recertification renewal - International Nurses Society on Addictions

RECERTIFICATION RENEWALBy 60 Points of CreditApplication Forms and InstructionsAddictions Nursing Certification BoardPayment Processing CenterPO Box 14846Lenexa, KS 66285-4846(Phone) 913.895.4622(FAX) 913.895.4652July 2011

Instructions on Completing the CARN Recertification ApplicationTo complete your <strong>recertification</strong> packet, you will need 60 points of credit from theprevious four years. The types of credits and the number of points you can use arelisted in this <strong>recertification</strong> application. Please complete the forms and return only theones you used; the others may be discarded. When completing your application,please keep the following in mind:In order to process your <strong>recertification</strong> application before the expiration date, returnyour completed application to our office by the due date.You are not required to mail proof of credits with your application. However, pleasekeep copies of all proof in the event that you are audited.Please fill in the blocks completely when completing the education, scholarly activity,and/or volunteer activity forms. For example, do not leave the program applicabilityblock blank or write “see attached.” If any blocks are left blank, the application willbe returned to you for completion.You may only use credits that are related to the enhancement of yourprofessional addictions nursing practice (see application for details). Courseson subjects such as computer skills will not be counted toward <strong>recertification</strong>.The timeframe for certification is based on the month of the initial certification byexamination. Thus, the <strong>recertification</strong> deadline is June 30 th for those certified in thespring, and December 31 st for those certified in the fall.Your <strong>recertification</strong> application will take approximately four to six weeks to process. Onceyour application has been processed, you will receive a new certificate and a new ANCBcard with your updated certification expiration date. You must recertify every four years tokeep your certification current and valid.If you have suggestions on improving the <strong>recertification</strong> process, we would love to hearfrom you. You may include suggestions with your <strong>recertification</strong> application.We look forward to working with you for another four years. Thank you for yourdedication to addictions nursing practice.IntNSA Payment Processing CenterAddictions Nursing Certification ProgramPO Box 14846Lenexa, KS 66285-4846913.895.4622913.895.4652 FAXRevised July 2011

Certified Addictions Registered NurseApplication: Recertification by Points of CreditThis booklet contains the instructions andforms necessary to apply for <strong>recertification</strong> asa Certified Addictions Registered Nurse –Advanced Practice (CARN-AP). Pleasereview all materials carefully beforebeginning to complete the forms. You mayduplicate forms if additional space is needed.Please make a personal copy of allapplication materials before submitting them.To recertify by points of credit, 60 pointsmust be submitted on the enclosed forms.Points will be accepted that meet thesecritieria:EducationA) Continuing education related to theenhancement of your professionaladdictions nursing practice, includingroles of an addictions nurse clinician,supervisor, administrator, consultant,researcher, or educator. One contacthour is equal to one point of credit. Theentire 60 points of credit may besubmitted in continuing educationcontact hours.B) Formal course work related to theenhancement of your professionalnursing practice in addictions, includingthe roles of an addictions nurse clinician,supervisor, administrator, consultant,researcher, or educator. One credit houris worth two points of credit. The coursework must be at the graduate level. Amaximum of 40 points of credit will beaccepted for formal course work.Scholarly ActivityC) Publication related to addictions nursingpractice, research, consultation, oreducation. Each publication is worth 10points of credit.D) Presentation of content related toaddictions nursing practice, research,consultation, or education. Each contacthour of presentation time is worth fivepoints of credit.E) Volunteer professional service in anaddiction-related professionalorganization. One year of service in anelected or appointed position is worthfive points of credit.F) Volunteer community service inaddictions-related activities. Ten hoursof service are worth one point ofcredit. A maximum of 20 points canbe earned as a combined total forprofessional volunteer service andcommunity volunteer service.Revised July 2011

A random selection of all <strong>recertification</strong>applications will be audited. Thoseapplicants to be audited will receivenotification and further instructions afterreceipt of their applications. Therefore, it isimportant that <strong>recertification</strong> applicants savematerials that substantiate the points ofcredit they submit if their applications areaudited:1) Copies of proof of attendance orcompletion (such as certificate) ofcontinuing education offerings orprograms. Include the date, year,program title, sponsor, provider number(if applicable), applicant’s name, andnumber of contact hours awarded. Theprogram objectives should be retained.2) Transcripts of formal course workcompleted.3) Letter of acceptance and copies ofprinted article(s) or chapter(s), includingproof that your name was published asan author.4) Correspondence related to professionaland volunteer community activities.Note: You may become ineligible topractice in your state beyond yourcertification expiration date.There is a mechanism for reconsiderationand appeal for candidates who have had<strong>recertification</strong> denied on the basis offalsification or application,misrepresentation, or failure to meet criteria.There can be no appeal based on the lackof current and unrestricted registered nurselicense or failure to meet deadlines.Certified nurses are responsible fornotifying the Addictions CertificationBoard’s national office of any addresschanges.Please submit the completed applicationat least 60 days before the expirationdate of your certification.If <strong>recertification</strong> by 60 points is denied, theapplicant may either apply to take the nextcertification examination or appeal theruling. If the appeal is denied, the applicantwill have time to apply for the nextexamination offered. If the applicant doesnot meet <strong>recertification</strong> criteria and does notpass the examination, certification will not berenewed. Recertification by points of creditwill be denied for any of the followingreasons:1) falsification of application2) misrepresentation3) failure to meet eligibility requirements4) lack of current and unrestrictedregistered nurse license5) failure to meet criteria for 60 points ofcredit6) failure to apply by the deadline7) failure to supply requested additionalmaterials by the deadline.Revised July 2011

