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 Asks For Feedback on 2015-2020 Strategic Plan Mission and Goals

Headquarters News

  1. NACNS Releases Paper on CNS Outcomes
  2. Alarm Fatigue Task Force Underway
  3. NACNS 2014 Conference, The Best Kept Secret - The Clinical Nurse Specialist Contribution to Quality Care  March 6 – 8, 2014
  4. Membership Survey – Complete Survey and Be Eligible to Win
  5. CNN Selects Clinical Nurse Specialist as “Best Job”

Association News

  1. AWHONN and NACNS Post Women’s Health/Gender Specific Clinical Nurse Specialist Competencies Enter Endorsement Phase

Clinical News

  1. Surgeon General’s Report on Smoking Tobacco
  2. Universal Screening for Gestational Diabetes

Federal and State Policy News

  1. Federal Budget
  2. Why Hospitals are Observing, Not Admitting Patients
  3. Back to the Future of Nursing: A Look Ahead Based on the Landmark IOM Report
  4. Reform of the Sustainable Growth Rate (SGR): A Status Report
  5. CMS Issues Proposed Rule on Emergency Preparedness Requirements

Featured Headline

1. NACNS Polls Membership for Opinions On the 2015-2020 Association’s Mission and Goals

NACNS’ 2013-2014 Board of Directors has sent a poll to NACNS members to gather feedback on the proposed 2015-2020 Mission and Goals. This survey is an important way for you to have input into the future plans of the association. This survey will be followed in the near future with a second member survey that will look at the specific tactics the organization hopes to implement to achieve the identified goals. Your input on the second survey will be critical data for the NACNS Board of Directors and will be used for their decision-making process.


Headquarters News

12. NACNS Board of Director’s Releases Paper on the Cost and Outcomes Associated with the CNS

On December 12, 2013, NACNS released a new White that provides evidence that Clinical Nurse Specialists (CNSs) have the advanced nursing education, skills and expertise necessary to meet the increased demand for health care and ensure the provision of quality care. A body of scientific research and several demonstration projects have shown that CNSs are uniquely suited to lead health care institutions’ efforts to implement programs, practices and interventions that will improve care quality and reduce cost in a variety of practice areas. The NACNS White Paper provides evidence of CNSs’ key roles in improving outcomes and reducing costs for: prenatal care; preventive and wellness care; care to reduce depression; chronic conditions; preventing hospital-acquired conditions (HACs); reducing lengths of stays in acute and community care centers; and preventing readmissions. Among the findings:

  • CNSs improved access to wellness and preventive services for people at risk for chronic diseases, such as diabetes and heart failure, through early identification of these individuals;
  • In private practice and as part of health care teams, CNSs implemented interventions that increased recognition of depression and provided effective behavioral health care to reduce depression;
  • CNSs providing prenatal home care improved outcomes for pregnant women at high risk for delivering low birth-weight babies;
  • CNSs effectively promoted self-care for patients with chronic conditions, reducing costs of treating the conditions and readmissions;
  • CNSs successfully led efforts to implement programs that dramatically reduced HACs in acute care settings;
  • CNSs implemented practices in acute care and community-based settings that significantly decreased patients’ length of stay; and
  • CNSs coordinated, implemented and evaluated plans that improved patient care and prevented

“The CNS has long been a crucial member of the health care team,” said NACNS President Carol Manchester. “That role is only going to become more central as the Affordable Care Act is rolled out. The dramatic increase in the number of people with access to health care services and provisions like penalties for high readmission rates for Medicaid recipients will push health care providers to take all possible measures to improve the quality of patient care and reduce costs. CNSs have the education and the skills to help institutions achieve these goals. They provide diagnosis, treatment, and ongoing management of patients. They also provide expertise and support to nurses caring for patients at the bedside, help drive practice changes throughout the organization, and ensure the use of best practices and evidence-based care to achieve the best possible patients.”

3. NACNS’ Alarm Fatigue Task Force Underway

Subsequent to an April 8, 2013 Joint Commission Sentinel Alert, the NACNS Board of Directors called for and appointed a task force of NACNS members to review the field of research and information on alarm fatigue and recommend to the Board what information and resources the CNS needs to address this issue in their clinical area. The task force is meeting monthly and is working on a number of resources including a tool kit of resources and a webinar on Alarm Fatigue for the CNS.

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

Snow and cold got you down? It is time to consider your plans to attend the NACNS 214 Conference. We are offering preconference topics including a 5 CE credit pharmacology course. 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 aand of course, the many activities in Orlando. 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.

5. NACNS Membership Survey

Make sure you check your email and take a few minutes to complete the NACNS Membership Survey. This survey is used to make decisions about the products and services you want. In addition, it gives us a good picture of how and where you work and what you are interested in. This year you can enter yourself into a drawing for a free registration to the March 2014 Annual Conference. So don’t miss the opportunity to give us your opinion and enter to win!

