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 firstname.lastname@example.org.
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Federal and State Policy News
On July 21, 2015, the NACNS Board of Directors officially released a revised position statement on the DNP Degree. In this statement, the NACNS Board of Directors calls for the DNP degree as a requirement for entry into practice for the CNS by 2030. The Board also asserts the importance of grandfathering all CNSs who have graduated with master’s degrees prior to 2030. This position calls for the DNP degree for new graduate CNSs from 2030 forward. The NACNS Board of Directors reserves the right to adjust this target date to accommodate changes in the health care environment.
Citing unforeseen and unintentional consequences, the Indiana Affiliate wrote directly to the Board to request that it reconsider the revision of this position statement. The Board considered this request in a closed session and communicated its response directly to the Indiana Affiliate leadership.
“The NACNS Board set aside time to directly deal with the letter sent by the Indiana Affiliate. We appreciate the time they took to capture their concerns in a communication to the Board. The Board engaged in open dialog about each of the issues and determined that while indeed there will be unintended consequences, the Board passed this revised position statement in order to ensure the future of the CNS role in our evolving health care system,” said NACNS President Peggy Barksdale, MSN, RN, OCNS-C, CNS-BC. “The Board intended this position to be as inclusive as possible by allowing 15 years for transition to DNP entry, grandfathering for all CNS that graduate with the MSN prior to 2030 and reserving the right for the Board to push back the implementation date for this change if needed.”
Much like adopting a position statement for BSN entry–to-practice for the registered nurse, the Board understands that this change may have varied impact in different regions of the country. Adoption of the DNP for entry-into-practice for the CNS is in recognition that the APRN role that serves as a clinical expert should hold the highest clinical degree. Our primary concern in revising this position is to prepare future CNSs to meet the needs of the increasingly complex patients, the dramatic and ongoing changes in health care, and to ensure the CNS continues to play a key role in ensuring high quality, evidence-based, patient-centered care.”
The position statement, a Q and A and a news release on the statement are available on the NACNS website - www.nacns.org.
NACNS made an important announcement in July, 2015 when we released our revised position statement on the DNP degree as preferred entry-into-practice by 2030. NACNS’ Board of Directors worked diligently to balance the need to position the CNS well with respect to the other advanced practice registered nurse (APRN) groups as well as offer as much inclusivity of master’s-level CNS graduates as possible.NACNS President Peggy Barksdale and representatives from the DNP Position Statement Revision Task Force presented a one-hour presentation on the revised position statement and provided attendees with the opportunity for professional dialogue. This webinar was taped so that members who could not attend would be able listen to the presentation and dialogue. You can access these archived sessions by emailing email@example.com and we will email you the link.
The NACNS Board of Directors held its face-to-face meeting in Philadelphia, PA at the beginning of October. This two-day meeting included a packed agenda. The Board held a number of significant discussions and made some important decisions. Below are some highlights:
Face-to-face meeting for 2016 – The Board determined that the 2016-2017 Board of Directors would hold its second face-to-face meeting in July 2016 to coincide with the Educator’s Forum and NACNS Summit. A task force has been appointed to start planning for the 2016 Educator’s Forum and Summit. This will be an important set of meetings designed to discuss policy issues facing the CNS.
DNP position statement - In the past months, two Affiliate leaders have written expressing their concerns about the process NACNS’ Board undertook in release of the position statement on the Doctorate of Nursing Practice (DNP). The Board reviewed those concerns and took action to ensure national-level feedback on future position statements. The Board was asked to rescind the position statement, and after a closed session discussion, it decided to not rescind this important policy.
PhD position statement – The Board reconfirmed that it has asked the DNP Position Statement Review Task Force to develop a PhD position statement. It is intended that this position will articulate NACNS’ support for PhD preparation in nursing and addresses the relationship between the DNP and PhD.
Position statement development policy– NACNS’ Board has followed a position statement process that has been in place for the last 5 – 6 years. In response to some of the issues raised by members, the NACNS Board considered and approved a new policy for position statement development. The key change in this position is the inclusion of a process that will allow for national feedback on draft position statements. NACNS will announce and post draft position statements on the NACNS Website for at least 2 weeks. A blast email and/or communication via other NACNS mechanisms will be employed to let members know of the opportunity to provide comment on a draft position. The Board elected to utilize this process rather than the historic method of open discussion at the Annual Convention because this method will allow all NACNS members to comment on a proposed position statement. NACNS will implement this process with the next position statement it considers.