Name:Certified Addictions Registered Nurse Recertification Application(PLEASE PRINT)Legal name_Address↑ Please write your name as you want it to appear on your CARN certificate.↑City/state or province/country/zip codePhone (H)( ) (W)( ) __________________________Email_Recertification fee:CARNPlease check the appropriate box below.Member $195 New Member $335 Non Member $395 January 1 – June 30SPRINGCERT January 1 – June 30SPRINGCERT January 1 – June 30SPRINGCERT July 1 – December 31FALLCERT July 1 – Debember 31FALLCERT July 1 – December 31FALLCERTReactivation fee: Applications received after the expiration date of the currentcertification and up to 2 years late must include the $100 reactivation fee.Payment: Check or money order: Check # ____________________Payable to <strong>International</strong> <strong>Nurses</strong> <strong>Society</strong> on Addictions(IntNSA).* Please note ‘Recertification fee’ in the memo section of the check.* Note: IntNSA is a nonprofit corporation and the parent organization of the ANCB.MasterCard VISA American Express DiscoverAccount numberExpiration dateName (printed)SignatureRevised July 2011

Name:Candidates for <strong>recertification</strong> must hold a current, full, and unrestricted license as a registerednurse in the United States, its possessions, or Canada. If licensed in more than one jurisdiction,candidates must hold a full and unrestricted license in all jurisdictions.Current registered nurse license number(s)State or ProvinceExpiration date(s)Points of credit submitted on attachedforms: Form AForm BForm C and DForm E and FTotalI hereby apply for <strong>recertification</strong> and attest that all information provided inthis application is accurate.______________Legal signature of candidate_______________________________________ Date ___________________Revised July 2011

Name:Verification of Experience in Addictions NursingThe applicant must provide verification of a minimum of 2,000 hours (1 year) of addictions nursingexperience as a registered nurse in a staff, administrative, teaching, consultation, private practice,counseling, or research capacity. This experience must have occurred in the 4-year certification period.This form must be completed by the applicant’s supervisor(s). If necessary, please use additionalcopies of this from. Completed form(s) attesting to the 2000 hours of addictions nursing must be returnedwith the <strong>recertification</strong> application.I verify that(applicant) had experience in addictions nursingin the following capacity:From the following date to .Month/yearMonth/yearAverage number of hours per week:Name of practice setting:Address:City State / Province Country Zip codeSupervisor (Print name)Supervisor (Signature)Contact information:Telephone:Email:Address (if different from above):Address:City State / Province Country Zip codeDate:Revised July 2011

Name:Form A: Continuing EducationPlease print or type and avoid using abbreviations.(1)Sponsor (includingprovider no., ifapplicable)(2)Date(s) ofprogram(3)Type of program(4)Title of program(5)Program applicability toaddictions nursing practice(6)Total number ofcontact hours(points)Maximum number of points accepted for form A is 60. Total points this page1 contact hour (50-60 minutes) = 1 point.Revised July 2011

Name:Form A: Continuing EducationPlease print or type and avoid using abbreviations.(1)Sponsor (includingprovider no., ifapplicable)(2)Date(s) ofprogram(3)Type of program(4)Title of program(5)Program applicability toaddictions nursing practice(6)Total number ofcontact hours(points)Maximum number of points accepted for form A is 60. Total points this page1 contact hour (50-60 minutes) = 1 point.Revised July 2011

Name:Form A: Continuing EducationPlease print or type and avoid using abbreviations.(1)Sponsor (includingprovider no., ifapplicable)(2)Date(s) ofprogram(3)Type of program(4)Title of program(5)Program applicability toaddictions nursing practice(6)Total number ofcontact hours(points)Maximum number of points accepted for form A is 60. Total points this page1 contact hour (50-60 minutes) = 1 point.Revised July 2011

Name:Form B: Formal Course WorkPlease print or type and avoid using abbreviations.(1)Institution&Address(2)Date and yearcompleted(3) Course number,department code, andtitle(4)How course is applicableto addictions nursing(5) Number ofcredit hours(6) Numberof credithours times2(7)Points ofcreditx 2x 2x 2x 2Maximum number of points accepted for form B is 40. Total points this pageRevised July 2011

Name:Form C: Scholarly Activity-PublicationsPlease print or type and avoid using abbreviations.Title of manuscript Name ofCheck appropriate box:publicationand publisher Text chapter Journal articleDate and year of publicationor acceptancePages wheremanuscript appearsPoints ofcreditForm D: Scholarly Activity-PresentationsPlease print or type and avoid using abbreviations.Title of presentationNumber of contact hoursawarded to participantsDate and year ofpresentationTitle of program and location wherepresentation was madePoints of creditMaximum number of points accepted for forms C and D is 30. Total points this pageRevised July 2011

Name:Form E: Volunteer Service---Professional Volunteer ActivityPlease print or type and avoid using abbreviations.Nature of professional Title of volunteerCheck appropriate box:service, Name & AddresspositionAppointed ElectedBeginning date ofpositionLength of termPoints ofcreditForm F: Volunteer Service---Community Volunteer ActivityPlease print or type and avoid using abbreviations.Nature of community service,Name & AddressSpecific role servedLength ofvolunteer serviceSponsoring agencyor associationDate and location ofeventPoints ofcreditMaximum number of points accepted for forms E and F is 20. Total points this pageRevised July 2011