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 members and colleagues have celebrated another successful CNS Week this past September 1 – 7, 2016. Speaking to the theme – The CNS: Leader in Building a Culture of Safety, ANA President Pam Cipriano presented a free webinar supported brought to you by NACNS. We had "a full set of phone lines" for this important and inspiring continuing education session.
Many NACNS members and NACNS Affiliate took advantage of the opportunity to celebrate and inform the public and other healthcare providers to the important work done by the CNS.
Armed with sample materials, on the NACNS website, these creative leaders made sure people in their sphere of influence learned more about the CNS. Events ranged from a CNS group at one facility all wearing the CNS week logo pin to seminars and op eds for local papers.
NACNS members Brandee Wornhoff and Jennifer Woodard were interviewed about CNS Week by the Hendricks County Flyer and several affiliates organized CNS recognition breakfasts at their hospitals and health systems.
It is not too late to share your creative ideas and successes. We would 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 are still for sale! Go to www.nacns.org and click on the CNS Week Logo for more information.
Two New Task Forces Set to Begin – The Board has appointed members to both the – Opioid Use and Abuse Task Force and the Family Across the Lifespan Crosswalk Task Force. The Opioid /Pain Management Task Force will make recommendations to the NACNS Board regarding resources and efforts CNSs needed to respond to the national opioid abuse epidemic and 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, those CNSs may eventually be eligible to take both the pediatric and adult/gero certification examinations for licensure across the lifespan.NACNS Comments on NANN's "Education Standards, Curriculum Guidelines, and Competencies for the Neonatal Clinical Nurse Specialist" –A group of neonatal CNS members were invited by NACNS to review this important draft document created by the National Association of Neonatal Nurses (NANN) and their feedback was the basis of NACNS response to NANN. To address the importance of developing CNS competencies for all of the population-foci identified in the APRN Consensus Model, NACNS will hold a conference call with NANN task force that developed their document and the NACNS taskforce responsible for reviewing and revising the CNS Core Competencies. The goal of the call is to support the work of NANN and clarify the expectations and anticipated timeline for the revision of the CNS Core Competencies.
NACNS is excited to announce the next webinars in its 2016-2017 webinar series on pharmacology and technology.
NOVEMBER 8, 2016 - 4:00pm Eastern
This session is focused on dementia and the pharmacology related to the care and treatment of dementia. Cholinesterase inhibitors, NMDA Antagonitst, off-label uses of anti-psychotics, and non-pharmacologic treatments will be covered. In addition, the speaker will system issues, such as the use of the electronic health record, that can be used to assist in the care and management of the patient with dementia. The importance of utilizing a pain assessment tool that has been validated for use with the cognitively impaired. The learner will be able to explain why all nurses should aim to improve care for older adults with dementia in the community.
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 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.All NACNS webinars are archived. Email firstname.lastname@example.org to order an archived webinar. Listen at your leisure and apply for CE certificate.
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.
To combat the nation's opioid epidemic, NACNS has joined forces with 28 other national nursing to offer a free online educational series for practicing nurses, faculty, and students. If you are a Non-AACN Member, you must register as a Non-Member without an Account.
NOTE: All webinars are archived and may be accessed at no cost. Most Webinars have continuing nursing education credit available for three years from the time of the original broadcast.
Stand Up and Be Counted!
The CNS Census is intended, to capture information about people who identify themselves as or who were educated as CNSs. This 2014 CNS Census was the first national survey of the CNS workforce. An infographic is posted on the NACNS website that summarizes key facts from that survey.
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.
NACNS has teamed up with the Indiana University School of Nursing to provide "Developing Your Skills as a Clinical Nurse Specialist Preceptor," an exciting new online training program for CNS preceptors working with students doing clinical rotations. This online self-study course will provide nursing programs and CNS preceptors with valuable tips and tools for working with students, and allows them to complete the course on their own schedule.
