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VIRGINIA NURSES ASSOCIATION
CONTINUING EDUCATION APPROVAL COMMITTEE
APPROVED PROVIDER APPLICATION
The awarding of Approved Provider status is the means whereby the Virginia Nurses Association (VNA),
an accredited approver of continuing nursing education by the American Nurses Credentialing Center’s
Commission on Accreditation, grants public recognition to an Approved Provider Unit that has met the
established standards for providing continuing nursing education (CNE) activities.
Approved Provider applications are accepted anytime during the year. Upon receipt of the application, a
two-member Nurse Peer Review team conducts an assessment. Each member independently evaluates
the application and then the Nurse Peer Review team members confer with each other regarding their
findings. The Nurse Peer Reviewers may contact the applicant to request additional materials, as
necessary, based upon this review. After the Nurse Peer Reviewers complete the initial review of the
application, the Nurse Peer Review Leader completes a separate review. It is highly encouraged that
you establish a process for proofreading your application prior to submitting it, monitoring for
typographical errors, grammatical errors, etc.
Approved Provider status is granted for a three-year period. Approved Providers are approved to offer
continuing nursing education activities during this three-year period. Approval as an Approved Provider is
recognition of an Approved Provider Unit’s capacity to award contact hours for continuing nursing
education activities, planned, implemented and evaluated by the Approved Provider Unit. The
Approved Provider Unit may offer an unlimited number of education activities during the period of
approval.
DIRECTIONS:
Information should be typed directly on the application form. Attach additional files as necessary.
Note: Refer to Instructions for Completing the Provider Application Form for information on how to
complete this application.
ALL SECTIONS OF THE FORM MUST BE COMPLETED FOR THE APPLICATION TO BE
CONSIDERED FOR REVIEW.
Please submit the application and all attachments electronically
http://www.virginianurses.com/Main-Menu-Category/Education/Become-an-Approved-Provider
If submitting by mail:
Fee: Make checks payable to the VNA.
Please send payments to:
Virginia Nurses Association
Attn: CE Committee, 6912 Three Chopt Rd, Suite H. Richmond, VA 23226.
Applications will not be considered until receipt of payment.
For additional questions, please email ksemp@virginianurses.com or call the VNA office at 804-2120693.
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
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Do not complete this application until eligibility has been assessed. If you have
questions regarding eligibility, please contact the VNA office.
___________________________________________________________________________
DEMOGRAPHIC DATA:
Date form completed:
Name of agency/business:
Address of agency/business:
Agency/business website:
Identify organization type:
Constituent member association of ANA
College or university
Healthcare facility
Health-related organization
Multi-disciplinary educational group
Professional nursing education group
Specialty nursing organization
Other: Describe:
Main phone number and extension:
First time provider applicant?
Yes
Previously approved provider?
Yes (dates approved:
Type of organization:
Single focused organization
Distinct, separately identified unit within a complex,
multi-focused organization
What type of activities do you offer or
plan to offer? (Check all apply)
No
to
)
No
Provider-directed, provider paced: Live (in-person
or webinar)
Provider-directed, learner paced: Enduring material
(print/journal, online, electronic)
Contact Information for Correspondence
Name and credentials:
Title/position:
Address (for all mailings):
Daytime phone number:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 3 of 25
Fax number:
Email address:
Website address:
A. ORGANIZATIONAL OVERVIEW
OO1. Demographics
Submit a description of the features of the Approved Provider Unit, including but not
limited to scope of services, size, geographic range, target audience(s), content areas,
and the types of educational activities offered.
Description:
If the Approved Provider Unit is part of a multi-focused organization, describe the
relationship of these scope dimensions to the total organization.
Description:
OO2. Lines of Authority and Administrative Support
The provider unit must have at least one Nurse Planner who is responsible for adhering to the
ANCC Accreditation Program criteria in continuing nursing education. The Nurse Planner
must be a registered nurse with a baccalaureate or graduate degree in nursing, as well as have
education or experience in the field of education or adult learning. If there is more than one
Nurse Planner, indicate the Primary Nurse Planner in charge of the Provider Unit. Attach a
completed biographical data form (Form C) for all nurse planners and key personnel. For
additional planners/personnel, please attach a separate list with the information requested
below.
