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 Articles

  1. The Harvard Nurse Study Recruiting Nurses

Headquarters News

  1. Never Too Early to Plan – NACNS 2014 Annual Meeting
  2. July 24, 2013 NACNS Summit a Success
  3. Validation Panel for Women’s Health CNS Competencies Meeting
  4. Board to Begin Strategic Planning for 2015 – 2020
  5. NACNS President Carol Manchester to Speak at "A Collaborative Approach to Diabetes Care II"

CNS Foundation

  1. CNS Foundation Coffee a Day Campaign

Clinical Headlines

  1. Alarm Fatigue
  2. FDA Warning Related to Illegal Diabetes Products
  3. Opioid Deaths Increase in Women
  4. More Evidence Needed for Treatment of Peripheral Artery Disease

Association News

  1. Canadian Association of Advanced Practice Nurses Meeting
  2. ANA Releases Safe Patient Handling and Mobility Guidelines
  3. ANA Holds Inaugural Membership Assembly
  4. Drexel University Invites NACNS Members to Attend "Driving Quality & Excellence in Advanced Practice & Doctoral Education"

Federal and State Policy News

  1. Home Health Care Legislation Re-Introduced and Endorsed by NACNS
  2. Federal Funding – What is Happening with Nursing Education and Practice Funding
  3. Graduate Nurse Education Demonstration Grant Update
  4. Advocacy Toolkit for Use in August

Featured Articles

1. Harvard Nurse Study Recruiting Nurses

The Harvard School of Public Health and Brigham and Women's Hospital are excited to announce that the Nurses' Health Study is growing. Previous cohorts taught us much of what we currently know about how diet and lifestyle can affect women's risk of developing cancer and other serious health conditions. The goal is to enroll 100,000 female nurses into a new web-based study! Read more of our story HERE.

If you are a female nurse between the ages of 20 and 46, JOIN the study!

The study has been endorsed by the American Nurses' Association and other major Nursing organizations.

Headquarters News

2. Never Too Early to Plan – 2014 Annual Meeting in Orlando Florida

Save the date! The NACNS 2014 Annual Conference will be held at the Orlando World Center Marriott in Orlando, Florida. The dates are March 6-8, 2014. Abstract submission is open and the deadline is September 11. The call for abstracts is available on the NACNS homepage. Exhibit and sponsorship information is also available on the NACNS website.

13. NACNS Summit Draws Over 50 Participants

The NACNS 2013 Summit was held on July 23, 2013 in Washington, DC. This year’s Summit focused on key implementation issues with the APRN Consensus Model, particularly grandfathering of current CNSs and the need for population-based certification exams for licensure. The issue and importance of maintenance of specialty was discussed as well. In the past, this meeting was by invitation only. In the last few years, NACNS has invited key partners to the meeting and opened the Summit to interested NACNS members for attendance. Information from the Summit and a general synopsis of the meeting will be posted on the NACNS web site by early August.

If you are interested in attending this meeting in 2014, watch for further announcements via blast email, on the NACNS web site or through this publication. If you have any questions, please contact Jason Harbonic at jharbonic@fernley.com.

4. AWHONN/NACNS Women’s Health/Gender Specific Clinical Nurse Specialist Competencies Validation Panel Meets

On July 19, 2013 AWHONN and NACNS held the first call to assemble the validation panel to review and comment on the Women’s Health/Gender Specific Clinical Nurse Specialist Competencies. These competencies were developed by an expert panel with representatives from NACNS, AWHONN, ACNM and NPWH. The validation panel was comprised of individuals who responded to a public call for women’s health experts interested in serving on this important work group. The validation panel work will be followed by a public comment period and organizational endorsement. The public comment period will be open in fall 2013.

5. NACNS Board of Directors to Begin 2015 – 2020 Strategic Planning

Beginning in August 2013, the NACNS Board of Directors will begin to review the association’s 2012 – 2014 Strategic Plan and begin to collect information and develop a process to engage in strategic planning for the 5-year window of 2015-2020. A strategic planning session will be held at the NACNS Board of Directors face-to-face meeting in October 2013. Be alert for blast emails that ask for membership input on this process!

