< Previous28 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com C YSTIC FIBROSIS (CF) is the most common progressive, life-shortening, genetic disease among whites. It affects more than 30,000 people in the United States and about 70,000 worldwide. Since 2010, newborn screening for CF has been required in the United States; more than 75% of children with CF are diag- nosed by age 2. In the 1950s, children with CF weren’t expected to live beyond 5 years, but the Cystic Fibrosis Foundation Patient Data Registry (CFFPR) shows that more than 54% of people with CF now live 18 years or longer. This percentage has been increas- ing by nearly 1% annually, and it’s estimated that in 10 years, 70% of Americans with CF will be adults. (See Living with CF.) Based on 2018 CFFPR data, the predicted median age of survival stands at 47.4 years, which means CF should no longer be considered a child- hood illness, but rather a lifelong disease di- agnosed in infancy. Longer life spans for these patients is the result of improvements in clinical practices and prescribed therapies. With the growing number of adults with CF and continued improvements in clinical care and prescribed therapies, nurses should be fa- miliar with the underlying cause of CF, its treatments and basic care guidelines, and the changing face of the disease. CF explained Individuals with CF inherit one copy of a ge- netic mutation of the CF transmembrane con- ductance regulator (CFTR) from each parent. These mutations result in either a malformed CFTR protein or no CFTR protein being made, which inhibits the movement of chloride in and out of the cells and causes the mucus that lines the body, most notably in the airways, to be thick and sticky. Since the CFTR gene was identified in 1989, more than 2,000 CFTR mutations have been identified in the Clinical and Functional Trans- lation of CFTR database; 10% to 15% of those mutations have been classified as disease caus- ing. Each mutation leads to diverse symptoms, making CF a multisystem disease. Although CF primarily affects the lungs and pancreas, it also may affect the sinuses, liver, gallbladder, and endocrine and reproductive systems. Mucus may clog lungs, leading to life-threatening in- fections. Obstruction in the pancreas prevents the release of natural enzymes to break down food for nutrient absorption, leading to steat- The changing face of cystic fibrosis It’s no longer a childhood illness. By Paula H. Lomas, MAS, RN, and Quynh T. Tran, MPHMyAmericanNurse.com March 2020 American Nurse Journal 29 orrhea, poor weight gain, and slow growth. The complex, progressive nature of CF re- quires specialized care by interprofessional clin- ical teams in a national network of over 130 care centers accredited by the Cystic Fibrosis Foundation (CFF). The care center staff obtain consent to share clinical information through the CFFPR. Since the 1960s, the data collected has been critical to driving care quality improve- ments, developing clinical guidelines, conducting observational research, and informing the design of clinical trials and ongoing safety studies. Treatment Disease and subsequent treatment burden vary widely among CF patients, largely based on age and genotype. This variability is ex- pected to increase with access to CFTR mod- ulators, a new class of Food and Drug Admin- istration (FDA)–approved drugs. Currently, individuals with CF are required to take many medications to maintain their health and slow disease progression. Pancreatic insuf- ficiency is treated with pancreatic enzyme ther- apy. Registry data suggest that almost 85% of patients with CF require oral pancreatic enzyme replacement therapy with all meals and snacks. Lung disease is treated with inhaled and oral antibiotics, airway clearance therapy, and mu- colytics. Lung treatments are both labor inten- sive and time-consuming, lasting 2 to 3 hours per day (more if the patient is acutely ill). Al- though these standard CF therapies address the symptoms of CFTR dysfunction, CFTR modula- tors (ivacaftor, lumacaftor/ivacaftor, tezacaftor/ ivacaftor, and elexacaftor/tezacaftor/ivacaftor) treat the underlying cause of CF and restore partial function in the gene mutation. (See Ap- proved CFTR modulators.) Ivacaftor In 2012, ivacaftor was the first drug in this class to be approved to treat patients with the G551D mutation. It works by keeping the chloride ion channel open. Subjects in clinical trials experienced more than a 10% improve- ment in their lung function. Unfortunately, on- ly 4.4% of individuals represented in the CFF- PR have this genetic mutation. Lumacaftor/ivacaftor F508del is the most common CFTR mutation in individuals with CF. According to the CFFPR, ap- proximately 44% of people with CF in the United States are