ANCC International Evidence-Based Practice Nursing Content Expert Application

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1 CERTIFICATION ANCC International Evidence-Based Practice Nursing Content Expert Application Instructions This application may be used to apply for an ANCC International Evidence-Based Practice Nursing Content Expert position. For more information, please visit the Content Expert Webpage. Please complete all sections of the following application and submit: 1. Resume/CV 2. Job description 3. If self-employed, include a letter describing professional responsibilities and a statement of commitment and ability to participate. Please type all answers and save the file using your last name in the file name (for example, SmithApplication.PDF ). All documents must be submitted in English. In addition, the certification development meetings are conducted in English. Content Expert applicants must be able to speak, read and write English proficiently. On-site translations are NOT provided. All documents must be returned to ANCC by (AnccVolunteer@ana.org) or by fax ( ). If you are having difficulty submitting your documents, please contact AnccVolunteer@ana.org. For more information about becoming an ANCC Content Expert, please visit our website: ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT

2 1. GENERAL INFORMATION All documents must be submitted in English. All meetings and communication will be in English. Content Expert applicants must be able to speak, read and write English proficiently. On-site translations are NOT provided. Primary language spoken: Secondary language spoken: I am applying to serve as an ANCC Content Expert. I am interested in :( check all that apply) Content Expert Panel Item Writing Standard-Setting Panel External Validation Panel Use your legal name on the application. Ms. Miss Mrs. Mr. Dr. Other: Last Name First Name MI Credentials (Academic Degree, Licensure/Stated Designation, etc.) Current Professional License(s), if ap plicable State/Country Iss ued Expiration Date Years in specialty Home Address City State/Province ZIP/Postal Country Preferred Phone Cell Home Work Alternate Phone Cell Home Work Preferred Alternate Please provide information about someone we could contact in case of emergency. Name Relationship Phone 2. CERTIFICATION(S) PLEASE CHECK N/A, IF THIS SECTION DOES NOT APPLYTO YOU N/A Name of Professional or Specialty Certification Certification Number (if applicable) Certifying Body Expiration Date Years of experience in Evidence-Based Practice: Name of Professional or Specialty Certification Certification Number (if applicable) Certifying Body Expiration Date Years of experience in Evidence-Based Practice: Other Certifications (name of certification held and certifying body that granted it) Years of experience in professional specialty area: ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 1

3 3. PRIMARY EMPLOYMENT INFORMATION Employer Name Position Title Department Dates of Employment Employer Address City State/Country ZIP/Postal Code Work Phone Ext. Work Fax Work 4. STAFF DEVELOPMENT EDUCATOR If You Are Not Faculty, Please Check the Box to Indicate You Are Not Faculty Are you a faculty member (includes full-time, part-time, and adjunct faculty)? Yes No If you have selected No, please proceed to Section 5 What levels of education do you teach? Associate Bachelor s Master s Doctorate Other: Are you primarily employed as faculty staff development member? Yes No Do you spend at least 50% of your professional time teaching in this specialty (evidence-based practice)? Yes No Are you also working in the specialty area in other capacities? Yes No What percentage of your time do you spend in the specialty in which you are applying to serve (including your work as faculty)? 5. PRACTICE SETTING Are you currently using evidence-based practice? Yes No If you have selected No, please proceed to Section 6 If yes, please describe your current work as it relates to evidence-based practice and complete all questions listed below: Are you primarily employed in this specialty? Yes No Did you spend at least 50% of your professional time engaged in work related to this specialty? Yes No ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 2

4 6. BRIEF DESCRIPTION Please provide a brief description of your expert abilities in evidence-based practice. Be sure to include education (continuing education or academic), volunteer work and your day-to-day work, as they relate to your daily practice. (2000 Character Limit) 7. EDUCATIONAL PREPARATION List your educational preparation. List highest level first. Do not state See CV or Resume. Educational Institution Area of Major Concentration Degree Year Awarded 8. PROFESSIONAL EXPERIENCE List your three most recent positions held. Do not state See CV or Resume Dates of Organization/Employer Position/Title Brief Description of Duties Employment ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 3

5 9. PROFESSIONAL SERVICE List THREE recent/significant activities within the last 5 years as it relates to evidence-based practice. For example, certifications, publications and dates, volunteer activities and offices held, presentations and to whom they were given, or honors (if applicable). Have you ever served as a content or subject matter expert or competency expert (for example, an item writer or standard-setting/cut score participant)? If yes, please explain and provide organization name and dates served. Yes No 10. OPTIONAL DEMOGRAPHICS Providing information in this section is strictly voluntary. It will be used for statistical purposes only. Sex: Male Female Race/ Ethnicity American Indian/Alaska Native Black/African American Whi te Asian/Pacific Islander Other: Hispanic/Latino 11. PROFESSIONAL ORGANIZATIONS Please provide a list of any professional organizations in which you are a current member. Do not use abbreviations, please be sure to fully spell out the organization(s) name. 12. STATEMENT OF UNDERSTANDING FOR CONTENT EXPERT APPLICANTS EXPERT CONTENTEXPERTAPPLICANTS You should also be aware that the time commitment for serving as an ANCC content expert is up to a 4- year term. The content expert panel may meet up to 3 times a year on weekdays; with a maximum of 3 days at a time during the year the examination is initially developed or updated. For detailed information, click here. If selected, I agree to serve: Signature* *Your typed name is sufficient as a signature. Remember to include with the application your resume, job description, and, if self-employed, a letter describing your professional responsibilities and a statement of commitment and ability to participate on the panel. All documents must be submitted in English. Certification development meetings are conducted in English. Content Expert applicants must be able to speak, read and write English proficiently. On- site translations are not provided. Note: Sections 13 and 14 are not applicable for this application. Date ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 4

