In 2012, the American Nurses Credentialing Center revised the criteria for nursing continuing education. These criteria are effective April 2013.

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1 LOUISIANA STATE NURSES ASSOCIATION 5713 Superior Drive, Suite A-6 Baton Rouge, LA Phone Fax American Nurses Credentialing Center Commission on Accreditation Criteria for Individual Educational Activity Continuing Nursing Education Approved by LSNA Revised February 2013 In 2012, the American Nurses Credentialing Center revised the criteria for nursing continuing education. These criteria are effective April LSNA is an accredited approver of nursing continuing education and utilizes the revised criteria in the approval of providers and individual educational activity. An Individual Educational Activity can be provided by an individual, organization or part of an organization. The applicant of the activity must have at least one currently licensed registered nurse prepared at the baccalaureate level or higher. This individual functions as the Nurse Planner for the activity. The Nurse Planner is responsible for ensuring that the activity is developed according to ANCC/LSNA accreditation criteria. The activity must be developed, planned, implemented and evaluated according to the following education design process with adult learning principles, professional education standards, and ethics. Two types of activities may be submitted for approval: Provider-directed, provider-paced: the applicant controls all aspects of the learning activity. The activity can be a live presentation or live Webinars. Provider-directed, learner-paced: the applicant controls the content of the learning activity including objectives based on a needs assessment, content, presentation methods, and evaluation methods. The learner determines the pace at which the learner engages in the activity. The activity can be a print article, online course, e-books, and self-learning modules/independent study. To determine if the activity is eligible for continuing education credit, review the document on the website entitled Determining Ability to Award Contact Hours. If you are unsure on whether the content is continuing education, see the document Differentiation between Orientation, In-service, and Continuing Education. The activity must meet the following guidelines: Content must be beyond basic knowledge Content must be generalizable regardless of employer of the nurse Content must enhance professional development of performance of the nurse Content must be evidence-based or based on the best available evidence Presented without promotion or bias CPR and ACLS is not eligible for continuing education REV 02/2013 Individual Educational Activity Criteria for Application - page 1

2 Applicants must complete the Applicant Eligibility Verification form and must meet all eligibility requirements. Complete all sections of the form. If the application meets the eligibility requirement of ANCC/LSNA, continue with your application. Applicants if asked by LSNA must complete the Applicant Eligibility Commercial Interest Addendum for and must meet all requirements. Complete all sections of the form. If the applicant meets the eligibility requirements of ANCC/LSNA, continue with your application. The educational design process is documented on the IEA Application: Assessment of Learner Needs Continuing nursing education activities are developed in response to, and with consideration for, the unique educational needs of the target audience i.e. RNs. A. The target audience for the activity must be developed on an education level for Registered Nurses. Other health care groups can attend. B. The educational activity must be based on a needs assessment. A variety of methods may be used for the needs assessment. C. Once the needs assessment has been completed, the applicant needs to identify sources of supporting evidence. A variety of sources can be used. The results/data from the needs assessment will need to be submitted with the application. D. The Nurse Planner and the planning committee will review the data and validate the need for the educational activity. The assessment data is used to identify and validate a gap in knowledge, skills, or practice that the activity is designed to improve or meet. The following table will guide the process. Identify on the application. Current State Desired State Identified Gap Gap due to Knowledge, Skills or Practice Purpose Outcome Measure Qualified Planners and Faculty Each education activity is planned collaboratively by at least one designated Nurse Planner and one other planner. Each planning committee must have representation from all of the following areas: the relevant content expertise and the responsibility for adherence to ANCC accreditation criteria. Multiple areas may be represented by each person, but two individuals are needed for a committee. Nurse planners contribute oversight and must be actively involved in both the planning and the analysis of evaluation data for the educational activity. The planning committee assures the qualifications of the faculty member(s) are appropriate and adequate. A. Planning Committee: Applicant must submit the name, degrees/credentials, role on committee and Biographical Data Form which identifies professional qualifications for each person involved in planning the CNE activity. 1. Each educational activity is planned collaboratively by a designated nurse planner who is a registered nurse and holds at least a baccalaureate degree in nursing and one other RN planner. The Nurse Planner is responsible for adhering to ANCC Accreditation Program Page 2 of 22

