Continuing Nursing Education FAQ
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1. What is Continuing Nursing Education or CNE?
As defined by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation, continuing nursing education “builds upon the educational and experiential bases of the Registered Nurse for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the public.”
The purpose of continuing education is to ensure that nurses stay abreast of current industry practices, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. According to the Texas Board of Nursing (BON), continuing nursing education included “programs beyond basic nursing preparation which are designed to promote and enrich knowledge, improve skills and develop attitudes for the enhancement of nursing practice, thus improving health care to the public.”
Registered nurses in the State of Texas are required to acquire 20 contact hours (not CEUs) every two years for relicensure. The acquisition of the contact hours must coincide with the nurse’s license renewal. Contact hours are based on the 60-minute hour.
2. What is Not CNE?
Activities NOT acceptable as continuing nursing education (CNE) are in-service education or those activities intended to assist the nurse in fulfilling the assigned responsibilities specific to the expectations of their employer. Also, on-the-job training, remedial and self-improvement type programs and orientation are NOT accepted for CNE contact hours for re-licensure in the State of Texas. Additionally, refresher courses and economic courses for financial gain are NOT acceptable for CNE.
For more information on what the Texas Board of Nursing (BON) defines as “unacceptable” CNE for re-licensure, visit www.bon.state.tx.us/nursingeducation/ceu.html.
3. Who Can Provide Continuing Nursing Education?
Providers of continuing nursing education (CNE) can be individuals or organizations that present education activities that meet the definition of and criteria for CNE for the State of Texas. Texas Nurses Association is an accredited approver of CNE through the accreditation process of the American Nurses Credentialing Center (ANCC). Whether or not an individual activity or an organization/individual is recognized through TNA as an Approved Provider is determined by processes defined by the ANCC.
Approval of an individual activity requires the submission of an application that goes through the review process and is then approved to award contact hours. Applications are submitted 45 or 60 days prior to the date of the first presentation.
Approved Provider status requires that a minimum of three (3) individual activities have been planned and presented within the preceding 12 months prior to submission of an application for Approved Provider status. The three (3) activities must meet the criteria established by the ANCC/TNA. Applications for Approved Provider status must be received by the 15th of January or the 15th of July during a calendar year.
Eligibility Requirements: Based on the ANCC “2015 ANCC Primary Accreditation Approver Application Manual” (2015), the following criteria continue in effect:
Approved Provider Units: The following two (2) types of organizations are ineligible for approval as an Approved Provider:
1. Commercial Interests: A commercial interest is any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients or is owned or controlled by an entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on patients. (This does not include hospitals, hospices, healthcare clinics or others who care directly for patients.)
2. Multi-Regional Providers: An organization that targeted/marketed greater than 50% of their education activities provided during the previous calendar year to Registered Nurses in multiple regions based on the US Department of Health and Human Services (DHHS) regional map. TNA falls within region 6.
Individual Activity Applicants: A commercial interest as defined above is not eligible to submit an individual activity application to TNA. However, a multi-regional provider may submit an individual activity for approval.
If you have questions regarding your eligibility status, please contact the TNA CNE Department..
4. How Do I Get My Individual Activity Approved to Award Contact Hours?
Approval of an activity requires submission of three (3) single-sided, hard copies of the appropriate application form with the appropriate review fee at least 45 days in advance of the desired date of first presentation of the activity. When the application is received, several items are considered before it is sent out for review:
- Whether the applicant meets eligibility criteria.
- Whether the activity meets the Texas Board of Nursing’s (BON) definition of and criteria for continuing nursing education.
- Whether or not the application was submitted in a timely manner.
- Whether or not the appropriate review fee enclosed was based on the contact hours requested on the title page.
- Whether or not there is a signature for the “Statement of Understanding.”
- Whether or not the Nurse Planner has a bachelor’s degree (or higher) in nursing and a valid, current, unencumbered RN license.
- Whether or not the Conflict of Interest forms have been signed, dated, and countersigned by the Nurse Planner.
- Whether or not the application includes an activity-specific certificate of successful completion, evaluation form, sample of the proposed promotional materials, and sample disclosure tool.
If the application meets these criteria, it is then sent out for review. The original is kept in the TNA Office. The two (2) additional copies are sent out to the assigned two (2) member Nurse Peer Review team.
The two (2) member Nurse Peer Review team reviews the activity application. They are reviewing to ensure that the activity meets ANCC/TNA criteria and standards; good, sound educational design principles; and the definition and criteria the BON has established for continuing nursing education. Once the Nurse Peer Reviewers have come to consensus regarding the application, one of the Nurse Peer Reviewers will emerge as a lead reviewer for that application and will contact the identified Nurse Planner for the activity regarding any revisions that need to be made to the application to ensure it meets the required 100% of criteria. After all the “i’s” are dotted and the “t’s” are crossed, the Nurse Peer Reviewer will notify the TNA CNE Department regarding approval of the activity. The TNA CNE Department will then issue the CNE Unique ID# for the activity.
5. What Are the Fees?
Approved Provider Application
Fee schedule … APU with less than 3 organizations $2,600; APU with 3 or more organizations
There will be a processing fee of $100 that is non-refundable should your application be withdrawn.
