Texas Nurses Association

July, 2018

.______

APPROVED PROVIDER APPLICATION July, 2018

______

Prior to completing this application read all the “Approved Provider Application Criteria and Guidelines,” and the “Application Submission Criteria” completely. All documentation requirements must be met prior to approval. Information presented within this application is required to meet the Texas Nurses Association (TNA) and the American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA) criteria for continuing nursing education. In addition, the objectives and content in your activities must meet the definition and criteria of continuing nursing education as established by the Texas Board of Nursing. The definition is found in the Texas Administrative Code, TITLE 22 EXAMINING BOARDS, PART 11 TEXAS BOARD OF NURSING, CHAPTER 216 CONTINUING COMPETENCY, Rule 216.1 Definitions, (9) Continuing Education (CE). It reads as follows: “Programs beyond the basic nursing preparation that are designed to promote and enrich knowledge, improve skills and develop attitudes for the enhancement of nursing practice, thus improving health care to the public.”

Criteria for what is not CE can be found in Rule 216.6 – “Activities that are not acceptable as Continuing Education”:

The following activities do not meet continuing education requirements for licensure renewal.

1-Basic Life Support (BLS) or cardiopulmonary resuscitation (CPR) courses.

2-Inservice programs. Programs sponsored by the employing agency to provide specific information about the work setting and orientation or other programs which address the institution’s philosophy, policies and procedures; on-the-job training; basic cardiopulmonary resuscitation; and equipment demonstration are not acceptable for CNE credit.

3-Nursing refresher courses. Programs designed to update knowledge or current nursing theory and clinical practice, which consist of a didactic and clinical component to ensure entry level competencies into professional practice are not accepted for CNE credit.

4-Orientation programs. A program designed to introduce employees to the philosophy, goals, policies, procedures, role expectations and physical facilities of a specific work place are not acceptable for CNE credit.

5-Courses which focus upon self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, and yoga.

6-Economic courses for financial gain, e.g., investments, retirement, preparing resumes, and techniques for job interview.

7-Courses which focus on personal appearance in nursing.

8-Liberal art courses in music, art, philosophy, and others when unrelated to patient/client care.

9-Courses designed for lay people.

Approval Period: The approval period for an Approved Provider Unit is three(3) years.

Fee:

$2,600.00

• Inpatient facilities (i.e. hospitals, rehab hospitals, etc.) with less than 3 phyiscal locations/separate addresses (not related to hospital license but to separate facilities).
• Universities/colleges with less than three (3) campuses served by the Approved Provider Unit.
• Clinics with less than three (3) physical locations/separate address (not related to a license) served by the Approved Provider Unit.
• Single-focused organization.

$3,600.00

• Inpatient facilities (i.e. hospitals, rehab hospitals, etc.) with more than 3 phyiscal locations/separate addresses (not related to hospital license but to separate facilities).
• Universities/colleges with more than three (3) campuses served by the Approved Provider Unit.
• Clinics with more than three (3) physical locations/separate address (not related to a license) served by the Approved Provider Unit.

To qualify for a $500.00 reduction in the required application review fee, the Approved Provider Unit’s Primary Nurse Planner or an appropriate designee must have attended a Texas Nurses Association/Foundation Approved Provider Workshop within the previous 10 months prior to submission.

To determine your Approved Provider application fee, please contact the CNE Program Coordinator at 512-452-0645 ext. 139.

GENERAL INFORMATION: This application consists of an eligibility section, a demographic section and four (4) sections that must be completed in their entirety. The application has been redesigned to add additional space as needed for each required element. If you need to add additional information/documentation, clearly label where the information continues. A table of contents with page numbers must be included. Each page of the application, the appendices and the education activities or approval letters must be numbered in sequence, beginning with page 1 on the “Eligibility Assessment” page. Submit three (3) typed copies of the completed application. Use tabs to separate sections in all three copies. Please proofread prior to submitting. Remove these first two pages prior to making copies.

