Nurses' associations say that education on the show floor can be kept clean - free from product promotion, that is. And, they say, the benefits outweigh the risks.

"Nurses want as much CE as they can cram in, and this helps them maximize their contact hours," says Barbara Mayer, education director for the American Association of Critical-Care Nurses (AACN) in Aliso Viejo, Calif. "Our participants love this option."

Mayer's "option" is a medical rarity: accredited educational sessions presented by exhibiting companies within exhibit booths. AACN is a pioneer in this area - it has offered such sessions at its annual National Teaching Institute (NTI) and Critical Care Exposition since 1989. At NTI 2000 in Orlando in May, 25 of the 400 exhibiting companies presented a total of 70 sessions on the show floor.

Alaris Medical Systems, which markets intravenous pumps and needle-free products, has sponsored exhibit CE sessions at AACN for at least five years, says Marianne Gill, senior manager, field response services and clinical support for the San Diego company. "We're in an educational environment, and we have an obligation to provide education," she says. "The nurses enjoy this - our sessions are packed."

Only a handful of associations offer such programs. For associations offering CME, Accreditation Council for CME regulations make it seemingly impossible. Other organizations fear that even if it's "legal," it would be too difficult to separate education from promotion in the booth. And some hold back because of the logistical, paperwork, and staffing challenges.

But organizations that make the effort and find ways to overcome the challenges see pluses for everyone. Attendees can earn more education credits at no additional cost. Exhibitors have another way to build booth traffic. And the association benefits because "it increases the number of contact hours we can advertise," says Lorry Schoenly, director of education for the National Association of Orthopaedic Nurses (NAON), Pitman, N.J. Associations also realize extra income from increased exhibitor fees.

Education as Enticement The driving force is education, of course, and the need today is greater than ever. "Many of our attendees have had their education budgets cut," says Christine Lindmark, CEM, director of exhibits for the Association of periOperative Registered Nurses (AORN), Denver, which added exhibit-floor sessions to its education program in 1997. "This is a way for them to get contact hours at sessions and on the exhibit floor as well. The feedback has been very positive."

It's not just the amount of education, however, but also the focus. "A nurse tends to know only about his or her experience in the hospital," says Lindmark. "From a company, you get the background on why products and technologies are developed the way they are. They are different perspectives, and both are valuable."

A similar view is voiced by Geri Shaffer, director, Aesculap Academy, for medical device manufacturer Aesculap Inc., South San Francisco, which has presented CE sessions at AORN for several years. "We strive to offer topics that, because of time constraints, can't necessarily be learned on a day-to-day basis," she says.

Keeping It Clean Exhibit booth education is taken seriously, and sessions must meet the same stringent criteria as those in the meeting rooms. Application forms require session summaries, objectives, and speaker credentials. The only real difference is that the sessions, which can be repeated, are shorter, usually 25 to 30 minutes, including a Q&A.

AACN's application form for Exhibits/CE states, "All programs must meet AACN's standards for continuing education credit. Acceptable presentations will contain educational concepts that relate to the products or service, and not be a promotion of the company's products and services. Reference or content related to specific products, services, or equipment will be edited out of the session summary."

You can't be much clearer than that. Still, planners are acutely aware of the special risks of in-booth CE and have built in a variety of controls.

First off, every organization that permits in-booth CE requires the exhibitor to purchase at least a two-booth space - 200 square feet. One booth-space is used as the presentation area, with classroom seating. "We spend a fortune for a booth big enough for 75 seats," says Marianne Gill at Alaris. "But because our organization is so tied into critical-care nursing, we have a dedication to education."

Exhibitor guidelines explain that the larger area is necessary to keep attendees within the booth and ensure that crowds don't block the aisles. What the regulations don't say, but should be obvious, is that this also creates a physical separation between the education and sales areas.