"Developing Your Skills as a Clinical Nurse Specialist Preceptor" was developed by expert CNS preceptors and faculty from several 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 is NOW OPEN!
NACNS members will receive a discounted rate of $99/registration with verification of membership, so be sure to take advantage of this opportunity! The individual non-member price is $129, and groups of 5 or more can receive discounted pricing as well.
Preceptor Course Planning Committee:Sharron Coffee, MSN, RN, CNS-BC, Milwaukee, WI; Julie Darmody, PhD, RN, ACNS-BC, Milwaukee, WI; Janet Fulton, PhD, RN, ACNS-BC, ANEF, FAAN, Indianapolis, IN; Jennifer Kitchens, MSN, RN, ACNS-BC, Indianapolis, IN, 2014 NACNS Preceptor of the Year; Francesca Levitt, MSN, Indianapolis, IN, 2012 NACNS Preceptor of the Year; Lisa Wagnes, MSN, RN, Indianapolis, IN
NACNS is heading south in March 2017 for the NACNS Annual Meeting, which will be held in Atlanta, Georgia on March 9-11, 2017 at the Loew Atlanta Hotel. This event will be an amazing combination of cutting-edge speakers, professional networking and fun! The theme is Tomorrow Belongs to Us: The Clinical Nurse Specialist Conquering Change in the Healthcare Environment. Registration to open in mid-November. Student poster submission deadline is December 5, 2016. More information available online at http://www.nacns.org/html/conf-2017.php.
Top Ten Reasons to Attend the 2017 NACNS Conference in Atlanta Georgia
Number 10 – Atlanta is the Peach City in the Peach State, and who doesn’t like peaches??
Now through July 2018, the American Psychiatric Nurses Association (APNA) is offering a free, on-demand CE course: Effective Treatments for Opioid Use Disorder: Educating & Empowering All Registered Nurses (RN) During an Epidemic. The module has been tailored to three separate groups: Registered Nurses (RNs), Psychiatric-Mental Health Nurses, and Advanced Practice RNs. Click here for more information.
On September 7, the American Academy of Nursing (AAN) released its position statement supporting the reduction of environmental noise - defined by the Environmental Protection Agency as "unwanted or disturbing sounds" within a person's environment. The negative health impacts of environmental noise are not always immediately noticed, and can build gradually over time. The effects, which are well-documented, include hearing loss, tinnitus, heart disease, stroke, anxiety, stress, depression, learning difficulties, poor job performance, sleep disorders, and reduced cognitive abilities.
In its statement, AAN recommends a coordinated federal effort to reduce exposure to environmental noise, including the reestablishment of the Office of Noise Abatement and Control within EPA. The Academy also supports the National Institute for Occupational Safety and Health's promotion of Buy Quiet programs, which encourage companies to purchase or rent quieter machinery to reduce their workers' exposure to harmful environmental noise.
The Emergency Nurses Association has released its Naloxone Education Toolkit (NET), a comprehensive resource designed to educate patients and their family members about opioid overdose, advise on the distribution and proper use of naloxone kits, and provide key step-by-step instructions to implement a custom opioid overdose prevention program in the ED. A free resource for ENA members, the NET is available for purchase by non-members for $25.The NET is a compilation of best practices and evidence-based approaches from a wide range of resources, including the latest guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA). Visit the SAMHSA Naloxone website for more guidance and additional resources.
The 100 Most Influential People in Healthcare awards and recognition program honors individuals in healthcare who are deemed by their peers and the senior editors of Modern Healthcare to be the most influential individuals in the industry, in terms of leadership and impact. Honorees come from all sectors of healthcare, including hospitals, health systems, insurance, government, vendors and suppliers, trade and professional organizations, and patients' rights groups. See the nurses who are on this year’s list by going to Modern Healthcare.
Alert: The Centers for Disease Control and Prevention (CDC) expect healthcare providers to report suspected Zika virus disease cases to their state, local, or territorial health department to facilitate diagnosis and mitigate risk of local transmission.
