March 1-4, 2017 Caribe Royale All Suite Hotel Orlando, Florida REGISTRATION BROCHURE Su s gy Phot otothth p Derm ch
Embracing the World of Dermatology ear Colleagues, I would like to personally invite you to the 35th annual Dermatology Nurses Association convention, being held March 1-4, 2017 at the Caribe Royale in beautiful Orlando, Florida. The definitions of world include mankind in general, a specific domain or an individual experience. Noreen Nicol, past president of the DNA and editor of our latest edition of Dermatology Nursing Essentials, will present the keynote address, Embracing the World of Dermatology Nursing: Overview and Opportunities, to help us grasp the impact of dermatology nursing issues worldwide. A patient will recount his individual experience in dealing with the stresses associated with a dermatological condition to assist us in understanding the myriad dilemmas patients face and ways to help them cope with these issues. This is the first time in several years that Dermatology Nurses Association, American Academy of Dermatology and the Association of Dermatology Administrators and Managers will be meeting in Orlando within days of each other, making Orlando the world of dermatology for a few days. Please note that this does impact our convention. In order to have exhibitors at our convention prior to their going to the AAD convention, we needed to move our convention ahead by one day. So our convention will start Wednesday, March 1, with the exhibit hall open on Wednesday and Thursday. Rather than pre-convention courses we will offer post-convention courses, including phototherapy, cutaneous surgery, and dermatology essentials. This year we will offer a special track for LPNs and MAs to meet their special needs. This will entail attending some specific courses at convention along with attending the Dermatology Essentials course and completing a post test. We are also offering a hands-on class on dressing difficult wounds for all attendees. DNA s primary goal is to provide education to promote excellence in dermatologic nursing care. Offerings at convention will continue this fine tradition with a variety of topics designed to help nurses at all levels gain new knowledge and develop new skills. Come, browse through the exhibit hall, interact with exhibitors and learn of new products and new techniques to enhance patient outcomes. Please remember to thank the exhibitors for their generosity in helping us provide this educational opportunity. I encourage you to join us in Orlando: to help celebrate our 35th annual convention; to greet old friends and make new ones; for educational and networking opportunities; and for sightseeing and fun in the sun (don t forget your sunscreen!). I am looking forward to seeing you!! Sincerely, Donna Beyer, President 2016-2017
35 th Annual Convention Goals and Objectives Integrate information from educational programs based on evidence-based practice as determined by feedback from previous convention, educational needs assessment, and current trends and literature to meet educational needs Utilize workshop opportunities to meet the specific needs of special interest groups Participate in networking, mentoring, and socializing to enhance professional growth of self and other members Increase interest in dermatology-related fields, including safety, ethics, research, clinical testing, publishing, management, and advocacy to advance dermatologic care The target audience is registered nurses, nurse practitioners, licensed practical nurses, medical assistants, other healthcare providers, and staff with an interest in dermatology. Disclaimers: Schedule is subject to change. Participation in these educational activities does not qualify you to perform the tasks presented, only provides a learning opportunity. DNA s contractors and attendees may be photographing or videotaping events at this convention. By attending the DNA, attendees acknowledge these activities and agree to allow their image to be used by DNA in association publications, on DNA s website, and in associated publications. 3 Register online 2017.dnanurse.org
