1. Rodriquez, Les MSN, MPH, RN, ACNS-BC, APRN

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As I sit here and write this, I have come to realize that this will be my last message as President of NACNS. The time has passed so quickly and so much has happened during the last 12 months. It's difficult to account for all the activities without scrutinizing my calendar to catalog meetings, phone conferences, and travel. Being the elected leader of a national organization is a difficult, time-consuming task and one that doesn't happen in isolation or a silo. Being the elected leader of a national organization doesn't happen by itself, it happens with the help and work of others both as paid workers and volunteer members of the organization.


I have been very fortunate over the last 12 months to have been involved with such a group of supportive people-from our executive and administrative directors, our management company Fernley & Fernley, and officers and members at large on the board. A leader is only as good as the people he/she surrounds himself/herself with. I have been extremely fortunate to have an incredible group of people who have assisted me:


Executive Director Melinda Ray has been the angel on my shoulder constantly providing me with feedback, inspiration, ideas of innovation, and rationale for motivation. She has been instrumental in the ongoing evolution of this organization, and I have been ever so grateful to her assistance in the leadership of this organization.


Administrative Director Jonathan Uitto from Fernley & Fernley, who has persistently kept the schedule running, making sure all of us on the board are aware of what is coming down the pike, what we have ahead of us, where we need to be, and what we need to be aware of. Jonathan has also been very pertinent to our ongoing evolution.


Immediate Past President Carol Manchester, who has spent the last several years on the board first as member, then in the role as president. She was and has been my mentor for the role and brings great history for decisions from the past along with recommendations for navigating the political waters I have found myself negotiating.


President-Elect Marguerite "Peggy" Barksdale, who has been at my side as colleague for the last several years and who will assume the helm in March 2015. Peggy's passion for the role and the organization will take us further into the future.


Vice President Rachael Moody, who demonstrated exceptional commitment by returning and filling the shoes of a vacant vice president's office after having served as vice president and president. Rachael is a classic demonstration of the typical characteristics that make up members of the board.


Secretary Anne Hysong, who has consistently kept me on my toes with tight deadlines along with overseeing the bylaws committee along with editing the newsletter that is present in each and every journal issue. Anne has represented and spoke for us at other organizations conferences speaking and promoting on our behalf.


Treasurer Cecilia Gray, who assumed the role when it emergently was vacated because of personal matters for then-Treasurer Anne Muller. Cecilia jumped on and began working with our management company to understand and get a grasp of the budget, its intricacies and nuances.


Member-at-Large Dr Gayle Timmerman, who has been the liaison to the research committee and who provides us with a pulse on the academic arena.


Member-at-Large Ginger Pierson, who has passionately been the liaison to our membership committee and who has worked tirelessly to recruit members as well as participate on the Conference Planning Committee.


Member-at-Large Fiona Winterbottom, who has been the liaison to the Leg/Reg committee which works on our behalf to keep NACNS and its members at the forefront of any licensing and regulatory issues that may affect our ability to practice.


Our newest Member-at-Large Deborah Tuggle, who has brought enthusiasm, fresh perspective, and zeal for promoting the organization and has been greatly involved as the liaison to our practice committee, keeping the board informed on practice related issues.


Journal Editor Dr Jan Fulton, who for years has worked to provide us with a rich, robust, and salient journal. She continues to promote the organization in the journal utilizing the 3 spheres.


As you see, I am surrounded by people of greatness doing great things. I am only the leader that I am because of the people who are around to support me. Our organization is only as great as it is because of the people who are members and the great things they are doing. Obviously, you make NACNS great, and it is you who has provided me with the honor and privilege to serve in this role. I wish to sincerely thank you for that opportunity and hope that I have served you well.


My best wishes to us and our future because remember "tomorrow belongs to us."


NACNS Board of Directors Approves 2015-2020 Mission and Goals

On the November 4, 2014, NACNS Annual Meeting, the NACNS Board of Directors approved the 2015-2020 Mission and Goals. Please see below:


NACNS Mission: To advance the unique expertise and value the clinical nurse specialist contributes to healthcare.


NACNS Goals:


* Increase the visibility and influence of CNSs.


* Serve as the national leader for CNS education.


* Promote the benefit the CNS brings to evidence-based quality, patient safety, and cost of healthcare delivery.


* Enhance professional leadership qualities among NACNS members.


* Be the authority for advancing the full scope of practice for the CNS.


* Promote CNS research in order to further define the value of CNS interventions.



NACNS Announces New Member Resource-Alarm Fatigue Toolkit is Now Online

NACNS' Alarm Fatigue Task Force has been focused on assessing and providing tools for the clinical nurse specialist to deal with the issue of alarm fatigue. They held a well-attended meeting at the 2014 Annual Conference, hosted 1 webinar and will host a second in December 2014, have submitted an article for publication in the NACNS journal, and have developed an extensive alarm fatigue online toolkit for members to use to gather information for their specific needs.


The toolkit can be found on the NACNS Web site at


NACNS' Board of Directors appointed the Alarm Fatigue Task Force because nurses in many settings run the risk of being overwhelmed by the sensory input of mechanical alarms. Clinical nurse specialists are in a unique position to effect change to improve patient safety. This is an issue of importance to the Joint Commission as well as the US Food and Drug Administration (FDA). In one 4-year period, before increased attention was given to this issue, the FDA reports that there were more than 560 alarm-related deaths in a 4-year period.



