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


Featured Headlines

  1. Status Report: AHCA

Headquarters News

  1. Two CNSs Appointed to MACRA Subcommittees
  2. CNSs Join the Front Lines of Infection Control
  3. NACNS 2017 - 2018 Webinar Series
  4. An Educated Patient is an Empowered Patient

Clinical News

  1. CDC Warns of New Superbug Fungus Risk
  2. Adverse Drug Events Associated with Hypoglycemia in the Older Population
  3. Deaths Attributable to Diabetes in the United States
  4. Rise in HCV Cases in Pregnant Women Tied to Opioids
  5. Some Patients Continue Opioids Long after Surgery

Federal/State Issues

  1. Title VIII Nursing Workforce Reauthorization Act of 2017 Introduced in the Senate
  2. President’s Opioid Plans
  3. Nurse Replaces Surgeon General
  4. HRSA Administrator Appointed


  1. Successful Models Support Opioid Abuse Treatment - Webinar Series
  2. CDC Updates Pre-Pandemic Planning Guidance
  3. CMS Releases Lookup Tool to Help Determine MIPS Participation Status

Featured Headlines

1. Status Report: AHCA

The House of Representatives passed the American Health Care Act (AHCA), H.R. 1628, on May 4. The AHCA was first introduced in March in response to promises by Republican members of Congress to repeal the Patient Protection and Affordable Care Act (ACA). The House-passed bill does not repeal the ACA, per se, because it does not address six provisions of the ACA’s ten titles, such as Medicare payment, quality, and care delivery reforms; fraud and abuse; workforce reform; and prevention.

The Congressional Budget Office (CBO) is scheduled to release its fiscal analysis (i.e., its score) regarding the approved House AHCA version on May 24. The CBO score on the March version of AHCA was distressing to NACNS and many other health care organizations. CBO projected that, if AHCA is enacted, the number of uninsured would grow by $24 million by 2026. AHCA would reduce the budget deficit by $337 billion over the 2017-2026 time period, mostly by cutting $880 billion from Medicaid and the current ACA means-tested tax credits and cost-sharing reduction payment by $673 billion. These ACA health care spending cuts would then be transferred to the wealthy via $883 billion tax cuts for high-income earners.

The final version that passed the House likely will suffer a more severe CBO score as it includes a new amendment allowing three types of state waivers. One waiver will allow insurers to get back in the business of pricing premiums based on people’s medical histories (i.e., ending guaranteed, affordable coverage for preexisting conditions).  Another allows states to opt-out of covering essential health benefits (EHBs). Currently insurers are required to cover ten categories of EHB at levels equivalent to typical employer plans (e.g., emergency care, wellness and prevention, mental health and substance use disorders, maternity and newborn care).

The granting of waivers would be more or less automatic. If states can opt out of coverage and pricing mandates, it may hinder the progress made on cost controls, such as different payment models designed to move from fee-for-service to a more bundled approach. Also, the AHCA does not sufficiently address the most demanding aspects of health care spending—chronic diseases. Half of overall health care spending is on 16% of people who have chronic illnesses.

AHCA now moves to the Senate. Republican senators are drafting their own health care bill in hopes of repairing the ACA and avoiding the unpopular House version. Since March, and on May 3 and May 4, the NACNS has issued comments voicing concerns about how the AHCA will result in reductions in health care coverage, particularly for vulnerable populations.

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Headquarters News

2. Two CNSs Appointed to MACRA Subcommittees

Two NACNS members were selected to join the Centers for Medicaid & Medicare’s MACRA (Medicare Access & CHIP Reauthorization Act) Episode-Based Cost Measures clinical subcommittees, meeting later this summer. The two clinical nurse specialists will make a valuable contribution and ensure the CNS perspective is included during the development of episode-based cost measures in various specialties.