Appointment of new task force and committee – The Board voted to appoint a new task force, the 2015-2016 Research Priorities Task Force. In addition, the Board directed the staff to send a notice to the membership to initiate a call for volunteers for the 2017 NACNS Annual Conference Planning Committee. NACNS’ Board and staff have been working over the past 3 years to begin planning for the March meeting earlier each year. This has been done to allow our members a better opportunity to plan for this meeting, and provide time for speakers and poster presenters to finalize their presentations.
Revision of the 2015-2020 NACNS Mission and Goals – The Board periodically reviews the NACNS Mission and Goals. As part of the budget development process, the Board engaged in a process where members discussed and analyzed the 2015-2020 NACNS Mission and Goals. As a result of this process, the Board reduced the number of goals because it recognized redundancy in the document. The Board will continue to refine this work on subsequent Board calls. The final 2015-2020 Mission and Goals will be made available to the membership once the document is completed.2016 Budget Development - NACNS’ Finance Committee has begun work on both the 2016 Budget as well as the process needed to comply with the NACNS Bylaws change and our fiscal year from January 1 – December 31 to July 1 – June 31. In order to do this, the Accountant has recommended that the Finance Committee develop a 6-month budget for January 1, 2015 until June 31. 2016. Concurrently, the Finance Committee will also develop a 12-month budget for July 1. 2016 – June 31, 2017. The 6-month budget will be approved by the Board at either the November or December Board call. The 12-month budget on the new fiscal year will be approved prior to the March 2016 Annual Meeting.
At the October 2 - 3, 2015 meeting, the Board voted to appoint a 2015-2016 Research Priorities Task Force. The purpose of this task force is to develop a research agenda to be approved by the NACNS Board of Directors. This research agenda will help NACNS advocate for funding for key research to support the role of the CNS. These priorities will serve as a guide for issues NACNS will advocate for and focus on.
If you wish to be considered for this task force, please submit your C.V. and/or resume and a brief description of why you are interested to info@NACNS.org. Please put NACNS Research Priorities Task Force in the subject line. There will be 5 – 7 positions available on this task force.
2017 Annual Meeting Planning Committee is another opportunity for NACNS volunteers. Each year, NACNS works to enhance and improve the NACNS Annual Meeting. This effort includes appointing our planning committee early so they have plenty of time to identify speakers and make plans. The 2017 Annual Meeting Planning Committee will begin its work before the 2016 Annual Meeting this year. If you are interested in serving in this volunteer role, please submit your C.V. and/or resume and a brief description of why you are interested to info@NACNS.org. Please put 2017 Annual Meeting Planning Committee in the subject line. There will be 3-5 positions available on this Committee.
Just one more session is left in our very successful NACNS 2015 Webinar Series.
On November 17, 2015 at 4:00 pm Eastern we will host Malnutrition and the Hospitalized Adult – Essential Considerations in Identification and Management Malnutrition in the hospitalized adult is often not assessed or treated. This gap in the care of patients increases the risk of complications. With support from Abbott Nutrition Health Institute, NACNS appointed a task force to develop tools for the CNS to use to assist the staff nurse in identification and treatment of malnourished adult patients.
*This activity has been approved for contract hours by the PA State Nurses Association. The PA State Nurses Association is accredited as an approver of continuing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Across the United States, CNSs are making a difference in the lives of patients they serve as well as improving care delivery in hospitals and health care systems. NACNS is collecting these stories.
In an effort to educate policymakers, the public, and leaders in the health care system about the important contribution of the CNS, NACNS is looking for stories from you about how you have made a difference in patient care, patient outcomes, systems and more! Whether it is decreasing length of stay for a patient population, decreasing the rate of wound infection, implementing new guidelines or regulations, or organizing care to address a unique patient care need, you are working in collaborative teams or as individual change agents to enhance the patient care experience and improve outcomes. And we want to hear about it!
NACNS will collect your stories about innovative practice projects and initiatives and use them in a variety of ways to illustrate the contribution of the CNS to improving health care. If you have a story to share, please send it (it only need be a couple of paragraphs long) to firstname.lastname@example.org.
It is not necessary to address the following questions, but they might provide a good guideline for your submission.
Please make sure that you do not use personal identifiable information related to patients in your story.Submit your stories to: email@example.com. Please put "innovative story" in the subject line.
We are excited to announce that NACNS, in collaboration with Indiana University School of Nursing, is developing a member-requested continuing education course designed to support CNS preceptors. This online course will be available to CNSs interested in becoming CNS student preceptors as well as experienced CNSs looking for new ideas. Academic programs seeking options for preparing CNS preceptors may also find this program quite useful. This course is slated to debut in spring, 2016!
