Q. Can commercial interest organizations apply for approval (that is to be an Approved Provider Unit)?
A. No. Nor can they apply to have their individual educational activities approved. However, the ANCC Nursing Skills Competency Program offers course accreditation for programs that utilize both knowledge-based testing and skill observation methods of participant outcomes in nursing skills.
Q. What is the value of ANCC accreditation status vs. California Board of Nursing approval? (It seems that other accreditation might be a cheaper and easier way to be approved)
A. The value of ANCC/Midwest MSD approval is that it is transferrable to a majority of states in the US and accepted by most of the State Boards of Nursing toward licensure requirements. Board of Nursing approval is not always transferrable outside of their state.
ANCC accreditation and Midwest MSD approval is recognized by all Boards of Nursing with the following exception: the CA and IA BONs will not recognize a provider’s CE if that provider enters those states to offer their CE (“Going into a state” includes on-line education that a nurse in that state completes), without the respective BONs approval. Iowa Board of Nursing Approval means that the agency/organization must apply to be an Iowa Provider. If the provider does not physically hold programs (including on-line and home study courses) in the states of CA or IA, then those BONs will recognized the provider’s contact hours awarded. Please contact the CA and IA BON’s for their specific regulations.
Q: Please explain the rule regarding the boundaries for Approved Providers.
A. The boundary rule applies to Approved Providers only, not individual activity applicants.
An organization must limit their marketing promotion or advertisement of continuing nursing education (CNE) to nurses in either their local DHHS region or a state contiguous to that single region to be eligible to seek Provider approval through an Accredited Approver such as the Midwest Multistate Division. A region is defined by US Department of Health and Human Services; (click here for HHS region map). Less than 50% of the organization’s programs are marketed to nurses outside of their region or a state contiguous to that region.
If an organization markets 50% or more of their programs to nurses outside of their region or a state contiguous to that region, regardless of the marketing method (Internet, flyers, print advertisement or similar), they are not eligible to apply for Approved Provider status through the Midwest MSD and must apply directly to the American Nurses Credentialing Center (ANCC) to become an Accredited Provider.
The actual audience make up/participation (from local or multiple regions) does not determine whether the organization must apply to ANCC. How the organization markets its activities is the determining factor. The audience make up, however, may provide evidence for the Accredited Approver in order to make an appropriate decision. The marketing method also does not determine whether an organization must apply to ANCC, but may provide additional evidence.
An organization provides 100 activities annually and advertises them within a 5 hospital system using a web – based link on its intranet. Only nurses from the local state attend.
- Eligible to be an Approved Provider – marketing all activities to nurses within a local region
An organization provides 100 activities annually and advertises 60 of them through a national publication. Only nurses from the local state attend.
- Not eligible to be an Approved Provider – marketing greater than 50% of activities to nurses in multiple regions.
An organization provides 100 activities annually and advertises 10 of them through a national database of CE activities. Nurses from multiple regions attend the 10 activities. Nurses from the local area attend the other 90 activities.
- Eligible to be an Approved Provider – marketing less than 50% of activities to nurses in multiple regions.
An organization provides 100 activities and only advertises in a small, local nursing publication. Nurses from the local area attend.
- Eligible to be an Approved Provider – marketing all activities to nurses within a local region.
An organization provides 100 activities annually and states that it advertises them only within a small, local nursing publication. Nurses from multiple regions attend.
- Would require further investigation. Nurses attending from multiple regions seem to contradict small, localized advertising.
Q. What is the reason for this rule?
A. There have been incidences of providers being denied by one approver who then go to a series of other approvers until they find one that will approve their activity. These come to our attention through complaints from participants. It is therefore more efficient and protects the participants if ANCC reviews and accredits all of the providers reaching the larger audiences, so that they can be monitored more closely.