6. NACNS President to Speak at "A Collaborative Approach to Diabetes Care II"

Back by popular demand this two day conference brings together some of the most influential speakers in diabetes care today. A collaborative clinical focus on diabetes care is the premise these lectures have to offer with the effort to reduce costs by reducing 30 day readmission's. Patient satisfaction will not be overlooked as lecturers from Emory University discuss Translational Research to Improve Diabetes Care, Incorporating Social Media from Massachusetts General proves to be an effective method to monitor patients and keep communication ongoing. Smoothing the transition from hospital to home from New York Presbyterian/Weill Cornell reveals why meeting the new endocrine society guidelines for inpatient Glycemic control will help prevent 30 day readmission's. NACNS President Carol Manchester will speak on "Guidelines to Effectively Manage Peri Operative Glycemic Management". A sure "not to miss" event for hospitals across the country realizing that diabetes care is a costly chronic disease with the highest burden of cost and loss of quality of life.

September 26-27, 2013
Crowne Plaza, Charlotte, NC

Contact Gia Bosch at Current Advantage at (414) 255-9525 to obtain the complete conference agenda and registration details. 

CNS Foundation

7. CNS Foundation Coffee a Day Campaign

The CNS Foundation is requesting that you participate in our Planned Giving Campaign. We are asking that you donate the price of a cup of coffee per week (about $20 a month) to help us continue the Foundation work. We appreciate any amount of money you could donate though as a one-time donation or through regular planned giving.


Clinical Headlines

38. Alarm Fatigue

The enormous number of systems in hospitals has resulted in an unintended consequence as the number of alerts and reminders have evolved into annoyances that are becoming increasingly ignored, instead of meaningful assists to the patient care process. The sheer number, several hundred alarms per patient per day, can cause alarm fatigue. It’s estimated that approximately 90% of alarms in various ICU settings are either false or insignificant.

As a result, the Joint Commission is requiring hospitals, starting in January, to identify the alarms that pose the biggest safety risks by unnecessarily adding noise or being ignored. By 2016, hospitals must decide who has the authority to turn off alarms.

The Joint Commission received 98 reports of alarm-related incidents, including 80 deaths, in the 3 1/2-year period ending in June 2012. In more than 60 percent of the cases, alarms were either inappropriately turned off or were not audible in all areas. Those voluntary reports are a gross undercount, says the commission, which estimates that there were close to 1,000 alarm incidents in which patients died or were injured, or faced those risks.

The ECRI Institute, a Pennsylvania-based patient-safety organization, listed alarm hazards as the No. 1 issue on its annual list of the top 10 health-technology dangers for 2012 and 2013. ECRI Institute is an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost effectiveness of patient care. They believe that the main reason for alarm fatigue is the large growth in the use of monitors that have alarm-based features and the number of alarms that clinicians need to deal with. One key way to reduce alarm fatigue is to eliminate unnecessary monitoring wherever possible. Marjorie Funk, PhD, RN, professor at the Yale School of Nursing in New Haven, Connecticut, and her team evaluated the use of electrocardiographic (ECG) monitoring in cardiac units. They found that 26% of more than 4300 patients on monitors did not meet American Heart Association practice standards for monitoring (J Am Coll Cardiol. 2013;61[10 suppl]:E1496).

The AACN (Association of Critical Care Nurses) has developed a Practice Alert on Alarm Management. One of the practical strategies to reduce the incidence of false or non-actionable alarms is to ensure good signal quality. The alert recommends that the electrode area be washed with soap and water and wiped with a rough washcloth or gauze. Alcohol should not be used because it dries the skin out. In addition, ECG electrodes should be changed at least daily.
Whenever possible, disposable adhesive pulse-oximetry sensors should be used, and sensors should be replaced when they no longer properly adhere to the patient's skin. Monitor alarms should be customized to meet the needs of the patient, and nurses should set customized alarms within 1 hour of assuming care and as the patient's condition changes.

