinical educator (as Nurse Planner), nurse manager for the oncology unit (as target audience) and an oncologist (as content expert) convened to plan the module. The purpose of the module was determined: To familiarize nursing staff caring for patients with breast, colon and rectal cancer with current updates in NCCN clinical practice guidelines. Two objectives were developed: 1) Describe three changes in NCCN clinical practice guidelines that affect patients with breast, colon or rectal cancers; and 2) Discuss nursing implications when utilizing orders based on new NCCN guidelines. The committee requested that a colleague of the physician content expert present the first part of the program, which was an overview of the most significant changes in the NCCN guidelines for the cancers specified, based on a similar presentation he had done for the physician group at the time the new guidelines were published. The oncology nurse manager was asked to present the second part of the program on nursing implications, based on her knowledge of the new guidelines and her background as a hand s on nurse manager. Both presenters decided to collaborate for seamless content that would address the objectives and purpose rather than present in two parts. They determined that addressing content from a cancer specific viewpoint would be more logical to the nurse audience and allow both presenters to integrate relevant content in a case study format, utilizing the published NCCN updated guidelines as the primary content. The clinical educator agreed to coordinate the media aspects of the program for optimal impact, and to ensure that the program was available to all nurses on the in house learning management system. Each objective must have written content that is directly related to that objective. Subject matter that relates to each objective should be supplied in the form of an outline or a narrative. The content should be in an outline form and provide the MONA CE Approver Unit Nurse Peer Reviewer with an idea of the information that will be included in the session. The content outline is more than a restatement of the objectives. This outline should provide information on the material that will be presented to support the intended outcome and facilitate learner achievement of the objective. Identification of the content/topics is a collaborative process between the planners and faculty/presenters/authors. Following the development of objectives and selection of content, the Approved Provider must describe how the teaching learning strategies were determined. The methods, strategies, and materials to be used by faculty/presenters/authors to cover each educational objective are identified, congruent with the objectives and content to be presented, and appropriate to the purpose, target audience, and overall design of the learning activity. Instructional methods that support attainment of the educational objectives should be used. 92

93 TEACHING STRATEGIES The lecture format involves a verbal presentation by a person to a generally passive audience. The advantages of the lecture format are that large numbers of participants can be given information at one time. Frequently, the amount of information given in a lecture format is greater than in other methods. Complex information can be given, especially if it can be supplemented by handouts or visual materials. A disadvantage of a lecture includes the difficulty of speaker audience interaction. It is often difficult to individualize the presentation according to the needs of each learner. Too often participants are reluctant to ask or it may be inappropriate to ask clarifying questions during a lecture. Effectiveness of the lecture format can be enhanced by using audiovisual materials to elaborate on or stress key concepts. With the increasing availability of computer presentation systems, many speakers are using computer software files projected on a large screen, rather than slides or overheads. The participants will appreciate receiving a content outline or printed copies of slides or overheads to reduce note taking. A demonstration frequently illustrates motor skills. The advantage of a demonstration is that this mode of learning facilitates learning steps and procedures, allows for teaching manipulative or operative skills, allows for hands on experience, and permits direct visualization of equipment. Demonstrations are best suited for small groups so techniques demonstrated can be easily seen by all participants. When using demonstrations as a learning method, equipment should be used that the participants may use in their work settings. Time should be allowed for practice and return demonstrations by all participants. It would also be helpful to have the procedural steps listed on a handout for each participant. Tabletop projection systems are now commonly available and are well suited for demonstrations. The presenter can demonstrate the skill at the podium and, using the tabletop projector system, the technique is projected on a large screen. Use of this new technology allows larger groups to benefit from demonstration teaching strategies. Group discussion allows for a sharing of ideas and viewpoints by the discussion leader and participants and also increases understanding of group process. Discussions may not be effective unless there is sufficient time to develop group interaction and the leader plans the discussion content in advance, especially if complex information is to be shared. Group discussion is best if the group is small, usually with eight to ten participants. Circular seating or seating around a conference table facilitates exchange among participants. Group discussion can also be used with a large audience. This might require some rearrangement of chairs to facilitate good discussion. When printed material or other audiovisual techniques are used, be sure the materials are educationally sound. Printed materials should be selected for their format, illustrations, style of writing, readability, accuracy, and editorial opinion. Audiovisual materials used often enhance learning by stimulating more of the sensory system than auditory learning alone. Transparencies can be used effectively for small to moderately sized groups but are often less effectively seen by large groups, especially if the offering is held in a large room or auditorium. Overheads made professionally are often more attractive; however, welldesigned instructor made overheads allow for creativity in expression. A variety of 93

94 computer programs are available that facilitate overhead and slide development. The computer projector systems now available involve use of a computer and a presenter system. It is important for faculty/presenters/authors to practice using their computer programs with the systems available so that compatibility of files is identified and the presenter gains some familiarity with a particular system prior to the actual presentation. Models, posters, charts, and flip charts are best used in a small group setting because of limited visibility. Discussion among the participants is often enhanced when using these tools. Slides, films, filmstrips, and videotapes are often used to supplement faculty presentations. Often entertaining, these videos work well in any size group and can be used to present complex information and to demonstrate procedures. It is important that the provider has an individual available to operate the equipment and troubleshoot when necessary. As part of the design process, the Planning Committee must develop ways in which learners will be provided feedback. This can include but is not limited to having question/answer sessions during or at the conclusion of a learning activity, self check questions, or comments within an activity, returning pre and/or post test questions with answers, or engaging learners in dialogue during or after the learning activity. The issues of delivery methods, materials, learner feedback and resources are particularly relevant in describing how learner directed activities are to be implemented. Delivery methods may be synonymous with teaching methods, as in lecture, or different; for example, a government panel of experts may present a panel discussion with call in questions from viewers (method), but the delivery method in this case is teleconference. The description should include how learners access/obtain the materials necessary for selfstudy activities; if they are web based, it is relevant to describe the hardware and software requirements for learners to interact with the course materials. Learner Feedback refers to interaction between learners and faculty/presenters/authors. It may be immediate programmed feedback, as in the case of case studies with a choice of decision options, each with programmed information as to the impact of the decision on the patient, or a print case study or post test with written feedback or scores returned to learners by providers/resources. Resources may be content experts who develop learning materials; in some instances, already available print or video materials have been selected as resources, and learning activities built around them. Materials may be handout materials of any type in an onsite (or provider directed) activity, or the materials learners access on their own print articles or modules, interactive webbased courses, or video presentations that learners do not access in real time. Successful completion for both live and enduring material/web based activities should be defined for each educational activity, consistent with the purpose, objectives, and teaching/learning strategies. The criteria for successful completion are based on the format of the educational activity and should indicate what constitutes successful completion, the rationale for the method of determining successful completion, and whether or not partial 94

95 credit is awarded for participation. Criteria for successful completion may include attendance at the entire event or session, attendance for a predetermined percentage of the event, attendance at one or more sessions, completion/submission of the evaluation form, achieving a passing score on a post test, and/or a return demonstration. The Planning Committee may elect to provide partial credit for educational activities. This could be contact hours awarded based on half day attendance or on a certain number of sessions attended in a multiday conference. The Planning Committee must determine how participation will be verified. The attendance/participation verification may include but is not limited to sign in sheets/registration forms, signed attestation statement by participant verifying completion of an entire activity, or a collection of participation verification via computer log. Recordkeeping requires that the Planning Committee determine the method to collect both the participant s name and a unique identifier. Time Frame Identify the time needed to complete each objective in minutes, rather than in time lapse format i.e. 9:30 10:30 a.m. Evaluation is considered part of the learning process and should be included in the calculation of contact hours. List the number of minutes devoted to evaluation time on the educational planning tool along with the method of evaluation used. References are the resources that were used to develop the presentation(s) within the activity i.e. bibliography, resource list, etc. Identify what evidence based, valid, reliable sources were used to develop the content for this CNE activity. Awarding Contact Hours Contact hours are determined in a logical and defensible manner. Contact hours are awarded to participants for those portions of the educational activity devoted to the learning experience and time spent evaluating the activity. One contact hour = 60 minutes. Activities must last a minimum of 60 minutes. After the first contact hour, fractions or portions of the 60 minute hour should be calculated. For example, 150 minutes of learning experience equals 2.5 contact hours. Time allowed for introductions, breaks and meals should be excluded. If rounding is desired in the calculation of contact hours, the provider must round down to the nearest 1/10th or 1/100th (e.g., should be 2.75 or 2.7, not 2.8). Educational activities may also be conducted asynchronously and contact hours awarded at the conclusion of the activities. Time frames must match and support the contact hour calculation for live activities. For enduring materials, print, electronic, Web based, etc., the method for calculating the contact hours must be identified. The method may include but is not limited to a pilot study, historical data, or complexity of content. Contact hours may not be awarded retroactively except in the case of a pilot study. Participants in a pilot study assist in determining the length of time required for completing an educational activity in order to calculate the number of contact hours to award. Those participants may be awarded contact hours once the number is determined. See Sample 8C for a description of a pilot study that was conducted. 95

96 SAMPLE 8C The buttons will take the learner to the 10 most commonly used anti depressants; one of the case studies will feature a patient who prefers non pharmacologic therapy; buttons will take the learner to research based information about herbals, exercise, yoga, imagery and affirmation. Learners will receive immediate feedback on their choices, with the rationale for why their choice is preferred/not preferred and references to buttons and to print sources. The tone of the feedback is always positive, and encourages further critical reasoning and problem solving. Learners have an opportunity to repeat the case study again to attain 80% correct responses on the 40 clinical decisions (5 per case study). The planning committee recruited 5 members to be Beta testers, take the depression program including reading case studies, reading all the buttons they required, choosing their strategy in response to 5 questions per case study, and reviewing the immediate response. They also completed a self assessment of learning, and a satisfaction survey. The average time required was 3 hours, and all 5 Beta testers thought the content was at an appropriate level for APRN's, that the immediate feedback on decisions with opportunity to clarify was satisfying, and they rated attractiveness and readability of the materials as appealing and motivating; four of them did the program at one sitting, and one in two sittings. Evaluation A clearly defined method that includes learner input is used to evaluate the effectiveness of each educational activity. The Planning Committee must determine the method(s) of evaluation to be used. The evaluation components and method of evaluation should be relative to the desired outcome of the educational activity. Approved Providers must consider the effectiveness of their educational activities in a broader context than learner satisfaction alone. If the end result of continuing nursing education is Improved nursing practice and patient outcomes, the provider is challenged to think about demonstrating those outcomes in the evaluation methods used. Evaluations may include both short and long term methods, as illustrated below. Evaluation Methods: Short Term Evaluation form with questions related to individual activity objectives. For example: o Effectiveness of speakers o Anticipated change in practice Active participation in learning activity Post test Return demonstration Case study analysis Role play 96

97 Long Term Longitudinal study with self reported change in practice Data collection related to quality outcome measures Observation of Performance A variety of evaluation methods can be utilized: written evaluation forms, rap sessions or discussions, performance checklists, or normed tests such as national achievement tests. Most often, provider developed written evaluation forms are used. The new criteria give Approved Providers a great deal of flexibility in designing evaluation tools and methods. The MONA CE Approver Unit suggests that Approved Providers include the following aspects of an activity in a provider developed written evaluation form or other evaluation tool: THE LEARNER'S ACHIEVEMENT OF EACH OBJECTIVE. Be sure to let the learner evaluate each of the objectives for the educational activity. A blanket statement such as "Did the program meet the objectives" is inappropriate since it does not tell the provider whether each objective was met. The provider needs to know if each of the educational activity's objectives has been met, thus each objective must be included on the evaluation form. THE EXPERTISE OF EACH INDIVIDUAL PRESENTER. Each presenter needs to be evaluated individually. Was the faculty member's presentation clear? Was the faculty member knowledgeable about the topic? EFFECTIVENESS OF THE TEACHING METHODS. Was the teaching method appropriate for the educational activity and individual sessions? Were the audiovisual materials appropriate to the audience? Did the film enhance learning the material presented? Were the learning materials developed for a learner directed activity in sufficient depth, visually clear and appealing? APPROPRIATENESS OF THE PHYSICAL FACILITIES, if provider directed or onsite. Was the room comfortable? Could the audiovisual materials be heard and seen from all areas of the room? Were the breaks or meals appropriate? Was the location easily accessible to the participant? One of the most important components of effective evaluation is evaluation data provided by participants. If the evaluation is properly designed and utilized, it can provide information about the overall activity as well as the specific components. To generate evaluation data that can be used to determine effectiveness of an activity and provide evidence for any necessary changes or improvements, a clearly defined method of evaluation should be developed as part of the planning. Improvements can best be initiated if specifics are measured (e.g., achievement of each objective and expertise of each individual presenter). The evaluation process helps to determine the effectiveness of the educational activity, including the teaching methodology and the value of the activity to the participant. In the continuing educational activity, evaluation is important since it can help to validate that learning has taken place. Besides assessing the effectiveness of the offering, evaluation can point out areas for corrective action or provide suggestions for future educational activities. For Approved Providers, evaluation of individual activities is an important part of the Approved Provider evaluation plan. Once the evaluations are complete, a summative evaluation is generated. The Planning Committee and/or Nurse Planner review the summative evaluation to assess the activity s effectiveness and to identify how results may be used to guide future educational activities. 97

98 Some helpful definitions of the categories and examples are listed below: Learner Satisfaction a measure of self reported attitudes of learners, usually using a likert type scale, indicating how they rate the extent to which they are able to meet the objectives, about the faculty/presenters/authors and their expertise, arrangements, and other aspects of the educational activity. Knowledge enhancement a measure of gain in cognitive information, usually using a pre and posttest of knowledge. Skill and attitude change a measure in observable behaviors which may be assessed within the time frame of the educational activity, or at a later time. Skills may be psychomotor only (demonstrates suturing of skin laceration), have both cognitive and psychomotor components (demonstrates neurological assessment of a newborn), or be primarily cognitive (calculates appropriate sample size). Attitude change is a measure of values and beliefs in relation to the topic of the educational activity; it may be measured with a self report instrument pre and post the educational activity, or inferred through observing behavior change, since behaviors express underlying attitudes. For example, quality improvement staff in a health care agency observe that nurses in the ER and urgent care settings spend less time with homeless individuals than other patients, take less detailed histories, and keep them waiting longer. An educational activity on issues of health care for the homeless is designed for front line staff. Following the educational activity, disparities in nurse interaction with homeless patient s decreased, so the planners infer that attitude change has taken place. Change in practice/performance a measure of change in nursing practice due to the application of new information gained during the educational activity. This may be through self report at a time after the educational activity, or by observation. For example, the literature indicates many benefits of breast feeding, but not all providers are skilled in discussing breast feeding with pregnant women. Midwives and women s health practitioners in a large OB clinic participate in an educational activity on individualizing health education to the needs of low income women, and subsequently develop a protocol for discussing breast feeding with each patient at specific points during prenatal care. Relationship of the practice change to the quality of services a measure of an outcome indicator in a patient population before and after a practice change based on educational activity. In the above example, breast feeding rates, duration, and satisfaction are possible indicators of the effectiveness of the new breast feeding education protocol. The provider of the educational activity creates most evaluations. At times, another organization's evaluation tools may be used. If another organization's tool is used, be sure to obtain permission from the originator before using the tool. A statement should appear on the evaluation that it is used with permission or adapted from an existing tool. Approved Provider Statement The provider approval statement is a mark of the Approved Provider s status. All communications, marketing materials, certificates, and other documents that refer to the Approved Provider's ANCC COA/MONA approval status must contain the official approval statement, must stand alone on its own line(s) of text, and be written as follows: 98

99 [Name of Approved Provider] is an approved provider of continuing nursing education by the Missouri Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. The provider approval statement cannot be added to, altered or changed in anyway and must read word for word on all promotional materials. When referring to contact hours, the term approved contact hours should never be used. An organization is approved; contact hours are awarded. Documentation of Completion A document or certificate of completion is awarded to a participant who successfully completes the requirements for the individual education activity. The document or certificate must include: Title and date of the educational activity Name and address of the provider of the educational activity (Web address acceptable) Number of contact hours awarded Official approval statement Participant name While not required, it is suggested that the certificate include the signature of the Nurse Planner responsible for the educational activity to demonstrate credibility and authenticity. Applicants should prepare and submit a sample certificate of completion, as it would appear following approval and containing the official approval statement. The approval statement communicates to participants, employers, and certifying groups that the provider of the educational activity has demonstrated adherence to professional standards. It may seem awkward or presumptuous as approval has not yet been issued for the individual activity and/or the Provider Unit has not been approved; however, the Nurse Peer Reviewers need to see how the certificate will be laid out i.e. designed, once approval is issued and that the required elements have all been included. Commercial Support & Sponsorship The Approved Provider must adhere to the American Nurses Credentialing Center s Content Integrity Standards for Industry Support in Continuing Nursing Educational Activities at all times. The Approved Provider must have a written policy or procedure that includes a signed, written agreement when commercial support or sponsorship is received. Organizations providing commercial support or sponsorship may not provide or co provide educational activities. A commercial interest, as defined by ANCC, is any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients, or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by or used on patients. Exceptions are made for nonprofit or government organizations, non healthcare related companies and healthcare facilities. Commercial support is financial or in kind contributions given by a commercial interest that are used to pay for all or part of the costs of a CNE activity. 99

100 Sponsorship is financial or in kind contributions from an organization that does not fit the category of a commercial interest and that are used to pay for all or part of the costs of a CNE activity. Content integrity of the educational activity must be maintained in the presence of commercial support or sponsorship. The provider developing the educational activity is responsible for ensuring content integrity. Providers developing educational activities must develop written policies and/or procedures for managing commercial support and/or sponsorship if the provider accepts commercial support or sponsorship. Written policies and/or procedures related to managing commercial support and sponsorship must address the following: Template of an agreement to be used for commercial support (Commercial Support Agreement) or Sponsorship (Sponsorship Agreement). The agreement must include: 1. Statement that the provider of commercial support or sponsorship may not participate in any component of the planning process of an educational activity, including: o Assessment of learning needs o Determination of objectives o Selection or development of content o Selection of faculty/presenters/authors o Selection of teaching/learning strategies o Evaluation 2. Statement of understanding that the commercial support or sponsorship will be disclosed to the participants of the educational activity 3. Statement of understanding that the provider of commercial support or sponsorship must agree to abide by the provider s policies/procedures 4. Amount of commercial support or sponsorship and description of in kind donation 5. Name and signature of the individual who is legally authorized to enter into contracts on behalf of the provider of commercial support or sponsorship 6. Name and signature of the individual who is legally authorized to enter into contracts on behalf of the provider of the educational activity 7. Date the agreement was signed 8. Method of documenting how commercial support or sponsorship was used for the educational activity or activities A commercial support and sponsorship decision tree has been developed to assist providers in determining the nature of and how to classify the support received. Please see Appendix B for a copy of this decision tree. Conflicts of Interest Evaluation & Resolution The Nurse Planner is responsible for evaluating the presence or absence of conflicts of interest and resolving any identified actual or potential conflicts of interest during the planning and implementation phases of an educational activity. The potential for conflicts of interest exists when an individual has the ability to control or influence the content of an educational activity and has a financial relationship with a commercial interest, the products or services of which are pertinent to the content of the educational activity. 100

101 A commercial interest, as defined by ANCC, is any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients, or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by or used on patients. Nonprofit or government organizations, non healthcare related companies, and healthcare facilities are not considered commercial interests. The Nurse Planner is responsible for ensuring that all individuals who have the ability to control or influence the content of an educational activity disclose all relevant relationships with any commercial interest, including but not limited to members of the Planning Committee, speakers, faculty/presenters/authors, and/or content reviewers. Relevant relationships must be disclosed to the learners during the time when the relationship is in effect and for 12 months afterward. All information disclosed must be shared with the participants/learners prior to the start of the educational activity. Relevant relationships, as defined by ANCC, are relationships with a commercial interest if the products or services of the commercial interest are related to the content of the educational activity. Relationships with any commercial interest of the individual s spouse/partner may be relevant relationships and must be reported, evaluated, and resolved. Evidence of a relevant relationship with a commercial interest may include but is not limited to receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (stock and stock options, excluding diversified mutual funds), grants, contracts, or other financial benefit directly or indirectly from the commercial interest. Financial benefits may be associated with employment, management positions, independent contractor relationships, other contractual relationships, consulting, speaking, teaching, membership on an advisory committee or review panel, board membership, and other activities from which remuneration is received or expected from the commercial interest. Providers must be proactive and take precautions to prevent bias in the presentation of educational activities, and to protect learners from commercial messages. For a detailed statement of do's and don ts, see the complete standards in Appendix C. Some examples of precautions are: Physically separate the area where learners check in and receive educational materials, and the areas where they may choose or not choose to pick up commercial handouts and "goodies" tote bags, pens, key chains, etc. with commercial product names and advertisements. Arrange space so that learners are not compelled to walk through an exhibit area on their way to the educational session/s; if refreshments are provided in the same room as the educational activity, and a commercial sponsor is providing them, the sponsor's name and product advertisements may not be placed in the room. The sponsor is to be acknowledged in the brochure, participant materials, by verbal announcement, and/or through other signage. Presenters who are affiliated with commercial entities are not permitted to use handouts that have commercial logos or advertisements on them, or to have such logos on their slides. 101

102 The Nurse Planner is responsible for evaluating whether any relationship with a commercial interest is considered relevant to the content of the educational activity. Disclosures may be categorized in the following ways: No relevant relationship with a commercial interest exists. No resolution required. Relevant relationship with a commercial interest exists. The relevant relationship with the commercial interest is evaluated by the Nurse Planner and determined not to be pertinent to the content of the educational activity. No resolution required. Relevant relationship with a commercial interest exists. The relevant relationship is evaluated by the Nurse Planner and determined to be pertinent to the content of the educational activity. Resolution is required. The Approved Provider must describe the process used to resolve any actual or potential conflicts of interest identified during the planning of the activity. Actions taken to resolve conflicts of interest must demonstrate resolution of the identified conflicts of interest prior to presenting/providing the educational activity to learners. Such actions must be documented and the documentation must demonstrate (1) the identified conflict and (2) how the conflict was resolved. Actions may include but are not limited to the following: Removing the individual with conflicts of interest from participating in all parts of the educational activity Revising the role of the individual with conflicts of interest so that the relationship is no longer relevant to the educational activity. Not awarding continuing education contact hours for a portion or all of the educational activity. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence based content or other indicator of integrity, and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence based content or other indicator of integrity, and absence of bias, AND reviewing participant feedback to evaluate for commercial bias in the activity. The provider may use the services of planners and faculty/presenters/authors that have a financial interest in a commercial entity, but they must address the conflict of interest and describe how it is resolved. One way of resolving the conflict required by ANCC/MONA Accreditation Program criteria is full disclosure to activity participants that the conflict exists. Another example is the active role of the Nurse Planner(s) in ensuring that content is unbiased: for example, if faculty/presenters/authors mention one company s drug trade name, they should also mention similar drugs made by other companies when, applicable. Conflict of Interest Decision Tree Conflict of Interest is considered an affiliation or relationship with a Commercial Interest Organization of a financial nature that might bias a person s ability to objectively participate in the planning, implementation, or review of a learning activity. All planners, reviewers, faculty, 102

103 presenters, authors, and content reviewers are required to complete Biographical/Conflict of Interest forms. Resolutions may include but are not limited to the following: Removing the individual with conflicts of interest from participating in all parts of the educational activity Revising the role of the individual with conflicts of interest so that the relationship is no longer relevant to the educational activity. Not awarding continuing education contact hours for a portion or all of the educational activity. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence based content or other indicator of integrity, and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence based content or other indicator of integrity, and absence of bias, AND reviewing participant feedback to evaluate for commercial bias in the activity. 103

104 Disclosures Provided to Participants Learners must receive disclosure of required items prior to the start of an educational activity. In live activities, disclosures must be made to the learner prior to initiation of the educational content. In enduring print materials or Web based activities, disclosures must be visible to the learner prior to the start of the educational content. Required disclosures may not occur or be located at the end of an educational activity. Evidence of the disclosures to the learner must be retained in the activity file. If a disclosure is provided verbally, an audience member must document both the type of disclosure and the inclusion of all required disclosure elements. Disclosures always required include: Notice of requirements for successful completion of the educational activity Learners are informed of the purpose and/or objectives of the learning activity and the criteria that will be used to determine successful completion, which may include but are not limited to: Required attendance time at activity (e.g., 100% of activity, or miss no more than 10 minutes of activity) Successful completion of post test (e.g., attendee must score X% or higher) Completed evaluation form Return demonstration Presence or absence of conflicts of interest for planners, presenters, faculty, authors, and content reviewers Any influencing relationships, or lack thereof, of planners, presenters, faculty, authors, or content reviewers in relation to the educational activity must be disclosed. Individuals must disclose: Name of individual Name of commercial interest Nature of the relationship the individual has with the commercial interest Disclosures required, if applicable, include: Commercial support: Learners must be informed if a commercial interest has provided financial or in kind support for the educational activity. Sponsorship: Learners must be informed if an entity has provided financial or in kind support for the educational activity. Non endorsement of products: Learners must be informed that accredited status does not imply endorsement by the provider of the educational activity or ANCC of any commercial products discussed/displayed in conjunction with the educational activity. Expiration of enduring materials: Educational activities provided through an enduring format (e.g., print, electronic, Webbased) are required to include an expiration date documenting how long contact hours will be awarded. This date must be visible to the learner prior to the start of the educational content. The period of expiration of enduring material should be based on 104

105 the content of the material but cannot exceed 3 years. ANCC requires review of each enduring material at least once every 3 years, or more frequently if indicated by new developments in the field specific to the enduring material. Upon review of enduring material for accuracy and current information, a new expiration date is established. Disclosure can be accomplished by including the requirements within the promotional materials developed for the activity or identifying the requirements in the announcements or handouts prior to or at the beginning of the program. Some providers include in each participant packet, Administrative information or a General Information Form, and may include the required information on such a form. If that is true the provider must include a copy of the form used. Whatever the method used, the participant should be informed of the criteria either prior to or at the start of the educational activity. Disclosures may not occur or be located at the end of an educational activity. Record keeping ANCC/MONA Approved Providers and Individual Activity Applicants must develop and describe a record keeping system that ensures confidentiality, safety, and consistency with record collection. The provider should identify who is responsible for ensuring that each record is complete, and what record checklists or other tools are used to ensure record completeness; the provider must describe how records, including records of activities and participant records, are maintained for the required six year period; how and where they are stored, how confidentiality and security of records is maintained, and how records can be retrieved by participants requiring duplicate verification. The provider is able to determine within its own setting how confidential records are maintained and handled and which personnel have access to the records. Mechanisms should be in place for systematic, easy retrieval of information by authorized individuals. The following paragraphs elaborate on the importance of each aspect of the record keeping storage and system: COLLECTION OF ACTIVITY RECORDS: A record checklist or list of required elements that can be filled in as the planning, implementation and evaluation steps take place are possible ways of collecting activity records. The record can be assembled by clerical staff, but the Primary Nurse Planner must have oversight and overall responsibility for the collection of activity records. RETENTION: Records pertaining to the CNE program should be retained for at least six years. If stored for longer periods of time, this should be stated. SECURITY SYSTEM AND CONFIDENTIALITY: How is the security of records managed? Are there keys to rooms and files? Are computer user codes needed for access to files? It is important that a secure system is in operation and that the information in the files is kept confidential. RECORD FILING: There should be a logical filing system that will allow filing and retrieval of information about the CNE educational activity. The file might be organized according to date, type of educational activity, or alphabetically by title. A variety of methods for record 105

106 filing can be used from the very elaborate to the simplistic. Some agencies, such as hospitals or health departments, may have more sophisticated methods for filing. Smaller agencies or district associations may have less elaborate storage methods, however, whatever method used should ensure confidentiality. Files and records can be kept on computer disks; however, a system should exist for backups and prevention of piracy or alteration of the disks. If the file disk is misplaced or lost, alternate disk information should be available in hard or soft copy. STORAGE: Paper records should be stored, if at all possible, in locked, fire resistant or fireproof containers. Information kept on magnetic disks, such as computer floppies or hard drive is always subject to loss when kept near electric fields. Computer disks should always be kept in a dry, electric/magnetic free area in a container that minimizes damage to the disk. As CD ROM recorders become increasingly available, providers may choose to record information about their continuing education programs on CD ROMs. This method of record storage is not as vulnerable to loss as magnetic disks. RETRIEVAL: Information should be retrieved as easily as possible. This means a filing system should be in place that others can use. If the individual who is responsible for filing is not available when records are needed, be sure that authorized personnel can obtain the records. Activity file records must be maintained in a retrievable file (electronic or hard copy) accessible to authorized personnel for 6 years. Required recordkeeping components include: Title and location (if live) of activity Type of activity format: live or enduring Date live activity presented or, for ongoing enduring activities, date first offered and subsequent review dates Description of the target audience Method of the needs assessment Findings of the needs assessment Names, titles, and expertise of activity planners Role held by each Planning Committee member (must include identification of the Nurse Planner and content expert(s)) Names, titles, and expertise of activity faculty/presenters/authors, and/or content reviewers Conflict of interest disclosure statements from planners Resolution of conflicts of interest for planners, if applicable Conflict of interest disclosure statements from faculty/presenters/authors, and/or content reviewers Resolution of conflicts of interest for faculty/presenters/authors, and/or content reviewers, if applicable Purpose of activity Objectives of activity Evidence of gap in knowledge, skill, or practice for the target audience Content of activity: a completed Educational Planning Tool 106

