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. PCORI- What it is About

Headquarters News

  1. 2015 Annual Meeting Call for Abstracts Now Open!
  2. 2014 NACNS Series Webinar: Cutting Edge Information for the Clinical Nurse Specialist
  3. Stand to be Counted – Clinical Nurse Specialist Census
  4. 2015 – NACNS Anniversary and Annual Conference

Association News

  1. ANA Publishes Psychiatric-Mental Health Nursing: Scope and Standards of Practice
  2. ANA Announces New President and Board
  3. ACP Announces New Guidelines for Pelvic Exam

Clinical News

  1. Increase in Seasonal Flu Vaccine Availability
  2. Multiple Chronic Conditions (MCC)
  3. The Joint Commission Sentinel Alert – Misuse of Vials

Federal and State Policy News

  1. HRSA Creates New Bureau of Health Workforce

Featured Headline

1. Patient-Centered Outcomes Research Institute – What it is All About

1The Patient-Centered Outcomes Research Institute (PCORI) is authorized by Congress to fund and disseminate research that will provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI's research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.

At PCORI, one of our core values is a commitment to evidence. As noted in our Strategic Plan, "We consistently rely on the best available science, and we evaluate our work to improve its reliability and utility." We are committed to functioning as a learning organization and strive to study and continuously improve upon all aspects of our work.

We also are committed to sharing what we learn to advance the science and practice of patient-centered outcomes research (PCOR). Even though it will sometimes require shining a light on our shortcomings, transparency is another of our core values; we hold ourselves accountable to all of our many passionate stakeholders.

In our effort to function as a learning organization, we pursue a wide range of evaluation activities. These are organized into a framework, which flows mainly from our strategic and operational plans but also, like everything we do, incorporates our stakeholders’ perspectives and priorities.

Research Agenda

  • Assessment of Prevention, Diagnosis, and Treatment Options
  • Improving Healthcare Systems
  • Communication and Dissemination Research
  • Addressing Disparities
Accelerating PCOR and Methodological Research

Headquarters News

2. 2015 Annual Meeting Call for Abstracts Now Open!

The Clinical Nurse Specialist: The Essence of Transformational Health Care is the theme for the NACNS 2015 Annual Conference. We will be meeting at the Loews Coronado Bay in Coronado, California. The dates are March 5-7, 2015. Abstract submission is now open and the deadline is August 11. The call for abstracts and abstract submissions are available on-line through  the NACNS homepage.

The conference theme is focused on innovative health care delivery, specifically transitions of care, in an age of health care reform. Reviewers will be looking for projects that address this issue and also those that demonstrate the increased visibility of CNS’s practice outcomes. Abstracts may highlight novel approaches to CNS practice within the three spheres of influence: the client sphere (individual, family, community), the staff sphere (nurses, nursing practice), and organization/system sphere (Statement on Clinical Nurse Specialist Practice and Education, 2004). Additionally, topics will be selected with an eye toward advanced practice registered nurse skills, including independent practice, pharmacology and advanced assessment and clinical management. Pharmacology credits will be offered for eligible sessions and abstracts are encouraged to address this educational priority.

3. 2014 NACNS Series Webinar: Cutting Edge Information for the Clinical Nurse Specialist – Register for Next Session!!

Coming Up Next - September 24, 2014 - CNS Competencies: Taking the Lead in Clinical Alarm Management – hear from national CNS leaders in clinical alarm management. Speakers for this session will be from NACNS' Alarm Fatigue Taskforce. This session will be designed to help the CNS address this issue in their facility and discuss different methods and strategies to make change.

Registration Fees:
Single Webinar: Member $45 Non Member $60 Student $30. To register – go to www.nacns.org. Any questions – info@nacns.org

Upcoming Dates and Topics for Future Webinars:
September 24, 2014 - CNS Competencies: Taking the Lead in Clinical Alarm Management
November 12, 2014 3 - The Cutting Edge of Diabetes Management – Pharmacology CE offered
December 10, 2014 - CNS Competencies: Positioning Yourself to Close the Clinical Alarm Gap

Times for all sessions: 
3:00 pm eastern/2:00 pm central/1:00 pm mountain/ 12:00 pm west coast

* 1.0 Contact hours will be awarded for this session.

