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

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Is the opportunity fraught with difficulty or is the difficulty fraught with opportunity?


-Author unknown


Happy New Year 2016 to all National Association of Clinical Nurse Specialists (NACNS) members. This year holds promise for the association and hopefully, for each of you. Since this issue includes February, in the Chinese zodiac, it is the year of the Monkey where one looks to luck and romance.


I wonder how many clinical nurse specialists (CNS) make resolutions. Resolutions are firm decisions to do or not to do something. I make resolutions yet I rarely will share them. Perhaps it is because I am able to achieve some and have to put others on the sidelines until the next year or delete them altogether.


When I first read the quote above, I could see how opportunity and difficulty might coincide or collide. All my life I have made decisions, and looking over my scorecard, I see a fairly good batting average with the big lifetime ones. Being NACNS President was one of the big ones. Leading the NACNS Board has been difficult sometimes but also a great opportunity. In a few months I will complete this term as president and begin looking forward to the rest of 2016.


This year we have continued the struggle of having clinical nurse specialists recognized as advanced practice registered nurse (APRN) in the legislative and regulatory arena. NACNS has submitted letters to government agencies and provided comments on House and Senate bills urging congress to recognize the contributions of the 72 000 plus CNSs who are practicing and helping to ensure positive and cost-effective outcomes for patients. We can't allow the CNS to be omitted from the listing of healthcare providers. NACNS recently commented on House bill 2208, Hospice Commitment to Accurate Encounters (CARE,) and Senate bill 2153, the Affordable Care Act Sunshine Act. In these cases, the CNS was included in each piece of legislation and we could thank the bill sponsors for their work and endorse the bills.


This year, the International Council of Nursing Statistics (ICONS) informed us that they had heard a rumor that the Bureau of Labor Statistics may not be willing to change the coding of the CNS role so that it is included as one of the APRN roles. Currently, the CNS numbers are captured in the general RN category. NACNS wrote a second letter, and amendment to our recent Federal Register response, to provide new information to BLS about the CNS. We focused this letter of new information not included in our previous letter. We emphasized the results from the NACNS 2014 CNS Census and referenced the new position statement endorsing the Doctorate of Nursing Practice (DNP) as entry-level education for all new graduating CNSs starting 2030. NACNS also circulated a sign-on letter among the nursing organizations to gain support for the BLS to include the CNS in the APRN category. To date, 18 organizations have signed onto this letter. This includes national organizations representing the other three APRN categories, in addition to national specialty nursing organizations. This is your association at work.


In the past months, Affiliate leaders have written expressing their concerns about NACNS'(tm) position statement on the DNP. The Board reviewed those concerns and takes them seriously but is committed to the DNP position statement. The task force is continuing to complete a position statement on the PhD doctoral degree. Because the Board did not rescind the position statement does not mean that we did not listen to the concerns. There have been a number of concerns about the "process" the NACNS Board undertook in developing this position statement. This position was developed using the same process as the last 5-6 positions the Board has taken. But, this does not mean that that process was the best process. With that in mind, the Board discussed how it could enhance the process and find a way to allow all members to provide comments on position statements the Board is considering. As a result, the Board adopted a new Board position statement policy which will allow for a minimum of 2 weeks for each position statement to be posted prior to finalization and consideration for adoption by the Board. This new process will start with the next position statement the NACNS Board considers. We will make members aware through a blast email and other communication vehicles when the position statement will be posted for comments.


Election results will be coming prior to the 2016 Annual Conference. The ballot for the new Board positions included president-elect, board directors, and nominating committee. I commend this year's committee: immediate past president as liaison Les Rodriguez, chair Theresa Murray, Vivian Haughton, JoAnne Phillips, and Kathleen Ray for filling the ballot with talented candidates.


In 2 months, the 2016 NACNS Annual Conference will begin. It is being held March 3-5, 2016, in historic Philadelphia, Pennsylvania. There will be outstanding podium, poster and symposium presentations that were selected from more than 225 abstracts that were submitted for consideration. Philadelphia is known as the City of Brotherly Love and it holds many attractions aside from the Philly steak sandwich. The first hospital and medical school began in this city. I encourage you to make those reservations soon. The 2017 conference committee is starting its work on designing the educational program and activities for the 2017 NACNS Annual Conference in Atlanta, Georgia. The committee is comprised of 10 members. NACNS will also soon begin considering topics and speakers for our popular webinar series.


So keep in mind your opportunity to make a "resolution" this year. I strongly urge that you add being active at the national level to your list.



