ASNA APPROVED PROVIDER APPLICATION

General Information

Approval as a provider is recognition of a provider’s capacity to award contact hours for continuing nursing education activities entirely planned, implemented, and evaluated by the provider. The provider may offer an unlimited number of educational activities during the approved time period. Approved providers may not approve activities either internally or externally.

Alabama State Nurses Association (ASNA) is an accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC).

ASNA adheres to the standards and guidelines set forth by ANCC. Sponsors who choose to participate in the ASNA Continuing Education Approval Process will be expected to comply with all ASNA/ANCC Operational Requirements as outlined in this document.

Approval time period is three (3) years.

Processing Fee: $2600.00 if paid in full (payment options of $900 per year are available with permission). An expedited review is available for $125.

Application must contain all information before review and approval may be granted. Should you need assistance contact the ASNA Continuing Education Department at (334) 262-8321, (334) 262-8578 (F), or

For Internal Office Use Only:

SPONSOR (AGENCY) OF ACTIVITY
CONTACT PERSON
ADDRESS
CITY / STATE / ZIP CODE
DAY PHONE
EMAIL
Sponsor Authorization for release of information. As the representative of this activity, I do hereby give ASNA permission to release information contained in this activity to interested parties.
SIGNED:
Upon request ASNA will publish information on the Continuing Nursing Education tab of the ASNA Website:
Publish online? / YES / NO

Alabama State Nurses Association

Approved Provider Self- Study Template

Approved Provider Organizational Overview(OO)

The Organizational Overview (OO)is an essential component of the application process thatprovides a context for understanding theApproved Provider Unit/organization. The applicant must submit the following documents and/or narratives:

Structural Capacity

OO1. Demographics

  • Submit a description of the features of the Provider Unit, includingbut not limited to size, geographic range, target audience(s), content areas, and the types of educational activities offered.

Description:

  • If the Provider Unit is part of a multi-focused organization, describe the relationship of these dimensions to the total organization.

Description:

OO2. Lines of Authority and Administrative Support

  • Submit a list of the names, credentials, positions, and titles of the Primary Nurse

Planner and Nurse Planners (if any) in theProvider Unit.

List:

  • Submit position descriptions of the Primary Nurse Planner and Nurse Planners (if any) in the Provider Unit.

Position Descriptions:

Primary Nurse Planner:

Nurse Planner(s):

  • Submit a chart depicting the structure of the Provider Unit,including the Primary Nurse

Planner and Nurse Planners (if any) in the Provider Unit.

Chart:

  • If part of a larger organization, submit an organizational chart, flowchart, or similar image that depicts the organizational structure and the Provider Unit’slocation within the organization.

Chart:

Educational Design Process

OO3. Data Collection and Reporting

Approved Provider organizations report data, at a minimum, annually to their ANCC Accredited Approver:

  • Submit a complete list of all CNE offerings provided in the past 12 months in NARS, including activity dates, titles, target audience, total number of participants, number of contact hours offered for each activity, joint provider status,andanycommercialsupport,includingmonetaryor in-kind contributions.

Attach the completed list.

  • New applicants: Submit a list of the CNE offerings provided within the past 12 months. If available, include the items listed above; and
  • Any additional requirements of the ANCC Accredited Approver.

Quality Outcomes

OO4. Evidence

A provider organization must demonstrate how its structure and processes result in positive outcomes for itself and for registered nurses participating in its educational activities

  • Submit a list of the quality outcome measures the Provider Unit has collected, monitored, and evaluated over the past 12 months specific to the Provider Unit. Outcomes must be written in measureable terms.

Examples of outcomes:

  • 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 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

List: include 1-3 items that your provider unit has been tracking and measuring over the past 12 months related to provider unit operations, specifying the desired outcome (e.g. decrease cost of learner participation by 10%).

  • Submit a list of thequalityoutcomemeasuresthe Approved Provider has collected, monitored, and evaluated over the past 12 months specific toNursingProfessionalDevelopment.(Referto Chapter1:The Primary Accreditation Program,sectiontitled FocusonQualityandOutcomes.) Outcomes must be written in measurable terms.

Examples of outcomes:

  • Professional practice behaviors
  • Leadership skills
  • Critical-thinking skills
  • Nurse competence
  • High-quality care based on best-available evidence
  • Improvement in nursing practice
  • Improvement in patient outcomes
  • Improvement in nursing care delivery

List: include 1-3 items that your provider unit has been tracking and measuring over the past 12 months related to professional development of nurses or improvement in practice, specifying the desired outcome (e.g. improve responsiveness to critical change in patient condition by 15%).

Note: New applicants should develop and submit with their self-study a list of quality outcome measures that will be collected, monitored, and evaluated during the 1st 12 months of approved provider status.

Approved Provider Criterion 1:Structural Capacity (SC)

The capacity of an Approved Provider is demonstrated bycommitment, 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,and Leadership to illustrate how structural capacity is operationalized.

Commitment. The Primary Nurse Planner demonstrates commitment to ensuringRNs’ learning needs are met by evaluating Provider Unit processes 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 Provider Unitprocesses are revised based on data.

