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.
Federal and Regulatory News
Resources of Interest
NACNS’ special summer meetings are open for registration. The 3rd Annual Educator’s Forum and 15th Annual CNS Summit will be held at the Westin Arlington Gateway, Arlington, VA. The Educator’s Forum and CNS Summit are a unique set of meetings that will help members improve their understanding of key issues impacting the clinical nurse specialist role. NACNS needs members at the table to help discuss these key issues!
CNS Educator’s Forum – July 18, 2015The goal of the CNS Educator’s Forum is to bring CNS leaders, educators and faculty members together to discuss critical issues pertinent to the survival and growth of the CNS role in today’s health care system. The first Educator’s Forum in 2014 drew interested faculty from around the nation. This year’s conversation will focus on:
CNS Summit - July 19, 2016
* NACNS has submitted the CNS Summit and Educator’s Forum to the AL State Nurses Association for approval to award contact hours. AL State Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Registration and Hotel Information
We are pleased offer the two-day meeting for a combined registration fee of $235.00, if you register on or before July 1. Single day registration fees are:
Please attend and jointhese critical national discussions. Your point of view is welcome and will be an important addition to the deliberations. Space is limited, so register early. After July 15 all participants will need to register onsite.
Mark your calendars for the Affiliate and Committee/Task Force Chairs Conference Calls!
Face-to-face meeting for 2016 – The 2016-2017 Board of Directors will hold its second face-to-face meeting in July 2016 to coincide with the Educator’s Forum and NACNS Summit. A task force is planning for the 2016 Educator’s Forum and Summit. These meetings will provide an important opportunity for participants to discuss policy issues affecting the CNS.
PhD position statement – The Board reviewed and approved a draft position statement on the PhD degree. The statement was posted on the NACNS website so that members could comment through March 31, 2016. A subset of the Board is reviewing these important member comments and will present a revised draft to the Board for consideration and a vote.
RFP for Website – In recognition of the limitations of our current website, NACNS’ Board reviewed proposals submitted by web vendors in response to an RFP the association sent out. Staff continues to work on this important upgrade. The goal is to begin moving to the new website before the end of 2016.
Society of Critical Care Medicine (SCCM) – NACNS Board considered a request members to to work with SCCM and the American Association of Critical-Care Nurses (AACN) to develop a paper that discusses health care outcomes attributed to the clinical nurse specialist. NACNS has contacted SCCM and will invite inviting two to three NACNS members to be part of this work.
GAPNA Endorsement Request – The Gerontological Advanced Practice Nurses Association (GAPNA) has asked NACNS to review and comment on GAPNA’s Consensus Statement on Proficiencies for the APRN Gerontological Specialist 2015. In a letter sent to GAPNA at the end of April, NACNS Board president, Sharon Horner identified concerns with the document, including but not limited to the lack of equal participation of the CNS in the document development and review process, and a bias toward the patient sphere of influence and little attention to the other two spheres of influence of the CNS role. It was also noted that if this document is to be an APRN document, it must include the nurse midwife and CRNA roles. NACNS looks forward to working with GAPNA to improve the document.Affiliate Survey – The NACNS Board approved the distribution of a survey developed by the Affiliate Committee. This survey will help NACNS’ Affiliate Committee update the list of Affiliate contacts and understand the needs of today’s Affiliate members. The survey will be open until June 3. If you are an affiliate leader and have not received the survey link, please contact NACNS.
NACNS is in the process of assembling our 2016 - 2017 Committees. Our committees are an important part of the NACNS volunteer structure. Serving on a committee is a great way to contribute to NACNS as well as to network with other CNSs from around the country!Most committee positions involve two-year terms, and the committees typically meet on a monthly basis. Please consider submitting your nomination for an open position. The committees will begin their work in July, 2016.
The NACNS 206-2017 webinar series started off with an excellent webinar on Capnography followed by one in April on meeting the needs of the Diabetic child and family. The theme for 2016-2017 is pharmacology and technology.
