ANA Recommendation: Include APRNs

The American Nurses Association (ANA) has recommended to a federal agency that health insurers seeking to offer plans on state health insurance exchanges must include a certain number of advanced practice registered nurses (APRNs) in each plan’s network of health care providers for the plans to qualify.

“Findings from several decades of research consistently demonstrate that APRNs provide safe, quality care with comparable patient outcomes to physicians and even higher patient satisfaction rates,” said ANA President Karen A. Daley, PhD, RN, FAAN. ”As many more millions of uninsured or underinsured seek primary care services through these exchanges, they will need access to qualified primary care providers. That will not happen if private insurers continue to exclude or restrict APRNs from their provider networks.”

In comments submitted to the Centers for Medicare & Medicaid Services (CMS) on a proposed rule governing the exchanges, ANA proposed that each health insurance plan in a particular state include at least a minimum number of APRNs in its provider network to qualify for the exchange. That minimum would be set equal to 10 percent of the number of APRNs who independently bill Medicare Part B in that state. About 100,000 APRNs nationwide are qualified and enrolled as independent Medicare providers and bill Medicare for services provided to Medicare patients under their own National Provider Identifier. More than 250,000 APRNs – nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists – are licensed nationally.

“This standard is easy to monitor and enforce, and easy to understand and meet for health insurance plans that are serious about addressing the real burden of patient access to primary care,” Daley said. “Recruiting and credentialing APRNs in these plans has to be a top priority.”

For Connecticut, which ranks as the median of the 50 states in APRN participation in Medicare Part B, ANA’s recommendation would require exchange plans to include 178 APRNs in their networks. Under ANA’s proposal, the required minimums per plan would range from a low of 16 APRNs in Hawaii to a high of 654 in Florida, according to CMS data from 2011.

Many private insurers traditionally have focused on forming networks of physicians and have not placed the same priority on credentialing other health care professions, including APRNs. This lack of inclusion in provider networks, combined with other barriers to practice such as restrictions in some state regulations, prevent many APRNs from offering the full range of services for which they are educated and licensed to provide. Consequently, APRNs are restricted from contributing to their fullest capabilities to alleviating the nation’s shortage of primary care providers, especially for certain patient populations such as the elderly, lower-income groups, and rural residents.

The exchanges, a key provision of the Affordable Care Act, will be online marketplaces where individuals and small businesses can compare and buy among a range of health insurance plans that cover at least a minimum baseline of essential services, but vary in cost and other factors. The exchanges are designed to enhance competition, improve choice of affordable health insurance to individuals, and give small businesses the same purchasing clout as large businesses. Exchanges are scheduled to start open enrollments October 1, for insurance that becomes effective January 1, 2014.

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ANA is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

ANA System Upgrade

ANA will be upgrading its Personify Association Member Management system this weekend. This upgrade is part of ANA’s continuing journey to the Cloud and improvement of its IT infrastructure. The upgrade will take place from 5:00 PM Friday, July 12 thru Sunday, July 14. ANA’s Software vendor  and ANA IT staff will be working together to load the new Cloud based systems with all of the most up to date member data over the weekend and testing to ensure all is well before Monday morning.

Over the weekend, members/customers will NOT be able to do the following:

  • Join online
  • Update member/customer information.
  • Pay dues or renew their membership online.
  • Make donations of any type on the site.
  • Purchase books or complete any financial or ecommerce transactions.


Over the weekend members/customers will be able to:

  • Log into the website and access their “My ANA” pages. 



ANA and Manual Patient Handling

The American Nurses Association (ANA) applauds the introduction of federal legislation to protect registered nurses (RNs) and other health care workers from costly, potentially career-ending injuries and musculoskeletal disorders (MSDs) caused by manual patient handling, such as lifting, transferring, and re-positioning.

