Nonprior approval is a "recognition" by AANA that certain CE activities have been prior approved by another recognized approval organization. Nonprior approval is used to award CE credit to CRNAs for attendance at or participation in learning activities that have not been prior approved by the AANA but were approved by a recognized approval or accrediting organization before presentation. This approval mechanism is initiated by the individual who submits the application. CE credit is not considered until an application and all required materials have been submitted.

Application Submission
CE activities that may be eligible for nonprior approval are not evaluated until after they have been presented and an official AANA application requesting CE credit has been submitted to the CE Department. It is the responsibility of the individual or group seeking credit to submit the application. Applications for approval should be submitted within 60 days after the conclusion of the activity.

Four options are available for submission of an application for nonprior approval:

1. Use an original AANA application form.
2. Use a photocopy of the AANA application form. Applications may be photocopied, but two copies of the front page must be submitted if the CRNA wants confirmation that the application has been processed. The photocopy must be on 8-1/2" x 11" white paper, clear, legible, and show all the information that is part of the front of an original application in an unreduced likeness.
   
   Facsimile (fax) copies of applications are accepted only if they are legible and if all the information on the form appears on the faxed copy. If the application is submitted by fax, all of the information required on the application must be received before the application can be processed.
3. Use a computer-generated application form. Two copies of the front page must be submitted, and they are accepted only if they are identical to the official AANA application form. The Committee suggests that a copy of the proposed computer form be sent to the CE Department for evaluation before submitting it for approval.
4. Use a pdf file. Contact the CE Department to receive this file or check the AANA web site for availability.

Educational activities for which AANA nonprior approval is sought must be reviewed thoroughly before approval. Allow at least 30 working days before contacting the CE Department about the status of the application. The CE Department does not acknowledge, by phone, facsimile, or e-mail, the receipt of applications for nonprior approval.

Fees
The application fee is waived for members of the AANA. An application for nonprior approval for nonmembers will be processed, provided the nonmember has established a recordkeeping service with the AANA. Each application form contains fee information for nonmembers. Applications for which a fee is required will not be approved unless the fee is received.

Nonprior Approval Notification
All CRNAs who submit an application for approval will be notified as to the status of the application within 30 working days.

The notification that an application has received nonprior approval contains the number of CE credits awarded, the date of AANA approval, and other necessary information. If additional material is requested before the application may be approved, it must be submitted within 3 months from the date of the request; otherwise, the application will no longer be processed for CE credit.

Types of Continuing Education Activities
A nonprior-approved CE activity is one that has not received prior approval from AANA’s CE Committee. Examples of such an activity include: (1) programs that have received approval or accreditation for CE credit from another recognized professional organization; (2) college or university courses; (3) publication of an original manuscript; (4) new clinical anesthesia experiences; and (5) research.

Content. See the section on Content for information on acceptable content. CE activities that are eligible for nonprior approval must be relevant to the practice of anesthesia in the clinical, educational, administrative, or research areas. Such activities must relate to professional growth and promote quality anesthesia care. Content relevant to the practice of anesthesia means that it is related to the development and promotion of the knowledge, attitudes, and skills necessary to maintain a high quality of nurse anesthesia practice. The CRNA is responsible for demonstrating how the program relates to the practice of anesthesia (clinical, education, administrative, or research). The relationship of a CE activity to anesthesia practice must be apparent through its purpose, objectives, and content.

Audio and videocassettes, interactive video instruction, CD-Roms, DVDs, or other similar materials, as well as participation in teleconferences or demonstrations, may be submitted as content only if a moderator or facilitator was present to lead a discussion, answer technical questions relative to the presentation, hand out evaluations, and record attendance. The materials may take the place of an in-person lecturer; they cannot be approved by themselves.

Materials to Submit
The CE Committee uses the number of credits awarded by the approval organization as a guideline. However, the full number of CE credits awarded by the approval organization is not automatically granted to the individual seeking nonprior approval; CE credits are awarded only for the presentations attended.

It is important to send the content or lecture agenda with the application for review in order to determine the number of eligible CE credits for the applicant. A program that is pre-approved by another approval organization may not automatically earn the same number of credits from AANA. Other organizations often grant credits for activities that are not eligible under the AANA Guidelines, such as coffee breaks, visiting with exhibitors, poster sessions, business meetings, tours of facilities with no lecture, and certain content areas.

In addition, many organizations issue certificates of attendance with a total number of CE credits that include every aspect of the program, rather than the actual number an attendee would be able to receive. As an illustration, many programs have multiple concurrent sessions such as panel and focus sessions, case discussions, hands-on and interactive workshops, miniworkshops, problem-based learning discussions, scientific exhibits, poster presentations, technical exhibits, and research contests. With all of these multiple activities occurring at the same time, it is simply not possible to evaluate what is eligible for CE credit with only a certificate of attendance. A lecture agenda, topic outline, or content is required because it provides the means to evaluate what sessions the CRNA actually attended and what is eligible for recertification purposes.