Tuesday, February 28, 2017 4:00 pm 8:00 pm Registration Open 8:00 pm 9:00 pm First-Time Attendee Reception All first-time attendees are welcome. Join the DNA Board of Directors and the Program Planning Committee for refreshments while networking with DNA leaders. Please select this event when completing your registration. Wednesday, March 1, 2017 6:30 am 5:30 pm Registration Open 7:00 am 8:00 am Seating is limited. Presentation theaters and breakfast will be provided if industry support is received. 8:00 am 8:15 am President s Address Donna Beyer, MSN, RN, DNC 8:15 am 9:15 am Keynote Address (1.0 contact hour) AANP 101 Nursing: Overview and Opportunities PD Noreen Heer Nicol, PhD, RN, FNP, NEA-BC 9:15 am 10:15 am General Session (1.0 contact hour) 102 Take Their Temperature. Blood Pressure. Pulse. Stress Level?! PD Observations of a Patient with Basal Cell Carcinoma Nevus Syndrome Tom Sprague, BS 10:15 am 12:15 pm Grand Opening of Exhibit Hall Join us for the official ribbon cutting ceremony to kick off the opening of the exhibit hall. A wide assortment of products, equipment, and services will be displayed by the leading suppliers of the dermatology industry. 12:15 pm 1:30 pm Lunch Symposium (pending corporate support) or Lunch on your own Educational Tracks PD Professional Development S/CO Surgical/ Cutaneous Oncology M/P Medical/ Pediatric C/L Cosmetic/ Laser C Community AANP = indicates session will be submitted to AANP for approval. 4 Register online 2017.dnanurse.org
1:30 pm 2:30 pm Concurrent Sessions (1.0 contact hour) 111 PD JDNA Writers Workshop Katrina Masterson, DNP, RN, FNP-BC, DCNP 112 S/CO AANP Dermoscopic Diagnosis: Chaos and Clues to Malignancy Marianne Woody, MSN, FNP-BC, DNCP, DAC 113 M/P AANP Applying Skin Cancer Research into Practice: Emphasis on Skin Cancer Prevention and Early Detection Victoria Siegel, EdD, RN, CNS 2:30 pm 4:00 pm Exhibits Open/Poster Viewing/Refreshment Break 4:00 pm 5:00 pm Concurrent Sessions (1.0 contact hour) 121 PD How to Become an Effective Speaker Krista Rubin, DNP, RN, FNP-BC, DCNP 122 C/L AANP Current Trends and Techniques in Aesthetic Dermatology Marianne Woody, MSN, FNP-BC, DCNP, DAC 123 M/P AANP The Impact of Diet in Dermatology Allison Arthur, MD 5:00 pm 6:00pm Seating is limited. Presentation theaters and light refreshments will be provided if industry support is received. Thursday, March 2, 2017 6:30 am 5:30 pm Registration Open 7:00 am 8:00 am Seating is limited. Presentation theaters and breakfast will be provided if industry support is received. 8:00 am 5:15 pm NP Forum Day 1 (See page 9 for full program. Additional fee.) 8:15 am 9:15 am General Session (1.0 contact hour) AANP 201 Holistic Care: A Cutaneous Journey M/P Heather Roebuck, DNP, FNP-BC, FAANP 9:15 am 10:45 am Exhibits Open/Poster Viewing/Coffee Break 5 Register online 2017.dnanurse.org
10:45 am 11:45 am General Session (1.0 contact hour) AANP 202 Evolving Stepwise Management of Atopic Dermatitis: M/P Basics Then Beyond Noreen Heer Nicol, PhD, RN, FNP, NEA-BC 11:45 am 1:00 pm Lunch Symposium Sponsored by Amgen 1:00 pm 2:00 pm Concurrent Sessions (1.0 contact hour) 211 C Tanning Beds: Is It Ethical to Ban Minors? Heather Roebuck, DNP, FNP-BC, FAANP 212 S/CO The Essential Dermatology Practice Trilogy: Scope, Procedures, Documation Maura Flynn, MA, RN, DNC 213 M/P What Should You Do When Cutaneous Vasculitis is More than Skin Deep? Michelle Burke, APRN, CNP 2:00 pm 3:00 pm Exhibits Open/Poster Viewing/Refreshment Break 3:00 pm 4:00 pm Concurrent Sessions (1.0 contact hour) 221 PD Advocacy 101 Jodie Curtiss, BA 222 S/CO AANP Melanoma Staging, Immunotherapies, Genetic Testing Krista Rubin, MS, FNP-BC 223 M/P AANP Biologics