Do not send complete CV or resume.
Name of Nurse Planner/Personnel (Degree and Credentials)
Bioform Attached
Primary Nurse Planner of Provider Unit (Degree and Credentials):

Other Nurse Planners (Degree and Credentials):





Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 4 of 25
Other Key Personnel (Degree and Credentials):



a. Submit position descriptions of the Primary Nurse Planner, Nurse Planners, and key
personnel in the Approved Provider Unit. Attach additional documentation if needed and
reference file name here.
Position Descriptions:
Primary Nurse Planner:
Nurse Planner(s):
Other Key Personnel:
b. Submit an organizational chart, flow chart or similar kind of image depicting the structure of
the Approved Provider Unit, including the Primary Nurse Planner, other Nurse Planner(s),
and all key personnel. This chart is on page/attached file is named:
c. 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. This chart is on page/attached file is named:
d. Scope and Standards: The Scope and Standards of Practice for Nursing Professional
Development (ANA, 2010) are incorporated into the Approved Provider Unit’s functions.
Initial:
e. Operational requirements for approved providers (see Appendix A): Operational
requirements will be implemented by the Provider Unit throughout the period of approval.
Signed attestation statement.
OO3. Data Collection and Reporting
New renewing applicants: Submit a complete list of all CNE offerings provided in the
past 12 months using the Annual Report Form H. File attached
Name of file:
OO4. Evidence
a. List Approved Provider Unit’s strategic goals with respect to CNE for the past and 12
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 5 of 25
months.


b. Submit a list of the quality outcome measures the Approved Provider collects, monitors,
and evaluates specific to the Approved Provider Unit.



c. Submit a list of the quality outcome measures the Approved Provider collects, monitors,
and evaluates specific to Nursing Professional Development. (Refer to section titled
Focus on Quality and Outcomes.)




Note: New applicants should develop and submit with their self-study a list of strategic
goals for the initial 2 years after achieving Approved Provider status and a list of quality
outcome measures that will be collected, monitored, and evaluated.
OO5. Business Practices
The provider unit must adhere to regional, state and national laws and regulations and
operate the business and management policies and procedures of its continuing nursing
education program (as they relate to human resources, financial affairs and legal
obligations) so that its obligations and commitments are met (see Appendix B).
Signed attestation by the leaders of the provider unit
OO6. Record Keeping
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 6 of 25
ALL applicants: Describe the record keeping storage system including retention of
records, confidentiality, and retrieval of records.
a. Storage of records: (Check each of the first two lines; describe on line 3)
Records are kept in secured files
There is a secure system if stored in the computer
Records are stored at (site location):
b. Confidentiality: (Check each line)
Access is limited to only designated personnel
Confidentiality is maintained for all records
c. Retrieval of records: (Check all that apply)
Am able to retrieve hard copy of records for the past 6 years (or will be able to
do so for 1st time provider applicants)
Am able to retrieve computer records for the past 6 years (or will be able to do
so for 1st time provider applicants)
Other: Describe:
OO7. Resources
a. Material Resources: Briefly describe material resources or check the best description
of resources available:
Office space with appropriate furniture, file cabinets, etc.
Audiovisual equipment needed to implement programs
Room space for live presentations
Ability to contract with outside organizations for room space
Computer technology available to carry out the activities
Other: Please describe:
b. Financial Resources: Sources of Financial Support (Check all that apply).
Allotted budget from parent organization
Fees from events (registrations)
Educational grants
Other: Please describe:
c.
This organization expects to be able to financially afford to maintain this provider
unit through the projected approval period. (Check box)
d. Describe how financial support will be sustained throughout the period of approval
(Do not submit budget/financial reports:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 7 of 25
e. Submit a report identifying the amount and frequency with which commercial support
for educational activities are received.
See page/file attachment:
B. CRITERION 1: STRUCTURAL CAPACITY (SC)
The capacity of an Approved Provider is demonstrated by commitment, 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, Leadership, and Resources to
illustrate how structural capacity is operationalized.