Submission:

1. Original copy of the Approved Provider application:

1. This copy will be kept at TNA
2. This copy should be a complete copy of the Approved Provider application

Core application

Appendices

Three (3) sample activities or three (3) approval letters, as appropriate. Include the evaluation summary.

1. The remaining two (2) copies:
2. These copies will be sent to the Nurse Peer Reviewers assigned to review your Approved Provider application.
3. These copies should include:

Core application

Appendices

1. TNA will scan your activities and send them electronically to the Nurse Peer Reviewers.

1. Criteria:
2. Secure each copy of the Approved Provider application with rubber bands or binder clips.
3. Do not place any of the applications in a binder.
4. Do not spirally bind any of the applications.

The information contained within this document is based upon the “2015 ANCC Primary Accreditation Approver Application Manual” (2015) published by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA). Some of the information is excerpted and directly quoted from the ANCC COA publication. All updates and changes from ANCC COA have been incorporated into this document.

The awarding of Approved Provider Unit status is the means whereby the Texas Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation, grants public recognition to a CNE Approved Provider Unit that has met the established standards for providing continuing nursing education activities.

Rev 040518 1

July, 2018

July, 2018

APPROVED PROVIDER APPLICATION

ELIGIBILITY ASSESSMENT

1.Is your organization a commercial interest? A “Commercial Interest” is defined as any entity either producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients; or that is owned or controlled by an entity that produces, markets, resells, or distributes health care goods or services consumed by, or used on patients.

____ Yes – You may not apply to become/reapply as anApproved Provider Unit. Contact ANCC.

____ No – Continue to the next question.

2.Did your organization promote/market/advertise/target more than 50% of your education activities in the past calendar year to registered nurses in multiple regions based on the Department of Health and Human Services regions (i.e. outside of region 6 and its contiguous states)?

____ Yes – You may not apply to become/reapply as anApproved Provider Unit. Contact ANCC.

____ No – Continue to the next question.

3.Are all Approved Provider Unit Nurse Planners currently licensed Registered Nurses with a baccalaureate or higher degree in nursing?

Yes ____ No ____

If “No”, the applicant organization is not eligible for Approved Provider status.

4.Does the applicant organization havean identified Primary Nurse Planner who acts as the contact with the ANCC Accredited Approver Unit, the Texas Nurses Association, and ensures compliance with the ANCC/TNA criteria across the Approved Provider Unit?

Yes ____ No ____

If “yes”, provide Primary Nurse Planner’s Name and Credentials:
If “no”, the applicant organization is not eligible for Approved Provider status.

5.Do the Approved Provider Unit’s Nurse Planner(s) actively participate in the planning, implementation and evaluation process of each continuing nursing education activity?

Yes ____ No ____

If “no”, the applicant organization is not eligible for Approved Provider status.

6.Has the applicant organization been operational for six (6) months using the ANCC/TNA criteria?

Yes ____ No ____

If “yes”, list the date the applicant organization became operational:
If “no”, the applicant organization is not eligible for Approved Provider status.

7.Has the applicant organization assessed, planned, implemented, and evaluated at least three (3) separate education activities within the past 12 months, provided at separate and distinct events:

With the direct involvement of the Nurse Planner;

That adhere to the ANCC/TNA criteria;

Each being at least one(1) hour (60 minutes) in length;(if a first time applicant)and

Were not joint provided (if a first time applicant)

Yes ____ No ____

If “no”, the applicant organization is not eligible for Approved Provider status.

8.Is the applicant organization in compliance with all federal, state, and local laws and regulations that apply to the delivery of CNE?

Yes ____ No ____

If “no”, the applicant organization is not eligible for Approved Provider status.

9.Have you read the “Approved Provider Application Criteria and Guidelines”?

____ Yes – Please continue with the remainder of the application.

____ No – STOP! Go back and read the information in the “Approved Provider Application Criteria and Guidelines”.

10. Do you know where to find the most current Approved Provider Unit forms?

____ Yes – Please insert link here: ______

____ No – Please find link and insert here: ______

DEMOGRAPHIC DATA

Name of Organization/Approved Provider Unit:

(The name that appears here must be identical to the name that appears on the certificate of successful completion and in the “Approval Statement” portion of the Operational Requirements Attestation.)