Update: What Every Dermatology Nurse Needs to know in 2017 Lakshi Aldredge, MSN, ANP-BC 3:00 pm 5:00 pm Evening Workshop 230 Difficult Wound Dressings (separate fee) S/CO Heather Onoday, FNP David Schlicting, LPN 4:00 pm 5:00 pm Concurrent Sessions (1.0 contact hour) 241 M/P AANP Safety Improvement in Biologic Therapy for Patients with Moderate to Severe Plaque Psoriasis: A Pilot Study and Quantitative Analysis Kara Addison, DNP, DCNP 242 S/CO AANP Skin Cancer Procedures and the Dermatology Nurse Robert Demetrius, MD 243 C Community Resources: A Dermatologic Focus Heather Roebuck, DNP, FNP-BC, FAANP 5:00 pm 6:00 pm Seating is limited. Presentation theaters and light refreshments will be provided if industry support is received. 6 Register online 2017.dnanurse.org
Friday, March 3, 2017 6:30 am 5:15 pm Registration Open 7:00 am 8:00 am Seating is limited. Presentation theaters and breakfast will be provided if industry support is received. 8:00 am 9:00 am General Session (1.0 contact hour) AANP Robin Weber Immunology Symposium 301 cgas, Trex1 and Type 1 Interferons Oh My! New Insights into the M/P Immunological Pathogenesis of Lupus Nicole Fett, MP, MSCE 8:00 am 5:15 pm NP Forum Day 2 (See page 9 for full program. Additional fee.) 9:00 am 10:00 am General Session (1.0 contact hour) AANP 302 Skin Manifestations and Safety Pitfalls in Patients with Skin of Color M/P Donna Howard, MS, RN, FNP-BC 10:15 am 11:15 am Concurrent Sessions (1.0 contact hour) 311 M/P AANP Exploring the Drug Store Aisle: Deciphering the Cornucopia of OTC Remedies for Common Dermatology Ailments Erika Kimble, MA, MS, BSN, RN, NP 312 M/P AANP Patch Testing Made Easy! How to Perform Patch Tests and Help Patients Avoid Common Allergens James Yiannias, MD, Nidhi Singh, BSN 313 M/P AANP Malignancies of the Skin: An Overview of Common and Uncommon Cutaneous Malignancies Stanislave Tolkachjov, MD 11:30 am 1:00 pm DNA Business Meeting and Awards Luncheon All main convention attendees are welcome. DNA membership is not required to attend. 1:00 pm 2:00 pm Concurrent Sessions (1.0 contact hour) 331 M/P AANP Update on HIV and the Skin Benjamin Ehst, MD, PhD 332 S/CO Exploring Oncodermatology Nursing Model Competencies: A Spotlight on Dermatologic Clinical Care in Cancer Patients Anna Skripnik Lucas, MSN, RN, DNC, FNP-BC Kathryn Ciccolini, BSN, RN, OCN 333 M/P AANP Pediatric Dermatology Take-Aways Tracy Funk, MD 7 Register online 2017.dnanurse.org
2:15 pm 3:15 pm General Session (1.0 contact hour) 340 Resilience Training Improves Nurses' Well-Being and Satisfaction PD Lynne Hulvey, MSN, RN 3:15 pm 4:15 pm General Session (1.0 contact hour) 360 Wicked Cool Gear, Gadgets, and Technology to Promote Skin Cancer C Prevention Maryellen Maguire-Eisen, MSN, RN Maura Flynn, MA, RN, DNC Saturday, March 4, 2017 7:30 am 5:00 pm Registration Open 8:00 am 12:00 pm Dermatology Nursing Certification Board Certification Exam Must have applied and obtained your entrance permit. 8:00 am 12:00 pm Post-Convention Workshop (4.0 contact hours) Additional fee. Offered pending corporate support. 901 Cosmetic Workshop 8:00 am 5:00 pm Post-Convention Workshops (7.5 contact hours each) Additional fee. Continental breakfast included. 902 Dermatology Nursing Essentials Workshop Karrie Fairbrother, BSN, RN, CDE, DNC, Chair Attendees of this workshop wishing to complete the MA/LPN specialized track must attend sessions 122, 212, and 242. This track is designed to provide the learner with recognized dermatologic education necessary to their specific role in the field. This education will be provided in the requisite 4 sessions and will be validated by a post-test. 903 The Joan Shelk Fundamentals of Phototherapy Workshop Cynthia Heaton, BSN, RN, Chair 904 Cutaneous Surgery Heather Onoday, FNP, Chair Educational Tracks PD Professional Development S/CO Surgical/ Cutaneous Oncology M/P Medical/ Pediatric C/L Cosmetic/ Laser C Community AANP = indicates session will be submitted to AANP for approval. 8 Register online 2017.dnanurse.org
