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. If you have any questions or wish to advertise in this publication – please contact Jason Harbonic at email@example.com.
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Federal and State Policy News
The results of the 2013 Gallop Poll, “U.S. Views on Honesty and Ethical Standards in Professions” once again finds nurses as the most trusted. Eighty percent of Americans say nurses have "very high" or "high" standards of honesty and ethics, compared with a 7% rating for members of Congress and 8% for car salespeople. It is an indication of the faith Americans have in their healthcare providers, and more specifically the nurse who provides the day to day care for patients. The nurse has been in the number one slot since the nursing profession was first added to the survey in 1999. One year, 2001 is the only exception. In 2001 firefighters were added to the list, and they took the top slot in response to their work and heroism during and after the 9/11 attacks.Nurses at 80% are followed by pharmacists and medical doctors that are tied for 2nd. Third place is shared by police officers and clergy at 50%. So, congratulate yourself and your colleagues for topping the list!
At the November 4, 2014 board meeting, the NACNS Board of Directors approved a proposal by the 2014 Bylaws Committee to bring a set of proposed bylaws changes to the NACNS membership for consideration and vote. According to the NACNS Bylaws, the membership must be made aware of the intention of the Board to have a bylaws related vote 30 days prior to the Annual Business meeting. The Annual Membership Business meeting is held every year at the NACNS Annual Conference, and will be held this year at the Annual Conference on March 6, 2014.
The bylaws changes seek to update the NACNS bylaws and streamline language throughout the document. Generally, the proposed changes in the bylaws recommend:
A detailed – side-by side – comparison of the current and proposed bylaws has been prepared. This document will be posted on the member’s only side of the NACNS web site – please look for the announcement on the right column of the NACNS homepage and click on the heading about the bylaws. This will allow you to sign in and go to the member’s only posting.
Additionally, NACNS hosted two call for members with the Bylaws Committee to allow members to discuss and to review the bylaws changes.The final vote will be by electronic ballot sent to all members and final votes will be collected at the NACNS Business meeting.
NACNS’ Nominating Committee worked diligently to identify NACNS volunteers in order to comprise the 2015 – 2016 Slate of Candidates of Officers and other elected positions. Details about each of these candidates is available on the NACNS Web site. The list of candidates included:
Board at Large (two open positions)
Nominating Committee (three open positions)
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.Exhibit and sponsorship opportunities are still available!
NACNS’ Board of Directors is committed to observing efforts to make our association “more green.” NACNS sent a request to members to complete a survey that asked if members would prefer receiving our journal – The Clinical Nurse Specialist: the International Journal of Nursing Practice, online versus in hard copy through the mail. Currently, the NACNS Journal is provided to all members in hardcopy and each member has the option to accessing the online journal. Just over one quarter of the NACNS membership responded to this question. 55.27% stated they would be interested in receiving the journal as an online publication only. When asked if they were aware of the iPad app that Wolters Kluwer as developed to ease access to the online journal – 66.77% of the respondents indicated that they were not aware of the availability of this app.If you are interested in downloading the Journal app on your IPad, you can learn information about it on the Journal’s web page. Please note, there I no similar apps available for other electronic formats.
NACNS’ Board of Directors would like to thank all of the clinical nurse specialists that participated in the 2014 CNS Census, which closed on December 31, 2014. This survey is the first national survey of clinical nurse specialists and will provide us with some helpful and interesting data about the clinical nurse specialist role. Each issue, the NACNS CNS Communiqué will publish one of the results of the survey.
The full survey will be published in the NACNS journal and a one pager highlighting the main features of the survey will be developed. Most importantly, the NACNS Board of Directors has indicated their interest in pursuing the CNS Census every 2 years. This will allow us to gather data that will assist in showing us trends in clinical nurse specialist practice.
The winners of the iPads are:
The winner of the free one- year NACNS membership is:
In order to allow NACNS members a chance to interact with task force members and provide direct input on the work of the task force we have held afternoon forums on Friday of the Annual Meeting. This year NACNS members and meeting participants are asked to select from the following Task Force Forums: Malnutrition and the Hospitalized Adult, Chronic Care Management and the Clinical Nurse Specialist, and Alarm Fatigue. We have applied for CE credit for each of these Forum sessions for the first time.