homozygous (they have two copies of this mutation); 40.5% are heterozygous (they have one copy of F508del and another disease- causing mutation). F508del causes the CFTR pro- tein to fold improperly, which prevents it from moving to the cell surface. Because ivacaftor doesn’t affect this protein expression of the CFTR mutation, lumacaftor/ivacaftor was developed. Clinical trials of this medication showed modest (about 3%) overall lung function improvement. Unfortunately, not all individuals with eligible mutations tolerate lumacaftor/ivacaftor because of respiratory and GI side effects. In addition, significant drug-to-drug interactions exist. Tezacaftor/ivacaftor Tezacaftor is similar to lumacaftor and is a broad- acting CFTR modulator, resulting in more protein Living with CF Cystic fibrosis (CF) is no longer a childhood disease. Children and adults with CF (by year) n Adults 18 years and older n Children 18 years and younger 19881998 Source: Cystic Fibrosis Foundation 29.4% 70.6% 36.8% 63.2% 46.3% 53.7% 54.6% 45.4% 2008201830 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com at the cell surface and improved chloride trans- port. Another benefit of tezacaftor over lumacaftor is that it doesn’t interfere with oral contraceptives. When combined with ivacaftor, tezacaftor/iva- caftor showed a 3.4% to 6.8% improvement in lung function as measured by forced expiratory volume. Lumacaftor’s respiratory side effects, such as chest tightness, weren’t observed. Elexacaftor/tezacaftor/ivacaftor Results show that lumacaftor/ivacaftor and tezacaftor/ivacaftor haven’t been as effective as ivacaftor in patients with the G551D muta- tion. In October 2019, the FDA approved a triple combination therapy that combines iva- caftor and tezacaftor with a third “next-gener- ation” CFTR modulator called elexacaftor. In clinical trials, this triple combination has been highly effective for individuals homozygous and heterozygous for the F508del mutation; they experienced nearly 10% to 14% improve- ment in their lung function. Highly effective triple combination modulator therapies may allow CF patients to live longer, and standard treatment plans will need to be re-evaluated. CFTR modulator limitations Even with effective modulator therapies, the damage that patients with CF have already sus- tained remains irreversible, leaving a generation of adults with the disease dependent on stan- dard therapies such as inhaled and oral antibi- otics to treat their symptoms; some with more advanced disease will require a lung transplant. Additionally, 10% of the CF population have two copies of rare CFTR mutations that don’t have an approved modulator therapy. Nursing implications When caring for patients with CF, nurses must be aware of drug-to-food and drug-to-drug interac- tions and treatment side effects. Individualized treatment plans are the standard of care to ad- dress specific genetic mutations. And as this pa- tient population survives longer, nurses will en- counter them in a variety of adult care settings. Interactions Drug-to-food and drug-to-drug interactions can lead to higher levels of CFTR modulator medication in the blood or reduced therapeu- The Food and Drug Administration has approved these cystic fibrosis transmembrane conductance regulator (CFTR) modulators to treat patients with cystic fibrosis. CFTR modulator Approved age for use Common side effects Interactions Ivacaftor 6 months and older • Elevated transaminases • CYP3A inducers (e.g., rifampin, rifabutin, • Cataracts phenobarbital, carbamazepine, phenytoin, • Abdominal pain St. John’s wort) • Hypoglycemia • Grapefruit • Headache • Seville oranges (often found in marmalade) • Oropharyngeal pain • Upper respiratory tract infection • Nasal congestion • Nasopharyngitis • Diarrhea • Rash • Nausea • Dizziness Lumacaftor/Ivacaftor 2 years and older Same as ivacaftor, plus: Same as ivacaftor, plus: • Shortness of breath • Oral birth control • Chest tightness • Increased blood pressure • Fatigue • Flulike symptoms • Menstrual abnormalities Tezacaftor/Ivacaftor 6 years and older Same as ivacaftor Same as ivac aftor Elexacaftor/Tezacaftor/ 12 years and older Same as ivacaftor Same as ivacafto r Ivacaftor Approved CFTR modulatorsMyAmericanNurse.com March 2020 American Nurse Journal 31 tic effect. For example, CFTR modulators must be taken with fat-containing foods to improve medication absorption. CYP3A inducers (such as rifampin), which are prescribed to treat nontuberculous mycobacterial (NTM) lung dis- ease in patients with CF, substantially decrease the therapeutic effect of ivacaftor. This drug-to- drug interaction could prevent patients with CF who have NTM lung disease from realizing the benefits of modulator therapy. Treatment side effects Side effects of CFTR modulators