Julie Rogan, MSN, RN, ACCNS-AG, AOCNS, CCRN, a clinical nurse specialist in the Medical Intensive Care Unit at Penn Presbyterian Medical Center is serving on the Pulmonary Disease Management Clinical Subcommittee, and Cathleen Shellnutt, MSN, RN, AGCNS-BC, CGRN, a Complex GI APRN in Surgical-Oncology at Medical City Plano in Texas is serving on Gastrointestinal Disease Management - Medical and Surgical Subcommittee.

Subcommittees will meet via webinars and in person later this summer to decide on episode groups to develop, reconcile trigger codes for the episode groups and discuss potential sub-groups, discuss episode group windows, and introduce activities related to the assignment of services. The clinical subcommittee’s goal for the summer is to fully develop at least one episode-based cost measure, with the goal of reporting cost measures based on these episode groups to clinicians through a dry run later this year. During the dry run, a set of measures will be calculated using Medicare administrative claims data and then privately reported to clinicians for the purposes of identifying potential issues with the measure specifications or the usability of the provider feedback reports.

CMS has contracted with Acumen, LLC, to develop episode-based cost measures to be used to implement the Cost Performance Category of the Merit-based Incentive Payment System (MIPS). In addition to the gastrointestinal and pulmonary clinical subcommittees, CMS has also created ophthalmologic disease management, cardiovascular disease management, musculoskeletal disease management - non-spine, peripheral vascular disease management, and neuropsychiatric disease management subcommittees.


3. CNSs Join the Front Lines of Infection Control

NACNS has joined the American Nurses Association (ANA) and the Centers for Disease Control and Prevention (CDC) in the Nursing Infection Control Education Network (NICE Network) so that clinical nurse specialists can better address emerging threats and follow infection control procedures to not only protect themselves, but also to protect their patients and nurses working at the bedside.



The NICE Network will:

  • provide real-time, tailored infection control training to nurses,
  • improve adherence to infection prevention and control practices known to be effective in preventing exposure to Ebola virus disease and other emerging infectious diseases; and
  • enhance the confidence of nurses to care for patients with Ebola virus disease or other highly contagious diseases through effective education and training.

As part of this work, NACNS created an Infection Control Task Force. It will identify the top concerns about infection control in today’s health care environment and make recommendations on the resources and education needed by clinical nurse specialists to implement refined practices in their work places. Task force members will meet twice a month for more than a year until goals are met.

Members of the NACNS Infection Control Task Force are:

  • Jacob John, RN, MSN Ed., ACNS-BC, a MDRO Prevention Coordinator (MPC) at VA Ann Arbor Health System in Canton, Mich.;
  • Pamela J. Laborde, DNP, APRN, CCNS, a CNS in Patient Care Services at UAMS Medical Center in Little Rock, Ark.;
  • Sharon R. Liska, NNP/NCNS-BC, RNC-N, a Clinical Nurse Specialist-Advanced at Providence Alaska NICU in Anchorage, A.K.;
  • Vanessa A. Makarewicz, MN, RN-BC, an Infection Control Operations Manager at Harborview Medical Center and University of Washington Affiliate Instructor in Seattle Wash.;
  • Michelle S. Milly, MSN, RN, AGCNS-BC, CMSRN, an Ebola Assessment Hospital Program Coordinator at Frederick Memorial Hospital in Frederick, Md.;
  • Chris Shakula, MS, RN, CNS-BC, CIC, an Infection Preventionist at Franciscan Health Crown Point in Crown Point, Ind.; and
  • Monica Weber, MSN, RN, CNS-BC, FAHA, a Director, Professional Practice/Magnet Program Manager at the Cleveland Clinic Foundation in Rocky River, Ohio.

Twenty other nursing organizations are joining NACNS and ANA in the NICE Network.


4. NACNS 2017 - 2018 Webinar Series*

NACNS is excited to announce the next webinars in its 2017-2018 series

Register today for these upcoming webinars.