All NACNS webinars are archived. Email firstname.lastname@example.org to order an archived webinar. Listen at your leisure and apply for CE certificate.
Webinars will now be held monthly and will provide CE at a reduced price of $25.00 for members. Group pricing is available; please email email@example.com for specific group size information. Webinar pricing has been restructured for 2016-2017. *Your purchase of the webinar includes access to the national-level, CNS specific continuing education and one person’s CE. If multiple individuals are listening to the webinar, the CE will only be available for one attendee. If you wish to register a group on one call-in line, please contact firstname.lastname@example.org. A group discount will be given for each additional CE on a single line.
All webinars are archived for later viewing.
To register, visit the NACNS website.
*This activity has been approved for contact hours by the Alabama State Nurses Association. The Alabama State Nurses Association is accredited as an approver of continuing education by the American Nurses Credentialing Center’s Commission on Accreditation. Each webinar is worth one CE credit.
Look for the opening of the 2016 CNS Census on June 1, 2016! - Stand Up and Be Counted!Clinical Nurse Specialists (CNSs) are valuable health care resources. In recognition of the importance of the role, the NACNS Board of Directors has directed the collection of crucial national data on the demographics, education and practice of the CNS. If you were educated as a CNS – (no, you don’t have to actively be practicing under the CNS title), don’t forget to help by taking the survey. The link can be found on the NACNS homepage at www.nacns.org – look for and click on the 2016 CNS Census icon to take the survey. Or you can go directly to the survey at: www.surveymonkey/r/2016cnscensus.
NACNS designed the first survey, the 2014 CNS Census, to capture information about people who identify themselves as or who were educated as Clinical Nurse Specialists (CNSs). It was the first national survey of the CNS workforce. An infographic on the NACNS website summarizes key finding from the first survey.University of San Diego, California PhD nursing students helped NACNS refine the survey and improve the speed of someone completing the survey. Don’t miss the chance to be part of this important initiative! And let your friends know! It is important that we get as many individuals educated as a CNS to be part of the 2016 CNS Census!
CNS Week is the time NACNS and CNSs around the country celebrate our profession. The NACNS Board is pleased to announce the theme for this year’s CNS Week - The CNS: Leaders in Building a Culture of Safety.
As part of this year’s celebration ANA President Pam Cipriano will present a webinar, Changing the Climate: Creating a Culture of Safety, for NACNS members on September 1. We hope to offer this webinar free for up to 200 registrants. NACNS will record and archive the webinar on the NACNS website, for members who cannot attend the live event.
As CNS Week approaches, we encourage NACNS members and Affiliates to consider what you might do to raise awareness of the CNS in your community and workplace. Many of resources are now available for you to use – get started now and make CNS Week special.
In the next few weeks, we have posted a press packet and other resources on the NACNS website that includes a range of template materials you can use.
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.Also look for NACNS logo items for sale! Go to www.nacns.org and click on the CNS Week Logo for more information. This year, we will again be selling a variety of products with the NACNS logo. In addition to the items we sold last year, we will be selling buttons with the CNS Week logo and NACNS baseball caps. Watch your email and check the NACNS website for more information.
NACNs is partnering with the American Association of Medical Instrumentation Foundation to provide their monthly seminars to our members. This collaboration will bring Interprofessional education to NACNS members through seminars that showcase the ways in which hospitals are addressing patient safety issues related to complex health care technology. Seminar registration is $25.00 for NACNs members and the seminars are expected to include nursing CE.
The first in the series will feature Johns Hopkins Hospital’s work improving the continuous monitoring of patients on parenteral opioids in the general care setting.Scheduled for Friday, May, 20, 2016, from 12 pm to 1 pm ET, “Does Continuous Vital Sign Monitoring Detect Early Deterioration of Patients Receiving Parenteral Opioids?” promises to be a very interesting look at the challenges and the benefits of implementing continuous monitoring.
