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VIRGINIA NURSES ASSOCIATION
CONTINUING EDUCATION APPROVAL COMMITTEE
APPROVED PROVIDER APPLICATION
For office use only – date received:
Amount received:
Check number:
Date Approved:
Approval #:
Date due for renewal:
DIRECTIONS:
1. Information should be typed directly on the application form. Please reference the attachment file name or
page number when applicable.
2. Information must be labeled and titled in accordance with the outline presented on the application form,
divided clearly, and numbered in sequence.
3. Please provide a table of contents of all items submitted.
4. ALL SECTIONS OF THE FORM MUST BE COMPLETED FOR THE APPLICATION TO BE
CONSIDERED FOR REVIEW.
5. Please submit the application and all attachments electronically to ksemp@virginianurses.com or on a
single CD-ROM mailed to the VNA.
6. Fee: make checks payable to the Virginia Nurses Association:
 Please indicate on your check if you are a new applicant or up for renewal.
 Send payments to the Virginia Nurses Association, Attn: CE Committee, 6912 Three Chopt Rd,
Suite H, Richmond, VA 23226.
 Applications will not be considered until receipt of payment.
7. For questions, please email the address listed above or call the VNA office at 804-282-1808 or 1-800-8686877.
8. For instructions on how to complete this application, please see the file titled Instructions for Completing
the Approved Provider Application.
ASSESSMENT OF ELIGIBILITY:
1. Has the provider unit assessed, planned, implemented, and evaluated at
least three separate educational activities (within the past 12 months,
provided as separate and distinct events)? (For new applicants, these
activities were submitted to the VNA, granted approval and were not coprovided).
Yes
No
2. Has the provider unit been operational for a minimum of 6 months using
the ANCC Accreditation criteria?
Yes
No
3. Are you a commercial entity applying to be an approved provider?
Yes
No
Yes
No
(Note: Please refer to instructions for a list of organizations exempt from the definition of
commercial interest. If you are a commercial entity, contact the office for further
assessment of eligibility).
4. During the past year, did your organization promote/market/advertise more
than half of your learning activities to nurses outside the states of your
region and the states contiguous to your region? (For region information,
refer to http://www.hhs.gov/about/regions/).
(more than 50%
targeted to
multiple regions)
(≤50% to
multiple
regions)
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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5. The provider unit is in compliance with all applicable Federal, State,
and Local laws and regulations that apply to the delivery of CNE.
Yes
No
6. All nurse planners in the provider unit are currently licensed registered
nurses with a baccalaureate degree in nursing, ensure compliance with the
ANCC criteria and are active participants in the planning, implementing
and evaluation process of each continuing education activity.
Yes
No
7. Has the applicant ever been denied, suspended, or revoked by the VNA,
the ANCC or other ANCC accredited approver unit?
Yes
No
If yes, action:
Denial
Suspension
Revocation
Date:
Describe situation:
Denied by:
ANCC
VNA
Other ANCC Accredited Approver
**If you answered NO to any of the questions 1, 2, 5, 6 OR YES to questions 3, 4, you are not eligible to
apply to the VNA as an approved provider. If you answered YES to question 7, please contact the VNA
office either by email or by phone to assess eligibility.
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
No
Previously approved provider?
Yes (dates approved:
to
)
No
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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Type of organization:
What type of activities do you offer or
plan to offer? (Check all apply)
Single focused organization
Distinct, separately identified unit within a complex,
multi-focused organization
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:
Fax number:
Email address:
Website address:
A. ORGANIZATIONAL OVERVIEW
OO1. Demographics
a.
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:
b.
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
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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a.
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)
Primary Nurse Planner of Provider Unit (Degree and Credentials):
Bioform Attached
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Other Nurse Planners (Degree and Credentials):
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Other Key Personnel (Degree and Credentials):
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b. 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:
c. 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:
d. 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:
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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e. 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:
f. 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
a. 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 months.
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b. Submit a list of the quality outcome measures the Approved Provider collects, monitors, and
evaluates specific to the Approved Provider Unit.
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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.)
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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
a. 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
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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OO6. Record Keeping
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.
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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:
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.
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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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:
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.
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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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.
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:
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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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:
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:
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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Specific Example:
3. Design Principles. The educational design process incorporates measurable educational objectives, bestavailable evidence, and appropriate teaching methods.
Describe and, using an example, demonstrate the following:
 EDP7. How measurable educational objectives are developed that address the change in nursing practice
or nursing professional development.
Process Description:
Specific Example:
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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:
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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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:
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:
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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Specific Example:
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).
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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 report.
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These educational activities must have been planned and implemented by your organization.
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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.
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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. Co-provided activities. Describe how responsibilities are assigned and maintained for co-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.
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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:
 QO3. Why the Approved Provider Unit selects specific stakeholders to participate in the evaluation
process.
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 15 of 22
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 16 of 22
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 17 of 22
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 non-approved 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 non-accredited 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
 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
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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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
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.
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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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.
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
Welcome & Introduction
Pre-test
Talk # 1
Discussion
Talk # 2
Break
Supervised Practice
Panel Discussion
Break
Talk # 3
Questions & Answers
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
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 22
3:15 – 3:30
Evaluation
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.
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.
14. 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 21 of 22
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 22 of 22
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.