6. CNN Identifies the Clinical Nurse Specialist as One of the “Best Jobs”

On November 13, 2013, CNN published an article on the nation’s best jobs – the clinical nurse specialist. Ranking second on their list, the clinical nurse specialist is described as a hot healthcare career. "With Obamacare raising the pressure to control health costs, it's no surprise this is a hot healthcare career. These change agents use their clinical expertise and organizational influence to develop policies designed to improve patient outcomes and deliver health care more efficiently."


Association News

7. AWHONN and NACNS Finish Public Comment Period for Women’s Health/Gender Specific CNS Competencies

The Association of Women’s Health, Obstetric and Neonatal Nurses and NACNS are drawing close to the end of our collaboration, having completed the public comment period for the Women’s Health/Gender Specific CNS Competencies. By the end of February it is anticipated that the original panel and validation panel will have the opportunity to review the public comments and provide final expert opinion on these competencies. Once the AWHONN and NACNS Boards of Directors approve the final CNS competencies, the document will be circulated for association endorsement.


Clinical News

38. Surgeon General’s Report – The Health Consequences of Smoking – 50 Years of Progress:  A Report of the Surgeon General

On January 17, 2014, the Surgeon General’s Office released their report, The Health Consequences of Smoking – 50 Years of Progress:  A Report of the Surgeon General. This report addresses the status of smoking-related diseases since the hallmark 1964 Surgeon General’s report. According to the new report, over the last 50 years, more than 20 million Americans have died from smoking. Cigarette smoking kills nearly half a million Americans a year, with an additional 16 million suffering from smoking-related conditions. They estimate the cost to America is on the order of $289 billion a year in direct medical care and other related economic costs. Approximately 5.6 million American children alive today – or one out of every 13 children under age 18 – will die prematurely from smoking-related diseases unless current smoking rates drop.

One point emphasized in the report was that of all tobacco products, cigarettes, or burned tobacco products are the most dangerous and addictive of all tobacco. This is attributed to the numerous chemical additives combined with the inhalation of the substances contained in cigarettes.  

The 1964 report concluded that cigarette smoking causes lung cancer. Since that time, smoking has been identified as a cause of serious diseases of nearly all the body’s organs. The new report adds diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and other conditions to the list of diseases that cigarette smoking causes. In addition, the report concludes that secondhand smoke exposure is now known to cause strokes in nonsmokers.

Although youth smoking rates declined by half between 1997 and 2011, each day another 3,200 children under age 18 smoke their first cigarette, and another 2,100 youth and young adults become daily smokers. Every adult who dies prematurely from smoking is replaced by two youth and young adult smokers.

Health and Human Services Secretary Kathleen Sebelius stated that, “We’re asking Americans to join a sustained effort to make the next generation a tobacco-free generation. This is not something the federal government can do alone. We need to partner with the business community, local elected officials, schools and universities, the medical community, the faith community, and committed citizens in communities across the country to make the next generation tobacco free.”

9. U.S. Preventive Services Task Force Universal Screening for Gestational Diabetes

On January 14, 2014, the U.S. Preventive Services Task Force (USPTF) announced its call for universal screening of asymptomatic pregnant women for gestational diabetes mellitus (GDM) after 24 weeks of pregnancy. GDM is glucose intolerance discovered during pregnancy. The prevalence of GDM in the United States is 1% to 25%, depending on patient demographics and diagnostic thresholds. Pregnant women with gestational diabetes are at increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia (which can cause shoulder dystocia and birth injury), and neonatal hypoglycemia. Women with GDM are also at increased risk for developing type 2 diabetes mellitus; approximately 15% to 60% of women develop type 2 diabetes within 5 to 15 years of delivery.

Screening for GDM generally occurs after the 24th week of pregnancy. Screening before 24 weeks may identify women with glucose intolerance earlier in pregnancy. Several factors increase a woman's risk for developing GDM, including obesity, increased maternal age, history of GDM, family history of diabetes, and belonging to an ethnic group that has increased risk for developing type 2 diabetes mellitus (Hispanic, Native American, South or East Asian, African American, or Pacific Island descent).

Factors associated with a lower risk for developing GDM include age younger than 25 to 30 years, white race, a body mass index (BMI) of 25 kg/m2 or less, no family history (that is, in a first-degree relative) of diabetes, and no history of glucose intolerance or adverse pregnancy outcomes related to GDM.


Federal and State Policy

10. FY 2014 Budget Deal Signed by President

On December 26, 2013, President Barak Obama signed into law the Bipartisan Budget Act of 2013 (BBA). This bill sets levels for overall spending for the next two fiscal years and replaces a large portion of the scheduled sequestration cuts, restoring almost two-thirds of the scheduled nondefense discretionary (NDD) cuts in 2014, but providing significantly less relief in 2015. In addition, the bill provides much needed certainty for FY 2014 and 2015 and paves the way for passage of appropriations bills through normal procedures – a welcome improvement over the more recent precedent of falling back on continuing resolutions and lurching from fiscal crisis to crisis.