This continuing nursing education activity was approved by the PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Criteria for successful completion includes attendance at minimum and completion of an evaluation form. The planning committee members and speakers have declared no conflict of interest. Approval of the continuing education activity does not imply endorsement by the provider, ANCC or PA State Nurses Association.

4. Stand and Be Counted – Clinical Nurse Specialist Census

With the retirement of the Health Resources and Services Administrations national nurse survey, the responsibility for data collection has been shifted to the states and other entities. NACNS has continued to assess the practice and interests of our membership through our NACNS member survey. We recently completed another round of this survey in fall 2013. Being concerned about the lack of national-level information about the CNS role, NACNS has launched a CNS Census. This surveymonkey-style tool is designed to capture demographic, practice and education data on those that complete the survey. Different from the NACNS member survey, we will be partnering with other organizations and will ask our members to forward the link for the CNS Census to any and all CNSs that you know. We want to hear from as many individuals that identify themselves as CNSs and/or were educated as CNSs. We are less interested in their current, specific job title. We want to see how those with CNS education and experience are contributing to the health care system. Results of the CNS Census will be published in the Clinical Nurse Specialist: The International Journal for Advanced Nursing Practice. The survey will be open until December 31, 2014. In order to take the survey go to: www.nacns.org and look for the button on the homepage.

5. Celebrate the NACNS 20th Anniversary in 2015

Yes, it has been 20 years! And the NACNS Board of Directors is planning on recognizing and celebrating our history and success throughout the 2015, but specifically at the NACNS 2015 Annual Conference. The theme for this meeting is, "The Clinical Nurse Specialists: The Essence of Transitional Health Care." This meeting is being held at the Loews Coronado Bay Resort in San Diego, California. This meeting hotel will allow for an excellent educational experience as well as relaxation and exploration of beautiful Southern California. The hotel offers three pools, a sand beach and a spa. So plan now for a 20th anniversary celebration that will allow you to take care of your mind and body! The Loews Coronado Bay Resort caters to relaxation and will allow all of us to learn, network and relax. Coronado Island is a 10 minute cab ride from downtown San Diego. This will give everyone the best of both worlds – shopping and restaurants in San Diego and pampering and beautiful views on Coronado Island. Do consider extending your trip by a day to appreciate the beauty of this area.

Plan on submitting a poster, a presentation or encourage your facility to exhibit! We have intentionally moved the dates for session/presentation and poster applications to earlier in the year. This will allow the planning committee more time to review and select your submissions.

Call for Podium, Posters, Clinical Management Lectures & Symposium Presenters
Call for Student Posters


Association News

6. New Psychiatric-Mental Health Book

The American Nurses Association today released a new edition of Psychiatric-Mental Health Nursing: Scope and Standards of Practice. The book is co-published by the American Nurses Association (ANA), the American Psychiatric Nurses Association (APNA) and the International Society of Psychiatric-Mental Health Nurses (ISPN).

Psychiatric-Mental Health Nursing: Scope and Standards of Practice articulates the essentials of psychiatric-mental health nursing, its activities and accountabilities—the who, what, when, where and how of practice—at multiple levels and in multiple settings. It specifies the standards and competencies for practice and professional performance in this nursing specialty, and reflects the diverse activities of general and advanced practice psychiatric-mental health registered nurses. To request a review copy of Psychiatric-Mental Health Nursing: Scope and Standards of Practice, contact Cynthia Lee at cynthia.lee@ana.org.

7. ANA Announces New Election Results

On June 14, the American Nurses Association's (ANA) Membership Assembly elected Pamela Cipriano, PhD, RN, NEA-BC, FAAN, of Charlottesville, Va., to serve as president of the professional association that represents the interests of the nation's 3.1 million registered nurses (RNs). The voting representatives of ANA's Membership Assembly also elected three other members to serve as officers of the 10 - member board of directors.