Q. In a Midwest MSD Approved Provider Unit, can only the Primary Nurse Planner plan education?
A. No, the Primary Nurse Planner is responsible for ensuring overall adherence of the Approved Provider Unit to accreditation criteria and hs specific duties to that role. However, they can also serve as a Nurse Planner for educational activities that the Unit provides.
The Planning Committee for each educational activity awarding nursing contact hours must include at least two people: the Nurse Planner and a Content Expert. The Nurse Planner may function as both the Nurse Planner and the content expert; however, a minimum of two people must be involved in the planning of each educational activity. The Nurse Planner must be knowledgeable about the CNE process, possess a bachelor’s degree or higher in nursing, and ensure that the educational activity is developed in compliance with ANCC/Midwest MSD accreditation criteria. The ‘Content Expert’ is a member of the Planning Committee that has appropriate subject matter expertise for the educational activity being offered. There is no limit to the number of additional individuals who may help plan the activity.
Q. Our Nurses Association district or region offers educational activities at each of our monthly meetings. Should we apply for approval for each educational activity or would provider approval be more appropriate?
A. If the district/region plans to offer a number of educational activities over a three-year period, it may be more cost effective and time efficient to submit an application and receive provider approval. This allows the district/region to offer educational activities that include seminars, workshops, a lecture series, or individual educational sessions during a three-year period and award nursing contact hours to participants. Or the district/region can submit an application for each educational activity individually using the criteria for approval of an educational activity if they are offering only a few activities. Non-peer reviewed contact hours may also be awarded for the educational activities, if this is acceptable by your state board of nursing.
Q. What is the appropriate way to list the approval statement and the contact hours on the certificate? We typically list these items in the same sentence. Is that still appropriate?
A. The approval statement must be separate from the number of contact hours awarded to participants. You are required to indicate the number of contact hours the participant received for attending the activity and include the approval statement, but they cannot be included in the same sentence.
Approval statements must be listed word for word. No additional words, phrases or statements may be attached to or included with the approval statement. If the activity has a multi-disciplinary audience and multiple approvals have been achieved for each discipline, each approval statement must be listed separately. For example, if the American Society of Radiologic Technologist has also approved the program for RT’s, another separate approval statement (written according to ASRT requirements) should be listed on another line.
Formal complaints can be, have been, and continue to be, lodged against organizations where incorrect statements are used. As the Accreditation Program processes and decisions become more outcome-focused and evidence-based, the presence of complaints in an organization’s file may, in the near future, result in additional requirements or documentation at the time of re-accreditation.
Q. Will other states accept Midwest MSD contact hours for re-licensure?
A. Usually, but not necessarily. Midwest MSD’s approval is recognized by all other states that are accredited as an approver, as well as by some states requiring mandatory continuing education for licensure renewal. If the state is a mandatory continuing education state then check with that state’s Board of Nursing. It is always best to contact the state’s board of nursing or other professional licensing body when one’s intent is to attend an educational activity to use the contact hours for re-licensure. The ANCC and Midwest MSD voluntary recognition systems are not related to mandatory continuing education requirements. States that require continuing education for re-licensure may have in place additional requirements that are not a part of the ANCC or Midwest MSD CE approval process, for example the topics and content provided may be restricted by the state board of nursing.
Q. We are a Midwest MSD Approved Provider Unit. When is our Annual Report due and what is included?
A. The Midwest MSD is an Accredited Approver by ANCC and as such we are required to report to ANCC annually the level of educational planning and implementation that the Midwest MSD Approved Provider Units have accomplished. Annually each Approved Provider Unit must complete the NARS Excel spreadsheet that details the activities provided throughout the calendar year. In addition to this data, other information and a portion of a sample activity developed and provided by the Unit must be submitted. A specific format and the required information will be supplied to Approved Provider Units annually in the fall. The completed information is to be submitted to the Midwest MSD office no later than January 31st of the following year. The information is to be provided in a calendar year report. The information requested each year varies. Minimally the information requested will deal with any major changes within the Approved Provider Unit and progress on Quality Outcomes Measures developed by the Unit. Other criteria may be requested depending on ANCC annual requirements.