107 Instructional strategies used Evidence of learner feedback mechanisms Rationale and criteria for judging successful completion Method or process used to verify participation of learners Number of contact hours awarded for activity, including method of calculation (Provider must keep a record of the number of contact hours earned by each participant.) Template of evaluation tool(s) used Marketing and promotional materials Means of ensuring content integrity in the presence of commercial support (if applicable) Commercial Support Agreement with signature and date (if applicable) Means of ensuring content integrity in the presence of sponsorship (if applicable) Sponsorship Agreement with signature and date (if applicable) Evidence of disclosing to the learner: o Purpose and/or objectives and criteria for successful completion o Presence or absence of conflicts of interest for all members of the o Planning Committee, faculty/presenters/authors, and content reviewers o Sponsorship or commercial support (if applicable) o Non endorsement of products (if applicable) o Expiration date (enduring materials only) o Evidence of verbal disclosure (if applicable) Documentation of completion which must include: o Title and date of the educational activity o Name and address of provider of the educational activity (Web address acceptable) o Number of contact hours awarded o Accreditation/approval statement o Participant name Summative evaluation List of participant names with unique identifier (Include a representative sample of data collected in the activity file to be reviewed. The provider must maintain all participant data in a safe and secure manner.) Division of responsibilities among co providers (if applicable) Co provider agreement with signature and date (if applicable) Co Providing Continuing Nursing Education Activities ANCC/MONA Approved Providers may co provide educational activities with other organizations. The co providing organization may not be a commercial interest or sponsor. The ANCC/MONA Approved Provider s Nurse Planner must be on the Planning Committee and is responsible for ensuring adherence to the ANCC/MONA accreditation criteria. The ANCC/MONA Approved Provider is referred to as the provider of the educational activity. The other organization(s) is referred to as the co provider(s) of the educational activity. In the event that 2 or more organizations are ANCC/MONA Approved Providers, one will act as the provider of the educational activity and the other(s) will act as the co provider(s). The ANCC/MONA 107

108 Approved Provider s Nurse Planner is responsible for: (1) ensuring that the provider s name is prominently displayed in all marketing material(s) and certificate, and (2) developing a coprovider agreement, signed by an authorized representative of the co provider that includes the following elements: Name of ANCC/MONA Approved Provider Approved Provider acting as the provider The name(s) of the organization(s) acting as the co provider(s) Statement of responsibility of the provider, including the provider s responsibility for: o Determining educational objectives and content o Selecting planners, faculty/presenters/authors, and content reviewers o Awarding of contact hours o Recordkeeping procedures o Developing evaluation methods o Managing commercial support and/or sponsorship o Name and signature of the individual legally authorized to enter into contracts on behalf of the Approved Provider o Name and signature of the individual legally authorized to enter into contracts on behalf of the co provider(s) o Date the agreement was signed Co providership refers to the planning, developing and implementing of an educational activity by two or more individuals, organizations, or agencies. A co provider agreement ensures that the appropriate provider maintains primary responsibility for the CNE activity. Co providership may be appropriate for some agencies. For example, a MONA district and a local specialty group may want to plan and offer programs that would meet the needs of both populations of nurses served by the organizations. It is critical that the provider receiving CNE approval assumes primary responsibility for the educational activity. The Approved Provider and/or Individual Activity applicant maintains responsibility for a) determination of objectives and content b) selection of faculty/presenters/authors and content reviewers c) awarding of content hours d) recordkeeping procedures e) developing evaluation methods and (f) managing commercial support or sponsorship. A written co provider agreement confirms these arrangements. It is important that these areas be agreed on by the co providers prior to presenting the CNE activity. Misunderstandings and confusion related to the responsibilities of the providers can be avoided if they are clearly delineated ahead of time. The following sample is an example of a co provider agreement between two organizations. Approving vs. Co Providing Co providing continuing nursing education activities is not to be confused with CNE approval, which is only allowed by the Missouri Nurses Association or another accredited approver unit through the ANCC. If the Primary Nurse Planner and/or Nurse Planner were not actively involved in the planning of the event, the organization cannot provide or co provide the activity. 108

109 Any advertising developed for the co provided activity should include the names of the provider and co provider. The Approved Provider must be prominently mentioned in the advertising and co provided language should be utilized. For example, This activity was co provided by Johnson Care Hospital and the Missouri Psychiatric Nurses Association. When determining if the organization should or is able to co provide an activity, the following elements should be considered: 1. Who is the Approved Provider Unit? Who is the Approved Provider Unit s target audience? Is the group seeking co providership part of or outside of the Approved Provider Unit? 2. Has one of the Approved Provider Unit s Nurse Planners been actively involved in the planning of the activity since the beginning? 3. Who is hosting the event, your organization or another organization? If your answer is no to one or more of the questions above then you are unable to co provide the activity with the agency requesting your participation. In any or all situations, an Approved Provider has the right to say no, we do not want to co provide. Below are a few situations that Approved Providers experience when contemplating coproviding an activity: If an employee of your organization is working with a group outside of the work setting, the employee must involve a Nurse Planner to see if it would be beneficial or appropriate for your Approved Provider Unit to co provide an activity with the group. If the answer is yes, then the Nurse Planner will develop the co provider agreement with the group, facilitate the planning process and proceed with the development of the coprovided event. The Approved Provider Unit s name must be included as one of the event providers on the promotional materials. If the co provider relationship is not desired or appropriate, the Nurse Planner may refer the employee and group to an Accredited Approver for individual activity approval. If an employee of the organization participates in a local chapter of a professional nursing organization and that local chapter wants to offer contact hours for an upcoming program, the employee should contact the Nurse Planner to see if it would be beneficial and feasible to develop a co provider agreement with the professional nursing organization. The Nurse Planner would be in contact with the other organization to plan and implement the co provided activity. The Approved Provider Unit s name must be included as one of the event providers on the promotional materials. If the coprovider relationship is not desired or appropriate, the Nurse Planner may refer the employee and group to an Accredited Approver for individual activity approval. If the Nurse Planner is approached by an entity that has planned and developed a CE activity ad is seeking contact hours for participants, the Nurse Planner must refer this organization to an Accredited Approver such as MONA to obtain approval. In this instance, the Nurse Planner has not been involved in the planning process, and therefore, cannot co provide. If the Approved Provider Unit has a co provider agreement with an organization to put on an event and the co provider now wants to offer the co provided activity in another 109

110 venue without the Approved Provider involvement, the Approved Provider must refer the organization to an Accredited Approver such as MONA. The organization would need to submit an application for approval to award nursing contact hours directly to the Accredited Approver. Co Provider vs. Co Sponsor The ANCC/MONA Accreditation criteria do not use the terms co provider and co sponsor interchangeably. Co providing is a term used when two or more organizations/groups work together to assess, plan, implement and evaluate continuing nursing education activities. A sponsor is a non commercial interest who provides monetary or in kind support for an activity. 110

111 9 CHAPTER PROVIDER APPROVAL CRITERIA Organizations interested in submitting an application to become an Approved Provider must complete the eligibility verification process and meet all eligibility requirements before submitting a provider application. The eligibility process includes submission of the intent toapply form and applicable fee. The intent to apply fee is non refundable if the organization submits an intent to apply form and decides not to proceed with the submission of the full Approved Provider application. The intent to apply fee will be credited toward the provider application review fee for organizations that proceed forward with the full Provider Application. The intent to apply form must be submitted between three to six months prior to the application submission deadline. MONA staff and the Nurse Peer Review Leader will review the organization s completed intentto apply form and notify them if they are eligible to apply for provider approval. Once the organization has been deemed eligible to apply, they may proceed with the approved provider application process. APPROVED PROVIDER ORGANIZATIONAL OVERVIEW (OO) An Approved Provider is defined structurally and operationally as the members of the organization who support the delivery of continuing nursing education activities. The Provider Unit may be a single focused organization devoted to offering continuing nursing education activities or a separately identified unit within a larger organization. If the Provider Unit is within a larger organization it is defined as a multi focused organization (MFO). The applicant applying for approval is the Provider Unit (PU). The MFO organization is not the applicant. The Organizational Overview (OO) is an essential component of the application process that provides a context for understanding the Approved Provider Unit/organization. The Approved Provider is: clearly defined, accurately named, and, in multi focused organizations, supported by the administrative structure. Approved Providers perform data collection and report data to the Missouri Nurses Association in a timely manner. Quality outcomes specific to continuing nursing education (CNE), to the Approved Provider Unit and to Nursing Professional Development are measured and evaluated regularly. The applicant must submit the following documents and/or narratives to demonstrate Approved Provider adherence: STRUCTURAL CAPACITY OO1. Demographics OO1.1. Submit a description of the features of the Approved Provider Unit, including but not limited to scope of services, size, geographic range, target audience(s), content areas, and the types of educational activities offered. *If the Approved Provider is part of a multi focused organization 1, describe the relationship of these scope dimensions to the total organization. 1 Multi focused organization (MFO) is an organization that exists for other purposes in addition to providing CNE. 111

112 Interpretation and rationale: The Approved Provider Unit may be a separate entity, or subunit of the entire organization. The documented beliefs and goals of the Approved Provider reflect the importance of continuing education for nurses and the needs and characteristics of the Approved Provider s potential learners. The goals may be derived from the parent organization s mission, strategic plans and goals, or from the mission of the Approved Provider Unit. The description of Approved Provider Unit features should include factors that help define the Unit s scope and areas of influence or focus. Approved Providers may be a separate, singlefocused entity whose only purpose is to provide CNE or they can be a multi focused organization (MFO), a subset of an organization such as a hospital, university, professional organization or clinic that exists for other purposes in addition to providing CNE. For example, a single focused organization is an education company providing live and online CE for multiple disciplines. A multi focused organization is an education department of a hospital or an education arm of a specialty nursing association. Most applicants will be part of a multi focused organization. See Sample OO1A for a sample description for a multi focused organization and Sample OO1B for a sample description for a single focused organization. SAMPLE OO1A Provider Unit Description Multi Focused Organization Johnson Case Hospital is a 235 bed Regional Medical Center and Level II Trauma Center serving multiple counties in central Missouri. The Education Department provides both in service and continuing education to all categories of employees. The Provider Unit is located within the Education Department, which also includes Clinical Education (orientation and in service) and Organizational Development (special projects and quality improvement studies). The Education Department has a staff of a non nurse Director, six masters prepared nurse educators, and two support staff. The Provider Unit staff includes the department director as administrator, a designated Primary Nurse Planner, and five other nurse planners. The Provider Unit is supported by one of the support staff of the Education Department. Nurses at all levels of the organization collaborate with Provider Unit staff by serving on planning committees as subject matter experts, pilot testing new web based activities, or helping survey their units for needs and preferences. The Provider Unit provides and advertises its CNE activities primarily to its own staff as an objective of professional development. Several times a year the Unit also plans activities for a larger audience, and invites nurses from neighboring health care facilities, as applicable. Nurses at Johnson Case are predominantly baccalaureate graduates, and they are the target audience for most of the CNE activities provided. 80% of the CNE activities are designed as web based activities that are focused on clinical topics where knowledge gaps have been identified from nursing needs assessment and QI data performance gaps. These activities allow verification of knowledge (testing) with targeted follow up. About 20% of the planned activities are focused on broader topics such as effective communication within teams or ethics. These additional activity types are provided as live conferences with opportunities for discussion and networking. The Education Department and the Provider Unit are fully supported by the budget of the Nursing division. The Director of Education reports to the VP for Nursing and as a member of the Executive Council, represents the needs of the Education Department/Provider Unit to hospital administration, and brings hospital wide goals and needs to the Education Department and Provider Unit. 112

113 SAMPLE OO1B Provider Unit Description Single Focused Organization Missouri Psychiatric Nurses Association is a specialty nursing group based in southern Missouri focused on the promotion of professional practices in psychiatric nursing. The group meets quarterly in person and monthly by telephone conference for the purpose of ongoing planning of continuing nursing education activities that meet the needs of the 100+ nurse members of their specialty association. The association members are located throughout Missouri, many of whom are certified psychiatric nurses and require ongoing professional education for maintaining ongoing certification. Both live programs and computer based learning modules focused on psychiatric specific topics are offered to members. OO2. Lines of Authority and Administrative Support OO2.1. Submit a list of the names, credentials, positions, and titles of the Primary Nurse Planner 2, other Nurse Planner(s) 3 (if any), and all key personnel 4 in the Approved Provider Unit. Interpretation and rationale: Educational and experiential qualifications must be documented for all Approved Provider personnel that appear in the description and organizational chart of the Approved Provider (Organizational Overview, Structural Capacity, OO2.3 Lines of Authority & Administrative Support). The Approved Provider must identify by name and credentials the Primary Nurse Planner and all additional Nurse Planner(s) that participate in the Approved Provider activities that support the overall functions of the Provider Unit. The educational and experiential qualifications of the Nurse Planner(s) must be documented clearly and concisely using a bio form that provides a narrative description or bio sketch of the nurses experience and achievements with respect to their professional career as a nurse. The Provider Unit may accept curriculum vitae to assist in determining expert subject matter experts and in evaluating whether the experiential qualification for nurse planners or key personnel, as long as the information submitted with the provider application includes a completed BIO/COI form. Information in a condensed format that highlights the experience related to adult education principles and expertise for the targeted educational activity or position within the Approved Provider Unit is very helpful. The provider is strongly encouraged to utilize the MONA biographical data form. Experiential qualification should be described in sufficient detail to provide evidence of the Nurse Planner's ability to plan, implement and evaluate nursing continuing education activities. 2 A currently licensed RN with a baccalaureate degree or higher in nursing who serves as the liaison between MONA and the Approved Provider Unit. 3 A currently licensed RN with a baccalaureate degree or higher in nursing who is actively involved in all aspects of planning, implementation, and evaluation of each CNE activity. This individual is responsible for ensuring that appropriate educational design principles are used and processes are consistent with the ANCC/MONA Accreditation criteria. 4 Key personnel are individuals who contribute to the overall functioning of the Provider Unit in a substantive, measurable way, without regard to pay or employment status. 113

114 For Nurse Planner(s), the required educational qualification must be "a minimum of a baccalaureate degree in nursing"; the position description must explicitly state the responsibility for planning, implementing and evaluating continuing nursing education activities for the Nurse Planner(s). The personnel/staff resources should be appropriate for the size and scope of the Approved Provider. A district nurses' association providing four (4) activities a year may well have a single Nurse Planner who is a volunteer and spends on average two days a month on Approved Provider activities, supported by a part time administrative assistant who spends 20% of her time on Approved Provider activities. If the Approved Provider is part of a large organization and provides many nursing educational activities, both web based and face to face activities each year, but the application identifies a single Nurse Planner and very limited support staff, then reviewers would question the capability of the Provider Unit to operate according to ANCC/MONA Accreditation criteria and their ability to provide quality educational activities. In a large Approved Provider Unit, a CNE coordinator or administrative assistant(s) may have an important role in the Approved Provider's full range of functions including managing contractual agreements with resources, conference sites and vendors for printing, arranging for tabulating activity evaluations and other data as required by the evaluation plan, and ensuring that records, whether electronic or paper, are maintained according to ANCC/MONA Accreditation criteria. See Sample OO2A for an example of a list of the Approved Provider Unit personnel that includes the Primary Nurse Planner, Nurse Planners, and other personnel. SAMPLE OO2A Primary Nurse Planner: Nurse Planner: Mary Jane Doe, MSN, RN Julie Smith, BSN, RN Educators: David Roe, EMT, RN Emergency Nurse Specialist Gina Smith, MBA, MS, RN Nursing Management Certificate Planning Committee Member pool: Planning Committee members are solicited based on their knowledge or experience as a member of the targeted audience and needs assessment for the individual activities. Individuals are selected based on their subject matter expertise, experience, and knowledge. Administrative Staff: Stacy Green, BA Biographical/COI forms for each member of the Provider Unit listed above can be found in Appendix A. OO2.2. Submit position descriptions 5 of the Primary Nurse Planner, Nurse Planners (if any), and key personnel in the Approved Provider Unit. Interpretation and rationale: The Approved Provider must submit position descriptions for each position, including Nurse Planners, support staff, volunteers and/or consultants, describing 5 Position descriptions should include the functions specific to the individual role within and related to the Provider Unit. 114

115 each position s qualifications, authority, and responsibilities related to their position within the Provider Unit and indicate what proportion of the individual's time is devoted to Approved Provider Unit activities and functions. The position descriptions must reflect the qualification requirements for the Nurse Planner(s) and other roles that are relative to providing continuing nursing education that are consistent with those of the ANCC/MONA Accreditation Program criteria and should specify elements of the roles (i.e. Primary Nurse Planner, Nurse Planner and other key personnel) in the Approved Provider Unit, such as performing needs assessment, program development, evaluation and goal setting. The minimum requirements outlined in the Accreditation criteria are as follows: Responsibility The Primary Nurse Planner must: 1. Hold a current, valid license as an RN and a baccalaureate degree or higher in nursing 2. Have the authority to ensure compliance with the ANCC/MONA Accreditation criteria in the provision of CNE 3. Hold overall responsibility for Approved Provider Unit compliance with ANCC criteria The Primary Nurse Planner has authority to ensure compliance with the ANCC/MONA Accreditation criteria in the provision of CNE. The Primary Nurse Planner is responsible for: 1. Orientation of all Nurse Planners and key personnel in the organization to the ANCC/MONA Accreditation criteria. 2. Confirming that all Nurse Planners hold a current, valid license as an RN with a baccalaureate degree or higher in nursing. 3. Developing an ongoing evaluation plan for the Approved Provider Unit 4. Participating in an ongoing evaluation of the Approved Provider Unit including policies & procedures, evaluation of individual activities offered, achievement of goals & identification of goals for improvement 5. Ensuring that: Each CNE activity has a qualified Nurse Planner who is an active participant in the planning, implementation and evaluation process Planning Committees have a minimum of a Nurse Planner and one other planner to plan each educational activity Each continuing nursing education activity adheres to the ANCC/MONA Accreditation criteria Nurse Planner(s) is reviewing biographical data/conflict of interest forms from each planning committee member, planner, faculty, presenter, author and content reviewer, to ensure appropriate qualifications and evaluation of actual or potential bias. 6. Maintenance of required records in accordance with the accreditation criteria. If the Primary Nurse Planner is the only Nurse Planner assigned to the Unit then they will be responsible for additional specific requirements related to the activity documentation. The Primary Nurse Planner would be responsible for: 7. Ensure adherence to the ANCC/MONA Accreditation criteria for each activity, including: conducting the needs assessment and identifying appropriate educational offerings based on the findings of the needs assessment 115

116 developing the purpose and educational objectives for the activity identifying the target audience identifying appropriate planners & faculty/presenters/authors collecting biographical data forms for all planners & faculty/presenters/authors ensuring educational objectives are written using measurable terms, that the content is congruent with the activity's objectives and goal (purpose), and that the teaching and learning strategies are congruent with the activity's objectives and content ensuring adherence to successful completion requirements for the offering ensuring that all elements are included on the promotional materials (approval statement, required disclosures & contact hours) ensuring that all elements are included on the certificate adhering to commercial support & sponsorship guidelines when applicable adhering to conflict of interest guidelines ensuring co provided activities are handled appropriately; and, evaluation both in identifying categories and in summarizing data Please see Sample OO2B for a position description for a Primary Nurse Planner and Sample OO2C for a position description for an additional Nurse Planner. Please note that if an organizational health system job description is used and does not correlate with the individual Provider Unit responsibilities, then the elements specific to the Nurse Planner role must be included. These human resource descriptions often do not have enough detail or they do not include role elements that are specific to the Nurse Planner role. Attaching an addendum to a traditional health care position description that includes the elements of the Provider Unit position descriptions is acceptable. 116

117 SAMPLE OO2B POSITION DESCRIPTION Primary Nurse Planner Required Qualifications Current, valid license to practice as an RN in Missouri Registered Nurse with a baccalaureate degree or higher in nursing from an accredited program. Be qualified by education and experience to guide the development of each activity provide by the Approved Provider Unit Education or experience in the field of education or adult learning Demonstrate knowledge of the ANCC/MONA Accreditation criteria Demonstrate excellent communication skills and a commitment to the organization s continuing education program mission and continuous quality improvement plan. Accountability The Primary Nurse Planner is directly accountable to the (example: Chief Nursing Officer or Director of Education). The Primary Nurse Planner guides all professional and non professional staff involved in the continuing nursing education activities provided by the Approved Provider Unit. Authority & Responsibility The Primary Nurse Planner has authority to ensure compliance with the ANCC/MONA Accreditation criteria in the provision of CNE. The Primary Nurse Planner is responsible for: Orientation of all Nurse Planners and key personnel in the organization to the ANCC/MONA Accreditation criteria. Confirming that all Nurse Planners hold a current, valid license as an RN with a baccalaureate degree or higher in nursing. Developing an ongoing evaluation plan for the Approved Provider Unit Ensuring that: o A Nurse Planner who understands the accreditation criteria actively participates in the planning, implementation, and evaluation of each educational activity. o All educational activity planning committees have a minimum of a Nurse Planner and one other planner involved in the planning process. o The Nurse Planner reviews the completed biographical/conflict of interest forms from each planner and presenter to ensure appropriate qualifications and evaluation of actual or potential conflicts of interest. Maintenance of required records in accordance with the accreditation criteria. 117

118 SAMPLE OO2C POSITION DESCRIPTION Nurse Planner Required Qualifications Current, valid license to practice as an RN in Missouri Registered Nurse with a baccalaureate degree or higher in nursing Be qualified by education and experience to guide the development of each activity provided by the Approved Provider Unit Education or experience in the field of education or adult learning Adhere to the ANCC/MONA Accreditation criteria Demonstrate excellent communication skills and a commitment to the organization s continuing education program mission and continuous quality improvement plan. Accountability The Nurse Planner is accountable to the Primary Nurse Planner. Authority & Responsibility The Nurse Planner will utilize an established process to assess, plan, implement and evaluate the CNE activities provided by the Approved Provider Unit. The Nurse Planner must: Actively participate in the planning, implementation, and evaluation of the educational activities of which they are assigned. Ensure the quality of the educational activity Review completed biographical/conflict of interest forms from each additional planning committee member and presenter to ensure appropriate qualifications and evaluation of actual or potential conflicts of interest. Ensure adherence to the ANCC/MONA Accreditation criteria for each activity, including: conducting the needs assessment and identifying appropriate educational offerings based on the findings of the needs assessment developing the purpose and educational objectives for the activity identifying the target audience identifying appropriate planners & faculty/presenters/authors collecting biographical data forms for all planners & faculty/presenters/authors ensuring educational objectives are written using measurable terms, that the content is congruent with the activity's objectives and goal (purpose), and that the teaching and learning strategies are congruent with the activity's objectives and content ensuring adherence to successful completion requirements for the offering ensuring that all elements are included on the promotional materials (approval statement, required disclosures & contact hours) ensuring that all elements are included on the certificate adhering to commercial support & sponsorship guidelines when applicable adhering to conflict of interest guidelines ensuring co provided activities are handled appropriately evaluation both in identifying categories and in summarizing data; and, Participate in ongoing evaluation of the Approved Provider Unit including policies & procedures, evaluation of individual activities offered, achievement of goals & identification of goals for improvement. Maintain required records in accordance with the accreditation criteria. 118

119 OO2.3. Submit a chart depicting the Approved Provider Unit structure, including the Primary Nurse Planner, other Nurse Planner(s) (if any), and all key personnel. Interpretation and rationale: The Approved Provider should design an organizational chart that identifies the lines of authority and communication within the Approved Provider Unit. The Primary Nurse Planner and Nurse Planner(s), staff, and volunteers should appear on the chart. This chart should display only those key personnel who play a role within the Approved Provider Unit. The name and credentials of each person should be listed. Please see Sample OO2D for a sample organizational chart for a community college. SAMPLE OO2D Mary Jane Doe, MSN, RN, Director, Primary Nurse Planner David Roe, EMT, RN, Coordinator, Emergency Nurse Specialist Program Educator Julie Smith, BSN, RN Nurse Planner Stacy Green, BA, Conference Coordinator Gina Smith, MBA, MS, RN, Coordinator, Nursing Management Certificate Program Educator Volunteer Planning Committee Members 119

120 OO2.4. If part of a larger organization, submit an organizational chart, flow chart, or similar kind of image that depicts the Approved Provider Unit s location within the organization structure. Interpretation and rationale: If the Approved Provider is part of a larger organization, a second organizational chart must be submitted to show how the Approved Provider Unit fits into the larger organization s configuration. While it is not necessary to show the entire organizational structure, it should be clear from this chart the line(s) of communication/authority for the Approved Provider Unit in relation to the larger organization. Please see Sample OO2E for an organizational chart for Johnson Case Hospital. SAMPLE OO2E EDUCATIONAL DESIGN PROCESS OO3. Data Collection and Reporting Approved Provider organizations report data, at a minimum, annually to their ANCC Accredited Approver, which includes the following: OO3.1. Submit a list of all CNE offerings provided in the past 12 months, including activity dates; titles; type of activity; target audience; total number of participants; number of contact hours offered for each activity; if the activity was co provided; and if the activity received sponsorship or commercial support (monetary & in kind amounts). OO3.2. The Approved Provider must notify the Missouri Nurses Association CE Program, in writing, within 7 business days of the discovery or occurrence of the following: Significant changes or events that impair your ability to meet or continue to meet ANCC/MONA Accreditation requirements or that make you ineligible for Approved Provider status Any event that might result in adverse media coverage related to the delivery of CNE Change in commercial interest status (i.e. if the Provider Unit becomes part of an organization that is considered a commercial interest.) 120

121 OO3.3. The Primary Nurse Planner or designee must notify the Missouri Nurses Association CE Program, in writing and within 30 days, of any change within the Approved Provider organization, including but not limited to: Changes that alter the information provided in the Approved Provider application A decision not to submit self study written documentation after intent to apply form has been submitted Change in Primary Nurse Planner or suspension, lapse, revocation, or termination of the Primary Nurse Planner s RN license Change in Nurse Planners, i.e. addition, removal of, or suspension, lapse, revocation, or termination of any of the Nurse Planners RN licenses Change in ownership that may or may not directly impact the Approved Provider Indication of potential instability (e.g. labor strike, reduction in force, bankruptcy) that may impact the organization s ability to function as an Approved Provider. Interpretation and rationale: The Approved Provider Unit must submit a listing of activities they have provided in the past twelve (12) months using the form provided by MONA. The twelve month period is different depending on the timing of the Approved Provider s application. For those submitting a provider application during the May cycle, the 12 month period may be April to March, July to June, etc. Approved Providers may decide when to begin the twelve months for the reporting during the application process. The Approved Provider Unit must also have a written policy and procedure or bylaw that describes how they will ensure timely communication, either written or electronic, with MONA. The description should include bulleted items from elements OO3.2 and OO3.3. SAMPLE OO3A Perinatal Nursing Society, Kansas City chapter Attached you will find our completed CNE Activity Form as required by MONA listing each of the CNE activities our organization has provided in the past year. The date range we are reporting is from April 2, 2013 through March 31, The chapter Education chairperson is the Primary Nurse Planner, and also serves as the contact person for communication with MONA. The Education chairperson will notify the MONA CE Program, in writing, within 7 business days of the discovery or occurrence of the following: Significant changes within our Provider Unit that deems us ineligible to maintain our Approved Provider status or impair our ability to meet the ANCC/MONA Accreditation criteria. Any activities or events that may result in negative media coverage that would have an impact on our delivery of CNE. A change in our status as an entity that is now a commercial interest. The Education chairperson will report any communication and action taken at the next monthly meeting. The Education chairperson, or in his or her absence, the chapter President assumes accountability as the designated person to inform MONA within 30 days by , followed by a hard copy letter of: changes in the organization, changes in its address/site where records are maintained, changes in the contact person/nurse Planner, or decision to terminate Approved Provider activities. A copy of the Annual Report is submitted to MONA once per year. 121

122 SAMPLE OO3A continued Perinatal Nursing Society, Kansas City chapter The chapter Education chairperson is the Primary Nurse Planner, and also serves as the contact person for communication with MONA. The Education chairperson will notify the MONA CE Program, in writing, within 30 business days of any change within the Approved Provider organization, including but not limited to: Changes that affect what was described and shared in the organization s Approved Provider application. A decision not to move forward and submit the Provider Application after submitting the intent to apply form. Change in Primary Nurse Planner or suspension, lapse, revocation, or termination of the Primary Nurse Planner s RN license Change in Nurse Planners, addition or removal, or suspension, lapse, revocation, or termination of any of the Nurse Planners RN licenses. Change in ownership that may or may not directly impact the Approved Provider Significant changes within our Provider Unit that deems us ineligible to maintain our Approved Provider status or impair our ability to meet the ANCC/MONA Accreditation criteria. The potential for organizational instability (e.g. labor strike, reduction in force, bankruptcy) that may impact the organization s ability to function as an Approved Provider. The Education chairperson will communicate with the MONA CE Program within 30 days, providing a description of any changes or issues occurring and will then report back to the membership at the next monthly meeting. The Education chairperson, or in his or her absence the chapter President, is also the designated person to inform MONA within 30 days by , followed by a hard copy letter of any of the above mentioned changes. QUALITY OUTCOMES OO4. Evidence OO4.1. List the Approved Provider Unit s strategic and measurable goals with respect to CNE for the past 12 months. OO4.2. Submit a list of the quality outcome measures the Approved Provider collects, monitors, and evaluates specific to the Approved Provider Unit. OO4.3. Submit a list of the quality outcome measures the Approved Provider collects, monitors, and evaluates specific to Nursing Professional Development. Interpretation and rationale: Structure and process are essential for an organization to function as an Approved Provider. The outcome of that infrastructure is to ensure the delivery of quality CNE that enhances nursing professional development. For this criterion applicants must also provide a list of the quality outcome measures the Approved Provider Unit collects, monitors, and evaluates specific to the Unit and also to nursing professional development. The Approved Provider must provide a list for each of the criteria listed in OO4.1, OO4.2 and OO4.3 that includes a list of their strategic and measurable goals they have been working on for 122