Process Description:

Specific Example:

Accountability. The Primary Nurse Planner is accountable for ensuring that all Nurse Planners in the Provider Unit adhere to the ANCC accreditation criteria.

Describe and, using an example, demonstrate the following:

SC2.How the Primary Nurse Planner ensures that all Nurse Planners of the ProviderUnit are appropriately oriented/trained to implement and adhere to the ANCC accreditation criteria.

Process Description:

Specific Example:

Leadership. The Primary Nurse Planner demonstrates leadership of the Provider Unit through direction and guidance given to individuals involved in the process of assessing, planning, implementing, and evaluating CNE activities in adherence with ANCC accreditation criteria.

Describe and,using an example, demonstrate the following:

SC3.How the Primary Nurse Planner providesdirection and guidance to individuals involved in planning, implementing, and evaluating CNE activities in compliance with ANCC accreditation criteria.

Process Description:

Specific Example:

Approved Provider Criterion 2:Educational Design Process (EDP)

The Provider Unit has a clearly defined process for assessing needs as the basis for planning,implementing, and evaluating CNE. CNE activities are designed, planned, implemented, and evaluated inaccordance with adult learning principles, professional education standards, andethics.

Examples for the narrative componentof the provider application (EDP 1-7) may be chosen from but are not limited to those contained in the three activity files. Evidence must demonstrate how the Provider Unit complies with each criterion.

Assessment of Learning Needs.CNE activities are developed inresponse to, and with consideration for, the unique educational needs of the target audience.

Describe and, using an example, demonstrate the following:

EDP1.Theprocess used to identify a problem in practice or an opportunity for improvement (professional practice gap).

Process Description:

Specific Example:

EDP2.How the Nurse Planner identifies the educational needs (knowledge, skills, and/or practice(s)) that contribute to the professional practice gap.

Process Description:

Specific Example:

Planning.Planning for each educational activity must be independent from the influence of commercial interest organizations.

Describe and, using an example, demonstrate the following:

EDP3.The process used to identify and resolve all conflicts of interest for all individuals in a position to control educational content.

Process Description:

Specific Example:

Design Principles.The educational design process incorporates best-available evidenceand appropriate teaching methods.

Describe and, using an example, demonstrate the following:

EDP4.How the content of the educational activity is developed based on best-available current evidence (e.g., clinical guidelines, peer-reviewed journals, experts in the field) to foster achievement of desired outcomes.

Process Description:

Specific Example:

DP5.How strategies to promote learning and actively engage learners are incorporated into

educational activities.

Process Description:

Specific Example:

Evaluation.A clearly defined method that includes learner inputis used to evaluate the effectiveness of eacheducational activity. Results from the activity evaluation are used to guide future activities.

Describe and, using an example, demonstrate the following:

EDP6. How summative evaluation data for an educational activity were used to guide future activities.

Process Description:

Specific Example:

EDP7. How the Nurse Planner measures change in knowledge, skills, and/or practices of the target audience that are expected to occur as a result or participating in the educational activity.

Process Description:

Specific Example:

Approved Provider Criterion 3:Quality Outcomes (QO)

The Provider Unit engages in an ongoing evaluation process to analyze its overalleffectiveness in fulfilling its goals and operational requirements to provide qualityCNE.

Provider Unit Evaluation Process. The Provider Unit must evaluate the effectiveness of its overall functioning as a Provider Unit.

Describe and, using an example, demonstrate the following:

QO1. The process utilized for evaluating effectiveness of the Provider Unit in delivering quality CNE.

Process Description:

Specific Example:

QO2. How the evaluation process for the Provider Unit resulted in the development or improvement of an identified quality outcome measure.(Refer to identified quality outcomes list in OO4.)

Process Description:

Specific Example:

Value/Benefit to Nursing Professional Development.The Provider Unit shall evaluate data to determine how the 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:

QO3. How, over the past 12 months, the Provider Unit has enhancednursing professional development.(Refer to identified quality outcomes list in OO4.)

Process Description:

Specific Example:

Part B Different Activities:

Provide three complete, different activities developed within the last year. (If the activity was not based on the criteria augment activity file with samples of data that would have been included had the application included in this document been used) (click here for form). At least one sample should be an enduring activity (if enduring activities are presented.). A comprehensive narrative format of the essential information is located on the ASNA Website at under the Continuing Nursing Education Tab.

Applicant's Name:

Is this continuing education? Is this learning activity 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 improve the health of the public and RNs’ pursuit of their professional career goals?

☐Yes ☐No If no, the activity is not eligible for approval.

Title of Activity: Click here to enter text.

Date Form Completed: Click here to enter a date.

Activity Type:

☐Provider-directed, provider-paced: Live (in person or webinar)

  • Date of live activity: Click here to enter a date.
  • Location of activity
  • Number of contact hours to be awarded and method of calculation

☐Provider-directed, learner-paced: Enduring material

  • Start date of enduring material:Click here to enter a date.
  • Expiration/end date of enduring material: Click here to enter a date.
  • Number of contact hours to be awarded and method of calculation

☐Learner-directed, learner-paced: Enduring material

  • Start date of enduring material:Click here to enter a date.