Upcoming Webinars:

June 16, 2017
2:00 p.m. ET
Nurses and Respiratory Therapists – Working Together for Safe Alarm Systems Management
This is a reprise of a webinar presented by the AAMI Foundation

Speaker: Shawna Strickland, PhD, RRT-NPS, RRT-ACCS, AE-C, FAARC
Associate Executive Director-Education
American Association for Respiratory Care

July 12, 2017
2:00 p.m. ET
NACNS Cost Analysis Tool Kit – Are you Capturing your Value?

Speakers:  NACNS Practice Committee

All of the association’s webinars are designed to meet help the clinical nurse specialist address specific gaps in knowledge they may have and provide resources to improve CNS practice. Learn more about these sessions online

NACNS member price $25.00; NACNS non-member price $60 and student $30. All NACNS webinars are archived. Email to order an archived webinar. Listen at your leisure and apply for CE certificate.


5. An Educated Patient is an Empowered Patient

Clinical nurse specialists at Cleveland Clinic decided to compile their collective wisdom into a book for patients and their families. Navigating Your Hospital Stay: A Guide Written by Expert Nurses contains valuable information on what patients should expect while hospitalized, questions they or their loved ones should be able to answer before discharge and highlights the unique contributions of the bedside nurse. This is the first book published for the lay public that is written by an ensemble of APRNs. It is a testament to the impact CNSs have on patient outcomes, nurse empowerment and professional advocacy

Many of the books written for the healthcare consumer describe all of the unfortunate mishaps that can occur to a patient who is hospitalized. This book was written to do the opposite- to covey the commitment of caregivers universally, to dispel consumer myths and alleviate fears. The book is intended to delineate the nursing interventions that keep patients safe and informed – promoting mobility, managing pain, administering medications, promoting nutrition and preparing for discharge and care transitions. It also contains a section devoted to chronic medical conditions such as cancer, depression, diabetes, heart failure, liver disease, respiratory conditions and stroke and includes recommendations on how patients and their loved ones can express their care needs and expectations.  


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Clinical News


6. CDC Warns of New Superbug Fungus Risk

The Centers for Disease Control and Prevention (CDC) is warning hospitals and other health care facilities that there have been more than 60 cases of a relatively new and potentially fatal superbug fungus. Candida auris enters the bloodstream and can cause a variety of infections. All but a few cases were identified in New York and New Jersey. A CDC official said the fungus can be transmitted between people or through the environment, including from hospital equipment.

The CDC issued a report six months ago saying the fungus had been found in 13 people and was linked to four hospital patient deaths in the United States. The CDC says that they are seeing a 30% death rate, but that those cases are often very sick people with a lot of medical problems when they contract the fungus.


7. Adverse Drug Events Associated with Hypoglycemia in the Older Population

The Food and Drug Administration's (FDA) Center for Drug Evaluation and Research has announced a one-day public workshop, ”Reducing the Risk of Preventable Adverse Drug Events Associated with Hypoglycemia in the Older Population.” It will be held on September 12 and will feature presentations on:

  • Scope of hypoglycemia-related adverse drug events in the older population;
  • Risks and benefits of various degrees of glycemic control;
  • Factors affecting patient-centered care;
  • Research into effective diabetes management; and
  • Concept and translation of individualized glycemic targets to minimize adverse events in practice settings.

Presenters will represent multidisciplinary backgrounds from government, academe, patient safety groups, the health care industry and clinicians. There will be opportunities for collaboration between speakers and attendees as well as question and answer sessions.

The public workshop will be held from 9 a.m. to 4 p.m. at the FDA White Oak Campus, Silver Spring, Md. Interested parties must register to attend the workshop in person or via webcast. Registration is free, but limited based on space availability, with priority given to early registrants. Persons interested in attending the workshop must register by midnight (ET) on August 29.

A transcript of the public workshop also will be available at approximately 30 days after the workshop.


8. Deaths Attributable to Diabetes in the United States

According to the Centers for Disease Control and Prevention (CDC), about 29 million Americans have diabetes. However, Boston University School of Public Health researchers argue in a recent study that diabetes is responsible for four times as many deaths in the United States, rather than the current rate reported in death certificates would indicate. The researchers also found that diabetics had a 90% higher mortality rate over a five-year period than nondiabetics.