Sue Sendelbach, PhD, RN, director of nursing research at Abbott Northwestern Hospital Minneapolis, Minnesota, says an interprofessional approach is required to address the issue of alarm fatigue. Clinical Nurse Specialists, staff nurses, hospital administrators, and physicians, biomed engineers, systems analysts, and industry need to collaborate. The issue of alarm fatigue can most effectively be addressed, and eventually eliminated, by working with the people closest to the patient and those who support the needs of the patient.

9. FDA Alerts Companies to Stop Illegal Sale of Diabetes Products

On July 23, 2013, the U.S. Food and Drug Administration (FDA) is announced it is taking action to remove from the market illegal products, including some labeled as dietary supplements, that claim to mitigate, treat, cure or prevent diabetes and related complications. The agency recently issued letters warning 15 companies that the sale of their illegally marketed diabetes products violates federal law. The letters were sent to foreign and domestic companies whose products were sold online and in retail stores.

The FDA is advising consumers not to use these or similar products because they may contain harmful ingredients or may be otherwise unsafe, or may improperly be marketed as over-the-counter products when they should be marketed as prescription products. Using these products could cause consumers to delay seeking proper medical treatment for their diabetes. FDA-approved diabetes treatments, prescribed by a licensed health care professional and shown to be safe and effective, are readily available for people with diabetes.

Nearly 26 million Americans have diabetes. Many of the illegally sold products that are the subject to this action include claims such as "prevents and treats diabetes," and "can replace medicine in the treatment of diabetes." In addition, some of the products may cause harm because the products contain undeclared active drug ingredients or may not have been manufactured and handled according to FDA quality standards. 
These illegally sold products include:

  • Products sold as "natural" treatments for diabetes, but containing undeclared active pharmaceutical ingredients in unknown quantities that could cause harm or complicate  medical conditions;
  • Dietary supplements and ayurvedic products (medicine of the healing arts that originated in India) with claims to treat, cure, and/or prevent diabetes; 
  • Unapproved drugs sold over-the-counter, including some homeopathic products, intended to treat complications associated with diabetes, which include relieving symptoms caused by nerve damage in the arms and legs (also called peripheral neuropathy); and
  • Prescription drugs for diabetes sold by online pharmacies without a prescription.

The FDA has requested a written response from these companies within 15 business days stating how the companies will correct the violations. Failure to promptly correct the violations may result in legal action, including product seizure, injunction, and/or criminal prosecution.

To date, the FDA is not aware of any reports of injury or illness associated with the illegally sold products but is taking action to protect the public health from potential harm related to these violative products. The FDA asks health care professionals and consumers to report any adverse reactions to FDA’s MedWatch program either by:

  • completing and submitting the report online; or
  • downloading and completing the form, then submitting it via fax at 1-800-FDA-0178.

For more information:

10. Prescription Painkiller Deaths Show Dramatic Rise in Women

Women are dying from prescription painkiller overdoses at rates never seen before, according to a new CDC Vital Signs. While men are more likely to die of a prescription painkiller overdose, the percentage increase in deaths since 1999 was greater among women (400 percent in women compared to 265 percent in men). Prescription painkiller overdoses killed nearly 48,000 women between 1999 and 2010.

  • About 42 women die every day from a drug overdose (including those from prescription painkillers). Since 2007, more women have died from drug overdoses than from motor vehicle crashes. More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010.
  • Prescription painkillers have been a major contributor to increases in drug overdose deaths among women. More than 6,600 women died from a prescription painkiller overdose in 2010. This is about 18 women a day; which accounts for nearly half of all drug overdoses that happen each day among women. In 2010, there were more than 200,000 emergency department visits for opioid misuse or abuse among women; about one every three minutes.
  • Health care providers and women can take steps to protect against prescription painkiller overdoses. It is important that health care providers follow guidelines for responsible opioid prescribing (including screening and monitoring for substance abuse and mental health problems). They should also discuss all pain treatment options with their patients (including ones that do not involve prescription drugs). Women should only use prescription drugs as directed by a health care provider and should dispose of medications properly as soon as the course of treatment is done.