123 the past twelve months that pertain to their continuing nursing education activities, goals that are specific to the Approved Provider Unit, and quality outcome measures that are specific to Nursing Professional Development. The strategic goals submitted should not include goals for orientation, in services or staff development. To differentiate among the terms structure, process and outcomes the following definitions may assist: Structure is defined as the commitment, accountability, leadership and resources of an organization that are required to support the delivery of quality CNE. Process is defined as the development, delivery, and evaluation of CNE activities. Outcomes are defined as the impact of structure and process on the organization as an Approved Provider and the value/benefit to nursing professional development. The following is a list of suggested outcome measures related to the organization and nursing professional development. Organizations may use one or more of these outcome measures or they may identify other outcome measures unique to their organization. Examples of quality outcome measures related to the Approved Provider include, but are not limited to, the following: Cost savings for customers Cost savings for Provider Unit Volume of participants in educational activities Volume of educational activities provided Satisfaction of staff and volunteers Satisfaction of learners Satisfaction of faculty Change in format of CNE activities to meet the needs of learners Change in operations to achieve strategic goals Operational improvements Quality/cost measures Turnover/vacancy for Provider Unit staff and volunteers Professional development opportunities for staff and volunteers Examples of quality outcome measures related to nursing professional development include, but are not limited to, the following: Professional practice behaviors Leadership skills Critical thinking skills Nurse competency High quality care based on best available evidence Improvement in patient outcomes Improvement in nursing care delivery 123

124 Please see Sample OO4A and Sample OO4B for two examples of a list of strategic and measurable goals and a list of quality outcome measures, one for Johnson Case Hospital and the second for the Missouri Psychiatric Nurses Association. In these examples, OO4.1 OO4.3 were addressed all on one response, which is perfectly acceptable to do within the application. SAMPLE OO4A 2012 Goals for Johnson Case Hospital Johnson Case Hospital Approved Provider Unit is committed to the delivery of quality CNE that enhances nursing professional development and has a positive impact on nursing practice. The following strategic goals were identified for the 2013 calendar year: Develop four learner paced modules on pain assessment based on the conceptual framework of mechanism based pharmacotherapy, in an effort to shift from a mainly empirical treatment paradigm toward theory driven treatment procedures. Ensure that all registered nurses demonstrate knowledge of pain concepts using theorydriven treatment procedures. Collect outcome measures for change in practice related to assessment, management and documentation of pain on all nursing units at 3 month, 6 month, and 1 year intervals following the initial course participation. Increase the number of web based learner paced activities by 10% and increase learner access to web based learning by adding 5 new CPU/Monitors dedicated to nursing education. Quality outcomes measures related to Provider Unit Increase the number of web based enduring activities by 10% Ensure that all Nurse Planners and Primary Nurse Planner participate in at least one course in web based teaching and testing methods Increase budget for IT/web design services by 20% Quality outcomes measures related to Nursing Professional Development Ensure that all registered nurses complete Pain modules with 80% or better post test scores no later than December 31, Design enduring activities to measure knowledge in 100% and application in 10% Ensure that all enduring web based activities are accessible by personal communication device by December of

125 SAMPLE OO4B 2012 Goals for Missouri Psychiatric Nurses Association The Missouri Psychiatric Nurses Association is committed to the delivery of quality CNE that enhances nursing professional development and has a positive impact on psychiatric nursing practice. The Approved Provider Unit reevaluates goals annually to ensure the Association is working toward this commitment and successful achievement of quality outcomes. The following strategic goals were identified for the 2012 calendar year: Develop improved survey method of members learning needs Increase the percent of members certified in psychiatric nursing Ensure that new Nurse Planners demonstrate competence in use of ANCC/MONA accreditation criteria Quality outcomes measures related to Provider Unit Nurse Planner and planning committee participate in training on computerized survey design and survey interpretation Vice President (Nurse Planner) and Vice President elect (subsequent Nurse Planner) attend the MONA provider workshop. Bylaws change to ensure that past Nurse Planner remains on planning committee as consultant to current incumbent. Quality outcomes measures related to Nursing Professional Development Certification review for certifying and recertifying members is offered twice in different regions Number of certified members increase by 10% Applicant Note: The next three sections of the Approved Provider application require a narrative explanation of the process the Provider Unit uses to address each criterion, as well as an example of how that process was operationalized. Each narrative must include a specific example that illustrates how the criterion is operationalized within the Provider Unit. The narrative should be clear, concise and describe the process the Provider Unit has developed to address the criteria. Reviewers should understand fully how the Provider Unit operates after reading. The example should describe one instance where the process was implemented or operationalized and is relevant to the Approved Provider. 125

126 APPROVED PROVIDER CRITERION 1: Structural Capacity (SC) The capacity of an Approved Provider is demonstrated by commitment to, identification of, and responsiveness to learner needs; continual engagement in improving outcomes; accountability; leadership; and resources. Applicants will write narrative statements that address each of the criteria under Commitment, Accountability, Leadership, and Resources to illustrate how structural capacity is operationalized. COMMITMENT: The Primary Nurse Planner demonstrates commitment to ensuring RNs learning needs are met by evaluating Approved Provider Unit goals in response to data that may include but is not limited to aggregate individual educational activity evaluation results, stakeholder feedback (staff, volunteers), and learner/customer feedback. Describe and, using an example, demonstrate the following: SC1. The Primary Nurse Planner s commitment to learner needs, including how Approved Provider Unit processes are revised based on data. Interpretation and rationale: This criterion relates to the overall capacity of the Provider Unit operations and how the Primary Nurse Planner commits to ensuring that the needs of the learner are met, and are not specifically limited to the individual activity planning. Applicants should describe how the Primary Nurse Planner demonstrates continual commitment to utilizing feedback from stakeholders (i.e. staff & volunteers), and learners or customers to evaluate the Approved Provider Units goals in response to the feedback. Approved Providers may receive numerous requests for the same or similar information. Or there may be discussion about how to increase the attendance at the activities provided by the Unit, with suggestions such as seeking sponsorship or commercial support to reduce the overall cost to attendees, adjusting the time frame of the activities or offering the activities numerous times to reach nurses depending on their work shift, or offering learner paced activities to reach nurses who continue to struggle taking off work to attend live programs. See Sample SC1A for a description of the process used and an example of that process operationalized. 126

127 SAMPLE SC1A As the Primary Nurse Planner, Mary Jane Doe is committed to meeting the needs of learners who have participated in the Scottsville Community College educational activities and ensuring that our Provider Unit s planning processes, procedures and activity implementation are revised based on data received. Annually Ms. Doe conducts a survey of all learners who have participated in the activities provided by Scottsville Community College in the past 12 months. The survey captures information to evaluate the individual s overall satisfaction with the specific activity as well as any interactions the learner had with Scottsville Community College and staff. As participants register for our educational activities they are asked to provide an address so they can receive updated event information, confirmation of their registration and a receipt for payment if applicable. Staff use the addresses to create a distribution list for the survey. The survey is conducted in late September to be collated and analyzed during the month of October. This allows the data to be used during the October quarterly Unit evaluation meeting as the Provider Unit identifies goals for the coming year. The survey is summarized by Stacy Green, conference coordinator who then presents it to Ms. Doe for review. The survey results are shared with all Nurse Planners, educators and volunteer planning committee members during the monthly staff meeting and again during the October meeting. The group gathers during this meeting to review the survey results, identify trends and opportunities for improvement that the Provider Unit can address in the coming year. The Primary Nurse Planner addresses any concerns with faculty on an individual basis. An example of how the Scottsville Community College used the data received from the learners was when the Unit adjusted the activity registration fees for all activities. The survey results indicated that 73% of respondents believed the registration fees were too high, citing the following reasons: reduced budgets, employers no longer covering or greatly limiting reimbursement of continuing education fees and other more inexpensive educational opportunities in the same geographic area existed. The Primary Nurse Planner, Ms. Doe took this feedback, highlighting the large number of respondents, to the additional Nurse Planners, educators and volunteer planning committee members during the October meeting so that it could be discussed. Additionally, Ms. Doe did a comparison of similar courses and determined that their fees were consistently higher than 10 similar offerings. The Provider Unit agreed that alternatives should be considered. Ms. Doe provided the following options for consideration: 1. seek out commercial support and sponsorship to help defray the costs for the learners; 2. hosting exhibits/vendors to help defray costs; 3. Co provide activities with other health care entities; or 4. eliminate one poorly attended high cost activity to offset a 25% reduction in fees. The Provider Unit Committee reviewed the options presented and determined that they would reduce the fees by 25% and seek out sponsorship/commercial support from community resources to off set costs. Several Unit members were appointed to head up a task force to work on soliciting additional funding to support the activities, whether it is in the form of educational grant funding or exhibitor/vendor funding. All promotional materials would highlight the reduction in registration fees to promote participation. Additional co provider opportunities will be considered for future cost saving efforts. 127

128 SC2. How the organization s leadership is committed to supporting the goals of the Approved Provider Unit. Interpretation and rationale: Leadership and learning play a critical role in enabling organizational growth and transformation and ultimately strategic success. Good strategy identifies an organization s current reality as well as its desired destination what it needs to develop and how it needs to change in order to successfully compete and achieve the objectives of the individual units within the overall organization. This criterion relates to the overall operations of the Approved Provider Unit and not to individual activities. It is important and necessary for the organization to support the work of the Approved Provider Unit through human, material and financial resources in order for the Unit to achieve their goals. To address this criterion, applicants need to describe how the organization s leadership demonstrates their commitment to the support of the Approved Provider Unit. The description should address the following elements 6 : How your organization/company allocates human, material and financial resources for the Approved Provider Unit If the organization supports the Approved Provider Unit s participation in the annual MONA Approved Provider Training, in order to stay up to date on the accreditation guidelines How the organization/company assists the Approved Provider Unit in achievement of their goals and in maintaining their integrity How leadership will abide by ethical business practices including all applicable federal, state and local laws and regulations. See Sample SC2A and Sample SC2B for two descriptions of the process used and an example of that process operationalized. 6 Elements adapted from the Ohio Nurses Association Provider Manual 128

129 SAMPLE SC2A The Director of Education works collaboratively with the provider unit staff annually in reviewing and identifying our staffing, equipment and budget resources as well as additional requests for the following budget year. The Director of Education then meets with the Chief Nursing Officer (CNO) to discuss any needs for the coming year. The CNO sits on the hospital budget planning committee and in this role serves as the advocate for the Provider Unit. The Director of Education and CNO collaborate to identify needs for the Unit and forward them to the budget planning committee for review. The requests for additional staffing, equipment and resources are reviewed in relation to the overall organization s strategic goals and funding resources available for that budget year. On going continuing education is valued within our organization and is part of our strategic plan thus reasonable requests for resources, staffing and equipment are usually funded. Continuing education for our provider unit director, nurse planners and coordinators is valued and planned for in the development of our budget. MONA began hosting the Approved Provider Training for all Provider Unit personnel in Since then it has become an annual event. The Director of Education saw the value this training provided staff in attendance and the improvements it had made to office operations and knowledge of the accreditation guidelines. The Director visited with the CNO to discuss incorporating this training into the annual budget for all Provider Unit personnel. The CNO prepared a request for additional funding in our Unit to support four (4) staff to attend the annual MONA Approved Provider Training, and shared that request with the budget planning committee. The budget committee saw the outcomes from past participation, and the training as an additional continuing education opportunity, and granted the request to incorporate the additional funding into the budget. 129

130 SAMPLE SC2B Operationally, the Approved Provider Unit of Johnson County Hospital Home Care is a component of the Professional Development & Staff Education Department. The Professional Development & Staff Education Department is responsible for the orientation program and educational development of 200 paraprofessional and personal care attendants, and for the orientation program and continuing professional development of approximately 300 registered nurses, as well as continuing needs assessments, program development, implementation and evaluation of staff development activities and continuing nursing education, consultative services to other departments, competency program development, healthcare safety and simulation training and management of leadership education. The leadership of the Approved Provider Unit is led by the Director of Professional Education and supported by four clinical educational specialists, and four administrative support personnel. The Director of Professional Education assumes the responsibilities of the Primary Nurse Planner and accountability for the ongoing continuing nursing education activities of the Provider Unit. Additionally, the Primary Nurse Planner is responsible for the education/ training of nurse planners and ensuring adherence to the ANCC/MONA Accreditation criteria. One example of how our organization supports the Approved Provider Unit is through the ongoing approval of our annual budget that includes the ongoing provisions for 57 continuing nursing education activities over the past year. Annually, for the past 5 years, our Approved Provider Unit has received adequate ongoing financial support that includes the resources of two full time clinical education specialists, and the administrative support of two non nursing personnel who are accountable to the adherence of the policies for the continuing nursing education process. Additionally, all nurse planners must demonstrate practice experience in education and adult learning principles and our organization provides additional compensation for nurse planners who pursue and obtain board certification that further support the goals of the Approved Provider Unit. Additionally, at the support of our organization, our Primary Nurse Planner and one additional Nurse Planner attends the Annual MONA Approved Provider Training each year to ensure that our Approved Provider Unit remains current with the most available information related to the ANCC/MONA Accreditation criteria. Due to the 2013 Accreditation Application changes and clarifications, five additional nurse planners were approved to attend the Annual MONA Approved Provider Training, so that all nurse planners could participate directly. This additional support ensures adherence to the new ANCC/MONA Accreditation criteria. ACCOUNTABILITY: The Primary Nurse Planner is accountable for ensuring that all Nurse Planners and key personnel in the Approved Provider Unit adhere to the ANCC/MONA Accreditation criteria. Describe and, using an example, demonstrate the following: SC3. How the Primary Nurse Planner ensures that all Nurse Planner(s) and key personnel of the Approved Provider Unit maintain adherence to the ANCC/MONA Accreditation criteria. Interpretation and rationale: The Primary Nurse Planner is a currently licensed registered nurse who holds a baccalaureate degree or higher in nursing, and serves as the liaison between ANCC/MONA and the Approved Provider Unit. The Primary Nurse Planner is responsible and 130

131 accountable for establishing a process to ensure that all Nurse Planners and key personnel, who contribute to the overall functioning of the Provider Unit, adhere to the ANCC/MONA Accreditation criteria. It is critical that the Primary Nurse Planner establishes a well defined and structured orientation process outlining the structure and policies and procedures to ensure that all individuals in the Approved Provider Unit are up to date with ANCC/MONA Accreditation criteria. A Nurse Planner is a currently licensed RN with a baccalaureate degree or higher in nursing who is actively involved in all aspects of planning, implementation, and evaluation of each continuing nursing education activity. The Nurse Planner is responsible for ensuring that appropriate educational design principles are used and processes are consistent with the requirements of the ANCC/MONA Accreditation criteria. The Primary Nurse Planner is administratively and operationally responsible for coordinating the process of planning, implementing, and delivering continuing nursing education for the Provider Unit. The Primary Nurse Planner also has authority to ensure compliance with the ANCC/MONA Accreditation criteria in all activities provided. Therefore, the Primary Nurse Planner must ensure that they themselves are kept up to date on the accreditation criteria. There are multiple ways the Primary Nurse Planner stays current with ANCC/MONA Accreditation criteria including, but not limited to: phone conversations with MONA staff; reviewing notifications from MONA regarding criteria changes; visiting the MONA website where applications and instructions are posted; attendance at the annual MONA Approved Provider Training; or consulting with the Nurse Peer Review Leader of MONA. The Primary Nurse Planner ensures that a qualified Nurse Planner is an active participant in the planning, implementation and evaluation process for each continuing nursing education activity provided. A critical step in meeting this criterion is operationalized in how this information is then shared with Nurse Planners and other individuals in the Approved Provider Unit so that it can be implemented in a timely manner and compliance is ensured at all times. The Primary Nurse Planner establishes a structured orientation process to educate all newly qualified Nurse Planners on the accreditation criteria they are to follow in the development of the CNE activities provided by the Approved Provider Unit. The Primary Nurse Planner may keep Nurse Planners and key personnel in the Approved Provider Unit current with ANCC/MONA Accreditation criteria in multiple ways including but not limited to: newsletters outlining/highlighting clarification or changes in criteria; announcements in meetings; postings on internal websites; face to face activities, webinars or other e learning methods, and through Approved Provider Unit education updates. The relevance of updates is dependent upon the frequency of changes in ANCC/MONA criteria or Nurse Planners. This is especially important as new Nurse Planners and key personnel are added to the Approved Provider Unit. There needs to be a clear process in place to orient and educate new personnel to ensure all individuals functioning within the Approved Provider Unit are adhering to the ANCC/MONA Accreditation criteria. The goal is to organize, develop, and deliver consistent, high quality educational activities, which is facilitated when everyone involved in planning educational activities are up to date and adhering to ANCC/MONA Accreditation criteria. 131

132 The Primary Nurse Planner assumes oversight for the quality of the educational activities, including ongoing evaluation of the Approved Provider Unit. See Sample SC3A for a description of the process used and an example of that process operationalized. 132

133 SAMPLE SC3A St. Elsewhere Primary Nurse Planner Responsibility for Nurse Planner Adherence to ANCC/MONA Accreditation Criteria 1. At St. Elsewhere the Primary Nurse Planner is qualified for the role by possessing a current RN license, having at least a baccalaureate degree or higher in nursing, and is knowledgeable of current ANCC/MONA Accreditation criteria. They also act as a liaison between St. Elsewhere and ANCC/MONA staff. 2. The Primary Nurse Planner is administratively and operationally responsible for coordinating the process of planning, implementing, and delivering CNE for the Provider Unit. She also assumes oversight for the quality of the education activities at St. Elsewhere which includes the ongoing evaluation of the Approved Provider Unit. 3. The Primary Nurse Planner is accountable and responsible for establishing a process to ensure that all Nurse Planners and key personnel adhere to the ANCC/MONA Accreditation criteria. At St. Elsewhere, the Primary Nurse Planner has the authority to ensure compliance with the ANCC/MONA Accreditation criteria for educational activities. 4. The Primary Nurse Planner stays current with ANCC/MONA Accreditation criteria with frequent phone conversations with staff at the MONA office and by attending the annual MONA Approved Provider Training. 5. The Primary Nurse Planner meets monthly with the Lead Nurse Planners to discuss/review Approved Provider Unit processes/mona issues and to discuss concerns that arise from Nurse Planners. These meetings also generate content for the announcements and the Approved Provider Unit education updates. 6. The process in place at St. Elsewhere to keep current nurse planners and key personnel up to date with ANCC/MONA Accreditation criteria includes several types of communication methods. Announcements are provided at the monthly Unit Educator meetings, one onone meetings via phone or in person to clarify questions/processes, and at our annual Approved Provider Unit education updates that is required for the Nurse Planners to attend. 7. Nurse Planners are also partnered with an experienced Education Specialist (also known as a Lead Nurse Planner) who works with them to ensure compliance with ANCC/MONA Accreditation criteria. This one on one arrangement has been very successful and has enhanced the knowledge and consistency among the Nurse Planners. 8. A formal process is in place to educate and orient new/novice Nurse Planners to the Provider Unit. 9. When a currently licensed RN requests to become a Nurse Planner or when it is identified that there is a need for additional Nurse Planners, there is a formal process to orient and educate these individuals. A MONA Nurse Planner class has been developed that each new/novice Nurse Planner is required to attend. In addition to attending the class, each Nurse Planner receives their own copy of the latest MONA Provider Approval manual for a resource. On occasion, when an experienced Nurse Planner joins St. Elsewhere staff, it is the discretion of the Primary Nurse Planner to determine if the individual needs to attend the class. If it is determined that the individual does not need to attend the class, then the Primary Nurse Planner meets one on one with the individual to review the ANCC/MONA Accreditation criteria and orient the nurse to St. Elsewhere s policies and procedures. Once the new Nurse Planner attends the class, they are then partnered with an Education Specialist/Primary Nurse Planner as they continue to learn and implement the role of the Nurse Planner. 133

134 SAMPLE SC3A continued An example of how this process is operationalized follows: At St. Elsewhere Hospital, the Director of Education assumes the role of Primary Nurse Planner. As Primary Nurse Planner, she is administratively and operationally responsible for coordinating the process of planning, implementing, and delivering CNE for the Provider Unit. She also assumes oversight for the quality of the education activities at St. Elsewhere which includes the ongoing evaluation of the Approved Provider Unit. By virtue of her position as Director of Education, she has the authority to ensure compliance with the ANCC/MONA Accreditation criteria for educational activities. This past spring the Provider Unit solicited additional Nurse Planners to assist with the educational activities due to an increased workload. An advertisement was placed on the hospital intranet and interested applicants were directed to the Primary Nurse Planner. The Primary Nurse Planner had each interested party complete a biographical data and conflict of interest form to signal their interest in serving. The completed forms were reviewed and verified for accuracy by the Primary Nurse Planner. Two applicants, Ashley and Robert, meeting the eligibility criteria were then enrolled in the MONA Nurse Planner class to begin training. Ashley and Robert were provided copies of the current MONA CE Manual to review and copies of internal forms used to document the requirements for the activities. Following their completion of the training Ashley and Robert met with the Primary Nurse Planner to get them up to speed on the Unit policies and procedures. They were then paired up with two Education Specialists (experienced planner) who will continue the mentoring and training process for a period of six months. Ashley and Robert will participate in the monthly Nurse Planner meetings and where the Primary Nurse Planner will discuss any question or concerns they may be having with the guidelines. During one of the monthly meetings a Nurse Planner questioned the need for presenters to complete a new conflict of interest form for each activity if an activity is being presented numerous times by the same individual. One of our new Nurse Planners spoke up and clarified this for the experienced planner, indicating that the one form only needs to be reviewed prior to each offering to verify that no changes have occurred and that verification documented on the form. There is no need to complete a new form for each offering. The experienced Nurse Planner had missed this change in the past year by being absent for two of the monthly meetings. It was great to see the training process working for the new Planners. The Primary Nurse Planner also noted that she needed to provide a summary of discussion points from the monthly planer meetings to all Nurse Planners via to reach those who may have been absent so everyone is up to date. SC4. How the Primary Nurse Planner is accountable for resolving issues related to providing CNE. Interpretation and rationale: The Primary Nurse Planner has accountability and responsibility to establish a process to identify and resolve issues/concerns regarding CNE for Approved Provider Unit. By virtue of the line of authority outlined in the Primary Nurse Planner position description (OO2.2), the Primary Nurse Planner is given the authority to deal with and resolve concerns/issues to ensure compliance with the ANCC/MONA Accreditation Program criteria. 134

135 There is a clearly defined and outlined communication and reporting structure regarding how issues/concerns are identified, addressed and resolved. The Primary Nurse Planner should think about common questions or situations that may occur in the day to day operations of the Approved Provider Unit and how problems are handled that arise 7. These areas will help the applicant develop the operationalized example required. See Sample SC4A for a description of the process used to resolve issues within the Unit and an example of that process operationalized. See also Sample SC4B for a second sample response to this criterion. SAMPLE SC4A At St. Agnes, the Primary Nurse Planner is the Director of Education and is responsible for establishing a communication structure regarding how issues and concerns are identified, addressed and resolved. By virtue of her role as Director of Education, she does have the authority to deal with and resolve any concerns or issues to ensure compliance with ANCC/MONA Accreditation criteria. A diagram of the structure showing the communication follows: Allied Health CE Planners Administration Provider Unit Key Personnel Primary Nurse Planner (Director of Education) Lead Nurse Planner (Education Specialists in Education Dept.) Lead Nurse Planner (Education Specialists in Education Dept.) Lead Nurse Planner (Education Specialists in Education Dept.) Nurse Planner (Addt l Planners in Organization) Nurse Planner (Addt l Planners in Organization) Nurse Planner (Addt l Planners in Organization) The Primary Nurse Planner meets monthly with the Nurse Planners which provides an opportunity to discuss educational activities, quality indicators/monitors, and issues or concerns that the Nurse Planners may have with the accreditation criteria and planning educational activities. These meetings are beneficial as content for the annual Provider Unit update is identified. 7 Questions adapted from the Ohio Nurses Association Provider Manual 135

136 SAMPLE SC4A continued One example of how the Primary Nurse planner took accountability for resolving issues related to providing CNE activities occurred during the planning of an educational activity for pediatric nurses in the local community. Julie Smith, the Nurse Planner for the Pediatric Nursing Conference, received a commitment from GeneroPharm to support $ toward the conference. Julie planned the activity i.e. fees, meals, etc. based on receipt of that support. During the planning process, July realized that she hadn t received the signed commercial support agreement form from the GeneroPharm representative. When Julie approached the representative to get their signature on the form, the representative refused to sign indicating that they were not allowed to sign documents pertaining to funds. Julie hadn t ever experienced this issue when receiving commercial support or sponsorship in the past therefore she consulted the Primary Nurse Planner at St. Agnes for assistance. The Primary Nurse planner confirmed that in order to proceed and accept the support, the Provider Unit needed to obtain a signed agreement from GeneroPharm. Julie and the Primary Nurse Planner scheduled a call with the representative from GeneroPharm to discuss the ANCC Accreditation Program/MONA criteria requirements related to commercial support. The representative apologized and shared that he had made a mistake and that yes a commercial support agreement was required to be signed by both parties. However, the form developed by St. Agnes could not be used, but rather the letter of agreement developed by GeneroPharm s legal department. The Primary Nurse Planner indicated that to be in compliance St. Agnes would need to see a copy of this letter of agreement to ensure it contained and referenced each of the requirements set forth by the ANCC/MONA criteria. If the requirements were included then the letter of agreement would be acceptable for our guidelines. The appropriate signatures from GeneroPharm were included and a letter of agreement sent to the Primary Nurse Planner for review. Together with Julie the Primary Nurse Planner reviewed the document, confirmed that the required elements were included and signed off on the support. A signed copy was retained for the files and one sent to GeneroPharm for their files. 136

137 SAMPLE SC4B Primary Nurse Resolves Issues Related to Providing CNE As the Primary Nurse Planner, my position in the organization is recognized as the individual accountable for ensuring that all educational activities awarding CNE credit are planned, implemented and evaluated in adherence to accreditation criteria. All Nurse Planners and key personnel who are in the process of planning, implementing or evaluating an activity and have a question or a problem are to bring all issues to me the PNP. In turn, I am accountable for ensuring that any issues relating to providing CNE are addressed and adequately resolved. In the event that I am unable to resolve issues independently, I use the resources within the organization to assist with the resolution process as needed. An example of accountability for resolving issues is described in the following example: Our provider unit was co providing an educational activity with another organization who was a CME provider. During the planning process for the educational activity, the Nurse Planner from our organization discovered that the CME provider had independently selected all faculty for the educational activity, developed the purpose and objectives, and had designed all the marketing materials. They wanted her to sign off on the activity to award CNE credit for nurses. The Nurse Planner knew that this process did not adhere to accreditation criteria but she felt intimidated by other members of the planning committee to sign off. She came to me for advice. I validated that the planning process did not adhere to accreditation criteria and worked with my Nurse Planner to clearly communicate the requirements of a CNE provider to the co provider, the CME provider. I also helped her identify the steps to resolve the lack of adherence, ensuring that the educational activity could still be provided as long as the steps were taken. The Nurse Planner then spoke to the CME provider and outlined the steps that needed to be taken in order for the educational activity to award contact hours. Feedback from my Nurse Planner was positive. The CME provider had not understood the CNE process and was happy that the educational activity could still move forward as long as the Nurse Planner was actively involved in the planning process. This did require some back tracking including sitting down and re vetting the process for selecting faculty, developing the purpose and objectives for the activity, and reviewing marketing materials as well as making changes to the educational activity that ensured the learning needs of nurses would be met. Although it delayed the timeline for the educational activity, both the Nurse Planner and CME provider felt the educational activity was stronger in the end. LEADERSHIP: The Primary Nurse Planner demonstrates leadership of the Approved Provider Unit through direction and guidance given to individuals involved in the process of assessing, planning, implementing, and evaluating CNE activities in adherence to the ANCC/MONA Accreditation criteria. Describe and, using an example, demonstrate the following: SC5. How the Primary Nurse Planner ensures that every Nurse Planner maintains accreditation standards and guides the Planning Committee or team for an individual educational activity. 137

138 Interpretation and rationale: The Primary Nurse Planner ensures that a qualified Nurse Planner provides oversight and is an active participant in the planning, implementation and evaluation process for each CNE activity provided. In addition, the Primary Nurse Planner establishes a process to ensure all Nurse Planners and key personnel in the Approved Provider Unit adhere to the ANCC/MONA Accreditation criteria when planning educational activities. Tools, such as an education activity planning form/worksheet may be developed to aid Nurse Planners in adhering to ANCC/MONA Accreditation criteria. (See Example of Planning Worksheet) The Primary Nurse Planner may also utilize the MONA Provider Approval Manual as an additional resource to educate Nurse Planners. It is recommended that these educational tools be incorporated or that other tools are designed and incorporated into the Nurse Planner orientation process to educate them regarding their role, responsibilities, and duties with regard to each activity they are involved. The Nurse Planners serving the Approved Provider Unit are accountable to the Primary Nurse Planner and take ownership of their role and seek to remain knowledgeable of the ANCC/MONA Accreditation criteria as directed by the Primary Nurse Planner. When planning educational activities, the Nurse Planner is responsible for adherence to ANCC/MONA Accreditation criteria as well as sharing/educating other planning committee members and faculty/presenters/authors to the criteria. The Primary Nurse Planner ensures compliance with the ANCC/MONA Accreditation criteria in all activities provided by the Approved Provider Unit. They are responsible for monitoring and evaluating the performance of each Nurse Planner and other key personnel to ensure accuracy and adherence to the ANCC/MONA Accreditation criteria. Monitoring and evaluation can be accomplished in several ways including but not limited to: conducting audits of Nurse Planner s educational activity documentation; submission of an exemplar from a Nurse Planner of an education activity; observation of the education activity planning process, development, implementation and evaluation; etc. See Sample SC5A and Sample SC5B for two descriptions of the process used to ensure adherence of all Nurse Planners and an example of the process operationalized. 138