Address:
(Street Address)
(City)(State)(Zip)
Main Phone Number: ( )

Location #2 (if applicable)

Address:
(Street Address)
(City)(State)(Zip)
Main Phone Number: ( )

Location #3 (if applicable)

Address:
(Street Address)
(City)(State)(Zip)
Main Phone Number: ( )

Duplicate page for additional locations, if needed.

IDENTIFY ORGANIZATION TYPE:

_____ Constituent Member Associations of ANA

_____College or University

_____Healthcare Facility

_____Health-Related Organization

_____Multidisciplinary Educational Group

_____Professional Nursing Education Group

_____Specialty Nursing Organization

_____Other ______

First time Approved Provider applicant (all applicants who are not currently Approved Providers)

Approved Provider Re-application: Current Approved Provider Number:______

Identify the Primary Nurse Planner:

Primary Nurse Planner’s Name and Degrees/Credentials:
Title or position:
Phone number: ( ) / State in which licensed as an RN:
Email address:
Alternate email address:

Identify a secondary contact person:

Name and Credentials:
Title or position:
Phone number: ( )
Email address:
Alternate email address:

Identify the person with whom we should correspond:

____ Primary Nurse Planner

____ Secondary contact person as listed above

____ Other

Name and Credentials:
Title or position:
Phone number: ( )
Email address:
Alternate email address:

Does your Approved Provider Unit have a publically accessible website that addresses your CNE activities?

Yes ____ No ____

If “yes”, the address is:

Did your Primary Nurse Planner and/or an appropriate designee attend a TNA “Approved Provider Workshop” within the past ten (10) months?

____ Primary Nurse PlannerDate attended

____ DesigneeDate attended

____ Neither attended an “Approved Provider Workshop”

Are you a member of the TNA CNE Committee?

Yes ____ No ____

Date you submitted this application to TNA: ______

CHECKLIST – Primary Nurse Planner to initial:

____ A check made payable to the “Texas Nurses Association” for the appropriate application fee.

____Three (3) copies of the application one (1) with all attachments, two (2) with just the core Approved Provider application and the appendices.

____ Application is typed. All pages, including the appendices and sample activities or approval letters,are numbered.A detailed table of contents is included. All three (3) copies are appropriately tabbed.

____ Application is printed one-sided.

____Sample activities (for re-applications) have a date of first presentationfromJuly, 2017 to July, 2018, and meet the Texas Board of Nursing’s (BON) definition of and criteria for continuing nursing education.

STATEMENT OF UNDERSTANDING

I attest, by my signature below, that I am duly authorized by (insert name of organization) to submit this application as an Approved Provider and to make the statements herein. On behalf of (insert name of organization), I have read the Approved Provider eligibility requirements and criteria. I understand that (insert name of organization) is subject to all eligibility requirements and criteria as an Approved Provider. I understand that becoming an Approved Provider depends on successfully meeting eligibility requirements and criteria and maintaining Approved Provider standing is dependent upon continued compliance.

On behalf of (insert name of organization), I expressly acknowledge and agree that information accumulated through the approval process may be used for statistical, research, and evaluation purposes and that anonymous and aggregate data may be released to third parties. Otherwise, all information will be kept confidential and shall not be used for any other purposes without (insert name of organization)’s permission.

On behalf of (insert name of organization), I hereby certify that the information provided on and with this application is true, complete, and correct. I further attest, by my signature on behalf of (insert name of organization), that (insert name of organization) will comply with all eligibility requirements and approval criteria throughout the entire approval period, including all reapplication periods for maintaining approval, and that (insert name of organization) will notify the Texas Nurses Association promptly if, for any reason while this application is pending or during any approval period, (insert name of organization) does not maintain compliance. I understand that any misstatement of material fact submitted on, with or in furtherance of this application for Approved Provider status shall be sufficient cause for the Texas Nurses Association to deny, suspend or terminate (insert name of organization)’s Approved Provider status and to take other appropriate action against (insert name of organization).