3 criteria in the provision of continuing nursing education. Additionally, the Nurse Planner must have education or experience in the field of education or adult learning which is documented on the Biographical Data Form. The Nurse Planner must demonstrate competence in performing successfully at the expected level. 2. Each member of the planning committee should represent one of the following areas: the relevant content expertise; nurse planner/responsibility for adherence to ANCC accreditation criteria; or an additional planning member. Multiple areas may be represented by each person. Members must document their expertise for the category of participation on the bioforms. The presenter typically fills the role of content expert. Nurse planners contribute oversight and must be actively involved in both the planning and the analysis of evaluation data for the educational activity. The planning committee assures the qualification of the faculty member(s) as appropriate and adequate. Activities specifically planned for the APRN with prescriptive authority require that an APRN be included on the planning committee. 3. The nurse planner is responsible for identification, evaluation and resolution of conflict of interest for all planning committee members. Conflict of interest disclosure statements shall be obtained from all activity planning committee members to identify the presence or absence or any potentially biasrd relationship of a financial, professional, or personal nature on the part of those who have an impact on the content of an educational activity. Planners and presenters must disclose the presence or absence of conflict of interest relative to EACH ACTIVITY for self and significant other. All potential conflicts shall be resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. The definition of conflict of interest includes personal, professional and financial relationships of self and significant other. If there is a conflict of interest, the nurse planner must identify the procedure for resolution. B. Program Faculty: The Planning Committee identifies the needed qualifications of faculty members and assures that the selected faculty members qualifications are appropriate and adequate. 1. Applicant must list the faculty names, degrees and credentials on the application and use the Educational Activity Content Outline to list the faculty person(s) for each topic or content area. Submit completed Biographical Data Forms for each presenter or content specialist. ( for Biographical Data Form/COI). Presenters present content in an area in which they have knowledge and expertise. NOTE:Presenters must have documented qualifications that demonstrate their education and experience in the content area they are presenting. Expertise in subject matter can be evaluated based on education, professional achievements and credentials, work experience, etc. Describe how the person qualifies as an expert. 2. The nurse planner is responsible for identification, evaluation and resolution of conflict of interest for all speakers. Applicant must document the conflict of interests of the faculty on the Biographical Data Form. Conflict of Interest: To ensure that all continuing nursing education activities are free from bias, all presenters must declare conflict of interests. Conflict of interest disclosure statements shall be obtained from all activity presenters to identify the presence or absence or any potentially biasing relationship of a financial, professional, or personal nature on the part of those who have an impact on the content of an educational activity. Faculty must disclose the presence or absence of conflict of interest relative to each activity for self and significant other. All potential conflicts shall be resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. The definition of conflict of interest includes personal, professional and financial relationships of self and significant other. Page 3 of 22

4 Describe how the qualifications of faculty/presenters were identified and assessed by the Planning Committee. Describe how the planning committee ensures that the faculty/presenters are appropriate and adequate to by on the activity. 3. Biographical Data Forms are to be electronically signed by the individual and verified by the Nurse Planner. All committee members and speakers are to complete a Biographical Data Form. C. Purpose - The purpose for the activity must be clearly stated and identifies gaps in knowledge, skills, practice identified (based on the needs assessment) which the activity is designed to address. Applicant must document the continuing education activity s purpose. It is not a restatement of the objectives. The purpose is an overall purpose for the entire activity/program. D. Educational Objectives - Objectives for the activity are stated in singular, behavioral and measureable terms that define the expected outcome for the learner. Applicant must state objectives in behavioral terms using the required format. Objectives must be stated from the perspective of the learner, and complete the statement: At the end of this activity, the RN will be able to. NOTE: The objectives are derived from the overall purpose of the activity. Educational objectives are written statements that describe the learner-oriented outcomes that may be expected as a result of participation in the educational activity. In the case of most CNE activities, these statements describe knowledge, skills and attitude changes, practice or customer service that should occur upon successful completion of the activity. Determination of objectives is a collaborative activity between planners and presenters. Learner-oriented objectives are expressed in measurable terms, identify observable actions, and specify one action or outcome per objective. The number of objectives for the program should be sufficient to accomplish the intended purpose of the activity. It is recommended that objectives be limited to one or two per hour. Number each objective consecutively. Quality of Content and time frames - This content outline is a required format, although applicants may choose which version to use. Indicate which objective(s) is/are related to each topic area. Content must be evidence based and documentation of how the content was chosen. Include a time period for each objective. Identify the presenter who will address each objective. The content is related to and congruent with the objectives. Content is described in the form of a content outline with corresponding time frames for each content area. EACH objective has a corresponding content outline. THE CONTENT MUST BE MORE THAN A RESTATEMENT OF THE OBJECTIVE. Number each content area with corresponding objectives. Time allotted for the activity is congruent with the objectives and appropriate for the content being presented. NOTE: The educational activities, the level and amount of content to be provided, and the estimated number of participants dictate the amount of time which will be required. Each topic area should have a designated time frame. The time allotments for content for each objective should be sufficient to facilitate achievement of the objective by the learner. Page 4 of 22