Zika is spreading throughout many countries, including outbreaks in a small area of the continental U.S. and most notably in Puerto Rico. Currently, with nearly 17,000 Americans infected with Zika – including 1,600 pregnant women and 16 babies born with birth defects caused by Zika – CDC recommends that healthcare systems prepare for patients seeking a diagnosis and/or symptom management.
CDC has developed a summary of key considerations for healthcare systems to ensure the following:
CDC recommends that easy-to-understand educational materials be widely available within healthcare systems (urgent care, hospitals, primary care provider offices) for all providers, employees, patients, families, and visitors.
Additional information can be accessed at the CDC Zika Virus webpage for Healthcare Providers.
A CDC-funded study underway at Emory University Hospital Midtown (EUHM) and Emory Johns Creek Hospital (EJCH) is testing a monitoring system to measure hand hygiene compliance. Data is collected by electronic sensors attached to alcohol hand-rub and soap dispensers in patient rooms and hallways at the two hospitals. At EUHM, an urban teaching hospital, the sensors are located in five adult ICUs and on two other floors. At EJCH, a smaller community hospital, the monitoring units have been installed in one ICU and on one medical floor.
Healthcare workers participating in the study wear badges equipped with Bluetooth technology to communicate with the sensors, which can detect when badge-wearing study participants are nearby, and whether they have used alcohol or soap. In some stages of the study, a voice reminder will sound if a healthcare worker enters a room and does not clean his or her hands. The researchers will compare the efficacy of different types of feedback to employees on how reliably they clean their hands.
A recent Stanford University study examined the translation of the evidence-based Better Choices, Better Health-Diabetes program in both Internet and face-to-face versions. It found that diabetic patients who participated in a largely online self-management program designed at Stanford had lower blood sugar levels and took their medication more regularly. The study, published in the Journal of Medical Internet Research, also showed that many participants exercised more and had fewer symptoms of depression.
Stanford is considered a leader in developing self-management programs. Researchers are experimenting with online and telehealth versions. In-person workshops have been proven effective in numerous studies, but the virtual programs have been studied less.
15. FDA's Ongoing Investigation of Nontuberculous Mycobacteria Infections Associated with Heater-Cooler Devices
Heater-cooler devices often are necessary during surgeries to warm or cool patients. The devices are especially important tools for cardiothoracic surgeries. The Food and Drug Administration (FDA) has issued a safety warning concerning infections caused by nontuberculous mycobacteria (NTM) organisms found in water, which can grow in water tanks of heater-cooler devices in operating rooms. While the water in the heater-cooler device is not intended to come into direct contact with the patient, if water within the heater-cooler tanks is contaminated with NTM, there is the potential for it to become aerosolized into the operating room. NTM infections are difficult to detect because infected patients may not develop signs and symptoms of infection for months to years after initial exposure.
The FDA recommends that healthcare professionals and facilities perform appropriate maintenance on such devices to reduce the risk of infection. For more information on heater-cooler devices, visit FDA’s website.
On August 25, the FDA issued a safety communication informing health care professionals that when using programmable syringe pumps to infuse therapies at low rates (e.g., less than 5 mL per hour, and especially at flow rates of less than 0.5 mL per hour), inconsistent rate of delivery can result in serious clinical consequences, e.g., delay of therapy, over-infusion or under-infusion. Reports of serious adverse events such as abnormal or unstable blood pressure, anxiety from loss of sedation, and increased pain indicators in critically-ill infants have been associated with lack of flow continuity.
The FDA believes that these concerns may extend to all programmable syringe pumps while infusing at low rates. However, based on current information, the FDA believes that the overall benefits of programmable syringe pumps outweigh their risks. Moving forward, the FDA has requested that manufacturers make labeling changes to their syringe pumps to address flow continuity concerns.
