MS Nurses Foundation



Approved Provider Process/Paperwork for Planning a CNE Activity

Below are planning forms for a continuing nursing education (CNE) activity. Please have all paperwork that is required prior to CNE activity completed and returned to the primary nurse planner for review at least _______ days before the presentation.

Forms Required Prior to Presentation:

App Provider planning form – Complete and return the planning form to the Primary Nurse Planner (nurse with BSN degree or higher) as listed on Attachment 2. Anyone else who has planned, developed, collaborated, or is presenting the education must be listed also. Evidence-based references for the activity must be included. See resources at the end for assistance in planning and writing the gap analysis and learning outcomes/outcome measures.

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Attachment B9 – the planning table must be completed (Must include references for presentation).

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Attachment A-3 – BIO/COI form must be completed and signed by the primary nurse planner and the content expert. The primary nurse planner will review all forms for conflict of interest and sign on the last page. Another nurse planner must review and sign the primary nurse planner’s BIO/COI.

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Attachment A4 – COI form must be completed and signed by each planning committee member and presenter (the primary nurse planner and content expert do not have to complete this form). The primary nurse planner will review all forms for conflict of interest and sign on the last page. Another planner will review the primary nurse planner’s BIO/COI form and sign the last page.

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Attachment 7 – Completed, if applicable, for commercial support

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CNE Advertisement – Advertisement should not occur until the CNE planning packet has been turned in and reviewed by the primary nurse planner. The ANCC approval statement must be placed on all CNE advertising including emails:

[Name of Approved Provider] is approved as a provider of nursing continuing professional development by The Mississippi Nurses Foundation, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

All advertisements need to be forwarded to primary nurse planner for review.

Forms During the Presentation

Attachment 5 – Sign in sheet. Sample attached but you can adapt. Must return to the primary nurse planner after the presentation and before certificates can be awarded.

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Attachment 8 – Disclosure Statement must be read aloud to participants at the beginning of the presentation

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Attachment 10 – Evaluation form for participants must be completed and used to complete the evaluation summary

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Forms Completed After the Presentation

App Prov evaluation summary form – will be turned in after the presentation as a summary of the participants evaluation responses.

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Attachment 6 – CE certificate – see sample. The primary nurse planner will provide the CNE certificate after the activity by email, mail, or in person.

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Record Keeping – all CNE files are keep for a minimum of 6 years in a secure location ___________________ and accessed only by the authorized staff. [pic]

Resources for CNE Development

Planning quality CNE activities

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ANCC Content Integrity – discusses integrity standards as it relates to sponsorship and conflicts of interest. This is for informational purposes while filling out the forms.

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Assessing learner needs and gaps in knowledge, skills, practice

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Writing learning outcomes (learning objectives are no longer used)

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