1. Barksdale, Peggy MSN, RN, CNS-BC, OCNS-C

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"Nothing ventured. Nothing gained."




I have found these words to have been inspirational in my life's journey and adopted them as my personal mantra. In our course through life, stepping up and trying something new can bring great satisfaction. When we are willing to step up, to take a risk and try something new, much can be accomplished.


As I move into my term as president, I have taken note of many persons approaching NACNS as an "open door" for numerous concerns. We have heard from members and nonmembers alike, all trying to navigate the changes that are being brought by regulation, education, certification, and clinical practice. Even with the chaos of change in our environments, I have been impressed by the creative approaches clinical nurse specialists (CNSs) are taking to manage this phase. While some of us try to avoid change, most CNSs embrace change and work hard to manage the change so that they can provide optimal care to their patients.


On the association side, NACNS is definitely working hard to manage change and facilitate member involvement to make NACNS a vital part of our professional lives.


We have had some amazing successes so far this year!


The 2015 Conference in San Diego was an incredibly successful meeting. The official count was 593 attendees, and I personally reviewed the evaluations and am pleased to report that the huge majority of them were amazingly positive evaluations.


We have already begun to plan for our next annual meeting. The 2016 Conference Planning Committee has begun its work with Chairman Linda Hoke and members Lydia Booher, Linda Thurby-Hay, Julia Linden, Shannon Rives, Mayra Rodriguez, and Yvonne Smith. This impressive group of members will be crafting the content of our next meeting, March 3 to 5, at the Loews Philadelphia Hotel, in Philadelphia, Pennsylvania. The theme of this meeting is "The Future is Today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist."


The NACNS Board is supporting a number of task forces. In addition to Chronic Care and the CNS and Malnutrition and the Hospitalized Adult task forces, the NACNS Board is planning to seat 2 new taskforces. One will to develop competencies for the CNS Psych/Mental Health CNS for the Future and the Family/Individual Across the Lifespan Task Force, including crosswalk of the adult/gerontology and pediatric examinations to see if this individual can qualify for both certification exams.


Under the leadership of past president Carol Manchester, the Doctor of Nursing Practice Task Force is reviewing NACNS' 2009 position statement on DNP education and the evolution of the DNP degree and will be making recommendations to the Board related to this degree.


Immediate past president Les Rodriguez is continuing discussion and work with ANCC CNS Pediatric examination. It is critical that individuals take a certification examination as soon as they can. Many states will be requiring them for practice as a CNS. While many states may grandfather their current advanced practice registered nurses (APRNs) and not require certification, this may not be the case if you ever have to move to a different state.


NACNS is active on the federal legislative front. We have provided testimony to the Senate and House Appropriations Committees in support of Title VIII funding for nursing education. In addition, NACNS continues to advocate for the Veterans Health Administration's nursing handbook, which would allow APRNs, including the CNS, the ability to work to the full extent of their education and training. We are active in coalitions that support expanding of federal recognition and reimbursement for all APRNs.


One growing challenge is the awareness of the graduating nurse of the title and role of the CNS. NACNS recently exhibited at the National Student Nurses Association Annual Meeting in Phoenix, Arizona. Those who ran our exhibit booth were surprised by the number of individuals, including some faculty, that were "unfamiliar with the CNS role." This really amazes me! I encourage all of you to take time to meet each of the nursing students in your clinical setting. Don't let them get out of your facility without knowing what a CNS is and how a CNS is unique among the 4 APRN roles. There is much work to be done-the future relies on the undergraduate nurse's understanding of the CNS role.


NACNS has planned a very full year! I want to make sure all of you have a chance to discuss these and other important issues with the NACNS leadership. One way to do this is to attend NACNS' 16th Annual CNS Summit on July 21, 2015. This meeting will allow attendees to discuss the CNS role with an emphasis on reimbursement, certification examinations, and DNP education. The meeting is preceded by the 2nd Annual CNS Educator's Forum. The Forum, scheduled for July 20, will provide CNS educators the opportunity to discuss key education concern and offer solutions and suggestions to NACNS. Because our meeting coincides with ANA's Membership Forum, we will be able to offer a day on the Hill in conjunction with ANA. July 22 Summit and Forum attendees can stay and sign up to spend the day on the Hill advocating for key nursing issues.


Doors will continue to open and close for NACNS, and your association will remain attentive to the concerns and issues that come to us.



NACNS is hosting 2 important annual meeting this summer in the Washington, DC, area. The NACNS Educator's Forum and the NACNS 16th Annual CNS Summit will be held on July 20 and 21. The Educator's Forum is designed to provide CNS educators from clinical instructors to program directors the opportunity to discuss key issues that impact CNS education. The preliminary agenda for this meeting includes a discussion of the DNP program for the CNS role. The current DNP Position Statement Task Force will be providing their position and seeking feedback from CNS faculty.


