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 Emily O'Connor at firstname.lastname@example.org.
Responding to evidence of high rates of depression and suicide among U.S. health care workers, the National Academy of Medicine (NAM, formerly the Institute of Medicine) is launching an “action collaborative” of health care organizations to promote clinician well-being and resilience. The initiative will identify priorities and collective efforts to advance evidence-based solutions and promote multidisciplinary approaches to reverse the trends in clinician stress, and ultimately to improve patient care and outcomes. NAM suggests that individual, organizational, and systems-level reform will be required to address this complex problem.
Clinician burnout has been linked to increased medical errors and patient dissatisfaction. Recent research finds that declines in the well-being of health care professionals cut across all ages, stages, and career paths – from trainees to experienced practitioners. NAM cites studies stating that as many “as 400 physicians commit suicide each year, double the suicide rate of the general U.S. population . . . A survey of more than 6,000 physicians conducted over a three-year period found that they have twice the risk of burnout compared with other professions. And the problem is not unique to physicians – nurses and other clinicians also report high rates of dissatisfaction and stress. For example, a 2007 study found that 24 percent of intensive care nurses and 14 percent of general nurses tested positive for symptoms of post-traumatic stress disorder.”
NACNS is excited to announce the next webinars in its 2016-2017 webinar series.
February 7, 2017
This session will identify the skill set required for CNSs to influence and provide leadership to best meet the needs of patients with chronic disease and to spot gaps/disparities in the current care of patients and/or populations with chronic disease. The health challenges of patients with chronic conditions and multiple chronic conditions are of interest to policymakers. The CNS is uniquely prepared to care for these complex patients. This session will review how the CNS Core Competencies relate to managing chronic conditions and identify areas where some CNSs have been able to significantly influence the care of chronic conditions. The CNS has made significant contributions to developing and implementing best practice in the reduction of hospital readmissions as well as in the improvement of the clients.
February 16, 2017 – Rescheduled from December 6, 2016
*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.
*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.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.
The 2016 CNS Census closed on December 31, 2016 with a total of 3,118 participants! The NACNS Board is thrilled with reaching this level of participation. The data will be analyzed and compared with the 2014 CNS Census. In addition to pursuing an academic-style publication on the results of the survey, NACNS will prepare an infographic to highlight key findings.
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 allow 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 five or more can receive discounted pricing as well.
Early Bird Registration Closes January 23, 2017
Don’t miss the early bird registration deadline – January 23. The 2017 NACNS Annual Conference is an important event for CNS’ around the nation. This is the premier meeting for clinical nurse specialists to attend to stimulate creativity and build collegial relationships that will strengthen personal and professional worlds. Don’t put off making your plans to attend!
Join us at the Loews Atlanta Hotel on March 9-11 for three days of discussion, idea sharing, networking, and fun on the theme of Tomorrow Belongs to Us: The Clinical Nurse Specialist Conquering Change in the Health Care Environment.
On Wednesday, March 8, we will hold our full day Pharmacology Pre-Conference Workshop. Interested CNSs can register for a full or half day.
The conference kicks off with keynote speaker, Kathleen Vollman, MSN, RN, CCNS, FCCM, FAAN. Vollman, President of Advancing Nursing, LLC in Northville, Mich., will encourage attendees to Know It, Drive It, Own it: Health Care’s Change Agent Now and In the Future. Friday’s general session speaker will be Barbara McLean, MN, RN, CCRN, CCNS-NP, FCCM of Grady Health System, and Saturday’s closing speaker will be Michael H. Ackerman, DNS, RN, APRN-BC, FCCM, FNAP, FAANP.
The three-day conference is a great opportunity to earn CE credit. NACNS anticipates offering approximately 16.75 CE hours for the main conference and six additional hours will be available for the pre-conference workshop. Pharmacology contact hours will also be available.
We look forward to seeing y’all in Atlanta, Georgia soon!
NACNS is pleased to announce the results of the elections:
Anne Hysong, MSN, APRN, CCNS, President-Elect
Nurses struggle with multiple health, safety, and wellness challenges. The American Nurses Association’s (ANA) 2016 Health Risk Appraisal shows unhealthy developments for RNs and nursing students, including:
To counter these trends the ANA is declaring 2017 to be the Year of the Healthy Nurse and is launching its Healthy Nurse, Healthy Nation™ Grand Challenge (HNHN GC), a social movement designed to transform the health of the nation by improving the health of the nation's 3.6 million RNs. HNHN GC focuses on five fundamental indicators of wellness: rest, nutrition, physical activity, quality of life, and safety.To help you prioritize your own care, ANA invites nurses and nursing students to participate throughout the year to tackle specific wellness issues that everyone can improve. Each month the HNHN GC website will highlight various health, safety, and wellness topics important not only to nurses, but to their co-workers, families, patients, and their communities.