Nurse Practitioner Forum Additional fee required Two action-packed days of education targeted to the advanced practice nurse practitioner with an interest in dermatology. Note: Attendees registering for the NP Forum should not select breakout sessions happening at the same time as dedicated NP Forum Sessions. This educational activity will be submitted to the American Association of Nurse Practitioners for approval of up to 12.0 contact hours. Thursday, March 2, 2017 7:00 am 8:00 am Seating is limited. Presentation theaters and breakfast will be provided if industry support is received. 8:15 am 9:15 am 201 General Session Holistic Care: A Cutaneous Journey Heather Roebuck, DNP, FNP-BC, FAANP 9:15 am 10:45 am Exhibits Open/Poster Viewing/Refreshment Break 10:45 am 11:45 am 202 General Session Evolving Stepwise Management of Atopic Dermatitis: Basics Then Beyond Noreen Heer Nicol, PhD, RN, FNP, NEA-BC 11:45 am 1:00 pm Lunch Symposium Sponsored by Amgen 12:45 pm 1:00 pm Opening Remarks 1:00 pm 2:00 pm 214 Cosmetic/Laser TBD 2:00 pm 3:00 pm Exhibits Open/Poster Viewing/Refreshment Break 3:00 pm 4:00 pm 224 What Should You Do When Cutaneous Vasculitis Is More Than Skin Deep? Michelle Burke, APRN, CNP 4:00 pm 5:00 pm 244 Patient Outcomes and Reimbursement David Adelson, MD 5:00 pm 6:00 pm Seating is limited. Presentation theaters and light refreshments will be provided if industry support is received. 9 Register online 2017.dnanurse.org
Nurse Practitioner Forum Additional fee required continued Friday, March 3, 2017 7:00 am 8:00 am Seating is limited. Presentation theaters and breakfast will be provided if industry support is received. 8:00 am 9:00 am 301 Robin Weber Immunology Symposium cgas, Trex1 and Type 1 Interferons Oh My! New Insights into the Immunological Pathogenesis of Lupus Nicole Fett, MP, MSCE 9:00 am 10:00 am 303 Pyoderma Gangrenosum and Other Neutrophilic Dermatoses: What's New Stanislav Tolkachjov, MD 10:00 am 10:30 am NPS Business Meeting 10:30 am 11:30 am 320 Acne and Endocrinology Heather Roebuck, DNP, FNP-BC, FAANP 11:30 am 1:00 pm DNA Business Meeting and Luncheon 1:00 pm 2:00 pm 334 Low Anabolic Profile in Assessing a Patient's Overall Hair Loss Program and SHAPIRO Chart Larry Shapiro, DO 2:15 pm 3:15 pm 350 NIH Dermatology Grand Rounds Edward Cowen, MD, MHSc 3:15 pm 4:15 pm 370 Dermatological Care of Transplant and Oncology Patients Victoria Lazareth, MA, MSN, NP- C, DCNP 4:15 pm 5:15 pm 390 Kodachromes and Pathology Interpretation Victoria Lazareth, MA, MSN, NP-C, DCNP 10 Register online 2017.dnanurse.org
General Information Caribe Royale All Suite Hotel 8101 World Center Drive Orlando, FL 32821 The Caribe Royale All Suite hotel has been designated as the headquarters hotel for the DNA Annual Convention. A block of rooms has been reserved at the special rate of $175 double queen/king. Rates are subject to applicable state and local taxes. Guest check-in time is 4:00 pm. Check-out time is at 11:00 am. To receive the convention rate, make online reservations through the DNA Convention website (2017.dnanurse.org) or call hotel reservations at 800-823-8300 and refer to the 2017 Annual DNA Convention. The convention rate is available until Monday, January 30, 2017. Reservations received after this date will be accepted on a space and rate available basis. Parking (DNA does not validate valet parking) The Caribe Royale All Suite Hotel has complimentary self-parking. Valet parking is available for a current charge of $12 plus tax per day. Pricing is subject to change. Transportation Orlando International Airport is about 25 minutes from the hotel. Mears Shuttle Service is available for approximately $23 one way or $37 round trip, and a taxi costs about $60 one way. You can make advance reservations for the shuttle on at 2017.dnanurse.org. All