The NACNS 16th Annual CNS Summit will provide an opportunity for NACNS members and representatives from collegial organizations to discuss issues impacting the CNS work environment. The preliminary agenda for this meeting includes the following:


* A discussion of the options for population-based examinations


* The CNS Core Statement Revision


* On-the-ground concerns about the APRN Consensus Model


* Background on the APRN Compact


* Federal Legislative Issues for the CNS



An exciting option for 2015! Our meeting coincides with the ANA's annual member Hill Day. We are working with ANA to give our meeting participants the opportunity to join ANA in their Hill day on July 22.


More details will be provided via that NACNS Web site. Please go to and click on the 2015 Summit for more information. Also, you can e-mail your questions to



The 2014 Bylaws Committee presented proposed bylaws changes to the membership at the 2015 NACNS Business Meeting at the NACNS Annual Meeting on March 6, 2015. This set of proposed bylaws changes was also sent to the NACNS membership for consideration and a vote. All mail-in ballots were due March 31, 2015. All of the proposed bylaws changes were approved by the NACNS membership. In addition, a modification to the bylaws was presented by a member at the Business Meeting and was approved by the membership. The change was to make the immediate past president as a member of the NACNS Board Executive Committee.


The other bylaws changes are the following


* Removal of policy-oriented text and the transfer of this from bylaws into NACNS policy


* Consolidation of the Secretary and Treasurer Board positions to a single position-secretary/treasurer. An at-large board member will be added so that the Board remains the same size


* Consolidation of the vice president and the president-elect positions to a single position. The president-elect will pick up the duties of the vice president. An at-large board member will be added so that the board remains the same size


* Addition of criteria to the full member category that would allow someone who has previously worked in a CNS role to be a full member


* Addition of 2 new membership rolls-legacy member, for individuals who have 20 years or more membership in NACNS, and an associate member, a member who does not meet the requirements of the full member, retired member, student member, and/or the legacy member and is supportive of the CNS role


* Deletion of the 2 membership categories that have been unused for a significant number of years-honorary member and corporate member. These 2 membership categories are recommended to be discontinued, and we will provide the opportunity to meet these relationship needs through policy rather than bylaws


* Change of the NACNS fiscal year from January 1 to December 31 to July 1 to June 30. This change would be made in order to improve fiscal tracking based on the timing of the NACNS Annual Conference


* Addition of language to allow for the appointment of task forces and work groups. A change of status for current committees to preserve the finance, leg reg, and nominating committee as standing committees and allow the other committee to continue but not considered standing committees



A detailed side-by-side comparison of the current and proposed bylaws has been prepared. This document will be posted on the member's only side of the NACNS Web site; please look for the announcement on the right column of the NACNS homepage and click on the heading about the bylaws.



On April 16, President Barack Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), permanently repealing the Sustainable Growth Rate (SGR) formula for payment of Medicare providers. The passage of this legislation ends a series of 17 so-called "doc fixes" since 1997 when the SGR formula originally was passed into law but never fully implemented because of physician uproar. The MACRA legislation averts what would have been a 21% cut to Medicare physician payment, replacing it with 0.5% "updates", or physician payment increases, in 2015, 2016, 2017, and 2018.


This legislation contains a number of significant features and provisions for APRNs including the following:


* APRNs, including CNSs, are fully and consistently recognized as eligible providers throughout the bill.


* The law allows CNSs and NPs to document the face-to-face encounters with Medicare patients required to write prescriptions for durable medical equipment. Under previous law, CNSs and NPs were required to certify that the order of durable medical equipment was based on a prior face-to-face visit with a Medicare patient as documented with a physician's cosignature.


* In an effort to promote greater use of chronic care management, Medicare will pay for these services and names APRNs as eligible providers. It also calls for a national education campaign to promote the use of chronic care management services in rural areas and in minority populations.


* Beginning in 2019, APRNs and doctors can participate in an updated incentive payment initiative (Merit-Based Incentive Payment System [MIPS]) in which they will be measured for quality, resource use, clinical practice improvement activities (which notably must include expanded practice access, patient engagement, patient safety, and care coordination), and electronic health record adaptation.