After the seminar, it is expected that attendees will be able to:
To register: https://attendee.gotowebinar.com/register/7329441640951913218
9. New Online Course from NACNS and Indiana University School of Nursing Will Help CNS Preceptors Hone Their Skills
This summer, NACNS is teaming up with the Indiana University School of Nursing to provide “Developing Your Skills as a Clinical Nurse Specialist Preceptor,” an exciting new online training opportunity for CNS preceptors working with students during their clinical rotations. This online self-study course will provide nursing programs and CNS preceptors with valuable tips and tools to prepare for working with students, and allow them to complete the course on their own schedules.
“Developing Your Skills as a Clinical Nurse Specialist Preceptor” is being developed by expert CNS preceptors and faculty from a number of health systems and universities. It includes three modules: Organizing the Learning Experience, Engaging the Student, and Providing Useful Feedback. The course addresses: how to start the process of talking with prospective students about expectations and fit; strategies and best practices for working with students and faculty; teaching approaches; CNS competency areas; and providing feedback to students and faculty members. Registration will open this summer. To be added to the mailing list and receive information when it becomes available, sign up at http://nursing.iupui.edu/development/online-courses/cns-preceptor.shtml
Pricing and official contact hour calculations are still pending. Watch the website for more information!
Preceptor Course Planning Committee:
On April 14, 2016 the Joint Commission released a statement on pain management in an effort to clarify their standards for the assessment and management of pain. Some critics have claimed that the Joint Commission’s standards are contributing to the national opioid epidemic. The publicly released letter says:
11. American Nurses Association: Call for Nominations for Appointed Positions – ANA Committees & Boards
The ANA Committee on Appointments has opened the 2016 Call for Nominations for Appointed Positions on ANA Committees and Boards. During the annual Call for Nominations, ANA members (C/SNA-ANA and ANA-Only) may nominate themselves and others for positions designated for registered nurses. Non-members may also be nominated and/or seek appointment to certain positions designated for members of the public. Self-nominations are submitted to ANA through completion of an online biographical data form, conflict of interest and financial disclosure forms, a confidentiality and intellectual property agreement.
Additional information about current vacancies and the appointments process can be found on the Committee on Appointments page. For additional information contact firstname.lastname@example.org. All nominations must be submitted by 5:00 pm ET, Monday, June 27
On March 21, 2016, the Joint Commission announced its approval of prepublication approval of new National Patient Safety Goals for Catheter-Associated Urinary Track Infections (CAUTI). This is important information for CNSs that are working to decrease the rate of catheter-associated urinary track infections.
The Centers for Disease Control and Prevention (CDC) is working to raise awareness of the growing number of working adults that are living with arthritis. Currently, an estimated 53 million adults (one in five adults) have this chronic disease. By 2040, the number of working adults with this painful and limiting condition is expected to increase by a dramatic 49% to 78 million.
The fact that half of the individuals with arthritis are of working age (18 – 64 years of age) may have an economic impact on the United States. Addition to not working, having reduced employment hours and/or requiring accommodations to work, people with arthritis often use the health care system more than other individuals. According to the Centers for Disease Control and Prevention (CDC), a dramatic increase in the number of patients with this condition will lead to a shortage of rheumatologists and orthopedic surgeons. This can drive up the cost of care. By 2040, arthritis will limit that daily activities of an estimated 34 million adults, an increase of 52%. This may cause an increasein the use of Social Security Disability insurance and Medicare.The care of patients with chronic conditions is well within the scope of practice for the CNS. This unfortunate trend may provide opportunities for the CNS to meet the needs for specialist care managing patients with arthritis.
A recent study by the Centers for Disease Control and Prevention (CDC) reveals what many health care providers have suspected: There is a link between exposure to e-cigarette advertisements and the use of e-cigarettes by middle and high school students. The study, published in the April 2016 issue of Pediatrics, noted that efforts to reduce youth exposure to advertising are critical to prevent youth from using e-cigarettes and other tobacco products.