Just added - the NACNS Research Committee has agreed to host a Forum at the same time for those interested in research and discussing NACNS’ efforts in the area of research with the committee.
Plan on attending a forum and provide you opinion and insight to the task force and committee members.
The approximately 4,700 respondents to the 2014 CNS Census answered a question about magnet status. According to our Census, of those responding to the survey, 38.84% work in an institution that has magnet status. 22.62% work in a facility seeking magnet status. The remainder, 19.09% work in facilities that are not eligible for magnet status or does not have magnet status.
2014 brought us the successful launch of the inaugural NACNS webinar series. The first year was very successful and allowed NACNS to offer contemporary and critical continuing education to our members.
Registration for each session will remain at 2014 prices!
NACNS president Les Rodriguez will be hosting a series of two conference calls with Committee and Task Force Chairs in February 2015. The goal of these calls is to update the Chairs on NACNS activities and to provide them with an opportunity to update NACNS leadership on their activities.
Committee and Task Force Chairs can select either February 11, 2015 at 7 pm eastern or February 18, 2015 at 7 pm eastern. Watch your email for more details.
The NACNS Research Committee has been focused the last several years on providing research resources to members. This includes research information, research tools, and recognizing members who have excelled at research in their roles. This update highlights some of the results of our work and to seek feedback on what additional resources you would find valuable in utilizing and/or conducting research in your roles.
We’ve built on the work of past Research Committees in creating a list of web-based research resources. When you go to the NACNS website, you will find links to sites for best practice guidelines, evidence-based practice and research resources, and researcher funding sources.
The Research Committee members are committed to sharing their expertise with members by presenting research pre-conferences at the annual NACNS meetings. The topic for this year’s pre-conference is “Challenges of Intervention Research for the Clinical Nurse Specialist.” In addition, Research Committee members have been available for one-on-one mentoring sessions at past annual meetings to assist members in developing research topics, providing mentoring support, and to discuss ways to resolve barriers to the conduct of research by CNSs in their work organizations. Committee members have also authored pertinent, timely articles for the “Research Corner” column in our journal, Clinical Nurse Specialist.
Our committee has the pleasure of soliciting and reviewing applications and making recommendations to the Board for the CNS Researcher of the Year award. The recipient of this award is recognized at the annual meeting for an accomplished program of original nursing research that has significantly enhanced the science of autonomous nursing practice, patient and family outcomes, and/or health care systems and has contributed to significantly advancing the profession of nursing. The Committee has recently revised the award evaluation tool in its commitment to fairly and objectively evaluate the nominees.
Finally the Research Committee wants to continue improving research resources and mentoring opportunities for CNSs interested in engaging in research. We welcome any feedback on how we can assist in supporting you in your research efforts! You can send that feedback to firstname.lastname@example.org or you can feel free to connect with us at the Annual Conference in San Diego.
On a recent association call, an ANCC staff person noted that ANCC has extended the application dates for a number of their NP and CNS certifications. This is good news for the CNS who may currently meet the requirements of the original certification exams, but do not meet the criteria for certification under the new – APRN Consensus Model-oriented certification exams. Generally speaking, these national certification exams will accept applications until December 31, 2016 and individuals will be eligible to take the exam until October 31, 2017. After that date, ANCC will only accept renewal by professional development and practice hour requirements for these older exams. No individual will be able to test for certification with these exams, but you will be able to renew.
You must review the specific information related to the CNS certifying exam you are interested in on the ANCC website. Please note, as this is a recent change, not all areas of the ANCC website indicate this change. The change in date information is found on each web page that describes the specific exam. As of the writing of this article, ANCC has not yet sent a press release on this information.
This impacts the following CNS exams offered by ANCC:
If your hospital has a residency or fellowship program designed to transition registered nurses (RNs) and advanced practice registered nurses (APRNs) into new practice settings, you might be interested in exploring if ANCC’s Practice Transition Accreditation is something you might want to pursue for this program. ANCC includes the follow program under their definition of practice transition programs:
Catheter-Associated Urinary Tract Infections (CAUTI) are the most commonly reported hospital-acquired condition, and despite efforts to identify and prevent this condition the rates continue to rise. More than 560,000 patients develop CAUTI each year, leading to extended hospital stays, increased health care costs, and patient morbidity and mortality. CNSs are often responsible for collecting data and training RNs and others to reduce CAUTI rates. ANA has announced the availability of an innovative, streamlined, evidenced-based clinical tool developed by leading experts that can help CNSs and RNs decrease CAUTI rates.
