INSTRUCTIONS:
Please download our form here and fill out information on the organization’s VNA approval number, anniversary date of providership, agency name, who the annual report was prepared by, contact information and dates continuing education programs were provided. Enter the dates of the continuing education programs given in the past year since the last annual report.
- Complete the date of the program, title of the program, number of nurse participants who attended the program, and the maximum number of contact hours a participant can receive.
- The total number of contact hours given at the activity should be calculated. If all participants received the maximum number of contact hours, the number of participants multiplied by the maximum number of contact hours a participant can receive would equal the total number of contact hours (i.e. 22 x 6 = 132). If partial contact hours were given to participants, the number of contact hours given to each individual participant should be summed to obtain the total number of contact hours.
- Identify if the activity is a live--provider-directed, provider-paced OR independent--provider-directed, learner-paced activity, whether or not the activity had commercial support or joint providership.
- A brief analysis of the evaluation summary should be reported to demonstrate outcome measure.
- Calculate summary totals: Total number of activities given in the year, the total number of nurse participants who attended all the activities provided in the year and the total number of contact hours given by the provider unit in the year.
- If an activity is repeated, complete an entry (fill out a row) each time the activity is repeated.
- If an activity is an independent—provider-directed, learner-paced activity, complete a summary total of all participants who have completed the activity up to the time of this report.
- Submit one sample activity with all the appropriate documentation for review. This activity should be selected from the activities listed on the summary and be representative of the activities given in the previous year. Note: Approved Providers may submit planning documentation for the 2016 Annual Report sample activity on the planning forms the organization was using prior to the VNA required transition to the provided ANCC/VNA Approved Provider Planning Templates. If the organization has used the ANCC/VNA Approved Provider Planning Templates in 2016, it is suggested that they submit a sample activity using these forms.
Note: Failure to submit or comply with these monitoring requirements can lead to a revocation of approval as a provider.