Responsibility for approximately 12% of deaths would make diabetes the third leading cause of death in the United States in 2010, after diseases of the heart and malignant neoplasms and ahead of chronic lower respiratory diseases and cerebrovascular diseases. Presently CDC lists diabetes as the seventh-leading cause of death. The inclusion of pre-diabetes in the risk category would raise the proportion of deaths attributable to diabetes by an additional 2%.


9. Rise in HCV Cases in Pregnant Women Tied to Opioids

Researchers at the Centers for Disease Control and Prevention reported in the agency's Morbidity and Mortality Weekly Report that the rate of pregnant women with hepatitis C infections at the time of delivery rose from 1.8 per 1,000 live births in 2009 to 3.4 in 2014, amid the ongoing opioid epidemic. The findings also showed an increased hepatitis C infection risk among those who smoked cigarettes and those who had hepatitis B during pregnancy.


10. Some Patients Continue Opioids Long after Surgery

A study in JAMA Surgery found about 6% of patients who had elective surgery filled an opioid drug prescription between 90 and 180 days after the procedure, compared with 0.4% of patients in a nonsurgical comparison group. Researchers said rates of new persistent opioid use were not affected by whether it was a major or minor surgical procedure.


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Federal/State Issues

11. Title VIII Nursing Workforce Reauthorization Act of 2017 Introduced in the Senate

Members of the U.S. Senate capped their recognition of the 2017 National Nurses Week by introducing legislation on May 11 to amend the Public Health Service Act, S. 1109. While referred to as the “Title VIII Nursing Workforce Reauthorization Act of 2017”, the official title of the bill is “[a] bill to amend Title VIII of the Public Health Service Act to extend advanced education nursing grants to support clinical nurse specialist programs, and for other purposes.” Senator Jeff Merkley (D-OR) introduced this bipartisan bill, co-led by senators Richard Burr (R-NC), Tammy Baldwin (D-WI), and Susan Collins (R-ME).

S. 1109 is a companion bill to the House version, H.R. 959, which was introduced in February. To help meet health care needs, the Nursing Workforce Reauthorization Act of 2017 would reauthorize and update the Nursing Workforce Development Programs under Title VIII, which include programs administered by the Health Resources and Services Administration that support and advance nursing education, practice, recruitment and retention.


12. President's Opioid Plans

In March, President Trump announced plans to set up a commission to address the country’s opioid crisis, the President's Commission on Combating Drug Addiction and the Opioid Crisis. To be administered and funded by the Office of National Drug Control Policy (ONDCP), the Commission shall:

  • Identify and describe existing federal funding used to combat drug addiction and the opioid crisis;
  • Assess the availability and accessibility of drug addiction treatment services and overdose reversal throughout the country and identify areas that are underserved;
  • Identify and report on best practices for addiction prevention, including health care provider education and evaluation of prescription practices, and the use and effectiveness of state prescription drug monitoring programs;
  • Review the literature evaluating the effectiveness of educational messages for youth and adults with respect to prescription and illicit opioids;
  • Identify and evaluate existing federal programs to prevent and treat drug addiction for their scope and effectiveness, and make recommendations for improving these programs; and
  • Within 90 days, submit to the President a report on its interim recommendations for improving the federal response to drug addiction and the opioid crisis.

Another aspect of the President’s plan is to tap White House Senior Advisor Jared Kushner to run an entirely new office with the sweeping authority to overhaul the federal bureaucracy and fulfill key campaign promises – such as reforming care for veterans and fighting opioid addiction.

However, the ONDCP’s acting director sent a letter to the drug agency employees in early May stating that the Trump administration is considering a plan that would slash the ONDCP’s budget by 95% in fiscal year 2018. The budget plan would zero out the High Intensity Drug Trafficking Areas program, designed to combat drug trafficking, and the Drug Free Communities program which supports local anti-drug efforts.