The Nurse and Health Care Worker Protection Act of 2013 (H.R. 2480) would improve patient safety and quality of care. Crafted with input from ANA, the bill is sponsored by Congressman John Conyers (D-MI), a long-time champion of safe patient handling and mobility (SPHM) issues. The legislation, revamped from earlier bills, incorporates key content of the newly published Safe Patient Handling and Mobility: Interprofessional National Standards, a publication for creating, implementing, and managing a SPHM program developed by ANA and a multi-disciplinary team of national subject matter experts.

“Now, even though there have been great advances in safe patient handling and mobility technology, its use and availability continue to be spotty, and policies have been inconsistent, as well,” said ANA President Karen A. Daley, PhD, RN, FAAN. “Federal legislation will increase protections for patients and ensure safe working conditions and overall health and wellness for nurses. Health care worker and patient safety go hand-in-hand.”

Data from the Bureau of Labor Statistics in 2011 showed that registered nurses ranked fifth among all occupations for the number of MSD-related injuries and illnesses resulting in days away from work. Safe patient handling and mobility programs have been shown to benefit both health care workers and patients.

Research from the National Institute for Occupational Safety and Health (NIOSH) in 2006 reported that the implementation of a SPHMprogram is associated with improved quality of care, resident safety, comfort, and satisfaction. Regarding cost, a study by the Centers for Disease Control and Prevention (CDC) found that the investment in equipment and training was recouped in less than three years in lower worker compensation claims.

Among its provisions, the bill would require the Occupational Safety and Health Administration to develop and implement a safe patient handling and mobility standard that will eliminate manual lifting of patients by direct-care RNs and health care workers, and require health care employers to:

• Develop a safe patient handling and mobility plan, and to obtain input from direct-care RNs and health care workers during the process of developing and implementing such a plan;

• Purchase, use and maintain equipment and to train health care workers;

• Track and evaluate injuries related to the application of the safe patient handling and mobility standard; and

• Make information available to employees and their representatives.

For more information on ANA’s safe patient handling and mobility initiative, visit


ANA is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

PSNA Call for Abstracts

The Pennsylvania State Nurses Association (PSNA) and the PSNA Environmental Health Committee have issued a Call for Abstracts for the 2013 Annual Fall Summit to be held October 18, 2013, at The Desmond Hotel & Conference Center, Malvern. Interested poster participants are encouraged to submit an abstract following the prescribed guidelines. No more than two (2) posters may be submitted by the same individual.

Embracing an ecocentric viewpoint has exhilarating potential for transforming nursing beyond its traditional boundaries. We live in a global culture united by economic interdependence, international air travel and worldwide communication networks. Contemporary environmental degradation and disasters have moved into the global arena. Realizing an ecocentric paradigm in nursing will encourage nurses to address worldwide environmental problems that affect the health of everything that exists. As a complement to this year’s theme, “Sustaining Healthy Future: Ecocentric Nursing in a Local and Global Environment,” PSNA is accepting poster abstract submissions utilizing research and evidence to support changes in the health care delivery system to our patients, including programs developed to promote sustainability and promote health in our local and global environments.

It is imperative to identify methods to sustain the world we live in and to identify methods that will promote healthy environments in our work and home environments that transcend traditional boundaries to explore new solutions for our environment. PSNA desires to recognize those who have contributed to quality patient care using best practice methods based on evidence-based practice and research that has led to effective care changes resulting in improved patient care and improved home and work environments in Pennsylvania and beyond. The poster abstract must describe work that has been completed or is near completion and processes that have been fully implemented with demonstration of their effects.

Click here to access submission criteria. Submission deadline is August 16, 2013.

Abstracts can be e-mailed to Patti Gates Smith at Abstracts are selected by members of the Cabinet on Nursing Practice and Professional Development. Notice of abstract review results will be mailed no later than September 9, 2013. For more information, contact PSNA Director of Professional Development, Patti Gates Smith, MSN, RNC-E, at 717-798-9975.