Cipriano, senior director at Galloway Advisory by iVantage, which helps hospital groups, health care payers and providers improve their operations, outcomes and profits, succeeds Karen A. Daley, PhD, RN, FAAN. Cipriano, who is also a research associate professor at the University of Virginia School of Nursing, served as The inaugural editor-in-chief of ANA's official journal, American Nurse Today, and is a member of the Virginia Nurses Association. From 2010 to 2011, Cipriano served as the Distinguished Nurse Scholar in Residence at the Institute of Medicine, where she helped study the safety of health information technology assisted care.

Elected as officers were Vice President Cindy R. Balkstra, MS, RN, ACNS -BC, Georgia Nurses Association; Secretary Patricia Travis, PhD, RN, CC RP, Maryland Nurses Association; and Treasurer Gingy Harshey-Meade, MSN, RN, CAE, NEA -BC, Ohio Nurses Association and Indiana State Nurses Association. Jesse M.L. Kennedy, RN, Oregon Nurses Association, was elected to serve as a director-at-large, recent nursing school graduate.

8. ACP Recommends against Routine Pelvic Screening for Asymptomatic Adult Women

On July 1, 2014, The American College of Physicians (ACP) recommended against pelvic screening for asymptomatic adult women, according to a systematic review and clinical guidelines published in the Annals of Internal Medicine. A panel of experts appointed by ACP examined the diagnostic accuracy, benefit, and harms of pelvic examination in asymptomatic, average risk, non-pregnant adult women. Data were extracted from 52 English-language studies, including 32 with primary data. The researchers found that pelvic examinations had a positive predictive value of less than 4% for detecting ovarian cancer. Based on this expert review of the literature, the ACP developed guidelines on the utility of screening pelvic examinations in adult women. The target patient population was asymptomatic, non-pregnant adult women. Based on a review of the evidence, the ACP recommended against screening pelvic examination in this population.


Clinical News

9. Opening of New U.S. Facility Increases Availability of Seasonal Flu Vaccine

3On June 17 an announcement was made that pronounced that our nation has reached a milestone in battling influenza. This announcement was made with the U.S. Food and Drug Administration's first approval to manufacture seasonal influenza vaccine using cell-based technology in a U.S. facility. That facility, owned by Novartis of Basel, Switzerland, and located in Holly Springs, N.C., now can manufacture cell-based vaccine against seasonal as well as pandemic influenza viruses. This new capability demonstrates the effectiveness of a multi-use approach to emergency preparedness. With the approval of manufacturing the Holly Springs facility, the capacity for seasonal influenza vaccine production in the United States has increase by at least 50 million doses. This work is part of the Biomedical Advanced Research and Development Authority (BARDA) established in 2006. It is part of the U. S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR). This work is part of their effort to develop new technologies for use in emergencies.

10. Multiple Chronic Conditions in the U.S.

In a recent article published in Preventing Chronic Disease, published April 17, 2014 titles, "Multiple Chronic Conditions among U.S. Adults: A 2012 Update," reports on revised estimates of the prevalence of single chronic conditions and multiple (>2) chronic conditions (MCC). These estimates were drawn from the 2012 National Health Interview Survey and is based on the non-institutionalized civilian US adult population. The study utilized 10 chronic conditions in their analysis: hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, current asthma or chronic obstructive pulmonary disease (COPD).

Approximately half or 117 million of U.S. adults have at least one of the 10 identified chronic conditions. Furthermore, 1 in 4 adults has multiple chronic conditions (MCC).

In 2012, approximately half (49.8%, 117 million), of the study population, had at least 1 of 10 selected chronic conditions. More specifically, 24.3% had 1 chronic condition, 13.8% had 2 conditions, and 11.7% had 3 or more conditions. Among adults with at least 1 chronic condition, more than half (approximately 60 million) had MCC.