Review fees are non-refundable for all applicants unless they withdraw prior to review by the CNE Committee.
If the Primary Nurse Planner and/or an appropriate designee attended the Approved Provider Workshop within the past 10 months, there is a $500 discount policy against the $2,600 or $3,600 effectively making the fee $2,100 or $3,100.
Individual Activity Applications
Fee schedules are $100.00 administration fee plus $10.00 per contact hour or fraction thereof.
0.5 – 1.0 contact hour $110.00
1.1 – 2.0 contact hours $120.00
2.1 – 3.0 contact hours $130.00
3.1 – 4.0 contact hours $140.00
Continue to add $10.00 per contact hour up to a maximum of $500.00. When calculating the review fee, round the number of contact hours up to the next whole number.
Review fees are non-refundable.
TNA reserves the right to revise the fee structure when and as needed.
6. What is the Process for Review?
Every week, applications are sent for review to two (2) members of the TNA Continuing Nursing Education (CNE) Committee, the Nurse Peer Review team. They use a standardized assessment/evaluation tool to review the application to make sure the application meets the definition of and criteria for continuing nursing education in the State of Texas, sound educational design principles and ANCC/TNA criteria. Nurse Peer Reviewers are volunteers who currently work or have experience in continuing nursing education.
The Nurse Peer Review team may approve an activity outright, defer the application back to TNA, or deny approval of the application. Deferred applications must be corrected within 30 days or risk being denied.
Any further action requires submission of a new application with a new review fee. Applicants with denied applications who wish to re-apply must submit a new application with the appropriate review fee.
7. How Do I Use the Forms and Applications in the CNE Section?
Each application and form was created in a Word application. This application allows anyone to change/integrate your own information where necessary. We suggest that you go through the forms and/or applications and put your organizational name in the appropriate locations, most of which are highlighted in yellow. In other words, make the forms your own and then download them to your system. To make things easier, choose a naming convention that incorporates the header date so you know if this is the most recent form.
Some of you may wish to change them to other applications and work with them. This is fine. We want you to be able to work and use the forms in the most comfortable format for you and your office.
We do ask that you NOT remove the header information that gives the date the form was created or change the formatting of the document(s). (i.e. you may not put the purpose statement in a different location, etc.) This helps us ensure that you are using a timely form for your work. You may add to the header if you wish but leave the original information alone.
You will notice several “tables” used within this form. When you are working with the form, you can avoid problems with it by doing the following:
1. Turn on your paragraph ¶ button, and
2. Use the tab button to create a new line for more information when necessary within a table. Tables expand automatically as you type in them, i.e. the form will not be thrown off with more material.
3. Use your Layout section at the top of your screen to help you insert new lines.
4. When you are “inside” a table, the “style” may not line up with your computer. You will notice this when you try to insert “bullets” or “numbers”. Highlight the column and go to “Change Styles” just below your Layout tab when you are on the “Home” screen. Click “Clear all” and close. This should allow you to insert bullets or numbers/letters as you need.
5. Finally, when you wish to put an “X” where a box is located, highlight the box and type your “X”- the box should disappear and leave your “X” in its place.
If you find that it is difficult to work with, contact the office at email@example.com or call 512/452-0645 extension 139 and we will assist you through the process.
8. Must the Presenter/Author Be a Registered Nurse?
A presenter/author is a person with content expertise in the topic to be presented by virtue of education, experience, expertise, professional achievement, credentials, honors, awards, publications, etc. The presenter/author should be comfortable with the teaching methodologies they are using and should have some level of familiarity with the target audience.
The presenter/author is not required to be a Registered Nurse. However, portions of a presentation that address the role of a nurse, nursing practice or specific nursing implications or interventions related to the presented contact/topic do require a nurse (RN) presenter/author. Many qualified presenters can teach nurses, by only a nurse can teach nursing.
9. What’s in a Name? The Organization’s Name
Both individual activity applications and the demographic section of the Approved Provider Application request the “organization name.” The organization name is unique to the applicant.
Once an organization’s name has been listed either on the individual activity’s title page or in the demographics section of an Approved Provider Application that is – verbatim – the organization name that must be used consistently throughout the application. For Approved Providers, the organization name – verbatim – is part of their approval statement that is used in promotional materials and on the certificate of successful completion.
Once established, changes in the organizational name must be reported to the TNA CNE Program Manager so appropriate action(s) can be taken.
10. Is the Title of Activity Important? Keys to Writing Titles for CNE Activities
When a Registered Nurse attends a continuing nursing education (CNE) activity, the only tangible “thing” he or she walks away with is their certificate of successful completion. The certificate of successful completion contains a lot of information – the activity’s provider; date of the activity; number of awarded contact hours – and the activity’s title. The activity’s title must reflect to entities outside of the activitiy’s planning committee – like the Texas Board of Nursing or a certifying/re-certifying body like ANCC – that the activity truly was CNE.
When developing a title for a CNE activity:
- Craft it to be reflective of the content of the activity. Obviously, as we are developing CNE activities, the content should be nursing/nursing practice focused based on a Registered Nurse target.
