As 2014, it is hard for me not to reflect on the many new and exciting experiences and work the National Association of Clinical Nurse Specialists ( NACN S) has seen over 2014. It has been a year of completion and a year of new beginnings for us!
This has been a challenging, exciting, fast-paced time for me as President, and I must admit it has been difficult to keep up the pace. As clinical nurse specialists (CNSs), we are constantly on the move looking for change and solutions to problems and filling voids and gaps in the healthcare arena.
Just recently, NACNS was asked to be one of a handful of nursing organizations that attended a briefing held at the White House by President Obama. The briefing was in recognition of the work that nurses and other emergency care and healthcare providers have done in the preparation and delivery of care for patients with Ebola. Our executive director, Melinda Ray, represented us at this important meeting. As President Obama was recognizing the work of all of us, I know many of you were "knee deep" in teaching the appropriate use of PPE! It was not many years ago that the Board was discussing how we could be recognized and be part of events such as this. I am honored and proud that we were on the invitation list during my tenure!
Another key innovation we have seen blossom in 2014 is the engagement of more volunteers in the work of NACNS. During my induction speech, I paraphrased John F. Kennedy's "ask not" request with "ask not what NACNS can do for you but what can you do for NACNS," and you have responded in masses. We have an established system of committees and elected positions that traditionally have been the mechanism for volunteers to get involved in the work of NACNS. But, many of these volunteer positions require a multiyear commitment, and some of us hesitate to volunteer when we face a longer commitment. A couple years ago, NACNS implemented a task force model as a way both to increase the number of NACNS members who can be engaged in our work and also to address specific issues in a targeted manner and therefore decrease the volunteer time needed to complete the work. We currently have 2 new task forces starting-Chronic Care and the Role of the CNS Task Force and Malnutrition and the Hospitalized Patient Task Force. These task forces have begun their work and will continue to delve into their topic throughout 2015.
Selecting members of the task forces is incredibly difficult as so many of those who volunteer are doing amazing work. With the appointment of the 2 latest task forces, we are trying something new. In addition to those who were selected to be on the task force, we selected the rest of the qualified applicants to be part of a review panel. The review panel will be a sounding board for the task force and provide added review to materials and concepts that the task force is developing. It is important to NACNS that we engage as many of you as possible! Remember that you are our experts!
The results of the task force work have been amazing and assisted to push forward the work and impact of NACNS, on our role as well as our clinical practice. If you have not had a chance to check out the online toolkit developed by the Alarm Fatigue Task Force, you really should! You will also see the mark of the task forces on sessions at the annual meeting, articles in the journal, and topics for the webinars that NACNS hosts.
As we press forward to 2015, I encourage all of you to consider how you can make your mark on NACNS and on the future of the CNS role. With all of the changes in healthcare, we must not be shy. We need to step up on the local, state, and federal level and be ready to articulate how the CNS can contribute to quality healthcare delivery. Joining the organization and participation in the work of NACNS has contributed to me as an individual both professionally and personally, and I am such a better individual for it. I look forward to new faces and ideas from those faces in our organization as we move ahead as "tomorrow belongs to us."
NACNS MOURNS THE PASSING OF OUR FIRST PRESIDENT
It is with great sadness that we note the passing of Patricia I. Bielecki, the founding President of the National Association of Clinical Nurse Specialists (NACNS). She was among a group of clinical nurse specialists (CNSs) in Indiana who came together to found the organization, to provide a unified voice for CNSs. She was dedicated to her profession and tirelessly kept up with the latest research, often staying up late to read peer-reviewed journals. Her contributions to advancing the role of the CNS have paved the way for the work of NACNS. In addition to her leadership role with NACNS, Bielecki was a CNS for Advocate Health Care in Park Ridge, Illinois, for many years.
Bielecki passed away peacefully at home on September 26. If you would like to make a donation in her honor, the family asks all donations be made in Ms Bielecki's name to the March of Dimes.
CENTRAL INDIANA ORGANIZATION OF CLINICAL NURSE SPECIALISTS, INC-RECOGNITIONS TO CELEBRATE
MEMBER NEWS
Congratulations to alumna Kristen Clark Swartzell, MSN, RN, ACNS-BC! Her master's thesis publication received the 2014 MEDSURG Nursing Research for Practice Writer's Award. Her publication, "Relationship Between Occurrence of Falls and Fall-Risk Scores in an Acute Care Setting Using the Hendrich II Fall Model" appears in MEDSURG Nursing: The Journal of Adult Health (22(3):180-187).
Deanna Reising, PhD, RN, ACNS-BC, ANEF, has been selected as a Macy Faculty Scholar. Deanna's Macy Faculty Scholars Program project proposed to engage interprofessional nursing and medicine student teams to serve as navigators for patients at risk for hospital readmission. The project aims to use interprofessional student navigator teams to safe transition of patients between healthcare environments and to simultaneously develop interprofessional relationships with experienced healthcare professionals. The project will advance scalable models of interprofessional education and practice that enhance patient quality and safety during transitions of care.
Congratulations to Rainey Martin, MSN student, and Mitchell Knisely and Susan Story, PhD students, on receiving a Clinical Nurse Specialist Foundation scholarship.