Here’s how you can help! The planning team is seeking stories to illustrate “in the field” perspectives – examples providing insight for future preceptors. Below is a list of suggested topical areas where exemplars/stories are requested.
Areas were exemplar stories are needed:
Thank you for considering this opportunity for sharing!
If you have a story to share, please click the link below for further information and submission instructions. There is no monetary compensation for volunteering your story, but we know that CNS preceptors would benefit from hearing about the experiences of others! To submit your story, please go to: https://www.surveymonkey.com/r/6MVFGJK. If you have questions, email Lisa Wages at firstname.lastname@example.org.
Preceptor Course Planning Committee:
Sharron Coffee, MSN, RN, CNS-BC, Milwaukee, WI; Julie Dramedy, PhD, RN, ACNS-BC, Milwaukee, WI; Janet Fulton, PhD, RN, ACNS-BC, ANEF, FAAN, Indianapolis, IN; Jennifer Kitchens, MSN, RN, ACNS-BC, Indianapolis, IN, 2014 NACNS Preceptor of the Year; Francesca Levitt, MSN, Indianapolis, IN, 2012 NACNS Preceptor of the Year; Deb Sips-Fears, MSN, RN, CCRN, Indianapolis, IN; Lisa Wages, MSN, RN, Indianapolis, IN
The Future is today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist
Planning is well underway for the 2016 NACNS Annual Meeting. The planning committee is diligently finalizing the scientific program and abstract submitters should expect to receive placement and acceptance information very soon.
The planning committee is happy to announce the following keynote speakers: Ann B. Hamric, PhD, RN, FAAN, Associate Dean of Academic Programs, Professor, School of Nursing, Virginia Commonwealth University; Regina Cunningham, PhD, RN, AOCN, FAAN, Chief Nurse Executive, Associate Executive Director, Hospital of the University of Pennsylvania, Assistant Dean for Clinical Practice, Adjunct Professor of Nursing, University of Pennsylvania School of Nursing; and Michelle Larkin, JD, MS, RN, Interim Vice President, Robert Wood Johnson Foundation.
The 2016 meeting program will provide more options for earning pharmacology CE credits during the Annual Meeting Preconference. We will provide pharmacology CE for a number of sessions at the meeting as well.The meeting will be held at the Loews, Philadelphia, which is right downtown, a short walk from key attractions such as City Hall, the Reading Terminal Market and lots of unique and high-quality restaurants. Philadelphia is steeped in history and is a melting pot of cultures. While you are in town, consider adding a day to see the Liberty Bell, or the Declaration of Independence or visit the yearly Philadelphia Flower Show. Details will be posted on the NACNS web site – www.nacns.org.
This year, NACNS was pleased to offer products for you to purchase for yourself or another CNS in honor of CNS Week. We had such a great response, we thought we would continue to offer these products until the end of 2015!
NACNS logo note cards – pack of 10 NACNS postcard-style logo note cards and envelopes - $5.00 per pack – buy 10 or more packs for $4.00 each. (Plus shipping and handling)
NACNS silver logo pen with stylus – single pens are priced $5.00 each. 10 or more - $4.00 each. 25 or more $3.50 each. (Plus shipping and handling)
Let us know how you celebrated CNS Week! We encourage all of you to take pictures at your events and send them to us at email@example.com, along with a paragraph describing the event. We will share as many of these as possible on our Facebook page and through other vehicles.
NACNS’ President, Peggy Barksdale, periodically schedules Affiliate and Task Force and Committee Chair conference calls in order to update volunteer leaders on key issues. NACNS will be hosting these calls as follows:
Affiliate Call – November 11 at 4:00 pm eastern
Task Force and Committee Chair Calls – November 12 at 6:00 pm eastern
You will receive a preliminary agenda and call in information after you register.
The AACN first announced their position statement on the Practice Doctorate in 2004. The publication of this paper is responsible for radical change in the education of post-graduate nursing. In a recent communication, AACN notes, “a decade later, the Doctor of Nursing Practice (DNP) is widely recognized as one of the discipline’s two terminal degrees and the preferred pathway for those seeking preparation at the highest level of nursing practice. Across the nation, the number of DNP programs continues to grow as more schools transition advanced nursing practice programs to the doctoral level.”
AACN commissioned a study by RAND Corporation which found that there is strong and near-universal agreement in nursing on the value of DNP education in preparing APRN to meet the future health care needs of the nation. Despite ongoing growth of these programs, there is much variability among DNP programs. This report, The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations, Report from the Task Force on Implementation of the DNP. The paper includes recommendations to describe and clarify the characteristics of DNP graduate scholarship, the DNP project, efficient use of resources, program length, curriculum considerations, practice experiences, and collaborative partnership guidelines. Following the task force’s recommendations are a glossary, references, a list of task force members and appendices to provide examples that support the individual recommendations.