The leadership team of Linda Thurby-Hay (president), Phyllis Whitehead (treasurer), Kim Nelson (secretary), and Cindy Ward (Web administrator) leads the Virginia Association of Clinical Nurse Specialists. We met in early December with the membership to formulate the following 2015 goals:


1. Update our bylaws for congruency with the NACNS and organizational realities.


2. Support membership development by offering a Continuing Education Unit-granting conference inclusive of pharmacology credit in the spring and using recruitment tables at other venues throughout the year.


3. Reformat our Web site to


a. Showcase populations served by Virginia Clinical Nurse Specialists;


b. Support preceptorships for clinical nurse specialist (CNS) students;


c. Share awards and recognitions earned by CNS members; and


d. Incorporate a "members only" section.


4. Organize promotion of CNS role during recognition week in early September.



The Virginia Association of Clinical Nurse Specialists is participating in an Advance Practice Registered Nurse workgroup, organized by the Virginia Nurses Association's Virginia Action Coalition, to develop mutually supportive legislation. We anticipate that efforts will culminate in a plan that improves access of Virginians to the services provided by all advanced practice nurses, for example, nurse anesthetists, nurse midwives, nurse practitioners, and CNSs, while emphasizing the collaborative relationships we enjoy with our physician colleagues.


Our annual meeting will occur in conjunction with the educational conference scheduled for April 24 in Lynchburg, Virginia. Maureen Cahill from the National Council of State Boards of Nursing will speak on the current state of Consensus Model implementation. Ann Hamric, national expert on advanced practice nursing, will share her expertise on moral distress in the workplace. Additional offerings include the work endeavors of Virginia Clinical Nurse Specialist. See our Web site,, for details.


Submitted by Linda Thurby-Hay MS, RN, ACNS-BC, BC-ADM, CDE



The Oklahoma Association of Clinical Nurse Specialists has a new Board:


* Officers:


[black small square]President: Tamara Meier


[black small square]President-elect: RuthAnn Fritz


[black small square]Treasurer: Debra Perdue


[black small square]Secretary: Stephanie Moore


[black small square]Immediate past president: Kelly Lang Sheppard


* Committee chairs:


[black small square]Director-at-large for Continuing Education Committee: Dawn Vines


[black small square]Director-at-large for membership: Lisa Lee


[black small square]Director-at-large for public relations: Cherene Black


[black small square]Chair of Nominations Committee: Lori Ormsby


[black small square]Chair of Legislative Committee: Melissa Craft


* Unofficial Board:


[black small square]Student representative: Kacy Aderhold


[black small square]Student representative: Samantha Kuplicki



We are preparing for the Annual Advanced Pharmacology Conference in the Spring:


* 2015 Advanced Pharmacology Conference, April 16-18, 2015



We have started a Web site upgrade that should be finished in the Summer.


CMS Issues Final Rule for Home Health, Including CNS Performing Face-to-Face Encounter for Home Health Services

On November 6, the Centers for Medicare & Medicaid Services (CMS) issued the final rule ( that implements changes to simplify the face-to-face encounter regulatory requirements for home health services. This rule also updates the Home Health Prospective Payment System rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the nonroutine medical supply conversion factor under the Medicare prospective payment system for home health agencies, effective for episodes ending on or after January 1, 2015.


The Affordable Care Act mandated that prior to a physician certifying the need for home health services, the physician or an allowed nonphysician practitioner, including a CNS, must perform a face-to-face encounter. The face-to-face encounter must be related to the primary reason the patient requires home health services and occur no more than 90 days prior to the home health start of care date or within 30 days of the start of the home healthcare.


In addition, current regulations require that, as part of the certification of eligibility, the certifying physician must document the date of the encounter and include an explanation of why the clinical findings of such encounter support that the patient is homebound and in need of either intermittent skilled nursing services, physical therapy, or speech-language pathology services.


CMS Issues Final Rule for Physician Fee Schedule, Including Chronic Care Management Services

This final rule ( includes responses to NACNS's comments to CMS on the proposed rule for the physician fee schedule. These include NACNSs comment on the definition of CNS on the Physician Compare Web site and the physician-centric approach in the Web site. The final rule also includes specific requirements for the delivery of chronic care services that can be provided by CNSs.


In NACNS's letter to CMS on the proposed rule, we requested that they use the definition recommended by NACNS, "The clinical nurse specialist is an individual prepared at the master's or doctoral level as a clinical nurse specialist from an accredited educational institution and/or holds an advanced degree in nursing from an accredited educational institution and is recognized by their state as a clinical nurse specialist."' CMS stated that they will take this under consideration in the future and will work with relevant stakeholders to update as appropriate.


NACNS also recommended to CMS that the Physician Compare Web site should allow the search function to be more inclusive of all qualified healthcare providers. CMS responded by saying that they will evaluate these recommendations for potential future inclusion.


The final rule contained the 2 HCPCS codes for chronic care management. These services can be provided by CNSs because they are considered qualified healthcare professionals. The codes are defined as follows.


* HCPCS Code 99490: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendarmonth,with the following required elements: multiple (>=2) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.



* HCPCS Code 99487: CComplex chronic care management services, with the following required elements: multiple (>=2)chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; establishment or substantial revision of a comprehensive care plan; moderate or high complexity medical decision making; 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.