For more information about prescription drug overdoses, please visit CDC's Injury Center.

11. Evidence Impacting Treatment of Peripheral Artery Disease is Lacking

According to the Agency for Healthcare Research and Quality (AHRQ), available evidence for the treatment of patients with peripheral artery disease (PAD) is limited by the few studies that provide direct comparisons of treatment options.  A limited number of studies on antiplatelet therapy for the prevention of cardiovascular events in patients with PAD found that aspirin has no benefit over placebo in asymptomatic PAD patients.  Dual antiplatelet therapy is not significantly better than aspirin at reducing cardiovascular events in patients with intermittent claudication (IC, leg muscle or lower extremity discomfort), or critical limb ischemia (CLI, ischemic rest pain for more than 14 days), ulceration, or tissue loss/gangrene. Exercise therapy, medical therapy such as cilostazol, and endovascular or surgical revascularization interventions all had an effect on improving functional status and quality of life for IC patients. However, the comparative effectiveness of different treatments or combinations of treatments is uncertain. Roughly 20 to 50 percent of patients diagnosed with PAD are asymptomatic, though they usually have functional impairment when tested. More studies of asymptomatic and symptomatic patients with PAD are needed to firmly conclude whether antiplatelet monotherapy or dual antiplatelet therapy is necessary in this high-risk cardiovascular population. Additionally, further research is needed to better understand the comparative effectiveness of different treatment options for IC and CLI for different outcomes and in different populations.


Association News

12. Canadian Association of Advanced Practice Nurses To Hold October Meeting

The Canadian Association of Advanced Practice Nurses is to hold its Biennial meeting in Halifax, Nova Scotia from October 2 – 4, 2013. This conference is presented in partnership with the Nurse Practitioners’ Association of Nova Scotia (NPANS).

The conference will bring together a broad constituency from across Canada. Advanced Practice Nurses (APNs), who include Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs), work with patients and families across the continuum of care. The program will include pre-conference workshops, dedicated exhibit time, keynote presentations, poster displays, breakout sessions, the CAAPN biennial general meeting, an opening reception, and a gala dinner.

For more information on how you can support this important event or to register, please visit: Click Here

13. ANA Releases Safe Patient Handling and Mobility Principles and Guidelines

The American Nurses Association (ANA) has released a set of safe patient handling and mobility principles and guidelines that provide a framework for establishing a comprehensive program to eliminate the manual handling of health care recipients and promote a stronger culture of safety.

Safe Patient Handling and Mobility: Interprofessional National Standards apply to multiple health care professions and settings across the continuum of care, and are designed to protect health care workers from musculoskeletal disorders and health care recipients from injury caused by manual mishandling.

The Standards were developed by an interprofessional group of subject matter experts including nurses, occupational and physical therapists, safety and ergonomics experts, architects, risk management specialists, and others. The coalition was convened by ANA which adopted a position statement to eliminate manual patient handling a decade ago. The aim of the coalition is to encourage incorporation of the Standards in health care practices, policies, regulations, and legislation to promote a safer work environment, healthier workers, and a higher quality of care.

Disabling musculoskeletal disorders remains one of nurses’ top work environment safety concerns. Even though technology to lift, move, and re-position health care recipients exists and is available in some facilities, it is used inconsistently, and education and training programs often are inadequate.

The Standards are based on evidence of effectiveness in improving patient outcomes and reducing injury, and include eight principles: 1) establishing a culture of safety; 2) creating a sustainable program; 3) incorporating ergonomic design principles; 4) developing a technology plan; 5) educating and training health care workers; 6) assessing patients to plan care for their individual needs; 7) setting reasonable accommodations for employees’ return to work post-injury; and 8) implementing a comprehensive evaluation system.

 For more information on the Standards, visit: www.NursingWorld.org/SPHM-Standards.