Janet S. Fulton PhD, RN, ACNS-BC, ANEF, FAAN, was inducted into NLN's Academy of Nurse Educators at the annual NLN Summit, September 19, 2014, in Phoenix, Arizona. The academy recognizes nurse educators for outstanding leadership contributions to nursing education.
CELEBRATE THE NACNS 20th ANNIVERSARY IN 2015
Yes, it has been 20 years! And the NACNS Board of Directors is planning on recognizing and celebrating our history and success throughout the 2015, but specifically at the NACNS 2015 Annual Conference. The theme for this meeting is: "The Clinical Nurse Specialists: The Essence of Transitional Health Care." This meeting will be held at Loews Coronado Bay Resort in San Diego, California. This meeting hotel will allow for an excellent educational experience as well as relaxation and exploration of beautiful Southern California. The hotel offers 3 pools, a sand beach, and a spa. So plan now for a 20th anniversary celebration that will allow you to take care of your mind and body! Loews Coronado Bay Resort caters to relaxation and will allow all of us to learn, network, and relax. Coronado Island is a 10-minute cab ride from downtown San Diego. This will give everyone the best of both worlds-shopping and restaurants in San Diego and pampering and beautiful views on Coronado Island. Do consider extending your trip by a day to appreciate the beauty of this area.
Please visit our Web site at http://www.nacns.org to get specific information.
NEW IMPROVED CDC EBOLA GUIDANCE
CDC Announces Tightened Guidelines for Healthcare Workers Caring for Patients With Ebola
The Centers for Disease Control and Prevention (CDC) announced on October 20, 2014, that they are recommending tightened infection control guidance for healthcare workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) healthcare workers should use and offers detailed step-by-step instructions for how to put the equipment on and take it off safely.
These changes based on the experience received from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center, and National Institutes of Health Clinical Center are reflected in the guidance.
All patients treated at Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center have followed the 3 principles. None of the workers at these facilities have contracted the illness.
Principle 1: Rigorous and Repeated Training
CDC has noted that focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Clinical nurse specialists have an important role in this work. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step-by-step putting on and taking off of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations.
Principle 2: No Skin Exposure When PPE Is Worn
Given the intensive and invasive care that US hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn.
CDC is recommending all of the same PPE included in the August 1, 2014, guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single-use, disposable full-face shield. In addition, goggles are not disposable and may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for US healthcare workers caring for patients with Ebola includes the following:
* double gloves
* boot covers that are waterproof and go to at least midcalf or leg covers
* single-use fluid-resistant or impermeable gown that extends to at least midcalf or coverall without integrated hood
* respirators, including either N95 respirators or powered air-purifying respirator
* single-use, full-face shield that is disposable
* surgical hoods to ensure complete coverage of the head and neck
* apron that is waterproof and covers the torso to the level of the midcalf (and that covers the top of the boots or boot covers) should be used if Ebola patients have vomiting or diarrhea
The guidance describes different options for combining PPE to allow a facility to select PPE for their protocols based on availability and healthcare personnel familiarity, comfort, and preference while continuing to provide a standardized, high level of protection for healthcare personnel.
The guidance includes having the following:
* 2 specific, recommended PPE options
* designated areas for putting on and taking off PPE.
* trained observer to monitor PPE
* step-by-step PPE removal instructions
* disinfection of gloved hands
Principle 3: Trained Monitor
CDC is recommending a trained monitor actively observe and supervise each worker putting PPE on and taking it off. This is to ensure each worker follows the step-by-step processes, especially to disinfect visibly contaminated PPE. The trained monitor can spot any missteps in real time and immediately address.
PPE Is Only 1 Aspect of Infection Control
It is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings, including the following:
* prompt screening and triage of potential patients
* designated site managers to ensure proper implementation of precautions
* limiting personnel in the isolation room
* effective environmental cleaning
Think Ebola and Care Carefully
The CDC reminds healthcare workers to "think Ebola" and to "care carefully." Healthcare workers should take a detailed travel and exposure history with patients who exhibit fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, and unexplained hemorrhage. If the patient is under investigation for Ebola, healthcare workers should activate the hospital preparedness plan for Ebola, isolate the patient in a separate room with a private bathroom, and to ensure standardized protocols are in place for PPE use and disposal. Healthcare workers should not have physical contact with the patient without putting on appropriate PPE.
CDC's Guidance for US Healthcare Settings Is Similar to MSF's (Doctors Without Borders) Guidance
Both CDC's and MSF's guidance documents focus on the following:
* protecting skin and mucous membranes
* meticulous, systematic strategy for putting on and taking off PPE
* use of oversight and observers
* disinfection of PPE prior to taking off
Five Pillars of Safety
CDC reminds all employers and healthcare workers that PPE is only 1 aspect of infection control and providing safe care to patients with Ebola. Other aspects include 5 pillars of safety:
* facility leadership has responsibility
* designated on-site Ebola site manager
* clear, standardized procedures
* trained healthcare personnel
* oversight of practices
For specific documents that contain this guidance:
October 20, 2014: Guidance on Personal Protective Equipment to Be Used by Healthcare Workers During Management of Patients With Ebola Virus Disease in US Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) (http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html)
October 20, 2014: CDC Fact Sheet: Tightened Guidance for US Healthcare Workers on Personal Protective Equipment for Ebola
October 20, 2014: Updated Case Counts (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html)
October 19, 2014: Caring for Suspect or Confirmed Patients With Ebola