ANA Holds Inaugural Event

The American Nurses Association (ANA) held its inaugural Membership Assembly Friday, June 28 through Saturday, June 29 in Crystal City, Va. The Assembly brought together representatives from ANA’s constituent and state nurses associations, Individual Membership Division, ANA Board of Directors and ANA’s specialty nursing organizational affiliates to develop a framework for shaping the future of the Association and the nursing profession.

The Membership Assembly, ANA’s new governing and policy-making body, replaced the previous governing body, the House of Delegates, which ANA members voted to dissolve in 2012.

Using the theme, “A Look into the Future: Advancing the Association; Advancing the Profession,” representatives explored pressing nursing and health care issues as part of an environmental scan to better position ANA to anticipate trends that may impact the nursing profession. The environmental scan also laid the foundation for policies and positions to ensure a stronger nursing presence in the emerging health care delivery system.

Assembly representatives discussed the important and sometimes competing interests regarding access to care, care coordination, patient outcomes, and licensure issues. In terms of specific actions, they referred a licensure jurisdiction proposal back to the ANA Board of Directors. The board will further review licensure implications for nurses who provide technology-enabled care, including follow-up phone calls after patient discharge, across state lines.

Representatives also voted on bylaws, or governing amendments, which included approving a timeline for smoothly transitioning to a smaller board of directors. Additionally, representatives adopted a structure that acknowledges registered nurses who are full members of a constituent/state nurses association as holding concurrent membership in ANA.

Assembly attendees also welcomed two new state nurses associations from Illinois and New York and celebrated the Alabama State Nurses Association’s centennial.

In advance of the Membership Assembly, on Thursday, June 27, hundreds of nurses met with federal legislators on Capitol Hill in Washington, D.C. as part of ANA’s annual Lobby Day to advocate for critical nursing issues, including safe staffing and eliminating scope of practice barriers.

The Membership Assembly will continue to meet annually. In 2014, the Assembly will elect a new slate of officers. For more information, please visit

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ANA is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public. Please visit for more information.


Alert: Heparin Vial Labeling

In November 2012, the National Alert Network (NAN) reported that the U.S. Pharmacopeial Convention (USP) updated labeling standards for Heparin Sodium Injection, USP and Heparin Lock Flush Solution, USP (including heparin prefilled flush solutions). The labeling changed from dose of drug per ml, to the identification of the total amount of drug per vial. These revised standards were official May, 1, 2013.

Significance: Misreading of the label has led to dangerous and deadly heparin overdoses.

Implications for Practice: Pharmacists, staff nurses, physicians, nurse educators, and risk managers need to have a heightened awareness of the heparin label changes.

Recommended Best Practices to Minimize Patient Risk:

  • Computer databases should express drug amounts to be consistent with vial labeling.
  • Separate heparin vials and use older vials with older labels first before dispensing the vials with updated labeling.
  • Completely transition to newly labeled heparin and discard older vials.
  • Place high-alert drug warnings on automated medication dispensers.
  • Restrict multi-dose heparin vials.
  • Keep unit stock vials as small as possible to limit the potential of heparin overdoses.
  • If a heparin bolus is required, consider heparin bolus doses dispensed from a pharmacy.

For more information:

PSNA Award Nominations Open

PSNA is accepting nominations for its 2013 PSNA Awards including: John Heinz Friend of Nursing Award, Lifetime Achievement Award, Distinguished Nurse Award, and Emerging Nurse Leader Award. Join us as we take time to celebrate the work and lifetime achievements of a special handful of individuals. Nominations are accepted through August 1, 2013.

Since 1991, the PSNA John Heinz Friend of Nursing Award has been given to an individual who has demonstrated leadership that has significantly impacted nursing practice, nursing education, nursing administration and/or nursing research within the Commonwealth. This award is open to PSNA members and non-members; nominees do not have to be a registered nurse.

The PSNA Lifetime Achievement Award recognizes a member of the Pennsylvania State Nurses Association who has demonstrated a lifetime of exemplary service and dedication to the profession of nursing and/or PSNA. The nominee’s distinguished career has yielded outstanding and noteworthy contributions and accomplishments that are significant to the nursing profession and/or health care arena throughout the Commonwealth, the nation or the global community. The nominee must hold current Pennsylvania State Nurses Association membership.