Some associations offer a lower-cost alternative, a CE theater. NAON creates a theater area with 100 seats and a microphone, podium, overhead projector, and slide projector. AACN this year introduced a CE theater on a smaller scale - 24 seats and a lavaliere microphone. Randy Bauler, exhibits and sponsorships director for AACN, has mixed feelings about the new venue. "Attendance was good," he says. The problem: "It takes people away from the booth, but we market exhibitor CE as a good way to draw a crowd." On the other hand: "When the CE session breaks, people are there in the area."

Boosting Revenue Associations can realize additional revenue from the fees for exhibit CE. AACN charges an application fee of $325, regardless of the number of sessions offered; exhibitors may reserve the theater for one or two sessions at $950 each. NAON charges $1,000 per topic to use its theater, and the exhibitor may present the topic once each day. There's no fee for in-booth CE, but the number of daily presentations may be no more than the number of booth spaces purchased.

During the application and approval process, planners exert a number of controls to keep promotion out of education. NAON's application requires that registered nurses be involved in planning and/or presenting the session "because you are directing your presentation(s) toward nursing implications of a particular product or technology." Dale Gibbons, manager of education services for the Emergency Nurses Association (ENA), Des Plaines, Ill., notes that "exhibitors often use a marketing tool, but we must review it first. We also ask that any marketing materials they send out be objective. Having the paper-work up-front helps a great deal."

Outsourcing the Oversight AORN goes even further. An accredited CE provider, it managed its exhibit CE program the first year. "We patterned it after AACN," says Lindmark. But since 1998 it has outsourced to what is now called HealthStream-Education Design, in Denver, an accredited provider of both CE and CME. (Education Design was formed in 1981 by four nurses who had worked for AORN. Recently, HealthStream purchased Educational Design.) HS-ED develops and writes the presentations for each exhibitor CE program, charging exhibitors for the service. (AORN's conference program remains in-house.)

Says Lindmark, "Our Exhibitors Advisory Committee felt strongly that if AORN were to continue with education on the exhibit floor, all exhibitors should go through one company to provide the contact hours. The committee believed that this would establish uniformity and consistency in length of sessions, qualification of speakers, and program development."

HS-ED program manager Judy Pfister says, "Our experts write the content and exhibiting companies aren't allowed to change it. We build the background on PowerPoint and don't let them put in trademarks. If a product is shown, it's in use in the OR, but not with the name evident. We also control the faculty and write and print the study guide."

How do exhibitors feel about this approach? "There's some resistance from companies that have had their programs accredited by another source," says Lindmark. "They feel that they shouldn't have to pay additional fees to HS-ED. So they choose not to provide the exhibit CE."

But Shaffer at Aesculap - who's a member of AORN's EAC - touts the advantages. "Staff at HealthStream-Education Design act as our gatekeepers, providing consistent and valuable guidance," she says. "They ensure that the educational programs are not infomercials." Another plus to working with an accredited provider like HS-ED: "They keep all the records. I don't have to staff to do that."

Show Floor Patrol AACN, however, "continues to manage Exhibits/CE in house, rather than outsourcing, because we need to maintain oversight of content and program quality," says Mayer. Three full-time staffers handle the complete NTI educational program - the 70 Exhibits/CE sessions plus some 140 conference and pre-con sessions.

That staff also is involved in on-site monitoring. "There is such a link between sales and marketing, and education that there has to be some monitoring," says Mayer. "That can be a manpower issue," she says, suggesting that that could be one reason that some associations avoid exhibit CE.

While HS-ED takes a formal approach, assigning one staff person for every five to eight exhibitors, AACN handles that issue "informally," using a combination of staff and volunteers, says Bauler. "They attend the sessions because they want the credits," he says, adding that they'd certainly be on the alert for any infractions.

Planners and exhibitors alike insist that infractions are almost nonexistent. "We've never had a problem," says Gibbons at ENA. "We're adults. They know the rules."

On the exhibitor side, Gill at Alaris says, "Our outlines are approved by AACN and we stick to the outline. My role is to provide education to our customers - I'm not in sales - and I feel passionately about drawing the line. We had a person with AIDS speaking about needle sticks. We sell a needle-free product line, but she didn't talk about it."