14. ANA Holds Inaugural Membership Assembly

The American Nurses Association (ANA) held its inaugural Membership Assembly on June 28 & 29, 2013 in Crystal City, Virginia. The Assembly brought together representatives from ANA’s constituent and state nurses associations, Individual Membership Division, ANA Board of Directors and ANA’s specialty nursing organizational affiliates to develop a framework for shaping the future of the Association and the nursing profession. NACNS was represented through Carol Manchester, NACNS 2012-2013 President.

The Membership Assembly, ANA’s new governing and policy-making body, replaced the previous governing body, the House of Delegates, which ANA members voted to dissolve in 2012.

Using the theme, "A Look into the Future: Advancing the Association; Advancing the Profession," representatives explored pressing nursing and health care issues as part of an environmental scan to better position ANA to anticipate trends that may impact the nursing profession. The environmental scan also laid the foundation for policies and positions to ensure a stronger nursing presence in the emerging health care delivery system.

Assembly representatives discussed the important and sometimes competing interests regarding access to care, care coordination, patient outcomes, and licensure issues. In terms of specific actions, they referred a licensure jurisdiction proposal back to the ANA Board of Directors. The board will further review licensure implications for nurses who provide technology-enabled care, including follow-up phone calls after patient discharge, across state lines.

Representatives also voted on bylaws, or governing amendments, which included approving a timeline for smoothly transitioning to a smaller board of directors. Additionally, representatives adopted a structure that acknowledges registered nurses who are full members of a constituent/state nurses association as holding concurrent membership in ANA.

The Membership Assembly will continue to meet annually. In 2014, the Assembly will elect a new slate of officers.

15. Drexel University Invites NACNS Members to Attend "Driving Quality & Excellence in Advanced Practice & Doctoral Education"

Drexel University cordially invites NACNS members to attend its upcoming conference, Driving Quality & Excellence in Advanced Practice & Doctoral Education, on November 6-8, 2013 in Baltimore, Maryland. The key to successful healthcare systems and care delivery in the 21st century will be developing high performing healthcare teams of professionals and staff. Advanced practice nurses and doctoral graduates in the 21st century must be prepared for leadership and interprofessional challenges for a variety of roles in healthcare to foster and promote quality healthcare. Conference participants will have the opportunity to share dialogue, strategies, opportunities and challenges in the education of nurses across the continuum. Examine the complexity in educating nurses for the healthcare of the future - nurses who will be on the front line to effect positive change in healthcare delivery systems.

Details may be accessed at http://drexel.edu/cne/conferencesCourses/conferences/Advanced_Practice_Doctoral_Education/

To date, the call for abstracts is open.
Continuing nursing education contact hours will be provided. RN participants must attend the entire program to receive continuing nursing education contact hours.


Federal and State Policy

16. NACNS Endorses Home Health Care Planning Improvement Act

On June 25, 32013, NACNS endorsed H.R. 2504, the Home Health Care Planning Improvement Act of 2013. The press release at the time of the bill’s introduction quoted NACNS President Carol Manchester.

H.R. 2504, introduced by Representatives Greg Walden (R-OR) and Allyson Y. Schwartz (D-PA), would allow clinical nurse specialists, nurse practitioners, certified nurse midwives, and physician assistants to order home health services for Medicare beneficiaries. Medicare currently only recognizes nurse practitioners and physician assistants as authorized providers who can order nursing home care for Medicare beneficiaries. Even in states that have explicitly expanded their laws to allow other medical providers to order home care, Medicare still does not certify payment for these services until a physician signs the order. 

The NACNS endorsement letter can be found at http://www.nacns.org/docs/Schwartz.pdf.