vary. Because of potential effects on liver function, liver en- zymes should be monitored every 3 months af- ter treatment begins and then annually for the duration of treatment. Some cases of noncon- genital cataracts have been reported in pediatric patients when initiating ivacaftor, so baseline and follow-up eye exams should be obtained. Individualized treatment CFTR modulator therapies require individual- ized treatment plans based on genetic muta- tions, patient age, and eligibility. Pediatric nurses should recognize that the treatment regimens that were once standard CF care may soon be evolving. For example, young chil- dren who begin CFTR modulator treatment at 6 months old may not require standard airway clearance therapy or experience pulmonary exacerbations that require hospitalization. Adult care settings As more patients with CF are seen in adult care settings, nurses will need to learn about the disease and the model of care used to meet pa- tient needs. Adults with the applicable genetic mutation will be eligible for modulator therapy, but the progressive nature of CF may mean they won’t benefit from this treatment; the air- way damage they’ve already sustained can’t be reversed. Modulators will likely not eradicate the bacterial colonization in their lungs from microbes such as Pseudo monas aeruginosa, so these patients will still require anti-infectives and other standard CF therapies. Clinical guidelines Nurses in specialty areas such as otolaryngol- ogy, endocrinology, reproductive health, and gastroenterology may see an increased num- ber of adults with CF and be asked to coordi- nate care with CF care teams. The CFF doesn’t have recommended guide- lines for patients with CF who are pregnant, but the lumacaftor/ivacaftor package insert states that the drug may substantially decrease the ef- fectiveness of hormonal contraception. It’s still too early to tell how the long-term effects of the new CFTR modulator therapies will alter hormonal contraception or affect pregnancy and fetal and maternal outcomes. However, a 2016 case report published by Kaminski and col- leagues described a safe, uncomplicated preg- nancy with a healthy fetal outcome in a woman on modulator therapy. We don’t know how many women with CF have had pregnancies while on CFTR modulators; however, the 2018 CFFPR reports that since 1990, the number of pregnancies among woman with CF has steadily increased, in contrast with those among the general U.S. population, which have declined. The CFF convenes expert committees to evaluate medical evidence and publish rec- ommendations. Guidelines for infection pre- vention and control, nutrition, diabetes, colon cancer screening, and mental health are avail- able at cff.org/Care/Clinical-Care-Guidelines . The Cystic Fibrosis Foundation recommends these infection preven- tion strategies when caring for patients with cystic fibrosis (CF). • Collaborate with the organization’s infection prevention depart- ment to establish protocols and checklists for standards of practice when caring for more than one patient with CF. • Ensure disposable surgical masks are available for patients with CF to wear upon entry to the healthcare facility. • Whenever possible, place patients with CF in an exam room upon arrival to an outpatient facility. • If caring for more than one CF patient, do not keep them in the wait- ing area after they check in; call them on their cellphones when an exam room is available. • Disinfect multiuse items, such as pens, stethoscopes, and tablets, with an Environmental Protection Agency–registered hospital disin- fectant before and after use by patients with CF. • Implement contact precautions. All healthcare professionals should wear gowns and gloves when caring for more than one patient with CF. • Disinfect high-touch items such as doorknobs and chairs between use by patients with CF. Infection prevention strategies32 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com Infection prevention Due to potential cross-contamination, nurses caring for patients with CF should adhere to the CFF infection prevention guidelines. In health- care settings, patients with CF should be on contact precautions, wear disposable surgical masks, and remain 6 feet apart from other peo- ple in common areas. If more than one person with CF is part of the setting, specific CFF infec- tion prevention strategies should be implement- ed. (See Infection prevention strategies.) Nutrition Optimal weight for height is associated with better lung function. Individuals with CF re- quire 110% to 200% of the recommended en- ergy intake for gender, age, and height to achieve or maintain a body mass index (BMI) of 23 if male and 22 if female. For patients un- der age 21, BMI should be at or above the 50th