Learn about effective public policy advocacy techniques and meet with your Representative and Senators on Capitol Hill at the annual Nurse in Washington Internship (NIWI) program. Organized by the Nursing Organizations Alliance – of which NACNS is a member – the 2017 NIWI will be held on March 12-14 in Arlington, VA.
NIWI is open to any RN or nursing student who is interested in an orientation to the legislative process. The program will:
There is no application or acceptance process to attend NIWI. Visit the NIWI site for more information and to register.
A study published in the Annals of Internal Medicine indicates that veterans with dementia, who also are users of the dual-system Department of Veterans Affairs (VA)—Medicare Part D, have increased rates of potentially unsafe medication (PUM) prescribing. While the study addresses medication prescribing for dementia in the VA system, it has implications for broader medication prescribing and daily clinical practice, particularly for the care of patients with chronic disease.
Researchers conducted a retrospective cohort study of 75,829 veterans with dementia who were continuously enrolled in Medicare from 2007 to 2010. Eighty percent were VA-only users, and 20% were VA–Medicare Part D (dual) users. Findings indicated that dual users had more than double the odds of exposure to any PUM compared with VA-only users (odds ratio, 2.2), and had increased odds of exposure to PUM-Health Care Effectiveness Data and Information Set (HEDIS) high-risk medication in older adults (PUM-HEDIS, odds ratio, 2.4) and any daily exposure to prescriptions with a cumulative Anticholinergic Cognitive Burden (ACB) score of three or higher (PUM-ACB, odds ratio, 2.1). Dual users also had higher odds of PUM-antipsychotic exposure (odds ratio, 1.5). For any-PUM exposure, dual users on average had 1.5 additional months of exposure.Recent federal policy changes attempt to expand veterans' access to providers outside the VA, with the assumption that more convenient access and added choices will be best for patients. But this study suggests that widening access could be problematic when the system increases choice without focusing on care coordination and information exchange between providers. Prescribing medications across unconnected systems may grow the risk of PUM, particularly in persons with dementia.
The National Scorecard on Rates of Hospital-Acquired Conditions shows that about 125,000 fewer patients died and more than $28 billion in health care costs was saved from 2010 through 2015 due to a 21% drop in hospital-acquired conditions (HACs). In total, hospital patients experienced more than 3 million fewer HACs from 2010 through 2015. HACs include adverse drug events, catheter-associated urinary tract infections, central line-associated bloodstream infections, pressure ulcers and surgical site infections.
The Agency for Healthcare Research and Quality (AHRQ) developed and tested much of the evidence on how to prevent HACs. Download materials related to the scorecard, including AHRQ tools that helped hospitals achieve this progress, and an infographic that highlights report findings online.
CNSs who are Drug Enforcement Administration (DEA) registrants take note that DEA announced procedural changes in its registration renewal process: Effective January 2017, DEA no longer will send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration.
Any person who is registered may apply for renewal not more than 60 days before the registration’s expiration date. Renewal notifications are mailed automatically to the mailing address on file 65 days prior to the expiration date. Any changes of address must be reported in writing to DEA at the time the change occurs so that the renewal notification will be sent to the correct address. Renewal notifications will not be forwarded by the U.S. Postal Service.
DEA will otherwise retain its current procedures for renewal of registration, including:
Online renewal is available at the DEA Diversion Control Division website.
An Urban Institute study, The Impact on Health Care Providers of Partial ACA Repeal through Reconciliation, released December 8 states that nearly 59 million Americans would lack health insurance – more than double the current number – by 2019 if the Affordable Care Act (ACA) is partially repealed by Congress. The report also forecasts a near-total collapse of the individual, or nongroup health insurance market, dropping from more than 19 million customers now to just 1.6 million customers by the beginning of 2019. The grim prediction by the Urban Institute was laid out as Republicans make plans to repeal the ACA.The Urban Institute's study does not factor in any replacement measures. Instead, after noting that there is "currently no consensus" on a replacement plan, it considered what would happen if Congress through the budget reconciliation process partially repealed the ACA. The study also assumes that Congress, just as it did with a similar effort that was vetoed earlier this year by President Obama, would delay the budgetary effects for two years, until 2019. The study's authors noted that approach would eliminate Medicaid expansion, which led to coverage gains among many more poor adults, as well as ending federal financial aid for most ACA private insurance customers. Researchers estimated that 82% of the people who became newly uninsured would be in working families, and that 56% would be non-Hispanic whites.