The American Journal of Infection Control article reports hospital-acquired conditions (HACs) are a major threat to patient safety with costs estimated to be $33 billion. ANA has partnered with the Centers for Medicare and Medicaid Services (CMS) Partnership for Patients (PfP) in an effort to reduce avoidable HACs by 40% and reduce 30-day hospital readmissions by 20% compared to 2010. According to PfP, ANA and PfP’s partnership has already contributed to a significant reduction in multiple HACs and preventable 30-day readmissions.
Partnership for Patients
The Partnership for Patients (PfP) is focused on quality improvement, patient safety and cost-effective patient care. Launched in 2011, PfP convened health care providers, hospitals, patients, and government and other stakeholders in a quest to reduce preventable hospital-acquired conditions (HAC) by 40% and 30-day admissions by 20% by the end of 2014. The program is funded by the Centers for Medicare and Medicaid Services (CMS) through the end of 2014. The organizations involved in PfP help identify, disseminate and engage interprofessional teams to use effective solutions that are reducing HACs. The PfP stakeholder partners work together to disseminate these findings to other hospitals and clinicians. As an early and active partner of PfP, ANA leads multiple efforts with nurses to reduce HACs. In these efforts, ANA works closely with the ANA’s organizational affiliates.
Nursing screening and assessment and evidence-based management of urinary retention and incontinence is essential to reduce catheter overuse. ANA identified the opportunity to fill the tool gap and develop a steam lined evidence-based tool to reduce CAUTI.
Using a consensus process, ANA assembled a technical expert panel (TEP) of nursing clinical experts to develop and disseminate an evidence-based CAUTI reduction tool for nurses with support by PfP. TEP members include ANA members, representatives from its specialty nursing organizational affiliates, infection control specialists and patient safety authorities.
Following a combine evidence-based and expert consensus process, ANA and other TEP members developed a two-part multi-factorial CAUTI reduction tool designed for nurses (link to tool here). The one-page tool is based on the CDC’s 2009 “Guideline for Prevention of Catheter-Associated Urinary Tract Infections.” (Guideline for Prevention of CAUTI - CDC) The evidence-based tool incorporates an algorithm to determine if a urinary catheter is appropriate based on nursing screening and assessments, as well as alternatives for retention and incontinence; timely removal; and a checklist on catheter insertion, cues for essential maintenance and post-removal care.
In a January 9, 2015 communication, the FDA noted the concerns arising from recent reports questioning the safety of prescription and over-the-counter (OTC) pain medicines when used during pregnancy. In order to attempt to address this concern, the agency evaluated research studies published in the medical literature and determined they are too limited to make any recommendations based on these studies at this time. Because of this uncertainty, the use of pain medicines during pregnancy should be carefully considered. FDA urges pregnant women to always discuss all medicines with their health care professionals before using them.
Severe and persistent pain that is not effectively treated during pregnancy can result in depression, anxiety, and high blood pressure in the mother.1 Medicines including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen can help treat severe and persistent pain. However, it is important to carefully weigh the benefits and risks of using prescription and OTC pain medicines during pregnancy.
The published studies we reviewed reported on the potential risks associated with the following three types of pain medicines used during pregnancy:
The FDA noted that they found all of the studies reviewed to have potential limitations in their designs; sometimes the accumulated studies on a topic contained conflicting results that prevented us from drawing reliable conclusions. As a result, the FDA did not make any changes in their recommendations on how pain medicines are used during pregnancy.
Pregnant women should always consult with their health care professional before taking any prescription or OTC medicine. Women taking pain medicines who are considering becoming pregnant should also consult with their health care professionals to discuss the risks and benefits of pain medicine use. Health care professionals should continue to follow the recommendations in the drug labels when prescribing pain medicines to pregnant patients.
The FDA will continue to monitor and evaluate the use of pain medicines during pregnancy and will update the public as new safety information becomes available.
AAMI Foundation Launches Campaign to Promote Continuous Monitoring of Patients on Opioids
The AAMI Foundation, has announced a campaign to increase the safety of patients who are receiving opioids. This multiyear initiative will highlight a potentially devastating patient safety problem—respiratory suppression with opioid use - and to make the case for a solution that can save lives.
