The University of Mississippi Medical Center (UMMC) School of Nursing CE Planning Form/RSS Worksheet

Directions:

Thank you for your interest in providing quality continuing nursing education (CNE) for the nurses at UMMC. Eligibility for becoming a nurse planner requires that you are an employee of UMMC, a registered nurse with a bachelor of science in nursing degree, or higher, have education and/or experience in the area of the CNE activity, and participate in planning meetings with the Primary/Lead Nurse Planner, Dr. Renée Williams, RN. Continuing education assists the learner in acquiring new knowledge and skills to enable advanced decision making in providing quality healthcare, enhancing professional attitudes, advancing career goals and promoting professional development.

There are two types of CNE activities that can be planned: Education Design I/Provider Directed and Education Design II/Learner Directed. Please contact the SON Continuing Education Office if you are interested in learning more about planning CE activities.

Planning process for CNE at UMMC: 1. Contact the SON Continuing Education Office at 601-984-6227 to schedule planning meetings with the Primary/Lead Nurse Planner, Dr. Renée Williams, RN, Director of Continuing Education, (DCE) 2. When meeting with the Primary/Lead Nurse Planner, bring a completed typed copy of the attached 2 page planning form worksheet with Attachments A & B forms. A computerized version of the planning form is available from the School of Nursing CE website in the yellow pages and the Division of CHPE website. 3. Retain one copy for your files and bring the original typed worksheet to the Continuing Education Office in the SON when meeting with the Primary/Lead Nurse Planner. 4. Initial planning meetings with the Director of Continuing Education (DCE) in the SON must occur at least 45 days prior to the activity presentation date. 5. Final planning meeting must take place at least 30 days prior to the presentation date to allow time to process all necessary paperwork. Exceptions to these instructions may be made only if unusual circumstances prevent planning within this time frame. Requests for exceptions must be made in writing, with an explanation of the circumstances which prevent compliance with the deadline for planning to the Director of Continuing Education in the SON.

I. Demographic Data:

Title of Program: Date forms completed:

Date of activity: one time repeat dates:

Location/Room#: City/State: Registration Fee Contact Hours Planned Contact Hours Awarded:

Registered Nurse Planner/Coordinator: List below in box after DCE Other Planners: Committee Member Name & Contact Information Credentials Degrees Role on Committee P. Renée Williams, Director of CE PhD, RN, CCE BSN, MSN, PhD Primary/Lead Nurse Planner 984-6227; [email protected] Nurse Planner/Coordinator Nurse Planner Select one. Select one.

II. Design: Live Webinar Module Audio/Video Other

1 Assessment of Learner needs: (p. 1) Check method(s) used: ____Survey _____Previous Evaluations_____ Staff Request _____Other:______

2. Identify the appropriate gap for the intended target audience that this educational activity will address based on needs assessment data: Review Section IV.B. to be completed with the DCE at planning meeting. Gap in Knowledge (knows) Gap in Skills (knows how) Gap in Practice (shows/does) Other - Describe: Description of current state:______Description of desired/achievable state: ______

B. Target Audience: Level of Education- Practice Area/Specialty- Geographical Area- Identify the target audience: All RNs Advance Practice RNs RNs in Specialty Areas (Identify Specialty) : LPNs Interprofessional (Describe): Other - (Describe):

C. Faculty/Presenter/Author (Complete Attachment A for each)

Faculty/Presenter/Author Name Credentials Degrees

D. Overall Purpose: (Complete on Attachment B Form) E. Objectives/Content (Complete on Attachment B Form) F. Teaching method: Lecture – Discussion- Group work –Role Play- Other______G. Evaluation: (Survey Monkey evaluations are provided by UMMC Division of CE)____

H. Verify participation: ______Sign in ____Badge scanner __Other______

I. Successful completion (p.7) ______Must attend entire session ______Partial credit- (if yes, must complete Section IV H.3).

J. Awarding Contact Hours: A contact hour is a 60 minute hour. Add the total minutes in actual didactic presentations and divide by 60 minutes. The contact hour may be taken to the hundredths; but may not be rounded up. (e.g. 2.758 should be 2.75 or 2.7, not 2.8)

III. Marketing/Advertisement (p.7)_____Flyer/Brochure ____Other______A. Please attach copy of Flyer and the Program Agenda before posting for advertisement.

2 IV. Commercial Support: ____No ____Yes (if yes, must complete Section X of planning form after meeting with the DCE)V. Co-provided: Yes______No______

Program Agenda (Example)

Title of program: Date:

TIME TOPIC SPEAKER 7:30 AM Registration 8:05 Welcome and Opening Remarks

12:00 noon Lunch

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For CE Office Use Only:

Sponsoring Department(s):

Maximum number expected to attend:

Please attach an agenda of the program.

A current curriculum vita for all course speakers must be attached when submitting application. This curriculum vita cannot be used in lieu of completing Attachment A. Both an Attachment A and a current curriculum vita are needed on each speaker.

Do you anticipate funding from any source other than registration fees? Yes No If yes, list name(s) of contributor(s) and amount of money or other assistance pledged. Pledges and Educational Grants must be confirmed in writing to CHPE.

For CE Office Use:

______

4 Nurse Planner/Coordinator Date

______P. Renée Williams, PhD, RN, CCE Date UMMC School of Nursing Administrator

______Director/Pharmacy Prof Dev: Date

______Social Work Liaison: Date

Approved by:______Vickie Skinner Date Director, Continuing Health Professional Education

CHPE Office Use Only MNF = _____ CHPE = _____ CEU = _____

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