- Take a step outside of your planning committee and ask the question – “if someone from outside our organization – like the Texas Board of Nursing or ANCC – read this title with no other supporting documentation would they know that this activity was continuing nursing education? Perhaps someone in your organization but outside of your activity’s planning committee could review the title and provide feedback.
- Avoid terms like “basic”, “introduction”, and “fundamentals” in the title. These terms imply lower-level basic content.
- Be wary of “cutsie” titles. It may be catchy and draw attention to your activity, but it still needs to mean something outside of your planning committee and be reflective of both nursing and the activity’s CNE content.
- Spell out abbreviations. Your abbreviations may make sense to you and your planning committee. But, again, look at it from an outside perspective. Even “ACLS” needs to be spelled out – “Advanced Cardiac Life Support.”
Additionally, whatever you decide the title of the activity is, it must be used consistently – verbatim – throughout the application. From title page through the certificate of successful completion, the wording of the title, wherever it is used, must remain the same.
11. What is a Learning Outcome Statement?
Over the past several years, we have seen an evolution in the healthcare industry from a focus on measuring quantity to measuring quality. Is what we are ding making a difference? We are seeing this trend in continuing nursing education (CNE) also. With the amount of time and money – and blood, sweat, and tears – that goes into developing, implementing, and evaluating a CNE activity and then attending said CNE activity – are we making a difference? Is professional continuing education improving professional practice and patient/client outcomes? As continuing professional education, in all sectors – nursing, medicine, and pharmacy – transitions to a focused emphasis on outcomes, it becomes imperative for the CNE activity Nurse Planner to be able to identify and measure outcomes and to be able to reflect those outcomes in a learning outcome statement.
There is no formula for writing a learning outcome statement. Writing a learning outcome statement requires an ability to analyze a problem in practice or an opportunity for improvement and then critically thinking the process through from the current state of nursing practice to the desired state of nursing practice. Developing a learning outcome statement is part of CNE activity development process.
A learning outcome statement should:
- Reflect what the learner – the target audience Registered Nurse – will be able to do as a result of participating in the CNE activity.
- Describe behaviors that are observable and measurable.
- Address the professional practice gap – the gap in knowledge, skill, and/or practice.
The learning outcome statement helps to keep the CNE activity on track to narrow or close the professional practice gap(s) it is addressing. The learning outcome in the statement may be assessed either in short or long term. And, depending on the complexity of your professional practice gap(s), there may be more than one learning outcome statement for the CNE activity.
As you critically think the process through to the learning outcome statement, consider the following:
- What is the professional practice gap?
- Why does the professional practice gap exist?
- How can education address the professional practice gap?
- Who is the target audience?
- What is the desired outcome?
- What is the professional practice gap? CNE activities are not being developed with a focus on how CNE can impact nursing practice and/or patient/client outcomes.
- Why does the professional practice gap exist: Over the years, the focus of CNE has been more on meeting regulatory or institutional requirements than on how to improve nursing practice and patient/client care. CNE activity development has been more about filling out forms than critically thinking the process through to a measurable, difference-making outcome.
- How can education address the professional practice gap? The American Nurses Credentialing Center (ANCC) with its 2015 criteria, has refocused the intent of CNE activity development and implementation from filling out a form to an analytical process with measurable, observable outcomes.
- Who is the target audience? The target audience would be Nurse Planners involved in the development, implementation, and evaluation of CNE activities.
- What is the desired outcome? Nurse Planners – be they part of an Approved Provider Unit or developing individual activities – will know the 2015 ANCC/TNA criteria related to the development, implementation, and evaluation of a CNE activity.
- Based on the above, what is the learning outcome statement? Nurse Planners will actively participate in the activity discussion and will indicate an intent to change practice on the post-activity evaluation tool.
A learning outcome statement is the product of a well thought out and purposeful process designed to set the foundation of an educational activity that will measurably improve nursing practice.
12. What is Joint Providing and How is it Done?
The American Nurses Credentialing Center (ANCC) defines joint providing as the “planning, developing, and implementing of an educational activity by two or more organizations” (Approver Application Manual, 2015, p. 56).
Joint providing an education activity is an excellent opportunity for organizations to share both expertise and workload. However, it is imperative that TNA Approved Providers and individual activity applicants (CNE providers) understand the requirements for establishing joint providerships in order to adhere to ANCC/TNA criteria.
What is joint providing and how is it done? Here is some additional information.
When two or more organizations joint-provide an education activity and one of the organizations is a TNA Approved Provider Unit, the TNA Approved Provider Unit is responsible for ensuring adherence to all criteria as outlined in their Approved Provider “Operational Requirements Attestation” – “Joint Providing Activities for Continuing Nursing Education.” The TNA Approved Provider Unit is termed the “provider” and the other organization(s) is termed the “joint-provider.”
When two or more organizations enter into a joint provider relationship and all are TNA Approved Provider Units, one (1) organization is designated as the “provider” and is responsible for adhering to all criteria as outlined in their Approved Provider “Operational Requirements Attestation” – “Joint Providing Activities for Continuing Nursing Education.” The other organization(s) assume the “joint provider” role.
