The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists. The purpose of this publication is to keep our members updated on the NACNS headquarters news; connect our members with fast-breaking clinical news; and update clinical nurse specialists on state and federal legislative actions.

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Featured Headline

  1. National Association of Clinical Nurse Specialists Speaks Out Against "Scrubbing In"

Headquarters News

  1. NACNS Board Meeting Updates
  2. Alarm Fatigue Task Force to Begin in Late November
  3. Student Poster Abstract for NACNS Conference
  4. NACNS 2014 Conference, The Best Kept Secret - The Clinical Nurse Specialist Contribution to Quality Care March 6 – 8, 2014
  5. NACNS Seeks Clarification from CCNE
  6. NACNS Journal – Clinical Nurse Specialist – App for the iPad

CNS Foundation

  1. CNS Scholarships
  2. CNS Foundation Silent Auction

Association News

  1. AWHONN and NACNS Post Women’s Health/Gender Specific Clinical Nurse Specialist Competencies for Public Comment

Clinical News

  1. Clinical Trial for New Breast Cancer Imaging Technology
  2. IOM Report – Sports Related Concussions in Youth

Federal and State Policy News

  1. Federal Budget – Next Steps After the Federal Shutdown
  2. House and Senate Continue Work on FY 2014 Spending Bills
  3. New Report Says Budget Cuts Make Us Sicker, Poorer, and Less Secure
  4. CMS Rules on CoPs for Community Mental Health Centers (CMHC)
  5. NACNS Comments on Veteran's Health Administration Nursing Handbook 1180.03
  6. ICD 10 Ready for Use in October 2014
  7. NACNS Advocates Against Hydrocodone Combination Product Up-Scheduling
  8. Briefing – Re-Design of Health Workforce
  9. Reform of the Sustainable Growth Rate (SGR): A Status Report

Featured Headline

1. National Association of Clinical Nurse Specialists Encourages Cancellation of MTV Show "Scrubbing In"

On October 24, MTV began airing a new reality show about nurses which has caused an uproar in the nursing community. The show, "Scrubbing In," features a cast of young traveling nurses and focuses primarily on their personal lives, rather than their work as nurses.

The National Association of Clinical Nurse Specialists (NACNS) called on MTV to cancel the show on the grounds that it is demeaning to nurses and detrimental to efforts to address the nursing shortage. Several other nursing associations, including National Nurses United, American Nurses Association, Canadian Nurses Association, and Change.org have also urged the network to chancel the show pointing out that its portrayal of nurses is offensive and may harm efforts to encourage young people to enter the profession.

In a letter addressed to MTV President Stephen Friedman, NACNS President Carol Manchester wrote:

As an organization representing nurses, we at the National Association of Clinical Nurse Specialists are deeply disappointed in MTV’s decision to air the reality television show "Scrubbing In." This program portrays nurses in a disrespectful and unfair light for purely salacious purposes. We urge you in the strongest possible terms to cancel it.

As the largest group of health care professionals, nurses are central to providing and improving our nation’s health care. As you must be aware, the United States is facing a shortage of nurses and there are efforts underway across the country to encourage young people to enter nursing and increase enrollment in nursing schools. A television program that intentionally reinforces negative and antiquated stereotypes about nurses and that shows them in the worst possible light does nothing to support those efforts, and, in fact, serves to do the opposite.

At a time when our nation needs nurses more than ever, this program is denigrating and demeaning the members of what has been shown time and again to be one of the most trusted professions in the United States. "Scrubbing In" does a serious disservice to nurses, nursing students, our health care system and our nation as a whole.

Headquarters News

12. NACNS Board Met in Orlando, Florida

The NACNS Board of Directors met October 11 and 12 at the Orlando World Center Marriott. This property is the site for the March 6 – 9, 2014 Annual Meeting. The Board engaged in strategic planning, media training in addition to the scheduled meeting agenda. NACNS membership will ask to engage in strategic planning through a www.surveymonkey.com assessment early in 2014. This will allow the Board to develop the 2015 – 2020 Strategic Plan for the association. The media training was performed by PR Solutions. The Board had the opportunity to practice on-camera media skills and develop talking points for the association to use to describe the role of the clinical nurse specialist.