139 SAMPLE SC5A At Johnson Case Hospital there is a formal process to orient and educate new Nurse Planners to the organization. When a bachelor prepared, licensed registered nurse requests to become a Nurse Planner or is identified as a potential candidate to become a Nurse Planner, the Primary Nurse Planner meets with the individual to explain the role, responsibilities, and expectations of the Nurse Planner. If the RN wants to proceed, they are scheduled to attend the class, Becoming a MONA Nurse Planner and receive their own copy of the MONA Provider Approval Manual as a resource. Once they complete the class, they are partnered with an Education Specialist/Lead Nurse Planner to continue learning the role of the Nurse Planner as well as to ensure compliance with the ANCC/MONA Accreditation criteria. This one on one arrangement has been very successful and has enhanced the knowledge and consistency among the Nurse Planners. Occasionally, an experienced Nurse Planner will request to become a Nurse Planner in the organization. In this case, the requirement to attend the formal class, Becoming a MONA Nurse Planner, is waived at the discretion of the Primary Nurse Planner. The Primary Nurse Planner meets one on one with the experienced individual to review the ANCC/MONA Accreditation criteria to orient them to Johnson Case s policies and procedures. The Primary Nurse Planner partners with the experienced individual to be a resource. Once new Nurse Planners have completed the class and are partnered with an Education Specialist/ Nurse Planner, there is a formal process to monitor compliance with ANCC/MONA Accreditation criteria. All Nurse Planners (new and experienced) utilize a CNE Worksheet, a tool developed to guide the Nurse Planner in designing and developing consistent, high quality, and effective education activities as well as ensure compliance with Johnson Case Hospital s documentation requirements and ANCC/MONA Accreditation criteria. The CNE Worksheet also functions as a tool for the Nurse Planner to guide and educate the planning committee regarding Johnson Case Hospital s requirements and ANCC/MONA Accreditation criteria. A CNE Audit Tool is utilized to evaluate Nurse Planner compliance and adherence to program design, Johnson Case Hospital s documentation requirements, and ANCC/MONA Accreditation criteria. New Nurse Planners are audited a minimum of four (4) times a year their first year as a Nurse Planner or until competency is demonstrated. All Nurse Planners (new and experienced) are audited a minimum of two (2) times a year and periodically as needed. The CNE Audit Tool has assisted in identifying gaps in knowledge or areas that could be strengthened among Nurse Planners. This information is then discussed among the Primary Nurse Planner and the Education Specialists/Nurse Planners when planning the annual MONA education update for the Nurse Planners. An example of how the Primary Nurse Planner ensured adherence to the accreditation criteria occurred when Rhonda McCullem became a new Nurse Planner for the Unit in the fall of As required, Rhonda completed the class, Becoming a MONA Nurse Planner and was paired up with Monica, another Nurse Planner/Education Specialist who had served in this role for two years. Rhonda shadowed Monica for two activities and then assumed the lead on a third. Nurse Planners/Education Specialists utilize the CNE Worksheet, a tool to promote adherence and document all educational design criteria for the activities provided. Rhonda completed the forms and led the planning committee through the entire process. Monica noted that Rhonda had picked up on the guidelines quickly and was excited to work with her. Following the collaboration with Monica and Rhonda, and Rhonda s leadership role on the final activity, the Primary Nurse Planner conducted her quarterly review of new Nurse Planners to ensure competency and utilized the CNE Audit Tool to determine their compliance to the guidelines. Remediation was initiated in areas as necessary. 139

140 SAMPLE SC5B SC5A continued The Primary Nurse Planner ensures that every Nurse Planner maintains the accreditation ensure adherence. Utilizing the CNE Audit Tool, the Primary Nurse Planner audited the three standards for continuing nursing education and guides the planning committee. The Primary activities Monica and Rhonda had planned the previous quarter. During that review the Nurse Planner provides orientation training for every new Nurse Planner using the MONA CE Primary Nurse Planner noted one item that was consistently incorrect. The combination Manual as a guide for orientation. All Nurse Planners are provided electronic access to the biographical data and conflict of interest forms were not being co signed by the Nurse MONA CE Manual, CE Planning Form, and Policies of the Provider Unit. Orientation of all Planner. Neither the seasoned nor the new Nurse Planner was reviewing the bio/coi and Nurse Planners includes the completion of the following components: signing off to its accuracy. The Primary Nurse Planner conducted further audits into the files from 1. other Review Nurse of the Planners MONA CE noting Manual that and several Provider others Unit Policies were also not addressing this requirement. 2. Completion of the following e learning modules: i. Completing a Needs Assessment The Unit hosts an annual training of Nurse Planners; however, that training was not scheduled ii. Principles of Adult Learning Principles for several more months and the Primary Nurse Planner felt this omission in the iii. Writing Measurable Outcomes documentation warranted a special called meeting. All Nurse Planners were gathered to iv. Identification & Resolution of Conflict of Interest discuss proper completion of the bio/coi form and the Nurse Planner s role. The Primary v. Developing Effective Evaluation Forms Nurse Planner also updated the CNE Worksheet to include a specific checklist item related to vi. Assessment & Planning Educational Activities the Nurse Planners review of each bio/coi, in an effort to further educate and decrease the vii. Completing Educational Design Tool number of errors. The Primary Nurse Planner has been pleased with the decrease in errors viii. Completing the Post CE Audit Tool since that discussion. ix. Using Survey Monkey for Post Participation Follow Up 3. Successful Completion of 3 CE Planning Forms prior to participating as a Nurse Planner for a CE Activity. Please see the sample CNE Audit Tool used to document Nurse Planner adherence. Recently, the Primary Nurse Planner created e learning modules that demonstrate completion of forms used by the Approved Provider Unit to ensure that all Nurse Planners are consistently utilizing and completing the forms associated with the continuing nursing activities. After the Primary Nurse Planner completes the overview of the MONA CE Manual, the new Nurse Planner must complete the e learning modules (previously noted) designed to foster consistency in using standardized tools. The e learning modules are to be completed at the learner s own pace during orientation; however, Nurse Planners may not participate in the planning or implementation of a continuing nursing education activity until successful completion has occurred. 140

141 SC6. How the Nurse Peer Review Leader of the Accredited Approver Unit (MONA) is used as a resource by the Primary Nurse Planner and/or other Nurse Planner(s) in the Approved Provider Unit. Interpretation and rationale: The Primary Nurse Planner utilizes the Nurse Peer Review Leader (NPRL) of the Accredited Approver Unit as a resource to interpretation of criteria as well as to ensure compliance/adherence to the ANCC/MONA Accreditation criteria. This is accomplished through utilizing but not limited to the following: and phone calls with MONA staff and NPRL; attendance at the annual MONA Approved Provider Training; participation in training webinars presented by the NPRL, etc. The applicant should evaluate the Approved Provider Unit operations related to this criterion. They should ask themselves how and when would the NPRL or designated representative be contacted i.e. have there been any occasions where they have had to contact this individual. They should also determine if there have been any resources designed by the NPRL that have helped your Unit with operations such as notifications, calls, update/training activities, newsletter, website materials, etc. 8. Recalling a time when they have contacted the NPRL will assist applicants in responding to the operationalized example required. See Sample SC6A for a description of how the NPRL is used as a resources and an example of that process operationalized. SAMPLE SC6A The Primary Nurse Planner at St. Agnes utilizes staff at the MONA office and the Nurse Peer Review Leader to ensure Approved Provider Unit compliance with ANCC/MONA Accreditation criteria. Methods utilized to communicate with the MONA office include s and phone conferences. The Primary Nurse Planner or designee attends the annual MONA Approved Provider Training, where they are able to learn from the Nurse Peer Review Leader about changes in the criteria and in discussions surrounding how to implement the guidelines within our Approved Provider Unit. The Nurse Peer Review Leader also provides us with her contact information including address and phone number to consult her when questions of a particular interesting nature arise. These methods assist with our Provider Unit with staying up to date with current accreditation criteria as well as providing an opportunity to clarify questions/concerns. Hospital administration of St. Agnes Hospital approached the Nursing Education Office about awarding nursing contact hours for the upcoming implementation of hospital wide electronic health record (EHR) training. The Primary Nurse Planner understood that there are elements of the electronic health record education that would be appropriate for CNE, but did not feel certain enough to combat the pressure from hospital administration. The Primary Nurse Planner obtained the content administration would like to cover and contacted the MONA Office for assistance. The Primary Nurse Planner visited with the MONA CE Coordinator at length. The CE Coordinator then contacted the MONA Nurse Peer Review Leader (NPRL) to help evaluate the content and address the issue with the Approved Provider. They discussed the content, how it should be structured to demonstrate the benefits the information has to nursing practice rather than simply how to create a note or chart a visit, and the Primary Nurse Planner felt more comfortable visiting with hospital administration and the other education departments to design an activity that would meet the definition of continuing nursing education and also meet the needs of the other disciplines in the hospital. 8 Questions to ponder adapted from the Ohio Nurses Association Provider Manual 141

142 RESOURCES: The Primary Nurse Planner advocates for and utilizes available human, material, and financial resources to ensure that the Approved Provider Unit achieves its goal of meeting identified quality outcome measures. Describe and, using an example, demonstrate the following: SC7. How the Primary Nurse Planner advocates for resources to ensure that the Approved Provider Unit achieves its goals related to quality outcome measures. Interpretation and rationale: One of the responsibilities of the Primary Nurse Planner is to ensure that the Approved Provider Unit has adequate resources to support their activities and achievement of goals. Applicants should describe the process the Primary Nurse Planner uses to advocate for resources to support the Approved Provider Unit. This description should address how the organizational structure and lines of authority are used, if the Approved Provider Unit has a budget and whether or not the Primary Nurse Planner has input into the budgeting process. For example, has the Unit required updated AV equipment to facilitate the educational activities or additional and/or change in personnel to service the Unit? If so, then how has the Primary Nurse Planner requested/advocated for resources to satisfy these needs? These are all areas the applicant must address in their response to this criterion. Recalling a need where they have utilized and initiated this process will assist applicants in responding to the operationalized example requirement. The Approved Provider should have sufficient human, material, and financial resources to support their operations and continuing nursing education activities they provide. Human resources include administrative staff, educators, Nurse Planners and other key personnel assisting the Provider Unit in operations. Educational and experiential qualifications must be documented for all Approved Provider personnel that appear in the description and organizational chart of the Approved Provider (Organizational Overview: Structural Capacity, OO2). Position descriptions must be submitted for each position including staff, volunteers, and/or consultants describing qualifications, authority, and responsibility. The position descriptions must reflect qualifications requirements for the Nurse Planner(s) and roles relative to continuing nursing education that are consistent with those of the ANCC/MONA Accreditation criteria. The Approved Provider must identify by name and credentials the Primary Nurse Planner and Nurse Planner(s). The educational qualifications of the Nurse Planner(s) must be documented clearly and concisely using MONA s combination biographical and conflict of interest form, a narrative sketch or a brief CV. Experiential qualification should be described in sufficient detail to provide evidence of the Nurse Planner s ability to plan, implement, and evaluate nursing continuing education activities. The human/personnel resources should be appropriate for the size and scope of the Approved Provider Unit. For example, a district nurses association providing four (4) activities a year may operate well having a single Nurse Planner who is a volunteer and spends an average of two days a month on Approved Provider Unit activities, and who is supported by a part time administrative assistant who spends 20% of her time on Approved Provider Unit activities. If the Approved Provider is part of a large company organization and provides many print, electronic and on site activities each year, but the application identifies a single Nurse Planner and very 142

143 limited support staff, MONA peer reviewers would question the ability of such a provider to operate according to ANCC/MONA Accreditation criteria and provide quality educational activities. In a large Approved Provider Unit, a CNE coordinator or administrative assistant(s) may have an important role in the Approved Provider s full range of functions, including an important role including managing contracts with resources, conference meeting facilities, audio visual equipment and printers, arranging for tabulating activity evaluations and other data as required by the evaluation plan, and ensuring that records whether electronic or paper, are maintained according to ANCC/MONA Accreditation criteria. Position descriptions should reflect the responsibilities assigned to each Approved Provider Unit staff/personnel member, and functions. The Primary Nurse Planner will ensure there are adequate personnel to support the Provider Unit activities. If the Unit requires additional staff the Primary Nurse Planner will use the lines of authority above him/her to fill the void. The Approved Provider should also document their material resources that support their operations and achievement of goals. Material resources include meeting room space, filing and storage, computer equipment, in house printing, audio visual services and equipment, food service and simulation laboratory equipment for skills training. The Approved Provider should describe the Unit s sources of financial support to clearly explain how they are supported financially throughout their approval period. It is important to demonstrate continuing financial viability and the parent organization s commitment to support the Approved Provider Unit. Occasionally the Approved Provider Unit may experience disconnect between the resources available and the resources required for them to achieve their annual goals. The Primary Nurse Planner must demonstrate how they will advocate for the necessary resources to reach their goals. This includes petitioning upper management for an increase line item in the budget, requesting equipment or staff needed to service the CNE activities, and purchasing supplies to better equip the Unit for the activities provided. See Sample SC7A for a description of how the Primary Nurse Planner advocates for resources and an example of that process operationalized. 143

144 SAMPLE SC7A Mission Hospital of Missouri is a moderate sized facility with a strong focus on providing quality patient care through continuing nursing education programs. The education department consists of one Primary Nurse Planner (PNP), an administrative assistant, two additional RNs, and one part time volunteer. The PNP also serves as the Education Director at Mission Hospital. Annually the PNP reviews the resources available to the Provider Unit to ensure they are adequate to meet their needs and goals. Mission likes to offer four off site CNE programs and monthly in house CNE programs for staff. In order for the Provider Unit hospital to provide quality programs, the PNP meets with department managers quarterly to assess learning needs and determine if the Unit has adequate resources to meet the needs. The PNP also meets with Provider Unit personnel annually to explore financial resources needed for the coming year as well as projected future needs such as: administrative services, personnel, speaker s expenses, technological equipment, printing/copying services, food, and facility accommodations. The Primary Nurse Planner (PNP) is committed to the mission of the Provider Unit and their continuous quality improvement plan. They will ensure the Unit has sufficient human, material, and financial resources to support their operations and continuing nursing education activities they provide. Annually the PNP will develop and submit a budget request to the Chief Nursing Officer (CNO) for review and approval. The annual budget amounts are released in October of the previous year (e.g. October 2012 for the 2013 calendar year). In the event the needs and goals of the Approved Provider Unit are greater than the resources provided, the PNP will submit a request to the CNO for additional resources, whether they need additional staff, equipment or supplies, or access to adequate meeting facilities. The CNO reviews the request and will respond to the PNP within 30 days. Mission Hospital, the CNO, and Clinical Directors fully support the Approved Provider Unit and the continuing nursing education activities they provide. They demonstrate this through continuously funding the work of the Unit and supporting the overall CNE program. An example of this process operationalized is described below: Mission Hospital seeks to provide four off site CNE programs to meet the needs of nurses in the community and foster continued relationships with area health care facilities without an ongoing, consistent CNE program of their own. As these activities grow in size and seek to meet the needs of more nurses the planning committees for each event began offering a larger variety of sessions requiring more meeting space and support. The Primary Nurse Planner (PNP) conducted their annual evaluation meeting of their events from the current year and learned there were needs among the Unit to address. Balance sheets were reviewed for each activity and it was noted that audio visual expenses had increased by 50%. This was directly due to the need for increased LCD projectors, screens, microphones, etc. for the concurrent sessions the Hospital began offering to reach a larger audience. Unit staff compared the costs to rent versus buy their own equipment. It was determined that it would be more cost effective to purchase additional audio visual equipment rather than continue to rent for the off site events. The need for this additional equipment was determined after the Hospital had released the budget for the coming year. Therefore the PNP and the administrative assistant prepared a request to send to the CNO for approval of additional funds to purchase the necessary audio visual equipment. The Unit only requested funds to support the purchase of 3 LCD projectors. Microphones are difficult to use depending on the sound system of the venue, and screens are far too bulky to travel with. LCD projectors are compact yet present the highest costs to the activity. Therefore the Unit determined the best purchase would be the LCD projectors. They outlined the purchase and provided their rationale in the request. The CNO reviewed the request and concurred that it would be cost efficient to purchase the additional equipment to support the off site activities. 144

145 APPROVED PROVIDER CRITERION 2: Educational Design Process (EDP) The Approved Provider Unit has a clearly defined process for assessing educational needs as the basis for planning, implementing, and evaluating CNE. CNE activities are designed, planned, implemented, and evaluated in accordance with adult learning principles, professional education standards, and ethics. Examples for the narrative component of the provider application (EDP 1 13) may be chosen from, but are not limited to, those contained in the submitted activity files. All elements should have a corresponding narrative response, unless otherwise specified in the criterion, showing Approved Provider adherence. Evidence must demonstrate how the Approved Provider Unit complies with each criterion. Each narrative must include a specific example that illustrates how the criterion is operationalized within the Provider Unit. The narrative should be clear, concise and describe the process the Provider Unit has developed to address the criteria. Reviewers should understand fully how the Provider Unit operates after reading. The example should describe one instance where the process was implemented or operationalized and is relevant to the Approved Provider. ASSESSMENT OF LEARNING NEEDS: CNE activities are developed in response to, and with consideration for, the unique educational needs of the target audience. Describe and, using an example, demonstrate the following: EDP1 The Nurse Planner s methods of assessing the current learning needs of the target audience. Interpretation and rationale: The Approved Provider must document processes used to plan educational activities that are consistent with ANCC/MONA Accreditation criteria, based on assessed needs, and appropriate to learners. A needs assessment is a systematic approach to identifying knowledge gaps and determining possible opportunities for supporting the professional growth of the target audience. CNE activities are developed in response to, and with consideration for, the unique educational needs of the target audience. Frequently, the need for the activity is evident because a formal needs assessment has been previously carried out. But there are a variety of ways to carry out a needs assessment. Needs assessments can be conducted using a variety of methods that may include but are not limited to: Annual needs assessment of members or staff Surveying stakeholders, target audience members, subject matter experts or similar Requesting input from stakeholders such as learners, managers, or subject matter experts Reviewing quality studies and/or performance improvement activities to identify opportunities for improvement Reviewing evaluations of previous educational activities Reviewing trends in literature, law, and healthcare Reviewing evaluation summaries 145

146 Requests from learners or management Organizational initiatives The Approved Provider must determine the appropriate vehicle to assess the needs of their constituents. Assessment data is evaluated by the Nurse Planner and Planning Committee and is used to validate the need for each educational activity. Assessment data is used to identify and validate a gap in knowledge, skills or practice that the educational activity is designed to improve or meet. See Sample EDP1A for a description of the methods used to assess the needs of the target audience and an example of that process operationalized. SAMPLE EDP1A Needs in the Johnson Hospital are determined in a variety of ways. The methods may vary depending on variables such as access to the target audience, time and/or resources required to access data about learning needs for a particular audie3nce, and whether specific data for a target audience exists. Nurse Planners from our Provider Unit have used methods such as surveying learners prior to the educational activity, looking for gaps in practice as identified in literature in peer reviewed journals, and evaluating feedback from previous educational activities. An annual needs survey is conducted throughout the hospital to determine the needs among the facility including those identified by administration, management and other disciplines beyond nursing. The four clinical specialists who serve as Nurse Planners for nursing continuing education are also responsible for collecting needs assessment data from their assigned nursing service areas, and using the data to plan continuing nursing education activities. These individuals report to the Primary Nurse Planner. Additionally, the CNE advisory council, a group of 10 nurses from staff, management and administrative positions, is elected for two year terms. The CNE advisory council is part of the Approved Provider structure, and provides input and expertise to the Nurse Planners and Primary Nurse Planner. Data from the nursing service areas are summarized and shared at the monthly meeting of the CE council. Data from the annual needs survey is summarized and discussed during the October meeting of the CE Council and at the goal setting meeting of the Provider Unit. Nurse Planners collaborate with nursing unit managers to analyze unit quality assurance data that indicate a need for continuing nursing education. The data are shared at the monthly meetings of the CE council. Evaluation data from activities that have been implemented is brought to the CE council and discussed to determine if activities should continue to be offered in their present form, changed, or discontinued. The Nurse Planners with the CE council identify a CNE calendar of activities six months prior to the month in which the activities will be presented. When new topics are identified, one Nurse Planner and another member of the CE Council who is familiar with the topic area determine whether the target audience will be novice or experienced nurses, and which nursing units may benefit from continuing nursing education on the topic. 146

147 SAMPLE EDP1A continued One example of the method used by one of our Nurse Planners to assess the needs of a target audience of advanced practice nurses (APRNs) was to review the facility needs survey, design a specific survey for the APRNs in the hospital and also to conduct a search of psychiatric journals. The APRN targeted survey results indicated that 80% of the group rated the assessment and management of depression in the primary care setting as a priority need and rated a web based activity as the preferred delivery format. The Nurse Planner enlisted the assistance of the CE Council to research articles in journals and find/develop case studies to address the gap in knowledge for the APRNs in the area of depression. The CE Council developed the goals for the activity and suggested objectives and resources for the content to the content specialist. The identified content specialist Jack James, RN, MSN, MHCNS, Mental Health Clinical Nurse Specialist refined the objectives and developed the content, case studies, and bibliography on the best available evidence. He consulted The American Journal of Psychiatry for up to date information on the assessment and management of depression and used the information found to develop the educational activity. Two separate activities were developed Screening for Depression in Primary Care and Management of Depression: To Refer or Not to Refer using articles and resources from the American Psychiatric Association and related journals. The activities were designed as learner paced activities online through hospital s learning management system. The CE Council, Nurse Planner, and content specialist developed a posttest requiring 85% correct responses for completion. Five nurses volunteered to pilot test the activity to determine the number of contact hours to award. Participants were informed of the required hardware and software capabilities, provided with step by step instructions for logging in, listening to the lectures, accessing and downloading the case studies and taking the posttest and completing the evaluation online. EDP2 How the Nurse Planner uses data collected to develop an educational activity that addresses the identified gap in knowledge, skills, and/or practice. Interpretation and rationale: The Nurse Planner must have a process in place to use the needs assessment data to address the identified gap in knowledge, skills, and/or practice e.g. where learners currently are and where they need to be. Assessment data is used by the Nurse Planner to identify and validate a gap in knowledge, skills or practice that the educational activity is designed to improve or meet. Activities to address the gap should also help to improve nursing practice and nursing professional development. See Sample EDP2A for a description of how the Nurse Planners uses needs assessment data to address gaps and an example of that process operationalized. 147

148 SAMPLE EDP2A Identifying a gap in knowledge, skills and/or practice has been a challenge for our Nurse Planners, as a review of our activities over the past 2 years reflected that we historically did not do a very good job identifying and/or documenting any gap but rather focused on perceived need for an activity based on needs assessment data alone (i.e. we did not connect the needs assessment data to a gap in knowledge, skills and/or practice to the development of the activity). The Nurse Planner team met in January this year to re assess our current level of knowledge related to using data to identify a gap (i.e. what type of data should we be collecting, what is feasible to collect, and strategies to conduct needs assessments), and develop a better method of connecting the needs assessment data to the identified gap in our planning process. We engaged one of our faculty as a facilitator for the meeting. As a result, we are now using a Gap Analysis Tool that Sally Smith had used in her previous place of employment. This tool requires us to describe the following for each educational activity: current level of practice for the intended target audience, desired level of practice, identified gap in knowledge, skills and/or practice, the purpose of the activity, and the outcome measure used to evaluate the activity (see Tab D for the tool). An example of this process in action can be described in how the educational activity, Communicating with Adolescents, was planned. Sally Smith, through reading pediatric literature and through networking with her colleagues in the pediatric community, was concerned that current practitioners in this area failed to consider electronic communication with adolescents as a method of engaging them in their own health promotion. She requested and was granted permission to distribute an electronic survey through the local chapter of pediatric nurses to validate her information. Approximately 150 pediatric nurses and nurse practitioners were sent the survey and 38 responded, resulting in a response rate of ~25%. Survey results revealed that only 10% of practitioners used electronic communication with their patients. Sally then used the Gap Analysis Tool to document her findings and plan her activity. She identified the current level of practice as 10% of practitioners use electronic communication. She chose to set the desired state of practice as 50% for this activity. She engaged the planning team to discuss the gap. The planning team, with expertise in the area of adolescent practice, felt that practitioners were not aware of the evidence that electronic communication was a source of providing information to adolescent patients and there was some literature that demonstrated it was an effective method. So, this was identified as a gap in knowledge. The planning committee also considered gaps in skills and/or practice, but since most practitioners were between 30 and 50 years old, the planning committee felt they knew how to and could communicate electronically (through text messaging and similar) but had not thought of using it with this population. Reference: American Nurses Credentialing Center s Standardized Self Study Application for Training. 17 September PLANNING: The planning for each educational activity must include one Nurse Planner and one other planner. One of the planners must have appropriate subject matter expertise for the educational activity. Describe and, using an example, demonstrate the following: 148

149 EDP3 The process used to select a planning team/committee for an educational activity, including why an individual member was chosen. Interpretation and rationale: Planning Committees must have a minimum of one Nurse Planner and one other planner to plan each educational activity. It is the Primary Nurse Planner s responsibility to ensure that a qualified Nurse Planner is actively involved in all aspects of planning, implementation, and evaluation of each CNE activity. This Nurse Planner is knowledgeable about the CNE process and is responsible for adherence to the ANCC/MONA Accreditation criteria. One planner also needs to have appropriate subject matter expertise for the educational activity being offered. The process of how an activity is planned, organized and provided ensures the delivery of highquality activities and the overall success of the activity. The content, knowledge, and skills needed to ensure the delivery of high quality activities is the responsibility of the Approved Provider Unit. The Primary Nurse Planner must document the expertise and the role of each person involved in the planning of an educational activity. The Planning Committee will examine the education and experience of the planner for appropriate expertise. The information should demonstrate how the committee member contributes to the Planning Committee. A committee member may have some content experience or experience planning programs. For example, a group of diabetic nurse educators may want to plan an activity focusing on nursing care of diabetic patients and new therapeutic interventions. At least one of the planning committee members should have previous experience in planning educational activities. That activity might have been a continuing education program, an in service program, or previous programming activities with the group of diabetic educators. While formal education or experience in nursing education is not critical, it is desirable to have planners who are involved in nursing education since they can be a valuable resource in developing the educational design of the program. One or more members of the planning committee should have some knowledge about caring for diabetic patients. The Nurse Planner is responsible for ensuring completion and review of the biographical data and conflict of interest forms by each Planning Committee member and each faculty/presenter/author to ensure appropriate qualifications and evaluation of actual or potential bias. Faculty/presenters/authors must have documented qualifications that demonstrate their education and/or experience in the content area they are developing or presenting. Expertise in subject matter may be evaluated based on characteristics such as education, professional achievements and credentials, work experience, honors, awards, professional publications, or similar. The qualifications must address how the individual is knowledgeable about the topic and how the individual gained that expertise. The Planning Committee, during the planning process, may also identify an individual(s) who functions as content reviewer(s). If additional individuals, such as faculty, presenters, or authors, will be creating or delivering content for the educational activity, Planning Committee members must identify the needed qualifications of the individual chosen. See Sample EDP3A for a description of the process used to select the members of activity planning committees and an example of that process operationalized. 149

150 SAMPLE EDP3A In our Provider Unit, the schedule of educational activities for the upcoming calendar year is finalized during our strategic planning session held in October annually. The schedule of events is modified during the year as needed based on evaluation feedback, budget constraints or current needs assessment data. Once the schedule of events is finalized, the Primary Nurse Planner assigns a Nurse Planner to each activity. The Nurse Planner assignments are made based on the individual s expertise in the general content area, but may also be assigned based on interest or geographic coverage area. Each Nurse Planner is responsible for selecting the planning team for their respective activity. The goal is to have a Nurse Planner, administrative support, representatives of the target audience and subject matter experts involved in the planning of each activity. The Nurse Planner determines the skills and expertise that will be needed to participate in the planning of the activity. Such skills and expertise may include but are not limited to: Content experts in the subject area Administrative support Partnering organization(s) Speakers/presenters Logistics support (marketing, scheduling sites) Other disciplines Members of the target audience Other Nurse Planners Based on the skill and expertise needs, the Nurse Planner begins to recruit the planning committee. The Nurse Planner may use data such as resumes/cvs, previous evaluations, drawing upon previous planners, personal invitation, recommendations from colleagues, and/or publications of authors/speakers/presenters to choose an individual member. One example of this selection process occurred during the Provider Unit s strategic planning session, when the need was identified for additional educational activities addressing the new pharmacology requirements for advanced practice nurses. The Unit decided to host at least two events or quarterly webinars to address the need. The Primary Nurse Planner assigned two Nurse Planners who were advanced practice nurses to these activities. The Nurse Planners reviewed the needs assessment data and gap analysis tools to determine the topics to be covered. They also visited the national certification bodies to determine the content requirements that would need to be met to qualify as acceptable education to satisfy the new certification requirements. They identified four content areas to cover during the education and opted to develop four webinars to meet the needs of the APRNs in the organization. Because of the number of activities and the content, they determined they would need additional planning committee members to assist with the activities. They identified the need for assistance with marketing, webinar software usage, and administrative support i.e. registration. They also needed planners with expertise in the areas of diabetes, hypertension, dermatology and immunizations. The Nurse Planners sought out recommendations from various areas of the hospital to identify individuals with appropriate expertise. They also perused the current Nurse Planner pool to determine that they had a diabetes educator and a dermatology nurse practitioner whose expertise they could utilize. The Nurse Planner ensured completion and review of the biographical data and conflict of interest forms by each Planning Committee member and each faculty/presenter/ author to ensure appropriate qualifications and evaluation of actual or potential bias. The Nurse Planners ensured that a subject matter expert was involved and also included a PharmD in the mix and began planning the pharmacology webinar series. 150