The study examined current (past 30-day) use of e-cigarettes and exposure to e-cigarette advertising in four different types of media: retail stores, the internet, TV/movies, and magazines/newspapers and compared it with data from the National Youth Tobacco Survey (NYTS), is a school-based, self-administered questionnaire given to more than 22,000 middle and high school students in 2014 that documents tobacco and e-cigarette use.
CDC researchers found that more exposure to e-cigarette advertisements was correlated with higher odds of e-cigarette use.
In January 2016, the CDC reported that spending on e-cigarette advertising rose from $6.4 million in 2011 to an estimated $115 million in 2014. During the same time period, e-cigarette use among youth grew dramatically from 1.5% in 2011 to 13.4% in 2014 among high school students, and from 0.6% in 2011 to 3.9% in 2014 among middle school students. In 2014, e-cigarettes became the most commonly used tobacco product among youth, surpassing conventional cigarettes.The U.S. Food and Drug Administration has regulatory authority over cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. The agency is finalizing a rule that would bring additional tobacco products such as e-cigarettes, hookahs, and some or all cigars under that same authority. Regulating the manufacturing, distribution, and marketing of tobacco products – coupled with proven population-based strategies – can reduce youth tobacco use and initiation. These strategies include funding tobacco control programs, increasing prices of tobacco products, implementing and enforcing comprehensive smoke-free laws, and developing hard-hitting tobacco cessation and prevention media campaigns.
Federal and Regulatory News
On April 26, 2016, the Department of Health and Human Services (DHHS), Office for Civil Rights (OCR) announced tthat it reached a $2.2 million settlement with New York Presbyterian Hospital (NYP) for disclosing two patients’ protected health information (PHI) to film crews and staff during the filming of “NY Med,” an ABC television series, without first obtaining authorization from the patients. In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop.
Further clarification of the issue of filming and working with film crews is found on a DHHS blog posted after the April 26 settlement announcement.
The HIPAA Privacy Rule does not require health care providers to prevent members of the media from entering areas of their facilities that are otherwise generally accessible to the public, which may include public waiting areas or areas where the public enters or exits the facility.A health care provider may utilize the services of a contract film crew to produce training videos or public relations materials on the provider’s behalf if certain protections are in place. Correct paperwork must be completed to enurse HIPAA restrictions are followed.
If patients are to be identified by the provider and interviewed by a film crew, or if PHI might be accessible during filming or otherwise disclosed, the provider must enter into a HIPAA business associate agreement with the film crew acting as a business associate. Among other requirements, the business associate agreement must ensure that the film crew will safeguard the PHI it obtains, only use or disclose the PHI for the purposes provided in the agreement, and return or destroy any PHI after the work for the health care provider has been completed. As a business associate, the film crew must comply with the HIPAA Security Rule and a number of provisions in the Privacy Rule, including the Rule’s restrictions on the use and disclosure of PHI. In addition, authorizations from patients whose PHI is included in any materials would be required before such materials are posted online, printed in brochures for the public, or otherwise publicly disseminated.
Finally, covered entities can continue to inform the media of their treatment services and programs so that the media can better inform the public, provided that, in doing so, the covered entity does not share PHI with the media without the prior authorization of the individuals who are the subject of the PHI.
For further information on the application of the HIPAA Rules in situations involving media access to protected health information, please see OCR’s new FAQ on this subject: http://www.hhs.gov/hipaa/for-professionals/faq/2023/film-and-media/index.html.The Resolution Agreement and Corrective Action Plan can be found on the HHS website at: http://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/new-york-presbyterian-hospital/index.html.
The Centers for Medicare & Medicaid Services (CMS) announced the launch of a new advanced primary care medical home model called Comprehensive Primary Care Plus (CPC+). CPC+ rewards primary care practices (internal medicine, general medicine, geriatric medicine, and/or family medicine) by offering an innovative payment structure to support comprehensive primary care. The model is built on the foundation of the Comprehensive Primary Care (CPC) initiative, which began in October 2012 and is scheduled to run through December 31, 2016. CPC+ is a five-year model and will begin in January 2017.