November is Diabetes Awareness Month. To get information on Diabetes for you, your family and/or your patients go to the American Diabetes Association at www.diabetes.com. Diabetes impacts over 29.1 million Americans which translates to about 9.3% of the American population. Of this number, it is estimate that 8.1 million are undiagnosed. The rate of diabetes in individuals over the age of 65 is fairly high, at 25.9%. Diabetes is the 7th leading cause of death in the United States in 2010.
13. U.S. Preventive Services Task Force (USPSTF) Releases Final Recommendation on Screening for High Blood Pressure
On October 10, 2015, the USPSTF released a final recommendation statement on screening for high blood pressure in adults. It recommends screening for high blood pressure in adults aged 18 years or older. The important change is the USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
In addition to office blood pressure (BP) measurement, ambulatory blood pressure monitoring (ABPM) devices and home blood pressure monitoring (HBPM) devices may be used to confirm a diagnosis of hypertension after initial screening. ABPM are small portable devices that monitor BP over a period of time. This device can capture BP readings over a 12-24 interval as people go through their normal home routines. HBPM devices are fully automated oscillometric devices that record measurements taken from the patient’s brachial artery. Many of these devices are available for retail purchase.As part of the evidence review for the recommendation, the USPSTF found that ABPM is the best method for diagnosing hypertension. Studies it reviewed indicated that frequently there was a significant difference in the office BP reading and the ABPM. When ABPM was used to confirm hypertension, fewer patients received treatment for high BP. Elevated ambulatory systolic blood pressure was consistently and significantly associated with increased risk for fatal and nonfatal stroke and cardiovascular events, independent of office blood pressure. For these reasons, the USPSTF recommends ABPM as the reference standard for confirming the diagnosis of hypertension.
Antibiotic resistance is an important issue in health care. A recent study published by The Lancet Infectious Disease included a meta-analysis to quantify what would happen if antibiotics used as preoperative prophylactics were 30% less effect. This study found that 120,000 more patients would get infections and 6,300 more would die from those infections. A 70% decrease in antibiotic effectiveness would lead to 15,000 more deaths (135,000) and 280,000 more infections (286,300). This analysis is a stunning estimate of what the future might hold unless we act to decrease the unnecessary use of antibiotics.
On October 16, 2015 the FDA granted accelerated approval to Praxbind (idarucizumab) for use in patients who are taking the anticoagulant Pradaxa (dabigatran) during emergency situations when there is a need to reverse Pradaxa’s blood-thinning effects.
Pradaxa is an effective anticoagulant, but serious clinical situations have been seen when patients taking Pradaxa experience trauma or other insults that initiate bleeding. Until the approval of Praxbind, there has been no drug to reverse the anticoagulant effects of Pradaxa. The FDA approved Pradaxa in 2010 to prevent stroke and systemic blood clots in patients with atrial fibrillation, as well as for the treatment and prevention of deep venous thrombosis and pulmonary embolism. Praxbind is the first reversal agent approved specifically for Pradaxa and works by binding to the drug compound to neutralize its effect. Praxbind solution is for intravenous injection.
The safety and effectiveness of Praxbind were studied in three trials involving a total of 283 healthy volunteers taking Pradaxa (i.e., people who did not require an anticoagulant). In the healthy volunteers who were given Praxbind, there was an immediate reduction in the amount of Pradaxa in participants’ blood (measured as unbound dabigatran plasma concentration) that lasted for a period of at least 24 hours. In this study, the most common side effect from use of Praxbind was headache.
Another trial included 123 patients taking Pradaxa who received Praxbind for uncontrolled bleeding or because they required emergency surgery. In this ongoing trial, based on laboratory testing, the anticoagulant effect of Pradaxa was fully reversed in 89 percent of patients within four hours of receiving Praxbind. In this patient trial, the most common side effects were low potassium (hypokalemia), confusion, constipation, fever and pneumonia.
Reversing the effect of Pradaxa exposes patients to the risk of blood clots and stroke from their underlying disease (such as atrial fibrillation). The Praxbind labeling recommends patients resume their anticoagulant therapy as soon as medically appropriate, as determined by their health care provider.
Praxbind is approved under the FDA’s accelerated approval program, which allows the agency to approve drugs for serious conditions that fill an unmet medical need based on an effect on a surrogate or an intermediate clinical endpoint that is reasonably likely to predict a clinical benefit to patients. The program is designed to provide patients with earlier access to promising new drugs, but the company will be required to submit additional clinical information after approval to confirm the drug’s clinical benefit.