NACNS has been urging the Department of Veterans Affairs (VA) to amend its restrictions on APRNs in VA facilities and allow them to provide health care services to the full extent of their education. On December 14, 2016, the VA issued a final rule that recognizes the full practice authority of three of the APRN roles – CNSs, nurse practitioners, and certified nurse-midwives.In response to the final rule, NACNS is requesting that the VA also include certified registered nurse anesthetists among the APRN roles allowed to practice to the full extent of their education and certification
The Independent Payment Advisory Board (IPAB) was created by the Affordable Care Act (ACA) when the law was enacted in 2010. IPAB is one of the "cost control mechanisms" designed to bring per capita Medicare spending back in line with statutory benchmarks, only if those benchmarks are exceeded. While an IPAB trigger has been avoided through last year, the IPAB still threatens many health care stakeholders. Here’s how IPAB works:
Lawmakers added IPAB to the ACA in response to criticism that Congress has been unable to make the politically risky and technically complex decisions needed to slow the growth of costs for Medicare. Yet, numerous health care stakeholders are organizing to monitor IPAB because they are concerned that it will be too difficult for Congress to overrule IPAB’s recommendations. Others worry that the board’s recommendations might reduce how much the government pays health care providers for services, or reduce payments to hospitals with very high rates of readmissions, or recommend innovations that cut wasteful spending.
IPAB is limited by statute to only make recommendations on the Medicare program and dual-eligible listed beneficiaries. IPAB should also give priority to recommendations that extend Medicare solvency, improve health care delivery, improve access to evidence-based-services in rural areas, and consider the impacts on provider payments.
As with any other uncertainty, stakeholders are trying to bring clarity to the game by speculating on the areas that are most likely to be affected by IPAB-driven cuts. Some ideas include: giving HHS the authority to negotiate drug prices in Medicare Part D, implementing a Part B formulary, adopting MedPAC's Part D recommendations on reducing Part D reinsurance and eliminating antidepressant and immunosuppressant drugs' protected class status, and increasing the coding intensity adjustment received by Medicare Advantage plans.While the Obama Administration has taken no steps to formalize, or even appoint the IPAB, the Medicare Trustees projected that the IPAB will be triggered in the 2017 determination year, and again in 2022, 2024, and 2025. A 2017 determination year trigger would result in a 2019 implementation year for proposals, barring congressional intervention. If the new 115th Congress intervenes by repealing the ACA, the IPAB also might be repealed. Until that time, NACNS will continue monitoring the IPAB controversy.
On December 8, 2016, U.S. Surgeon General Vivek H. Murthy released a report on an emerging public health threat affecting the nation: E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. It is the 33rd Surgeon General’s report in 53 years to address the impact of tobacco on health. It is the first to focus on e-cigarettes.
The report confirms that there is no acceptable level of nicotine when it comes to children and young adults. It notes that e-cigarettes are often a delivery system for nicotine, a highly addictive substance that can harm the developing brain. The report also confirms that the aerosol from e-cigarettes is not harmless. It can contain chemicals and particulates that are dangerous to the person using these products (“vaping”) and to anyone who may inhale that aerosol second-hand.
The Centers for Medicare & Medicaid Services (CMS) is conducting a Clinical Practice Improvement Activities (CPIA) Study, as outlined in the MACRA final rule. MACRA is the Medicare Access and CHIP Reauthorization Act of 2015 that repealed the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS). SRG was replaced with two new alternatives: the Merit-based Incentive Payment System (MIPS) for certain eligible clinicians or groups under the PFS, and Alternative Payment Models.
CMS is leading this study to:
The following clinicians are encouraged to apply for the CPIA Study:
Clinicians and groups who are eligible for MIPS that participate successfully in the study will receive full credit for the Improvement Activities performance category. In addition, participants will receive direct feedback from other study participants and CMS about how to minimize challenges with data collection and submission during the study period.
Study participants must meet the following requirements between January and December 2017:
The deadline to apply for the CPIA study is January 31. For more information visit the CMS website.
The Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization, funds comparative clinical effectiveness research (CER), as well as supports work that will improve the methods used to conduct such studies. PCORI is the largest single research funder that has CER as its main focus.
PCORI has a statutory mandate to develop a process for peer-reviewing PCORI-funded primary research and for making research findings publicly available. Peer review for PCORI ensures that studies are held to the highest standards of scientific integrity, methodological rigor, and relevance and usefulness to patients, caregivers, clinicians, and other health care stakeholders. The PCORI process includes reviews by content experts, methodologists, patients, and other health care stakeholders with experience related to the study.
PCORI seeks a wide variety of individuals to provide its process with the knowledge and perspectives reviewers have acquired through their unique experiences. If the research PCORI funds are to be valuable to the diverse communities within the health care system, CNS peer reviewers will be key to promoting high quality nursing research. Visit the PCORI website to sign up to become a peer reviewer.