When two or more organizations enter into a joint provided relationship under the auspices of an individual activity, the applying organization would be the “provider” and is responsible for adherence to the ANCC/TNA criteria as outlined in the “Individual Activity Guidelines and Criteria.” The other organization(s) would be the joint provider(s).
The “provider” in a joint provider relationship is responsible for the following:
- Determining educational objectives and content
- Selecting planners and presenter/authors and/or content reviewers
- Determining appropriate number and awarding of contact hours
- Record keeping procedures
- Developing evaluation methods
- Managing any commercial support
- Ensuring the Provider – as defined above – is prominently displayed on all promotional material and the certificate of successful completion
- Ensuring that the joint provider relationship is reflected on promotional materials and the disclosure to participants.
The “provider” is responsible for ensuring “Joint Provider Agreements” are completed with each joint providing organization and are filed appropriately. (Sample agreement forms can be found on the TNA website, http://texasnurses.site-ym.com/page/FormPage3.)
All documentation and communication, including promotional materials (flyers, brochures, save-the-date cards, websites etc.) must clearly demonstrate the provider/joint provider relationship. The name of the “provider” organization must be loud and proud on all communications related to the education activity.
“Provider Organization Name
In conjunction with
Joint-provider Organization Name
Joint-provider Organization Name
Proudly Presents ---“
- Approved Providers: Your Approved Provider organization name should match your official TNA Approved Provider Unit name and should be in support of your official approval statement.
- Individual Activity Applicants: Your provider organization name should match the organization name listed on the title page of the individual activity application.
When applying as a first-time applicant to become an Approved Provider, none of the three (3) individual activity applications may be joint provided. When re-applying for Approved Provider status, if your Approved Provider Unit has joint provided an activity within 12 months of your application date (January 15th or July 15th) at least one of your sample activities must be a joint provided activity.
When Continuing Nursing Education (CNE) and Continuing Medical Education (CME) work together:
- When CNE and CME work together to jointly produce an education activity, it is NOT considered joint providing. CNE is responsible for adherence to ANCC/TNA criteria. CME is responsible for adherence to the Accreditation Council for Continuing Medical Education (ACCME) criteria. They may share documents as appropriate, etc. but they remain separate adhering to their separate criteria. This holds true for other continuing education providers like the Accreditation Council for Pharmacy Education (ACPE).
- ACCME and ACPE now use the term “joint providership” to describe two or more organizations providing an education activity. ANCC does NOT use the term “co-sponsor.”
- As in all things CNE, the active involvement of the identified Nurse Planner must be evident. When planning, implementing, and evaluating an education activity, documentation must reflect the role of the Nurse Planner. The Nurse Planner must ensure that the education activity adheres to the ANCC/TNA criteria and guidelines and that the needs of the target audience, the Registered Nurse, are addressed. This can be a challenge when organizations are planning education activities that are targeted to an inter-professional audience. Activity applications/documents document the inclusion of the Nurse Planner as a member of the planning committee but often fail to clearly demonstrate how the Nurse Planner has been an integral part of planning, implementing, and evaluating the education activity – just having an appropriately credentialed RN listed in section “H” of the activity application does not an active Nurse Planner make. Evidence of a Nurse Planner’s active involvement could include but are not limited to:
- A learning outcome includes nursing-focused outcomes.
- Topics that address the learning needs of the Registered Nurse.
- Content is congruent with the learning outcome statement and addresses the scope of practice of a Registered Nurse.
- Outcomes that address gaps in the knowledge, skills, and/or practice of the Registered Nurse.
13. Are “Electronic Signatures” Allowed on CNE Documents?
According to US law, and “electronic signature” is “an electronic sound, symbol, or process, attached to or logically associated with a contact or other record and executed or adopted by a person with the intent to sign the record.”. It is a fairly broad, generic term encompassing any electronic process used to signify an agreement to or approval of terms.
Electronic signatures can include a broad range of technologies and methodologies including but not limited to use of faxes, e-signatures, and encrypted digital signatures. Electronic signatures are a natural progression in the movement toward electronic documents.
A common concern with any form of electronic signature is its authenticity. How does one actually know who “signed” the document? The responsibility for ensuring that electronic signatures are valid and reliable rests with the activity’s Nurse Planner.
Please consider the following when using electronic signatures:
- The preference is the use of original signatures and initials.
- Electronic print of an actual signature placed on a document is acceptable.
- A signed document that is scanned and then electronically submitted is acceptable.
- Documents that are signed and then faxed are acceptable.
- A “font print” signature is acceptable as long as the document is attached to a printed email from the signatory’s email address.
An electronic signature is considered to be a legal signature with all that entails.
14. May Previously Developed Content (“canned programs”) Be Incorporated Into CNE Activities and, Thus Award Contact Hours?
The bottom line answer to the question is “yes.” However, the process for developing a CNE activity must be followed.
The role of the Nurse Planner remains pivotal in the assessing, planning, implementing, and evaluating of the education activity. The purpose of the following guidelines, adopted from the American Nurses Credentialing Center (ANCC), is to provide the Nurse Planner flexibility in incorporating previously developed content while adhering to ANCC/TNA criteria and guidelines.