The NACNS Board approved the 2014 slate for the NACNS election; a balanced budget for 2015; and exploration of the association to offer webinars to the clinical nurse specialist. The Board will continue to work on the adoption of a paper that describes the outcomes of clinical nurse specialist practice. This document is being written by the NACNS Legislative/Regulatory Committee and will be completed by the end of 2013 for use with various audiences. Additionally, the NACNS Legislative/Regulatory Committee presented a document designed to assist state board in their consideration of prescriptive authority for the clinical nurse specialist. This document will be provided to NACNS members that are working with their state boards on this issue.

The NACNS Board of Directors meets monthly via conference call. They will meet face-to-face at the NACNS Annual Meeting in March, 2014.

3. Alarm Fatigue Task Force to Begin in Late November

NACNS received approximately 30 applications for the Board’s recently approved Alarm Fatigue Task Force. The individuals have been selected and will receive notification from the NACNS Headquarters shortly. The Task Force is anticipated to being their work in late November. The purpose of this task force is to provide recommendations to the NACNS Board of Directors on activities and resources that the clinical nurse specialist needs in order to provide leadership in their workplace on this important issue. 

4.  Student Poster Abstract for NACNS Conference

While the Call for Abstracts deadline for our 2014 Conference, The Best Kept Secret - The Clinical Nurse Specialist Contribution to Quality Care to be held in Orlando, FL from March 6-8th is Wednesday closed on September 11, 2013… students still have an opportunity to respond! Student poster abstracts may be submitted through Monday, December 2, 2013. All submissions must be made online through our Abstract Management System. Please visit the submission site for all instructions and guidelines. 

5. NACNS 2014 Conference, The Best Kept Secret - The Clinical Nurse Specialist Contribution to Quality Care  March 6 – 8, 2014

It is time to consider your plans to attend the NACNS 214 Conference. The conference offers the opportunity for you to network with your colleagues as well as enjoy the sunny resort environment of the Orlando World Center Marriott and of course, the many activities in Orlando. Conference registration and lodging information will be available soon. Room rates at the Orlando World Center Marriott will be available for $189/night for single or double rooms. For specific questions about registration or hotel accommodations, please contact the NACNS office at 215-320-3881 or info@nacns.org.

We hope to see you in Orlando, FL in March, 2014!

6. NACNS Seeks Clarification from CCNE

During the past year, the Commission on Collegiate Nursing Education (CCNE) revised the Standards for Accreditation of Baccalaureate and Graduate Nursing Programs. The NACNS reviewed the proposed standards during the comment period and requested that the Criteria for Evaluation of Clinical Nurse Specialists’ Masters, Practice Doctorate, and Post-Graduate Certificate Educational Programs be considered as either a reference or resource document in the revised document. Although the Criteria have been endorsed by the CCNE, the Criteria are not directly referenced in the final published version of the 2013 Standards. Please note the following paragraph excerpted from the Standards which directs accreditation applicants to identify and use documents such as the Criteria when applying for specialty programs:

Throughout this document, the need for programs to demonstrate the incorporation of professional nursing standards and guidelines is emphasized. CCNE requires, as appropriate, the following professional nursing standards and guidelines: 1) The Essentials of Baccalaureate Education for Professional Nursing Practice [American Association of Colleges of Nursing (AACN), 2008]; 2) The Essentials of Master’s Education in Nursing (AACN, 2011); 3) Criteria for Evaluation of Nurse Practitioner Programs [National Task Force on Quality Nurse Practitioner Education (NTF), 2012]; and 4) The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006). Programs identify additional nursing standards and guidelines selected as the basis for specialty programs, as appropriate. (Page 4) (Emphasis added)

The NACNS continues to seek specific clarification from the CCNE about the use of the Criteria by programs applying for accreditation of CNS programs and will update the membership as further information becomes available.