The estimated prevalence of MCC varied by specific subpopulations of US adults.

  • Women were more likely than men to have exactly 2 conditions or 3 or more conditions.
  • The prevalence of MCC was higher among non-Hispanic white adults, non-Hispanic black adults, and non-Hispanic adults of other races.
  • The percentage of adults with MCC (both 2 and ≥3) increased with age.
  • MCC prevalence was greater among adults with public coverage than among adults with private or some other type of coverage.

11. The Joint Commission Raises Alarm on Misuse of Vials

June 16, 2014 The Joint Commission published Sentinel Event Alert 42: Preventing Infection from the Misuse of Vials. This alert focuses on the factors that contribute to the misuse of vials and sets out recommended strategies for improvement. This is a signification issue. According to the Centers for Disease Control and Prevention (CDC) since 2001, at least 49 outbreaks have occurred due to the mishandling of injectable medical products. More than 150,000 patients required notification during this time frame to undergo bloodborne pathogen testing after their potential exposure to unsafe injections. Unsafe and inappropriate handling of single use and multiuse vials has caused occurrences and outbreaks of bloodborne pathogens and associated infections, including hepatitis B and C virus, meningitis, and epidural abscesses. Adverse events caused by this misuse have occurred in both inpatient and outpatient settings.

While there are a variety of causes of infection from the misuse of vials, the most common error is the reuse of single-dose vials. These vials are intended to be used once and for a single patient. These vials typically do not contain preservatives. The use of these vials beyond the intended single dose use can result in a significant increase in the risk for bacterial infection, contamination.

Research from the CDC indicates that since 2001 there were at least 49 outbreaks that have been tracked to mishandling of vials/injectable medical products. Twenty-one of these outbreaks involved the transmission of hepatitis B or C. The remainder of the outbreaks were mostly invasive bloodstream infections. As anticipated, many of the outbreaks occurred in inpatient settings, but a high percentage also occurred in pain management and cancer clinics.

Generally, the cause of these adverse events are related to unsafe injection practices and lapses in infection control practices. The alert emphasizes that staff should always follow safe injection and infection control practices–including correct aseptic technique, hand hygiene and the one-time-only use of needles and syringes–along with the specific recommendations for single-dose/single use vials and multiple-dose vials in this alert. Safe infection control practices always apply when transporting, storing, preparing and administering medications, solutions and related supplies.  The Joint Commission Alert includes specific recommendations on effective processes and procedures that should be implemented to reduce the mishandling of vials.


Federal and State Policy

12. HRSA Creates New Bureau of Health Workforce

The Health Resources and Services Administration (HRSA) announced June 3 the creation of the new Bureau of Health Workforce, which encompasses all programs and functions previously within the Bureau of Health Professions and the Bureau of Clinician Recruitment and Services. Associate Administrator Rebecca Spitzgo will lead the new bureau. The Federal Register notice announcing the new bureau includes information on its organization and indicates that the transition of the new bureau will take 90 days to complete.

The mission of the Bureau of Health Workforce is to improve the health of the nation's underserved communities and vulnerable populations by developing, implementing, evaluating, and refining programs that strengthen the nation's health care workforce. Bureau programs holistically support a diverse, culturally competent workforce by addressing components including:

  • education and training;
  • recruitment and retention;
  • financial support for students, faculty, and practitioners, supporting institutions; and
  • data analysis, and evaluation and coordination of global health workforce activities.

The Title VIII Nursing Workforce Development programs at HRSA will fall under the coverage of two offices—the Office of Workforce Development and Analysis, to be led by Jennifer Fiedelholtz, and the Office of Health Careers, to be led by Kimberly Klein.

In a conference call shortly after the announcement, HRSA Administrator Mary Wakefield stated the realignment would help the agency better respond to the needs of the nation with a high quality workforce especially in the communities that need them the most. She stressed that this was important now that more Americans have access to health care as a result of the Affordable Care Act.

For more information, visit the Bureau of Health Workforce

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