TEXAS NURSES ASSOCIATION - cdn.ymaws.com · Web viewAll documentation requirements must be met prior to approval. Information presented within this application is required to meet

January 2019TEXAS NURSES ASSOCIATION

4807 Spicewood Springs Road, Building 3, Suite 100, Austin, Texas 78759Phone: (512) 452-0645 Fax: (512) 323-5379 E-mail: [email protected]

Web site: www.texasnurses.org.________________________________________________________________________________

APPROVED PROVIDER APPLICATION January 2019_________________________________________________________________________________

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.

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mailto:[email protected]

January 2019

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 physical 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 physical 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 one (1) typed copy of the completed application. Please proofread prior to submitting. Remove these first three pages prior to sending.

Submission:1. Organize the Approved Provider application as follows:

Approved Provider Core Application: Cover sheet/page Table of contents Eligibility Assessment Demographic Data Organizational Overview (OO) Structural Capacity (SC) Educational Design Process (EDP) Quality Outcomes Appendices

Job/Position description – Primary Nurse Planner Job/Position description(s) – Nurse Planner(s) Approved Provider Unit organizational chart Multi-focused organization organizational chart Operational Requirements Attestation (ORA) form

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Sample Activities – Re-applicants: Title page Sections A through T – including the Nurse Planner summative evaluation section Attachments

Section H qualified planners/presenter(s)/author(s)/content reviewer(s) grid Conflict of interest (COI) forms – in the order they appear on the section H grid. Do

not include the instructions page Education documentation form(s) (EDFs) with reference lists Post-activity evaluation tool Promotional material(s) Certificate(s) of successful completion Commercial support agreement(s) – as appropriate Disclosure to participant tool(s) Joint provider agreement(s) – as appropriate Summative evaluation

Repeat for each sample activity Approval Letters – First-time Applicants:

Individual activity application approval letter Summative evaluation Repeat for each activity

Approved Provider Application Decision Form

Submission Process:

Develop your Approved Provider application in Word or Adobe (PDF). Divide your Approved Provider application into its four (4) sections

Core application and appendices Sample activity #1 or approval letter #1 Sample activity #2 or approval letter #2 Sample activity #3 or approval letter #3 and the Approved Provider application form

Attach each of the above listed sections to a separate email – four (4) separate emails in total In the Subject line of the email include your Approved Provider name and what section is attached

IE: ABC Approved Provider Unit – Core application and appendices ABC Approved Provider Unit – Sample activity #1 or Approval letter #1 ABC Approved Provider Unit – Sample activity #2 or Approval letter #2 ABC Approved Provider Unit – Sample activity #3 or Approval letter #3 and decision

form If your activity is too large to fit into one (1) email, divide it up.

In the Subject line include: ABC Approved Provider Unit – Sample Activity #1A ABC Approved Provider Unit – Sample Activity #1B

Send all the emails to: [email protected]

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.

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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.

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January 2019TEXAS NURSES ASSOCIATION

4807 Spicewood Springs Road, Building 3, Suite 100, Austin, Texas 78759Phone: (512) 452-0645 Fax: (512) 323-5379 E-mail: [email protected]

Web site: www.texasnurses.org

January 2019APPROVED 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 an Approved 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 an Approved 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 have an 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.

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January 20199. 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: _______________________________

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January 2019DEMOGRAPHIC 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)


Main Phone Number: ( )

Location #3 (if applicable)

Address:

(Street Address)


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:

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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 publicly 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 Planner Date attended ____ Designee Date 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: _______________________________________

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January 2019CHECKLIST – Primary Nurse Planner to initial:

____ Application is typed. All pages, including the appendices and sample activities or approval letters, are numbered. A detailed table of contents is included.

____ Sample activities (for re-applications) have a date of first presentation from January 2018 to January 2019, and meet the Texas Board of Nursing’s (BON) definition of and criteria for continuing nursing education.

STATEMENT OF UNDERSTANDINGI 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 regula-tions. 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 sub-sequent revocation of their Approved Provider status, (insert name of organization) agrees to appeal in accor-dance with the TNA Accredited Approver Unit appeal process (copies are available from the TNA Accredited Ap-prover Unit) and to accept the decision of the Appeal Panel as final and non-appealable.

Signature of Primary Nurse Planner DateType or Print Full Name of Above:

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January 2019I. APPROVED PROVIDER ORGANIZATIONAL OVERVIEW (OO)

Structural Capacity

OO1. Demographics1. 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).

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January 2019OO2. Lines of Authority

1. Submit a list by 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 descriptions for 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 chart depicting 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:

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January 2019Educational Design Process

OO3. Data Collection and ReportingApproved 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 January 2019. (You can attest to the 2018 activities)

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.

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January 2019II. 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’s 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 the Approved Provider Unit processes are revised based on data.