Opioid treatment is a critical tool in the treatment of patients in pain, the use of such drugs can be invaluable to their well-being and healing. However, their use comes with risks, and can result in respiratory depression, even death, in some patients. AAMI’s solution to this problem is the continuous monitoring of all patients on opioids.
The AAMI Foundation has assembled The National Coalition to Promote Continuous Monitoring of Patients on Opioids, and the group is holding its kick-off event on November 14 in Chicago.
On Nov. 14, AAMI invited patient safety advocates, researchers, executives in the medical device industry, clinicians, hospital administrators, healthcare technology professionals, representatives from stakeholder-professional societies, and families who have lost loved ones to respiratory depression connected to opioids will gather to build the case for continuous monitoring of all patients receiving opioids. NACNS had a representative at this meeting.
This effort is unlike past initiatives in this space in that the goal is to develop recommendations for how hospitals can overcome the barriers to continuous monitoring of these patients. Presentations demonstrated strong financial justification and improved patient outcomes when continuous monitoring is used. Powerful testimonials were presented from families who talked about their losses.
The campaign is expected to unfold in phases over several years. Through the use of webinars, publications, online resources, conference proceedings, and general outreach, members of the coalition hope to rally the entire healthcare community behind the idea that continuous monitoring must become standard operating procedure for patients on opioids.
In a January 14, 2015 report, the CDC reported that progress has been made in the effort to eliminate infections that commonly threaten hospital patients, including a 46 percent decrease in central line-associated bloodstream infections (CLABSI) between 2008 and 2013. This same report noted that additional work is needed to continue to improve patient safety. CDC’s Healthcare-Associated Infections (HAI) progress report is a snapshot of how each state and the country are doing in eliminating six infection types that hospitals are required to report to CDC. For the first time, this year’s HAI progress report includes state-specific data about hospital lab-identified methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile (C. difficile) infections (deadly diarrhea).
The annual National and State Healthcare-associated Infection Progress Report expands upon and provides an update to previous reports detailing progress toward the goal of eliminating HAIs. The report summarizes data submitted to CDC’s National Healthcare Safety Network (NHSN), the nation’s healthcare-associated infection tracking system, which is used by more than 14,500 health care facilities across all 50 states, Washington, D.C., and Puerto Rico. Healthcare-associated infections are a major, yet often preventable, threat to patient safety. On any given day, approximately one in 25 U.S. patients has at least one infection contracted during the course of their hospital care, demonstrating the need for improved infection control in U.S. healthcare facilities.
This report focuses on national and state progress in reducing infections occurring within acute care hospitals. Although not covered by the report released today, the majority of C. difficile infections and MRSA infections develop in the community or are diagnosed in healthcare settings other than hospitals. Other recent reports on infections caused by germs such as MRSA and C. difficile suggest that infections in hospitalized patients only account for about one-third of all the healthcare-associated infections.
Tracking National Progress
On the national level, the report found a:
Research shows that when healthcare facilities, care teams, and individual doctors and nurses, are aware of infection control problems and take specific steps to prevent them, rates of targeted HAIs can decrease dramatically.
Data for Local Action
The report provides data that can be used by hospitals to target improvements in patient safety in their facilities. For example, together with professional partners, CDC, the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organizations and Partnership for Patients initiative, and the Agency for Healthcare Research and Quality’s (AHRQ) Comprehensive Unit-based Safety Program (CUSP) increased attention to the prevention of catheter-associated urinary tract infections, resulting in a reversal of the recent increase seen in these infections. CAUTI data for early 2014 demonstrating these improvements will be publicly available on the CMS Hospital Compare website in 2015. CDC is also working to use HAI data to help identify specific hospitals and wards that can benefit from additional infection control expertise
Not all states reported or had enough data to calculate valid infection information on every infection in this report. The number of infections reported was compared to a national baseline.
In the report, among 50 states, Washington, D.C., and Puerto Rico, 26 states performed better than the nation on at least two of the six infection types tracked by state (CLABSI, CAUTI, MRSA, C. difficile, and SSI after colon surgery and abdominal hysterectomy). Sixteen states performed better than the nation on three or more infections, including six states performing better on four infections. In addition, 19 states performed worse than the nation on two infections, with eight states performing worse on at least three infections.