7. NACNS Journal – Clinical Nurse Specialist – App for the iPad

Beginning September 30, Clinical Nurse Specialist for the iPad will be restricted to members and subscribers to the Journal. Your subscription to CNS includes 6 print issues per year, full online access to cns-journal.com, including archived issues, and now exclusive access to the CNS iPad App!

As a member, it’s easy to continue access to issues of CNS for the iPad. 

  • Open the CNS app on your iPad, click “Sign In” at the top left of your screen, and follow the instructions

Activate your subscription today to continue to access CNS for the iPad

If you haven’t seen Clinical Nurse Specialist for the iPad, download today - and join your colleagues who have already chosen CNS as their professional journal of choice.

Have questions? Need assistance? LWW Customer Service can help. Contact them at custserv@lww.com or call 1-800-638-3030.


CNS Foundation

8. CNS Scholarships

The CNS Scholarship applications now have a due date of December 31, 2013. Winners will be notified by January 31, 2014. A poster identifying the winners will be able to be viewed at the CNS Foundation Silent Auction table in the Exhibit Hall. Please visit the CNS Foundation page to review the application criteria.

9. CNS Foundation Silent Auction

The CNS Foundation will host another Silent Auction at the 2014 NACNS Conference. We ask individuals and affiliates to submit prizes to be auctioned off during the conference. Electronics, jewelry, gift cards and crafts have sold well in the past. Please bring you items to the conference or mail them Kathy Baldwin, the foundation chair (7029 Brierhill Court, Fort Worth, TX 76132). Small, easily transportable items are recommended.


Association News

310. AWHONN and NACNS Post Women’s Health/Gender Specific Clinical Nurse Specialist Competencies for Public Comment

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and NACNS has been partnering to develop the Women’s Health/Gender Specific Clinical Nurse Specialist Competencies. These Competencies have been developed by an initial committee with representatives from AWHONN, NACNS, ACNM and NPWH. This work was then reviewed by a validation panel. The validation panel reviewed every distinct competency and provided comments that have resulted in the draft of the Competencies that is posted for public comment. The public comment period is now open for the Women's Health Clinical  Nurse Specialist Competencies. The deadline for comment is December 18, 2013

Note that the Women’s Health CNS Competencies are built upon the National CNS Core Competencies (NACNS, 2008) for all clinical nurse specialists. These core competencies are listed on the left of the WH CNS competencies document for your reference.

In order to comment, you must open two documents: 

  1. Draft competencies, posted on the NACNS Homepage.
  2. Survey tool

Please provide your comments in this survey tool on www.SurveyMonkey. Due to the expected volume of comments, we cannot guarantee that we will be able to accept comments in any other format.


Clinical News

11. Hope for a More Accurate Breast Cancer Diagnosis?

A new clinical trial is investigating a non-invasive, radiation-free imaging system that has the potential to help health care providers more effectively determine which patients need biopsies. It could potentially help women benefit from a more accurate breast cancer diagnostic process in the future if they ever have a suspicious breast lesion.  

12. IOM Report - Sports-Related Concussions in Youth: Improving the Science, Changing the Culture

Despite growing awareness of sports-related concussions and campaigns to educate athletes, coaches, physicians, and parents of young athletes about concussion recognition and management, confusion and controversy persist in many areas. The IOM and the National Research Council formed an expert committee to review the science of sports-related concussions in youth from elementary school through young adulthood, as well as in military personnel and their dependents. The committee's report finds that while some studies provide useful information, much remains unknown about the extent of concussions in youth; how to diagnose, manage, and prevent concussions; and the short- and long-term consequences of concussions as well as repetitive head impacts that do not result in concussion symptoms.