pricing is current at the time of printing and is subject to change. Disney Parks Shuttle Service Caribe Royale will provide scheduled shuttle services to the Walt Disney World Theme Parks and an evening shuttle to Disney Springs. The shuttles operate between the four Disney Theme Parks, Disney Springs, and two other hotels. Travel times vary depending on the time of year. A current schedule is always available at the hotel bellstands. Weather Typical temperatures in Orlando in February will get up to about 78 degrees during the day and a low of 58 degrees in the evenings. Be sure to pack a sweater or light jacket or wear layers in the airconditioned session rooms. We also suggest that you bring comfortable walking shoes for your convention activities. Convention Moderators Needed Moderators play an important role in the overall success of DNA s Annual Convention. Serving as a moderator is a great first-time volunteer role. Responsibilities include: Attending a brief moderator orientation on Wednesday, March 1, 2017 Introducing the speaker and making any housekeeping announcements Monitoring questions from audience microphones Helping keep the speaker and session on time To volunteer to be a session moderator, please check off this option when registering online. Product theaters give you the unique opportunity to attend a session about specific products/services of interest in the comfort of a private, seated environment. These sessions are meant to be promotional and do not offer any educational credit. Our exhibitors have been offered the opportunity to host one of the many product theaters taking place outside of the Exhibit Hall. Seating will be limited. Privacy Disclosure Attendees of the DNA Convention are asked to register and provide some limited information. This data is submitted voluntarily. DNA asks attendees to provide their name, member number (for members), organization name, business phone, and email address. 11 Register online 2017.dnanurse.org
Continuing Education Information The Dermatology Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. Attendees may earn up to 15.0 contact hours for main convention sessions. Provider approved by the California Board of Registered Nursing, Provider Number CEP5708. Designated sessions within the general convention will be submitted to the American Association of Nurse Practitioners for approval of a maximum of 11.0 contact hours of accredited education. NP Forum: This education activity will be submitted to the American Association of Nurse Practitioners for approval of a maximum of 12.0 contact hours of accredited education. DNA is a group member of AANP, which entitles NP members to $10 off their membership dues. Group #0503263 It is the DNA policy to fully vet and resolve any relative conflicts of interest disclosed by the planners and presenters of this convention. Full disclosure will be available in the Annual Convention Guide. This convention is commercially supported by several commercial entities. A full listing of commercial supporters will be available in the Annual Convention Guide. The Post-Convention Workshops and the NP Forum will be awarded contact hours separately. Contact hours may also be awarded separately for commercially supported educational symposia if available. Criteria for Completion Credit is awarded for each session completed in its entirety. There is no partial credit awarded for any session. Statements of credit will be awarded based on the participant s attendance and submission of the activity evaluation form for each session. All participants will receive a continuing education certificate via email upon completion of their online evaluation. The LPNs and MAs attending the 4-part track must also complete a post-test with a passing score of 70% or better. Speaker Presentations/Handouts DNA will post all available speaker presentations online prior to the convention. Attendees will be emailed a link to access the presentations. Attendees should download or print presentations of interest prior to arriving at the convention. Workshop and NP Forum attendees will receive separate links to print out those handouts prior to the convention as well. Upon check-in at registration, attendees will receive an Annual Convention Guide, which will include all pertinent convention information, such as the schedule, room locations, and instructions for obtaining continuing education credit. Speaker presentations will not be included. 