17. Senate Appropriations Subcommittee Increases FY 2014 Funding for Title VIII Programs

On July 9, 2013, the Senate Appropriations Subcommittee on Labor, Health and Human Services (LHHS) approved its FY 2014 appropriations bill by voice vote. The bill provides $251.099 million for the Title VIII Nursing Workforce Development programs, consistent with the President’s FY 2014 budget recommendation and the request made by NACNS. The increase in funding for Title VIII was directed to the Advanced Nursing Education program bringing the total for this program to $83.469 million. The remaining Title VIII programs were funded at levels consistent with the President’s recommendations. Additionally, $5 million was set aside for Nurse-Managed Health Clinics. The increase to the Title VIII programs is 15% over the FY 2013 post sequestration levels.

The full Senate Appropriations Committee then approved its subcommittee’s proposal on July 11. There is no word yet on when the FY 2014 LHHS Appropriations will be debated on the Senate floor. 

While it is unclear if the House LHHS Appropriations Subcommittee will hold a markup this year, the subcommittee has indicated there could be a markup prior to the August recess. Regardless of when the House takes action on the FY 2014 LHHS appropriations bill, the House funding levels for the Title VIII programs will be less than what the Senate Appropriations Committee approved. The overall funding level for programs funded by the House version of the FY 2014 LHHS Appropriations bill is $121.8 billion, an 18.6% cut below FY 2013.

18. APRN Organizations Comment on GNE Evaluation 

On June 3, 2013, NACNS joined eight other nursing organizations in a letter to the Centers for Medicare and Medicaid Services (CMS) commenting on the proposed evaluation of the Graduate Nurse Education Demonstration (GNE) project. GNE, passed as a part of the Patient Protection and Affordable Care Act (PPACA), is a first-of-its-kind government venture.

The project aims to help increase access to quality health care for all by growing the supply of advanced practice registered nurses. GNE seeks to do so by providing Medicare reimbursements to hospitals for the reasonable cost of providing clinical training to APRN students. The demonstration involves five hospital systems and the partnerships they have created with 21 nursing schools and community-based care settings, such as nurse-managed health clinics, community health centers, and home health organizations. Of the 21 nursing schools involved in the demonstration, nine schools are including CNSs in their recruitment and training, plus two other nursing schools propose to recruit NPCNSs over the course of the four-year project.

The June letter NACNS signed with the other APRN organizations comments on the proposed evaluation’s gathering and analyzing of quantitative and qualitative data from primary and secondary sources. The initial evaluation results likely will be publicly available by the end of 2013. 

19. Advocacy Toolkit for August Congressional Recess Available Online

During its August Recess (August 5 – September 9), Members of Congress will return to their home states and meet with constituents. It is critically important that you talk to your elected officials about the benefits of investments in the Title VIII Nursing Workforce Programs at the Health Resources and Services Administration (HRSA). The ANSR Alliance, of which NACNS is a member, has drafted an advocacy toolkit to provide you with all of the tools you need to contact your senators and representatives.

Here's why your actions during the August Recess are important:

Our country continues to be challenged by a chronic nursing shortage of RNs that was first noted more than 15 years ago in 1998. This shortage presents an extremely serious challenge in the delivery of high-quality, cost-effective services, especially with the expected influx of new people into the health care system.

These important programs provide the main federal funding for nursing education, practice, and retention, aimed at maintaining an adequate supply of nurses to attain the nation's goal of ensuring access to affordable, high-quality health care, particularly for the country’s vulnerable populations.

Funding for the Title VIII programs have been reduced over the last three fiscal years. The March 2008 study, The Future of the Nursing Workforce in the United States: Data, Trends, and Implications, calculates an adjusted projected demand of 500,000 full-time equivalent registered nurses by 2025. According to the U.S. Bureau of Labor Statistics, employment of registered nurses is expected to grow by 26 percent from 2010 to 2020 resulting in 711,900 new jobs. Reducing funding for programs such as HRSA’s Title VIII Nursing Workforce Development Programs will do more harm than good.

Three actions you should take in August:
1. Schedule meetings with your Members of Congress. Here's how.
2. Send a letter to the editor of your local newspaper. Here's how.
3. Find and attend a town hall meeting. Here's how to find one and what to ask.

Be sure to let us know how it goes!  

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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