The PSNA Distinguished Nurse of the Year Award recognizes a member of the Pennsylvania State Nurses Association who has demonstrated leadership characteristics and rendered distinguished service to the nursing profession, and whose contributions and accomplishments are of significance to the nursing profession throughout the Commonwealth, the nation or the global community. Other considerations include community involvement, participation in professional nursing organizations, recognition by peers and demonstration of interdisciplinary collaboration. The nominee must hold current Pennsylvania State Nurses Association membership.

The PSNA Emerging Nurse Leader Award recognizes an RN who has completed the Star Leadership Institute program and is an exceptional professional of merit and accomplishment in their professional practice. This Nurse has demonstrated innovative thinking, a commitment to the advancement of nursing and transformational leadership. This nurse demonstrates exceptional leadership characteristics that may include, but are not limited to, leading others by example, mentoring, transferring knowledge to others, taking risk to achieve desired outcome, delegating tasks in a clear and logical manner, motivating others to strive beyond what they believe can be achieved and demonstrating quality improvement methods.

Winners will be notified by September 1, 2013 and honored at the PSNA 110-Year Anniversary Gala on Thursday, October 17, 2013 at The Desmond Hotel, Malvern. For a full list of criteria, previous award recipients or to nominate a nurse for these prestigious awards, complete the online form at  


CDC Health Update

The Centers for Disease Control and Prevention (CDC) is working closely with the World Health Organization (WHO) and other partners to better understand the public health risk posed by Middle East Respiratory Syndrome Coronavirus (MERS-CoV), a novel coronavirus that was first reported to cause human infection in September 2012. No cases have been reported in the United States. The purpose of this HAN Advisory is to provide updated guidance to state health departments and health care providers in the evaluation of patients for MERS-CoV infection including expansion of availability of laboratory testing and, in consultation with WHO, expansion of the travel history criteria for patients under investigation from within 10 to 14 days for investigation and modification of the case definition. Please disseminate this information to infectious diseases specialists, intensive care physicians, internists, infection preventionists, as well as to emergency departments and microbiology laboratories.

Background: MERS-CoV, formerly called “novel coronavirus,” is a beta coronavirus that was first described in September 2012, when it was reported to have caused fatal acute lower respiratory illness in a man in Saudi Arabia. Genetic sequence analyses have shown that this new virus is different from other known human coronaviruses, including the one that caused severe acute respiratory syndrome (SARS). Diagnosis relies on testing with real time reverse transcription polymerase chain reaction (RT-PCR) assays. There is no specific treatment for MERS-CoV infection; care is supportive.

As of June 7, 2013, 55 laboratory-confirmed cases of MERS-CoV infection have been reported to WHO—two from France, three from Italy, two from Jordan, two from Qatar, 40 from Saudi Arabia, two from Tunisia, one from the United Arab Emirates, and three from the United Kingdom (UK). Additional details can be found in the June 7, 2013 MMWR Early Release ( To date, all cases have a direct or indirect link to one of four countries: Saudi Arabia, Qatar, Jordan, and the United Arab Emirates. No cases have been reported in the United States. Illness onsets were from April 2012 through May 2013. Of the 55 cases, 31 were fatal, for a case-fatality rate of 56%. The median age of cases is 56 years. All of the patients were aged >24 years, except for two children, one aged 2 years and one aged 14 years.

Eight clusters of illnesses have been reported by six countries (France, Italy, Jordan, Saudi Arabia, Tunisia, and UK). These clusters provide clear evidence of human-to-human transmission of MERS-CoV. The largest cluster reported to date consists of 25 cases, 14 of which were fatal, associated with a health-care facility in Al-Ahsa governorate in Saudi Arabia. Two of the case-patients in that cluster were health-care personnel who acquired the infection after exposure to patients with confirmed MERS-CoV infection.