percentile on the Centers for Disease Control and Prevention growth chart. Most pa- tients represented in the CFFPR require pan- creatic enzyme replacement therapy to aid fat, carbohydrate, and protein digestion. Salt should be used freely because abnormal CFTR causes salt loss through sweat; a typical “healthy” low-fat, low-salt diet isn’t advised. Diabetes CF-related diabetes (CFRD) is the most com- mon comorbidity with a prevalence of almost 30% among adults with CF. Patients with CFRD may have no symptoms, and treatment doesn’t include limiting caloric intake; it’s treated primarily with insulin, not diet, exer- cise, or oral agents. Colon cancer screening According to the CFFPR, the onset of colorectal cancer occurs 20 to 30 years earlier for people with CF than the general population. Screening with colonoscopy for patients with CF is rec- ommended at age 40; for those who’ve re- ceived a lung transplant, screening should begin at age 30. Bowel preparation for the pro- cedure is more intense because of thick, sticky mucus in the colon. Patients may require three to four washes, with the last wash occurring 4 to 6 hours before the colonoscopy. Mental health Patients with CF have various mental health needs. Chronically ill patients with CF and their caregivers exhibit signs of anxiety and depression at two to three times the rate of the general population. This can affect their ability to sustain daily care, physical health, and qual- ity of life. Patients must work hard to over- come the obstacles of CF self-care, so non- judgmental support is important as providers partner with CF patients to identify goals. Pa- tients attending a CFF-accredited care center should be screened annually for anxiety and depression. If the screen is positive, they should be offered treatment by a mental or be- havioral health provider who is aware of clin- ical practice guidelines and special require- ments for individuals with CF. Providing quality care Because CF is no longer a pediatric disease, nurses in primary adult care and specialized fields are more likely to encounter patients with it. Nurses should partner with patients’ CF care teams and familiarize themselves with the CF model of care and special requirements, starting with clinical care guidelines. Many re- sources are available to help implement guide- lines and ensure high-quality care. AN To view a list of references, visit myamericannurse.com/ ?p=64890. The authors work at the Cystic Fibrosis Foundation in Bethesda, Maryland. Paula H. Lomas is senior director of clinical communica- tions, and Quynh T. 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Travaline • 215-489-7000 • jtravaline@healthcommedia.com A D I NDEX March 2020 American Nurse Journal 33 ANA ON THE FRONTLINE NEWS FROM THE AMERICAN NURSES ASSOCIATION nn Nurses make their voices heard34 American Nurse Journal Volume 15, Number 3 By Gregory Craig, MPA, MS, and Samuel Hewitt P romoting the critical role nurses play in the health of patients and the nation, as well as guaranteeing a strong nursing workforce into the future, are core components of the American Nurses Association’s (ANA’s) federal legislative agenda. In 2020, as the second session of the 116th Congress gets underway, ANA is focusing its legisla- tive efforts in key areas: passage of Title VIII reau- thorization for nursing workforce programs, pre- venting workplace violence, defending the scope of practice of registered nurses (RNs) and advanced practice RNs (APRNs), helping to curb the opioid epidemic, and preventing gun violence. These legis- lative priorities are based on ANA’s strategic goals, positions, emerging issues, and the current political environment. Factors influencing policy Election years are always tough for legislative and policy victories, especial- ly during a presidential election year. Members of Congress will spend more time at home cam- paigning for reelection, while hearings and com- mittee work will essen- tially shut down from July until the election. The House impeachment of the President and Senate trial will have an impact on what gets accom- plished by Congress for the remainder of the year. Although no one can predict what will happen after the elections in November, ANA will remain nimble in its efforts to promote nursing. ANA’s 2020 legislative priorities include the following. Passage of Title VIII Nursing Workforce Reauthorization Act Title VIII of the Public Health Service Act authorizes Nursing Workforce Development Programs, which support RN and APRN education and training pro- grams across the country. The House passed the Title VIII Nursing Workforce Reauthorization Act of 2019 (H.R. 728/S. 1399) on October 28, 2019, by voice vote. The Senate Health, Education, Labor, and Pen- sions (HELP) Committee passed the legislation out of committee in November, meaning the next hurdle is a vote on the Senate floor. But because an amend- ment was made during the legislative markup in HELP, the House will once again have to pass the bill or amend it and send it back to the Senate. At press time, ANA was expecting action on this measure. Funding of Title VIII Nursing Workforce Development Programs and the National Institute of Nursing Research (NINR) 2019 was a banner year for nurses in the annual Con- gressional appropriations process. Through ANA’s grassroots and legislative efforts, along with others from the nursing community, Congress appropriated an increase of $10.5 million in Title VIII Nursing Work- force Development Programs funding for FY2020 for a total of almost $260 million. In addition, Congress appropriated an increase of more than $6 million in funding for the NINR at the National Institutes of Health (NIH), bringing the total funding to $169 mil- lion. These are signifi- cant increases com- pared with 2019, when Congress appropriated flat funding for both programs. Workplace violence prevention One in four nurses are assaulted on the job, which is why prevent- ing workplace violence continues to be a top priority for ANA. In 2019, ANA members helped the House pass the Workplace Vio- lence Prevention for Health Care and Social Service Workers Act (H.R. 1309/S. 851). This bill requires the Department of Labor (DOL) to promulgate an occu- pational safety and health standard that requires em- ployers in healthcare and social services settings to implement comprehensive plans to protect their em- ployees from workplace violence. DOL has had vol- untary guidelines on the record for years, but no en- forcement mechanisms to make employers in these settings comply. ANA will continue to push for pas- sage of this legislation in the Senate in 2020. Opioid crisis The SUPPORT for Patients and Communities Act of 2018 included a provision that granted nurse practi- tioners and physician assistants permanent prescrip- Federal legislative agenda ANA focuses on key workplace and workforce issues ADVOCACY Nurses attending ANA Hill Day in Washington, DC, visit Rep. Joe Courtney (D-CT) to advocate for key nursing issues. Courtney, at left, sponsored workplace violence prevention legislation in the House. March 2020 American Nurse Journal 35 tive authority for buprenor- phine; clinical nurse specialists (CNSs), certified nurse-mid- wives (CNMs), and certified registered nurse anesthetists (CRNAs) were given 5-year authority. As of January, more than 18,000 APRNs have com- pleted the continuing educa- tion requirements to be grant- ed the waiver to prescribe buprenorphine for addiction treatment. While this is great progress, it’s not a silver bullet to solving the opioid crisis. All prescribers with a controlled substance license can already prescribe buprenorphine for pain, but not for addic- tion treatment. ANA has endorsed the Mainstreaming Addiction Treatment Act (H.R. 2482/S. 2074), which will remove the requirement for additional continuing education to be able to provide medication-assisted treatment to patients with opioid use disorder. It also will eliminate the sunsetting of CNS, CNM, and CRNA authority to prescribe buprenorphine. Gun violence prevention ANA achieved another long-term goal in 2019 in the appropriations process: For the first time since 1996, Congress appropriated money to the Centers for Dis- ease Control and Prevention (CDC) and the NIH to study gun violence. Congress has been unwilling or unable to provide such funding since 1996, when a policy rider, known as the Dickey Amendment, was attached to the annual federal spending bill. This rid- er stated that none of the funds made available for injury prevention and control at the CDC may be used to advocate or promote gun control. The actual law didn’t specifically ban CDC and NIH from re- searching gun violence. However, career employees feared if they continued to direct money to research the issue, Congress might cut their overall funding, so they discontinued the programs. In 2018, Congress amended the law to clarify that such research is allowed, and this year added funding for it in the latest appropriations package. Another achievement on be- half of nurses was the pas- sage of H.R. 8, the Bipartisan Background Checks Act of 2019. Endorsed by ANA, this legislation prevents firearm sales between pri- vate parties unless a licensed gun dealer conducts a background check. We’re proud of the progress made, but it’s unlikely to get a vote in the Senate, and President Trump has said he would veto the bill if it passed Congress. ANA will continue to advocate for funding for the CDC and NIH for research into gun violence prevention and