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

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Featured Headlines

  1. CNS Week – Celebrate September 1–7
  2. NACNS Board Revises DNP Position Statement
  3. Open Forum Webinar – Talk with NACNS President and DNP Position Statement Revision Task Force

Headquarters News

  1. 2015 NACNS Webinar Series Continues
  2. Help Get the Word Out - NACNS Seeking Innovative Stories
  3. NACNS Annual Summit and Educator’s Forum a Success
  4. Plan Now for 2016 Annual Conference – Important Dates

Association News

  1. ANA’s Dialogue Forums
  2. NCSBN Announces New CEO
  3. The Joint Commission – Patient-centered Communication Resources

Clinical News

  1. Medicare Readmission Penalties
  2. Legionnaires Disease Outbreak in NYC
  3. Heroin Use Climbs
  4. HRSA’s Multiple Chronic Disease Resources
  5. FDA Warning on NSAIDs Strengthened
  6. FDA Exploring Long Term Safety of OTC Antiseptic Products

Federal and State Policy News

  1. CMS Releases Proposed Updates to the “Two-Midnight” Rule
  2. LTC Proposed Rules Give CNS Authority to Provide Services

Featured Headlines

1. Celebrate CNS Week - September 1 - 7, 2015

CNS Week is an important time for us to celebrate our profession and our contribution to healthcare. CNS Week’s date was selected to coincide with Hildegard Peplau’s birthday. In honor of this year’s 20th Anniversary, we are pleased to offer a webinar presented by nationally-known speaker Linda Burnes Bolton, DrPH, RN, FAAN.

NACNS Celebrate CNS Week  
September 1 – 7, 2015 is CNS Week and we celebrate "The Clinical Nurse Specialist: The Vital Link in Healthcare Reform." NACNS has developed a collection of helpful materials you can use to plan events to recognize the work of the CNS in your facility and/or healthcare system. You can find them on the NACNS website at

Resources to Get Ready
Here are some resources for you! You can click on the individual links or go to and click on the CNS Week logo.

On the website you will find: an idea guide, fact sheet, flyer, paper on the CNS role 2015, draft letter to the editor, sample proclamation, draft oped, template news release and sample social media posts.

Free CE Webinar
Free Webinar for CNS Week. Linda Burnes Bolton, DrPH, RN, FAAN, will present a webinar for CNSs around the nation.  This free webinar, "Role of a Clinical Nurse Specialist in a Culture of Health," will be held on September 2nd at 3:00 pm Eastern Daylight Time.

Please note that there are a limited number of registration slots for this webinar, so we encourage you to register early to ensure you can join it. For those unable to join, the webinar will be archived on the NACNS website.

Click here to register for the free CNS Week Webinar

Gifts to Purchase
This year, NACNS is pleased to offer products for you to purchase for yourself or another CNS in honor of CNS Week.

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 picutres at your events and send them to us a, along with a paragraph describing the event. We will share as many of these as possible on our Facebook page and through other vehicles.

2. NACNS Board of Directors Announces Revised Position Statement on the DNP Degree

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. The NACNS Board of Directors reserves the right to adjust this target date to accommodate changes in the healthcare environment.

"In recognition of the increasingly complex needs of patients, the dramatic and ongoing changes in healthcare, and the pivotal role that the CNS plays in ensuring high quality, evidence-based, patient-centered care, NACNS has determined that the DNP will better prepare these nurses to meet the future demands of the evolving health care system," said NACNS President Peggy Barksdale, MSN, RN, OCNS-C, CNS-BC.

The position statement, a Q and A and a news release on the statement are available on the NACNS website.

3. Open Forum Webinar – Talk with NACNS President and DNP Position Statement Revision Task Force

NACNS made an important announcement in July, 2015 when we released our revised position statement on the DNP 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 will be presenting a brief presentation on the position statement with the opportunity for professional dialogue. Please join us! This webinar is free for all NACNS members, but you must register.

