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
At the instigation of NACNS, technical changes are being included in the House Title VIII Reauthorization bill - sponsored by Representatives Lois Capps (D-CA) and David Joyce (R-OH) - that will create equity among the APRN roles. Specifically, the Title VIII statute would be amended in two places to include clinical nurse specialists:
The Nursing Workforce Development programs (Title VIII of the Public Health Service Act) have helped to meet the nation’s demand for nursing services. Administered by the Health Resources and Services Administration, these programs address all aspects of nursing workforce demand, including education, practice, recruitment, and retention. The Title VIII programs bolster nursing education at all levels, from entry-level preparation through graduate study, and also provide support for institutions and nurse faculty. Between FYs 2006 and 2013, the Title VIII programs supported over 520,000 nurses and nursing students as well as numerous academic nursing institutions and healthcare facilities, to ensure patients receive high-quality nursing care.The hope is that the House will pass the reauthorization bill this year. A companion bill has not yet emerged in the Senate.
On June 23, The New York Times published a letter-to-the-editor from NACNS President Peggy Barksdale. She submitted it in response to the front page story, "Aid to Women, or Bottom Line? Advocates Split on Libido Pill." Flibanserin has been part of an ongoing media debate sine the pill was recommended by the FDA's advisory committee in early June. Earlier this year, the NACNS Board of Directors voted to support the Even the Score coalition, a campaign designed to level the playing field when it comes to the treatment of women's sexual dysfunction. Flibanserin is the first drug the FDA Advisory Committee has considered to treat women's sexual dysfunction. Before its recent approval by the Advisory Committee, the committee reviewed filbanserin in the past and recommended additional research prior to reconsideration. The final decision about whether the FDA will approve filbanserin is expected to be announced in early August.
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 healthcare systems. NACNS is collecting these stories.In an effort to educate policymakers, the public and leaders in the healthcare system about the important contributions of the CNS, NACNS is looking for stories from you – on how you have made a difference in your role, 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.
NACNS will collect your innovative practice projects and initiatives and use them in a variety of ways to articulate the contribution of the CNS. We are asking members to send brief stories – just a few paragraphs – to email@example.com.
Please make sure that you do not use personal identifiable information related to patients in your story.Submit your stories to: firstname.lastname@example.org. Please put "innovative story" in the subject line.
NACNS is hosting two important annual meetings this summer in the Washington, DC area. The NACNS Educator's Forum and the NACNS 16th Annual CNS Summit will be held on July 20th and 21st. The Educator's Forum is designed to provide CNS educators from clinical instructors to program directors the opportunity to discuss key issues that impact CNS education. The preliminary agenda for this meeting includes a discussion of the DNP program for the CNS role. The current DNP Position Statement Task Force will be providing its position and seeking feedback from CNS faculty.
The NACNS 16th Annual CNS Summit will provide an opportunity for NACNS members and representatives from collegial organizations to discuss issues impacting the CNS work environment. The preliminary agenda for this meeting includes:
An exciting option has been added to the 2015 NACNS CNS Summit Agenda. Our meeting coincides with the ANA's annual member Hill Day. ANA has graciously agreed to allow interested NACNS members to join ANA on their Hill day on July 22nd. You can register for the Hill Day as part of the NACNS CNS Summit registration. There is no charge for participating in the ANA Hill Day, but you must pre-register for Hill Day. ANA requires that you register with them by Wednesday, July 8th to reserve a spot for Hill Day, click here to register. For more information – please send your questions to email@example.com. You may sign up for the 2015 NACNS CNS Summit – the Educator's Forum, Summit and Hill Day at www.nacns.org. Please click on the icon for the 2015 NACNS CNS Summit.
NACNS is excited to continue our high quality webinar programming in 2015. This series of webinars is designed to provide the CNS with cutting-edge clinical and role information. The topics have been selected with an eye toward issues that cross specialties and may be seen in a variety of clinical situations. In addition, we have intentionally designed some of the sessions to provide much needed pharmacology CE! Please sign up for one or more:
Looking Beyond the First Impression – Malnutrition Identification and Assessment
Moving toward a Violence Free Workplace
Malnutrition and the Hospitalized Adult – Essential Considerations in Identification and Management
*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.