for other common- sense legislation to protect all Americans, including universal background checks. Giving nurses a voice ANA strives to ensure that nurses, the most honest and ethical profession for the past 18 years, are rep- resented on critical issues facing the profession and healthcare. Through legislative efforts in 2020, ANA will continue to advocate on behalf of nurses and the patients they serve, and to elevate the role of nursing in America’s healthcare system. — Gregory Craig is a senior health policy advisor and Samuel Hewitt is a senior associate director in the Policy & Government Affairs Department at ANA. ANA resources RNAction—Get involved, take action, and learn more about critical nursing issues. Visit ana.aris- totle.com/SitePages/HomePage.aspx Capitol Beat Blog —Stay up to date on the latest healthcare policy and advocacy. Visit anacapitol- beat.org #NursesVote—ANA empowers nurses across the country to become engaged advocates. #Nurses- Vote is your go-to resource for information on candidates, ANA’s nursing priorities, and how best to engage with and support the candidate of your choice. ANA encourages all nurse advo- cates to become well-informed voters and help ensure every presidential candidate considers advancing the nursing profession to be one of their core priorities. Visit nursesvote.org North Carolina Nurses Association leaders met with Sen. Richard Burr (R-NC) (center), along with ANA President Ernest Grant and Enterprise CEO Loressa Cole. Burr is Senate sponsor for Title VIII nursing workforce legislation. Nurses from Arizona prepare for their Capitol Hill visits in Washington, DC. 36 American Nurse Journal Volume 15, Number 3 A lthough the relationship between nursing care and safe, high-quality patient care is widely understood today, healthcare leaders have difficulty agreeing on a systematic method for allo- cating nursing resources, accord- ing to a new report published by the Healthcare Financial Manage- ment Association (HFMA). The American Nurses Association (ANA) and the American Organi- zation for Nursing Leadership co- authored the report with HFMA. The report also was endorsed by the American Association of Criti- cal-Care Nurses. “Nurses have a direct impact on quality of care and patient and family satisfaction. It is time to shift the nurse staffing paradigm so that the contributions of nurs- es to positive patient outcomes are understood, valued, and viewed as a priority investment rather than a discretionary ex- pense,” said ANA President Ernest J. Grant, PhD, RN, FAAN. With 2020 declared the Year of the Nurse and the Midwife, this 19-page report is especially timely and critical in advancing an important nursing priority. It explores the different sources of stress that nursing and finance leaders routinely encounter in the course of their work. Enhancing mutual understanding of their respective professional roles and challenges can help the two groups work together toward shared goals, according to the authors. ANA Past President Pamela Cipriano, PhD, RN, FAAN, is the lead ANA author. The report, The Business of Car- ing: Promoting Optimal Alloca- tion of Nursing Resources , also calls on healthcare leaders to pi- oneer creative nurse staffing ap- proaches, assess the impact of new technology on all phases of care, strive for fierce collabora- tion, and agree on principles for allocating appropriate nursing resources for patient care. These principles include the following: nurse staffing makes a critical difference for patients and for the care experience; safe nurse staffing leads to better patient outcomes; and optimal staffing reduces nurse turn- over, which in turn reduces the cost of care. The report is available at bit.ly/nursingreport. L illee Smith Gelinas, MSN, RN, CPPS, FAAN, editor-in-chief of the Ameri- can Nurse Journal and an American Nurses Association (ANA) and Texas Nurses Association member, was recent- ly selected to serve on the Patient Safety Measures of Hospital Harm Technical Ex- pert Panel (TEP) through the Centers for Medicare & Medicaid Services (CMS). The purpose of the TEP is to develop and maintain patient safety measures of hos- pital harm related to falls, postoperative bleeding, and diagnostic errors for CMS quality and payment programs, such as the Hospital Inpatient Quality Reporting Program and the Hospital-Acquired Con- ditions Reduction Program. “ANA congratulates Ms. Gelinas on her appointment to this CMS patient safety panel,” said ANA President Ernest Grant, PhD, RN, FAAN. “Her leadership and expertise on patient safety issues will no doubt help move this important work forward.” The TEP’s objectives are to improve pa- tient safety and reduce or eliminate hos- pital-acquired conditions, to evaluate and address performance