5 E. Teaching-Learning Strategies - Applicant must list the teaching method used by each presenter for each topic or content area. For individual activities, the applicant must use the required format (Educational Activity Content Outline). Teaching methods/ learning strategies are congruent with the objectives, content presented, time allotted and faculty/ learner ratio. NOTE: Instructional methods that support attainment of the educational objectives should be used. The action indicated as the expected outcome determines the teaching strategies to be used. For example, a learning objective that requires the learner to successfully demonstrate a psychomotor skill should include teaching strategies that utilize demonstration and return demonstration. An objective that requires a learner to describe a phenomenon would include teaching strategies such as lecture and discussion. In addition to teaching strategies that support the learning objectives, attention must be given to the fact that principles of adult learning should be evident in the selected strategies. Teaching methods include but are not limited to: lecture, panel discussion, role play, questions and answers, demonstrations, practice, specific audiovisuals, slides (do not use the term Powerpoint - use Slide Presentation), etc. Materials and resources could include handouts, references, etc. F. Describe how learners will provide feedback on the activity. G. Applicant must identify criteria for judging successful completion of the activity that are consistent with the learning goal (purpose), objectives, and teaching and learning strategies. The rationale for method selected should be identified. And, lastly, if partial credit is to be awarded, identify how much. H. Awarding Contact Hours Contact hours associated with the official accreditation statement are awarded to participants for those portions of the educational activity devoted to didactic or clinical experience or to evaluating the activity. Contact hours are calculated in a logical and defensible manner. One contact hour = 60 minutes. Learning activities may be conducted asynchronously or may be bundled to allow a full learning experience to take place. Contact hours are to be awarded in units using two decimal places or less. If rounding is desired in the calculation of contact hours, the provider is to round DOWN to the nearest 1/10th or 1/100th. Time spent completing the evaluation form may be counted. (EX - 45 minutes equals 0.75 contact hours.) Contact hours MAY NOT be awarded retroactively. Applicant must clearly describe the rationale used to determine the contact hours to be awarded. 1. If the activity is a live presentation, applicant must submit a copy of the schedule. Contact hours are determined in a logical and defensible manner, consistent with the objectives, content, teaching/learning strategies, and target audience. The rationale used to determine the number of contact hours to be awarded needs to be described. For example, an agenda or schedule identifying the amount of time spent on each section of the activity can be used to determine contact hours. The time spent on welcome, introductions, pre/post tests, breaks, and evaluation needs to be clearly and separately stated. Welcomes, introductions, breaks and exhibits are not included in the calculation of contact hours. The topic, pre/post tests, demonstration/return demonstration, and evaluation are included in the calculation of contact hours. 2. If the activity is a print or web-based application, a description of how the number of contact hours was determined needs to be included in the application. The contact hours determined must be in a logical and defensible manner, consistent with the objectives, content, teaching/learning strategies, and target audience. The rationale used to determine the number of contact hours to be awarded needs to be described. For example, a pilot study using several Page 5 of 22