A. Process Description (Procedure – How do you do it?):

B. Specific Example:

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


SC2. How the Primary Nurse Planner ensures that all Nurse Planners of the Approved Provider Unit are appropriately oriented/prepared to implement and adhere to ANCC/TNA criteria.



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January 2019C. 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 with ANCC/TNA criteria.


SC3. How the Primary Nurse Planner provides direction and guidance to individuals – especially Nurse Planners - involved in the planning, implementing, and evaluating of CNE activities in compliance with ANCC/TNA criteria.



SC4. How the Nurse Peer Review Leader of the Texas Nurses Association is used as a resource by the Primary Nurse Planner and/or other Nurse Planner(s) in the Approved Provider Unit.



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January 2019III. APPROVED PROVIDER CRITERION 2: EDUCATIONAL DESIGN PROCESS (EDP)

A. Assessment of Learning Needs. CNE activities are developed in response to, and with consideration for, the unique educational needs of the Registered Nurse target audience.


EDP1. The process used by the Nurse Planner to identify a problem in practice or opportunity for improvement (professional practice gap).



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

A. Process Description (Procedure – How do you do it? ):


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


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



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C. Design Principles. The educational design process incorporates best-available evidence, and appropriate learner engagement strategies.


EDP4. How the Nurse Planner ensures 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.



EDP5. How the Nurse Planner ensures strategies to promote learning and actively engage learners are incorporated into educational activities.



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January 2019D. Evaluation. A clearly defined method that includes learner input is used to evaluate the effectiveness of each education activity. Results from the activity evaluation are used to guide future activities.


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



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



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January 2019IV. APPROVED PROVIDER CRITERION 3: QUALITY OUTCOMES (QO)

A. Approved Provider Unit Evaluation Process. The Approved Provider Unit must evaluate the effectiveness of its overall functioning as an Approved Provider Unit.


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

A. Process Description:What is evaluated?

When is the evaluation done? Triggers?

Who participates in the process?

How is the evaluation performed?

Data sources Outcomes/Results

Procedures and FormsMaterial ResourcesFinancial ResourcesHuman ResourcesActivities

Repeated Activities


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January 2019QO2. How the evaluation process for the Approved Provider Unit resulted in the development or

improvement of an identified quality outcome measure. (Tie to identified quality outcomes listed in OO4-1).

OO4-1:Submit a list of the quality outcome measures the Approved Provider Unit collected, monitored, and evaluated over the past 12 months specific to the Approved Provider Unit. Outcomes must be written in measurable terms.

List:



B. 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 RN learners.


QO3. How, over the past 12 months, the Approved Provider Unit has enhanced nursing professional development. (Tie to quality outcomes listed in OO4-2).

OO4-2:Submit a list of the quality outcome measures the Approved Provider Unit collected, monitored, and evaluated over the past 12 months specific to Nursing Professional Development . Outcomes must be written in measurable terms.

List:



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January 2019C. Operational Requirements Attestation: Provide an Operational Requirements Attestation

statement that the Approved Provider Unit must adhere to during the three-year period of approval. The Approved Provider Unit Primary Nurse Planner must sign the attestation.

_____Page number(s) in the document or appendix where you have placed the signed Operational Requirements Attestation.

D. Three (3) Education Activities :

Re-applicants : Include three (3) sample activities. These activities should be from the past 12 months (January 2018 – January 2019). Don’t forget to include the evaluation summary for each of the three (3) activities.

First-time applicants : Include your three (3) TNA Individual Activity approval letters. Don’t forget to include the evaluation summary for each of the three (3) activities.

[The last page of this application is a form used by the Nurse Peer Review team. Please complete Section I in full. Please do not separate this form into two (2) pages.]

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January 2019Approved Provider Application Decision Form

SECTION I.Name of Organization: (The organization name that appears here must be identical to the organization name that appears on the front of this application.)If you are re-applying, your current Approved Provider ID # ________________________________Submitted Activities: PD LP

Title #1 _________________________________________________________

Title #2 _________________________________________________________

Title #3 _________________________________________________________

THIS ENTIRE PAGE SHOULD BE PLACED AT THE VERY END OF YOUR APPLICATION!

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SECTION II. TO BE COMPLETED BY TNA NURSE PEER REVIEWER:

APPLICATION: First Time Re-application

SCORING: Structural Capacity (SC):

Educational Design Process (EDP):

Quality Outcomes (QC):

COMMENTS: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SAMPLE ACTIVITIES:

No. #1 % Score

No. #2 % Score

No. #3 % Score Average Score

COMMENTS: (May use activity number from above for reference.)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Review and Consultation time: Indicate date(s) and amount of time(s) spent: Individual Review

1st Consensus Review

Time with Applicant

Final Consensus Review

TOTAL: _________________

Reviewed by: ___________________________ REVIEWERS! This sheet must be removed from the application, and added to your evaluation

Documents

TEXAS NURSES ASSOCIATION - cdn.ymaws.com · Web viewAll documentation requirements must be met prior to approval. Information presented within this application is required to meet