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.
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 you grow in your understanding of key issues impacting you as a CNS. We need you at the table to help us discuss these key issues!
CNS Educator’s Forum – July 18, 2016
The goal of the CNS Educator’s Forum is to bring together CNS leaders, educators and faculty members to discuss key issues related to the survival and growth of the CNS role in today’s health care system. The first forum, held in 2014, drew interested faculty from around the nation. This year’s conversation will focus on three important areas:
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 this two-day meeting experience for a combined registration fee of $235.00 if your registration is received on or before July 1, 2016. We are also offering single day registration fees:
We encourage you to attend and participate in these critical national discussions. Your point of view is welcome and will provide a rich addition to the deliberations. Due to space limitations please make your reservation soon. We are accepting reservations until July 11, 2016. After this date, you can register onsite to attend the meeting.
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) please help by completing the survey. The link can be found on the NACNS homepage at www.nacns.org – look for the 2016 CNS Census icon and click on to link directly to the survey. Or you can go directly to the survey at: www.surveymonkey.com/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 is posted on the NACNS website that summarizes key facts from the 2014 CNS Census.
NACNS is pleased to have the support of two leading health care publishers in this important effort. Springer Publishing Company, LLC and Wolters Kluwer, publisher of NACNS' official journal the Clinical Nurse Specialist: The International Journal for Advanced Nursing.
CNSs who complete the survey will be automatically entered in a drawing for an Apple Watch, donated by Springer Publishing, and an iPad Mini, donated by Wolters Kluwer.
The 2016 CNS Census was produced in concert with PhD nursing students at the University of San Diego, who helped refine the questions and reduce the amount of time required to complete the survey.
Information on the results of the 2016 CNS Census will be published in the Clinical Nurse Specialist: The International Journal for Advanced Nursing and available on the NACNS website.Don’t miss your opportunity to be part of this important initiative!
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. The task force that planned 2016 Educator’s Forum and Summit has ensured that these meetings will provide an important opportunity for participants to discuss policy issues affecting the CNS.
Two New Task Forces Set to Begin – The Board has created and will be appointing members to two key task forces to address cutting edge policy and practice issues – Opioid Use and Abuse Task Force and the Family Across the Lifespan Crosswalk Task Force. The Opioid Use and Abuse Task Force will make recommendations to the NACNS Board regarding resources and efforts CNSs need to respond to the national opioid abuse epidemic and to utilize best practices in managing opioid use. The Family Across the Lifespan Crosswalk Task Force will review the draft CNS competencies for this population and crosswalk them with CNS competencies in adult/gero and pediatric. If there is significant overlap, this could lead to those CNSs being eligible to take both the pediatric and adult/gero certification examinations for licensure across the lifespan.
The NACNS 2016-2017 webinar series on pharmacology and technology is now well underway. The first four presentations addressed capnography, treating Type 1 Diabetes, and pain management.
All NACNS webinars are archived. Email email@example.com to order an archived webinar. Listen at your leisure and apply for CE certificate.
Webinars are held monthly and provide CE at a reduced price of $25.00 for members. Group pricing is available; please email firstname.lastname@example.org 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 email@example.com. A group discount will be given for each additional CE on a single line.
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.
CNS Week is coming up soon! This year’s theme is The CNS: Leaders in Building a Culture of Safety.
On September 1, ANA President Pam Cipriano will present a webinar, Changing the Climate: Creating a Culture of Safety, which we will offer 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. A press packet and other resources, including a range of template materials, are now available on the NACNS website.
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 firstname.lastname@example.org. 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.
Products for CNS WeekThis year, we will once again be selling a variety of products with the NACNS logo. In addition to the note cards and pens we sold last year, we will be selling buttons with the CNS Week logo, as well as flash drives, ear buds, and baseball caps with the NACNS logo. Watch your email and check the NACNS website for more information.