The Future is Today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist
Join clinical nurse specialists from around the country at the original capital of America. If you have never been to Philadelphia, this is your chance! Philly is a melting pot of history, traditions and immigrant cultures. This means lots to do and amazing culinary options! It is the home to the Liberty Bell and the Declaration of Independence, both tributes to the city's contribution to the founding of our nation. Details will be posted on the NACNS web site – www.nacns.org.
Abstract Submission Opened on June 1, 2015.
In May, 2015 NACNS started the first in a series of short surveys designed to get information from NACNS members on issues of interest. This will allow all of us with limited time to "click the link" and go to the survey. These surveys will each be limited to 5-6 questions and should take 1-2 minutes for you to complete. Our first survey had a wonderful response rate, so thank you for clicking through and letting us know your opinions!
President Peggy Barksdale has been engaged in working with the NACNS Board of Directors to ensure that NACNS has written policies and procedures to support the work of the Board, committees and other NACNS volunteer entities. This intensive internal work gives NACNS a record of processes to assist future leaders and volunteers. Recently, the NACNS Board of Directors approved position descriptions for the different volunteer board roles. These descriptions will be used by the NACNS Nominating Committee to help them recruit future NACNS leaders. The Board also approved an ethics policy to help current and future Board members understand the ethical standards the Board wishes to adhere to and it provides NACNS members with an understanding of the key expectations of Board members as they engage in the work of the association. A copy of the NACNS Board Ethics Policy can be obtained upon request. If interested, please email firstname.lastname@example.org.
September 1 – 7 is National CNS Recognition Week, a time when hospitals and health care systems pay tribute to and build awareness of the important role that CNSs play in ensuring that patients receive high quality care based on the best and most recent research evidence.
This year, the theme for CNS Week is The Clinical Nurse Specialist: Vital Link in Health Care Reform.
To help you and your colleagues work with your hospital or health care system to publicize National CNS Recognition Week, we have developed a set of materials, that you will find on the NACNS website, including:
We would also love to share photos of this year’s events on our Facebook page. Please send photos, along with the name of the hospital or health care system, the city and state, and a description of the activity to email@example.com. We will post as many as possible on the Facebook page.
ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, and ANA Chief Executive Officer, Marla J. Weston, PhD, RN, FAAN, were both on the ballot for Modern Healthcare’s "100 Most Influential People in Healthcare" ranking. We look forward to hearing the outcome of the vote. If you voted – thanks for voting for nurses!
The National Council of State Boards of Nursing (NCSBN) is holding its annual meeting in Chicago August 19-21, 2015. The theme of the meeting is "A United Mission for Regulatory Excellence." NCSBN has invited organizations to be part of a special exhibit that will allow meeting participants to interact and ask questions about different clinical practices. With the implementation of the APRN Consensus Model, it is more important than ever that State Board members be aware of the unique contributions the CNS brings to health care.
On March 31, 2015, JCAHO released Sentinel Event Alert # 54. This Sentinel Event builds on a prior alert – Sentinel Event Alert #42 that was written on the safe implementation of health information and related converging technologies. Alert #54 focuses on the need to take into account the socio-technical factors that come into play with the use of HIT. This alert emphasizes the need for a culture of safety, process improvement and leadership in the use and evaluation of HIT.
As part of the White House Forum on Antibiotic Stewardship on June 2, 2015, JCAHO announced its efforts to promote effective antibiotic stewardship. The Joint Commission announced its commitment to increase its efforts to promote effective antibiotic stewardship within health care facilities.
Antibiotic resistance is a growing concern as health care providers and institutions are seeing an increase in antibiotic-resistant diseases. This trend may have a huge impact on the health and welfare of society. JCAHO noted that it will be reviewing its current standards and work with accredited organizations and others to identify where new standards may be needed to promote effective antibiotic stewardship. JCAHO will develop any new standards as rapidly as possible and simultaneously provide new tools to help providers use antibiotics judiciously. This issue is a high priority for JCAHO because the rise of antibiotic-resistant bacteria represents a serious threat to public health. The Centers for Disease Control and Prevention (CDC) estimates at least 2 million illnesses and 23,000 deaths in the United States each year are caused by antibiotic-resistant bacteria, and 20 to 50 percent of all antibiotics prescribed in acute care hospitals in the United States are either unnecessary or inappropriate. Inappropriate use of antibiotics includes, but is not limited to:
15. NIH-funded Trial Shows Early Antiretroviral Treatment Improves Outcomes for HIV-infected Individuals
New findings from the Strategic Timing of AntiRetroviral Treatment (START) study, a large-scale randomized clinical trial, have demonstrated that earlier antiretroviral treatment benefits all HIV-infected individuals. The results specifically indicate that HIV-infected individuals have a lower risk of developing AIDS or other serious illnesses if they are started on antiretroviral drugs earlier. Typically, recommended therapy involved waiting until the CD4+ T-cell count dropped to lower levels. Now, based on this study and a combination of other studies it has been shown that early treatment not only helps the HIV-infected individual and also early treatment can reduce the risk of HIV transmission to uninfected sexual partners. These findings support offering treatment to everyone with HIV.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, provided primary funding for the START trial. Though the study was expected to conclude at the end of 2016, an interim review of the study data by an independent data and safety monitoring board (DSMB) recommended that results be released early.