12 Register online 2017.dnanurse.org
REGISTRATION FORM Name Credentials Employer/Organization Preferred Mailing Address home work City State Zip/Postal Code Daytime Telephone home work cell Required email address To receive your receipt/confirmation, conference updates, and to log in for contact hours. 3WAYS TO REGISTER Mail with payment to: DNA Registration East Holly Avenue, PO Box 56 Pitman, NJ 08071-0056 Fax payment with credit card info to: 856-218-0557 Register online at: 2017.dnanurse.org (Credit card payments only) Disability or dietary needs? Please state: REGISTRATION FEES FULL CONVENTION (Tuesday, February 28 at 8:00 pm Friday, March 3 at 4:15 pm) Includes all educational and social activities, excluding Post-Convention Workshops, NP Forum and any other additional registration fee selections. SESSIONS Please indicate your 1st & 2nd choice for each concurrent session and select optional activities you plan to attend. On-site changes are permitted upon availability. Tuesday, February 28 Wednesday, March 1 Thursday, March 2 Friday, March 3 8:00 pm First-Time Attendee Reception Yes No Member Non-Member TOTAL Super Early Fee On or before January 19, 2017 $350 $425 $ Early Fee Postmarked January 20, 2017 through February 23, 2017 $400 $470 $ Regular/Onsite Fee February 24, 2017 and after $435 $510 $ Student (Studying for RN degree proof of enrollment required) $215 $ One Day Only Wednesday Thursday Friday $225 $265 $ Student One-Day Only Wednesday Thursday Friday $120 $ NP Forum (Thursday, March 2 Friday, March 3) NP Forum Only (Both Days) $290 $355 $ NP Forum (One Day Only) Thursday Friday $255 $300 $ ADDITIONAL WORKSHOPS 230 Difficult Wound Dressings (March 2) must be registered for full convention $25 $25 $ 901 Cosmetic Workshop (offered pending corporate support) (March 4) $100 $100 902 Dermatology Nursing Essentials (March 4) $185 $205 $ 902 Dermatology Nursing Essentials MA/LPN certificate track (March 4) must be registered for full convention $210 $230 $ 903 The Joan Shelk Fundamentals of Phototherapy Workshop (March 4) $185 $205 $ 904 Cutaneous Surgery (March 4) $185 $205 $ Guest Badge for Exhibit Hall and Opening Reception $50 Guest name $ Amount Due for Convention Registration $ PAYMENT OPTIONS Charge my: Visa Mastercard American Express Discover Credit Card Number Name of Card Holder (please print) Credit card billing address Signature Exp. Date Security Code* * Last 3 digits, signature strip, back of credit card. American Express - Front 4 digits. Attendees are automatically registered for President s Address, Keynote Address, General Sessions, Business Meeting and Awards Luncheon. * pending support Cancellation Policy Cancellations must be submitted in writing by midnight Tuesday, January 31, 2017. Please e-mail your request to dna@dnanurse.org or fax to (856) 218-0557. A $50 administrative fee applies. All requests submitted after January 31 will not be honored. All refunds are pr ocessed after convention. Membership nonrefundable/nontransferable. 7:00 am * 12:15 pm Lunch Symposium* 1:30 pm 111 112 113 7:00 am * 11:45 am Lunch Symposium* 1:00 pm 211 212 213 7:00 am * 10:15 am 311 312 313 4:00 pm 121 122 123 11:30 am Business Meeting/ 3:00 pm 221 222 223 5:00 pm * Awards Luncheon 4:00 pm 241 242 243 1:00 pm 331 332 333 5:00 pm *