The Nurse Planner and activity planning committee have:
- Conducted an independent needs assessment of the target audience;
- Identified previously developed educational content that relates to the needs assessment and meets the learning needs of Registered Nurse target audience;
- Evidence that the previously developed content is current, evidence-based/best-practice, and meets current standards or practice guidelines;
- Evidence of modifications (revisions/deletions/additions) made to the previously developed content or evidence stating why previously developed content did not require modifications to meet the learning needs of the Registered Nurse;
- Ensured that the previously developed content is objective, unbiased, and free of any promotional influences; and
- Verified that the previously developed content meets the definition of and criteria for “continuing nursing education” as outlined by ANCC, TNA and the
Texas Board of Nursing.
Compliance with these guidelines by individual activity applicants will be monitored throughout the activity application’s review process.
Nurse Planners and planning committees affiliated with TNA designated Approved Provider Units may not “approve” a previously developed activity and award contact hours without complying with these guidelines.
Approved Provider Units are reminded that they have guidelines addressing this issue – “Provide Not Approve Activities.” Failure to comply with these guidelines could result in loss of Approved Provider status.
15. What Are the Criteria for Offering Poster Sessions During a
A poster is a communication tool that combines a visual display with a verbal presentation. Posters provide an opportunity to engage colleagues in conversation while displaying focused information on a specific topic. When you gather several posters together to be viewed at the same place and the same time, you have a poster session. Both ANCC and TNA allow the awarding of contact hours for poster sessions. The following must be addressed:
- The titles of the posters should be listed in the “Content” column (column I) of the education documentation form (EDF).
Calculating Contact Hours:
- The same criteria must be followed to calculate contact hours as any other CNE activity. There must be a documented logical, defensible, and rational method used to determine the number of contact hours to be awarded.
- The approach taken to determine the number of contact hours to award may depend on the location of the posters, the activity schedule, and the objective(s) of the poster session.
- There are a number of options. Options include but are not limited to piloting, historical data, and observation. The total number of minutes should be listed in the “Time Frame” column (column J) of the EDF. However, please note that simply assigning time in the activity schedule to view the posters is not enough.
- Poster presenters must submit conflict of interest disclosure forms (COIs)
- Their names should be listed by their poster title in “Presenter/Author” column (column K) of the EDF.
- Appropriate disclosures regarding conflicts of interests should be shared with attendees.
- In order for the poster to award contact hours, the author(s) of the poster must attend their poster during the open poster viewing times.
- Posters developed by under graduate-level nursing students under the supervision of a RN faculty member may be considered for inclusion in the contact hour calculation.
- The target audience for the poster must be the Registered Nurse.
- COIs for the faculty and the student(s) must be submitted to the activity’s Nurse Planner for review and consideration by the planning committee.
Awarding of Contact Hours:
- The planning committee, under the auspices of the Nurse Planner for that activity, determines the criteria for successful completion of the poster session and the method to be used to “track” or verify participation in the poster session, thus, leading to the accurate awarding of contact hours. This process should be described in detail in Section “N” of the activity application – “Verifying Participation and Successful Completion.”
- Establish an evaluation method appropriate for the setting. The planning committee will determine if an evaluation tool for each poster reviewed is required or if one for the full poster session is adequate. Post-testing is another accepted evaluation methodology.
Poster Development Guidelines:
- Neither ANCC or TNA have criteria/guidelines related to the development of the actual poster. Criteria for poster development are usually determined by the activity’s planning committee. CNE educational design concepts should be taken into consideration when developing a poster just like with any other continuing nursing education presentation/activity.
Posters can be used to disseminate information on current trends in research, best practice, leadership, and education. They are excellent conversation starters. And, with some advanced planning and consistent criteria, a source of contact hours.
16. So You Want to Be a CNE Approved Provider? Timeline for Success.
The process to become an “Approved Provider” of continuing nursing education (CNE) takes at least six (6) months to complete.
An Approved Provider is an individual, institution, organization or agency that has an established process for assessing an educational need, and then planning, implementing, and evaluating continuing nursing education activities. First time applicants must have an operational CNE provider unit for at least six (6) months prior to submitting an Approved Provider Application. The six (6) month time frame is measured by the date on the first TNA activity application approval letter.
First time Approved Provider applicants must have planned, implemented, and evaluated at least three (3) different continuing nursing education activities which are at least 1.0 contact hours and were approved by TNA during the 12 months prior to submitting the Approved Provider Application. Submitting three (3) sessions from the same conference is not permitted. None of these three (3) activities may be joint provided.
Applicants must also meet certain eligibility requirements. In order to apply, applicants may not be a commercial interest or a multi-regional provider.
Commercial Interests: A commercial interest is any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients or is owned or controlled by an entity producing, marketing, reselling or distributing healthcare goods or services consumed by, or used on patients.
Multi-Regional Providers: An organization that targeted/marketed greater than 50% of their education activities provided during the previous calendar year to Registered Nurses in multiple regions based on the US Department of Health and Human Services (DHSS) regional map. TNA falls within region 6.