The FDA communiqué is aimed at healthcare professionals who interact with programmable syringe pumps or administer high risk and life-sustaining medication therapies, such as those who work in neonatal and pediatric intensive care or critical care units, labor and delivery units, operating rooms, and emergency departments. The safety communication outlines some of the steps that clinicians should take to ensure that programmable syringe pumps deliver consistent, predictable flows regardless of flow rate.
Prompt reporting of adverse events can help the FDA identify and better understand the risks associated with medical devices. FDA urges providers who suspect a programmable syringe pump is having problems with flow continuity at low infusion rates, to file a voluntary report through MedWatch, the FDA Safety Information and Adverse Event Reporting program.
Federal and Regulatory News
The Office of Management and Budget’s (OMB) Standard Occupational Classification (SOC) Policy Committee failed to correctly classify clinical nurse specialists as an individual occupational category. In the July 22, 2016 SOC Document Number 1-0120 – Clinical Nurse Specialists, the SOCPC specifically did not accept multiple recommendations – including one by NACNS – requesting that a new detailed occupation be established in the SOC for the CNS. As a result, the CNS occupation remains subsumed in the general registered nurses 2010 SOC broad occupational and detailed occupational classifications (29-1141).
This is the second time that the SOCPC vetoed the appeal to make the CNS a discrete, detailed occupation in the SOC, different from the RN. In July 2014, NACNS submitted an extensive filing explaining why the CNS should be included in the SOC as its own occupational identity.
On September 16, in response to this latest denial, NACNS filed comments specifically addressing SOC Classification Principles 2 and 9, which are the structural principles the SOCPC cited as reasons for not accepting the CNS recommendation.
To assist members in drafting a comment letter on this policy issue, the NACNS developed a web-based 2018 Standard Occupational Classification Resource Center. In addition to directions for submitting personal comments to the Policy Committee, the site linked to talking points, key NACNS background resources, and the October 2015 letter submitted to the SOCPC by an alliance of 28 nursing organizations contending that the CNS should be included in the Standard Occupational Classification as a separate category.
Zika outbreaks are growing. Florida has reported 56 locally transmitted cases of Zika, and the CDC predicted that 25% of Puerto Rico's population, about 1 million U.S. citizens, will be infected by December 2016. The CDC administration also has warned that as of September 30, the $222 million that CDC had redirected as a stopgap measure for initial, time-critical activities to fight Zika will be expended.
In February, President Obama requested $1.9 billion of emergency funding to address and prevent Zika infections. In response over 45 congressional hearings and several briefings on this emergency have been held. By May, the Senate passed a $1.1 billion Zika emergency funding bill. The House rejected that measure.
Instead, the House passed its own $1.1 billion bill, but added several debatable provisions. Those riders included weakening decades-old pesticide restrictions to combat mosquitoes, and partially paying for Zika emergency funding by cutting monies from Planned Parenthood and from the Affordable Care Act's comprehensive federal health insurance program. After returning in September from its longest summer recess in six decades, the Senate failed to pass the bill and address the growing Zika crisis.
Lawmakers hope to overcome the Zika funding political gridlock later this month as part of a must-do spending package. Speculation is that elected officials will work to include emergency funding for Zika in a budget deal, such as a continuing resolution, that Congress must pass to avoid a government shutdown at the end of September.
With the stopgap $222 million, CDC's Emergency Operations Center has been activated at Level 1, its highest level. The Level 1 response includes working with state, local, and territorial health departments to alert healthcare providers and the public about Zika; posting travel notices and other travel-related guidance; providing state health laboratories with diagnostic tests; monitoring and reporting cases of Zika; publishing guidelines to inform testing and treatment of people with suspected or confirmed Zika; and studying neurological disorders associated with Zika virus infection.
On August 25, the U.S. Surgeon General took an historic action by sending a personal letter to more than 2.3 million healthcare practitioners and public health leaders asking them to pledge their "commitment to turn the tide on the opioid crisis" Please take a moment to read the letter and then go to the Turn the Tide website to join other clinicians from across the country in ending this epidemic.