IMPORTANT NOTE: Each narrative must include a specific example that illustrates
how the criterion is operationalized within the Provider Unit.
1. 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 data.
Process Description:
Specific Example:

SC2. How the organization’s leadership is committed to supporting the goals of the
Approved Provider Unit (Note: Complete only if the provider unit is part of a
larger organization).
Process Description:
Specific Example:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 8 of 25
2. 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 accreditation
criteria.
Describe and, using an example, demonstrate the following:

SC3. How the Primary Nurse Planner ensures that all Nurse Planners and key
personnel of the Approved Provider Unit maintain adherence to the ANCC
accreditation criteria.
Process Description:
Specific Example:
 SC4. How the Primary Nurse Planner is accountable for resolving issues related to
providing CNE.
Process Description:
Specific Example:
3. 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 accreditation
criteria.
Describe and, using an example, demonstrate the following:
 SC5. How the Primary Nurse Planner ensures that every Nurse Planner maintains
accreditation standards and guides the Planning Committee or team for an individual
educational activity.
Process Description:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 9 of 25
Specific Example:
 SC6. How the Nurse Peer Review Leader of the Accredited Approver Unit is used as a
resource by the Primary Nurse Planner and/or other Nurse Planner(s) in the Approved
Provider Unit.
Process Description:
Specific Example:
4. Resources. The Primary Nurse Planner advocates for and utilizes available human,
material, and financial resources to ensure that the Approved Provider Unit achieves its goal of
meeting identified quality outcome measures.
Describe and, using an example, demonstrate:
 SC7. How the Primary Nurse Planner advocates for resources to ensure that the
Approved Provider Unit achieves its goals related to quality outcome measures.
Process Description:
Specific Example:
C. CRITERION 2: EDUCATIONAL DESIGN PROCESS (EDP)
The Approved 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 in accordance with adult learning principles, professional
education standards, and ethics.
NOTE: Each narrative must include a specific example that illustrates how the
criterion is operationalized within the Provider Unit.
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 10 of 25
Examples for the narrative component of the provider application (EDP 1-13) may be chosen
from but are not limited to those contained in the three activity files. Evidence must
demonstrate how the Approved Provider Unit complies with each criterion.
1. Assessment of Learning Needs. CNE activities are developed in response to, and with
consideration for, the unique educational needs of the target audience.
Describe and, using an example, demonstrate the following:
 EDP1. The Nurse Planner’s methods of assessing the current learning needs of the
target audience.
Process Description:
Specific Example:
 EDP2. How the Nurse Planner uses data collected to develop an educational activity
that addresses the identified gap in knowledge, skills, and/or practices.
Process Description:
Specific Example:
2. Planning. 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.
Describe and, using an example, demonstrate the following:
 EDP3. The process used to select a planning team/committee for an educational
activity, including why an individual member was chosen.
Process Description:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 11 of 25
Specific Example:
 EDP 4. The process used to identify all actual and potential conflicts of interest for all
members of the Planning Committee, presenters, authors, and content reviewers.
Process Description:
Specific Example:
 EDP5. The process for resolution of an actual or potential conflict of interest and the
outcome achieved.
Process Description:
Specific Example:
 EDP6. The process utilized during the planning phase of the educational activity to
determine how participants will successfully complete the learning activity.
Process Description:
Specific Example:
3. Design Principles. The educational design process incorporates measurable educational
objectives, best-available evidence, and appropriate teaching methods.
Describe and, using an example, demonstrate the following:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 12 of 25
 EDP7. How measurable educational objectives are developed that address the change
in nursing practice or nursing professional development.
Process Description:
Specific Example:
 EDP8. How the content of the educational activity is selected based on best-available
current evidence (e.g., clinical guidelines, peer-reviewed journals, experts in the field).
Process Description:
Specific Example:
 EDP9. How content integrity is maintained for CNE activities, including what
precautions are taken to prevent bias and how those precautions are implemented.
Process Description:
Specific Example:
Note: If the applicant or approved provider organization never accepts commercial
support/sponsorship, do not provide a narrative for EDP10, and proceed to
EDP11.