TThe CPC+ model, will be implemented in up to 20 geographic regions and will accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide physicians the freedom to care for their patients the way they think will deliver the best outcomes and to pay those physicians for achieving results and improving care.
CPC+ will bring together Medicare with commercial and state payer partners to support eligible practices in both tracks. In order to participate, all CPC+ practices must have multi-payer support, use Certified Electronic Health Record Technology (CEHRT), and demonstrate other capabilities.
Primary care practices will participate in one of two tracks. In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.
For more information about the CPC+ model, including a fact sheet, please visit: http://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus.
Unprecedented opioid misuse and overdose in the United States requires a comprehensive response from state and federal lawmakers. Congress and a number of state legislatures are taking important steps to address this epidemic. The challenge, however, is achieving consensus on simple and achievable prevention, treatment, and recovery policies that can stop opioid overdose. To that end, NACNS joined the Coalition to Stop Opioid Overdose, led by the American Society of Addiction Medicine.
The Coalition’s efforts will focus around four key strategies to combat the opioid epidemic:
The Coalition will:
More information will be forthcoming as the Coalition gears up.
In April 14 testimony before the House and Senate Appropriations Subcommittees on Labor, Health and Human Services, Education, and Related Agencies, NACNS urged the subcommittees to fund the Title VIII Nursing Workforce Development Programs at $244 million in FY 2017.
According to the Bureau of Labor Statistics (BLS), the RN workforce will grow 16% percent from 2014 to 2024, outpacing the 7% average for most other occupations. BLS also projects that this growth will result in 439,300 job openings, representing one of the largest numeric increases for all occupations. In addition, employment of APRNs is projected to grow 31% from 2014 to 2024, much faster than the average for all occupations.
NACNS President Sharon Horner commented, “NACNS believes that the deepening health inequities, inflated costs, and poor quality of health care outcomes in this country will not be reversed until the concurrent shortages of nurses, advanced practice registered nurses, and qualified nurse educators are addressed... Without national efforts of some magnitude to match the healthcare reality facing the nation today, it will be difficult to avoid the adverse effects on the health of our nation from the inability of our under resourced nursing education programs to produce sufficient numbers of high quality RNs and APRNs.”As these appropriations bills move through Congress, NACNS will provide updates to its membership.
On May 5, the Food and Drug Administration (FDA) unveiled new federal rules including a ban on the sale of e-cigarettes to people under 18. Cigars, pipe tobacco and hookah tobacco are also subject to the new rules. In announcing the ban, Sylvia Burwell, Secretary of the Department of Health and Human Services, said the announcement was “an important step in the fight for a tobacco-free generation.”
E-cigarettes are battery-operated devices that turn flavored nicotine liquid into an inhalable vapor. They lack the chemicals and tars of tobacco and are widely used by smokers trying to quit. However, the nicotine is addictive. The FDA noted that a recent survey showed e-cigarette use among high school students had risen from 1.5% in 2011 to 16% in 2015 and that the use of hookah tobacco had increased significantly.
The new rules, which go into effect in 90 days, will require retailers to ask buyers for proof of age and will ban the sale of the products in vending machines. Free samples will also be barred.
Public health advocates welcomed the announcement.
Resources of Interest
Opioid Prescribing, Use and Abuse
OOpioids are commonly prescribed for pain. An estimated 20% of patients presenting to health care provider offices with non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. The increase in prescriptions has been accompanied by a rise in the rate of opioid-related deaths.
In response to these statistics, the White House has launched an effort to bring awareness to the use and abuse of opioids. The resources below may be useful to the CNS who is working with patients who require pain relief or are receiving opioids.
This online toolkit was developed by the Substance Abuse and Mental Health Services Administration (SAMSHA). It was prepared to equip health care providers, communities and local governments with materials to guide practice and policies to help prevent opioid-related overdoses and deaths. The toolkit has resources for a wide range of audiences, including health care providers, first responders, treatment providers, and those recovering from opioid overdose.
Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.
The Centers for Disease Control and Prevention (CDC) developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for prescribing opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.
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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.