A program prior approved by another organization must meet their approval standards to receive an approval designation. Organizations such as the Accreditation Council for Continuing Medical Education, American Nurses Credentialing Center, and state Boards of Nursing and nursing associations, to name just a few, require providers who receive approval to keep certain documents such as outcomes, lecture agendas, hourly schedules, certificates, curriculum vitae, etc. and make them available for retrieval purposes for the participants and audits after the program for a specific period of time.

Acceptable activities for nonprior approval may include:

A. Educational Programs. Sponsored by associations or organizations at the local, state, regional, or national level, an educational program is a planned, organized series of educational sessions (offerings) that have a common theme and an overall purpose. These programs may vary in length.

To be considered for credit, a completed application and the following materials must be submitted:

1. Professionally printed material that provides a detailed description of the program attended and includes an hourly schedule. All lectures attended must be marked. For ACLS and other life support courses, an hourly schedule or lecture agenda must be included. Life support textbooks are not required.
2. A copy of the certificate of attendance issued by the provider to verify attendance at or participation in the CE activity.
3. Documentation of approval for CE credit by another recognized professional approval or accreditation organization. This material must indicate the number of CE credits awarded. The American Heart Association does not approve programs for CE credit.
4. A copy of the ACLS card or other life support course card issued by the American Heart Association or its equivalent, if approval of an ACLS or other life support course is sought.

B. Inservice Programs. An inservice program is a planned, ongoing educational program, other than a departmental orientation or policy meeting, intended to assist the professional nurse anesthetist in acquiring, maintaining, and increasing competence in fulfilling assigned responsibilities specific to the expectations of an employer. Such meetings are usually held on a regular basis.

To be considered for credit, a completed application and the following materials must be submitted:

1. A description of the content of the inservice programs, e.g., mortality and morbidity (M&M) conferences, journal clubs, grand rounds, patient and clinical conferences, and quality assurance meetings.
   
   If some of the information in the conferences is confidential and not for public inspection, a summary of the conferences may be submitted by the provider or applicant.
2. A copy of the certificate of attendance issued by the provider to verify attendance at or participation in the program.
3. Documentation of approval for CE credit by another recognized professional accreditation or approval organization. The material submitted for approval must indicate the number of CE credits awarded.

C. Provider-Directed Independent Study. Independent study is a self-paced learning activity that has been developed for individual use in which the participant receives program materials through the mail and completes the required activity outside a formal, organized learning environment. Each activity submitted for approval is evaluated individually to determine the number of CE credits it will receive.

To be considered for credit, participation in this type of activity requires that a completed application and the following materials be submitted:

1. A complete packet of all instructional materials sent to subscriber.
2. Material that describes the subscription process, how to use the learning materials, testing, and learner feedback. This information must be in the form of printed material that is created by the provider and not a statement submitted by the applicant.
3. Documentation of five (5) learner objectives and ten (10) test questions for each CE credit requested.
4. Evidence of a minimum passing score of 80%.
5. A certificate of attendance issued by the provider. Dates on the certificate should indicate the number of CE credits earned within an August 1 to July 31 time frame.
6. Documentation of approval for CE credit by a recognized professional accreditation or approval organization. The material must indicate the number of CE credits awarded.

D. College or University Courses. Regardless of the academic degree pursued, only courses or parts of courses that are shown to be relevant to anesthesia practice (clinical, educational, administrative, or research) will be considered for CE credit. The institution must be accredited by an agency recognized by the U.S. Department of Education. The minimum grade eligible for CE credit is a "C" or a "pass" on a pass-fail scale.

Undergraduate courses or parts of courses may not be appropriate for CE credit, because they reflect basic knowledge acquired in the undergraduate nursing or anesthesia program of study. The course content must go beyond the basic educational level of the CRNA.

CE credit is not awarded automatically because the course is a required part of the curriculum that leads to a specific degree or because an employer requires the CRNA to take it.

To be considered for credit, a completed application and the following materials must be submitted:

1. A description of the college or university course from the college catalog or course syllabus.
   
   Because of the diversity of academic offerings, additional documentation may be required, such as a class schedule for the entire semester or quarter or other materials that describe the weekly outline of classes.
2. A statement of relevance that clearly reflects individual CE needs, e.g., how the course is relevant to the CRNA’s practice. The statement must include: (a) a description of the CRNA’s current practice; (b) areas in the course that are most applicable to the CRNA’s practice; and (c) how the CRNA will incorporate the new information into practice.
   
   The course’s relevance to anesthesia practice must be clearly stated and supported by the material. Additional documentation supporting the material’s relevance to anesthesia may be requested by the CE Committee.
3. A college or university transcript with an official seal. Photocopies of transcripts and grade reports or grade slips are not acceptable. It is the responsibility of the individual applying for credit to obtain such a transcript.

CE credit for courses or parts of courses will be awarded as follows:

1. Semester (16 weeks): A maximum of 16 CE credits for each semester credit hour (e.g., a 3-hour semester course may equal up to 48 CE credits).
2. Trimester (12 weeks): A maximum of 12 CE credits for each trimester credit hour (e.g., a 3-hour trimester course may equal up to 36 CE credits).
3. Quarter (10 weeks): A maximum of 10 credits for each quarter credit hour (e.g., a 2-hour quarter course may equal up to 20 CE credits).

