APPROVED PROVIDER
APPLICATION
Three (3) flash drivesor one (1) email* containingfour Word or Adobe.pdf files(*not to exceed 5 MB in size)of the Approved Provider Application package and applicable review fee must be submitted to the Midwest Multistate Division (Midwest MSD) Office by February 1st, June 1stor October 1st.Application packages received more than 10 days after the deadline, without prior arrangements with the Midwest MSD, will not be accepted for that cycle. For additional guidance in completing the Approved Provider Application, please refer to the Midwest MSD website for instructions, tools and resources available.
Please note: The Approved Provider Application package consists of a total of fourseparateWord or Adobe.pdf files – one of the Approved Provider Application and supporting documentation and one for each sample activity.
The appropriate Application review fee must accompany the Application package for the review process to begin. Please also ensure a copy of this page is included in your submission to aid in processing. The review process takes four months to complete (Example:Applications submitted by February 1st will be considered for a June 1st approval start time). Provider approval is granted for a three-year period.
If you have any questions, please contact the Midwest MSD Nurse Peer Review Leader at or the Midwest MSD Office by email to or by phone to 573-636-4623 ext. 102.
Application Review Fee:(Based on type of Provider below)
$2,000.00 / Single Agency Provider (see definition in Application instructions)$4,800.00 / System Provider (see definition in Application instructions)
Applicant Information:
Organization Name:Name of Approved Provider Unit (if different):
Address:
City: / State: / Zip Code:
Primary Nurse Planner Name:
Phone: / Preferred Email:
Contact for Application: / If same as Primary Nurse Planner indicate “Same as above”
Phone: / Preferred Email:
New Applicant? ☐ Yes ☐ No
Payment:
☐ Check (Make checks payable to the Midwest Multistate Division or Midwest MSD)☐ Credit Card – Visit the Midwest Multistate Division Website at to Pay via Credit Card
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.Please utilize the Application Instructionsdocument available on the Midwest MSD website at for specific details on how to write and prepare your Approved Provider Application for submission.
Approval decisions are determined based on compliance with the ANCC/Midwest MSD Accreditation criteria. In order to validate compliance, it is essential that the Midwest MSD 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.
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.a Submit a description of the features of the Approved Provider Unit, including but not limited to size, geographic range, target audience(s), content areas, and the types of educational activities offered.
Description:
OO1.b Is the Approved Provider Unit part of a larger, multi-focused organization?
☐ ☐Yes ☐ No
If yes, please describe the relationship of these scope dimensions to the total organization.
Description:
OO2.Lines of Authority and Administrative Support
OO2.a Submit a list of the names, credentials, positions, and titles of the Primary Nurse Planner[1], and other Nurse Planner(s)[2] (if any) in the Approved Provider Unit.
Primary Nurse Planner:Nurse Planner(s):
☐ Please see the attached Nurse Planner Biographical data forms for the Primary Nurse Planner and Nurse Planner(s)
OO2.b Submit position descriptions[3]for the Primary Nurse Planner and Nurse Planners (if any) in the Approved Provider Unit.
☐ Please see the attached position description(s) for the Primary Nurse Plannerand Nurse Planner(s) on Page#
☐ 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
OO2.c Submit an organizational chart, flow chart, or similar imagedepicting the structure of the Approved Provider Unit, including the Primary Nurse Planner and other Nurse Planner(s) (if any).
☐ Please see the attached organizational chart for the Approved Provider Unit on Page#
OO2.d If the Approved Provider Unit is part of a larger organization, submit an organizational chart, flow chart, or similar image that depicts the organizational structure and the Approved Provider Unit’s location within the organization.
☐ Please see the attached organizational chart for the entire organization depicting the Approved Provider Unit’s location within the organizational structure on Page#
☐ Not applicable. Our organization is not part of a larger organization
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.a Submit a completed NARS Annual Reporting Spreadsheetlisting all CNE offerings provided in the past 12 months, including, at a minimum: activity dates; activity titles; target audience; total number of participants; total number of nurses; total number of nursing contact hours offered for each activity; if the activity was jointly provided; any commercial support received(monetary & in-kind amounts).
☐ Please see the attached NARS Annual Reporting Spreadsheet listing data for all activities our Approved Provider Unit provided within the previous 12-month period on Page#
Activity Date Range on NARS Annual Reporting Spreadsheet:
February applicants: January 1, 2017 –January 1, 2018
June applicants: May 1, 2017 – May 1, 2018
October applicants: September 1, 2017 – September 1, 2018
☐ Our organization is a new applicant. Please see the attached sample activity documentation for the three activities planned, implemented and evaluated during the twelve (12) months prior to Application submission.
Were these three activities individually approved by the Midwest MSD? ☐ Yes ☐ No(please select one)
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, andLeadershipto 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 aggregate data, which may include but is not limited to individual education activity results, stakeholder feedback (staff, volunteers), and learner/customer feedback.
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/Midwest MSD Accreditation criteria.
Describe and, using an example, demonstrate the following:
SC2.How the Primary Nurse Planner ensures that all Nurse Planner(s) of the Approved Provider Unit are appropriately oriented/trained to implement and adhere to the ANCC/MSD Accreditation criteria.
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/Midwest MSD Accreditation criteria.
Describe and, using an example, demonstrate the following:
SC3.How the Primary Nurse Planner provides direction and guidance to individuals involved in planning, implementing and evaluating CNE activities in compliance with ANCC/MSD accreditation criteria.
