2016-2018 Public Policy Agenda
The National Association of Clinical Nurse Specialists is the voice of more than 70,000 clinical nurse specialists. NACNS exists to enhance and promote the unique, high value contribution of the CNS to the health and well‐being of individuals, families, groups, and communities, and to promote and advance the practice of nursing.
CNSs are advanced practice registered nurses with graduate preparation in nursing (master’s or doctorate) as a clinical nurse specialist. They have unique and advanced level competencies that meet the increased needs of improving quality and reducing costs in today’s healthcare system. CNSs provide direct patient care, including assessment, diagnosis, and management of patient healthcare issues which may include prescriptive authority. They are leaders of change in health organizations, developers of scientific evidence‐based programs to prevent avoidable complications, and coaches of those with chronic diseases to prevent hospital readmissions. CNSs are facilitators of interprofessional teams in acute and chronic care facilities to improve the quality and safety of care including, but not limited to, preventing hospital acquired infections, reducing length of stays, and preventing hospital readmissions.
NACNS is committed to work with policymakers, healthcare organizations, other professional groups and industry to promote an agenda addressing the most pressing issues facing quality patient care and the nursing profession. Our goal is to represent the clinical nurse specialist perspective effectively in all aspects of the practice environment through our advocacy efforts.
The Public Policy Agenda reflects the current priorities of the NACNS membership and the issues on which the board of directors initiates action. However, in response to a dynamic legislative and regulatory environment, out of necessity, NACNS also will need to address other emerging healthcare issues. One example of this is the opioid epidemic. NACNS will continue to remain in the forefront during discussion of identified issues.
Keeping the nation’s health demands in mind, in 2016 ─ 2018, the NACNS will focus on the following priorities:
Health Information Technology
- Collaborate with other organizations, including state and federal partners, to ensure that proposed legislative and regulatory changes (1) recognize full scope of practice and prescriptive authority for CNSs in all healthcare settings including those at the Veterans Health Administration; (2) do not limit the access of patients to care or to CNS services; (3) do not have a negative impact on patient safety; and (4) do not impose barriers to CNS practice.
- Advocate for the Department of Labor to recognize the clinical nurse specialist as a “detailed occupation” in the Standard Occupation Classification.
- Promote increased funding for policy initiatives, such as the Title VIII ─ Nursing Workforce Development Programs, that help alleviate the nurse and nurse faculty shortages and increase the retention and recruitment of registered and advanced practice registered nurses.
- Support the efforts of federal agencies, such as the Centers for Medicare and Medicaid Services (CMS), the Departments of Defense and Veterans Affairs and the Indian Health Services, to ensure a high quality and appropriately educated federal nursing workforce that maximizes the clinical nurse specialist role.
According to the Bureau of Labor Statistics (BLS), demand for registered nurse (RN) will grow 16% from 2014 to 2024, outpacing the 7% average for most other occupations.1 Several factors will contribute to this increase, including a large number of newly insured patients resulting from healthcare legislation, the prevalence of chronic disease, an increased emphasis on preventive care, and the large, aging babyboom population. This increased demand is projected to result in 439,300 job openings, representing one of the largest increases for all occupations. In addition, with more than 500,000 seasoned RNs anticipating retirement by 2022, the U.S. Bureau of Labor Statistics projects the need to produce 1.1 million new RNs for expansion and replacement of retirees.2
Quality healthcare delivery in the U.S. is threatened on multiple fronts. Today’s shortage of appropriately prepared nurses still outpaces the level of investment necessary to meet the nation’s growing healthcare demands. CNSs are prepared to provide care to at risk populations with increasingly complex health needs, such as our aging populace, and to support a nursing workforce that will have fewer seasoned nurses taking direct care of those complex patients. The CNS also serves as a resource to the novice through expert nurses in our healthcare workforce.
NACNS believes that the deepening health inequities, inflated costs, and poor quality of healthcare outcomes in this country will not be reversed until the concurrent shortages of RNs, APRNs, and qualified nurse educators are addressed. Without national efforts of some magnitude to match the healthcare reality facing the nation today, it will be difficult to avoid the adverse effects on the health of our nation from the inability of our under resourced nursing education programs to produce sufficient numbers of high quality RNs and APRNs.