6 nurses may review the activity and the time for completing the activity or calculation of number of pages/words. 3. The calculated contact hours must support the number of objectives. If the CNE activity is presented more than once in its entirety, a second schedule does not need to be submitted. 4. The appropriate measure of credit is the 60 minute contact hour. A contact hour is 60 minutes of an organized learning activity, which is either a didactic or clinical experience. The minimum number of contact hours to be awarded is 0.5 contact hour. For example, 75 minutes of learning experience equals 1.25 contact hours. Evaluation, up to 15 minutes, is considered part of the learning activity and needs to be included in calculation of contact hours. To calculate the number of contact hours, add the total number of minutes of allowed time and divide by 60. EXAMPLE: 8:00 8:10 Welcome & introduction 10 minutes (not applicable) 8:10 8:30 Pre-test 20 minutes 8:30 9:00 Talk #1 30 minutes 9:00 9:20 Discussion 20 minutes 9:20 10:10 Talk #2 50 minutes 10:10 10:25 Break 15 minutes (not applicable) 10:25 11:15 Supervised practice 50 minutes 11:15 12:15 Lunch & exhibits 60 minutes (not applicable) 12:15 1:55 Panel discussion 100 minutes 1:55 2:10 Break 15 minutes (not applicable) 2:10 3:00 Talk #3 50 minutes 3:00 3:15 Questions and answers 15 minutes 3:15 3:30 Evaluation 15 minutes 350 minutes total 350 minutes divided by 60 = 5.83 contact hours 5. Applications for single continuing nursing education activities are approved for a period of two (2) years. I. Verify Participation identify has participation will be verified. A unique identifier must be used for each participant. The nurse planner and planning committee should select the identifier during the planning process. SS# cannot be used. Initials and birth date and month are one example. Evaluation A clearly defined method, which includes learner input, is used to evaluate the effectiveness (i.e. were the activity objectives met?) for each education activity. A. Applicant must check the best description of and/or describe the method used to evaluate the activity. (page of the application) There is a clearly defined method which includes learner input, used to evaluate the effectiveness of each educational activity. B. After the completion of the program, the planning committee should generate a summative evaluation of the evaluations received. C. The summative evaluation is to be reviewed by the committee to assess the achievement of objectives, speaker effectiveness, adherence to unbiased presentation of content with no Page 6 of 22

7 violation of conflict of interest, appropriateness of facility, and participant achievement of criteria for successful completion of the activity are to be evaluated and suggestions for improvement of future activities are to be identified. The results are used to guide future educational activities. Revisions are made to ongoing continuing nursing education activities based on evaluation data and participant input.. NOTE: One of the most important components of effective evaluation is evaluation data provided by participants. If properly designed and utilized, the evaluation can provide information about the overall activity as well as the specific components. To generate evaluation data that can be used to determine effectiveness of an activity and provide evidence for any necessary changes or improvements, a clearly defined method of evaluation should be developed as part of the planning process. D. Applicant must submit a copy of the learner evaluation instrument with each copy of the application. Each faculty member must be evaluated individually. Achievement of the objectives from the learner s perspective must also be evaluated. ( At the end of this activity, the RN will ) The evaluation tool will include: A. Learner s achievement of each objective. B. Presenter s knowledge of content, presentation skills, and organization of content. C. Plan to implement change. D. Opportunity to indicate awareness of conflict of interest or lack thereof E. Opportunity to indicate that program was presented in a fair, unbiased manner Approval Statement for Individual CNE Activities A. All communications, marketing materials, and other documents must include the approval statement. The approval statement must be displayed and stand alone on its own line of text, and be written exactly as stated below. This continuing nursing education activity was approved by Louisiana State Nurses Association, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. Applicant must submit a copy of the advertising material(s). Advertising material includes any method of announcing an educational event. This may include a brochure, flyer, bulletin board announcement, newsletter, memo, or web site. This material must be submitted with the application. If advertising is provided on a web site, include information on where and how to find it. Also, include a hard copy of the web site advertising. The advertising material may be the completed copy or a mock-up of the final material. If a mock-up of the advertising material was sent with the application, the final copy of the advertising material must be submitted as soon as it is printed. If the provider must release the advertising material prior to receiving approval and has submitted an application to LSNA the provider may state the following: This activity has been submitted to Louisiana State Nurses Association for approval to award contact hours. Louisiana State Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center s Commission of Accreditation. Page 7 of 22

