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Neonatal Network: The Journal of Neonatal Nursing
Copyright Transfer and Conflict of Interest Statement
Names of All Authors:
Title of Manuscript:
Date:
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Your Name:
Credentials/Degrees:
If RN, Nursing Degree(s):
Current Employer:
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Mailing Address:
Phone Number:
Email:
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☐ AD ☐ Diploma ☐ BSN ☐ Masters ☐ Doctorate
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Please describe expertise and years of training specific to the article listed above.
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Each author must read, sign and return the following document. This form may be copied and distributed
to individual authors. This form must be returned by either mail, fax, or by email to:
Megan Larkin, Managing Editor
Springer Publishing Company, LLC
11 West 42nd Street, 15th Floor
New York, New York 10036-8002
Fax: 212-941-7842
Email: [email protected]
SUBMISSION CRITERIA
PUBLISHER COPYRIGHT: Copyright of published text, figures, tables, or illustrations will be maintained by
Springer Publishing Company, LLC, publisher of Neonatal Network: The Journal of Neonatal Nursing. For
future use of the accepted manuscript in other works, authors must submit a written permission request
(email, fax, letter) to the Managing Editor.
AUTHORSHIP: All authors agree that each has participated in the study and/or preparation of the
manuscript to a satisfactory degree deserving of authorship and that all authors have viewed the final
version prior to submission of the manuscript to the publisher.
ORIGINALITY: All authors agree that the article and supporting work is original and they are authorized to
submit such material to the journal. As well, that the manuscript has not been published elsewhere and will
not be submitted to another publisher without official response from the editors of the journal and that the
manuscript will not be published, nor republished once accepted, without permission.
TRANSFER OF COPYRIGHT
The undersigned author(s) transfers all copyright ownership of the above named article to Springer
Publishing Company, LLC, in the event that the article is published in the Journal. This transfer of copyright
includes, but is not limited to, the worldwide rights to any and all forms of publication now known or
hereafter developed, including all forms of print and electronic media. The undersigned author(s) warrants
and represents that the article is original, is not under consideration by another journal, has not been
published previously, and contains no matter that is libelous, unlawful, or that infringes upon another
copyright.
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Date: Click here to enter a date.
CONFLICT OF INTEREST DISCLOSURE
Each author must disclose relevant financial relationships or any potential bias with an entity with a
commercial interest. An entity with a commercial interest is one that produces, markets, sells, or distributes
health care goods or services consumed by or used on patients.
Manuscripts submitted to the journal may be chosen by the editors for inclusion in the continuing
education activities offered by the Academy of Neonatal Nursing. The journal therefore complies with
Criterion 2 of the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. ANCC
considers financial relationships in any amount as relevant if they occurred in the last 12 months. Financial
relationships of spouse, family member, or partner are also considered relevant.
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Is there an actual, potential or perceived conflict of interest for yourself or spouse/partner?
☐ No ☐ Yes
If yes, please complete the table below for all actual, potential or perceived conflicts of interest.
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that
apply
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Category
Description
Salary
Royalty
Stock
Speakers Bureau
Consultant
Other
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Do you address “off label” use in your article? ☐ No ☐ Yes
[“Off-label” use is using a product for a purpose other than that for which it was approved by the FDA]
If “yes,” how will you inform readers?
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Signature: (electronic or handwritten)
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FOR EDITORIAL OFFICE USE ONLY
CONFLICT RESOLUTION
Procedures used to resolve conflict of interest or potential bias if applicable for this activity:
☐
Not applicable since no conflict of interest.
☐
Removed individual, with conflict of interest, from participating in all parts of the educational activity.
☐
Revised the role of the individual with conflict of interest so that the relationship is no longer
relevant to the educational activity.
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Not awarding contact hours for a portion or all of the educational activity.
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Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,
balance in presentation, evidence-based content or other indicators of integrity, and absence of bias,
AND monitoring the educational activity to evaluate for commercial bias in the presentation.
☐
Undertaking review of the educational activity by a content reviewer to evaluate for potential bias,
balance in presentation, evidence-based content or other indicators of integrity, and absence of bias,
AND reviewing participant feedback to evaluate for commercial bias in the activity.
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Other—Describe: Click here to enter text.
Nurse Planner Signature
An “X” in the box below serves as the electronic signature of the Nurse Planner reviewing the content of
this Copyright Transfer and Conflict of Interest Statement.
☐ Electronic Signature (Required)
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Date: Click here to enter a date.