151 SAMPLE EDP3A continued A second example of the selection process for the planning committee is as follows: Midwest Hospital System is planning a one hour continuing nursing education program on Updates in Contraception. The Primary Nurse Planner identified a staff nurse in the OB Department to serve as the Nurse Planner. This individual has also planned and organized several continuing education activities for the Provider Unit in the past. The Primary Nurse Planner also identified the need for at least two additional planning committee members. The Primary Nurse Planner worked with the Nurse Planner for the activity to review work affiliation, planning participation in other activities, qualifications, educational background, and experience of potential candidates. She also sought out recommendations from the OB Unit in the hospital for qualified nurses. The Nurse Planner selected one RN, BSN, who is a current student in a master s degree program, with five years work experience on a labor and delivery unit. And another RN, who has served on continuing education Planning Committees for both Midwest Hospital System and with a local pediatric nurse chapter in the community. These were both individuals who had served as planners for previous activities. Therefore, the Primary Nurse Planner ensured both members of the Planning Committee were up to date on ANCC/MONA criteria and had completed the biographical data and conflict of interest form to verify their current qualifications and experience. EDP4 The process used to identify all actual and potential conflicts of interest for all members of the Planning Committee, faculty, presenters, authors, and content reviewers. Implementation & Rationale: The Nurse Planner is responsible for ensuring that all individuals who have the ability to control or influence the content of an educational activity disclose all relevant relationships with any commercial interest, including but not limited to members of the Planning Committee, faculty/presenters/authors, and/or content reviewers. Relevant relationships must be disclosed to the learners during the time when the relationship is in effect and for 12 months afterward. Conflict of interest forms shall be obtained from all activity planners and faculty/presenters/authors to identify the presence or absence of any potentially biasing relationship of a financial, professional, or personal nature on the part of those who have an impact on the content of an educational activity. Planners and faculty/ presenters/authors must disclose the presence or absence of conflict of interest relative to each activity. Any information disclosed must be shared with participants/learners prior to the start of the educational activity. See Sample EDP4A for a description of the process used to identify conflicts of interest and an example of that process operationalized. 151

152 SAMPLE EDP4A The process of evaluating for actual or potential conflicts of interest for members of the planning committee, faculty/presenters/authors, and/or content reviewers is found in our organizational policy and included in the Appendix under Tab F. The Primary Nurse Planner, Nurse Planners and key personnel, as well as their spouses and/or significant others must disclose their relationships with commercial interests. Provider Unit personnel complete a bio/coi form annually for review. The Primary Nurse Planner s form is reviewed by another Nurse Planner from the Unit, and all other forms are reviewed by the Primary Nurse Planner to evaluate potential conflicts. All relationships are listed on our strategic planning worksheet used in the coming year when assigning Nurse Planners to particular activities. This ensures that an individual is not assigned to an activity that would impose an actual or potential conflict. The Nurse Planner for each educational activity is responsible for ensuring that any actual or potential conflicts of interest are identified and resolved in the planning phase of the activity. The Nurse Planner reviews the bio/coi for each planner and presenter and confirms that no changes have occurred in the information listed. Any potential conflicts of interest are identified by the Nurse Planner and evaluated using the following process: The Nurse Planner is responsible for evaluating whether any disclosed relationship with a commercial interest organization is considered relevant to the content of the educational activity. Disclosures are categorized as: 1. No relevant relationship with a commercial organization exists. No resolution required. 2. Relevant relationship with a commercial interest organization exists. The relevant relationship with the commercial interest organization is evaluated by the Nurse Planner and determined to not be specific to the content of the educational activity. No resolution required. 3. Relevant relationships with a commercial interest organization exist. The relevant relationship is evaluated by the Nurse Planner and determined to be specifically related to the content of the educational activity. In addition, when the educational activity is presented, the Nurse Planner or her designee monitors for any actual or potential conflicts of interest that may arise. All activity evaluation forms (see example included in the Appendix under Tab G and in each educational activity submitted as Attachments A, B and C) include an item where learners can report any bias, conflict of interest, or any other concern that should be brought to the attention of the planning committee. An example of how the process of evaluating for an actual or potential conflict of interest is described below: Our organization was planning an educational activity on the treatment of asthma in the pediatric patient. The Nurse Planner completed a conflict of interest form and declared that she had no actual or potential conflict of interest related to the content of the educational activity. The Lead Nurse Planner of our organization reviewed the form to ensure that there was no COI and signed off on the form in the space for the reviewer. The Nurse Planner then asked everyone on the planning committee to complete a COI form. Our COI form is found in the Appendix under Tab E. The Nurse Planner reviewed each COI form and signed off in the space for the reviewer. No COI was declared by any member of the planning committee. The planning committee then identified an expert in the field of pediatric asthma from the local children s hospital. The expert agreed to present for the educational activity. When the expert completed the COI 152

153 SAMPLE EDP4A continued form, it was identified that the expert declared relationships with three pharmaceutical companies. The Nurse Planner reviewed the COI form and determined that one of the pharmaceutical companies made an asthma medication for pediatric patients. The Nurse Planner and planning committee met to discuss whether the expert had an actual or potential conflict of interest. The Nurse Planner and planning committee determined that the relationship declared by the expert was relevant to the content of the educational activity and that resolution would be required to ensure that the activity was presented without bias to the learners. The options for resolution were reviewed by the Nurse Planner and planning committee members and they included: 1. Removing the individual with conflicts of interest from participating in all parts of the educational activity. 2. Revising the role of the individual with conflicts of interest so that the relationship is no longer relevant to the educational activity. 3. Not awarding continuing education contact hours for a portion or all of the educational activity. 4. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence based content or other indicator of integrity, and absence of bias, AND monitoring the educational activity to evaluate for commercial bias in the presentation. 5. Undertaking review of the educational activity by a content reviewer to evaluate for potential bias, balance in presentation, evidence based content or other indicator of integrity, and absence of bias, AND reviewing participant feedback to evaluate for commercial bias in the activity. Because the expert from the pediatric hospital was considered a leader in the field of pediatric asthma, the Nurse Planner and planning committee felt that it was important that the target audience had the benefit of hearing his presentation. At the same time, they knew that they had to implement a process to resolve the COI. They chose to implement resolution process #4 as outlined above. First, they spoke to the expert and provided him with a copy of the speaker guidelines developed by the organization (see Appendix under Tab H). They asked the speaker to submit his slides 2 weeks prior to the presentation so that they could be reviewed by a content reviewer. Because the Nurse Planner and planning committee members were not experts in the field of pediatric asthma and therefore could not effectively review the content for potential bias, the Nurse Planner and planning committee identified a content reviewer to review the slides. Before the content reviewer reviewed the presentation, she submitted a COI form which was reviewed by the Nurse Planner. No COI was declared by the content reviewer or identified by the Nurse Planner. The content reviewer reviewed the presentation and the content was found to be evidence based and according to accepted clinical guidelines. In addition, all drug names referenced in the presentation were generic. The content reviewer signed off on the presentation as acceptable. During the presentation by the expert, the Nurse Planner remained in the audience to ensure that the expert did not deviate from the presentation and introduce bias into the activity. No bias was identified and the speaker was well received. The Nurse Planner documented her findings for the activity file. 153

154 EDP5 The process for resolution of an actual or potential conflict of interest and the outcome achieved. Interpretation and rationale: The Nurse Planner is responsible for evaluating the presence or absence of conflicts of interest and resolving any identified actual or potential conflicts of interest during the planning and implementation phases of an educational activity. The Nurse Planner is also responsible for evaluating whether any relationship with a commercial interest is considered relevant to the content of the educational activity. All potential conflicts must be resolved prior to the planning, implementation, or evaluation of the continuing education activity. The Approved Provider must describe the process used to resolve any actual or potential conflicts of interest identified during the planning of the activity. Actions taken to resolve conflicts of interest must demonstrate resolution of the identified conflicts of interest prior to presenting/providing the educational activity to learners. Such actions must be documented and the documentation must demonstrate (1) the identified conflict and (2) how the conflict was resolved. See Sample EDP5A for a description of the process used to resolve actual and potential conflicts of interest and an example of that process operationalized. 154

155 SAMPLE EDP5A Happy Home Health Agency requires that all individuals who participate in the planning of educational activities identify, address, and attempt to resolve any conflict of interest or potential conflict of interest. The primary responsibility of resolution belongs to the Primary Nurse Planner. The following mechanisms for resolving conflicts of interest may be used: 1) Attestation Presenters or members of the planning committee who indicate the existence of potential or actual conflict of interest will be asked to agree in writing that reported conflicts (or relationships) will not influence or bias their involvement in the educational activity and practice recommendations will be limited to evidence based practice guidelines. 2) Participant Evaluation Participants will be asked about bias (or absence of bias) during the evaluation process of the educational activity. Members of the planning committee will review the evaluation summaries and comments, and incorporate findings into needs assessment and/or areas of improvement. 3) Peer Evaluation Periodically, the planning committee may designate an informed participant or peer who is not involved in the planning and/or presentation of the activity to observe and audit the educational activity. The evaluator will be asked to complete an evaluation to note the presence or absence of any bias in the activity. 4) Content Review Members of the planning committee and the Primary Nurse Planner will review the content of the slides prior to the educational activity to ensure that conflicts of interest are identified and resolved prior to the activity. The responsibility of content review belongs to the Primary Nurse Planner. The Primary Nurse Planner will measure whether the resolution was adhered to during the educational activity. 5) Altering Financial Relationships Individuals who report a prior financial relationship with commercial interests will be asked to disclose prior relationship for a period of 12 months if educational activities of an enduring nature exist. 6) Altering Control over Content Members of the planning committee may choose any of the following interventions for altering control over content when potential or actual conflicts of interest arises: a. Change the focus of the educational activity b. Choose someone else who does not have a relationship or conflict of interest to present that part of the content c. Limit the content of the presenter s assignment to another activity that is not relevant to the area of conflict d. Limit the practice recommendations e. Limit the content to a report without recommendations. For example, if an individual has been funded by a commercial interest, the presentation may be limited to data and results only. Assign the broader implications and recommendations to another presenter. 7) Elimination/Disqualification. Committee members and faculty/presenters/authors that are perceived as having conflicts of interest or being biased may be eliminated from consideration as resources in subsequent educational activities. 155

156 SAMPLE EDP5A continued Three examples of the resolution process operationalized are as follows: 1. Committee members participate in the selection of faculty/presenters/authors for the annual conference on Diabetes. A committee member taking part in the selection process discloses a financial relationship with one of the vendors who is providing commercial support for the annual conference and who will also provide resources for content presentation. The committee member was reassigned to other elements not related to the educational activity presented by the commercial vendor representative. 2. Ms. Smith participated in a research project and has been invited to speak to the Missouri Psychiatric Nurses Association. During the content review process, Ms. Smith disclosed a financial relationship with a pharmaceutical company who funded the research project. The Primary Nurse Planner informed Ms. Smith that content would be limited to a report without recommendations. Ms. Smith advised that a non biased assistant would present the broader implications and recommendations during the educational activity. 3. During content review, the Primary Nurse Planner noted that the presentation slides for the educational activity Improving Constipation in the Elderly contained advertisement for a specific pharmaceutical vendor. The Primary Nurse Planner informed the presenter of the conflict of interest and requested that the presenter modify the slides removing the advertisement. The presenter was also asked to alter presentation content to eliminate bias by including other pharmaceutical products in their content. EDP6 The process utilized during the planning phase of the educational activity to determine how participants will successfully complete the learning activity. Interpretation and rationale: The Approved Provider is required to identify the requirements for successful completion, explain how the requirements for completion are determined, and describe the method and process used to verify completion as evidence of compliance with this criterion. Criteria for verifying completion must be determined as part of the overall planning of the activity. Educational activities may differ in expectation and requirements for completion of the activity. The learner is informed of these criteria prior to participation in the activity. Verification of participation may be achieved by a variety of methods, for example, roll call, sign in sheets, self reported attendance, submission of a mailed or online registration form and posttest, or return of evaluation tools. Completion may be achieved by a variety of methods, for example, submission of a written posttest and a self reported level of achievement of objectives, return demonstration, and evaluation discussion with preceptors, or attendance at the entire activity. The Approved Provider must determine why they selected a particular requirement for successful completion. Prior to the educational activity, the provider must determine how verification of completion will be determined. One provider may define completion as achievement of the objectives, while another provider may define successful completion as attendance at a percentage of the educational activity (e.g., 85%). Another provider may require completion of the evaluation form and self report of the achievement of the objectives as evidence of verification of participation and successful completion of the educational activity. Some combination of these methods may also be used. If partial credit is awarded to participants who attend less than the 156

157 entire educational activity, the organization providing the activity, provider, needs to determine the criteria for offering partial credit. A provider may choose to award contact hours for each session attended and not limit participants to receiving contact hours only if the entire activity is attended. This method might be appropriate if the objectives of the activity could be achieved without attending the entire activity. For learner paced activities, completion might be defined as reading materials and sending a posttest with 90% correct, a registration, and evaluation form. In addition, learner paced activities usually have a target date by which they must be completed, at which time the activity is due for either revision or removal. Learners must be informed of target dates for completion so that they complete all required interaction with program materials prior to that date. Whatever the method used, the participant should be informed of the criteria at the start of the educational activity. See Sample EDP6A for a description of the process used to determine successful completion requirements and an example of that process operationalized. SAMPLE EDP6A Participants at all St. Elsewhere Hospital continuing education activities are required to attend the entire activity, since each activity is planned as a whole, and complete an evaluation form. Additional successful completion requirements are chosen based on the type of activity (i.e. live vs. enduring) and the outcome desired for the activity such as a change in knowledge, skill and/or practice. The individual activity Nurse Planners and planning committee members, in collaboration with the Primary Nurse Planner, determine the appropriate successful completion requirements for the content being delivered and the delivery format. They also determine the method of notifying the participants of the requirements prior to the activity. One example of how the successful completion requirements were determined for a recent activity was for the Clinical Diabetes Update: What s New in Diabetes Mellitus. Participants must attend the entire educational activity, complete the evaluation form, and, on the evaluation form, indicate the degree to which the objectives were met in order to receive a certificate of completion. Since the activity was designed to meet the needs of both seasoned and new nurses there was general information provided in the beginning and at the conclusion with two tracks for the beginner and the advanced practitioner in the middle of the day. Because of this format it was necessary to also require the completion of a verification of attendance form for participants to complete and submit indicating the sessions they attended during the event. The planning team determined they would include the verification of attendance information on the back page of the evaluation form so they could easily be submitted and verified as received from each participant. The verification of attendance section asked for the participant's name, mailing address, for them to mark the individual sessions they attended and then sign the bottom to attest to the accuracy of the information provided above. Individuals who leave before the end of the activity, who did not submit their verification of attendance form or did not complete the activity evaluation did not receive a certificate. 157

158 DESIGN PRINCIPLES: The educational design process incorporates measurable educational objectives, best available evidence, and appropriate teaching methods. Describe and, using an example, demonstrate the following: EDP7 How measurable educational objectives are developed that address the change in nursing practice or nursing professional development. Interpretation and rationale: The Approved Provider must describe the Unit s process for developing the educational objectives for the activities they provide and how they ensure that the educational objectives will address the change in nursing practice or nursing professional development. The Approved Provider must ensure that the purpose, objectives, content, teaching learning strategies are consistent, that they are written using appropriate terminology, and that they are specific to the particular audience and its identified learning needs. Needs assessment data and gap analysis is used by the Nurse Planner to formulate the objectives for the educational activity. The purpose and objectives address current needs of the learners in the target audience related to their practice or professional development. The faculty/presenters/authors, if applicable, work with the Nurse Planner and Planning Committee to develop objectives, content, and teaching methods for the target audience. Educational objectives are written statements that describe learner oriented outcomes that may be expected as a result of participation in the educational activity. These statements describe knowledge, skills, and/or practice changes that should occur upon successful completion of the educational activity. Specific objectives for the learning activity are developed collaboratively by the planners and faculty/presenters/authors (if applicable) and must relate to the purpose of the activity. It is critical that the objectives provide the structure for the activity. Learner oriented outcomes are expressed in measurable terms, identify observable actions, and specify one action or outcome per objective. The number of objectives should be sufficient to accomplish the intended purpose of the activity. For example, the Midwest Diabetic Nurse Educator Association developed several goals and objectives for their educational activity. The goal statements begin with non measurable verbs: 1) increase understanding of use of biomedical technological advances in treatment of diabetics, and 2) to broaden the nurses' knowledge about innovative treatment opportunities to decrease complications of the disease. How would one measure "increased understanding" or "broaden nurses' knowledge"? These statements are appropriate for goals but not for objectives. See Sample EDP7A for a description of the process used to develop the educational objectives and an example of that process operationalized. 158

159 SAMPLE EDP7A The planning process begins by reviewing the needs assessment data, determining the current state of practice, determining the desired state of practice, identifying the gap in knowledge, skills and/or practice the activity is intended to address, developing the purpose and identifying the measureable outcome or outcomes for the activity. Nurse Planners document these components on the Activity Planning Documentation Form and the Gap Analysis Tool. An example of objectives from one of our educational activities is described below: A need was identified through the annual survey for education on new guidelines for immunizations. The Nurse Planner and planning committee defined the purpose for the activity as: At the end of the two hour webinar, participants will be able to apply the guidelines for immunizing adolescent clients between the ages of The identified gaps in knowledge, skills and/or practice were defined as knowledge about recommended immunizations for adolescents and applying the knowledge in practice. The measureable objectives for this webinar were written to support the purpose and identified gap and are as follows: Discuss recommendations for the most current immunization schedules for adolescent populations. Review frequently encountered questions and situations during patient discussions including safety, efficacy, and possible misinformation Implement strategies for improving immunization rates within one s clinical practice, taking into account current immunization schedules and guidelines EDP8 How the content of the educational activity is selected based on best available current evidence (e.g. clinical guidelines, peer reviewed journals, experts in the field). Interpretation and rationale: The Approved Provider must describe how they ensure the content delivered at their educational activities is chosen based on the best available current evidence. Approved Provider s must first describe how they ensure that the educational activities provided meet the definition of continuing nursing education (CNE). Documentation should address how they are ensuring that the information presented is not outdated and validating that the faculty is using the best available, current evidence. Some Approved Provider Units identify a content reviewer responsible for evaluating the content to ensure that the information being presented is current. Others document the quality of the evidence chosen through evidence based practice, literature/peer reviewed journals, clinical guidelines, best practices, and content experts/expert opinion. Approved Providers must also have a process in place to determine if the faculty/authors have the necessary qualifications to address the topic being presented 9. See Sample EDP8A and Sample EDP8B for two descriptions of the how the content for educational activities is selected and an example of that process operationalized. 9 Item adapted from the Ohio Nurses Association Provider Manual 159

160 SAMPLE EDP8A To ensure that the content delivered at all of our Provider Unit s continuing nursing education activities is based on the best available, most current evidence, the Unit first ensures that each offering meets the definition of continuing nursing education. CNE involves systematic professional learning experiences designed to augment the knowledge, skills, and attitudes of nurses, and therefore enrich nurses contributions to quality healthcare... (ANA, 2010, p. 43). Educational activities must meet the following guidelines in order to be eligible for awarding of continuing education credit (contact hours): Content must be beyond basic knowledge Content must be generalizable regardless of employer of the nurse Content must enhance professional development or performance of the nurse Content must also be: Evidence based or based on the best available evidence Presented without promotion or bias An educational activity may include content that is eligible for continuing education credit and content that is not eligible for continuing education credit. In that circumstance, continuing education credit may be awarded for the content that is eligible. All activities planned by our Provider Unit must include a resource or reference list of the evidence based resources used to plan the activity. Evidence based resources are documented on the Activity Planning Guide as well as on the Educational Planning Tool, and both documents are maintained in the activity documentation. The Nurse Planner assigned to the activity is responsible for ensuring that documentation of the evidence based resource is maintained. The Nurse Planner also provides guidance to other members of the planning committee, authors, presenters or faculty in selecting the best available evidence and resources. Nurse Planners are also encouraged to involve a content expert in their planning process to ensure that the most current information is utilized when designing the program. As an additional resource, we provide an evidence hierarchy in the orientation manual for new Nurse Planners. An example of how the content was selected based on the best available evidence was during our Update on Immunizations activity. This activity provided updated guidelines and recommendations for immunizations in children and adolescents. The evidence based resource used to develop the content was the American Academy of Pediatric Guidelines document revised in 2011 on immunizations. This resource can be found by visiting The Nurse Planner also involved a content expert with a background in Pediatrics and immunization administration to participate in the planning and ensure the content was outlined appropriately. Reference: American Nurses Credentialing Center s Standardized Self Study Application for Training. 17 September

161 SAMPLE EDP8B The content for educational activities are selected based on the identification of a learning need. A recent increase in the number of HIV + patients in one of the community based clinics provides an example of how a learning need provides an opportunity for determining the need for an educational program. All of the Nurse Planners and members of the planning committee use the following guide when determining whether a request for learning is the result of a learning need: 1. The review of needs assessment results in a learning need 2. The educational content suggested meets the learning needs identified 3. The learning objectives are measureable and based on currently available evidence 4. The content is relevant, objective, unbiased, and excludes any promotional influence One example of how the process for determining the content for educational activities occurred is based on a request for training that resulted as an increase in HIV + patients receiving treatment in a small community based outreach clinic. The Approved Provider Unit received a request to provide a continuing nursing education program for HIV from the community based clinic s nurse manager due to a recent increase in the number of HIV + clients being treated in the community based outreach clinic. An Individual Training Needs Assessment was sent to the 40 Registered Nurses who were currently working in the community based outreach clinic. See Attached IndivNA Nursing Staff needs assessment. Based on the results of the Individual Training Needs Assessment, a learning need was identified. A Nurse Planner was assigned to facilitate the planning process and to develop the educational content needed for the learning need or to identify subject matter experts who could provide the program content. The nurse planner identified key committee members needed to complete the planning and implementation of the CNE activity. EDP9 How content integrity is maintained for CNE activities, including what precautions are taken to prevent bias and how those precautions are implemented. Interpretation and rationale: The Approved Provider must be proactive and take precautions to prevent bias in the presentation of educational activities, and to protect learners from commercial messages. For a detailed statement of do's and don ts, see the complete standards in Appendix C. Some examples of precautions are: Physically separate the area where learners check in and receive educational materials, and the areas where they may choose or not choose to pick up commercial handouts and "goodies" tote bags, pens, key chains, etc. with commercial product names and advertisements. Arrange space so that learners are not compelled to walk through an exhibit area on their way to the educational session/s; if refreshments are provided in the same room as the educational activity, and a commercial sponsor is providing them, the sponsor's name and product advertisements may not be placed in the room. The sponsor is to be acknowledged in the brochure, participant materials, by verbal announcement, and/or through other signage. 161

162 Faculty/presenters/authors who are affiliated with commercial entities are not permitted to use handouts that have commercial logos or advertisements on them, or to have such logos on their slides. See Sample EDP9A for a description of the process used to ensure content integrity is maintained and an example of that process operationalized. SAMPLE EDP9A Maintaining content integrity is a multi step process involving the Nurse Planner, all other members of the planning committee as well as faculty/presenters/authors and content reviewers. Maintaining content integrity ensures that content for the educational activity is evidence based or based on the best available evidence; is presented free from bias or promotion; all individuals in the position to control content have been evaluated for conflict of interest and any identified COI has been resolved; and there has been independence from any organization providing financial support for the activity. The Nurse Planner of the activity is accountable for ensuring content integrity yet it is essential that all members of the planning committee as well as any individual in a position to control content take an active role in ensuring content integrity is maintained. The process for ensuring content integrity begins with evaluation of conflict of interest for the Nurse Planner, all other planning committee members, faculty/presenters/authors and content reviewers. All actual or potential conflicts of interest are identified and resolved as applicable. Content chosen for the activity must be evidenced based or based on the best available evidence. This is documented on the Activity Planning Documentation Form and the educational planning tables. The Nurse Planner is responsible for the Activity Planning Documentation Form and reviews all educational planning tables submitted by other planning committee members, authors or presenters/speakers to ensure that an evidencebased resource is documented. In the event that there is no evidence based resource documented or the evidence based resource is not acceptable (outdated, not really evidence, etc.), the Nurse Planner contacts the responsible individual, reviews the concern and ensures evidence is identified, used and documented. In the event there is no evidence provided or the evidence provided is not acceptable and the individual is unable to provide evidence, the session is not held or no contact hours are awarded for the session. We ensure strict separation between any organization providing funding for the activity and the activity planning. We provide our presenters with presentation guidelines to ensure that they are aware of our policies regarding continuing education for learners not being used as a vehicle for promoting any products or services of an individual or company. We do review all slides and materials developed by planners, authors, and/or presenters/speakers to ensure that they do not include inappropriate references to products or services as a method to promote through the educational activity. We also monitor sessions in person and/or review evaluations for bias. On every form, we include a question related to bias. Finally, we provide our learners with our contact information in case they have any complaints about an educational activity they want to discuss/document. Mary Jane Doe is responsible for documenting and responding to complaints. 162

163 SAMPLE EDP9A continued One specific example we would like to highlight involved an individual who was chosen to speak at our annual conference who was also the author of a book on adolescent risk behavior. This individual was a well known author and frequent speaker within the pediatric/ adolescent community. She was chosen to be a speaker by the planning committee based on her reputation. As a speaker, she was asked to complete and submit a Conflict of Interest/ biographical data form. She disclosed no relationships with commercial interest organizations. She completed the educational activity planning table including objectives, outline of her content and evidence based references. The Nurse Planners identified no issues when reviewing the table. The objectives were well written and content was evidencebased. She had included her own publications on the reference list but also provided other references. We gave her our speaker guidelines and she confirmed receiving them and had no questions. Because many of the members of the planning committee were interested in hearing her speak, they attended the live session. During the live session, unfortunately, the speaker promoted only her own publications including bringing her book to the session, holding it up in the air and explaining how participants could order it. Needless to say, we, the planning committee, were horrified. We tried to do damage control at the end of the session, but by that time, it was too late. We debriefed both as a committee and as a Provider Unit to determine what we could have done to prevent this from happening. We decided that before any presentation that we thought had risk for a similar situation to occur, we would make an announcement during the speaker introduction that included the following language: The Provider Unit providing contact hours has implemented steps to ensure that this presentation promotes the professional development of registered nurses and is committed to ensuring that the presentation is not biased or promotional in nature. If you have any concerns during or after this presentation that should be shared with the Provider Unit, please indicate your concern on the evaluation form or contact the Nurse Planner directly. We also decided to review the speaker guidelines with each speaker, not just provide the speaker with a copy of the guidelines. We hope that this direct route will reduce the chance of a similar situation happening again in the future. Reference: American Nurses Credentialing Center s Standardized Self Study Application for Training. 17 September EDP10 In the presence of commercial support/sponsorship, how additional precautions are taken to maintain content integrity for CNE activities, including what precautions are taken to prevent bias and how those precautions are implemented. NOTE: If the applicant/approved Provider never accepts commercial support/ sponsorship, do not provide a narrative for EDP10, and proceed to EDP11. Interpretation and rationale: The Approved Provider is responsible for ensuring content integrity when there is the presence of commercial support and/or sponsorship. Please refer to Appendix C for a detailed list of methods to ensure content integrity. See Sample EDP10A for a description of the precautions taken to maintain content integrity and prevent bias in CNE activities and an example of that process operationalized. 163

164 SAMPLE EDP10A Extra precautions are taken to maintain content integrity during the planning of CNE activities where there is the presence of commercial support or sponsorship. There is potentially a greater risk for an organization providing commercial support or sponsorship to want to influence the content of the educational activity that it is supporting or to influence learners who are attending the activity. Therefore, the Nurse Planner for the educational activity receiving funding must be particularly cautious to ensure that content integrity is maintained and that the educational activity is not used as a vehicle to promote the products or services of the commercial interest or sponsoring organization. For all educational activities that are supported by an outside organization, we require a written, signed commercial support or sponsorship agreement. This ensures that the organization providing funding is aware that there must be independence between the organization and all planning, implementation and evaluation of the activity because we include this language in the agreement (see template agreements under Tabs G and H). The agreements clearly state that the organization providing financial or in kind support may not participate in any of following: Assessment of learner needs Determination of objectives Selection or development of content Selection of presenters or faculty Selection of teaching/learning strategies Management of commercial support or sponsorship Evaluation In addition to requiring a written, signed agreement, we implement the same processes for ensuring evaluation and resolution of conflicts of interest, ensuring content is evidencebased or based on the best available evidence and the activity is presented free from promotion or bias as described in EDP9. Finally, we take extra precautions to ensure that the organization providing commercial support or sponsorship does not try to inappropriately use the educational activity in ways to promote its products or services, such as trying to offer giveaways during the learning activity that promote its products or services, trying to recruit learners through the educational activity, or trying to pressure the Provider Unit to use speakers or presenters from the commercial interest or sponsoring organization. 164