After an extensive review of the latest scientific evidence, the Food and Drug Administration (FDA) announced on August 31 that it is requiring class-wide changes to drug labeling, including patient information, to help inform healthcare providers and patients of the serious risks associated with the combined use of certain opioid medications and benzodiazepines.Among the changes, the FDA is requiring boxed warnings and patient-focused Medication Guides for prescription opioid analgesics, opioid-containing cough products, and benzodiazepines. These actions are among a number of steps the FDA is taking as part of the agency’s Opioids Action Plan, which focuses on policies aimed at reversing the prescription opioid abuse epidemic, while still providing patients in pain access to effective and appropriate pain management.
The National Institute on Minority Health and Health Disparities has launched a research program to develop, implement and disseminate community-based interventions to combat chronic diseases among minority and underserved populations. The two Transdisciplinary Collaborative Centers include researchers, clinicians, healthcare systems, public health agencies and other community organizations that will develop and disseminate health interventions that can be implemented in real-world settings, such as clinics, churches and community centers.
On September 2, Michael Botticelli, Director of National Drug Control Policy, announced $85.9 million in grants for 698 Drug-Free Communities (DFC) Support Programs. The DFC Program provides grants of up to $625,000 over five years to community coalitions that facilitate youth and adult participation at the community level in youth drug use prevention efforts.
September 8, 2016 CMS posted the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, which affects conditions of participation in Medicare and in Medicaid. The regulation goes into effect on November 16, 2016. Healthcare providers must comply and implement all regulations by November 2017.
The requirements apply to all 17 provider and supplier types, e.g., Hospitals, Community Mental Health Centers, Federally Qualified Health Centers, Rural Health Clinics, Critical Access Hospitals, Hospices, Long-Term Care Facilities, and Home Health Agencies. As healthcare leaders in these institutions, CNSs will be instrumental in complying with the regulation.
The rule requires providers to plan adequately for both natural and human-made disasters, and to coordinate with federal, state, tribal, regional, and local emergency preparedness systems. The following four industry best practice standards must be met:
Emergency plan: Based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider.
Policies and procedures: Develop and implement policies and procedures based on the plan and risk assessment.
Communication plan: Develop and maintain a communication plan that complies with both federal and state law. Patient care must be well-coordinated within the facility, across health care providers, and with state and local public health departments and emergency systems.Training and testing program: Develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan.
These regulations were first proposed in 2013, following various disasters, i.e., September 11, 2001 attacks, the subsequent anthrax attacks, catastrophic hurricanes in the Gulf Coast states in 2005, flooding in the Midwestern states in 2008, 2009 H1N1 influenza pandemic, tornadoes and floods in the spring of 2011, and Hurricane Sandy in 2012.
For more information see a blog by Dr. Lurie, HHS assistant secretary for preparedness and response, and the CMS Survey & Certification – Emergency Preparedness webpage.
Resources of Interest
Sepsis can occur to anyone, at any time, from any type of infection, and can affect any part of the body. It can occur even after a minor infection. For nearly 80% of patients, sepsis begins outside of the hospital. According to a new Vital Signs report released by the Centers for Diseases Control and Prevention (CDC), about 7 in 10 patients with sepsis had used healthcare services within the previous month or had a chronic disease that required frequent medical care. These represent opportunities for healthcare providers to prevent, recognize, and treat sepsis long before it can cause life-threatening illness or death.
Healthcare professionals can play a critical role in protecting patients from infections that may lead to sepsis, and in recognizing this complication early on, by following a few simple recommendations:
Go to CDC’s sepsis website for more information on sepsis and CDC’s work visit.
The NIOSH Hazardous Drug List, 2016 will assist in the safety of healthcare providers and patients. Drugs that are considered hazardous include those that exhibit one or more of the following six characteristics in humans or animals: carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, and structure and toxicity profiles of new drugs that mimic existing drugs determined to be hazardous. The current update (2016) adds 34 drugs, five of which have safe-handling recommendations from the manufacturers.
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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.