Federal and State Policy

13. The Continuing Resolution: What it really Means

On October 17, 2013, President Obama signed the Continuing Appropriations Act of 2014 (H.R. 2775), which funds government agencies at current FY 2013 post-sequestration levels through January 15 and avoids default by extending the nation’s debt ceiling.

The House and Senate appointed conferees to negotiate longer-term budget plans and a framework for FY 2014 spending, including resolving House-Senate differences in the overall level of discretionary funding available to appropriators. The budget conference report is due December 13, 2013. 

While the continuing resolution (CR) extends the FY 13 funding level for Title VIII Nursing Workforce Development Programs through January 15, 2014, the programs’ FY 2014 funding will not be finalized until Congress completes its appropriations work before the CR expires.

14. House and Senate Continue Work on FY 2014 Spending Bills

The Budget Conference Committee, led by House Budget Committee Chairman Paul Ryan (R-WI) and Senate Budget Committee Chairwoman Patty Murray (D-WA), has been charged with finding a path forward on fiscal year (FY) 2014 spending and finding alternative ways to reduce the deficit to replace sequestration, which will continue through 2021 if Congress does not take action. Currently, the federal government is operating under a continuing resolution through January 15, 2014, which keeps the same spending levels that were in place before the shutdown.

While expectations are tempered, and there seems to be little momentum for a "grand bargain." House and Senate leaders remain about $91 billion apart on FY 2014 spending, and finding areas of agreement on replacements for sequestration’s automatic spending cuts will likely force lawmakers to have difficult discussions about politically sensitive issues, including:

  • Tax reform
  • Changes to Medicare, Medicaid, Social Security, and other mandatory programs
  • Additional healthcare reforms
  • More targeted spending cuts to defense and non-defense programs (which include many health related programs)

The conference committee has a self-imposed deadline of December 13 to send a conference report of recommendations to the full Congress. If they are unable to reach an agreement, House and Senate leadership is expected to take over negotiations to work out at least another short-term funding extension beyond January 15.

15. New Report Says Budget Cuts Make Us Sicker, Poorer, and Less Secure

In a new report released on November 11, titled Faces of Austerity: How Budget Cuts Have Made Us Sicker, Poorer, and Less Secure, NDD United tells the stories of people who have been affected by federal budget cuts, including across-the-board cuts known as sequestration. NDD United is a coalition of leaders joining forces in an effort to save public services (known in Congress as nondefense discretionary (NDD) programs) from budget cuts. NACNS has supported NDD United advocacy efforts on sequestration.

The report breaks down how budget cuts have affected Americans sector-by-sector. Here are some highlights from the report’s public health section:

  • In fiscal year 2013, the federal government spent about 1% of its total budget on public health; the equivalent of just 0.2% of our nation’s overall economy.
  • Since fiscal year 2010, federal discretionary funding for public health has been cut nearly 12% — including sequestration, but before accounting for inflation — with wide variation in how these cuts are distributed across federal agencies.
    • Core discretionary budgets for the Centers for Disease Control (CDC) and Prevention and the Health Resources Services Administration have been cut 19% and 27%, respectively.
    • The bulk of federal public health dollars – for CDC, as much as 70% – flows directly to state and local health departments and other external partners.
    • Since 2008, 46,000 state and local public health professionals have been laid off – those who monitor and respond to outbreaks, immunize children and the elderly, and inspect restaurants.

For more statistics, to read stories about real people impacted by these numbers, or to read the full report, visit www.nddunited.org.

16. CMS Rules on CoPs for Community Mental Health Centers (CMHC)

CMS issued a final rule establishing, for the first time, conditions of participation that CMHCs must meet in order to participate in Medicare. The regulations are effective October 29, 2014.

The rule states that non-physician practitioners, such as APRNs, are essential to the care of clients served in a CMHC.  To address the use of an APRN for assessment and as a member of the treatment team, CMS modified language in various provisions of the Code of Federal Regulations Title 42, Section 485, covering the Medicare program. For example, a CNS as a member of an interdisciplinary team is allowed to coordinate care and treatment decisions with each client, to ensure that each client’s needs are assessed, and to ensure the active treatment plan was implemented as indicated.