The Future Is Today: Entering a World of New Practice Challenges for the Clinical Nurse Specialist

Registration is now open for the 2016 NACNS Annual Meeting. The planning committee is happy to announce the following keynote speakers: Ann B. Hamric, PhD, RN, FAAN, Associate Dean of Academic Programs and professor, School of Nursing, Virginia Commonwealth University; Regina Cunningham, PhD, RN, AOCN, FAAN, chief nurse executive and associate executive director, Hospital of the University of Pennsylvania, and Assistant Dean for Clinical Practice and adjunct professor of nursing, University of Pennsylvania School of Nursing; and Michelle Larkin, JD, MS, RN, interim vice president, Robert Wood Johnson Foundation. The 2016 meeting program will provide numerous options for continuing education (CE) credits as well as more options for earning pharmacology CE credits during the Annual Meeting Preconference. We will provide pharmacology CE for a number of sessions at the meeting as well. The early bird registration deadline is January 18, so act fast to take advantage of the early bird discounts!


The meeting will be held at the Loews Philadelphia Hotel, which is right downtown, a short walk from key attractions such as City Hall, the Reading Terminal Market, and lots of unique and high-quality restaurants. Philadelphia is steeped in history and is a melting pot of cultures. While you are in town, consider adding a day to see the Liberty Bell or the Declaration of Independence or visit the yearly Philadelphia Flower Show. Reservation information is available at The cutoff for the NACNS discounted hotel rate is February 4, 2016.



The NACNS is excited to continue our high-quality webinar programming in 2016. 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! Go to for more details and register today!


Webinar Cost: Series of 6 webinars


Members $260


Non-members $295 student $150


All webinars have been archived for later viewing.


Single webinar


Members $45


Non-members $60 student $30



The NACNS received information from the International Council of Nursing Statistics that the BLS may not be willing to change the coding of the CNS role to be included with the APRN roles. Instead, they seem inclined to have the CNS remain part of the general registered nurse category. The NACNS, upon receiving this information, prepared a letter to the BLS, as an amended Federal Register response, to provide them additional information to consider that was not available at the time of the original Federal Register announcement deadline. We included results from the NACNS 2014 CNS Census and referenced the new position statement the NACNS Board adopted that calls for the DNP as entry-level education for all new CNSs starting 2030.


In addition, NACNS is circulating a sign-on letter among the nursing organizations to gain support for the BLS to include the CNS in the APRN category. At the time of writing, 14 organizations have signed this letter. This includes national organizations representing the other 3 APRN categories in addition to national specialty nursing organizations.



Alarm Fatigue

The number and types of clinical alarms generated by medical devices can be overwhelming for clinicians, patients, and families. "Alarm fatigue" occurs when clinicians become desensitized and nonreactive to the sensory overload created by an overwhelming number of alarms, many of which are nuisance or nonactionable alarms. Delayed response and silenced alarms constitute significant threats to patient safety. Alarm fatigue has been implicated as the lead contributing factor in sentinel events related to alarm safety (Sentinel Event Alert, 2013).


The Task Force has


* Developed and posted a toolkit on the NACNS Web site that has also been recognized by Agency for Healthcare Research and Quality.


* Provided 2 webinars during 2014.


* Provided a session at the 2015 Annual Meeting.


* Conducted a member forum at the 2015 Annual Meeting.


* Submitted a manuscript to the Journal and is in the process of revising it for resubmission as 2 articles.




Today, it is estimated that at least one-third of patients arrive at the hospital malnourished. It is also estimated that of those who did not arrive malnourished, one-third will become malnourished while in the hospital (Tappenden, 2013). In essence, anywhere from 20% to 50% of hospitalized patients are malnourished (Kirkland, 2012).


Task force work is being underwritten by Abbott, who also hosted a dinner at the 2015 NACNS Annual meeting and featured a speaker.


The Task Force has


* Begun meeting via conference call in January 2015. This group meets every 2 weeks.


* Held a face-to-face meeting and forum at the NACNS Annual Meeting, March 2015. The task force met for a long half day. Lunch was with the Board of Directors and featured a speaker identified by Abbott Nutrition on malnutrition to bring the Board up-to-date on the issue. The forum was a session that allowed interested members to interact and discuss the issue with the Task Force.


* Drafted a working definition of malnutrition and conceptual model to guide work as it progresses. This was the main topic of discussion at the face-to-face meeting. This work will be modified throughout the process as needed.


* Developed an outline for the white paper (final product) based on the model. Currently, the paper has been broken into sections and writing has been assigned.


* Reviewed the literature to support the work of the Task Force. Currently, the literature reviews have been done and incorporated into a table.


* Planned 2 webinars as part of the 2015 NACNS Webinar Series-9/15 and 11/17. An online survey using Survey Monkey has been developed to determine educational deficits related to nutrition knowledge of members and evaluate learning post webinars-institutional review board approval being obtained.


* Begun planning a session for the 2016 Annual Meeting.


* Another product that the Taskforce is working on is an Online Toolkit-this Web-based resource should include a literature table, crosswalk with links to resources, FAQs.


* Other products to be developed include a discharge planning checklist specific to ongoing nutritional needs and articles for publication.