8 Commercial Support and Sponsorship A commercial interest is defined by ANCC as any entity either producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients or an entity that is owned or controlled by an entity that produces, markets, re-sells or distributes health care goods or services consumed by, or used on, patients. Exceptions are made for non-profit or government organizations and non-health care related companies. Commercial Support is financial, or in-kind, contributions given by a commercial interest, which is used to pay for all or part of the costs of a CNE activity A sponsor is identified as an organization that does not meet the definition of commercial interest. Sponsorship is financial, or in-kind, contributions given by an entity that is not a commercial interest, which is used to pay all or part of the costs of a CNE activity. Education must be kept separate from promotional activities. Commercial support, exhibits, or the presentation of research conducted by a commercial company shall not influence the design and scientific objectivity of the educational activity. Commercially supplied funds for an educational activity that are given in any form of an educational grant or in-kind assistance shall be acknowledged in the brochures and/or printed material for the educational activity. See Attachment Standards for Disclosure and Commercial Support. Applicant will submit a description of sponsorship or commercial support related to the activity (name of organization, funding or in-kind donation, and type of organization). The applicant will identify how content integrity will be maintained and what precautions were taken to prevent bias in the educational content. Signed commercial support or sponsor agreement must accompany the application. The signed statement must show that the applicant was responsible for the following activities: Assessment of learning needs Determination of objectives Selection or development of objectives Selection of presenters or faculty Selection of teaching/learning strategies Evaluation Other statements in the signed support are: Statement of how the information will be disclosed Statement of how provider of support will abide by the applicant s policies/procedures Amount of support Signature of legally authorized of individual that can enter into the contract for both provider of support and applicant Date agreement was signed. Disclosures Provided to Activity Participation Learners must receive disclosure of required items prior to the start of an educational activity. In live activities, disclosures must be made to the learner prior to initiation of the educational content. In enduring materials (print, electronic, or Web-based activities), disclosures must be visible to the learner prior to the start of the educational content. Required disclosures may not occur or be located at the end of an educational activity. If a disclosure is provided verbally, an audience member must document both the type of disclosure and the inclusion of all required disclosure elements. Disclosures provided to activity participants: (a) Successful completion purpose, objectives, and criteria for successful completion; (b) Absence or presence of Conflicts of interest; (c) Commercial support; (d) Sponsorship; Page 8 of 22

9 (e) (f) Non-endorsement of products; Expiration date for awarding contact hours Submit a handout of disclosures made for the activity are to be included in the application. Documentation of Completion A. Applicant must submit a completed sample of the verification form/certificate awarded to the participants with each copy of the application. Participants will receive written verification/certificate which includes the following: A. Name of the learner B. Name and address of the provider of the educational activity C. Title and date of the educational activity. E. Official approval statement: F. Number of contact hours awarded B. Participants receive written verification of their successful completion of an activity. See Attachment Sample Certificate. Record-Keeping System For the educational activity, documentation is kept in a secure, confidential and retrievable manner for 6 years. Applicant needs to be aware that the Continuing Education Committee may ask to see your activity file at any time after the activity has been presented. A. Planning: Applicant must submit a written statement of the commitment to maintain the educational activity records for six (6) years. 2. The applicant agrees to the following record-keeping criteria and will submit activity file when requested. Check to indicate willingness to comply. All correspondence; completed copy of application which includes 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 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 Page 9 of 22

10 Content of activity: an Educational Planning Table or other documentation showing up to three hours of content (Note: If more than three contact hours were awarded for the activity, documentation demonstrating a minimum of three hours of content along with the schedule and advertising for the full activity must be submitted for review. The entire content of the activity must be maintained in the provider s secure files with all other recordkeeping components.) 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 (if applicable) o Non-endorsement of products (if applicable) 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 Name and address of provider of the educational activity (Web address acceptable) o Number of contact hours awarded o Approval statement o Participant name 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) Co-Providership If the activity is co-provided, list organization s name, signed and written co-provider agreement form and the co-providers name is to be prominently displayed in marketing material. See for Co-Provider Agreement Page 10 of 22

11 Additional Instructions for Provider-Directed Activity Specifically for APRN with Prescriptive Authority The target audience must be designed specifically for the Advanced Practice Registered Nurse with Prescriptive Authority. Other RNs can attend and receive the normal continuing nursing education contact hours, but only APRNs with prescriptive authority can receive the continuing nursing education contact hours specifically designated for APRN with prescriptive authority. Keep the following in mind: 1. Check the APRN with Prescriptive Authority category (page ). 2. The planning committee for this activity must include at least one APRN who has prescriptive authority. 3. Develop the objectives (page 10 or 11) at the Analysis, Synthesis and Evaluation levels (#4, 5, 6 in Bloom s Taxonomy). All objectives must be at these levels. 4. Ensure that the certificate (sample, page 13) reflects the awarding of APRN continuing nursing education contact hours. The following guidelines for providing these activities were established collaboratively by the Louisiana State Board of Nursing and the Louisiana State Nurses Association. The educational activity must include content relevant to advanced practice nursing and the use of pharmacological agents in the prevention of illness, and the restoration and maintenance of health. The following guidelines should be followed. 1. Target Audience The target audience must be identified as an APRN with prescriptive authority. Some activities will be specific for an APRN in a specific practice setting while others may be appropriate for several areas of practice. Any Registered Nurse (RN) who successfully completes an offering will be awarded contact hours. 2. Objectives and Content Program objectives and content must be relevant to the practice of the APRN with prescriptive authority. The objectives, content, and learning experiences must enhance the knowledge, attitudes, and skills of the APRN regarding pharmacotherapeutics at a level above that required for initial certification. The content must go beyond the basic level of the APRN. Objectives and content for pharmacotherapeutics should focus on new developments, therapies, and/or research in the APRN s area of specialization and identify the relationship to prescriptive authority. Other content may be directed toward outcomes in prevention of illnesses, and/or restoration and maintenance of health. 3. Planning Committee The planning committee for a continuing nursing education activity directed toward APRNs with prescriptive authority should include at least one APRN with prescriptive authority. Physicians and pharmacists may also have input into the planning process. Page 11 of 22