Expiration/end date of enduring material:

  • Number of contact hours to be awarded and method of calculation

☐Blended activity

  • Date(s) of prework and/or post-activity work:Click here to enter a date.
  • Date of live portion of activity: Click here to enter a date.
  • Number of contact hours to be awarded and method of calculation

NARS Reporting Information

This section is included to assist with NARS data entry. Below is the list of terms and all information necessary to “open” and “close” an activity in the system. Please consult the NARS FAQs page, NARS user manual, and Annual Reporting Page for more information.

NARS Reporting Conversion Terms

NARS Activity Type:

☐Course- A course is a live educational activity where the learner participates in person.

☐Regularly Scheduled Series-A regularly scheduled series (RSS) as a course that is ☐planned as a series with multiple, ongoing sessions.

☐Internet Live Course- An Internet live activity is an online course available via the ☐Internet at a certain time on a certain date and is only available in real-time.

☐Journal Based CNE- A journal-based CNE activity includes the reading of an article (or adapted formats for special needs).

☐Other- (Manuscript Review, Test writing item, Committee Learning, Performance Improvement, Internet searching and learning)

Total number of nurses (Registered Nurses)Click here to enter text.

Please only include the total number of registered nurses.

Nurse Planner contact information for this activity.

Name and credentials: Click here to enter text.

Email Address: Click here to enter text.

  1. Description of the professional practice gap (e.g. change in practice, problem in practice, opportunity for improvement)

Describe the current state:

Describe the desired state:

Identified gap:

  1. Evidence to validate the professional practice gap (check all methods/types of data that apply)

☐Survey data from stakeholders, target audience members, subject matter experts or similar

☐Input from stakeholders such as learners, managers, or subject matter experts

☐Evidence from quality studies and/or performance improvement activities to identify opportunities for improvement

☐Evaluation data from previous education activities

☐Trends in literature, law and health care

☐Direct observation

☐Other—Describe:

Please provide a brief summary of data gathered that validates the need for this activity:

  1. Educational need that underlies the professional practice gap (e.g. knowledge, skill and/or practices)

Choose an item

  1. Description of the target audience. (You can select more than one target audience).
  1. Choose an item.
  2. Choose an item.
  3. Choose an item.
  4. Choose an item.
  1. Desired learning outcome(s) (What will the outcome be as a result of participation in this activity?)

Area of impact (check all that apply):

☐Nursing Professional Development☐Patient Outcome

☐Other- Describe:

  1. Outcome Measure(s) (A quantitative statement as to how the outcome of this activity will be measured):
  1. Content of activity: A description of the content with supporting references or resources

☐See Educational Planning Table OR

☐Describe content and include time calculation for content: Click here to enter text.

Content for this educational activity was chosen from:

☐Information available from the following organization/web site (organization/web site must use current available evidence within past 5 - 7 years as resource for readers; may be published or unpublished content; examples – Agency for Healthcare Research and Quality, Centers for Disease Control, National Institutes of Health):

☐Information available through peer-reviewed journal/resource (reference should be within past 5 – 7 years):

☐Clinical guidelines (example -

☐Expert resource (individual, organization, educational institution) (book, article, web site):

☐Textbook reference:

☐Other:

  1. Learner engagement strategies

☐See Educational Planning Table OR

☐Integrating opportunities for dialogue or question/answer

☐Including time for self-check or reflection

☐Analyzing case studies

☐Providing opportunities for problem-based learning

☐Other:

  1. Criteria for Awarding Contact Hours

Criteria for awarding contact hours for live and enduring material activities include:

(Check all that apply)

☐Attendance for a specified period of time (e.g., 100% of activity, or miss no more than 10 minutes of activity)

☐Credit awarded commensurate with participation

☐Attendance at 1 or more sessions

☐Completion/submission of evaluation form

☐Successful completion of a post-test (e.g., attendee must score % or higher)

☐Successful completion of a return demonstration

☐Other - Describe:

  1. Description of evaluation method: How will change in knowledge, skills, and/or practice be evaluated at the end of this activity? (Refer back to identified practice gap and educational need – evaluation must occur at the level of need identified in “C” above

Short-term evaluation options:

☐Intent to change practice

☐Active participation in learning activity

☐Post-test

☐Return demonstration

☐Case study analysis

☐Role-play

☐Other – Describe:

Long-term evaluation options:

☐Self-reported change in practice

☐Change in quality outcome measure

☐Return on Investment (ROI)

☐Observation of performance

☐Other – Describe:

Attachment 1

Individuals in a Position to Control Content

Complete the table below for each person in a position to control content of the educational activity and include name, credentials, educational degree(s), role on the planning committee. There must be one Nurse Planner and one other planner to plan each educational activity. The Nurse Planner is knowledgeable of the CNE process and is responsible for adherence to the ANCC criteria. One planner needs to have appropriate subject matter expertise for the educational activity being offered (Content Expert). The individuals who fill the roles of Nurse Planner and Content Expert must be identified.