ONDCP is a three-decades-old office that President Ronald Reagan and Congress created to orchestrate the country’s drug policy and strategies. The previous ONDCP promoted expanded access to naloxone and other kinds of treatment, and shepherded a prescription drug monitoring program that is active in all states except Missouri.

Some Republicans are pushing back on the president’s impending budget request to nearly eliminate funding for ONDCP amid an opioid epidemic. Likewise, NACNS joined with other stakeholders in February advocating strong support for retaining the ONDCP.


13. Nurse Replaces Surgeon General

Rear Admiral Sylvia Trent-Adams, Ph.D., R.N., F.A.A.N. has been appointed by President Trump to serve as the nation’s Acting Surgeon General. She was appointed when the President abruptly asked U.S. Surgeon General Vivek H. Murthy to resign, quickly moving Murthy’s deputy, Trent-Adams, into the position.

Surgeons general have few staff and little power, but generally use their positions to call attention to important public health priorities. It was well-reported that the gun lobby was no fan of Murthy, who has for years insisted that gun violence should be classified as a public health threat. While U.S. violent crime has fallen sharply over the past quarter century (50%), firearm violence – including accidents, suicides, homicides – remain a health problem in need of fixing.

The Surgeon General chairs the National Prevention Council, which provides coordination and leadership among 20 executive departments with respect to prevention, wellness, and health promotion activities. The position also oversees the U.S. Public Health Service Commissioned Corps, an elite group of more than 6,700 uniformed public health professionals working throughout the federal government whose mission is to protect, promote, and advance the health of our nation.

Trent-Adams is the second nurse to serve in this role. Richard Henry Carmona was the first nurse, as well as a physician, who served as the 17th Surgeon General, appointed by President George W. Bush in 2002. For now, Admiral Trent-Adams will be in an acting role until an official replacement is named. Prior to joining the Office of the Surgeon General, Trent-Adams was the Deputy Associate Administrator for the HIV/AIDS Bureau, Health Resources and Services Administration. Trent-Adams began her career in the Commissioned Corps of the USPHS in 1992.


14. HRSA Administrator Appointed

On May 1, George Sigounas, M.S., Ph.D. became the new Administrator of the Health Resources and Services Administration (HRSA).  Previously, Dr. Sigounas was a Professor of Medicine at East Carolina University's Brody School of Medicine.

According to HRSA, Sigounas’ involvement in the establishment and operation of the Bone Marrow Transplantation Program, clinical trials and patient committees provided him with extensive understanding of the various aspects involved in patient treatment, including treatment processes, and financial issues. For more on his bio, click here.


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Resources of Interest

15. Successful Models Support Opioid Abuse Treatment – Webinar Series

A free webinar on Successful Models and Resources to Support Opioid Abuse Prevention and Treatment will be held on Tuesday, June 13, 2017, from 2:00 PM - 3:30 PM EDT.  Online registration is required.

Sponsored by Health Resources and Services Administration’s Bureau of Health Workforce (BHW), this webinar will highlight innovative health workforce resources and models for combating the opioid misuse epidemic. Presenters will provide details about their current training curriculum, community partnerships, policy, innovative approaches, and recruitment strategies. The BHW Workforce Grand Rounds Webinar Series aims to improve health professions training to increase the number of high-quality health professionals, particularly in rural and underserved communities.


16. CDC Updates Pre-Pandemic Planning Guidance

The Centers for Disease Control and Prevention (CDC) recently issued updated guidance on using non-pharmaceutical interventions to control disease and exposure during a flu pandemic. The guidance incorporates the latest scientific evidence and lessons learned from the 2009 H1N1 flu pandemic, new and updated pandemic assessment and planning tools, and links to pre-pandemic planning guides for different community settings.


17. CMS Releases Lookup Tool to Help Determine MIPS Participation Status

Clinicians can now use an interactive tool on the CMS Quality Payment Program website to determine if they should participate in the Merit-based Incentive Payment System (MIPS) in 2017. To determine your status, enter your national provider identifier and the system will determine whether or not you should participate in MIPS this year and where to find resources.


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