12 4. Presenters Presenters must have appropriate experience and education to teach advanced pharmacotherapeutics. Pharmacists, medical doctors, APRNs, or other professionals prepared at a masters or doctoral level may serve as faculty. 5. Certificates of Attendance The number of advanced pharmacotherapeutic contact hours must be indicated on the certificate of successful completion. Appropriate Provider information, as required by ANCC and LSBN, must also be included on the certificate. The provider must place the name of the APRN receiving the contact hours on the certificate. Adopted by LSBN October, 2001 Page 12 of 22

13 ATTACHMENT A1 Evaluation Form Sample Louisiana State Nurses Association Evaluation Form Name of Organization Providing Program Name of the Program Faculty and Program Evaluation Date (Example: Tuesday, June 18, 2009) Place, City, State Presentation: Name of Presentation 1 Rate your achievement of each objective After completing this session, I am able to: 4 Excellent 3 good 2 Fair 1 Poor 0 NA 1. List the objectives in this section 2 3 Comments: Presenter: Name and Credentials of Presenter 1 (Rate the Presenter s:) Knowledge of content Presentation skills Organization of content Comments: Presentation: Name of Presentation 2 Rate your achievement of each objective After completing this session, I am able to: 1. List the objectives in this section Comments: Presenter: Name and Credentials of Presenter 2 (Rate the Presenter s:) Knowledge of content Presentation skills Organization of content Comments: Page 13 of 22

14 Overall Program Evaluation Rate your component of this activity To what degree did this educational activity meet your expectations? 2. Rate the value of handout content. 3. How well were program objectives defined? 4. Was the room conducive to learning? 5. To what degree did this activity: Meet your needs Increase your knowledge Change a skill or attitude Change your practice performance Improve your customer service/quality of service 1. How do you plan to implement or utilize this change (from question 5 above)? 2. Were Conflicts of interest or lack thereof disclosed in writing or verbally by the planners and/or faculty? Yes No 3. Was this program presented to you in a fair, unbiased manner? Yes No 4. Comments and/or Suggestions For Programs You Need Or Would Like: Page 14 of 22

15 ATTACHMENT A2 Evaluation Form Sample Louisiana State Nurses Association Program Evaluation: Date of Program: Please respond to each statement below by circling the number that best reflects your opinion. At the end of the session, I am better able to: 4 Excellent 3 Good 2 Fair 1 Poor Speaker Evaluation: Circle the number that corresponds to your opinion of how well each speaker attained each statement. The scale is: 4 Excellent, 3 Good, 2 Fair, 1 Poor (speaker name) (speaker name) (speaker name) (speaker name) Knowledge of content Presentation skills Organization of content Handouts Overall, on a scale of 1 to 10 (with 10 being OUTSTANDING), I would rate this program a(n). 9. This program contributed to a change in my: knowledge, skill/s, attitude to the subject, practice, quality of service. 10. How do you plan to implement/utilize the new information? 11. (A) Was this program presented in a non-biased manner? Yes No (B) Were you informed of any possible commercial conflict of interest? Yes No 12. Which parts were MOST valuable to you? 13. Which parts were LEAST valuable to you? Comments and/or Suggestions For Programs You Need Or Would Like: Page 15 of 22

16 ATTACHMENT C Sample Certificate Louisiana State Nurses Association Name of Organization Offering Program Address of Program City, State Phone: (xxx) xxx-xxxx Participant s Name Has successfully completed Name of Program Contact Hours Location Held City, State Date Contact Hours: This continuing nursing education activity was approved by Louisiana State Nurses Association an accredited approver by the American Nurses Credentialing Center s Commission of Accreditation. Approval valid through (insert expiration date after approval) [only if print or webinar) Signature of Nurse Planner/Planning Committee Member Page 16 of 22