Q. Our organization’s name is changing soon. Do we need to notify anyone?
A. Yes, it is important to keep the Midwest MSD staff informed of any major changes within an Approved Provider Unit, and its “parent” organization. The Primary Nurse Planner should complete an “Approved Provider Unit Change Notification Form” and submit it to the Midwest MSD staff within 30 days of any changes.
Changes could include organization name change, change of ownership of the organization, re-structuring of administrative oversight, key personnel in the Approved Provider Unit, or a change in Primary Nurse Planner, or additional Nurse Planners serving in the Unit.
Q. What would be some warning signs that an Approved Provider Unit is struggling?
A. There are sometimes “warning signs” of an accredited organization approaching a problematic time. The following list is provided as a tool that may be used by the accredited organization to identify a time when the organization might provide particularly close watch and care of the accredited CNE unit. These “warning signs” are based on evidence collected by the Accreditation Program and have been validated by other continuing nursing education accreditation bodies.
The presence of:
- A major change in the organizational structure (includes change in ownership, mergers, acquisitions, significant change in job responsibilities, etc.).
- Significant staff turnover (either in numbers of staff, e.g. 50%, or in key personnel, e.g. nurse planner).
- Changes in key personnel (nurse planner, in some cases this may include the administrator and/or the administrative assistant).
- Presence of conflict of interest (including commercial support).
- Presence of complaints lodged against the accredited organization.
- Incomplete or unacceptable interim, annual, or other reports or updated self-study.
- Lack of appropriate actions toward CNE unit goals.
The items listed above are not necessarily definitive—but have been found useful and valid in identifying possible problematic times. They are provided to assist the accredited organization.
Q. How long is the approval period?
A. If applying for Approved Provider accreditation, the approval period is up to three years.
Q. My agency recently received provider approval. Several area-nursing organizations have asked us to approve their programs for contact hours. Is this acceptable?
A. No. An organization with provider approval can only issue contact hours for educational activities designed by that organization. Provider approval does not allow the Approved Provider to review educational activities and award contact hours. Nor can an Approved Provider award contact hours for educational activities provided by the agency if no member of the Approved Provider Unit has participated on the planning committee. If contact hours are to be awarded for an educational activity, a nurse member of the Approved Provider must be on the planning committee from the time that planning begins. A key point for providers to remember is that Providers provide but not approve activities.
Q. Comments from the Midwest MSD reviewers on our last provider application indicated our evaluation of the overall provider program was weak. How can we enhance this aspect of our application?
A. Under the ANCC/Midwest MSD criteria, the emphasis is on continual quality improvement of the Approved Provider’s activities and operations. The criterion states: The Approved Provider “engages in an ongoing evaluation process to analyze its overall effectiveness in fulfilling its goals and operational requirements to provide quality CNE” (ANCC, 2015, p.40).
A plan for evaluation indicates that the provider has a systematic method for evaluating its goals, operations, resources, and activities, involving the participation of faculty, planners, and learners. According to Phillips (1994), there are seven steps in developing an evaluation plan: 1) Define the purpose of evaluation; 2) Identify resources and limitations; 3) Decide what is to be evaluated and when; 4) Decide specifically what it is you want to know; 5) Decide how to do it; 6) Draft a plan; and 7) Review and test the plan.
Q. My agency has received provider approval through the Midwest MSD. We are in the process of merging with another agency. How does this affect our approved provider status?
A. The review of the application and the awarding of the Approved Provider status were effective for your agency prior to any merger. Approved Provider status does not transfer to the newly merged, created agency. If an organization wants to continue to have Approved Provider status within the newly formed organization, the Midwest MSD CE staff should be contacted for guidance regarding what the organization needs to do to remain an Approved Provider.