NIAID Director Anthony S. Fauci, MD stated, "We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later," said NIAID Director Anthony S. Fauci, M.D. "Moreover, early therapy conveys a double benefit, not only improving the health of individuals but at the same time, by lowering their viral load, reducing the risk they will transmit HIV to others. These findings have global implications for the treatment of HIV."
START is the first large-scale randomized clinical trial to offer concrete scientific evidence to support the current U.S. HIV treatment guidelines, which recommend that all asymptomatic HIV-infected individuals take antiretrovirals, regardless of CD4+ cell count. Current World Health Organization HIV treatment guidelines recommend that HIV-infected individuals begin antiretroviral therapy when CD4+ cell counts fall to 500 cells/mm3 or less.
Federal and State Policy
On June 3, the Senate Veterans' Affairs Committee held a hearing on the Frontlines to Lifelines Act, S. 297, introduced by Senator Mark Steven Kirk (R-IL). One of the major provisions of this bill authorizes the Veterans Administration (VA) to allow a covered nurse to practice independently, without the supervision or direction of others, under a set of VA-approved privileges, regardless of the state in which the VA employs the covered nurse. The bill defines a "covered nurse" as an advanced practice registered nurse who is employed by the VA as: (1) a nurse midwife; (2) a clinical nurse specialist, with respect to the provision of mental health care; or (3) a nurse practitioner.
NACNS, as part of the APRN Workgroup, submitted testimony for the hearing record, which requested that S. 297 be amended to add CRNAs to the list of APRNs, to allow Full Practice Authority to all VHA CNSs and not just mental health CNSs, and to replace "independent practice" with language supporting "Full Practice Authority."With the push to provide better medical services for the nation's veterans, there is a good chance that the Senate will pass this bill and send it to the House.
On June 4, 2015, an FDA Bone, Reproductive and Urologic Products Advisory Committee took an important step in providing equity for women by approving flibanserin, a drug to treat lack of sexual desire in women. NACNS is part of the coalition that engaged in an intense lobbying campaign to have FDA's federal advisory panel re-consider this drug after twice declining approval. "It was a matter of equity for the NACNS Board of Directors," said NACNS President Peggy Barksdale, MSN, RN, CNS. "A woman's sexual health is part of her general health and well-being. Some women, including those prior to menopause may suffer from reduced sexual desire that is related to a health issue. It is important that women also have access to pharmacology therapy for their sexual health."
NACNS is a member of the coalition Even the Score that worked to have flibanserin re-considered by FDA. This medication has been characterized by some as Viagra for women. Flibanserin was developed by Sprout Pharmaceuticals.By a vote of 18-6, the advisory committee to the Food and Drug Administration favored approval of the drug, flibanserin, for women whose lack of sexual desire was not attributable to other causes such as disease or relationship troubles, providing that certain steps were taken to limit the risks of the drug. Some of the side effects include low blood pressure, fainting, nausea and dizziness. There is some possibility that there will be a certification process for providers who prescribe this medication. The Advisory Committee recommendation goes to the FDA for final drug approval. The FDA is expected to act on this recommendation by August 8, 2015.
In a letter to the Centers for Medicare & Medicaid Services (CMS) Republican legislators are asking that an ICD-10 contingency plan be developed that addresses how Medicare will process claims if on the implementation date--Oct. 1--the agency is unable to process the new codes. The letter requests CMS to:
A House bill introduced by Rep. Diane Black (R-Tenn.) would require end-to-end testing of the transition from ICD-9 to ICD-10 by the Health and Human Services Department, and would provide an 18-month transition period to the new code set.
Rep. Ted Poe (R-Texas) introduced legislation that would ban outright the use of the code set.
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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.