 EDP10. In the presence of commercial support/sponsorship, how additional precautions
are taken to maintain content integrity for CNE activities, including what precautions are
taken to prevent bias and how those precautions are implemented.
Process Description:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 13 of 25
Specific Example:
 EDP11. How teaching methods were chosen that are appropriate to achieve the
purpose and objectives of the CNE activity.
Process Description:
Specific Example:
4. Achievement of Objectives. 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:
 EDP12. How summative evaluation data for an educational activity were used to guide
future activities.
Process Description:
Specific Example:
 EDP13. How evaluation data were collected to measure change in nursing practice or
nursing professional development.
Process Description:
Specific Example:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 14 of 25
5. Sample activities. Sample activities must be submitted with the appropriate
documentation (i.e. VNA single activity application, attachments, advertising material,
biographical forms, summative evaluation).


-
First time applicants should submit 3 activities (activities previously approved by
the VNA)
Renewing applicants submit 1 sample activity and identify the previous activities
submitted with your annual reports for previous years.
These educational activities must have been planned and implemented by your
organization
These samples must be representative of the types of educational activities usually
provided and include both live face to face presentations and independent learning
activities if both types of activities have been provided.
These activities must be at least one hour in length and cannot be co-provided
activities. Submit documentation for all contact hours (i.e. for a 20 contact hour
program, provide form A for all 20 hours).
Please complete the following information.
Title of Activity
Date of
Activity
Renewing Applicants: Year
Submitted with Annual Report Form
Activity # 1
Activity # 2
Activity # 3
6. Certificate. Please provide a sample certificate with the appropriate approval statement.
Certificate will include a line for name of learner, number of contact hours, name and
address of the provider unit, title and date of the educational activity and official approval
statement (stands alone and worded as stated below).
See page/file name for sample certificate:
(Name of the approved provider) is an approved provider of continuing
nursing education by the Virginia Nurses Association, an accredited
approver by the American Nurses Credentialing Center's Commission on
Accreditation.
7. Joint-provided activities. Describe how responsibilities are assigned and maintained for
joint-provided activities, if any:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 15 of 25
D. 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.
NOTE: Each narrative must include a specific example that illustrates how the criterion is
operationalized within the Provider Unit.
1. 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:
 QO1. The process utilized for evaluating effectiveness of the Approved Provider Unit in
delivering quality CNE.
Process Description:
Specific Example:
 QO2. How the evaluation process for the Approved Provider Unit resulted in the
development or improvement of an identified quality outcome measure. (Refer to
identified quality outcomes list in 004)
Process Description:
Specific Example:
2. Approved Provider Unit Evaluation Participants. The Approved Provider Unit shall
include a variety of stakeholders, comprising those with a vested interest in Approved Provider
Unit outcomes, in the evaluation process.
Describe and, using an example, demonstrate the following:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 16 of 25
 QO3. Why the Approved Provider Unit selects specific stakeholders to participate in the
evaluation process.
Process Description:
Specific Example:
3. Approved Provider Unit Quality Outcome Measures. The Approved Provider Unit must
demonstrate quality improvement efforts including strategies for working on targeted goals,
evaluating progress toward goals, and revising or establishing new goals.
Describe and, using an example, demonstrate the following:
 QO4. How input from stakeholders resulted in development of or an improvement in
quality outcome measures for the Approved Provider Unit. (Refer to identified quality
outcomes list in 004).
Process Description:
Specific Example:
4. 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.
Describe and, using an example, demonstrate the following:
 QO5. How, over the past 12 months, the Approved Provider Unit has enhanced nursing
professional development. (Refer to identified quality outcomes list in OO4.)
Process Description:
Specific Example:
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 17 of 25
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 18 of 25
ATTESTATIONS:
I attest, by my signature below, that I am duly authorized by ( insert name of applicant
) to
submit this application as an approved provider offered by the American Nurses Credentialing
Center (ANCC) through Accredited Approvers and to make the statements herein. On behalf
of ( insert name of applicant
), I have read the approved provider eligibility requirements
and criteria. I understand that ( insert name of applicant
) 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 applicant
), 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 applicant
)’s permission.