165 SAMPLE EDP10A continued One example that demonstrates our diligence in ensuring content integrity for educational activities receiving commercial support or sponsorship was the activity on the treatment of Type 2 diabetes in adolescents. The Provider Unit was able to obtain funding from one commercial interest and one sponsor that directly supported this activity. A commercial support agreement and a sponsorship agreement were obtained from both organizations. Biographical data and COI forms for all planners, speakers and presenters were reviewed. The Nurse Planner and planning committee made sure that the content was evidence based and added an item on the evaluation form to alert the learners to indicate if any bias or promotion were detected during the activity. During the planning process, however, an employee from the commercial interest organization contacted a planning committee member. This employee tried to provide the planning committee member with a list of speakers with content expertise in treating Type 2 diabetes in adolescent patients. The members of the Provider Unit are all aware that there must be independence from commercial influence in the planning process for educational activities and this planner who had been approached knew it was inappropriate to accept a suggestion for speaker(s). The planner brought the situation to the attention of the Primary Nurse Planner for follow up with the leadership in the commercial interest organization. A list of all members of their speakers bureau was requested. The planning committee used this list of speakers and cross referenced the names of all confirmed speakers to ensure that none of them were on this commercial interest s speaker s bureau. Fortunately none were listed. Had any of them been listed, the committee would have discussed whether or not to include them in the final agenda due to the perceived bias. Reference: American Nurses Credentialing Center s Standardized Self Study Application for Training. 17 September EDP11 How teaching methods were chosen that are appropriate to achieve the purpose and objectives of the CNE activity. Interpretation and rationale: Following the development of objectives and selection of content, the Approved Provider must describe how the teaching learning strategies were determined. The methods, strategies, and materials to be used by faculty/presenters/authors to cover each educational objective are identified, congruent with the objectives and content to be presented, and appropriate to the purpose, target audience, and overall design of the learning activity. Instructional methods that support attainment of the educational objectives should be used. The action indicated as the expected outcome determines the teaching methods to be used. For example, a learning objective that requires the learner to successfully demonstrate a psychomotor skill should include teaching strategies that utilize demonstration and return demonstration. An objective that requires a learner to describe a phenomenon would include teaching strategies such as lecture and discussion. In addition to teaching methods that support the learning objectives, attention must be given to the fact that principles of adult learning should be evident in the selected strategies. See Sample EDP11A for a description of the process used to select the teaching methods for CNE activities and an example of that process operationalized. 165

166 SAMPLE EDP11A Needs assessments occur via various methods and can include evaluations from previous educational activities, surveys, focus group discussions, internal quality data, new technologies, regulatory agencies, recommendations from professional organizations and current trends in reliable medical literature. All aspects of planning, implementing and evaluating an educational activity are based on the needs assessment. This includes the determination of target audience, development of objectives and content, identification of teaching learning strategies and the delivery format. Based on expertise and clinical background, the Nurse Planners provide/coordinate education to meet the needs of their assigned clinical area(s). Teaching learning strategies used, including resources, materials, delivery methods, and learner feedback mechanisms are decided collaboratively between the Primary Nurse Planner, Nurse Planners, and planning committee members. All activities are planned with adult learning principles in mind; therefore, delivery methods and learner feedback mechanisms are selected to meet the unique needs of the adult learner. Presentation materials are reviewed prior to the activity to ensure content is free from bias and addressed the identified need(s) and corresponding objectives. If the content does not address the identified need(s), the speaker is asked to modify the presentation. In a previous example EDP8B, the teaching methods were chosen based on the identification of how the registered nurses that completed the needs assessment responded to the questions; How do you best acquire and retain information? And in what language? ; and the identification of THREE most effective and efficient methods of training. The information identified by the target audience suggested that lecture, role playing, and mentoring were the three most effective methods of training. The information collected from the needs assessment was used by the primary nurse planner and nurse planners to meet the learning needs of the target audience. The planning committee determined that the best teaching learning strategy would be best accomplished using a clinical education specialist from within the health system to ensure that mentoring could occur. See sample EDP8B. The Approved Provider Unit uses a Process Evaluation (or Formative Evaluation) this process occurs while the CNE is being designed, developed, and delivered. It allows trainers to determine what needs to change in their training plans and delivery so that a quality CNE program will be most effective for participants. The following table includes an example of the Formative Evaluation utilized for the CNE activity. Using the formative evaluation process, the planning committee were able to identify that the faculty needed to provide examples of case studies to enhance the learner s experience and better ensure a change in professional practice related to treatment of HIV + patients in the community based setting. 166

167 SAMPLE EDP11A continued FORMATIVE EVALUATION Please address each question (Please) marking if complete or if more work is required. Include any comments and recommended actions or follow up activities. YES NEEDS MORE WORK QUESTIONS AND CONSIDERATIONS NOTES & FOLLOW UP Did you have adequate input from content experts? Did you conduct a review and/or pilot training with a good representation of stakeholders? Do you have enough/too much time allotted for each portion of the continuing nursing education program? If not, what measures were taken? If any, what content areas need more examples, statistics, case studies, etc.? Is there a blend of participant and instructor talk? Is there adequate time given to class discussion, faculty explanation/lecture, question answer periods, group activity, and individual exercises? What should the faculty work on regarding classroom presence, style, and overall teaching effectiveness? Does the course content actually meet the stated learning objectives? Do the learning objectives need to be modified? Have you built in adequate evaluation to assess the curriculum, the process, and participant learning and application? ACHIEVEMENT OF OBJECTIVES: A clearly defined method that includes learner input is used to evaluate the effectiveness of each educational activity. Results from the activity evaluation are used to guide future activities. Describe and, using an example, demonstrate the following: EDP12 How summative evaluation data for an educational activity were used to guide future activities. Interpretation and rationale: The Approved Provider must have a clearly defined method of evaluating the effectiveness of each educational activity provided, that includes learner input. 167

168 Evaluation methods may include both short and long term methods. Once the evaluations are completed by the learners, a summative evaluation is developed. The Nurse Planner and/or Planning Committee review the evaluation summary to assess the activity s effectiveness and identify how results may be used to guide future educational activities. The evaluation process helps determine the effectiveness of the educational activity, including the teaching methodology and the value of the activity to the participant. In the continuing education activity, evaluation is important since it can help to validate that learning has taken place. Besides assessing the effectiveness of the offering, evaluation can point out areas for corrective action or provide suggestions for future educational activities. For Approved Providers, evaluation of individual activities is an important part of the Approved Provider evaluation plan. See Sample EDP12A for a description of how the summative evaluation data is used to guide the development of future activities and an example of that process operationalized. 168

169 SAMPLE EDP12A The Nurse Planner and planning committee are responsible for compiling and reviewing evaluation data from each activity they are responsible for planning, implementing and evaluating for the Provider Unit. The summarized data is reported to the Primary Nurse Planner and the remaining Provider Unit personnel to identify and address potential improvements for the activities the Unit provides. The Provider Unit meets monthly to review summative data for activities provided in the past month. Each Nurse Planner provides a short summary of the data received for the activities they were assigned and the group provides feedback and comments. The Provider Unit staff determines what if any improvements need to be made to the overall planning process or to individual activities based on the feedback received from participants and their discussions during these monthly meetings. The Primary Nurse Planner also tracks the trends identified during these review meetings to use during the overall Unit evaluation and strategic planning for the upcoming year. One example of how the summative data was used to improve and develop future activities can be demonstrated in the changes initiated to the Critical Care program the Unit provides. Feedback received from the participants allowed the Staff Development Department to revise and improve core components, speakers and the timing of the offerings. Participants indicated that providing the critical care course over five straight days caused mental fatigue, disruptive schedules, overloaded classrooms and limited attendance. The Provider Unit reviewed this data at a monthly meeting and initiated changes to hold the activity two to three days per week over a two week period and made these changes effective for the next offering. Summative data received from participants following the initiation of these changes was very positive. The learners indicated they were able to retain the content more easily and the scheduling and attendance issues had all been resolved. The classrooms still remained crowded, which continued to be noted by participants. The Nurse Planner will take that issue to the next Provider Unit meeting to determine if a larger classroom is available to provide more space or if the activity should be offered numerous times in a month to address the increased attendance. Another example of how summative data was used to improve and develop future activities can be demonstrated in the changes initiated to the leadership course for nurse managers. Feedback from participants indicated that only half of the objectives had been addressed and met because the speaker ran out of time. The comments shared the speaker was talking so fast it was difficult to follow the content. And that the presenter simply ran out of time and couldn t cover all of the content they intended to during the presentation. The Nurse Planner reviewed the marks and comments provided by participants and first initiated a conversation with the presenter. They discussed the issues that arose during the presentation regarding the uncovered content. The two agreed that they had inadequately identified the time required to cover the content and objectives. They discussed increasing the time/length of the activity and/or separating the content into two presentations. To accomplish the goal for the activity it was decided to increase the time by one hour making the entire activity 2.0 contact hours/clock hours in length. The Nurse Planner reported the learner feedback to the Primary Nurse Planner and Provider Unit members during their monthly review meeting, as well as the solution she and the presenter had come up with to resolve the issue. The Provider Unit members agreed that the appropriate solution was to lengthen the activity by 60 minutes. The leadership course was offered the following month and the 2.0 contact hour format was provided. Evaluation data from this revised activity were very positive. Learners reported that more objectives had been met and did not share comments about not making it through all of the slides. Therefore the planners believed the issues to be resolved. 169

170 EDP13 How evaluation data were collected to measure change in nursing practice or nursing professional development. Interpretation and rationale: The Approved Provider must demonstrate how evaluation data was collected to measure changes in nursing practice or nursing professional development. They should describe their method of collecting evaluation data and how it relates to the needs assessment, gap analysis and desired outcome identified for CNE activities. They should also identify how this data received relates to changes in nursing practice or professional development. The measurement process can be accomplished using either short or long term methods. See Sample EDP13A for a description of the process used to collect evaluation data to measure change and an example of that process operationalized. SAMPLE EDP13A The Nurse Planner and planning committee are responsible for compiling and reviewing evaluation data from each activity that they are responsible for planning, implementing and evaluating for the Provider Unit. The summarized data is reported to the Primary Nurse Planner and the remaining Provider Unit personnel to identify and address potential improvements for the activities the Unit provides and to measure any changes in nursing practice or nursing professional development. In addition to tracking trends for potential improvements, the Provider Unit also utilizes the Gap Analysis tool and a flow chart format to track the need, identified gaps, activity content & objectives, evaluation summary and follow up QI activities to determine if the gap was addressed and thus the need met. The Provider Unit includes discussion about measuring changes in nursing practice and the addressing of gaps in their monthly review meeting where they evaluate the activities provided in the past month. Results are included in the evaluation flow chart for the Provider Unit and used during the annual Unit effectiveness evaluation meeting. One example of how the summative data was used to measure the changes in nursing practice and nursing professional development can be demonstrated in the pain management activity. A quality improvement study through chart review revealed that there was a gap in adequate documentation of pain assessment, pain relief measures, and their effectiveness on five out of six surgical units. The Provider Unit identified a Nurse Planner and assembled a planning committee to plan an activity to address the gap. The planning committee sought to address the large gap identified and believed a learner paced activity would reach a larger audience. Therefore the planning committee developed a series of learner paced activities in pain assessment and pain management for all nursing staff. Six months after all target audience members completed the learner paced activities, a quality improvement study was conducted. The results from this follow up survey indicated there was an 80% decrease in records rated as incomplete. 170

171 APPROVED PROVIDER CRITERION 3: Quality Outcomes (QO) The Approved Provider Unit engages in an ongoing evaluation process to analyze its overall effectiveness in fulfilling its goals and operational requirements to provide quality CNE. Each narrative must include a specific example that illustrates how the criterion is operationalized within the Provider Unit. The narrative should be clear, concise and describe the process the Provider Unit has developed to address the criteria. Reviewers should understand fully how the Provider Unit operates after reading. The example should describe one instance where the process was implemented or operationalized. APPROVED PROVIDER UNIT EVALUATION PROCESS: The Approved Provider Unit must evaluate the effectiveness of its overall functioning as an Approved Provider Unit. Describe and, using an example, demonstrate the following: QO1 The process utilized for evaluating the effectiveness of the Approved Provider Unit in delivering quality CNE. Interpretation and rationale: The Approved Provider must have a mechanism/process/plan in place for evaluating the effectiveness of the Approved Provider Unit. The evaluation of effectiveness moves beyond the evaluation of individual activities provided. The Approved Provider must engage in a process to analyze their overall effectiveness, the quality of their operations and their achievement of goals and outcomes in providing quality continuing nursing education activities. This process should be ongoing and the Unit consistently evaluated for continuous quality improvement. The plan should also reflect the participation of presenters/faculty/ content experts, Nurse Planner(s), learners, and any other key individuals involved in the CNE activities. A comprehensive evaluation process should identify what component is to be evaluated, when the evaluation is to be done, who is to do the evaluation, and how the evaluation is to be done. The process should be designed to provide evidence that operations are consistent with ANCC/MONA Accreditation program criteria, and are effective and efficient. The Approved Provider should see that the following components of the Unit are being evaluated: 1) that resources are adequate and consistent with the services of the Unit; 2) that the Unit's accomplishments are measured with respect to its stated goal(s) and purpose(s); and 3) that individual activities are evaluated according to the procedures identified by the accreditation criteria. Approved Providers should also evaluate administrative and operational procedures, identified outcomes and results, and goals for improvement. Evaluation provides a means of assessing the effectiveness of implemented decisions and points out areas where corrective action is needed. Evaluation is also a means of looking ahead to more effective activities rather than correcting unchangeable past events. This evaluation process helps Approved Providers make improvements to their overall operations that will ultimately have an effect on the quality of activities the Unit provides. Policies and procedures may become ineffective and require revisions, or the provider may determine it s necessary to amend the length of an activity to provide more adequate time to 171

172 cover the content or modify the objectives to better meet the time frame. The Unit may also review the congruence between the organization s mission and goals and the specific goals of the Approved Provider Unit or assessment of the hardware and software available to deliver CNE and the location of the Unit office itself or the classrooms used to deliver CNE. These areas can all be addressed within the evaluation process for the overall Approved Provider Unit. See Sample QO1A for a description of the process used to evaluate the effectiveness of the overall Approved Provider Unit and an example of that process operationalized. SAMPLE QO1A Our Provider Unit routinely evaluates our effectiveness during our annual strategic planning meeting. During this strategic planning meeting, we review data collected by a variety of different methods throughout the year to evaluate our overall effectiveness in delivering quality CNE. Data collected includes: aggregate evaluation summary results both quantitative and qualitative; results from an annual presenter/faculty/content expert satisfaction survey; results from an annual employee satisfaction survey; evaluation of our profit margin; our scheduling processes; our cycle time for planning activities; and any complaints or concerns about the educational activities the organization provides. Our Unit uses this data to critically evaluate our current educational offerings, our processes and procedures for planning activities, our internal and external customer service, and our overall efficiency and profitability. We also use this data to identify trends that might be important for our Unit to respond to in the coming year. The Provider Unit has designed an Approved Provider Evaluation matrix to identify the various portions of our operations that we need to evaluate, at what time or # of times per year to evaluate each, the individual responsible for conducting the evaluation and an explanation of how the individual should be evaluating the particular element. This matrix is very helpful to have at hand for the second portion of our annual strategic planning meeting as well as to make available to all Provider Unit personnel through the year. Changes to our what, when, who and how will help our Unit track and document our effectiveness and accomplishments during the year to assist staff in pulling together the annual overview. An example of the process utilized at our strategic planning meeting can be demonstrated in the annual overview provided by Megan Dougherty for all members of the Provider Unit. Megan gathers data collected throughout the year and develops a presentations as well as handouts to share with the group. The presentation slides and handouts include data that is presented in tables, graphs, and in narrative format. This is really the only opportunity that the entire Provider Unit gets to see a summary of their work throughout the year. The slides and handouts have been included under Tabs I and J in the appendix and are organized according to this general outline: 1. Summary of activities provided throughout the year a. Total number of activities b. Number of activities by activity type live, enduring c. Total number of participants d. Total number of contact hours awarded e. Amount of commercial support and/or sponsorship per activity 2. Number of activities measuring knowledge 3. Number of activities measuring skill 4. Number of activities measuring practice 172

173 SAMPLE QO1A continued 5. Average overall satisfaction score for each activity provided 6. Trends in comments or suggestions from evaluation summaries 7. Overall satisfaction of faculty, presenters, speakers 8. Suggestions for improvement from faculty, presenters, speakers 9. Overall satisfaction of Provider Unit members 10. Suggestions for improvement from Provider Unit members 11. Profit margin 12. Scheduling processes for staff 13. Cycle time for planning processes 14. Summary of complaints received and actions taken Please also see the Approved Provider Evaluation Matrix below outlining the what, when, who and how our Unit evaluates its effectiveness annually. Reference: American Nurses Credentialing Center s Standardized Self Study Application for Training. 17 September

174 SAMPLE QO1A continued Approved Provider Evaluation Matrix What When Who How Approved Provider operations: Consistency of unit goals with mission Achievement of program goals Effectiveness of organizational structure Record keeping system Goals for improvement Material Resources: Adequacy of Material resources Physical plant: offices Classroom facilities Storage facilities Library and media resources Staff and Faculty: Adequacy of number of personnel in line and staff positions Job description review Expertise of staff in program planning Faculty selection Educational Activities: Needs assessment Learner achievement of goals and objectives Effectiveness of teaching strategies Spring Quarterly Fall Fall Quarterly January Ongoing July January January January Ongoing July Ongoing Ongoing Nurse Planner(s), administration Nurse Planner(s), faculty, Staff " Nurse Planner(s), administration Nurse Planner(s), Faculty, learners " Staff Faculty, learners Nurse Planner(s) Nurse Planner(s) Nurse Planner(s), learners, faculty Review of mission, goals Review of goals for program activities Staff report, review of communication system Review 10% of files for completeness Review improvement indicators Staff report Faculty and learner evaluation of facilities Secretary report Staff report Review by staff and administrator Review by staff and administrator Administrative review Staff report; participant evaluations Personnel questionnaire Organizational goals Environmental demands Review of activity Learner satisfaction Ongoing Review of activity impact on practice skills & knowledge Marketing Activities: Quality of brochures, news releases Evaluation of usefulness October October Nurse Planner(s), learners Staff Learner evaluation summary report Review of timeliness, presentation Review participants/ cost of mailing 174

175 QO2 How the evaluation process for the Approved Provider Unit resulted in the development or improvement of an identified quality outcome measure. (Reference the identified quality outcomes measure(s) listed in your response for OO4). Interpretation and rationale: The Approved Provider must describe their results from the Approved Provider Unit evaluation process and how those results helped them identify new or reach current identified quality outcome measures. The Approved Provider should reference each of the quality outcomes measures listed in their response for Organizational Overview 4 (OO4). See Sample QO2A for a description of the results of the evaluation process for the Unit and an example of that process operationalized. SAMPLE QO2A The quality outcome measures that our Provider Unit chose for evaluating ourselves in 2012 included: Increasing the number of enduring material educational activities provided by 10% Achieving an overall satisfaction rating of at least 4.0 on a scale of 1 5 for 90% of educational activities provided Ensuring each Nurse Planner and the Primary Nurse Planner participates in at least one (1) professional development activity Recruiting 5 additional faculty for the Provider Unit The evaluation process we use annually, as outlined in QO1, helps our Provider Unit to both identify new quality outcome measures, as well as improve the quality outcome measures we currently collect and monitor. At our annual strategic planning meeting, we review the quality outcome measures we have chosen, and use our evaluation data to determine whether these quality outcome measures are still appropriate for the upcoming year, require revision, should be deleted or if new quality outcome measures would be more appropriate. A specific example that demonstrates this process is described below: During our last annual strategic planning meeting in December, we reviewed data from our customer satisfaction survey. Our customers clearly liked the activities we provided as demonstrated by moderately high satisfaction rating of 3.8 on the evaluations. The Provider Unit chose to set a goal of increasing the satisfaction rate to 4.0 for 90% of our educational activities to push ourselves to continue to provide high quality activities and excellent customer service. Another example is from the same strategic planning meeting in December. We reviewed data from our individual nurses needs assessment and the summative evaluations for all continuing nursing activity provided. We determined that the overall level of knowledge based on the needs assessment data, that greater than 75% of the nurses responding identified a knowledge level of Basic for management of pain using evidenced based treatment protocols. Based on a 60% completion/returned rate for submitted needs assessment, the Provider Unit believed that this number represented an adequate amount of feedback and made the decision to adopt a model for evaluation that uses a multi factor approach and includes a faculty self assessment before and after the continuing education activity to identify the level of effectiveness related to the teaching strategies. 175

176 APPROVED PROVIDER UNIT EVALUATION PARTICIPANTS: The Approved Provider Unit shall include a variety of stakeholders, comprising those with a vested interest in Approved Provider Unit outcomes, in the evaluation process. Describe and, using an example, demonstrate the following: QO3 Why the Approved Provider Unit selects specific stakeholders to participate in the evaluation process. Interpretation and rationale: The Approved Provider serves a number of different stakeholders, including learners, planners, faculty/presenters/content experts, and staff. The Approved Provider should first identify the stakeholders they involve in the evaluation process and why they were selected. Then they should describe how each of the stakeholders participates in the evaluation process and how they add value to the process. See Sample QO3A for a description of which, why and how stakeholders are involved in the evaluation process and an example of that process operationalized. 176

177 SAMPLE QO3A The Education Department of Midland Hospital, a MONA Approved Provider, involves many individuals in both continual evaluation data collection from educational activities, and periodic evaluation of specific aspects of the Approved Provider Unit operations, goals, and strategies for improvement. Learners participate in evaluating each educational activity, providing data on the effectiveness of the content, methods and presenters/resources in helping achieve learning objectives. Activities are often planned to address a specific need that is related to patient care and patient outcomes. When educational activities present new, evidence based nursing knowledge and skills related to a specific patient group, or patient problem, learners and unit managers are surveyed weeks or months after the educational activity to determine 1) to what extent have the new protocols or practices been implemented by educational activity participants, and 2) to what extent desired changes in patient outcomes are observed. Change in patient outcome indicators is an important indicator of Approved Provider Unit effectiveness. Planners including the Primary Nurse Planner and other nurses participating in planning educational activities, review the summarized evaluations of every educational activity. They provide input on operations and resources, and suggest changes to streamline the processes of needs assessment, activity planning, implementation and evaluation. Planners meet with the Vice President for Nursing quarterly to evaluate the effectiveness of the Approved Provider Unit in helping meet the strategic goals of the Nursing Department, and review resource needs. Planners meet with a number of leadership and staff task forces and committees, both nursing and interprofessional, to gather evaluation data of Approved Provider Unit effectiveness and needs assessment data for future planning. Annually, the Nurse Planners prepare a report for the institution's annual report; this includes a quantitative report of number of activities, participants, contact hours awarded, income and expenses, as well as goals and how they were met, and goals for the following budget year. Faculty/Presenters/resources: At the conclusion of each educational activity, a summary of their own presenter evaluations is shared with presenters if the activity is delivered as a live presentation. In addition, presenters and resources are asked to evaluate the Approved Provider in relation to communication with presenters/resources, effective support for the presentation or learner directed activity development, guidance in regard to ANCC/MONA Accreditation criteria, and feedback after the presentation or development of the activity. 177

178 SAMPLE QO3A continued An example of this evaluation process and use of stakeholders operationalized is as follows: Midland Provider Unit staff summarized the evaluations from a diabetes education activity provided recently to the nursing staff. The learners evaluated each objective assigned, the teaching methods of the instructors and also provided information on how they intend to use the content delivered. Initially the Primary Nurse Planner and Provider Unit staff reviewed the summary data. Then the Primary Nurse Planner convened a meeting of the planning committee to discuss the evaluation summary. They discussed any areas the learners indicated needed improvement and/or objectives or speaker delivery issues that needed to be addressed. It was noted during this particular activity that the evaluation process was cumbersome and involved. Each session offered had to be evaluated before and after, and there were many repetitive elements to the evaluation itself. Because of this feedback the planning committee discussed developing an online evaluation tool to use for future offerings. They will allow participants to evaluate the individual sessions during the activity but only once at the end of the event saving time and paper. The Primary Nurse Planner will work with the administrative staff assigned to the Unit to move toward an electronic evaluation process. The Primary Nurse Planner will arrange for each Nurse Planner to participate in a training session on the design and development of online surveys. This improvement will not only help the participants but it will also help the Provider Unit staff and Nurse Planners. This development will improve efficiency in the Unit office by removing the requirement for hand tallying of evaluation data. The new training and process will provide the Nurse Planners with knowledge on how to properly survey their audience, which will help with the needs assessment process, and in the quality outcomes measures. Following the planning meeting Provider Unit staff forwarded a copy of the evaluation summary to each presenter involved in the activity and also asked for them to complete a survey about how the planning process worked for them from initial invitation to speak to the delivery of the content. This element helps the Provider Unit staff determine if there are areas of their procedures that need improvement. The Primary Nurse Planner also prepared the survey to be forwarded to all participants at the diabetes education activity to determine how they have used the new information and management techniques in their practice and if they have seen any changes in patient outcomes. This survey is sent out 90 days following the activity and again at 6 months to determine if the Unit s outcomes have been achieved through this activity. APPROVED PROVIDER UNIT QUALITY OUTCOME MEASURES: The Approved Provider Unit must demonstrate quality improvement efforts including identifying strategies for working on targeted goals, evaluating progress toward goals, and revising or establishing new goals. Describe and, using an example, demonstrate the following: QO4 How input from stakeholders resulted in the development of or an improvement in quality outcome measures for the Approved Provider Unit. (Reference the identified quality outcomes measure(s) listed in your response for OO4). Interpretation and rationale: The Approved Provider Unit must describe how they have utilized input from their stakeholders to develop or improve a quality outcome measure. The input received from the various stakeholders the Unit involves in the evaluation process can be very 178

179 valuable to the educational design process. Improvements to the Unit or to the implementation of educational activities themselves can best be initiated if specifics are measured. See Sample QO4A and Sample QO4B for two description of how input from stakeholders is used to achieve quality outcome measures and an example of those processes operationalized. SAMPLE QO4A Johnson Case Hospital as reiterated in the Organizational Overview section, the quality outcomes measures for the Provider Unit are as follows: Quality outcomes measures related to the Johnson Case Provider Unit 1. Increase the number of all web based enduring activities by 10% 2. Ensure that all Nurse Planners and Primary Nurse Planner participate in at least one course in web based teaching and testing methods 3. Increase budget for IT/web design services by 20% Our stakeholders provide keen insight and a different perspective into the activities our Unit provides. Learners participate by attending the events and helping the Unit meet quantifiable goals for participation. They also provide feedback on strengths and areas of improvement related to the educational design process and activity implementation. The presenters/faculty involved help by providing feedback into the educational design process and how the Unit collaborates with presenters/faculty, requests paperwork, facilitates the event on site, and makes presenters aware of the requirements for nursing continuing education. This feedback helps the Unit set new goals for improvement, ensures they are justifying the need for certain improvements, and meeting their goals. The planning committee and Nurse Planners discuss the accomplishments of goals annually and activity specific accomplishments and needs following each event. The Primary Nurse Planner, Provider Unit staff and Planning Committee members meet quarterly to ensure that quality outcomes are being achieved. They have developed a mechanism to track their successes and also to highlight areas that still require attention so that they reach their strategic goals for the year. One example of the input from stakeholders that led to the development of a quality outcome measure is as follows: The Provider Unit reviewed evaluation data and feedback from all activities provided in 2011 during their opening planning meeting in Participants continued to share that they were having difficulty taking off work to attend the activities our Unit provided because of limited staff and funds to support continuing education. They were forced to be more selective in their choices of activities to attend in person. The Provider Unit reviewed the feedback and decided that to continue to meet the needs of their customers they needed to increase the number of learner paced, webinar, web based, etc. activities in response to the feedback received from the learners. The Provider Unit identified the quality outcome measure to increase the number of web based educational activities by 10% based on the trend in feedback received from the learners. 179

180 SAMPLE QO4B Missouri Psychiatric Nurses Association as reiterated in the Organizational Overview section, the quality outcomes measures for the Provider Unit are as follows: The quality outcomes measures related to the MO Psychiatric Nurses Association Provider Unit are: 1. Nurse Planner and planning committee participate in training on computerized survey design and survey interpretation 2. Vice President (Nurse Planner) and Vice President elect (subsequent Nurse Planner) attend the MONA Approved Provider workshop. 3. Bylaws change to ensure that past Nurse Planner remains on planning committee as consultant to current incumbent. 4. Recruiting 2 additional Nurse Planners to assist the Provider Unit Our stakeholders provide keen insight and a different perspective into the activities our Unit provides. Learners participate by attending the events and helping the Unit meet quantifiable goals for participation. They also provide feedback on strengths and areas of improvement related to the educational design process and activity implementation. The presenters/faculty involved help by providing feedback into the educational design process and how the Unit collaborates with presenters/faculty, requests paperwork, facilitates the event on site, and makes presenters aware of the requirements for nursing continuing education. This feedback helps the Unit set new goals for improvement, ensures they are justifying the need for certain improvements, and meeting their goals. The planning committee and Nurse Planners discuss the accomplishments of goals annually and activity specific accomplishments and needs following each event. The Primary Nurse Planner, Provider Unit staff and Planning Committee members meet quarterly to ensure that quality outcomes are being achieved. They have developed a mechanism to track their successes and also to highlight areas that still require attention so that they reach their strategic goals for the year. An example of this process operationalized is as follows: The Provider Unit reviewed evaluation data and feedback from all activities provided in 2011 during their opening planning meeting in Nurse Planners and planning committee members shared increased feedback regarding the increased number of activities they were responsible for during the calendar year. They indicated that their workload and the number of activities they were assigned increased by 35% during the past year. Because their role as a Nurse Planner and/or planning committee member was in addition to their nursing responsibilities, many were finding it difficult to manage and keep up with the CNE, ANCC/MONA criteria requirements. The Provider Unit discussed options to address the feedback from the planners. The Provider Unit decided that to continue to meet the needs of the Unit it was necessary to recruit two additional Nurse Planners to assist in managing the current educational calendar for the year. Therefore based on the feedback received from Nurse Planners and planning committee members the Provider Unit identified the quality outcome measure to recruit two additional Nurse Planners to support the Unit. The Unit will revisit this in six months to ensure that the workload per Nurse Planner was reduced significantly enough or if additional Nurse Planners are required. 180