Additionally, prior to starting the journey to become an Approved Provider, the first time applicant may want to complete an organizational self-assessment to evaluate the organization’s readiness to meet Approved Provider criteria and to identify potential gaps. T:\CNE Education\Website Forms and material\2014\2014B\Provider Application Only\OrgSelfAssessTool - Approved Provider Dec 2014.docx.
Approved Provider Applications are accepted twice a year – January 15th and July 15th. Therefore -
I. At least six (6) months prior to January 15th or July 15th , you must:
- Establish your “CNE provider unit”. A CNE provider unit is defined as that part of the organization that is administratively and operationally responsible for coordinating all aspects of the continuing nursing education activities provided by the organization.
- Operationalize your “CNE provider unit”. A CNE provider unit is defined as operational when it is functioning under all of the relevant criteria of the American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA) and the Texas Nurses Association (TNA) with all essential CNE provider unit personnel (i.e. Primary Nurse Planner and, as appropriate, other Nurse Planner(s)) in place for at least six (6) months.
- Submit your first individual activity application to TNA for review and approval. (See guidelines for individual activity application submission on the TNA website). Remember that the six (6) month time frame is measured by the date on your first TNA individual activity approval letter.
- Start developing your Approved Provider Unit based on the ANCC/TNA operational and administrative guidelines found in the Approved Provider “Operational Requirements Attestation” located in the “Approved Provider Application” section of the TNA website.
- Wait until you receive feedback on your first individual activity application before submitting your second application for review. Submit your third individual activity application after you receive feedback on your second individual activity application.
II. At least three (3) months prior to January 15th or July 15th:
- Begin working on your Approved Provider Application. Check the TNA website for the most current application format. Review the guidelines and submission criteria in detail. Refer to your copy of the “Scope and Standards of Practice for Nursing Professional Development.” (This publication can be purchased off the ANA website). If you attended an “Approved Provider Workshop,” refer to your manual.
- By reviewing all of the above in detail, you can decide either to postpone submitting the Approved Provider Application and work on developing areas of weakness or begin writing the application for submission with all of its associated attachments.
III. By 5:00 p.m., on January 15th or July 15th:
- Submit three (3) complete single-sided, hard copies and three (3) USBs of your Approved Provider Application to the TNA office with the appropriate application fee.
- By submitting your Approved Provider Application, you are verifying your organization’s eligibility to apply for Approved Provider Status.
- The application should also identify the Primary Nurse Planner for your organization with whom the Nurse Peer Review team will communicate regarding the application.
IV. Within six (6) weeks after submission:
- Within a week, all submitted Approved Provider Applications are reviewed for completeness and processed through the TNA office. Your Approved Provider Application, along with several others, will be sent to a two-person Nurse Peer Review team for further review and evaluation. Nurse Peer Review team consist of members of the TNA CNE Committee.
- Nurse Peer Review team members may request additional information or revisions to the Approved Provider Application. Compliance with the Nurse Peer Review team requests within their specific time frame is highly encouraged.
V. March for January submitted applications; September for July submitted applications:
- The CNE Committee meets in March and September to discuss CNE Committee business and approve/defer/deny Approved Provider Applications.
- Decisions regarding the outcome of an Approved Provider Application are determined at the CNE Committee meeting.
VI. By the end of March or September:
- Final decisions will be made and a letter will be sent to the Primary Nurse Planner reflecting the final decision of the CNE Committee.
Approved Provider status is awarded upon approval of an Approved Provider Application for three (3) years. An annual report and log of the previous year’s activities is required every February 15th. Periodic audits of selected activities may be requested to ensure ongoing compliance with ANCC and TNA criteria.
17. What Are Some Keys to Writing Narratives for the Approved
In compliance with the 2015 American Nurses Credentialing Center’s Commission on Accreditation (ANCC COA) guidelines and standards, Approved Provider applicants are required to address some elements of the Approved Provider Application through use of a narrative. A narrative is a clear and concise description of the element that should give the Nurse Peer Review team a clear picture of what the Approved Provider Unit does in relation to the criteria being addressed.
The Approved Provider applicant will be asked for a “process description” narrative and a “specific example” narrative.
Process Description: Describes the Approved Provider Unit’s method for addressing the criteria.
Specific Example: Describes/illustrates how the criterion is operationalized/implemented within the Approved Provider Unit.
Tips for writing narrative responses:
- Pause and reflect on the intent of the criterion/question.
- Answer the question directly – don’t “data dump” by adding extraneous information.
- Be precise and concise but complete.
- Give enough background/context for the Nurse Peer Reviewers to understand the response.
- Ask colleagues to proof your responses and tell you if they make sense.
- Focus on key words within the criterion/question and make sure to address them.
The process description tells the story while the specific example describes the good work done by the Approved Provider Unit for Registered Nurses.
18. What is the Difference Between Joint Providing and Commercial Support?
Joint providing and commercial support are very different from each other with different goals for the continuing nursing education (CNE) activity. Two (2) possible common threads are that they:
Are entities from outside of the CNE providing organization that will have an impact on the CNE activity, and
Can not use the CNE activity as a way to promote their products or services. Promotion and education must be kept separate.