NACNS’s partnership with the American Association of Medical Instrumentation Foundation to provide their monthly seminars to our members has been very successful so far. These interprofessional seminars highlight how hospitals are addressing patient safety issues related to complex healthcare technology. The seminars are just $25.00 for NACNS members and include nursing CE. Please watch your email for information about upcoming seminars.
On March 28, the American Association of Colleges of Nursing (AACN) announced the release of a new report titled Advancing Healthcare Transformation: A New Era for Academic Nursing, which addresses how baccalaureate and higher degree schools of nursing can amplify their role in improving health and health care at the local, state, and national levels. This report provides a strategic framework for engaging nursing and medical school deans, health system executives, and university presidents and chancellors in the collaborative work needed to spark clinical innovation, align critical resources, and fortify the public’s health.
Key recommendations from the AACN-Manatt report include that:
In addition to 14 real-world examples from nursing schools engaged in best practices, the report features specific implementation strategies for deans of nursing, deans of medicine, health system leaders, and university presidents and chancellors. The report concludes with an Organizational Self-Assessment tool that can be used to determine the degree of alignment that currently exists between healthcare and higher education institutions, which will help to highlight areas where work needs to continue.Advancing Healthcare Transformation: A New Era for Academic Nursing may be accessed online. Report talking points and PowerPoint slides are also available online.
AACN periodically publishes AACN Practice Alerts in order to guide practice. These bulletins are highlighted on the AACN website. In February 2016, this AACN Practice Alert was released:
The full AACN Practice Alert, complete with rating of the evidence and reference list is available on AACN’s website.
The June 2016 Issue of the Bulletin of the World Health Organization, includes a compelling editorial on the Zika virus written by Anthony Costello of the Department of Maternal, Newborn, Child and Adolescent Health at the World Health Organization in Geneva, Switzerland and his colleagues. The editorial, “Defining the syndrome associated with congenital Zika virus infection” describes the impact of the Zika virus as a public health emergency and discusses the neurotropic qualities of the virus. In pregnant women, the Zika virus can cause viral cerebritis that can disrupt cerebral embryogenesis and result in microcephaly and other neurological abnormalities. The authors argue that because the Zika virus is an intensely neurotropic virus that particularly targets neural progenitor cells and neuronal cells in all stages of maturity, microcephaly is not the only neurologic side effect of infection.
The authors identify trends in collected evidence including unpublished data that WHO has received which highlight a range of neurologic abnormalities. These other manifestations include craniofacial disproportion, spasticity, seizures, irritability and brainstem dysfunction including feeding difficulties, ocular abnormalities and findings on neuroimaging such as calcifications, cortical disorders and ventriculomegaly. Similar to other infections acquired in utero, cases range in severity; some babies have been reported to have neurological abnormalities with a normal head circumference. Preliminary data from Colombia and Panama also suggest that the genitourinary, cardiac and digestive systems can be affected.The editors suggest that the range of abnormalities reported to be caused by the Zika virus may be defining a new congenital syndrome that has a wide spectrum of symptoms. They also announce that the WHO has set in place a process for defining the spectrum of this syndrome. The surveillance system that was established as part of the epidemic response to the outbreak initially called only for the reporting of microcephaly cases. This surveillance guidance has been expanded to include a spectrum of congenital malformations that could be associated with intrauterine Zika virus infection.
On May 28, the World Health Organization (WHO) put out a news release offering public health recommendations for the Olympics in the light of the Zika virus and announced modified advice regarding sex and the need for safer sex and potentially abstinence for a longer time period to reduce Zika virus transmission.
Brazil is 1 of almost 60 countries and territories which to date report continuing transmission of Zika by mosquitoes. WHO advises pregnant women not to travel to areas with ongoing Zika virus transmission. This includes Rio de Janeiro. Pregnant women’s sex partners returning from areas with circulating virus should be counselled to practice safer sex or abstain for the duration of throughout the pregnancy.
Anyone considering travel to the Olympics should:
On May 26, the U.S. Food and Drug Administration approved Probuphine, the first buprenorphine implant for the maintenance treatment of opioid dependence. Probuphine is designed to provide a constant, low-level dose of buprenorphine for six months in patients who are already stable on low-to-moderate doses of other forms of buprenorphine, as part of a complete treatment program.