Q. When a hospital is approved, but is part of a larger organization system, can they offer programs for the entire system under their name?
A. The Approved Provider can use their approved status only for those activities their provider unit plans, implements and evaluates. However, this does not prohibit who the target audience is. This provider can also jointly provide with other hospitals (either within the hospital system or without).
Q. May our agency submit a jointly provided (formerly co-provided) sample as one of the three samples required in the provider application?
A. Approved Provider applicants may submit jointly provided samples as long as the applicant is the primary provider of the educational activity and they are not a first-time applicant.
Q. Can a first-timer provider applicant submit a jointly provided (formerly co-provided) activity as one of the three sample activities?
Q. I am trying to respond to the criterion related to commercial support. We are not holding exhibits or receiving money from pharmaceutical companies, therefore we are not receiving commercial support for the activity. However, the activity is being sponsored by another company. How do I respond to the criterion?
A. If the company providing you with monies or in-kind donations is not a commercial interest organization, you are not required to provide information about that sponsorship on the application. Mark that no commercial support was received for the activity.
Q. When the Approved Provider Unit Application asks for an example to support the criterion, can we attach our policy?
A. The applicant is asked to provide a narrative example of how the Approved Provider Unit is meeting or has operationalized the criterion. Attaching policies, procedure manuals, forms, or examples copied from other sources is prohibited. Examples must be specific scenarios encountered within the Unit where an existing procedure is being utilized and demonstrated.
Q. We have a new Primary Nurse Planner in our unit. Is there anything we need to do?
A. The Primary Nurse Planner or a designee must notify the Midwest MSD CE Division in writing within 30 days of any changes within the Approved Provider Unit that alters the information in the Approved Provider application. This includes changes in Primary Nurse Planners, change in ownership, change in name or address. A Change in Approved Provider Unit Form needs to be completed and submitted to the Midwest MSD along with any supporting documents necessary based on the nature of the change.
Q. Is it permissible to put the ANCC Accreditation logo on a certificate?
A. No, the ANCC logo is not permitted to be used by non-ANCC entitites.
Q. Our agency does not have an office. Our CNE documents travel from one officer to the next officer at the end of the biennium. We don’t have a system for record keeping. What can we do?
A. All providers of CNE must have a system for record filing, storage, retrieval, and retention, and a system to ensure record security and confidentiality. It is important for your agency to develop an appropriate record keeping system. Perhaps the agency could purchase storage boxes and file folders to organize a filing system or utilize a “cloud” based electronic system. The agency should develop a written policy and procedure describing the filing system and rotation of the files. It is also important to maintain these records for at least six years. If an electronic system is used, you must also determine how it is backed-up in case of technical problems.
Q. Our agency offers workshops, seminars, and lecture series. We also offer learner-paced activities. In our Approved Provider application, can we submit examples of three on-site educational activities?
A. Even though independent study or learner-directed activities maybe planned and implemented differently there is a single educational design process to be utilized. If the Approved Provider offers both provider-directed and learner-directed learning activities, they should submit a sample of each type with their Approved Provider application.
Q. The criterion asks the applicant to identify the number of contact hours to be awarded, with supporting documentation. What supporting documentation are they looking for?
A. The learning outcomes and the level and amount of content to be provided dictate the amount of time that will be required when the learners and presenters interact in real time, as in a course, seminar, or video conference. Each topic area should have a designated time frame. The time allotments for content for each topic area should be sufficient to facilitate achievement of the learning outcomes by the learner. Occasionally, adequate time is not allotted for the speaker to cover the content and help the learner achieve the outcomes.
Q. Can we change any of the ANCC/Midwest MSD educational event planning forms?
A. An Approved Provider Unit may add their logo or additional content to the Midwest MSD planning forms. It is prohibited to remove any questions/information unless it is provided elsewhere in planning documents. Remember the goal is if audited or submitted as part of a renewal application, the reviewers need to be able to find all of the criteria requirements easily.