181 VALUE/BENEFIT TO NURSING PROFESSIONAL DEVELOPMENT: The Approved Provider Unit shall evaluate data to determine how the Approved Provider Unit, through the learning activities it has provided, has influenced the professional development of its nurse learners. Describe and, using an example, demonstrate the following: QO5 How, over the past 12 months, the Approved Provider Unit has enhanced nursing professional development (Reference each identified quality outcomes measure listed in your response for OO4). Interpretation and rationale: The Approved Provider must describe how they have enhanced nursing professional development through their work toward the strategic goals outlined in their response for Organizational Overview 4 (OO4). What achievements and/or progress have been made and how do they enhance nursing professional development. See Sample QO5A, Sample QO5B and Sample QO5C for various descriptions of how the Unit has achieved quality outcome measures that have enhanced nursing professional development and an example of that process operationalized. SAMPLE QO5A Johnson Case Hospital as reiterated in the Organizational Overview section, the quality outcomes measures for the Provider Unit are as follows: Quality outcomes measures related to Nursing Professional Development 4. Ensure that all registered nurses complete Pain modules with 80% or better post test scores 5. Design enduring activities to measure knowledge in 100% and application in 10% 6. Ensure that all enduring web based activities are accessible by personal communication device by December of Our Provider Unit is still working to evaluate the link between the continuing education activities we provide and improvements in nursing professional development. We selected the three quality outcome measures listed above at our annual strategic planning meeting based on what our Unit is capable of achieving, how we hope to progress in the coming year and understanding the positive impact achievement of these outcomes would have on nursing professional development. An example of how the quality outcomes were achieved for enhancing nursing practice for the measure: Ensure that all registered nurses complete Pain modules with 80% or better post test scores is demonstrated in the successful completion of all registered nurses completing the post test scores with 80% or greater. The total number of successful completions for immediate post test scores and a total number of follow up responses to change in nursing practice at 6 months suggested enhanced nursing practice with regard to utilizing standard protocols for pain management. The collection of the summative data is presented during the annual strategic planning meetings and on an individual basis with faculty where concerns or issues are identified. 181

182 SAMPLE QO5B Missouri Psychiatric Nurses Association as reiterated in the Organizational Overview section, the quality outcomes measures for the Provider Unit are as follows: Quality outcomes measures related to Nursing Professional Development 5. Certification review for certifying and recertifying members is offered twice in different regions 6. Number of certified members increase by 10% Our Provider Unit is still working to evaluate the link between the continuing education activities we provide and improvements in nursing professional development. An example of quality outcome measures related to Nursing Professional Development is demonstrated in the summative report of an increase in the Number of certified members by 10%. A review of the literature reported that specialty nursing certification is often equated with expert, high quality, competent professional nursing practice. It is defined as a voluntary practice that provides formal recognition of specialized knowledge, skills, and clinical practice experience beyond the requisite mandatory and regulatory minimal requirements of licensure. According to recent estimates, registered nurses in the United States were potentially eligible for more than 115 different nursing specialty certifications through 45 nursing and interdisciplinary organizations. During the annual strategic meeting, the increase in the number of certified members increased by 14%. 182

183 SAMPLE QO5C As an approved organization, we are committed to improving the professional practice of nursing. On a yearly basis, our Approved Provider Unit collects yearly summative evaluation data from our activities. With the inception of the new criteria, our Approved Provider Unit decided to determine what nursing professional development outcome we want to evaluate for the next year. In 2011, we determined we wanted to evaluate an improvement in nursing practice or nursing care delivery. Our organization made a commitment to ensure that 20% of the educational activities that we provided in the past 12 months included an evaluation of an improvement in nursing practice or nursing care delivery. In 2011, 20% of our educational activities equaled 15 activities. Because evaluation of an improvement in nursing practice or nursing care delivery cannot be assessed at the end of an educational activity and must be assessed after the nurse learner has returned to the practice setting, this required that our organization identify a way to contact the nurse learner after the activity was over. We chose to collect an address for each nurse learner participating in an educational activity that was designed to improve practice or care delivery and we sent a survey out 3 months after the educational activity was presented. We did ask nurses their permission to use their address for the survey and let them know that we would contact them at 3 months. We also told them that their address would be kept confidential and that the information that we received from the 3 month survey would help us do a better job providing educational activities in the future as well as provide evidence of the value of continuing nursing education. We used an electronic tool to distribute the survey. Our overall response rate was 30% which was a little disappointing because we really wanted to capture all of our nurse learner feedback but a 30% return rate is not bad compared to expected survey response rates reported in the literature. When we analyzed the 3 month post survey responses from the educational activities designed to improve nursing practice or care delivery, we found that most nurses implemented at least one change in the practice setting that resulted in an improvement in practice or care delivery. The most frequently implemented change was using a clinical practice guideline instead of their usual method of delivering care. The second most frequently implemented change was ensuring that all patients received discharge planning instructions at a level the patient could understand. One concern we identified was that 35% of nurses did not implement a change due to barriers within the practice setting. As a result of this information, our educational activities in the future will include a discussion of how to overcome barriers in the practice setting. Reference: American Nurses Credentialing Center s Standardized Self Study Application for Training. 17 September American Nurses Credentialing Center. All rights reserved. Reproduced with permission from the American Nurses Credentialing Center. 183

184 APPROVED PROVIDER CRITERION 4: Sample Activities (SA) As a component of the educational design process, the Approved Provider applicant should select and submit three (3) samples of CNE activity files (not three sessions of the same conference) that have been planned within 12 months of the Approved Provider application and comply with the ANCC/MONA Accreditation criteria. Each educational activity must be at least one contact hour (60 minutes) in length and must have been provided at least once. Sample activities may not be co provided. Please see the Activity Planning Guide for assistance in documentation for the sample activities. Remember, sample activities submitted must include a table of contents providing a page number for all corresponding supporting documentation. SAMPLE ACTIVITY #1 TITLE OF ACTIVITY: LOCATION OF ACTIVITY: ACTIVITY FORMAT: Live Enduring (please select one double click shaded box & select checked) DATE OF ACTIVITY: (Insert date live activity presented or, for ongoing enduring activities, date first offered and subsequent review dates) Please see the activity planning guide addressing each of the required criteria and all supporting documentation for this educational activity (double click shaded box & select checked) SAMPLE ACTIVITY #2 TITLE OF ACTIVITY: LOCATION OF ACTIVITY: ACTIVITY FORMAT: Live Enduring (please select one double click shaded box & select checked) DATE OF ACTIVITY: (Insert date live activity presented or, for ongoing enduring activities, date first offered and subsequent review dates) Please see the activity planning guide addressing each of the required criteria and all supporting documentation for this educational activity (double click shaded box & select checked) SAMPLE ACTIVITY #3 TITLE OF ACTIVITY: LOCATION OF ACTIVITY: ACTIVITY FORMAT: Live Enduring (please select one double click shaded box & select checked) DATE OF ACTIVITY: (Insert date live activity presented or, for ongoing enduring activities, date first offered and subsequent review dates) Please see the activity planning guide addressing each of the required criteria and all supporting documentation for this educational activity (double click shaded box & select checked) 184

185 GLOSSARY This glossary includes selected definitions that are frequently used in the American Nurses Credentialing Center s (ANCC) Accreditation Program criteria and explanation of the accreditation process. In some instances, definitions from the ANA Nursing Professional Development: Scope and Standards of Practice (ANA, 2010) are also useful to understand or explain a term. Reference: 2013 ANCC Primary Accreditation Application Manual for Providers and Approvers, 2011, ANCC. Academic Education Courses taken for undergraduate or graduate credit in an institution of higher learning that may or may not lead to a degree or completion of a certificate program. Although professional development begins on entry into the basic nursing education program for the purpose of this definition, academic education refers to those courses taken in colleges or universities after the basic nursing education program. Accountability Responsibility for adherence to the ANCC accreditation criteria as they apply to providing quality CNE. Accreditation The voluntary process in which a nongovernmental agency or organization appraises and grants accredited status to institutions and/or programs or services that meet predetermined structure, process, and outcome criteria (time limited). Accredited Approver An eligible organization credentialed by ANCC after having submitted to an in depth analysis to determine its capacity to assess and monitor other organizations compliance with ANCC accreditation criteria that support the provisions of quality CNE activities, as well as approve those educational activities offered by other organizations or individuals in compliance with ANCC accreditation criteria. Accredited Provider An eligible organization credentialed by ANCC after having submitted to an in depth analysis to determine its capacity to provide quality continuing education over an extended period of time. Adult Learning Principles The basis for or the beliefs underlying, the teaching and learning approaches to adults as learners based on recognition of the adult individual s autonomy and self direction, life experiences, readiness to learn and problem orientation to learning. Approaches include mutual, respectful collaboration of educators and learners in the assessment, planning, implementation, and evaluation of education activities. (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010) American Nurses Credentialing Center s Commission on Accreditation (ANCC COA) The ANCC Accreditation Program is a subsidiary of the American Nurses Association (ANA) and governed by a volunteer commission whose members represent a variety of expertise from the 185

186 field of continuing education including academia, educational companies, domestic and international nursing associations, and governmental organizations. The Commission on Accreditation (COA) provides strategic direction for the program and confers all accreditation decisions. The ANCCs mission is to promote excellence in nursing and health care globally through credentialing programs. They recognize healthcare organizations that promote nursing excellence and quality patient outcomes, while providing safe, positive work environments. In addition, ANCC accredits healthcare organizations that provide and approve continuing nursing education. It also offers educational materials to support nurses and organizations as they work toward their credentials. The ANCC Accreditation program recognizes the importance of highquality continuing nursing education (CNE) and skills based competency programs. Around the world, ANCC accredited organizations provide nurses with the knowledge and skills to help improve care and patient outcomes. Among its responsibilities, the COA develops program criteria, implements its national accreditation programs, accredits approvers and providers of continuing nursing education, and evaluates the Accreditation Program. Appointed by, and accountable to, the ANCC Board of Directors, the members of the COA are selected to represent a range of accredited organizations, consumers, nursing evaluation experts, adult education professionals, and the public at large, and include representatives from the Congress on Nursing Practice and Economics. Appeal A process that allows the applicant/accredited organization to obtain reconsideration by an appellate body with regard to an adverse decision made by an original decision making body. Approval A decision made by an Accredited Approver that the educational design criteria or provider approval criteria have been met. Approved Provider Recognition by an ANCC Accredited Approver of a provider s capacity to award contact hours for continuing education activities, planned, implemented, and evaluated by the provider. Approver Unit Comprises the members of an organization who support the approval of other organizations and/or continuing nursing education activities. Bias Tendency or inclination to cause partiality, favoritism or influence. Biographical Data Information required of persons involved in the peer review process or the planning and delivery of continuing education activities. The data provided should document their qualifications relevant to the continuing education process or a specific activity with respect to their education, professional achievements and credentials, work experience, honors, awards, and/or professional publications. 186

187 Commercial Interest Any entity either producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by, or used on, patients. Exceptions are made for nonprofit or government organizations and non healthcarerelated companies. Commercial Support Financial, or in kind, contributions given by a commercial interest that are used to pay for all or part of the costs of a CNE activity. Providers of commercial support may not be providers or coproviders of an educational activity. Commission on Accreditation (COA) Appointed by and accountable to the ANCC Board of Directors, this body is responsible for development and implementation of the ANCC program for accreditation of CNE. The COA is composed of at least nine members selected from CNE stakeholder communities such as accredited organizations, consumers, nursing evaluation, and adult education. Commitment Duty or responsibility of those providing or approving continuing education to meet learner needs, provide quality CNE, and support Provider Unit goals and improvements. Conflict of Interest An affiliation or relationship of financial nature with a Commercial Interest Organization that might bias a person s ability to objectively participate in the planning, implementation, or review of a learning activity. All planners, reviewers, and faculty/presenters/authors are required to complete the MONA combination Biographical Date and Conflict of Interest form. Contact Hour A unit of measurement that describes 60 minutes of an organized learning activity. One contact hour = 60 minutes. Content Subject matter of an education activity that relates to the educational objectives. (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010) Content Expert An individual with documented qualifications demonstrating education and/or experience in a particular subject matter. Also Subject Matter Expert. Content Reviewer An individual selected to evaluate an educational activity during the planning process or after it has been planned but prior to the delivery to learners for quality of content, potential bias, and any other aspects of the activity that may require evaluation. 187

188 Continuing Education Activities Those learning activities intended to build upon the educational and experiential bases of an individual for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the public. Continuing Education Unit (CEU) The ANCC Accreditation Program does not utilize this term when referring to the CNE unit of measurement. The CEU is an educational measurement utilizing criteria of the International Association for Continuing Education and Training (IACET). One CEU is equal to ten (10) clock hours of educational achievement used by many universities and professional organizations following the IACET criteria to attest to clock hour completion of continuing education activities. Continuing Nursing Education (CNE) Activities Those learning activities intended to build upon the educational and experiential bases of the professional RN for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the public and RNs pursuit of their professional career goals. Co provided Activities Educational activities planned, developed, and implemented by two (2) or more organizations or agencies. Credentialing A generic term for licensure, certification, and registration. It can also be used as a term for a voluntary process under the auspices of private sector associations. Deferral An action taken when the ANCC or MONA determines that more information is needed from the applicant before an approval decision can be made. Denial An action taken when an applicant s written application materials substantiate that the organization is not in compliance with the ANCC Accreditation Program/MONA criteria and will not be able to comply within a definite time frame of two (2) years. Directory of Accredited Organizations An electronic listing that serves as public notification of an organization s status as an accredited approver and/or provider of continuing nursing education. All accredited organizations appear in this directory, which is available online by visiting the ANCC at Distance Learning A formal educational activity in which most of the instruction occurs when the learner and the educator are not in the same place. The instruction may take place either synchronously (at the same time) (e.g., interactive video) or asynchronously (at different times) (e.g., online/internet or correspondence courses). 188

189 Domains of Learning Three areas in which learning takes place: the cognitive, psychomotor, and affective. Educational Activity A planned, organized effort aimed at accomplishing educational objectives. Educational Objectives Derived from the overall purpose of the activity, educational objectives are written statements that describe learner oriented outcomes that may be expected as a result of participation in the educational activity. These statements describe knowledge, skills, and/or attitude changes that should occur upon successful completion of the educational activity. Eligibility An applicant s ability to meet certain criteria in order to be considered qualified to apply for accreditation. Enduring Materials A non live CNE activity that endures over time. Examples of enduring materials include programmed texts, audiotapes, videotapes, monographs, or computer assisted learning materials, or other electronic media that are used alone or with printed or written materials. Enduring materials can also be delivered via the Internet. The learning experience by the nurse can take place at any time in any place rather than only at one time or in one place. Evaluation The process of determining significance or quality by systematic appraisal and study (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010). Evaluation Criteria Relevant, measurable indicators of significant or quality standards (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010). Evidence Specific information that documents compliance with accreditation/approval criteria. Gift in kind Nonmonetary support (e.g. marketing assistance, meeting room, event registration assistance, etc.) provided by the giver to the taker. (In the accreditation community the taker is the provider of CNE.) Goal A measurable end result having one or more objectives to be achieved within a pre determined timeframe. In service Educational Activities Activities intended to assist the professional nurse to acquire, maintain, and/or increase competence in fulfilling the assigned responsibilities specific to the expectations of the employer. 189

190 Key Element Relevant, measurable indicators of the standards. Key Personnel Individuals who contribute to the overall functioning of the Provider/Approver Unit in a substantive, measurable way, without regard to pay or employment status. Lead Nurse Planner A currently licensed RN with a master s degree or higher or international equivalent, and with either the baccalaureate or graduate degree in nursing, who has the authority within the Accredited Provider Unit to ensure adherence to the ANCC Accreditation Program criteria in the provision of CNE. Leadership The provision of direction and guidance to individuals involved in the process of assessing, planning, implementing, and evaluating CNE activities in adherence to the ANCC accreditation criteria. Learner Directed, Learner Paced Activity An educational activity in which the learner takes the initiative in identifying his or her learning needs, formulating learning goals, identifying human and material resources for learning, choosing, and implementing appropriate learning strategies, and evaluating learning outcomes. The learner also determines the pace at which the learning activity is engaged. Learner directed activities may be developed with or without the help of others, but they are engaged in by only one individual. Learning Goal A statement describing the overall purpose of the educational activity. Marketing Materials Method of announcing an educational activity. This may include a brochure, flyer, bulletin board announcement, newsletter, memo, e mail, Intranet posting, electronic message or Web site. Multidisciplinary To relate to or to include several disciplines at once, e.g., a multidisciplinary approach to planning a continuing education activity; also may be referred to as interdisciplinary. Multi Focused Organization (MFO) An organization that exists for more than the purpose of providing CNE. Needs Assessment The process by which a discrepancy between what is desired and what exists is identified. Nurse Peer Review Leader A currently licensed RN with a master s degree or higher, and with either the baccalaureate or graduate degree in nursing, who has the authority within the organization to evaluate adherence to the ANCC Accreditation Program criteria in the provision of CNE. 190

191 Nurse Peer Reviewer A currently licensed RN with a baccalaureate degree or higher in nursing who is actively involved in evaluating each Approved Provider or Individual Activity Applicant to evaluate adherence to the ANCC criteria. Nurse Planner A currently licensed RN with a baccalaureate degree or higher or international equivalent in nursing who is actively involved in all aspects of planning, implementation, and evaluation of each CNE activity. The Nurse Planner is responsible for ensuring that appropriate educational design principles are used and processes are consistent with the requirements of the ANCC Accreditation Program. Nursing Professional Development The lifelong process of active participation by nurses in learning activities that assist in developing and maintaining their continuing competence, enhancing their professional practice, and supporting achievement of their career goals. (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010) Off Label Use Using products for a purpose other than that for which it was approved by the Food and Drug Administration (FDA). Operational Functioning under all of the relevant criteria of the ANCC Accreditation Program, with all essential approver and/or provider unit personnel in place. Application is permitted once the provider meets the designated eligibility requirements. Organization The overall administrative and functional structure that includes the approver unit and/or provider unit. For example, a hospital, college, association, or private business. Organizational Chart A diagram or other schematic used to depict informal and formal lines of communication and relationships within the overall organization including the Approver and/or Provider Unit. Orientation The process of introducing nursing staff to the philosophy, goals, policies, procedures, role expectations, and other factors needed to function in a specific work setting. Orientation takes place both for new employees and when changes in nurses roles, responsibilities, and practice settings occur (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010). Outcome The impact of structure and process on the organization as a provider or approver and the value/benefit to nursing professional development. 191

192 Outcome Measurement The process of observing, describing, and quantifying predefined indicators of outcomes of performance. (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010) Peer Review Professional judgment on the quality of the continuing nursing education offered based on designated standards and criteria for continuing nursing education. ANA s Code of Ethics recognizes that effective peer review is indispensable for holding nursing practice to the highest standards. Peer review helps address the boundaries of duty and loyalty for all nurses, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth." Planning Committee At least 2 individuals responsible for planning each educational activity; one individual must be a Nurse Planner and one individual must have appropriate subject matter expertise. Policy Policy is defined as a course of action to be followed by a government, business, or institution to obtain a desired effect (Nies and McEwen, 2011, p. 200). Portfolio Material documenting the professional development, career planning, demonstration of learning and maintenance of continuing professional nursing competence of the individual nurse (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010). Position Description Description of the functions specific to the role of the Lead Nurse Planner, Nurse Planner, Nurse Peer Review Leader, Nurse Peer Reviewers, Primary Nurse Planner, and key personnel that relate to the Provider or Approver Unit. Primary Nurse Planner A currently licensed RN with a baccalaureate degree or higher in nursing who is designated as the Primary Nurse Planner and serves as the liaison between the ANC Accredited Approver Unit and the Approved Provider Unit. Procedure A written statement defining how a particular policy is implemented. Process For Accredited and Approved Providers, process is the development, delivery, and evaluation of CNE activities. For Accredited Approvers, process is the evaluation of providers of CNE and/or individual CNE activities. Professional Development See nursing professional development above. 192

193 Provider An individual, institution, organization, or agency responsible for the development, implementation, evaluation, financing, record keeping, and quality of continuing nursing education activities. Provider Unit Comprises the members of an organization who support the delivery of continuing nursing education activities. Provider Directed, Learner Paced Activity An educational activity in which the provider controls the content of the learning activity, including the learning objectives based on needs assessment, the content of the learning activity, the method by which it is presented, and the evaluation methods. The learner determines the pace at which the learning activity is engaged (examples include print article, self learning module/independent study). Provider Directed, Provider Paced Activity An educational activity in which the provider controls all aspects of the learning activity. The provider determines the learning objectives based on a needs assessment, the content of the learning activity, the method by which it is presented, and evaluation methods (examples include live activities, live Webinars). Purpose Written outcome statement related to what the learner will be able to do at the conclusion of the activity (i.e. The purpose of this activity is to enable the learner to ). Reconsideration A process that allows an applicant to obtain a review of and adverse decision on an application for accreditation or approval by submission of clarifying materials to the original decisionmaking body. This is also a process that allows for a review of a revocation decision. Retroactive Approval Peer review and approval of an activity that has already taken place; not authorized in the ANCC Commission on Accreditation system. Resources Available human, material, and financial assets used to support and promote an environment focused on quality CNE and outcome measures. Resubmission A process that provides for review and action on applications that had been previously submitted and withdrawn prior to action. Revoke To rescind approved/accredited status. Single Focused Organization An organization that exists for the sole purpose of providing CNE. 193

194 Specialty A concentration in an area of nursing that has standards and that reflects a well defined base of knowledge within the overall discipline of nursing. Specialty Nursing Organization (SNO) A national nursing body that has a majority of voting members who are RNs practicing in a specialized nursing area, as so defined in the organization s governing documents. Sponsor An organization providing financial or in kind contributions that does not meet the definition of a commercial interest. Sponsorship Financial or in kind contribution(s) from an organization that does not fit the category of a commercial interest. Staff Development The systematic process of assessment, development, and evaluation that enhances the performance or professional development of health care providers and their continuing competence (National Nursing Staff Development Organization, 1999) (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010). Standards of Nursing Practice Authoritative statements that describe a level of care or performance common to the profession of nursing by which the quality of nursing practice can be judged and measured (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010). Standards of Professional Performance Authoritative statements that describe a competent level of behavior in the professional role, including activities related to quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization (Nursing Professional Development: Scope and Standards of Practice, ANA, 2010). Structure Characteristics of an organization, including commitment, accountability, leadership, and resources that are required to support the delivery of quality CNE. Target Audience The group for which an educational activity has been designed. Teaching Strategies Instructional methods and techniques that are in accord with the principles of adult learning. Withdrawal Termination of an application, without prejudice to any future applications, prior to the date on which an official decision is made. 194

195 REFERENCES The following references were cited and used during the development of this edition of the Provider Approval Manual and others have been included to provide nursing educators with resources to facilitate development, implementation, and evaluation of educational activities. Most of the journals and books should be available in college and university libraries or in medical libraries in health care institutions. Some older classic resources are included because of their value to nursing education and continuing education. Abruzzese, R. S. (1992). Evaluation in nursing staff development. In R. S. Abruzzese, Nursing staff development: Strategies for success. St. Louis: Mosby YearBook. Abruzzese, R. S. (1992). Nursing staff development: Strategies for success. St. Louis: Mosby YearBook. Abruzzese, R. S. (1996). Nursing Staff Development, 2nd Ed St. Louis, MO: Mosby Year book, Inc. Abruzzese, R. S., & Hinthorn, P. C. (1987). Credentialing. Pp in Puetz, B. E., Contemporary Strategies for Continuing Education in Nursing. Rockville, MD: Aspen Publishers, Inc.American Nurses Association. (2004). Scope and Standards of Practice for Nursing Professional Development. Washington, DC: Author. American Nurses Association. (2001). Code of Ethics for Nurses With Interpretive Statements. Washington, DC: Author. American Nurses Association. (2010). Nursing Professional Development: Scope and Standards of Practice. Silvery Spring, MD: Nursebooks.org. American Nurses Association. Nursing's Social Policy Statement, Second Edition, 2003, p. 6 & Nursing: Scope and Standards of Practice, 2004, p. 7 American Nurses Credentialing Center's Commission on Accreditation. (2001). Manual for accreditation as an approver of continuing education in nursing. Washington, DC: Author. American Nurses Credentialing Center's Commission on Accreditation. (2001). Manual for accreditation as a provider of continuing education in nursing. Washington, DC: Author. American Nurses Credentialing Center's Commission on Accreditation. (2006). Manual for accreditation as a provider or an approver of continuing nursing education. Washington, DC: Author. American Nurses Credentialing Center s Commission on Accreditation (2009). Application Manual, Accreditation Program Accrediting Excellence in Continuing Nursing Education. Silver Spring, MD: Author. American Nurses Credentialing Center s Commission on Accreditation (2011) ANCC Primary Accreditation Application Manual, Accreditation Program for Approvers and Providers. MD: Author. ANCC COA. The Value of Accreditation for Continuing Nursing Education: Quality Education Contributing to Quality Outcomes. June Anderson, J. (1982). Acquisition of cognitive skill. Psychological Review, 89,

196 Armstrong, M.L., Gessner, B.A., & Cooper, S.S. (2000). POTS, PANS AND PEARLS: The nursing profession's rich history with distance education for a new century of nursing. The Journal of Continuing Education in Nursing, 31 (2), Aslanian, C. B. & Brickell, H. M. (1980). Americans in transition: Life changes as reasons for adult learning. NY: Future Directions of a Learning Society, College Board. Aucoin, J. W. (1998). Participation in continuing nursing education programs by development specialists. Journal of Nursing Staff Development, 14(5): Ausubel, D. P. (1968). Educational psychology: A cognitive view. NY: Holt, Rinehart and Winston. Bandura, A. (1976). Modeling theory. In W. S. Sahakian (ed.), Learning: Systems, models, & theories (2nd ed.). Chicago: Rand McNally. Bell, D. (1986). Developing instructional objectives for continuing education offerings. The Missouri Nurse, 55(3). Bell, D.F., Chelf, J.H., & Geerdes, P. (2000). An outcomes model prototype: Integrating continuing education learning into practice. The Journal of Continuing Education in Nursing, 31 (3), Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison Wesley. Bevis, O. E. (1972). Curriculum building in nursing: A process. St. Louis: C.V. Mosby. Bevis, O. E., & Watson, J. (1989). Toward a caring curriculum: A new pedagogy for nursing. NY: National League for Nursing. Billings, D. & Halstead, J. (2009). Teaching in nursing: A guide for faculty. St. Louis: Saunders Elsevier. Bloom, B.S. (1984). Taxonomy of Educational Objectives. Boston, MA: Pearson Education. Bloom, B. S. et al, (ed.). (1956). Taxonomy of education objectives: The classification of education goals. Handbook I, Cognitive domain. New York: David McKay. Bradley Springer, L. (1993). Discovery of meaning through imagined experience, writing, and evaluation. Nurse Educator, 18(5): Brooks, E. L., Fletcher, K., & Wahlstedt, P. A. (1998). Focus group interviews: Assessment of continuing education needs for the advanced practice nurse. Journal of Continuing Education in Nursing, 29(1): Cariton, K.H. (1997). Redefining continuing education delivery. Computers in Nursing, 15(1), Cheesman, SD. (2009). The "connection" between continuing education and quality. Journal of continuing education in Nursing. 40(8), Clevenger, K. (1998). Setting up a continuous venovenous hemofiltration educational program. A case study in program development. Critical Care Nursing Clinics of North America, 10(2): Cooper, S. S. Self directed learning in nursing. Rockville, MD: Aspen. Cooper, S. S. The practice of continuing education in nursing. Rockville, MD: Aspen. 196

197 Cross, K. P. (1988). Adults as learners. San Francisco: Jossey Bass. Cullen, P. D. (1998). Delaware RNs' reasons for nonparticipation in continuing education. Journal of Continuing Education in Nursing, 29(5): Emblen, J.D. & Gray, G.T. (1990). Comparison of nurses' self directed learning activities. The Journal of Continuing Education in Nursing, 21, Finkelman, A., & Kenner, C. (2009). Teaching IOM: Implications of the Institute of Medicine Reports for nursing education. 2nd ed. Washington, DC: Nursebooks.org. Flavell, J. H. (1985). Cognitive development. Englewood Cliffs, NJ: Prentice Hall. Gagné, E. D. (1985). The cognitive psychology of school learning. Boston: Little, Brown. Gronlund, M.E. (2004). Writing Instructional Objectives for Teaching Assessment, 7th Ed. Upper Saddle River, NJ: Pearson Prentice Hall. Gronlund, N. E. (1991). Stating objectives for classroom instruction, (4th ed.). New York: MacMillan. Hawkins, V.E., & Sherwood, G.D. (1999). The pyramid model: An integrated approach for evaluating continuing education programs and outcomes. The Journal of Continuing Education in Nursing, 30 (5), Heimericks, B. (1993). ANCC COA revises criteria for approval of CE activities. The Missouri Nurse, 62(4), 4. Houle, C. O. (1961). The Inquiring mind. Madison: University of Wisconsin Press. Hughes, J. (1992). College teaching. Columbia, MO: University of Missouri Columbia. Kalnins, I. (2002). New criteria for approval of CE activities. The Missouri Nurse, 71(1), 13. Knowles, M. S. (1980). The modern practice of adult education: From pedagogy to androgogy (2nd ed.). NY: Cambridge Books. Krathwohl, D., et al. (1964). Taxonomy of educational objectives: The classification of educational goals. Handbook II, affective domain. New York: David McKay. Mager, R. (1962). Preparing instructional objectives. Palo Alto, CA: Fearon Publishers. Merriam, S. B. (Ed.). (2001). A New Update on Adult Learning Theory: New Directions for Adult and Continuing Education Series (No. 89). San Francisco, CA: Jossey Bass Merriam, S.B. (1984). Adult development: Implications for adult education. Columbus, OH: ERIC Clearinghouse on Adult, Career, and Vocational Education. Mezirow, J., & Associates. (1991). Fostering critical reflection in adulthood: A guide to transformative and emancipatory learning. San Francisco: Jossey Bass. National Nursing Staff Development Organization (NNSDO). (1999). Strategic Plan Pensacola, FL: National Nursing Staff Development Organization. Perry, W. (1970). Forms of intellectual and ethical development in college years. NY: Holt, Rinehart & Winston. 197