On behalf of ( insert name of applicant
), 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 applicant
), that ( insert name of applicant
) 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 applicant
) will
notify the VNA CEA Committee promptly if, for any reason while this application is pending or
during any approval period, ( insert name of applicant
) 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 VNA CEA Committee
to deny, suspend or terminate ( insert name of applicant
)’s approved provider status and
to take other appropriate action against ( insert name of applicant
).
If insert name of applicant
is approved as an approved provider by the VNA CEA
Committee, I attest that I am only allowed to provide contact hours for programs provided or
co-provided by my organization. I attest that as an approved provider, we are not acting in any
way or form as an Accredited Approver (an approval process similar to the VNA CEA
Committee). I understand that any evidence suggesting an approval process (i.e. application,
review of application, approval letter) can lead to revocation of provider status. I will abide by
the VNA CEA Committee and ANCC criteria for providing continuing nursing education.
(Applications received without a signature incur a delay in processing which will cause a delay
in the review of the approval application.)
Signature:
Date:
By checking this box, I am providing my electronic signature approving all the information
entered above (please enter name and date on signature and date lines above)
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 19 of 25
APPENDIX A:
OPERATIONAL REQUIREMENTS ATTESTATION
Operational requirements must be implemented by the Provider Unit throughout the period of
approval. The Provider Unit may develop a policy and procedure manual to incorporate these
requirements or simply use the signed Attestation Form as a guide to operations throughout
the approval period. However, the signed Attestation Form must be submitted with the
application. Adherence to the operational requirements will be assessed through review of
application documents, as well as monitoring of the approved provider after approval is
granted. Should there be a complaint about the provider or a need for review of the provider’s
records during the approval period, the Virginia Nurses Association will use criteria and
operational requirements to determine continued adherence to criteria.
Approved Providers will:
1. Use ANCC Commission on Accreditation (ANCC COA) educational design criterion as
provided by the Virginia Nurses Association to plan and implement all continuing
education activities.
2. Maintain responsibility for the following when/if activities are co-provided with nonapproved providers or non-accredited providers:
a. Determination of the educational objectives and content
b. Selection of the content specialist planners and activity presenters/content
specialists/contributors
c. The awarding of contact hours, as appropriate, to the individual successfully
completing the educational activity
d. Record keeping procedures
e. Evaluation methods and categories
f. Management of any commercial support or sponsorship
Note: A provider unit nurse planner must be the person directly involved and
responsible for assuring that ANCC COA educational design criteria as provided by the
Virginia Nurses Association CEA Committee are used to plan and implement the
activity.
When co-providing an educational activity with non-approved providers or nonaccredited providers, tasks involved in planning, implementing, and evaluating the
activity may be shared; however, the final responsibility and accountability to insure that
the criteria are met remain with the approved provider. A written co-provider agreement
confirms these arrangements.
3. Maintain records for each activity for six (6) years in a safe, secure and confidential
manner and include the following essential information for the individual activity:
 Title and location (if live) of activity
 Type of activity format: live or enduring
Date live activity presented or, for ongoing enduring activities, date first offered and
subsequent review dates
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 20 of 25
 Description of the target audience
 Method of the needs assessment
 Findings of the needs assessment
 Names, titles, and expertise of activity planners
 Role held by each Planning Committee member (must include identification of the
Nurse Planner and
Content Expert(s))
 Names, titles, and expertise of activity presenters, faculty, authors, and/or content
reviewers
 Conflict of interest disclosure statements from planners
 Resolution of conflicts of interest for planners, if applicable
 Conflict of interest disclosure statements from presenters, faculty, authors, and/or
content reviewers
 Resolution of conflicts of interest for presenters, faculty, authors, and/or content
reviewers, if applicable
 Purpose of activity
 Objectives of activity
 Evidence of gap in knowledge, skill, or practice for the target audience
 Content of activity: Form A or Form B for all contact hours
 Instructional strategies used
 Evidence of learner feedback mechanisms
 Rationale and criteria for judging successful completion
 Method or process used to verify participation of learners
 Number of contact hours awarded for activity, including method of calculation
(Individual Activity
Applicant must keep a record of the number of contact hours earned by each
participant.)