The first case reported by France was in a person with an underlying immunosuppressive condition who initially had abdominal pain and diarrhea and subsequently developed respiratory complications. This case raises the possibility that presentations may not initially include respiratory symptoms. Among  cases reported to WHO in which more detailed information is available, most are reported to have chronic underlying medical conditions or immunosuppression; such persons may be at increased risk of MERS-CoV infection or severe disease, or both. In some instances, sampling with nasopharyngeal swabs did not detect MERS-CoV by PCR; however, MERS-CoV was detected by PCR in lower respiratory tract specimens from those same patients. Therefore, lower tract respiratory specimens should be a priority for collection and PCR testing, in addition to nasopharyngeal swabs.

Recommendations: Recommendations and guidance on MERS-CoV case definitions, case investigation, specimen collection and shipment for testing, and infection control (including use of personal protective equipment) are available at the CDC MERS website ( Information and guidance posted on this website may change as we learn more about the virus. Please check CDC’s MERS website regularly for the most current information. State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100 or


As a result of investigations suggesting incubation periods for MERS CoV may be longer than 10 days, the time period for considering MERS in persons who develop severe acute lower respiratory illness days after traveling from the Arabian Peninsula or neighboring countries* has been extended from within 10 days to within 14 days of travel.

In particular, persons who meet the following criteria for “patient under investigation” (PUI) should be reported to state and local health departments and evaluated for MERS-CoV infection: 

  • A person with an acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough; AND 
  • Suspicion of pulmonary parenchymal disease (e.g., pneumonia or acute respiratory distress syndrome based on clinical or radiological evidence of consolidation); AND 
  • History of travel from the Arabian Peninsula or neighboring countries* within 14 days; AND 
  • Symptoms not already explained by any other infection or etiology, including clinically indicated tests for community-acquired pneumonia according to local management guidelines. 

In addition, the following persons may be considered for evaluation for MERS-CoV infection: 

  • Persons who develop severe acute lower respiratory illness of known etiology within 14 days after traveling from the Arabian Peninsula or neighboring countries* but who do not respond to appropriate therapy; OR
  • Persons who develop severe acute lower respiratory illness who are close contacts of a symptomatic traveler who developed fever and acute respiratory illness within 14 days of traveling from the Arabian Peninsula or neighboring countries.* 

In addition, CDC recommends that clusters of severe acute respiratory illness (SARI) should be investigated and, if no obvious etiology is identified, local public health officials should be notified and testing for MERS-CoV conducted if indicated.

CDC requests that state and local health departments report PUIs for MERS-CoV and clusters of SARI with no identified etiology to CDC. To collect data on PUIs, please use CDC’s Interim Health Departments MERS-CoV Investigation  Form available at State health departments should FAX completed investigation forms to CDC at 770-488-7107 or attach in an email to (subject line: MERS-CoV Patient Form).

Laboratory Testing

Testing of specimens for MERS-CoV is currently being conducted at CDC. The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) on June 5, 2013, to authorize the use of the CDC Novel Coronavirus 2012 Real-time RT-PCR Assay (NCV-2-12 rRT-PCR Assay) to test for MERS-CoV in clinical respiratory, blood and stool samples. This EUA is needed because, at this time, no FDA-approved tests that identify MERS-CoV in clinical specimens are available. This assay will be deployed to Laboratory Response Network (LRN) laboratories in all 50 states over the coming weeks. Updated information about laboratories with the capacity to conduct MERS testing with the NCV-2-12 rRT-PCR Assay will be provided on CDC’s MERS website (

To increase the likelihood of detecting MERS-CoV, CDC recommends collection of specimens from different sites– for example, a nasopharyngeal swab and a lower respiratory tract specimen such as sputum, bronchoalveolar lavage, bronchial wash, or tracheal aspirate. Specimens should be collected at different times after symptom onset, if possible. Lower respiratory tract specimens should be a priority for collection and PCR testing; stool specimens are of lower priority. Specimens should be collected with appropriate infection control precautions

Case Definitions

The MERS-CoV case definition continues to evolve and is available at In consultation with WHO, the definition of a probable case of MERS has been updated to also include persons with severe acute respiratory infection with no known etiology with an epidemiologic link to a confirmed MERS-CoV case.