198 O'Very, D.I. (1999). Self paced: The right pace for staff development. Journal of Continuing Education in Nursing, 30, Phillips, L. (1994). The continuing education guide: The CEU and other professional development criteria. Dubuque, IA: Kendall/Hunt Publishing. Redman, B. K. (1988). The process of patient teaching in nursing, 6th ed. St. Louis: C.V. Mosby. Rogers, C. (1951). Client centered therapy: Its current practice, implications, and theory. Boston: Houghton Mifflin. Schlossberg, N. K. (1984). Counseling adults in transition. NY: Springer. Simpson, E. J. (1972). The classification of educational objectives in the psychomotor domain. in The Psychomotor Domain, vol. 3. Washington: Gryphon House. 198

199 APPENDIX A APPROVED PROVIDER APPLICATION NOTE: Each applicant wishing to apply to become an Approved Provider must first complete and submit an intent to apply form to the MONA Office. Please see Appendix B for a copy of this form or contact the MONA office to obtain an electronic copy. 199

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201 PROVIDER APPROVAL PROCESS CHECKLIST The following checklist has been developed to ensure a successful application submission and review process for those agencies utilizing the MONA CNE Approval Process, seeking provider approval. There are several steps to the application process that Approved Provider applicants must complete in order to meet the guidelines. Please ensure that each area listed below is addressed. Please Note: To place an X in a shaded box, double click the shaded box & select the checked option. Obtain most current copy of MONA Approved Provider Application Visit or contact MONA office Purchase Copy of Current Provider Approval Manual Visit or contact MONA office Review Provider Approval Manual and Application Requirements Review Intent to Apply Form Listing Eligibility Requirements Complete Intent to Apply Form applicants must meet eligibility requirements to proceed forward with the full Provider Application Submit Intent to Apply Form for Review due to MONA six (6) months prior to application cycle deadline e.g. December 1 st for July cycle; June 1 st for the January cycle. Intent to apply fee of $ submitted with Intent to Apply form applied to application review fee Complete Approved Provider Application Please see the Provider Application Checklist (next page) for a list of all elements that must be addressed/included in application packet(s) Prepare the application and supporting documentation into either: Hard copies: a total of three (3) copies of application and supporting documentation OR Electronic: a total of four (4) separate Word or Adobe.pdf files, not to exceed 5 MB in size (Electronic applications must be submitted on a flash drive. The application and supporting documentation must be collated into one Word or Adobe.pdf file and each of the sample activities into a separate Word or Adobe pdf file.) Submit application to the MONA Office Physical Address: 1904 Bubba Lane, Jefferson City, MO Mailing Address: P.O. Box , Jefferson City, MO sara@missourinurses.org Submit Application Review Fee Application review fees are non refundable Mailed/Submitted with application(s) Payment sent separately Payment Method: Estimated Arrival Date: Receive Decision from MONA Review Committee feedback provided within 6 7 weeks following submission FOLLOWING APPROVAL: Submit Annual Report due to MONA by March 1 st of each calendar year Submit Annual Renewal Fee due to MONA by March 1 st of each calendar year Payment Method: 201

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203 PROVIDER APPLICATION CHECKLIST The following elements must be addressed/included in the Approved Provider application packet(s). Please check the box below next to each criterion indicating that it was addressed and provide the corresponding page number where the criterion was addressed within your submission. A copy of this completed checklist including page numbers must be included in the final application submission. Organizational Overview (OO) OO1.1 Provider Unit Description Page #: OO2.1 Provider Unit Personnel Page #: OO2.2 Position Descriptions must be specific to Provider Unit responsibilities Page #: OO2.3 Organizational Chart for Provider Unit Page #: OO2.4 Organizational Chart of Total Organization Page #: OO3.1 CNE Activity Form must use MONA required form for reporting Page #: OO3.2 Reporting Requirements Page #: OO3.3 Reporting Requirements Page #: OO4.1 Provider Unit Strategic Goals Page #: OO4.2 Quality Outcome Measures for Approved Provider Unit Page #: OO4.3 Quality Outcome Measures for Nursing Professional Development Page #: Approved Provider Criterion 1: Structural Capacity (SC) each with process description and an example SC1 Page #: SC2 Page #: SC3 Page #: SC3 Page #: SC5 Page #: SC6 Page #: SC7 Page #: Approved Provider Criterion 2: Educational Design Process (EDP) each with process description & an example EDP1 Page#: EDP6 Page#: EDP11 Page#: EDP2 Page#: EDP7 Page#: EDP12 Page#: EDP3 Page#: EDP8 Page#: EDP13 Page#: EDP4 Page#: EDP9 Page#: EDP5 Page#: EDP10 Page#: Approved Provider Criterion 3: Quality Outcomes (QO) each with process description and an example QO1 Page #: QO2 Page #: QO3 Page #: QO4 Page #: Approved Provider Criterion 4: Sample Activities (SA) The following elements should be submitted for each sample activity. Completed Activity Planning Guide Biographical Data & COI Forms for all planners and presenters/authors/content reviewers Biographical Data & COI Forms all reviewed and co signed by Nurse Planner Copy of the Evaluation Tool/Method(s) Copy of the Certificate of Completion Copy of any promotional materials i.e., flyer, brochure, electronic announcement, print screens, etc. Documentation of Disclosures Provided to Activity Participants Co Provider Agreement if applicable Commercial Support and/or Sponsorship Agreement(s) if applicable 203 v.6.13

204 204 v.6.13

205 APPROVED PROVIDER APPLICATION Three (3) hard copies OR one (1) Word or Adobe.pdf file of the application and supporting documentation must be submitted to the Missouri Nurses Association office accompanied by the appropriate application fee. Approved Provider applications must be submitted by November 1 st (for a January December calendar) or May 1 st (for a July June calendar.) Approved Provider applications received later than 10 days after the deadline will not be accepted for that cycle, without prior arrangements with the MONA Office. Provider approval is granted for a three year period. Please refer to the Continuing Education Excellence in Missouri: Provider Approval Manual, 8 th ed., for additional guidance in completing this application. This manual provides step by step instructions on completing the Approved Provider application as well a detailed chapter on the educational design process and the planning of activities to assist Approved Providers with adherence to the accreditation guidelines during their approval period. APPLICATION REVIEW FEE: (Based on type of Provider below. Applicants are given the option of paying in full when submitting the application or in three installments. See below for payment schedule options.) $2, Single Agency Provider (see definition in application instructions) $4, System Provider (see definition in application instructions) APPLICANT INFORMATION: APPROVED PROVIDER: ADDRESS: CITY: STATE: ZIP CODE: PERSON TO NOTIFY OF APPROVAL: PHONE: FAX: FIRST TIME APPLICANT? Yes No (double click shaded box & select checked) HAS THIS APPROVED PROVIDER APPLICATION BEEN PREVIOUSLY SUBMITTED & DENIED BY ANOTHER APPROVER UNIT? Yes No If yes, provide name of organization issuing denial SINGLE AGENCY PAYMENT SCHEDULE OPTION: $ initial payment and $ due each year on the anniversary date of approval. (This amount reflects a service fee.) MULTI AGENCY PAYMENT SCHEDULE OPTION: $1, initial payment and $1, due each year on the anniversary date of approval. (This amount reflects a service fee.) PAYMENT: CHECK ENCLOSED (MAKE CHECKS PAYABLE TO THE MISSOURI NURSES ASSOCIATION) CHARGE MY CREDIT CARD [ ] MASTERCARD [ ] VISA [ ] AMERICAN EXPRESS [ ] DISCOVER CARD # EXP DATE: BILLING ZIP CODE: CARD ISSUED TO: SIGNATURE: CVV: 205 v.6.13

206 PROVIDER APPROVAL CRITERIA The following five sections are required written documentation for new Approved Provider applicants and those organizations currently approved as providers reapplying to maintain their provider approval status: Approved Provider Organizational Overview (OO) Approved Provider Criterion 1: Structural Capacity (SC) Approved Provider Criterion 2: Educational Design Process (EDP) Approved Provider Criterion 3: Quality Outcomes (QO) Approved Provider Criterion 4: Sample Activities (SA) Please respond to each of the Criterion and corresponding sections with a narrative response to demonstrate Approved Provider adherence. Approved Provider Criterion 1 3 require a process description and an example illustrating how the process is operationalized within the Provider Unit. Criterion 4 requires the submission of three sample activities held in the previous 12 month period. Approval decisions are determined on the basis of compliance with the ANCC/MONA Accreditation Program criteria. In order to validate compliance, it is essential that the MONA review team receive a comprehensive, well organized Approved Provider application, including narrative descriptions for each criterion, sample activity files demonstrating compliance and supplemental evidence as required or requested. Validation of compliance is based on the written documentation provided in this provider application. Please remember the following requirements as you prepare your Approved Provider application: 1. Respond to each criterion listed below in an organized easy to follow manner. All applicants are encouraged and should be able to type responses directly onto this application. However, if you are unable, please address each Criterion by name and number, i.e. Approved Provider Criterion 3 Quality Outcomes, Approved Provider Unit Evaluation Participants, QO 1, and follow the sequence in order. 2. All pages should be numbered sequentially, including appendices and sample activity documentation to facilitate the review process. 3. Type the entire application and ensure all copies are clearly reproduced. 4. Do not provide lengthy narratives addressing more than one criterion without numbering the responses accordingly. 5. Please limit the narrative portion of your application (OO, SC, EDP, & QO sections) to 50 typewritten pages, double sided. Does not include supporting documents and activity files. 6. Appendices should be utilized when submitting frequently cited materials or supporting documentation such as a sample certificate, evaluation form, and other sample forms used in the Approved Provider s operations. 7. Documents must be cross referenced and directional references provided within the narratives 8. Supporting documentation i.e. certificate that will be used during next approval period, may be integrated with the narrative component or accumulated in a separate cross referenced section. 206 v.6.13

207 APPROVED PROVIDER ORGANIZATIONAL OVERVIEW (OO) The Organizational Overview (OO) is an essential component of the application process that provides a context for understanding the Approved Provider Unit/organization. The applicant must submit the following documents and/or narratives: STRUCTURAL CAPACITY OO1. Demographics OO1.1. Submit a description of the features of the Approved Provider Unit, including but not limited to scope of services, size, geographic range, target audience(s), content areas, and the types of educational activities offered. *If the Approved Provider is part of a multifocused organization 1, describe the relationship of these scope dimensions to the total organization. Description: Is the Approved Provider Unit part of a larger, multi focused organization? Yes No (please select one double click shaded box & select checked) If yes, please describe the relationship of these scope dimensions to the total organization. Description: OO2. Lines of Authority and Administrative Support OO2.1. Submit a list of the names, credentials, positions, and titles of the Primary Nurse Planner 2, other Nurse Planner(s) 3 (if any), and all key personnel 4 in the Approved Provider Unit. Primary Nurse Planner(s): Nurse Planner(s): Key Personnel: Please see the attached bio/coi forms for all Provider Unit staff including the Primary Nurse Planner, Nurse Planner(s) and key personnel (double click shaded box & select checked) 1 Multi focused organization (MFO) is an organization that exists for other purposes in addition to providing CNE. The Provider Unit is a distinct, separately identified unit within a complex, multi focused structure. 2 A currently licensed RN with a baccalaureate degree or higher in nursing who serves as the liaison between MONA and the Approved Provider Unit. 3 A currently licensed RN with a baccalaureate degree or higher in nursing who is actively involved in all aspects of planning, implementation, and evaluation of each CNE activity. This individual is responsible for ensuring that appropriate educational design principles are used and processes are consistent with the ANCC/MONA Accreditation criteria. 4 Key personnel are individuals who contribute to the overall functioning of the Provider Unit in a substantive, measurable way, without regard to pay or employment status. 207 v.6.13

208 OO2.2. Submit position descriptions 5 of the Primary Nurse Planner, Nurse Planners (if any), and key personnel in the Approved Provider Unit. Please see the attached position description for the Primary Nurse Planner, Nurse Planner(s) and any key personnel (double click shaded box & select checked) The Primary Nurse Planner assures that the position descriptions are specific to the individual s role and responsibilities to their position within the Approved Provider Unit (double click shaded box & select checked) OO2.3. Submit a chart depicting the Approved Provider Unit structure, including the Primary Nurse Planner, other Nurse Planner(s) (if any), and all key personnel. Please see the attached organizational chart for the Approved Provider Unit (double click shaded box & select checked) OO2.4. If part of a larger organization, submit an organizational chart, flow chart, or similar kind of image that depicts the Approved Provider Unit s location within the organization structure. Please see the attached organizational chart for the entire organization depicting how the Approved Provider Unit fits into the organizational structure (double click shaded box & select checked) Not applicable. Our organization is not part of a larger organization (double click shaded box & select checked) EDUCATIONAL DESIGN PROCESS OO3. Data Collection and Reporting Approved Provider organizations report data, at a minimum, annually to their ANCC Accredited Approver, which includes the following: OO3.1. Submit a list of all CNE offerings provided in the past 12 months, including activity dates; titles; type of activity, target audience; total number of participants; number of contact hours offered for each activity; if the activity was co provided; and if the activity received sponsorship or commercial support (monetary & in kind amounts). Please see the attached CNE Activity Form listing data for all activities our Approved Provider Unit provided within the previous 12 month period (double click shaded box & select checked) Activity Date Range on CNE Activity Form: (Example: October 1, 2012 September 30, 2013 or April 1, 2013 March 31, 2013) Our organization is a first time applicant. Please see the attached Activity Form listing data for the three activities planned, implemented and evaluated during the six (6) months prior to application submission. Were these three activities individually approved by MONA? Yes No (please select one) OO3.2. The Approved Provider must notify the Missouri Nurses Association CE Program, in writing, within 7 business days of the discovery or occurrence of the following: Significant changes or events that impair your ability to meet or continue to meet ANCC/MONA accreditation requirements or that make you ineligible for Approved Provider status Any event that might result in adverse media coverage related to the delivery of CNE Change in commercial interest status (i.e. if the Provider Unit becomes part of an organization that is considered a commercial interest.) Description: 5 Position descriptions should include the functions specific to the individual role within and related to the Provider Unit. 208 v.6.13

209 OO3.3. Description: The Primary Nurse Planner or designee must notify the Missouri Nurses Association CE Program, in writing and within 30 days, of any change within the Approved Provider organization, including but not limited to: Changes that alter the information provided in the Approved Provider application A decision not to submit self study written documentation after intent to apply form has been submitted Change in Primary Nurse Planner or suspension, lapse, revocation, or termination of the Primary Nurse Planner s RN license Change in Nurse Planners, i.e. addition, removal of, or suspension, lapse, revocation, or termination of any of the Nurse Planners RN licenses Change in ownership that may or may not directly impact the Approved Provider Indication of potential instability (e.g. labor strike, reduction in force, bankruptcy) that may impact the organization s ability to function as an Approved Provider. QUALITY OUTCOMES OO4. Evidence OO4.1. List the Approved Provider Unit s strategic and measurable goals with respect to CNE for the past 12 months. Please see the attached listing of goals for the Approved Provider Unit pertaining to CNE within the previous 12 month period (double click shaded box & select checked) OR Our Approved Provider Unit goals for the previous 12 months are listed below: OO4.2. Submit a list of the quality outcome measures the Approved Provider collects, monitors, and evaluates specific to the Approved Provider Unit. Please see the attached listing of quality outcome measures the Approved Provider Unit has collected, monitored, and evaluated specific to the Approved Provider Unit (double click shaded box & select checked) OR The Approved Provider Unit quality outcome measures pertaining to the Approved Provider Unit are listed below: OO4.3. Submit a list of the quality outcome measures the Approved Provider collects, monitors, and evaluates specific to Nursing Professional Development. (Refer to Chapter 8 of the 8 th edition of the CE Provider Approval Manual). Please see the attached listing of quality outcome measures the Approved Provider Unit has collected, monitored, and evaluated specific to the Nursing Professional Development (double click shaded box & select checked) OR The Approved Provider Unit quality outcome measures pertaining to Nursing Professional Development are listed below: 209 v.6.13

210 APPROVED PROVIDER CRITERION 1: Structural Capacity (SC) The capacity of an Approved Provider is demonstrated by commitment to, identification of, and responsiveness to learner needs; continual engagement in improving outcomes; accountability; leadership; and resources. Applicants will write narrative statements that address each of the criteria under Commitment, Accountability, Leadership, and Resources to illustrate how structural capacity is operationalized. Each narrative must include a specific example that illustrates how the criterion is operationalized within the Provider Unit. COMMITMENT: The Primary Nurse Planner demonstrates commitment to ensuring RNs learning needs are met by evaluating Approved Provider Unit goals in response to data that may include but is not limited to aggregate individual educational activity evaluation results, stakeholder feedback (staff, volunteers), and learner/customer feedback. Describe and, using an example, demonstrate the following: SC1. The Primary Nurse Planner s commitment to learner needs, including how Approved Provider Unit processes are revised based on data. Description of Process: Example: SC2. How the organization s leadership is committed to supporting the goals of the Approved Provider Unit. Description of Process: Example: ACCOUNTABILITY: The Primary Nurse Planner is accountable for ensuring that all Nurse Planners and key personnel in the Approved Provider Unit adhere to the ANCC/MONA Accreditation criteria. Describe and, using an example, demonstrate the following: SC3. How the Primary Nurse Planner ensures that all Nurse Planner(s) and key personnel of the Approved Provider Unit maintain adherence to the ANCC/MONA Accreditation criteria. Description of Process: Example: SC4. How the Primary Nurse Planner is accountable for resolving issues related to providing CNE. Description of Process: Example: LEADERSHIP: The Primary Nurse Planner demonstrates leadership of the Approved Provider Unit through direction and guidance given to individuals involved in the process of assessing, planning, implementing, and evaluating CNE activities in adherence to the ANCC/MONA Accreditation criteria. 210 v.6.13

211 Describe and, using an example, demonstrate the following: SC5. How the Primary Nurse Planner ensures that every Nurse Planner maintains accreditation standards and guides the Planning Committee or team for an individual educational activity. Description of Process: Example: SC6. How the Nurse Peer Review Leader of the Accredited Approver Unit (MONA) is used as a resource by the Primary Nurse Planner and/or other Nurse Planner(s) in the Approved Provider Unit. Description of Process: Example: RESOURCES: The Primary Nurse Planner advocates for and utilizes available human, material, and financial resources to ensure that the Approved Provider Unit achieves its goal of meeting identified quality outcome measures. Describe and, using an example, demonstrate the following: SC7. How the Primary Nurse Planner advocates for resources to ensure that the Approved Provider Unit achieves its goals related to quality outcome measures. Description of Process: Example: 211 v.6.13

212 APPROVED PROVIDER CRITERION 2: Educational Design Process (EDP) The Approved Provider Unit has a clearly defined process for assessing educational needs as the basis for planning, implementing, and evaluating CNE. CNE activities are designed, planned, implemented, and evaluated in accordance with adult learning principles, professional education standards, and ethics. Examples for the narrative component of the provider application (EDP 1 13) may be chosen from, but are not limited to, those contained in the sample activity files. All elements should have a corresponding narrative response, unless otherwise specified in the criterion, showing Approved Provider adherence. Evidence must demonstrate how the Approved Provider Unit complies with each criterion. Each narrative must include a specific example that illustrates how the criterion is operationalized within the Provider Unit. ASSESSMENT OF LEARNING NEEDS: CNE activities are developed in response to, and with consideration for, the unique educational needs of the target audience. Describe and, using an example, demonstrate the following: EDP1 The Nurse Planner s methods of assessing the current learning needs of the target audience. Description of Process: Example: EDP2 How the Nurse Planner uses data collected to develop an educational activity that addresses the identified gap in knowledge, skills, and/or practice. Description of Process: Example: PLANNING: Planning for each educational activity must include one Nurse Planner and one other planner. One of the planners must have appropriate subject matter expertise for the educational activity. Describe and, using an example, demonstrate the following: EDP3 The process used to select a planning team/committee for an educational activity, including why an individual member was chosen. Description of Process: Example: EDP4 The process used to identify all actual and potential conflicts of interest for all members of the Planning Committee, presenters, authors, and content reviewers. Description of Process: Example: EDP5 The process for resolution of an actual or potential conflict of interest and the outcome achieved. Description of Process: Example: 212 v.6.13

213 EDP6 The process utilized during the planning phase of the educational activity to determine how participants will successfully complete the learning activity. Description of Process: Example: DESIGN PRINCIPLES: The educational design process incorporates measurable educational objectives, bestavailable evidence, and appropriate teaching methods. Describe and, using an example, demonstrate the following: EDP7 How measurable educational objectives are developed that address the change in nursing practice or nursing professional development. Description of Process: Example: EDP8 How the content of the educational activity is selected based on best available current evidence (e.g. clinical guidelines, peer reviewed journals, experts in the field). Description of Process: Example: EDP9 How content integrity is maintained for CNE activities, including what precautions are taken to prevent bias and how those precautions are implemented. Description of Process: Example: EDP10 In the presence of commercial support/sponsorship, how additional precautions are taken to maintain content integrity for CNE activities, including what precautions are taken to prevent bias and how those precautions are implemented. NOTE: If the applicant/approved Provider never accepts commercial support/ sponsorship, do not provide a narrative for EDP10, and proceed to EDP11. Description of Process: Example: EDP11 How teaching methods were chosen that are appropriate to achieve the purpose and objectives of the CNE activity. Description of Process: Example: 213 v.6.13

214 ACHIEVEMENT OF OBJECTIVES: A clearly defined method that includes learner input is used to evaluate the effectiveness of each educational activity. Results from the activity evaluation are used to guide future activities. Describe and, using an example, demonstrate the following: EDP12 How summative evaluation data for an educational activity were used to guide future activities. Description of Process: Example: EDP13 How evaluation data were collected to measure change in nursing practice or nursing professional development. Description of Process: Example: 214 v.6.13

215 APPROVED PROVIDER CRITERION 3: Quality Outcomes (QO) The Approved Provider Unit engages in an ongoing evaluation process to analyze its overall effectiveness in fulfilling its goals and operational requirements to provide quality CNE. Each narrative must include a specific example that illustrates how the criterion is operationalized within the Provider Unit. APPROVED PROVIDER UNIT EVALUATION PROCESS: The Approved Provider Unit must evaluate the effectiveness of its overall functioning as an Approved Provider Unit. Describe and, using an example, demonstrate the following: QO1 The process utilized for evaluating the effectiveness of the Approved Provider Unit in delivering quality CNE. Description of Process: Example: QO2 How the evaluation process for the Approved Provider Unit resulted in the development or improvement of an identified quality outcome measure (Reference each identified quality outcomes measure listed in your response for OO4). Description of Process: Example: APPROVED PROVIDER UNIT EVALUATION PARTICIPANTS: The Approved Provider Unit shall include a variety of stakeholders, comprising those with a vested interest in Approved Provider Unit outcomes, in the evaluation process. Describe and, using an example, demonstrate the following: QO3 Why the Approved Provider Unit selects specific stakeholders to participate in the evaluation process. Description of Process: Example: APPROVED PROVIDER UNIT QUALITY OUTCOME MEASURES: The Approved Provider Unit must demonstrate quality improvement efforts including identifying strategies for working on targeted goals, evaluating progress toward goals, and revising or establishing new goals. Describe and, using an example, demonstrate the following: QO4 How input from stakeholders resulted in the development of or an improvement in quality outcome measures for the Approved Provider Unit (Reference each identified quality outcomes measure listed in your response for OO4). Description of Process: Example: 215 v.6.13

216 VALUE/BENEFIT TO NURSING PROFESSIONAL DEVELOPMENT: The Approved Provider Unit shall evaluate data to determine how the Approved Provider Unit, through the learning activities it has provided, has influenced the professional development of its nurse learners. Describe and, using an example, demonstrate the following: QO5 How, over the past 12 months, the Approved Provider Unit has enhanced nursing professional development (Reference each identified quality outcomes measure listed in your response for OO4). Description of Process: Example: 216 v.6.13

217 APPROVED PROVIDER CRITERION 4: Sample Activities (SA) As a component of the educational design process, the Approved Provider applicant should select and submit three (3) samples of CNE activity files (not three sessions of the same conference) that have been planned within 12 months of the Approved Provider application and comply with the ANCC/MONA Accreditation criteria. Each educational activity must be at least one contact hour (60 minutes) in length and must have been provided at least once. Sample activities may not be co provided. Please see the Activity Planning Guide for assistance in documentation for the sample activities. Remember, sample activities submitted must include a table of contents providing a page number for all corresponding supporting documentation. SAMPLE ACTIVITY #1 TITLE OF ACTIVITY: LOCATION OF ACTIVITY: ACTIVITY FORMAT: Live Enduring (please select one double click shaded box & select checked) DATE OF ACTIVITY: (Insert date live activity presented or, for ongoing enduring activities, date first offered and subsequent review dates) Please see the activity planning guide addressing each of the required criteria and all supporting documentation for this educational activity (double click shaded box & select checked) SAMPLE ACTIVITY #2 TITLE OF ACTIVITY: LOCATION OF ACTIVITY: ACTIVITY FORMAT: Live Enduring (please select one double click shaded box & select checked) DATE OF ACTIVITY: (Insert date live activity presented or, for ongoing enduring activities, date first offered and subsequent review dates) Please see the activity planning guide addressing each of the required criteria and all supporting documentation for this educational activity (double click shaded box & select checked) SAMPLE ACTIVITY #3 TITLE OF ACTIVITY: LOCATION OF ACTIVITY: ACTIVITY FORMAT: Live Enduring (please select one double click shaded box & select checked) DATE OF ACTIVITY: (Insert date live activity presented or, for ongoing enduring activities, date first offered and subsequent review dates) Please see the activity planning guide addressing each of the required criteria and all supporting documentation for this educational activity (double click shaded box & select checked) 217 v.6.13

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219 APPENDIX B APPROVED PROVIDER SAMPLE FORMS, FIGURES & TOOLS The following sample forms, figures and tools have been included in this section of the manual to assist applicants: Intent to Apply (Eligibility) Form Activity Planning Guide Biographical Data & Conflict of Interest Form Educational Planning Tool Sample Commercial Support Agreement Sample Sponsorship Agreement Sample Attestation of Disclosures Form Sample Co Provider Agreement Approved Provider CNE Activity Form Acceptable Verbs Listing Commercial Support & Sponsorship Decision Tree CNE Activity Planning Process: Awarding Contact Hours Decision Tree Additional resources are available on the MONA website at 219

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221 MISSOURI NURSES ASSOCIATION P.O. Box Jefferson City, MO Voice: Fax: APPROVED PROVIDER INTENT TO APPLY FORM Organizations interested in submitting an application as an Approved Provider must complete the eligibility verification process and meet all eligibility requirements and submit a $200 intent to apply fee 1. The Missouri Nurses Association is responsible for ensuring that the applicant is eligible to apply. An Approved Provider is defined structurally and operationally as the members of the organization who support the delivery of continuing nursing education activities. The Provider Unit may be a single focused organization devoted to offering continuing nursing education activities or a separately identified unit within a larger organization. If the Provider Unit is within a larger organization it is defined as a multi focused organization (MFO). The applicant applying for approval is the Provider Unit (PU). The MFO organization is not the applicant. Step 1 Contact Information Name of Agency: Address: City/State/ZIP: Contact Name: (Please type or print) Title: Daytime Phone: Fax: Step 2 Eligibility Requirements Please Note: To place an X in a shaded box below, double click the shaded box & select the checked option. Have you previously been denied, suspended and/or had approval revoked from other ANCC Accredited Approver Units and/or other accrediting/approving organization? Yes No If yes, STOP and contact the MONA Office for guidance before moving forward. Eligible applicants must: (NOTE All boxes are required and must be checked) Be one of the following: Constituent or State Nurses Association (C/SNA) of the American Nurses Association (ANA), College or University, Healthcare facility, Health related organization, Multidisciplinary educational group, Professional nursing education group, or an Specialty Nursing Organization (SNO). Be operational for a minimum of six (6) months prior to application. Be in compliance with all applicable federal, state, and local laws and regulations that affect the organization s ability to meet the ANCC/MONA criteria. Not be a commercial interest as defined in the Content Integrity Standards for Industry Support in Continuing Nursing Educational Activities. Market the majority (>50%) of their CNE activities to nurses in their local geographic region. Agencies who target more than 50% of their CNE activities to nurses in multiple regions, or in states other than those within or contiguous to a single region, are not eligible to become an Approved Provider and must apply directly to the American Nurses Credentialing Center (ANCC) to become an Accredited Provider. Activities offered via the Internet are considered to be targeted to nurses in multiple regions. 221