DATES - September 8, 6:00 pm eastern or September 10, 3:00 pm eastern

Please register for one of the two webinars by completing the following:

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Headquarters News

4. NACNS 2015 Webinar Series *

After a short summer respite – NACNS' webinar program will resume in September 2015. We are pleased to announce the addition of a webinar in honor of CNS Week – "Role of the CNS in a Culture of Health." The webinar is free, but there are a limited number of slots for participants, so please register early! The program will be archived on the NACNS website for those unable to register for this opportunity. Please register online.

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.    NACNS will be offering special pricing for two webinars on this issue – the first is scheduled for September 15 at 4:00 pm eastern and the second will be held November 17, at 4:00 pm eastern.

Please watch your email for added webinar sessions!!

Please sign up for one or more:

Webinar Cost:
Series of 6 Webinars
Members $260
Non- Members $295
Student $150

All webinars have been archived for later viewing.

Single Webinar
Members $45
Non-Members $60
Student $30

**Looking Beyond the First Impression – Malnutrition Identification and Assessment
9/15/15 - 4:00 pm Eastern

Moving Toward a Violence Free Workplace
10/21/15 - 2:00 pm Eastern

**Malnutrition and the Hospitalized Adult – Essential Considerations in Identification and Management
11/17/15 - 4:00 pm Eastern


*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.

** Special pricing for both Malnutrition Webinars - Register before September 15 and you can attend both sessions for a member price of $50.00 instead of $90.00 if you paid separately. (Non-member discount $100 for both; Student discount $50.00 for both.)

5. NACNS Seeking CNS Innovation Stories

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 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 healthcare. If you have a story to share, please send it (it only need be a couple of paragraphs long) to

It is not necessary to address the following questions, but they might provide a good guideline for your submission.

  • What problem were you trying to solve/address?
  • What solution/innovation did you implement?
  • Who did you engage in this solution/innovation?
  • What spheres of influence did your solution/innovation address (patient/family; nurse; systems)?
  • What outcomes have you seen?
  • If you can, please estimate or cost out any savings that you have seen.

Please make sure that you do not use personal identifiable information related to patients in your story. 
Submit your stories to: Please put "innovative story" in the subject line.

6. Don’t Miss the Annual Educator's Forum and NACNS 16th Anniversary Summit

On July 20 - 22 NACNS hosted a series of important and well-attended meetings. The NACNS Educator's Forum brought together some 50 educators, certifiers and clinicians to discuss critical issues in CNS education. The group discussed the newly released NACNS position statement on the DNP as a requirement for entry into practice for the CNS by 2030. The discussion was lively and participants had the opportunity to learn from each other. In response to participants' suggestions, the 2016 Educator's Forum will be structured as a curriculum exchange. Plan now to join the discussion and learn how your colleagues are designing their programs.

The NACNS 16th Annual CNS Summit on July 21 included a rich discussion of the issues facing the CNS in today's healthcare environment. Participants noted that while there has been an increase in demand for the CNS in many facilities, there is an inadequate number of CNS education programs meet that demand. Participants also reviewed the status of the APRN Consensus Model and explored the aspects of the APRN Compact that provide opportunity and challenge for the CNS.

Importantly, the sessions covered the key federal legislative issues the impact the CNS role. Speakers provided an overview of key legislation and participants discussed upcoming regulations that will allow the CNS (NP and PA) to prescribe durable medical equipment. Close to 80 people attended this important meeting.

ANA’s annual Membership Assembly includes a Hill day for participants, and this year, NACNS Summit attendees were invited to participate in that event. We have heard rave reviews for this important professional opportunity and hope that NACNS will be able to provide more opportunities like this to our members.

NACNS is making plan for our 2016 Educator's Forum and Summit. Mark your calendars and be part of the conversation! The 2016 Educator's Forum and Summit are scheduled for July 18 and 19.