3 WAYS TO REGISTER Mail with payment to: DNA Registration East Holly Avenue, PO Box 56 Pitman, NJ 08071-0056 Fax payment with credit card info to: 856-218-0557 Register online at: 2017.dnanurse.org (Credit card payments only) 14
Dermatology Nurses Association Membership Application Preferred Address (for membership and meeting materials to be mailed): Home Work 435 N. Bennet Street Southern Pines, NC 28387 800-454-4DNA Fax 910-246-2361 www.dnanurse.org dna@dnanurse.org Name Credentials Home Address City State Zip Code Telephone: Home/Cell Email Address Employer Employer Address City State Zip Code Telephone: Work Referred by (Name of DNA member) DNA Membership Join or renew today and register at the member rates! New Member Renewal Nurse Practitioner $135.00 (Membership includes NP Society) License # State Nurse $85.00 (RNs, LPNs, LVNs only) License # State Associate $75.00 Medical Assistant Physicians Assistant Other, Please specify Note: $12.00 of membership dues is applied to a subscription of the Journal of the Dermatology Nurses Association. Check enclosed (payable to DNA in US funds) Charge my AMEX M/C Visa Card # Exp. Date Amount $ Signature DNA occasionally makes available member information to organizations and vendors that provide products and services of value to the dermatology nursing community. If you prefer not to be included in these lists, please check the box provided. DNA s membership year is January 1-December 31. For the first year of membership, all new members will have an expiration date of 12 months from the month joined. After the first year all memberships expire on December 31. Thank you for your membership! Please provide the following demographic information, if applicable. Check all that apply. 1. Professional Status: RN NP LPN/LVN Medical Assistant Physicians Assistant 2. Employment: Full Time Part Time Not Employed Retired Student 3. Position: Staff Nurse Head Nurse Clinical Specialist Supervisor/Coordinator Instructor Administrator Research Nurse Nurse Practitioner Medical Assistant 4. Practice Setting: Inpatient Unit Outpatient Clinic Extended Care Facility Critical Care Unit Physician s Practice Day Care Unit Phototherapy Unit Dermatology Surgery Other 5. Clinical Specialty: General Practice Acne Cosmetic Dermatology Cutaneous Oncology Dermatologic Surgery Geriatrics Pediatrics Phototherapy Psoriasis Reconstructive Surgery Wound Healing 6. Highest Level of Education Completed: High School Diploma-Nursing Associate Nursing Associate Other Bachelor s Nursing Bachelor s Other Master s Nursing Master s Other Doctorate 7. Are you a member of the American Nurses Associations? (Check one) Yes No 8. YEARS IN DERMATOLOGY PRACTICE: (Check one) 0-2 3-5 6-9 10-14 15-19 20+ 9. Clinical Focus Groups: Cosmetic Dermatology CTCL/Photopheresis Office Management Lasers Medical Dermatology Pediatrics Phototherapy Psoriasis Skin Cancer/Surgery Clinical or Nursing Research Wound Care 10. How did you learn about the DNA? Dermatologist DNA Chapter Meeting DNA Chapter Email DNA Chapter Ad/Press Release DNA Chapter Social Media Network DNA Convention DNA Member Referral DNA Website Facebook Industry Representative JDNA LinkedIn Nursing School Event Other DNA Education Twitter Other Additional questions for Nurse Practitioner Members: A. Area of NP Specialty Certification: Adult Family Pediatrics Women s Health Geriatrics B. Area of Current Practice: General Dermatology Dermatologic Surgery Cosmetic Surgery Primary Care C. Does Your State: Require you to practice with a supervising physician? Require you to practice with a collaborating physician? Allow you to practice as a licensed independent practitioner (LIP)? D. What is the specialty of your supervising physician, if applicable: Dermatology Pediatrics Cosmetic Surgery Moh s Surgery Pathology Family Medicine Pediatric Dermatology Plastic Surgery Cutaneous Oncology Research E. Do you have prescriptive authority? (Check one) Yes No