In fact, exhibitors' customers - the session attendees - are the toughest judges of all. "Attendees know when it's promotion and when it's education," says Lindmark, "and they'd probably call you on it if you crossed the line."

Beyond Nursing The Healthcare Information & Management Systems Society (HIMSS) will launch exhibit CE at its meeting in February 2001, outsourcing the program to HS-ED.

"Exhibitors can offer a lot of information and education," says Margaret Schulte, vice president, education for Chicago-based HIMSS. "We want to draw on their knowledge to expand the educational opportunities. And our due diligence showed that this will pull people to the exhibit floor."

But HIMSS is well aware of the risks and is addressing them, says Schulte. "There could be a perception among our members that this is another sales pitch. So they'll see us working to be totally sure that it's noncommercial."

Planner after planner says that the Accreditation Council for CME prohibits CME on the exhibit floor at physician meetings. But, they say, the American Nurses Association Credentialing Center's Commission on Accreditation permits exhibit floor CE at nursing meetings. Not exactly.

The ACCME's Standards for Commercial Support of CME do appear to expressly forbid exhibit hall education. Regulation 4b states that "no commercial promotional materials shall be displayed or distributed in the same room immediately before, during, or immediately after an educational activity certified for credit."

But, according to Murray Kopelow, MD, executive director of ACCME, that point is not really a prohibition of exhibit floor CME. He says that the two key points in the Standards for Commercial Support of CME are that the accredited provider must have control over the "content, quality, and scientific integrity" of CME, and that there must be an absence of commercial bias and a separation of promotion from education. "You can't fulfill those standards in an exhibit hall," he maintains. "Nobody says you can't go from the learning to the product," he adds, pointing out that attendees are free to walk from a meeting room to the exhibits. But ACCME providers choose not to offer exhibit CME "because of their own internal standards."

As for the American Nurses Association's position, "None of our criteria would prohibit" exhibit floor education, says Kami Monarch, director of accreditation and magnet programs for the American Nurses Credentialing Center. But they also don't specifically allow it. "The criteria aren't setting-specific," says Monarch. "CE can be provided anywhere that nurses gather." If standards were violated in any setting - classroom or exhibit floor - attendee evaluation forms would alert planners.

It's your call.

When Abbott Laboratories wanted to create awareness of its new sedative among attendees at the American Association of Critical-Care Nurses meeting in Orlando in May, it partnered with medical education company Health Learning Systems, Wayne, N.J.

A literature search revealed two relevant and hot issues for critical-care nurses, says Barbara Gallagher, CMP, senior program director for HLS. First, nurses oppose the new "fast tracking" procedure for moving patients from the intensive care unit to a step-down unit. "The nurses think it's done not to help the patient, but to save money," says Gallagher. "They're not into it, but they have no choice." One reason patients are kept in the ICU is that they need to be on a ventilator. Abbott's sedative allows patients to get off the ventilator more quickly.

The second issue: Every ICU will receive new scales for assessing sedated patients, and nurses must learn to use them. Armed with that information, HLS sought highly experienced critical-care nurses who had been involved in clinical studies for Abbott's sedative to help prepare and present the program. AACN approved both the program, "Innovations and Options in ICU Sedation," and the invitations for pre-registrants.

The session itself presented "case studies using all types of sedation, including competing products," says Gallagher. "We made it clear that sales reps were not allowed on the education side of the booth. If people asked questions that were a rep's responsibility, the speaker was to say, `I can't answer that, but someone on the other side can.' It's our responsibility to coach clients in what they can and cannot do."

Based on the 746 post-session evaluation forms, the program was a big success:

- 95.9% of the respondents found the content relevant to the program goals and learner needs.

- 95.3% said the speakers were qualified and held their interest.

- 96.1% rated the audiovisuals good or excellent.

- 92.9% felt that the program validated a change of practice.

The sessions, concludes Gallagher, "allow the benefit of education as well as specific product information in a short period."