The Future Is Today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist March 3-5, 2016; Loews Philadelphia Hotel, Philadelphia, Pennsylvania

Join CNSs from around the country at the original capital of America. If you have never been to Philadelphia, this is your chance! Philly is a melting pot of cultures, traditions, and immigrant cultures. This means lots to do and amazing culinary options! It is the home to the Liberty Bell and the Declaration of Independence, both tributes to the city's contribution to the founding of our nation. Details will be posted on the NACNS Web site,



The Future Is Today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist March 3-5, 2016; Loews Philadelphia Hotel, Philadelphia, Pennsylvania

Abstract Submission Opens: June 1, 2015


Deadline for Abstract Submission: August 3, 2015


Deadline for Student Poster Submission: October 26, 2015


Innovative healthcare delivery, new practice challenges in an age of healthcare reform, and increased visibility of CNSs' practice outcomes are the bywords for the 2016 conference. The conference will highlight innovative approaches to CNS practice within the 3 spheres of influence: the client sphere (individual, family, community), the staff sphere (nurses, nursing practice), and organization/system sphere (Statement on Clinical Nurse Specialist Practice and Education, 2004). In addition, topics will be selected with an eye toward APRN skills, including pharmacology and advanced assessment and clinical management. Pharmacology credits will be offered for eligible sessions. Abstract submitters are encouraged to include pharmacologic content when applicable so that NACNS members who have prescriptive authority can benefit from attending your session.


Topics of interest include the following:


* Assessment & Management of Pain: Focus on comprehensive approaches to pain management including pharmacological and nonpharmacological approaches, adherence to federal prescribing guidelines


* Care Transitions: Focus on practices or programs that support client populations in a variety of transitions (eg, changes in level of locations of care, developmental transitions, management of health problems across systems of care)


* Clinical Management Topic: Focus on clinical and pharmacological management. An emphasis on content that assists in selection of optional pharmacologic choices should be noted


* Cutting-Edge Issues: Member-requested presentations on cutting-edge issues in hematology, psychiatric care, diabetes, respiratory care, cardiovascular care, and autoimmune diseases, including pharmacological and nonpharmacological approaches


* Costing-Out Care: Focus on actual cost savings that result from CNS practices or CNS-driven programs of care. Discussions on the processes used to calculate costs savings are encouraged and welcome


* Impact of State/National Policy on Health Care: Focus on changes in healthcare delivery by the CNSs that results from policy implementation


* Innovations in Education: Focus on innovative educational practices or programs designed to improve the care provided by healthcare professionals. These innovations can be directed to clinical education, continuing education, and/or innovative delivery in schools and universities


* Innovations in Practice: Focus on innovative clinical interventions planned and/or implemented by the CNSs or interprofessional teams led by the CNSs to provide high-quality, cost-effective care. Methods to assess patient outcomes and costs savings should be mentioned


* Interprofessional Educational/Practice Initiatives: Focus on educational/clinical practices or programs that facilitate interprofessional and/or team-based approaches to healthcare


* Pharmacology for the CNS: Member-identified topics include pain medications, antimicrobial medications, cardiac medications, diabetes medications, anticoagulation medications, pulmonary medications, and neurological medications. A session may focus on a category of medications, an update on new medications and/or the utilization of a profile of medications with a patient population or a disease state



Additional detailed information is available on the NACNS Web site,




NACNS is excited to continue our high-quality webinar programming in 2015. This series of webinars is designed to provide the CNS with cutting-edge clinical and role information. The topics have been selected with an eye toward issues that cross specialties and may be seen in a variety of clinical situations. In addition, we have intentionally designed some of the sessions to provide much needed pharmacology CE! Please sign up for 1 or more:


Humpty Dumpty Syndrome: Putting the Septic Patient Back Together Again


May 21, 2015; 2:00 PM Eastern; Pharmacology CE


Breaking the Pain Cycle-Pain Management Update


June 18, 2015; 7:00 PM Eastern; Pharmacology CE


Looking Beyond the First Impression-Malnutrition Identification and Assessment


September 15, 2015; 4:00 PM Eastern


Moving Toward a Violence Free Workplace


October 21, 2015; 2:00 PM Eastern


Malnutrition and the Hospitalized Adult-Essential Considerations in Identification and Management


November 17, 2015; 4:00 PM Eastern



The Washington Affiliate continues advocacy and partnership with the Nursing Care Quality Assurance Commission (state board of nursing) to obtain CNS inclusion in the advanced practice rules. The current timeline for CNS inclusion is as follows:


Nursing Commission and CNS stakeholder workgroup meeting April/May 2015


CNS work group meeting with rule experts April/May 2015


ARNP Subcommittee meeting for review/approval May 20, 2015


Draft CR102 and associated cost analysis June 30, 2015


Public comment period July 1 to August 4, 2014


Rule package filing date August 5, 2015


Vote on ARNP CNS inclusion rule-September 11, 2015, at the Nursing Care Quality Assurance Committee business meeting


Questions about this process? Contact affiliate chair Heather Schoonover, MN, RN, PHCNS-BC,