Until now, buprenorphine for the treatment of opioid dependence was only approved in the form of a pill or a film placed under the tongue or on the inside of a person’s cheek until it dissolved. While effective, a pill or film may be lost, forgotten or stolen. Asan implant, Probuphine provides a new treatment option for people in recovery who may value the unique benefits of a six-month implant compared to other forms of buprenorphine, including the convenience of not needing to take medication on a daily basis. An independent FDA advisory committee supported the approval of Probuphine in a meeting held earlier this year.
Expanding the use and availability of medication-assisted treatment (MAT) options like buprenorphine is an important component of the FDA’s opioid action plan and is one of three top priorities for the U.S. Department of Health and Human Services’ Opioid Initiative aimed at reducing prescription opioid and heroin related overdose, death and dependence.
Opioid dependence is the diagnostic term used for the more common concept, “addiction,” in the Probuphine clinical trials. Addiction is defined as a cluster of behavioral, cognitive and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use, persisting in drug use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, and the possibility of the development of tolerance or development of physical dependence. Physical dependence is not the same as addiction. Newer diagnostic terminology uses the term “opioid use disorder,” which includes both milder forms of problematic opioid use as well as addiction.
MAT is a comprehensive approach that combines approved medications (currently, methadone, buprenorphine or naltrexone) with counseling and other behavioral therapies to treat patients with opioid use disorder. Regular adherence to MAT with buprenorphine reduces opioid withdrawal symptoms and the desire to use, without causing the cycle of highs and lows associated with opioid misuse or abuse. At sufficient doses, it also decreases the pleasurable effects of other opioids, making continued opioid abuse less attractive. According to the Substance Abuse and Mental Health Services Administration, patients receiving MAT for their opioid use disorder cut in half their risk of death from all causes.
Probuphine should be used as part of a complete treatment program that includes counseling and psychosocial support. Probuphine consists of four, one-inch-long rods that are implanted under the skin on the inside of the upper arm and provide treatment for six months. Administering Probuphine requires specific training because it must be surgically inserted and removed. Only a health care provider who has completed the training and become certified through a restricted program called the Probuphine Risk Evaluation and Mitigation Strategy (REMS) program should insert and remove the implants. If further treatment is needed, new implants may be inserted in the opposite arm for one additional course of treatment. The FDA is requiring postmarketing studies to establish the safety and feasibility of placing the Probuphine implants for additional courses of treatment.
The safety and efficacy of Probuphine were demonstrated in a randomized clinical trial of adults who met the clinical criteria for opioid dependence and were considered stable after prior buprenorphine treatment. A response to MAT was measured by urine screening and self-reporting of illicit opioid use during the six month treatment period. Sixty-three percent of Probuphine-treated patients had no evidence of illicit opioid use throughout the six months of treatment – similar to the 64 percent of those who responded to sublingual (under the tongue) buprenorphine alone.
Probuphine has a boxed warning that provides important safety information for health care professionals, including a warning that insertion and removal of Probuphine are associated with the risk of implant migration, protrusion, expulsion and nerve damage resulting from the procedure. Probuphine must be prescribed and dispensed according to the Probuphine REMS program because of the risks of surgical complications and because of the risks of accidental overdose, misuse and abuse if an implant comes out or protrudes from the skin. As part of this program, Probuphine can only be prescribed and dispensed by health care providers who are certified with the REMS program and have completed live training, among other requirements.Probuphine implants contain a significant amount of the drug that can potentially be expelled or removed, resulting in the potential for accidental exposure or intentional misuse and abuse if the implant comes out of the skin. Patients should be seen during the first week after insertion and a visit schedule of no less than once-monthly is recommended for continued counseling and psychosocial support.