17 ATTACHMENT C Standards for Disclosure and Commercial Support Louisiana State Nurses Association Permission to copy has been granted by MaryMoon Allison, BSN, RN, MHSE, CAE Director, Accreditation Program American Nurses Credentialing Center 8515 Georgia Avenue, Suite 400 Silver Spring, MD August 18, 2009 Application Manual Accreditation Program (2009). American Nurses Credentialing Center. Silver Spring, MD. (pp ) Appendix B STANDARDS FOR DISCLOSURE AND COMMERCIAL SUPPORT These Standards have been adapted from the Accreditation Council for Continuing Medical Education (ACCME), which articulates its policies for disclosure and commercial support in: (1) The Standards For Commercial Support: Standards to Ensure Independence in CME Activities, as adopted by ACCME in September 2004; and (2) ACCME policies applicable to commercial support and disclosure. STANDARD 1: INDEPENDENCE 1.1 An entity has a commercial interest if it is: 1. An entity that produces, markets, sells or distributes health care goods or services consumed by, or used on, patients; OR 2. An entity that is owned or controlled, in whole or in part, by an entity that produces, markets, sells, or distributes health care goods or services consumed by, or used on, patients. An entity is NOT a commercial interest if it is: 1. A government entity; 2. A non-profit (503 ) organization; 3. A non-health care related entity This definition permits an accredited [approved] provider to be owned by an entity that is not a commercial interest. It also allows a provider to have a sister company or parent company that is a commercial interest, as long as the accredited provider has and maintains adequate corporate firewalls to prohibit any influence or control by the sister or parent company over the continuing education program of the accredited provider. In this case, ANCC would expect that the accredited provider would have an adequate corporate firewall in place to prohibit any influence or control by the sister company over the continuing education program. ANCC does not consider providers of clinical service directly to patients to be commercial interests. 1.2 A continuing nursing education provider must ensure that the following decisions were made free from the control of a commercial interest: (a) identification of continuing nursing education needs, (b) determination of educational objectives, (c) selection and presentation of content, Page 17 of 22

18 (d) selection of all persons and organizations that will be in a position to control the content of the continuing nursing education, (e) selection of educational methods, and (f) evaluation of the activity. 1.3 An entity with a commercial interest cannot take the role of non-accredited partner in a co-provider relationship. STANDARD 2: RESOLUTION OF PERSONAL CONFLICTS OF INTEREST 2.1 An individual must disclose any financial relationships with an entity with a commercial interest (See STANDARD 1). 2.2 The provider must be able to show that each individual who is in a position to control the content of an education activity has disclosed all financial relationships with any entity with a commercial interest in the provider. ANCC defines financial relationships as those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options, or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial relationships can also include contracted research where the institution gets the grant and manages the funds and the individual is the principal or named investigator on the grant. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking, and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received or expected. ANCC considers relationships of the person involved in the continuing nursing education activity to include financial relationships of a spouse/partner. Financial relationships must be disclosed to the learners during the time when the relationship is in effect and for 12 months afterward. With respect to personal financial relationships, contracted research includes research funding where the institution gets the grant and manages the funds and the person is the principal or named investigator on the grant. ANCC considers financial relationships in any amount occurring within the past 12 months as relevant in terms of creating a conflict of interest. 2.3 An individual who refuses to disclose financial relationships will be disqualified from being a planning committee member, a teacher, or an author of continuing nursing education and cannot have control, or responsibility for, the development, management, presentation, or evaluation of the CNE activity. 2.4 The provider must have implemented a mechanism to identify and resolve all conflicts of interest prior to the education activity being delivered to learners. 2.5 ANCC considers a conflict of interest to exist when an individual has an opportunity to affect continuing nursing education content in relation to a commercial interest with which he/she has a financial relationship. ANCC considers opportunity to affect continuing nursing education content to include content about specific agents/devices, but not necessarily about the class of agents/devices, and not necessarily content about the whole disease class in which those agents/devices are used. With respect to financial relationships with commercial interest, when a person divests himself/herself of a relationship, it is immediately not relevant to conflicts of interest but it must be disclosed to the learners for 12 months. Page 18 of 22