The BBA increases the NDD 2014 spending cap to $491.773 billion and $492.456 billion in 2015. It avoids tax increases, shrinks the sequester by $63 billion over the next two years and modestly lowers the long-term deficit. The law sets a $1.012 trillion discretionary spending level for 2013 – halfway between the $967 billion House sequester level and the Senate $1.014 trillion level for 2014. The additional spending now would come at the expense of more spending later – notably in pension benefits for federal workers and other items that have yet to be detailed. The long-term deficit will be cut by $23 billion. 

Most importantly, this law lifted the threat of a second government shutdown and may be a sign of some old partisan wounds beginning to heal.

11. Why Hospitals are 'Observing' – Not Admitting – Patients

The Alliance for Health Reform recently held a briefing on an increasing trend at hospitals of "observing", instead of admitting, Medicare beneficiaries to hospitals – even when they are there for more than 48 hours. The briefing follows on an AARP report issued earlier this month, Rapid Growth in Medicare Hospital Observation Services: What’s Going On?. Health care experts say the situation is far from ideal for both hospitals and patients. Hospitals are feeling increased pressure from Medicare to classify patients the “right” way or risk losing reimbursements. In turn, patients face higher bills for services they receive in the hospital, and also the possibility of not qualifying for Medicare-covered nursing home care after their hospital stay.

Keith Lind (AARP Public Policy Institute) discussed the report as well as changes that AARP is recommending. A key reason for the rise in hospital observations among Medicare beneficiaries is that under the Affordable Care Act, hospitals can face penalties of 2% of hospital charges for patients readmitted to the hospital before thirty days after discharge – which do not apply if the patient is observed rather than admitted.

Marc Hartstein (Centers for Medicare and Medicaid Services) explained observation status and provided an overview of a recently released Medicare rule. One reason for hospitals to use "observation status" is to lower their chances of getting no payment at all from Medicare for what an auditing contractor may later find was an unnecessary admission

12. Back to the Future of Nursing: A Look Ahead Based on the Landmark IOM Report

The Institute of Medicine’s (IOM) recently celebrated the three-year anniversary of The Future of Nursing: Leading Change, Advancing Health report. The event highlighted the impact of the report through implementation of recommendations at both the national and local levels, discussed the continued work of the Future of Nursing: Campaign for Action, and charted future directions and priorities for the nursing profession. 

Former Department of Health and Human Services Secretary Donna Shalala, Ph.D., FAAN, kicked off the event with a keynote address. Secretary Shalala discussed the report’s influence three years later including how this report is a part of nursing curriculum today. 

In their opening remarks and subsequent discussion, panelists highlighted the following: the importance of modifying scope of practice laws to ensure that the full health care team can provide care; all pathways to the nursing profession are important and the need to recognize nursing students are coming through community college and LPN programs in addition to four-year baccalaureate programs; and education of health professionals must be team-based in addition to the team-based approach for patients. 

An archived webcast of the event can be found at http://www.iom.edu/rosenthal2013.

13. Congressional Committees Pass Comprehensive SGR Legislation Fix

In December, both the Senate Finance and the House Ways and Means Committees marked up and reported out legislation to permanently repeal and replace the sustainable growth rate (SGR) payment formula for Medicare provider payments. The portions of the two committee bills that reform the SGR are similar, as they are based on a consensus proposal that was developed last year, but there are differences between the two bills, including a number of amendments that were added by the Senate.

While this is a watershed moment in a decade and a half of unsuccessful efforts to repeal the SGR, numerous challenges exist for passage before April 1 when the 3-month short-term SGR patch expires. If Congress cannot reach agreement by that date, it is likely they will do another patch.

The House Ways and Means Committee is expected to work with the House Energy and Commerce Committee, which passed a version of this legislation in July 2013, in an attempt to meld the two bills passed in each committee before taking a combined bill to the House floor early this year. The Senate Finance committee also hopes to take their bill to the floor of the Senate.  

A number of scenarios exist on how this could be accomplished by April 1:

  • The legislation could potentially move through the process as a freestanding bill. However, moving a freestanding bill could encounter problems in the Senate. 
  • The SGR bill could be attached to a larger vehicle like a debt limit extension bill. Currently, the Treasury is authorized to borrow through February 7.
  • Finally, the committees could make a deal and forward the SGR through unanimous consent. Unanimous consent is a procedure that allows legislation to be passed as long as no lawmaker objects. The most likely scenario is that Congress will seek to add the SGR legislation to a debt limit extension bill that would move in February or March.

14. CMS Issues Proposed Rule on Emergency Preparedness Requirements

On December 27, 2013, the Centers for Medicare & Medicaid Services issued a proposed rule that establishes national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to ensure that they adequately plan for both natural and man-made disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems. It would also ensure that these providers and suppliers are adequately prepared to meet the needs of patients, residents, clients, and participants during disasters and emergency situations. CNSs are specifically mentioned under Section L, Emergency Preparedness Regulations for Critical Access Hospitals.

The proposal can be found at http://www.gpo.gov/fdsys/pkg/FR-2013-12-27/pdf/2013-30724.pdf. The deadline for comments is February 25, 2014. 

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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.
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