As defined by the American Nurses Credentialing Center (ANCC), joint providing (formerly “co-providing”) is the “planning, developing, and implementing (of) an educational activity by two or more organizations” (Approver Application Manual, 2015, p. 56.) Joint providing an educational activity is an excellent opportunity for organizations to share both expertise and workload. However, it is imperative that the organizations coming together to plan, develop, and implement an education activity understand the requirements for establishing joint providerships in order to adhere to ANCC/TNA criteria. (See FAQ “What is Joint Providing and How is it Done?”) Joint providing is a collaborative effort that focuses on the quality of the education activity.
Commercial support is a method that can be used to financially support your educational activity. Commercial support is defined as “financial or in-kind contributions . . . that are used to pay for all or part of the costs of a CNE activity” (Approver Application Manual, 2015, p. 54). The contributions are specifically earmarked for the provision of the CNE activity. Commercial support comes from the commercial interest – defined as “any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients, or an entity that is owned or controlled by an entity that produces, markets, resells, or distributes healthcare goods or services consumed by or used on patients (Approver Application Manual, 2015, p. 54). Financial support for the CNE activity is the sole purpose of commercial support. Commercial supporters may not have any input into the development of the CNE activity. They may not suggest topics, objectives, presenters, etc. They are simply there to provide financial or in-kind support.
Commercial support is handled as follows:
- There must be a written and signed agreement.
- The organization providing the CNE activity must have a policy/procedure that addresses commercial support.
- The commercial supporters must be listed on the CNE activity’s promotional materials.
- The commercial supporters must be disclosed to the CNE activity participants/attendees prior to the start of the CNE activity.
19. What is a “Unique Identifier” and Why Is It Used?
As defined by the American Nurses Credentialing Center (ANCC) – and thus, by the Texas Nurses Association (TNA) – a unique identifier is “something that is used to match an individual with a recordkeeping list for an individual educational activity.” (Application Manual, 2011, p. 106)
A unique identifier can be used to distinguish between continuing nursing education (CNE) activity attendees with similar names or to verify that an attendee is who they say they are and did, indeed, attend the CNE activity.
Per ANCC, no part of the social security number can be used as a unique identifier. Per Texas, the Registered Nurse (RN) license number may not be used as a unique identifier. Examples of what can be used as a unique identifier are things like the attendee’s birth month and day – not year as that has been determined to be discriminatory – or the attendee’s employee ID number. However, if the CNE provider or Approved Provider Unit open their CNE activities to attendees outside of their organization, a unique identifier other than the employee ID number will need to be identified and used for those non-employees. The unique identifier needs to be easy to remember and something that won’t change or be forgotten in the six (6) years CNE providers and Approved Provider Units are required to maintain the CNE Activity files. The unique identifier and its associated recordkeeping list should be kept with/in the CNE activity in a safe and secure manner.
The unique identifier is addressed in section N-1 of the CNE activity application/document. What is being used as the unique identifier needs to be reflected in Section N-1. How the unique identifier information is being collected needs to be reflected on whatever the CNE provider/Approved Provider Unit is using as a participation verification tool. The Accredited Provider – TNA – may audit CNE providers and Approved Provider Units for compliance with this criteria.
20. How Do I Calculate and Award Contact Hours for Pre-Work or
As continuing nursing education (CNE) providers and Approved Provider Units look for creative and innovative ways to provide CNE, the ability to award contact hours for “pre-work” and “blended education” has become imperative.
“Pre-work” is defined as self-directed activities that are done in preparation for attendance at a CNE activity. An example would be reading an article in preparation for a journal club.
“Blended education” is defined as combining both the elements of a Provider-Directed activity and a Learner-Paced activity into one (1) activity. An example would be completing online modules related to the topic (Learner-Paced) in preparation for a live, preceptor-monitored demonstration of a skill or process (Provider-Directed).
Pre-work can award contact hours independently through the development of a Learner-Paced activity application/document or by being included in the contact hour calculation of a Provider-Directed activity application/document. If included as part of a Provider-Directed activity application/document, the number of minutes to be included in the contact hour calculation for the pre-work must be determined either through a pilot study or a word count process. The minutes calculation – the actual math – should be reflected in section O-3 of the activity application/document.
- Blended education can also award contact hours.
- The CNE provider/Approved Provider Unit needs to develop only one (1) activity application/document to cover the two (2) activity formats.
- For the Provider-Directed portion of the activity application/document, use the four (4) columned education documentation form (EDF) to document the time frames, and thus minutes, associated with the Provider-Directed portion of the activity. Reflect this contact hour calculation in section O-3 of the activity application/document.
- For the Learner-Paced portion of the activity application/document:
- Use the three (3) columns of the EDF as directed at the top of the EDF form.
- Use either a pilot study or a word count process to calculate the number of minutes to be included in the contact hour calculation.
- The minutes calculation – the actual math – should be reflected in section O-3 of the activity application/document.
- In section N-1 of the activity application/document, address all participation verification methods that will be used. Develop and include a sample of all methods to be used with your individual activity application/in your CNE Activity file.
- In section N-2 of the activity application/document, address all that will apply to both methodologies used.
- Throughout section P of the activity application/document, address all that will apply to both methodologies used.