A similar opportunity can be found in the Department of Health and Human Services’ Health Resources and Services Administration (HRSA), which also is looking for new and experienced grant proposal reviewers. HRSA Grant Proposal Reviewers are chosen for specific funding programs based on their knowledge, education, experience, and are free from conflicts. Reviewers gain an understanding of HRSA’s objective review process and have the opportunity to communicate with colleagues who often share common backgrounds and interests.
All CNSs working in or who are knowledgeable about health care services are invited to register in HRSA’s Reviewer Recruitment Module.
Legislation requiring Michigan's health care providers to secure patient consent before using telehealth services received unanimous approval from the state Legislature and will become effective in March 2017. The measure seeks to address patient privacy and quality of care concerns from telehealth, lawmakers said.S.B. 753, introduced in February 2016 by State Senator Peter MacGregor, passed unanimously in the House on December 1 and in the Senate on December 6. It will become law in 90 days, making Michigan the latest state to set guidelines for telehealth. “This is a commonsense healthcare reform for a modern age,” MacGregor said following the bill’s passage. “Society has never been more connected, yet a patient’s ability to see a medical professional is becoming more and more constrained as hospital wait times grow. This bill would help improve access to care, which could lead to healthier patient outcomes."
The Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants Booklet is available from CMS. It includes information about required qualifications, coverage criteria, billing, and payment for services furnished by advanced practice registered nurses, anesthesiologist assistants, and physician assistants.
The Centers for Disease Control and Prevention (CDC) launched a new mobile app for health care providers – Opioid Guideline App. It will “help providers apply the recommendations of CDC’s Guideline for Prescribing Opioids for Chronic Pain into clinical practice by putting the entire guideline, tools, and resources in the palm of their hand. Managing chronic pain is complex, but accessing prescribing guidance has never been easier,” stated the CDC.
The app includes a link to the full Guideline, summaries of key recommendations and an interactive motivational interviewing feature to help providers practice effective communications skills and prescribe with confidence. The application also includes a Morphine Milligram Equivalent (MME) calculator.
Please note that the MME calculator is not intended to replace clinical judgment or to guide opioid dosing for patients receiving active cancer treatment, palliative care, end-of-life care, or for patients younger than 18. The application is not intended to provide guidance on dosing of opioids as part of medication-assisted treatment for opioid use disorder. The calculator does not account for incomplete cross-tolerance between opioids and should not be used to guide opioid rotation or conversion between different opioids. Equianalgesic dose ratios are approximations and do not account for interactions between opioids and other drugs, patient weight, hepatic or renal insufficiency, genetic factors, and other factors affecting pharmacokinetics.
Visit the CDC website to access the suite of opioid prescribing guideline resources for providers (e.g., videos, trainings, posters) and to download the free Opioid Guideline App.
In a December 2016 podcast, the Food and Drug Administration’s (FDA) director of the Center for Drug Evaluation and Research (CDER) discussed recent FDA actions addressing the opioid epidemic.
CDER approved the labeling updates and Medication Guides – for certain opioid analgesics, benzodiazepines, and opioids approved for medication assisted treatment (MAT) of opioid addiction – to include safety information FDA required earlier in 2016. These labels and Medication Guides now are available to health care providers and patients to inform them of the risks associated with these products:
As part of its Opioids Action Plan, FDA continually assesses IR and ER/LA opioid analgesic medications through its Risk Evaluation and Mitigation Strategies program. For more information visit the FDA’s Opioid Medications website.
On December 2, 2016, the Government Accountability Office released the following report, VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans.
Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism examines the nation's ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Supported by a grant from the Robert Wood Johnson Foundation, the Trust for America’s Health (TFAH) has produced Ready or Not? every year since 2003. This year’s report indicates that health emergencies often catch the nation off guard when a new threat arises – such as a Zika or Ebola outbreak or a bioterrorist threat – which then requires diverting attention and resources away from other priorities.
Some key findings include:
A fact sheet released by the Office of the National Coordinator for Health IT and the HHS Office for Civil Rights describes nine hypothetical scenarios in which HIPAA regulations allow the sharing of patients' protected health information. "The new fact sheet provides examples about how HIPAA supports the electronic exchange of information, including contagious disease tracking, provider participation in cancer registries, and monitoring the health of children who have experienced lead poisoning," according to Lucia Savage, the ONC's Chief Privacy Officer, and Matthew Penn, director of the CDC's Public Health Law Program.
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The CNS Communiqué is an electronic publication of the National Association of Clinical Nurse Specialists.