19 STANDARD 3: APPROPRIATE USE OF COMMERCIAL SUPPORT 3.1 The provider must make all decisions regarding the disposition and disbursement of commercial support. ANCC defines commercial support as financial, or in-kind, contributions given by a commercial interest, which is used to pay all or part of the costs of a continuing nursing education activity. ANCC does not consider providers of clinical service directly to patients to be commercial interests. For the purposes of eligibility, ANCC considers the following types of organizations eligible for accreditation and free to control the content of continuing nursing education (Standard 1): Liability insurance providers Health insurance providers Group medical practices Acute care hospitals (for-profit and not-for-profit) For-profit rehabilitation centers For-profit nursing homes Universities with nursing development and continuing nursing education programs Specialty Nursing Organizations Constituent Member Associations Federal Nursing Services National nurses organizations based outside the United States A single-focused organization devoted1 to offering continuing nursing education 1 The single-focused organization exists for the single purpose of providing education. 3.2 A provider cannot be required by an entity with a commercial interest to accept advice or services concerning teachers, authors, or other education matters, including content, from the entity as conditions of contributing funds or services. 3.3 All commercial support associated with a continuing nursing education activity must be given with the full knowledge and approval of the provider. Written Agreement Documenting Terms of Support 3.4 The terms, conditions, and purposes of the commercial support must be documented in a written agreement with the entity that includes the provider and its educational partner(s). The agreement must include the provider, even if the support is given directly to the provider s educational partner or a co-provider. 3.5 The written agreement must specify the entity that is the source of commercial support. 3.6 Both the entity and the provider must sign the written agreement regarding the support to be provided/accepted. Expenditures for an individual providing continuing nursing education 3.7 The provider must have written policies and procedures governing honoraria and reimbursement of out-ofpocket expenses for planners, teachers, and authors. 3.8 The provider, the co-provider, or designated educational partner must directly pay any teacher or author honoraria or reimbursement of out-of-pocket expenses in compliance with the provider s written policies and procedures. 3.9 No other payment shall be given to the director of the activity, planning committee members, teachers, or authors, co-provider, or any others involved with the supported activity. Page 19 of 22

20 3.10 If teachers or authors are listed on the agenda as facilitating or conducting a presentation or session, but participate in the remainder of an educational event as a learner, their expenses can be reimbursed and honoraria can be paid for their teacher or author role only. Expenditures for Learners 3.11 Social events or meals at continuing nursing education activities cannot compete with, or take precedence over, the educational events The provider may not use commercial support to pay for travel, lodging, honoraria, or personal expenses for non-teacher or non-author participants of a continuing nursing education activity. The provider may use commercial support to pay for travel, lodging, honoraria, or personal expenses for bona fide employees and volunteers of the provider, co-provider or educational partner. This element applies only to nurses whose official residence is in the United States. Accountability 3.13 The provider must be able to produce accurate documentation detailing the receipt and expenditure of commercial support. STANDARD 4. APPROPRIATE MANAGEMENT OF ASSOCIATED COMMERCIAL PROMOTION Commercial exhibits and advertisements are promotional activities and not continuing nursing education. Therefore, monies paid by commercial interests to providers for these promotional activities are not considered commercial support. However, accredited providers are expected to fulfill the requirements of Standard 4, and to use sound fiscal and business practices with respect to promotional activities. 4.1 Arrangements for commercial exhibits or advertisements cannot influence planning or interfere with the presentation, nor can they be a condition of the provision of commercial support for continuing education activities. 4.2 Product-promotion material or product-specific advertisement of any type is prohibited in or during continuing nursing education activities. The juxtaposition of editorial and advertising material on the same products on subjects must be avoided. Live (staffed exhibits, presentations) or enduring (printed or electronic advertisements) promotional activities must be kept separate from continuing nursing education. Print, advertisements and promotional materials shall not be interleafed within the pages of the continuing nursing education content. Advertisements and promotional materials may face the first or last pages of printed CNE content as long as these materials are not related to the continuing nursing education content they face and are not paid for by the entities with commercial interests in the continuing nursing education activity. Computer-based, advertisements and promotional materials shall not be visible on the screen at the same time as the continuing nursing education content and shall not be interleafed between computer windows or screens of the continuing nursing education content. Audio and video recording, advertisements and promotional materials shall not be included within the continuing nursing education. There will be no commercial breaks. Live face-to-face continuing nursing education, advertisements and promotional materials shall not be displayed or distributed in the educational space immediately before, during, or after a continuing nursing education activity. Providers shall not allow representatives of an entity with commercial interests to engage in sales or promotional activities while in the space or place of the continuing nursing education activity. 4.3 Educational materials that are part of a continuing nursing education activity, such as slides, abstracts, and handouts, shall not contain any advertising, trade name, or a product-group message. Page 20 of 22