7. Save the Date for NACNS' Annual Meeting - March 3 – 5, 2016, Philadelphia, PA

The Future is Today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist
March 3-5, 2016 ~ Loews Philadelphia Hotel, Philadelphia, Pennsylvania

Planning is well underway for the 2016 NACNS Annual Meeting. The planning committee has been meeting and has identified exciting and engaging keynote speakers. 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 –

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Association News

8. ANA Holds Dialogue Forum as Part of Membership Assembly

Among the important events at the ANA Membership Assembly are the Dialogue Forums, at which attendees hear presentations about important topics and have an opportunity to discuss those topics with their colleagues. The topics for this year’s Dialogue Forums were: infection prevention and control; measuring and publicly reporting nurses' essential contributions to quality patient care; and fostering an ethical work environment and culture. A report on these discussions can be found in The American Nurse.

9. NCSBN Announces New CEO

The National Council of State Boards of Nursing (NCSBN) Board of Directors (BOD) has named David Benton, RGN, RMN, BSc, M Phil, PhD, FFNF, FRCN, to succeed retiring CEO Kathy Apple. Benton will assume the duties of CEO on October 1, 2015.

Benton is currently CEO of the International Council of Nurses (ICN), a post he has held since 2008. Immediately prior to that appointment he served as an ICN consultant in nursing and health policy specializing in regulation, licensing and education. He has also served on the Editorial Advisory Board for the NCSBN Journal of Nursing Regulation since its launch in 2010.

Benton has held senior leadership roles for more than 25 years across a range of organizations including working as executive director of nursing at a health authority in London; as a senior civil servant in Northern and Yorkshire Region in England; as chief executive of a nurse regulatory body in Scotland; and as nurse director of a University Trust Health System.

110. The Joint Commission’s Resources on Patient-centered Communications

Clinical nurse specialists know that effective communication is critical to the successful delivery of health care. But there are many barriers to effective communication in the healthcare setting. It is estimated that more than 300 languages are spoken in the United States and more than 90 million Americans have low health literacy. These issues can have a significant impact on an individual’s understanding of his or her healthcare needs. The Joint Commission has a number of resources designed to improve communication between healthcare professionals and patients. The Joint Commission’s Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care web page provides extensive information about patient-centered communications. Some examples of resources include:

  • Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals
  • Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide
  • Speak Up™ – A free, national patient safety campaign from The Joint Commission includes animated videos, brochures, posters and infographics urging patients to take a role in preventing healthcare errors by becoming active, involved and informed participants on the healthcare team.

You: The Smart Patient: An Insider’s Handbook For Getting The Best Treatment – A for-sale publication written by best-selling authors Michael F. Roizen, M.D. and Mehmet C. Oz, M.D.

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Clinical News

11. Medicare Readmission Program Results in Hospital Penalties

According to an article in Kaiser Health News, close to 2, 600 hospitals will incur penalties for missing the readmission targets set by Medicare. This will result in a combined total penalty of $420 million which translates to an average Medicare payment reduction of 0.61% per patient stay. The most common diagnosis for these patient is heart attack, heart failure, pneumonia, chronic lung problems or hip and knee replacements. This is part of the Hospital Readmission Reduction Program created under the Affordable Care Act. These penalties are part of a program intended to make hospitals pay closer attention to what happens to patients after discharged. 

This is a rich area for CNS’s to address in their clinical areas. Since the fines began, national readmission rates have dropped, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month.

12. Legionnaire’s Disease Reported in New York’s South Bronx Area

Starting on July 10th the New York City Health Department reported that four patients had died and dozens were sickened in an outbreak of Legionnaires' disease focused in South Bronx. The mortality rate for Legionnaire’s is 5 % - 30 %, with those suffering from other diseases being more vulnerable. The deputy commissioner for disease control in New York City’s health department said the disease-causing bacteria had been found in five cooling towers around the South Bronx. People who inhaled contaminated water droplets or vapor from the towers before they were cleaned are still at risk for infection. New York City’s health officials are assuring the public that the city water supply is not at risk.  At the same time, New Yorkers with respiratory systems, such as fever, cough, chills, and muscle aches, are being asked to quickly seek medical attention.