Just as America’s growing and aging population needs the high‐quality care that CNSs provide, numerous federal and state policy barriers continue impairing the ability of CNSs to practice to the full extent of their education. Improper and costly barriers to CNS services include unnecessary and burdensome “supervision” requirements, inappropriate discrimination in credentialing and recognition, and unsupported payment differentials that encourage use of higher‐cost providers without improving quality.
1 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016‐17 Edition, Registered Nurses, on the Internet at http://www.bls.gov/ooh/healthcare/registered‐nurses.htm.
2 McMenamin, P. QuikStats – Projected State RN Job Demands by 2022. (2014 July 18). Community. American Nurses Association, on the Internet at http://community.ana.org/blogs/peter‐mcmenamin/2014/07/18/quik.
- Advocate for reimbursement for clinical nurse specialist services across all healthcare delivery settings, including home health services.
- Support efforts to validate advanced practice nursing contributions in value‐based purchasing, accountable care organizations, and medical (primary care) homes, among other models of care.
- Monitor state and federal healthcare reforms to ensure that the clinical nurse specialist is a full partner in healthcare delivery.
- Collaborate with other nursing organizations to support the CMS‐directed Graduate Nurse Education Demonstration Project that provides reimbursement for the reasonable cost of providing clinical education to APRN students.
The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, recommends that APRNs should be able to practice to the full extent of their education. Advocating for reimbursement by expanding and amending coverage to include CNS services will remove barriers that restrict practice and will meet the public need of access to qualified healthcare providers.
With the increasing demand for high quality cost‐effective healthcare combined with newly designed care delivery models, it is imperative that CNSs, who are well educated to lead and diffuse quality improvement outcomes and cost savings across all models of care, be an integral member of the interprofessional team as a leader of change.
Consistent with the recommendations of the IOM report, nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States. Research and demonstration projects have shown that the CNS role is uniquely suited to lead implementation of evidence‐ based quality improvement actions that also reduce cost throughout the health care system. This leadership has been demonstrated in the following areas, but not limited to, providing pre‐natal care, preventive and wellness care, behavioral health care, care to those with chronic conditions and facilitating transitions in care.
The Graduate Nurse Education Demonstration Project is an innovative strategy designed to increase the number of APRN students across the country by providing for the cost of clinical training through reimbursement to eligible hospitals from CMS. Providing support for this initiative will increase the APRN workforce and help achieve the goal of meeting the demand for primary healthcare services. Advocating for the inclusion of CNS students as one of the four APRN roles being trained at future participating clinical sites is critical.
Health Information Technology
- Effectively represent the role of the clinical nurse specialist in the legislative and policy arenas of health information technology (HIT).
- Advocate for increased access to healthcare through the use of technology.
As digital innovation explodes, so does our ability to provide access to quality healthcare regardless of traditional time and distance constraints. According to the Office of the National Coordinator on Health Information Technology, the advent of digital systems for health records has a number of benefits: (1) improved patient care; (2) improved care coordination; (3) practice efficiencies and cost savings; (4) increased patient participation; and (5) improved patient diagnostics and outcomes.
At the federal and state level, HIT policy is focused on promoting person‐centered care, value, innovation, research utilization, and healthcare accessibility through the proper storage, dissemination, protection, transfer, and analysis of health information. While much of the discussion to date has been on organizational reimbursement and on improving an individual’s access to their protected health information, nursing’s contribution to meaningful use of HIT remains challenging due to factors such as cumbersome documentation systems and lack of knowledge regarding current technology. This situation is detrimental to the health of the nation and the advancement of nursing practice in terms of knowledge generation, practice evaluation, and the standardization of evidence‐based care.
As advanced practice registered nurses, clinical nurse specialists are qualified to optimize patient outcomes, implement evidence‐based practice, close the access to care gap and enhance quality of care through cost‐effective and creative means. The CNS role has been strengthened by the availability of HIT, allowing enhanced analytic capabilities, mobile and cloud‐based service integration, and access to myriad databases to strengthen impacts on outcomes. HIT also brings the opportunity for patients across continuums and populations to receive care from clinical nurse specialists ultimately increasing the impact of CNSs on the nation’s healthcare system.