Infection Control

There is clear evidence of limited human-to-human transmission, possibly involving different modes, such as droplet and contact transmission, but further studies are required to better understand the risks. Until the transmission characteristics of MERS-CoV are better understood, patients under investigation and probable and confirmed cases should be managed in healthcare facilities using standard, contact, and airborne precautions. As information becomes available, these recommendations will be re-evaluated and updated as needed.


* Countries considered to be on or neighboring the Arabian Peninsula include Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon, Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

Examples of respiratory pathogens causing community-acquired pneumonia include influenza A and B, respiratory syncytial virus, adenovirus, Streptococcus pneumoniae, and Legionella pneumophila.

Close contact is defined as 1) any person who provided care for the patient, including a health-care worker or family member, or who had other similarly close physical contact, or 2) any person who stayed at the same place (e.g., lived with or visited) as the patient while the patient was ill.

For more information: please consult the CDC MERS website at:

State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100 or


The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

Survey: What Keeps You Engaged at Work

We invite you to share your thoughts to support the research of Penn State University PhD Candidate Catherine Baumgardner. The letter below discusses her research in the area of workforce engagement and what influences nurses. The survey is open through June 18, 2013. In addition, Catherine is offering a drawing to win one of six $50 VISA gift cards as a thank you for completing the survey. We encourage you to participate in her survey and thank you for assisting in her data collection. She will be sharing her findings so that we may use the insights to further strengthen our support of the nursing field. Thank you in advance for all that you do!

The purpose of this survey is to assess your views and attitudes about your career as a Registered Nurse. Information gathered may be used to influence the thinking of organizational leaders, educators, legislators and nurse advocacy groups. All responses remain anonymous. Once you complete the survey, you will have the option to enter a random drawing to win one of six $50 VISA gift cards as a thank you for your time. There is no obligation to answer any of the questions. Please read each item and provide the response that best reflects how you feel. Completion and submission of the survey implies that you consent to take part in the research. The Implied Informed Consent Form for Social Science Research is available by clicking on

Star Leadership Institute: Accepting Applications

Health care needs interactive and collaborative leaders prepared for today’s dynamic environment – from the bedside to the boardroom. The Pennsylvania State Nurses Association (PSNA), representing more than 211,000 registered nurses in Pennsylvania, is accepting applications for the Star Leadership Institute, a leadership development program designed to assist nurses in contributing to the delivery of high-quality health care while collaborating with other leaders in the reform needed to redesign health care in the U.S.  Attendees will participate in interactive sessions focusing on leader attributes, real-world problem solving, employment practices, healthy dialogue, evidence-based practice and finance.

Titled Building the Future Leader of Tomorrow…Today, this three-day program will bring together experts including David Nelson, Master Trainer in Crucial Conversations©; and Lucretia C. Clemons, Esquire. These featured presenters will join five additional experts who will offer knowledge and related skills to enhance each participant’s managerial abilities.

Participants will be collaborating with senior leadership to identify a problem within their immediate area of responsibility; researching and developing an action plan for the resolution of the identified problem; implementing and completing the action plan within the organization; and presenting their problem-solving project to peers. Criteria for participation includes: front line nurse managers, nurse leaders or promising nurses who desire to move into management or leadership roles; demonstration of leadership ability; and commitment to attend the three sessions.

The program will be held October 16 and 17, 2013 and April 9, 2014 at The Desmond Hotel & Conference Center, Malvern. The program is a competitive application process with only 30 nurse leaders being accepted from across the Commonwealth. For more information about the Star Leadership Institute, or to download a program brochure and application, visit  Applications must be July 1, 2013.