CMS states "…there is no documented research demonstrating improved outcomes in partial hospitalization program by having a physician leading the team, and such a requirement may limit collaboration and the role of the other qualified practitioners. Therefore, based on the client’s needs, in addition to a physician, CMS now allows for a nurse practitioner, a clinical nurse specialist, a clinical psychologist, a physician assistant, or clinical social worker to serve as the leader of a CMHC team, if permitted by State law and within her or his scope of practice. This allows the CMHC greater flexibility to meet the client’s needs."

17. NACNS Comments on Veteran’s Health Administration Nursing Handbook 1180.03

In September, NACNS sent a letter to the Department of Veteran’s Affairs Secretary Eric Shinseki to   comment on the Veterans Health Administration (VHA) updating of the VHA Nursing Handbook 1180.03.  The VHA is a leader in healthcare delivery and is moving to more fully utilize the advanced practice registered nurse (APRN) including the clinical nurse specialist.   This draft of the VHA Nursing Handbook recognizes advanced practice registered nurses (APRNs), including clinical nurse specialists (CNS), as licensed independent practitioners (LIPs).   In our comments we reinforced unique and advanced level competencies that the CNS possess that can meet the increased needs of improving quality and reducing costs in our healthcare system.  We spoke to the CNS as leaders of change in health organizations, developers of evidence-based programs to prevent avoidable complications, coaches of those with chronic diseases to prevent hospital readmissions, facilitators of teams in acute care and other facilities to improve the quality and safety of care, including preventing hospital acquired infections and reducing length of stays. In addition, we noted that there are growing numbers of CNSs providing Medicare Part B services to beneficiaries and have prescriptive privileges in most states.

NACNS also highlighted the need for the VHA to consider some modifications that would allow the CNS section of the VHA Nursing Handbook to be more closely aligned with the state implementation of the APRN Consensus Model.  We specifically identified the challenge that certain CNS groups face with the lack of population certification examinations in their specific area of practice.

NACNS will continue to monitor the progress of the VHA’s Nursing Handbook 1180.03. 

18. ICD-10 Required in October of 2014 – Some Resources

The Centers for Medicare & Medicaid Services has posted a draft ICD-10 definitions manual and code editor for the fiscal year 2014 Medicare Severity-Diagnosis-Related Groups (version 31). Health care providers can use the manual and editor, available under "downloads," to better understand the impact of the ICD-10 coding system for medical diagnoses and inpatient procedures on the MS-DRG system. Hospitals and other entities covered by the Health Insurance Portability and Accountability Act must convert to the ICD-10 coding system by Oct. 1, 2014. For more information, the Medicare Learning Network offers resources and educational videos on ICD-10.

19. NACNS Joins Numerous Health Care Organizations Expressing Concern Over FDA’s Promotion of Up-Scheduling of Hydrocodone Products

The diversion, misuse, and abuse of opioids have reached unacceptable levels in certain parts of the United States and in an effort to reduce this problem, the U.S. Food and Drug Administration (FDA) has sent a letter to the Department of Health and Human Services asking for efforts to reclassify hydrocodone-combination drugs as Schedule II controlled substances. Because of the impact this move would have on access to care and the ability of many non-physician providers to prescribe pain relief medications for their patients, NACNS these organizations in declaring this action would "… irrefutably have serious health consequences for patients." Overall, reclassification would severely limit patient access to effective pain treatment and would, in some cases, completely eliminate the ability of some types of providers to deliver treatment to their patients when they need care and during a critical time in the healing process.


Of course, it is important to underscore that NACNS, and these partner organizations, wholeheartedly agree that concrete steps must be taken to help stem the tide of abuse, misuse, and diversion of all opioid products, But, the FDA recommendation that calls for the wholesale up-scheduling of hydrocodone-combination products is a blunt and imprecise tool which will in the end prove to do more harm than good. In our letter we asked Secretary Sebelius to reject the FDA recommendation and engage in discussions with the full prescribing community in order to come up with reasonable strategies to find a more targeted and less harmful approach to combatting opioid diversion, abuse, and misuse across America. 