I confirm that my signature below indicates that (insert name of organization) is administratively and operationally responsible for coordinating the entire process of planning, implementing and delivering CNE activities within the Approved Provider Unit.

I confirm that my signature below indicates (insert name of organization)’s commitment to maintain all required records for six (6) years in an easily retrievable, but confidential manner, available only to authorized personnel.

I hereby attest that (insert name of organization) adheres to all local, regional, state, and federal laws and regulations. I further attest that this Approved Provider Unit maintains and follows business and management policies and procedures to ensure its legal and ethical obligations and commitments – as they relate to human resources and financial affairs – are met.

In the event (insert name of organization) wishes to appeal denial of this Approved Provider Application or a subsequent revocation of theirApproved Provider status, (insert name of organization) agrees to appeal in accordance with the TNA Accredited Approver Unit appeal process (copies are available from the TNA Accredited Approver Unit) and to accept the decision of the Appeal Panel as final and non-appealable.

Signature of Primary Nurse PlannerDate

Type or Print Full Name of Above:

I.APPROVED PROVIDER ORGANIZATIONAL OVERVIEW (OO)

Structural Capacity

OO1.Demographics

1.Submit a description of the features of the Approved Provider Unit, including by not limited to size, geographic range, target audience(s), content areas, and the types of education activities offered.

Description:

Size of the Approved Provider Unit

Geographic range

RN target audience

Content areas

Types of activities offered

2.Is the Approved Provider Unit part of a multi-focused organization?

Yes ____ No ____

If “yes”, describe the relationship of these dimensions to the total organization.

A. Describe the multi-focused organization.
B. Describe the relationship of the Approved Provider Unit to the multi-focused organization based on the above dimensions (001).

OO2.Lines of Authority

1.Submit a listby completing the information in the boxes below of all members of the Approved Provider Unit to include the names and degrees and credentials, employment positions or titles of the Primary Nurse Planner, and Nurse Planner(s).

2.Submit position descriptionsfor the Primary Nurse Planner and Nurse Planners.

A.Primary Nurse Planner:

Name and Degrees/Credentials:
Title or position:
Position description on page:

B.Nurse Planner(s):

Name and Degrees/Credentials:
Title or position:
Position description on page:

(Repeat this area as often as necessary to completely list all Nurse Planners for your Approved Provider Unit. If you serve as Primary Nurse Planner and as a Nurse Planner for your Approved Provider Unit, include yourself in this section of the application also.)

3.Submit an organizational chartdepicting the structure of the Approved Provider Unit, including the Primary Nurse Planner and Nurse Planner(s). Include person’s name, Approved Provider Unit title, employer job title, and degrees/credentials.

Page:

4.If part of a larger organization, submit an organizational chart, flowchart, or similar image that depicts the organizational structure and the Approved Provider Unit’s location within the organization. Highlight where the Approved Provider Unit sits in the multi-focused organization.

Page:

Educational Design Process

OO3.Data Collection and Reporting

Approved Provider organizations report data, at a minimum, annually to TNA.

1.______Primary Nurse Planner Initials: The Primary Nurse Planner affirms that the Approved Provider Unit’s Nursing Activity Reporting System (NARS) is complete through June 30, 2018 (do NOT attest to the 2018 activities in NARS)..

First time applicants: Submit current logs for your three (3) TNA approved individual activities.

Page:

Quality Outcomes

OO4.Evidence

An Approved Provider Unit must demonstrate how its structure and processes result in positive outcomes for itself and for Registered Nurses participating in its educational activities. This section has been moved to the Quality Outcomes (QO) section of the Approved Provider Application.

II.APPROVED PROVIDER CRITERION 1:STRUCTURAL CAPACITY (SC)

A.Commitment. The Primary Nurse Planner demonstrates commitment to ensuring RNs’ learning needs are met by evaluating the Approved Provider Unit’sprocesses 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.