 Template of evaluation tool(s) used
 Marketing and promotional materials
 Means of ensuring content integrity in the presence of commercial support (if
applicable)
 Commercial support agreement with signature and date (if applicable)
 Means of ensuring content integrity in the presence of sponsorship (if applicable)
 Sponsorship agreement with signature and date (if applicable)
 Evidence of disclosing to the learner:
o
Purpose and/or objectives and criteria for successful completion
o
Presence or absence of conflicts of interest for all members of the
planning committee,
presenters, faculty, authors, and content reviewers
o
Sponsorship or commercial support
o
Non-endorsement of products
o
Expiration date (enduring materials only)
o
Evidence of verbal disclosure (if applicable)
 Documentation of completion must include:
o
Title and date of the educational activity
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 21 of 25
o
Participant name
o
Name and address of provider of the educational activity (Web address
acceptable)
o
Number of contact hours awarded
o
Approval statement
(Name of the approved provider) is an approved provider of
continuing nursing education by the Virginia Nurses Association, an
accredited approver by the American Nurses Credentialing Center's
Commission on Accreditation.
 Representative sample of participant names with unique identifier to be collected
(The provider must maintain all participant data in a safe and secure manner.)
 Division of responsibilities among co-providers (if applicable)
 Co-provider agreement with signature and date (if applicable)
4. Maintain timely communication with the VNA by providing any reports requested and
inform the VNA of any changes to the approver unit.
a. Reports of data requested by VNA CEA Committee.
b. Timely submission of annual reports to the VNA due June 1st of every year.
c. Within 30 days, information about change in 1). Name, ownership, or structure of the
organization, or 2). Change in the nurse planner(s), or 3). Change in the name of
the contact person. A new biographical form will be submitted with each new person.
Any new Nurse Planner must sign this attestation statement.
d. Information about termination of approved provider activities, within 30 days of the
decision to terminate.
5. Use appropriate language for the activity approval on all communications, marketing,
materials & certificates of attendance. The following approval statement must be on the
certificate and marketing materials. This is the only approval statement allowed for use.
(Name of the approved provider) is an approved provider of continuing
nursing education by the Virginia Nurses Association, an accredited
approver by the American Nurses Credentialing Center's Commission on
Accreditation.
6. Implement the ANCC Commission on Accreditation system of awarding credit:
a. The appropriate measure of credit is the 60 minute contact hour.
b. A contact hour is 60 minutes of an organized learning activity, which is either a
didactic or clinical experience.
c. The ANCC allows a minimum of 0.5 contact hours to be awarded and provider units
are allowed to award a minimum of 0.5 contact hours.
d. After the first contact hour, fractions or portions of the 60 minute hour should be
calculated. For example, 120 minutes of learning experience = 2.0 contact hours.
e. If rounding is desired in the calculation of contact hours, rounding down to the
nearest 1/10th or 1/100th should be practiced. For example, 175 minutes of learning
experience = 2.9 or 2.91 contact hours. Round up should not be practiced.
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 22 of 25
f. Registration, welcome, introductions, orientation, breaks and viewing of exhibits are
not included in the calculation of contact hours. Evaluation is considered part of the
learning activity and needs to be included in calculation of contact hours. When
calculating hours, include any pre and post tests, practice, discussion, and
evaluation.
g. To calculate the number of contact hours, add the total number of minutes of
allowed time and divide by 60.
h. Note: The Continuing Education Unit (CEU) system is NOT authorized by the
ANCC Commission on Accreditation for use. This means contact hours, NOT
CEUs, will be awarded. The 60 minute contact hour may be a classroom, clinical or
independent study experience. In the case of an independent study, it will be the
responsibility of the provider to substantiate the rationale for determining the number
of contact hours to be awarded. This may occur by means of a pilot test, calculation
of number of pages/words, etc.