The bacterium is named after a 1976 outbreak, which occurred in Philadelphia during a convention of the American Legion. A milder infection, also caused by Legionella bacteria, is called Pontiac fever. The term "legionellosis" (LEE-juh-nuh-low-sis) may be used to refer to either Legionnaires' disease or Pontiac fever. The CDC warns that the disease is spread through mist from water sources including air conditioning and cooling towers. The CDC also has resources for clinicians and patients about the disease.

13. Heroin Once Again Popular in Drug Abuse Circles

Heroin use has increased across the US among men and women in most age groups, and at all income levels. Some of the greatest increases occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes.

Not only are people using heroin, they are also abusing multiple other substances, especially cocaine and prescription opioid painkillers. Nearly all (96 percent) people who reported heroin use also reported using at least one other drug in the past year. More than half (61 percent) used at least three other drugs. Prescription opioid painkiller abuse or dependences was the strongest risk factor for heroin abuse or dependence; 45% of people who used heroin also abused or were dependent on prescription opioid painkillers in the past year.

As heroin use has increased, so have heroin-related overdose deaths. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people died in 2013.

In looking at this drug abuse trend, there are some important facts providers should be aware of:

  • One of the largest risk factors for heroin addiction is addiction to prescription opioid painkillers. If you identify a patient who abuses one of these substances, you may wish to explore whether that patient also uses the other.
  • Naloxone can prevent an opioid overdose death.
Heroin overdose symptoms may be masked or altered because of the formulation of the heroin and other drugs the individual took. Typical symptoms of heroin overdose are euphoria, miosis, and respiratory and central nervous system depression; cardiovascular effects are not a common finding. The CDC has reported some atypical side effects such as tachycardia and palpitations after reported heroin use.

14. Health Resources and Services Administration Announces Education Materials on Chronic Conditions

New healthcare professional training materials are available for providers who care for individuals living with chronic conditions. The U.S. Department of Health and Human Services (HHS) Education and Training Resources on Multiple Chronic Conditions (MCC) for the Healthcare Workforce were created by the Office of the Assistant Secretary for Health in collaboration with the Health Resources and Services Administration (HRSA). 

Technical assistance webinars are planned to review these new Multiple Chronic Conditions Education and Training materials and to help address questions users might have. The September session will be held:

Thursday, September 17, 2015; 2:30 - 4:00 p.m. EDT
Webinar Details: Call in number: 888-455-0579; Participant passcode: 1245558

Register now by RSVPing to MCC@HHS.GOV indicating the date you would like to attend as attendance is limited to 300 for each session.

15. Coming Soon – FDA Warnings on NSAIDs to be Strengthened

FDA has posted a notice that drugs that fall into the non-aspirin nonsteroidal anti-inflammatory drugs category will soon carry a stronger warning about an increased chance of heart attack or stroke.  It is a good reminder that patients using these drugs and providers caring for these patients should be alert for heart-related side effects.

16. FDA Exploring Long Term Safety of OTC Antiseptic Products

The US Food and Drug Administration (FDA) recently issued a proposed rule relating to the safety and effectiveness of the use of over-the-counter (OTC) antiseptic products in healthcare settings. Products included in the rule are "healthcare antiseptics" (healthcare personnel hand washes, healthcare personnel hand rubs, surgical hand scrubs, surgical hand rubs, and patient preoperative skin preparations). "Washes" are products are defined as those that are rinsed off with water, and "rubs" are leave-on products.

The FDA is seeking additional data from manufacturers on the safety and effectiveness of the active ingredients in these products, including absorption data, potential hormonal effects, and possible bacterial resistance. The FDA is interested in establishing the long-term safety of daily, repeated exposure to the active ingredients in these antiseptic products.

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Federal and State Policy

17. CMS Released Proposed Updates to the "Two-Midnight" Rule

3On July 1st, 2015, CMS released proposed updates to the “Two-Midnight” rule regarding when inpatient admissions are appropriate for payment under Medicare Part A. These updates were included in the calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.