6 NOTE: IF YOU ARE INTERESTED IN APPLYING AS A STANDARD-SETTER OR AN ITEM WRITER, PLEASE COMPLETE THE SECTIONS BELOW: Section 15. FOR STANDARD-SETTING PANEL APPLICANTS How many years have you used evidenced based practice concepts and principles? Do you precept students? Yes No If yes, please provide a description of your practice. Please indicate any previous experience with certification or licensure examination development: Standard setting (cut score) for this examination development: Test itemwritingforthisexamination development: Test item reviewing for this examination development: Other (please specify) for this examination development: Describe briefly why you would like to serve as a Standard-Setting Panelist. This might include particular qualifications or experiences you will bring to the panel. What are your personal goals? (No more than 100 words) Note: Volunteering to be a standard-setting panelist requires participation in a two-day meeting held in Silver Spring, MD. For detailed information please click here. If selected, I agree to serve: Signature* Date *Your typed name is sufficient as a signature. Remember to include with the application your resume, job description, and if self-employed, a letter describing your professional responsibilities. Section 16. FOR ITEM WRITER APPLICANTS Do you have access to a personal computer with either Internet Explorer (7.0 or higher) or Firefox (3.5 or higher) and Internet access? Yes No Have you completed any previous item writer training or written test items for a certification or licensure examination? Yes No If yes, specify organization(s): Date(s) of prior item writer training or item writing activity, if any: ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 5

7 Section 16. FOR ITEM WRITER APPLICANTS WRITINGEXERCISES 1. Briefly state why you would like to become an item writer. This might include what you hope to gain from the instruction and the experience or your personal goals. (No more than 1500 characters.) 2. What special qualities or experiences do you feel you will bring to the task of writing items? This might include any item writing, practical, and/or teaching experience you have, though no experience is required. (No more than 1500 characters.) ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 6

8 Section 16. FOR ITEM WRITER APPLICANTS WRITING EXERCISES CONTINUED 3. Completeitem writing exercises A and B. A. Review and edit one(1) of the two (2) test items below. As you edit, consider both content and grammar. 1. A 32-year-old patient who is receiving a low-thoracic epidural infusion with a combined opioid and a local anesthetic is being assessed by the nurse for the extent of motor blockade. Twelve hours after gastric bypass surgery, the patient is asked by the nurse to: 1. Count backwards by 7 s from one hundred. 2. Raise their buttocks and wiggle their toes. 3. Turn, cough, and breathe deeply. 4. Touch the tip of their nosewith their right-hand. 2. An elderly man has worked over 35 years in a grain factory and tells the nurse practitioner that he has coughed for a long time and has trouble breathing, whichis getting worse. The patient has smoked 1 ½ packs of cigarettes a day for the past 30 years. He has increased AP diameter, short expirations, and a pulmonary function study indicates an abnormal forced expiratory volume. What risk factor for this patient will be given immediate attention? 1. Age of patient 2. Cigarette smoking 3. Gender of the patient 4. Work environment ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 7

9 Section 16. FOR ITEM WRITER APPLICANTS WRITING EXERCISES Write one (1) multiple-choice item with four (4) options on a topic that is related to nutrition. When writing the item, use the following criteria: 4. Only one (1) option can be correct; the other three (3) options must be plausible however technically incorrect. 5. The item must be phrased in the positive (do not use negatives such as NOT or NEVER). In addition, the item stem must be in the form of either a complete question (e.g., which procedure is recommended for a patient withan occluded distal superficial femoralartery?) oran incomplete sentence (e.g., When teaching a couple to use positive reinforcement techniques with their child, a psychiatric nurse recommends). Do not use fill-in-the-blank-style items. 6. Indicate the correct answer and provide a rationale for why it i s correct. Note: Volunteering to be an item writer requires participation in a two-day item writing workshop which is usually held in Silver Spring, MD and writing 35 test items. For more details click here. If selected, I agree to serve: Signature* Date *Your typed name is sufficient as a signature. Remember to include with the application your resume, job description, and if self-employed, a letter describing your professional responsibilities. ANCC International Evidence-Based Practice Nursing Content Expert Application CPM-FRM-071 INTERNATIONAL CONTENT EXPERT APPLICATION 8 0

ANCC Volunteer Application

C E R T I F I C AT I O N ANCC Volunteer Application Instructions Use this application to apply to be a volunteer with ANCC. Please indicate the positions for which you are interested, such as serving as