Federal and Regulatory News
On June 9, the Senate Committee on Appropriations approved the Fiscal Year (FY) 2017 Labor, Health and Human Services, Education, and Related Agencies (LHHS-ED) bill by a vote of 29-1 (Read the Committee’s summary). This came just two days after the Senate LHHS-ED Subcommittee approved it in with bipartisan support. In total, the bill includes $161.9 billion in discretionary spending ($270 million below FY 2016).
The bill recommends of $229 million (level funding with FY 2016) for the Nursing Workforce Development programs (Title VIII of the Public Health Service Act). The Committee recommends an increase of $2 billion for the National Institutes of Health (for a total of $34 billion) to address priorities including the Precision Medicine Initiative, Alzheimer’s disease research, and the BRAIN Initiative to map the human brain. The National Institute of Nursing Research has an appropriation of $152 million (an increase of $5.48 million over FY 2016).
Next Steps in the Appropriations ProcessThe House LHHS-ED Appropriations Subcommittee will need to schedule a mark-up of their respective bill. Should the Subcommittee approve it, it will then need to be approved by the full House Committee on Appropriations. Given that Congress will likely break for Congressional recess early this summer, this condensed timeline may prove a barrier to passing a bicameral, bipartisan bill before the end of the fiscal year (September 30).
NACNS announced on May 27, our support for the Department of Veterans Affairs Federal Register rulemaking that proposes to amend its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment.
NACNS maintains that granting full-practice authority to all APRNs, including CNSs, nurse practitioners, certified registered nurse anesthetists and nurse midwives, would immediately improve access to vital health care services for our nation’s veterans. Increasing the pool of qualified health professionals will result in streamlining health services, eliminating redundancies and bottlenecks and alleviating delays in care delivery. NACNS, in our statement noted that it is past time that the VA implement this solution, as recommended in the seminal 2010 report from the Institute of Medicine on the Future of Nursing, and allow all APRNs to practice to the full scope of their education and training.
Every day across this country, CNSs provide expert care to patients and their families, support nurses caring for patients at the bedside, help drive practice changes throughout their organizations, and ensure the use of best practices and evidence-based care to achieve the best possible patient outcomes.
Sharon Horner, PhD, RN, MC-CNS, FAAN is the President of the 2016-2017 NACNS Board of Directors said, “If every health care setting employed CNSs, more of the care provided would be based on research and best practices, our health care system would be more efficient, and we would all be healthier.”NACNS will prepare comments on this rulemaking in support of the CNS role, and will provide sample comments to be sent by NACNS members as part of a grassroots effort. In addition, ANA has offered its grassroots system for NACNS use to further advocate for this rulemaking. Please watch your blast email and the NACNS homepage for further information.
Resources of Interest
Communication and Optimal Resolution (CANDOR) is a process that health care institutions and practitioners can use to respond in a timely, thorough, and just way when unexpected events cause patient harm. Based on expert input and lessons learned from the Agency's $23 million Patient Safety and Medical Liability grant initiative launched in 2009, the CANDOR toolkit was tested and applied in 14 hospitals across three U.S. health systems.
The CANDOR toolkit contains eight different modules each containing PowerPoint slides with facilitator notes. Some modules also contain tools, resource or videos.
Agency for Healthcare Research and Quality (AHRQ) has published two new resources to help primary care clinicians and their patients make evidence-based decisions about which medications to use for treating alcohol use disorder (AUD), the medical diagnosis for problem drinking that causes mild to severe distress or harm.
The new resources—a pair of research summaries designed to facilitate treatment discussions between clinicians and patients—will make it easier for primary care clinicians to work with their patients to make treatment decisions about medications used to treat AUD. Primary care providers are typically trained to refer patients with AUD for specialized treatment, and fewer than 10 percent of people treated for AUD receive medications currently.
This is a publication of the National Association of Clinical Nurse Specialists. You are receiving this publication because you are identified as holding a membership in NACNS. If you wish to unsubscribe from this publication, please email email@example.com. Please note, if you unsubscribe, this will remove you from all email communications from NACNS.
The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.