The decision to award or not award the maximum number of CE credits for a particular course rests with the discretion of the CE Committee.

E. Acceptance of Original Paper for Publication. Publication or acceptance for publication of an original paper will be eligible for a maximum of twenty (20) CE credits. The publication must be the result of independent laboratory or library research by the author(s). CE credit is awarded based on the date the work was completed or a letter of acceptance from the publisher, not the date of actual publication.

To be considered for credit, a completed application and the following materials must be submitted:

1. The paper in the same typewritten format as was submitted to and accepted by the publisher.
2. Notice of the date the paper was submitted for publication and correspondence from the publisher or editor indicating the decision to accept the paper for publication.
3. Information about when the data were collected.
4. A definition of applicant’s role in the preparation of the paper, that is, first author, co-author, etc.

The criteria used for evaluating a non-research paper are as follows:

1. Subject matter: Relevant to the practice of anesthesia - clinical, educational, administrative, or research.
2. Literature review: Reflects a comprehensive review of the current literature.
3. Presentation: Reflects organization, style, grammatical structure, and clarity.

In evaluating an original research paper, the following areas are reviewed: statement of problem, review of literature, hypothesis, methodology, results, conclusion, and implications for practice.

F. New Clinical Anesthesia Experiences. A new clinical anesthesia experience that did not constitute part of the basic nurse anesthesia curriculum may be eligible for a maximum of five (5) CE credits. A new clinical anesthesia experience is a planned exposure that enables the CRNA to apply new knowledge and develop proficiency in skills under supervision in a clinical setting. These experiences may include the use of new drugs and anesthetic techniques.

Such an experience must include demonstrations, discussions, lectures, and selected reading before using a new drug or technique. The applicant’s preparation, actual use of the new drug or technique, and level of competence must be properly documented and verified by another individual.

When seeking credit for a new clinical experience, the following requirements should be observed:

1. The intent of awarding CE credit for new clinical anesthesia experiences is to recognize that anesthesia is changing and that individuals will be exposed to new experiences and should be able to receive credit for learning about the use of new drugs and techniques that were not available or not part of the individual’s basic anesthesia education.
2. The drug or anesthetic technique must be new to anesthesia practice (introduced within the past 5 years) as well as new to the anesthetist. The fact that an individual did not use a particular drug or technique during the basic anesthesia education does not automatically mean that the drug or technique is eligible for CE credit.
3. Credit is awarded only once for the use of a new drug or technique.
4. No CE credit will be given for a single use of a new drug or technique. The applicant must use it in at least seven cases to constitute a new clinical experience.
5. The new experience cannot simply be the modified use of a drug or the modification of a technique that is already in use or that the individual has used before.
6. CE credit will be recorded by dates of experience.

To be considered for credit, a completed application and the following materials must be submitted:

1. A written statement that describes and verifies the learning experiences involved. The written statement must include a description of the following items: (1) objectives; (2) observation of and discussions related to the experience; (3) lectures attended; (4) reference material reviewed before the experience; (5) return demonstrations; (6) number of cases performed; (7) method of evaluation; and (8) an indication of the CRNA’s ability to incorporate the new experience into clinical practice.
2. The application must be signed by someone who can clearly attest to the competence achieved and verify that the CRNA actually performed what is claimed. Those who can attest to competence include other CRNAs, dentists, and physicians.

G. Research in Anesthesia-Related Fields. Scientific investigation that has an impact on anesthesia practice (clinical, educational, administrative, research) is eligible for a maximum of forty (40) credits. Twenty (20) CE credits may be awarded for the proposal and twenty (20) CE credits for the completion of the project.

To be eligible for credit, the CRNA must be the principal investigator or a co-investigator of the research project.

The following information must accompany the application for CE credit:

1. A copy of the research proposal and a statement supporting its relevance to anesthesia practice. The role of the CRNA who is a co-investigator in the research project including tasks and responsibilities, must be defined.
2. Where applicable, a copy of the approved research proposal from the institution(s) where the research was conducted.
3. Where applicable, a copy of the approval document or letter of authorization issued by an institutional review committee or its equivalent.
4. Where applicable, a copy of the informed consent form that research subjects must sign for the protection of human rights.
5. Where applicable, a copy of the protocol stating that humane standards concerning the use of animals were used that equal those of the American Physiologic Society.
6. A copy of the research protocol and the results of the study, designating the CRNA as author or co-author of the research design.

In evaluating the project, the following areas are reviewed: problem statement, review of literature, hypothesis, methodology, results, conclusion, and implications for practice.

Incomplete Applications
If an application is incomplete, a letter will be sent to the CRNA requesting additional information. The CRNA has 90 days in which to return the additional material and complete the processing. If no action is taken in 90 days, the application is considered inactive and will not be processed. However, the application can be reactivated and processed for CE credit when all the materials requested in the original notice are submitted.