Example:
8:00 – 8:10
8:10 – 8:30
8:30 – 9:00
9:00 – 9:20
9:20 – 10:10
10:10–10:25
10:25 -11:15
12:15 – 1:55
1:55 – 2:10
2:10 – 3:00
3:00 – 3:15
3:15 – 3:30
Welcome & Introduction
Pre-test
Talk # 1
Discussion
Talk # 2
Break
Supervised Practice
Panel Discussion
Break
Talk # 3
Questions & Answers
Evaluation
10 minutes, not applicable
20 minutes
30 minutes
20 minutes
50 minutes
15 minutes, not applicable
50 minutes
100 minutes
15 minutes, not applicable
50 minutes
15 minutes
15 minutes
350 minutes
**350 minutes divided by 60 = 5.83 Contact Hours
9. To ensure that all CE activities are free from bias, all presenters/content
specialists/contributors and planning committee members must declare conflict of
interest. Note: This information must be collected during the planning process and
documented in the record keeping file for each activity. Learners must be informed if
presenters/content specialists/contributors and planning committee members have
conflicts of interest. Conflict of interest is to be evaluated by the Nurse
Planner/independent third party and signed on the bioform.
10. In the event that any form of commercial support or sponsorship is provided for an
education activity, the approved provider will maintain control of the education content
and disclose to the learners all financial relationships or lack of, between the
commercial supporter and/or sponsor and the applicant and/or presenters/content
specialists/contributors.
a. Funds from a commercial source should be in the form of an education grant to the
applicant of the education activity and must be acknowledged in printed material and
brochures.
b. Arrangements for commercial exhibits will not influence the planning of or interfere
with the presentation of education activities.
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 23 of 25
c. Learners will be made aware of the nature of all commercial support of all education
activities.
d. Education activities are distinguished as separate from endorsement of commercial
products. When commercial products are present, participants will be disclosed that
approved status refers only to its CE activities and does not imply ANCC COA &
VNA endorsement of any commercial product (disclosure of non-endorsement of
products).
e. Education activities that present research conducted by commercial companies will
be designed and presented with scientific objectivity.
f. Non-endorsement of products disclosure: Activity participants are advised that
approval does not imply endorsement by the VNA or ANCC of any commercial
products, service or company referred to in the activity nor of any company
subsidizing costs related to the activity. A statement reflecting the fact that approval
status refers only to the continuing education activity and does not imply ANCC
commission on Accreditation or the Virginia Nurses Association approval or
endorsement of any commercial product must be disclosed to participants. One
example of this statement is: “This Continuing Nursing Education Activity is
underwritten by an unrestricted educational grant from ABC Company. Approval as
a provider refers to recognition of educational activities only and does not imply
ANCC Commission on Accreditation or the Virginia Nurses Association approval or
endorsement of any product”).
11. Approved providers provide continuing education activities and cannot approve
their own or another organization’s activities. Providers can only provide activities in
which the provider unit nurse planner(s) assume(s) an active role in the entire process,
from planning through evaluation. Providers can never approve activities.
12. Adhere to the monitoring requirement (annual report) established by the VNA,
which includes a review of the approved provider’s educational design, management of
commercial support, provision of appropriate disclosures to learners, and assurance
that all required items noted above are kept on file. It is understood that failure to
submit or comply with these monitoring requirements can lead to a revocation of
approval as a provider.
13. All nurse planners are required to adhere to these operational requirements and
have a signature on file.
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013
ANCC manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.
Page 24 of 25
I agree to adhere to these operational requirements for continuing education (attach additional
signatures as necessary).
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013 ANCC
manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Page 25 of 25
APPENDIX B:
BUSINESS PRACTICES ATTESTATION
According to the ANCC, provider units must adhere to all regional, state and national laws and
regulations related to business practices. Provider units must also operate the business and
management polices and procedures of its continuing nursing education program (as they relate to
financial affairs, human resources and legal obligations) so that its obligations and commitments are
met. The provider unit must adhere to all reasonable ethical expectations in its provision of
continuing nursing education and its business practices.
This attestation is to be signed by the leaders of the provider unit. By signing below, I attest
that the provider unit complies with all applicable local, regional, state or national laws and
regulations and operates its business in an ethical manner (attach additional signatures as
necessary).
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Signature:
Date:
By checking this box, I am providing my electronic signature attesting to the above.
Copyright© by the Virginia Nurses Association, Continuing Education Approval Committee, 2010. Provider Application 11/16/09. Revised 2/4/13. 2013 ANCC
manual.
Virginia Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.