Federal and State Policy
At a recent meeting of the International Council of Nursing Statistics (ICONS), NACNS learned of a rumor that the Bureau of Labor Statistics (BLS) may not be willing to change the coding of the CNS role so that it is included as one of the APRN roles in the Standard Occupational Classification (SOC). Currently, the CNS numbers are captured in the general RN category. NACNS wrote a letter as an amendment to our response to the Federal Register announcement that requested comments on the new revision of the Standard Occupational Classification (SOC). This second letter, an expansion to our recent Federal Register response, was designed to provide new information to BLS about the CNS. We emphasized the results from the NACNS 2014 CNS Census and referenced the new position statement endorsing the Doctorate of Nursing Practice (DNP) as entry-level education for all new graduating CNSs starting in 2030. NACNS also circulated a sign-on letter among the nursing organizations to gain support for the BLS to include the CNS in the APRN category. To date, 28 organizations have signed onto this letter. This includes national organizations representing the other 3 APRN categories, in addition to national specialty nursing organizations.
On October 21, 2015, President Obama addressed an audience in Charleston, WV to raise awareness on the prescription drug abuse and heroin epidemic. Part of the announcement was information on federal, state, local and private sector efforts to address this epidemic. NACNS is one of more than 40 provider groups that will provide opioid prescriber training to their members. In addition, CBS, ABC, the New York Times, Google, the National Basketball Association, Major League Baseball and other companies will donate millions of dollars in media space for PSAs produced by the Partnership for Drug-Free Kids about the risks of prescription drug misuse.
Opioids are a class of prescription pain medications that includes hydrocodone, oxycodone, morphine and methadone. Heroin belongs to the same class of drugs, and 4 in 5 heroin users started out by misusing prescription opioid pain medications. More Americans now die every year from drug overdoses than they do in motor vehicle crashes and the majority of those overdoses involve prescription medications. Health care providers wrote 259 million prescriptions for opioid pain medications in 2012 – enough for every American adult to have a bottle of pills.
In 2010, the President released his first National Drug Control Strategy, which emphasized the need for action to address opioid use disorders and overdose, while ensuring that individuals with pain receive safe, effective treatment. Since then, the Administration has supported and expanded community-based efforts to prevent drug use, pursue ‘smart on crime’ approaches to drug enforcement, improve prescribing practices for pain medication, increase access to treatment, work to reduce overdose deaths and support the millions of Americans in recovery.
President Obama addressed two specific issues in his announcement:
He issued a memorandum to Federal Departments and Agencies directing 2 important steps to combat the prescription drug abuse and heroin epidemic:
Prescriber Training: First, to help ensure that health care professionals who prescribe opioids are properly trained in opioid prescribing and to establish the Federal Government as a model, the Presidential Memorandum requires Federal Departments and Agencies to provide training on the prescribing of these medications to Federal health care professionals who prescribe controlled substances as part of their Federal responsibilities.
Improving Access to Treatment: Second, to improve access to treatment for prescription drug abuse and heroin use, the Presidential Memorandum directs Federal Departments and Agencies that directly provide, contract to provide, reimburse for or otherwise facilitate access to health benefits, to conduct a review to identify barriers to medication-assisted treatment for opioid use disorders and develop action plans to address these barriers.
The most recent data show that the rate of overdoses involving prescription pain medication is leveling off, although it remains at an unacceptably high level. But there is a dramatic rise in heroin-related overdoses – which nearly doubled between 2011 and 2013.NACNS will continue to follow this issue and provide pertinent information to NACNS members as it becomes available.
NACNS recently endorsed the Hospice Commitment to Accurate and Relevant Encounters Act (Hospice CARE). This legislation addressed practical ways to ensure that hospices can continue to deliver high quality end-of-life care. The legislation expands the type of hospice employees that can provide face-to-face encounters to include the CNS.
This bill also changes the reference to “the 180th day recertification” to “the first 60 day period” in order to make the statute consistent with CMS’s interpretation, and allows hospice up to 7 days after the patient elects hospice to provide a face-to-face encounter in the limited circumstance of a hospice newly admitting a patient who requires a face-to-face encounter because of past hospice experience with a difference hospice. These changes will ensure that patients are not denied timely access to hospice services.
Hospice services are considered Medicare Part A services. CNS services are generally covered under Medicare Part B services. This bill would serve to expand the use of the CNS in Medicare Part A.
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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.