Chronic Care

The Centers for Disease Control and Prevention has identified chronic disease as a major public health problem that caused 7 out of 10 deaths in 2010. Chronic conditions are defined by the Department of Health and Human Services as conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living. They include physical conditions as well as mental and cognitive disorders, such as ongoing depression, substance addiction, and dementia. It was reported in a December 2014 White House Conference on Aging webinar that the most common chronic condition experienced by adults is multimorbidity, the coexistence of multiple (>=2) chronic diseases or conditions that affect a person at the same time. For example, both a person with arthritis and hypertension and a person with heart disease and depression have multiple chronic conditions. The Department of Health and Human Services states that multiple chronic conditions pose a significant and increasing burden on the health of America.


The goal of the Task Force is to consider activities and resources that the CNS needs to provide leadership in the care of chronic care patients from wellness to acute care and across the lifespan.


The Task Force has


* Been meeting by teleconference every 2 weeks since December 2014.


* Held a forum at the 2015 Annual Meeting to solicit member input.


* Identified and reviewed key references from the literature.


* Implemented an action plan to develop a white paper that defines, supports, and validates the role of the CNS in the care and management of the chronic care patient. Four subgroups of the task force (TF) membership and review panelists have been formed that will address implications for patients (clinical), CNS practice, policy, and models of care. Each workgroup will develop a 3-to-5-page summary with referenced bullet points, remedy any gaps in the literature, and identify lingering questions/issues. The work of the Transitions of Care TF will be used (the chair of that TF is working with this TF).


* Begun planning for a webinar during 2016 and for a forum at the 2016 Annual Meeting.




The Virginia Association of Clinical Nurse Specialists

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


President, Virginia Association of Clinical Nurse Specialists


The Virginia Association of Clinical Nurse Specialists (VACNS) is led by a core group of individuals dedicated to promoting the role of CNSs as well as providing a forum for discussion of challenges affecting the role and practice of CNSs. Our leadership team includes Linda Thurby-Hay, DNP, RN, ACNS-BC, BC-ADM, CDE (president), Phyllis Whitehead, PhD, RN-BC, APRN, ACHPN (treasurer), and Kimberly Nelson, DNP, RN-BC, ACNS-BC, CCPC, CCRP, RDCS (secretary), along with committee chairs for program planning (Linda Jenkins, MSN, RN-BC, ACNS-BC), legislation/regulation (Beth Hundt, MSN, RN, ACNS-BC, NP-C), and public relations (Cindy Ward, DNP, RN-BC, ACNS-BC, CMSRN).


Consistent with our purpose of providing educational and networking opportunities, the VACNS offered 2 conferences this year. Our spring conference featured keynote speaker Ann Hamric, PhD, RN, FAAN, presenting "The CNS as an Ethical Leader: Moral Distress and Ethical Practice Environments," and a presentation by National Council of State Boards of Nursing spokesperson, Maureen Cahill, MSN, RN, "Moving Consensus for the CNS Role." In addition, CNS members contributed their expertise with talks on pain management (Dr Whitehead) and military sexual violence (Beverly Ross, MS, RN, PMHCNS-BC). Our pharmacology conference was offered in the fall to all Virginia advanced practice nurses in conjunction with CNS Recognition Week, with presentations by Dr Nelson, Dr Thurby-Hay, and our pharmacist and physician colleagues. As a result, our membership has tripled.


In promoting the visibility of CNSs, our leadership team led efforts to inform the public and our healthcare colleagues about the impact of CNSs. Governor Terry McAuliffe proclaimed September 1 to 7 CNS Recognition Week in Virginia, acknowledging the contributions of CNSs in improving clinical outcomes and bringing high-quality nursing care to patients and families, as did the communities of Fredericksburg, Lynchburg, Richmond City, Roanoke, and Williamsburg. In addition, healthcare organizations across the state, including Carilion, Centra, University of Virginia, and the Veterans Administration, demonstrated their appreciation of CNS practice through special gatherings. This was shared with the public through our Web site and Facebook page piloted by Dr Ward and Amy Lucas, MSN, RN, CCNS, CCRN.


The VACNS is fulfilling its call to collaborate with others as we address barriers to full scope of practice with our APRN colleagues. Dr Whitehead is coleading the Virginia Action Coalition's Access to Care group, which created a video showcasing the 4 APRN roles a few years ago, and is now developing presentations that will educate the public about major health issues affecting Virginians and the role of APRNs in influencing those health outcomes. Dr Thurby-Hay is leading the first effort focused on diabetes care and patient self-management.


Finally, our leadership team remains actively engaged in pursing change in legislative/regulatory language to align with the "Consensus Model for APRN Regulation." With the guidance of our lobbyist Becky Bowers-Lanier, former nursing dean at Norfolk State University, we intend to pursue legislation (1) differentiating the role and practice of the CNS from the professional nurse and (2) establishing the CNS as an APRN during the 2016 General Assembly. We have partnered with our APRN colleagues to educate legislators about barriers to APRN practice this fall through legislative receptions planned throughout Virginia.


*This activity has been approved for contract hours by the PA State Nurses Association. The PA State Nurses Association is accredited as an approver of continuing education by the American Nurses Credentialing Center's Commission on Accreditation. [Context Link]