In recent years, through the Recovery Audit program, CMS identified high rates of error for hospital services rendered in a medically-unnecessary setting (i.e., inpatient rather than outpatient).

CMS also observed a higher frequency of beneficiaries being treated as hospital outpatients and receiving extended “observation” services. Hospitals and other stakeholders expressed concern about this trend, especially since days spent as a hospital outpatient do not count towards the three-day inpatient hospital stay that is required before a beneficiary is eligible for Medicare coverage of skilled nursing facility services.

To provide greater clarity to hospital and physician stakeholders, and address the higher frequency of beneficiaries being treated as hospital outpatients, CMS adopted the Two-Midnight rule for admissions beginning on or after October 1, 2013. This rule established Medicare payment policy regarding the benchmark criteria that should be used when determining whether inpatient admission is reasonable and payable under Medicare Part A.

In general, the Two-Midnight rule stated that:

  • Inpatient admissions will generally be payable under Part A if the admitting practitioner expected the patient to require a hospital stay that crossed two midnights and the medical record supports that reasonable expectation.
  • Medicare Part A payment is generally not appropriate for hospital stays not expected to span at least two midnights. 

The Two-Midnight rule also specified that all treatment decisions for beneficiaries were based on the medical judgment of physicians and other qualified practitioners. The Two-Midnight rule does not prevent the physician from providing any service at any hospital, regardless of the expected duration of the service. 
In the CY 2016 OPPS proposed rule, CMS is:

  • Proposing to change the standard by which inpatient admissions generally qualify for Part A payment based on feedback from hospitals and physician to reiterate and emphasize the role of physician judgment.
  • Announcing a change in the enforcement of the standard so that Quality Improvement Organizations (QIOs) will oversee the majority of patient status audits, with the Recovery Audit program focusing on only those hospitals with consistently high denial rates.

Comments on the two midnight proposed rule are due on August 31. See the proposed rule under Contacts and Addresses for details on submitting comments. (see hotlink above.)

18. LTC Proposed Rules Give CNS Authority to Provide Services

The proposed rule, Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care (LTC) Facilities, revises the requirements that Long-Term Care facilities must meet to participate in the Medicare and Medicaid programs. They include several proposed changes that authorize Clinical Nurse Specialists (CNS) to provide services in these facilities. The regulatory changes, sometimes called the Conditions of Participation for LTC Facilities, put in place requirements that will help facilities achieve broad-based improvements both in the quality of health care and in patient safety.

The proposed rules allow CNSs, along with nurse practitioners and physician assistants, to provide an in-person evaluation of a facility resident prior to a transfer to the hospital. In addition, they may order laboratory, radiology, and other diagnostic services for a resident in accordance with state law, and they may be notified of abnormal laboratory results when they fall outside of clinical reference ranges. The rule ensures that the resident knows the name, specialty and means of contacting the professionals officially responsible for his or her care, whether that provider is a CNS, physician, nurse practitioner or physician assistant. The proposed rule specifies that when a physician recommends that the individual be admitted to a facility, a physician, a CNS, a physician assistant or a nurse practitioner must provide orders for the resident’s immediate care and needs.

The proposed rules also address the following areas:

  • Extensive and specific requirements around training of new and existing staff;   
  • Comprehensive Person-Centered Care Planning;
  • Discharge planning requirements;
  • Appropriate nurse staffing based on facility’s population;
  • Infection control standards;
  • Updated special care issues like pain management and dialysis;
  • Quality assurance and performance improvement (QAPI);
  • Compliance and ethics programs;
  • Reporting of suspicion of a crime;
  • Training requirements related to dementia and abuse prevention;
  • Focus on the appropriate use of psychotropic medications; and
  • New requirements for behavioral health services, including non-pharmacological interventions.
To submit a comment, visit, enter the file code CMS–3260–P and click on “Submit a Comment.” The comment period closes at 5pm on September 14, 2015.

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