Provider Application Activity File Requirements

The following evidence needs to be retained in your activity files for 6 years. When you submit your three sample activities with your provider application, please put your documents in the following sequence: 

Activity Documentation Form or Equivalent (Note: This list follows the sequence of planning outlined on the CNA activity documentation form.)

  • Title, date and location (if face-to-face) of activity
  • Number of contact hours to be awarded
  • Type of activity format: Live, Blended, or Enduring
    • Date live activity presented or, for ongoing enduring activities, date first offered and expiration dates.
    • Rationale for number of contact hours to be awarded
      • Names/credentials/roles of members of planning committee, faculty, others involved with the activity (must include names of nurse planner and content expert required to be on the planning committee)
      • Attestation that nurse planner has validated absence of conflict of interest because the activity is not related to any products/services of a commercial entity, if applicable.
      • Description of professional practice gap
      • Evidence that validates professional practice gap
      • Educational need that underlies the professional practice gap
      • Description of target audience
      • Desired learning outcomes
      • Description of evidence based content with supporting reference or resources
      • Learner engagement strategies used
      • Criteria for awarding of contact hours
        • Description of evaluation method (Evidence that change in knowledge, skills, &/or practices of target audiences was assessed)
        • Presence or absence of commercial support
        • Presence or absence of joint providership

This follows the sequence of the attachments as noted on the CNA activity documentation form.

  • Conflict of interest documentation information from all individuals in a position to control content (planners presenters, faculty, authors, & content reviewers as applicable) including action taken by the nurse planner to resolve any existing conflict – UNLESS the nurse planner has validated that there is no conflict of interest because the activity is not related to any products/services of a commercial entity.
  • Agenda for the activity, if it lasts longer than 2 hours
  • Marketing material (email, flyer, posted notice, etc.); if marketing is web based, please submit a screen shot of the relevant page(s)
  • Evidence of required disclosures provided to the learners:
    • Required for all activities:
      • Approved provider statement
      • Criteria for successful completion to earn contact hours
      • Presence or absence of conflicts of interest for all individuals in a position to control content (planning committee, presenters, faculty, authors, &/or content reviewers)
    • To be included if applicable:
      • Commercial support – list name of commercial support provider
      • Expiration date for enduring material only
      • Joint Providership – list name(s) of joint provider(s), making sure your name as the activity provider is prominent
        • Materials associated with this activity (marketing materials, agendas, and certificates of completion) must clearly indicate the Provider awarding contact hours and responsible for adherence to the ANCC criteria
  • Certificate or Documentation of completion must include:
    • Name of learner
    • Title and date of the educational activity
    • Name and address of provider of the educational activity (web address acceptable)
    • Number of contact hours awarded
    • Approved provider statement
  • Commercial Support Agreement with signatures and date (if applicable)
    • Name of the Commercial Interest Organization (CIO)
    • Name of the Provider
    • Complete description of all the commercial support provided, including both financial and in-kind support
    • Statement that the CIO will not participate in planning, developing, implementing or evaluating the educational activity
    • Statement that the CIO will not recruit learners from the education activity for any purpose
    • Description of how the commercial support is to be used by the Provider (unrestricted use &/or restricted use)
    • Signature of a duly authorized representative of the CIO
    • Signature of a duly authorized representative of the Approved Provider Unit
    • Date on which the written agreement was signed
  • Summative evaluation

 

Colorado Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Parts of this document has been used with permission from Pam Dickerson, PhD, RN-BC, FAAN and Montana Nurses Association.