The national baseline will be reset at the end of 2015. Starting in 2016, HAI prevention progress from 2016-2020 will be measured in comparison to infection data from 2015.
The federal government considers elimination of healthcare-associated infections a top priority and has a number of ongoing efforts to protect patients and improve healthcare quality. CDC provides expertise and leadership in publishing evidence-based infection prevention guidelines, housing the nation’s healthcare-associated infection laboratories, responding to health care facility outbreaks, and tracking infections in these facilities. Other federal and non-federal partners are actively working to accelerate the ongoing prevention progress across the country. In collaboration with CDC, these agencies use data and expertise to mount effective prevention programs and guide their work, including efforts of CMS Quality Improvement Organizations, the Agency for Healthcare Research and Quality’s Comprehensive Unit-based Safety Program, and the National Action Plan to Prevent Healthcare-Associated Infections: Road Map to Elimination.
Preventing infections in the first place means that patients will not need antibiotics to treat those infections. This can help to slow the rise of antibiotic resistance and avoid patient harm from unnecessary side-effects and C. difficile infections, which are associated with antibiotic use. Continued progress and expanded efforts to prevent HAIs will support the response to the threat of antibiotic resistance.
In a drug safety communication issued today, the US Food and Drug Administration (FDA) says it is aware of recent reports "questioning" the safety of prescription and over-the-counter (OTC) pain medicines when used during pregnancy, but that it lacks adequate studies to change current recommendations.
Women with posttraumatic stress disorder had a nearly two-fold increased incidence for type 2 diabetes compared with women with no trauma exposure, according to study findings published in JAMA Psychiatry. By using survey, chart review and data from the Nurses’ Health Study II. Researchers connected with an original cadre of 54,282 who were surveyed in 2008 were and asked if they had trauma exposure or signs and symptoms of PTSD. At the time 51% said they had a trauma and no history of PTSD.
In follow up with this cadre, 3, 091 of the 49,739 who could be reached developed type 2 diabetes. According to the results of this study, those with symptoms of PTSD showed a higher incidence in a dose-response fashion with the incidence of type 2 diabetes.They also found that antidepressant use and greater BMI was associated with PTSD for nearly half of those with an increased risk for type 2 diabetes. This association is important to identify as many individuals – fewer than half of Americans with PTSD – receive treatment.
Federal and State Policy
On January 20, 2015 President Obama gave his State of the Union Address to Congress. With the turnover of the House and Senate to Republican leadership, the politics will change and require a more collaborative approach between the parties if progress is to be made.
President Obama presented an upbeat speech to the Republican majority Congress, laying down the gauntlet on a number of his priorities. The theme of the speech was largely domestic policy with economics as a central theme. Of course, a discussion of the President’s policy on immigration was included. Some highlights of the themes in the President’s speech:
With a two-day hearing held earlier this week, Congress began its annual process to try and overhaul the Sustainable Growth Rate formula (SGR) used to calculate Medicare reimbursement for health care professionals. There is widespread agreement for the need to replace Medicare's payment system, but deep divisions over how to pay for a new reimbursement model.
Congress placed the first temporary patch on SGR in 2003, and the quest for a permanent Medicare "fix" has become an annual ritual ever since. The latest patch, which Congress adopted last year, is set to expire on March 31.
In his opening remarks, the chairman of the House Energy & Commerce Subcommittee on Health, Joe Pitts, (R-PA), called finding a permanent replacement for SGR the paramount issue facing the health panel. Representative Gene Green of Texas, the ranking Democrat on the health subcommittee, noted that Congress has patched the SGR formula 17 times since 2003, at a total cost to taxpayers of about $169.5 billion.Witnesses and lawmakers from both sides of the aisle called for the resurrection of last winter's bipartisan deal, the SGR Repeal and Medicare Provider Payment Modernization Act. The 10-year replacement plan for SGR features a five-year period of stability in the Medicare payment system, with a 0.5% annual pay rate hike. In the last five years of the plan, the pay rate would be frozen and a series of reforms would be launched to help push Medicare reimbursement toward value-based models. "After this hearing, we should wait no longer at rolling up our sleeves," said Representative Frank J. Pallone Jr., (D-NJ). "We all agree the previous bill is a good compromise."
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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.