Description of Process:
Example:
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 1-7) 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.
Effective Design Principles: CNE activities are developed in response to, and with consideration for, the unique educational needs of the target audience. 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. The educational design process incorporates identified gap(s), measurable learning outcomes, best available evidence, and appropriate learner engagement strategies. 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:
EDP1The process used to identify a problem in practice or an opportunity for improvement (professional practice gap).
Description of Process:
Example:
EDP2How the Nurse Planner identifies the educational needs (knowledge, skills, and/or practice(s)) that contribute to the professional practice gap.
Description of Process:
Example:
EDP3The process used to identify and resolve all conflicts of interest (COI) for all individuals in a position to control content (planning committee, presenters, authors, and content reviewers).
Description of Process:
Example:
EDP4How the content of the educational activity is developed based on best-available, current evidence to foster achievement of desired outcomes (e.g. clinical guidelines, peer-reviewed journals, experts in the field).
Description of Process:
Example:
EDP5How strategies to promote learning and actively engage learners are incorporated into educational activities.
Description of Process:
Example:
EDP6How summative evaluation data for an educational activity are used to guide future activities.
Description of Process:
Example:
EDP7How the Nurse Planner measures change in knowledge, skills, and/or practices of the target audience that are expected to occur as a result of participating in the educational activity.
Description of Process:
Example:
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:
QO1The process utilized for evaluating the effectiveness of the Approved Provider Unit in delivering quality CNE.
Description of Process:
Example:
QO2Submit a list of the quality outcome measures the Approved Provider Unit collected, monitored, and evaluated over the past twelve (12) months specific to the Approved Provider Unit.
☐ Please see the attached listing of quality outcome measures the Approved Provider Unit collected, monitored, and evaluated specific to the Approved Provider Unit on Page#
OR
☐ The Approved Provider Unit quality outcome measures pertaining to the Approved Provider Unit are listed below:
Describe and, using an example, demonstrate the following:
QO3How the evaluation process for the Approved Provider Unit resulted in the development or improvement of an identified quality outcome measure for the Approved Provider Unit(Reference at least one of the identified quality outcomes measures listed in your response for QO2).
Description of Process:
Example:
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.
QO4Submit a list of the quality outcome measures the Approved Provider Unit collected, monitored, and evaluated over the past twelve (12) months specific to Nursing Professional Development.
☐ Please see the attached listing of quality outcome measures the Approved Provider Unit collected, monitored, and evaluated specific to the Nursing Professional Development on Page#
OR
☐ The Approved Provider Unit quality outcome measures pertaining to Nursing Professional Development are listed below:
Describe and, using an example, demonstrate the following:
QO5How, over the past 12 months, the Approved Provider Unit has enhanced Nursing Professional Development(Reference at least one of the identified quality outcomes measures listed in your response for QO4).
Description of Process:
Example:
APPROVED PROVIDER CRITERION 4: Sample Activities (SA)
As a component of the educational design process and the final element of the Approved Provider Application package, the Approved Provider applicant will select and submit three (3) samples of CNE activity files in their entirety that have been planned and implemented within 12 months of the Approved Provider Application and comply with the ANCC/Midwest MSD Accreditation criteria.
Current/Renewing Providers:Please submit three sample activity files demonstrating adherence to the accreditation criteria in effect at the time the activity was provided. Each educational activity must be at least one contact hour (60 minutes) in length, must have been provided at least once, and must be the entire activity file (not a portion of an activity, or one day of a three-day activity). Sample activities must also not have been previously submitted or designed using previously developed content. Sample activities should be representative of the types of activities offered by your Approved Provider Unit. If your Unit is not able to meet the requirements please contact the Midwest MSD office.
If in the last 12 months, the:
- APU has jointly provided an educational activity, submit the activity file from such an event
- APU has awarded contact hours for an enduring activity, submit the activity file from such an event
- APU has received commercial support for an activity, submit the activity file from such an event
- Single Agency APU has formed a System Provider APU, submit sample activity files from each Single Agency APU participating in the system
New Applicants: New applicants must have three activities (not jointly provided) approved by the Midwest MSD or another ANCC Accredited Approver during the twelve (12) months prior to Application submission. Each educational activity must be at least one contact hour (60 minutes) in length, must have been provided at least once, and must be the entire activity file (not a portion of an activity, or one day of a three-day activity). Sample activities must also not have been previously submitted or designed using previously developed content.
The activity files for these three activities must be submitted with the Provider Application package and demonstrate adherence to the accreditation criteria in effect at the time the activity was provided. Please also submit a template of a certificate that will be given to participants upon completion of the Provider Unit’s educational programs once Approved Provider status has been granted. Use the following provider approval statement on your certificate template:
(Name of your organization) is an approved provider of continuing nursing education by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Please see the CNE Activity Planning Guide for assistance in documentation for the sample activities. Remember, each activity file must be submitted as a separate PDF file and it is recommended that applicants include a table of contents, providing a page number for all corresponding supporting documentation.
Sample Activity #1
title of activity:Activity Format: ☐ Live☐ Enduring ☐ Blended
date & Location of activity:Sample Activity #2
title of activity:Activity Format: ☐ Live☐ Enduring ☐ Blended
date & Location of activity:Sample Activity #3
title of activity:Activity Format: ☐ Live☐ Enduring ☐ Blended
date & Location of activity:V1.2018 Page 1