20. Briefing on Redesign of Health Care Workforce

The November 2013 issue of Health Affairs, "Redesigning The Health Care Workforce," centers on how the U.S. healthcare workforce can respond to the Affordable Care Act’s expanded coverage and new models of care, as well as to an aging population. Some of the studies from the November issue were discussed at a health policy briefing held in Washington, D.C. on November 14. 

Amid constant debate over health delivery system reforms, insufficient attention has been given to the needs of the future healthcare workforce in light of rapid changes. The briefing noted that current healthcare workforce trends show:

  • Increased demand for care
  • Cost increases
  • Aging population and expanded access
  • System reforms
  • Innovation
  • Increased attention to primary care, chronic care prevention, behavioral health and population health.

A growing awareness exists of the role of the health care workforce in system transformation. Panelists reiterated that effective healthcare workforce planning is a federal–state responsibility and national workforce statistics may mask the need in local communities. More data, research and studies are needed to inform workforce decision making and make policy more evidence-based. 

Additionally, new models of clinical education need to be created as the current environment is hospital-based rather than community-based. Interdisciplinary teams will help this situation. One panelist recommended moving from a time-based to competency-based education system as well as investing more in faculty.

In the discussion on nurse managed health centers (NMHC) and patient-centered medical homes (PCMH), the study found that the physician shortage decreases as the use of NMHCs and PCMHs grow. Physician shortage projections are sensitive to changes in primary care delivery models. 

Videos of the November 14 briefing are available.

21. Reform of the Sustainable Growth Rate (SGR): A Status Report

The last chance for Congress to block a nearly 25% cut in Medicare provider payments is fast approaching. On December 31, a long list of health policy provisions will expire. Traditionally, Congress has continued the payments one year at a time. This year, interest groups are hoping for solutions that will last for at least a few years, if not a decade.

On October 31, the chairmen of the House Ways and Means and Senate Finance committees released a draft legislative proposal that would replace the current SGR system with a pay-for-value system focused on medical outcomes rather than procedures and which would provide no increases in pay through 2023. The new proposed pay system, called the Value-Based Performance (VBP) Payment Program, would allow Part B providers to earn performance-based incentive payments through a compulsory budget-neutral program.

The VBP program would apply to physicians beginning with payment year 2017; to physician assistants, nurse practitioners and clinical nurse specialists beginning with payment year 2018; and to all others beginning with payment year 2019. Another part of the proposal would encourage care management services for individuals with complex chronic care needs through the development of new payment codes for such services, beginning in 2015.
NACNS, along with other APRN organizations, are advocating the following principles in our discussions with Congress:

  • Congress should direct that registered nurses (RNs) and APRNs be made full partners in the development, use and evaluation of quality measures, including measures used for Medicare payment and incentives.
  • Congress should ensure that measures evaluate the work being done by the provider who is performing the service. There should be no measures that reward physicians or other providers solely for the services RNs or APRNs lead and deliver.
  • Congress should require that the infrastructure for quality reporting be accessible and transparent. Currently, the services RNs and APRNs provide are often kept from being reported to registries organized and managed by medical specialty societies. 
  • Medicare payment reform legislation should ensure that the development and implementation of alternative payment systems such as Accountable Care Organizations and bundled payment involves and recognizes APRNs in the same manner that physicians are recognized.

In the current political climate, some provider groups have acknowledged that getting even a short-term extension will be difficult and an uphill battle.

This is a publication of the National Association of Clinical Nurse Specialists. You are receiving this publication because you are identified as holding a membership in NACNS. If you wish to unsubscribe from this publication, please email info@nacns.org. Please note, if you unsubscribe, this will remove you from all email communications from NACNS.
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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.
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www.nacns.org | info@nacns.org