- On the grid in section U of the activity application/document, address all that will apply to both methodologies used.
- Develop separate “Disclosure to Participants” tool to accommodate the ANCC/TNA requirements for the Provider-Directed disclosure tool and the Learner-Paced disclosure tool. Include a sample of both tools with your individual activity application/in your CNE activity file.
Bottomline, contact hours must be determined in a logical, defensible, rationale manner. The process for calculating/determining contact hours must be clearly delineated in the activity application/document.
21. Are There Guidelines That Can Be Used to Develop CNE Activities That Meet the Texas Board of Nursing’s Mandatory CNE Requirements?
The 83rd session of the Texas Legislature produced some changes to the Texas Board of Nursing’s (BON) rules and regulations, specifically rule 216 – “Continuing Competency.” The changes now require both Registered Nurses (RN) and Licensed Vocational Nurses (LVN) to acquire – as appropriate – a minimum of 2.0 contact hours in nursing jurisprudence and ethics, geriatric care or older adult, and forensic evidence collection.
The purpose of this FAQ is to provide guidance to continuing nursing education (CNE) providers - be they Approved Provider Units or individual activity applicants - in the development of CNE activities that will meet the BON’s requirements.
Nursing Jurisprudence and Ethics:
All Nurses are required to acquire information related to nursing jurisprudence and ethics prior to the end of every third licensure renewal cycle. In order to meet this requirement, the Nurse must complete at least 2.0 contact hours that cover the following content:
- Texas Nursing Practice Act
- Texas Board of Nursing rules including rule 217.11
- Standards of Nursing Practice
- Texas Board of Nursing Position Statements
- Principles of Nursing Ethics
- Professional Boundaries
Geriatric Care or Older Adult:
All Nurses who provide nursing care to any patient or patients who are older adults are required to acquire information related to the older adult or geriatric care with every licensure renewal cycle. In order to meet this requirement, the Nurse must complete at least 2.0 contact hours that cover the following content:
- Elder abuse
- Age related memory changes
- Age related disease processes, including chronic conditions
- End-of-life issues
Updated Forensic Evidence Collection:
All Nurses who perform a forensic examination on a sexual assault survivor in any practice setting must have basic forensic evidence collection training or its equivalent prior to performing said examination. This is a one-time requirement for Nurses who meet the criteria. In order to meet this requirement, the Nurse must complete at least 2.0 contact hours that cover the following content:
- Forensic evidence collection
- Age or population-specific nursing interventions
- Use of service-approved evidence collection kit and protocol
What does this mean for CNE Providers:
It is the Nurse’s responsibility to make sure he/she meets all the mandatory requirements that pertain to him/her. However, CNE providers have responsibilities also. Nurses come to CNE activities in good faith that what is presented – and awards contact hours – meets both the BON’s and the American Nurses Credentialing Center’s (ANCC) requirements so that if audited, the certificate of successful completion that is awarded to the attendee will “fly below the radar of the Board of Nursing.”
What that means for CNE providers is as follows:
- The contact hours that are awarded must be approved as continuing nursing education by an agency/organization the BON recognizes.
- The content to be covered is “broadly specific.” There is specific content that must be covered – see above – but the content can be addressed broadly based on the needs of the Nurses the activity is designed for - the target audience.
- The CNE activity should be developed as any other CNE activity is developed.Start with the needs assessment. Identify your target audience. Analyze the gap – the professional practice issue – and develop a learning outcome that sets the foundation for the activity. Pull together your planning committee. Etc.
- The “current state” – problem in practice – can not be that the activity is being offered to meet a regulatory requirement. Consider what is occurring in practice that requires these activities.
- The activity can focus on a specific target audience, patient population, or disease process.
- Example: In the jurisprudence/ethics activity – how professional boundaries are addressed with school nurses may be different than how they are addressed with nursing faculty.
- Example: In the geriatric care/older adult activity – if the target audience Nurse works in an osteoporosis clinic, the focus of the activity content could be on the patient with osteoporosis. If the target audience Nurse works in an acute care hospital, the approach to the required content would probably be very broad.
- Content should be based on evidence-based, best available references.
- The content may be provided asynchronously, ie: the jurisprudence/ethics activity may be divided into one-hour of jurisprudence on one (1) day and one-hour of ethics on another day.
- The activities do not have to include all of the required content – although from a Nurse’s perspective, he/she would probably like to get all of the required topics in the 2.0 contact hour time frame. However, if the activity does not include all of the required content, the CNE provider must notify potential activity attendees and actual attendees by:
- Listing what content will not be included in the activity on promotional materials, and
- Including what content will not be included in the activity in the activity’s “Disclosure to Participants.”
- Reflect on the certificate of successful completion – either through the title of the activity or additional verbiage on the certificate of successful completion – that your activity meets the Texas BON’s mandatory CNE requirements for the activity being presented.
- For ease of review by either Nurse Peer Reviewers or the Texas Board of Nursing, it is highly encouraged that the content areas being covered be highlighted in the objectives or content columns of the education documentation form (EDF).
As CNE providers, we need to be proactive in assisting the Nurses of Texas in meeting these CNE requirements.