gaps, identify and incentivize opportunities for im- provement, and to develop, maintain, reevaluate, and implement patient safe- ty measures, including electronic clini- cal quality measures (eCQMs) for falls, post-operative bleeding, and diagnostic errors for CMS’ hospital-level quality re- porting programs. A strong nursing presence in decision- making related to patient safety measures is critical, particularly when it comes to avoidable hospital harm. Nursing care is the frontline of preventing these types of harm, and ANA continues to be a leader in ensuring that nursing is represented in these discussions. Payers and health systems are transitioning to measuring patient safety through eCQMs, which presents the profession with the opportunity to demonstrate the central role of nursing in patient safety. ANA representative named to CMS patient safety panel Guidance for improving allocation of nursing resources ANA NEWS Lillee Smith Gelinas March 2020 American Nurse Journal 37 RECOGNITION C ertified Nurses Day™, celebrated annually on March 19, is a day of recognition that honors nurses worldwide who contribute to better patient outcomes through board certification in their specialty. Employers, certification boards, education facilities, and healthcare providers take this day to publicly acknowledge nurses who care enough to earn and maintain the highest credentials in their specialty, demonstrating their commitment to nurs- ing professionalism and excellence. Certified Nurses Day is celebrated on the birthday of Margretta “Gretta” Madden Styles, EdD, RN, FAAN, a renowned pioneer and expert in nurse cre- dentialing. Styles, who was an accomplished advo- cate for nursing standards and certification, ad- vanced nursing practice and regulation worldwide for more than two decades. Certified Nurses Day is the perfect opportunity to in- vite all nurses to advance their career by choosing certification. The American Nurses Credentialing Center (ANCC) provides free downloadable tools and celebra- tion ideas at certi- fiednursesday.org. Winners of the ANCC Certified Nurse Awards are announced in con- junction with Cer- tified Nurses Day. The awards showcase certified nurses in various specialties who have made impact- ful and valuable contributions to the nursing profes- sion and the field of healthcare. To view the outstanding nurses who exemplify the value of continuing professional development through certification as the 2020 Nurse Award recipients, visit bit.ly/ANCC_CNA_Winners. A s part of the ANA Enterprise’s efforts to cele- brate and elevate nurses’ essential contribu- tions to health and healthcare during the Year of the Nurse and Midwife, it will expand National Nurses Week—traditionally celebrated May 6 to 12— to a month-long celebration in May. The theme for Nurses Month is “You Make a Differ- ence,” and each week will focus on activities to sup- port nurses, advance their practice, and encourage future generations of nurses: • Self-care Week—May 1-9 • Recognition Week—May 10-16 • Professional Development Week—May 17-23 • Community Engagement Week—May 24-31 In addition, the American Nurses Association (ANA) is hosting a webinar, “Magnify your voice—Use storytelling to advance nursing,” at 1 PM ET on May 20. Carolyn Jones, award-winning filmmaker, teaches participants how to better tell the story of their nurs- ing journey. Free to everyone, registration for the webinar is available at nursingworld.org/continuing- education/magnify-your-voice-use-storytelling-to- advance-nursing. To promote Nurses Month in local communities and media, download the Nurses Month toolkit, which in- cludes a Nurses Month logo to use on promotional materials, in social media, and at celebrations and ac- tivities, at anayearofthenurse.org. In partnership with The Washington Post , ANA is pre- senting Star Nurses, a nurse-recognition event on May 12 to honor outstanding nurses in the Washing- ton, D.C., area. The Post is accepting nominations from patients or their families, colleagues, or anyone else who is familiar with exemplary care from a nurse in D.C., Maryland, or Virginia. To learn more, visit pages.nursingworld.org/ starnurses. All nurses, hospitals, and other stakeholders are encouraged to participate in and pro- mote Nurses Month to help recognize nurs- es and educate the public about the profes- sion’s invaluable work. Be sure to share your Nurses Month activities on social me- dia channels such as Facebook and Twitter at #ANANursesMonth. With your help, this landmark year can raise the visibility of the nursing profession—enhancing nurses’ influence in policy dia- logue, as well as spurring expanded investment in ed- ucation, practice, and research. Recognizing certi昀ed nurses March 19 Celebrating Nurses Month in 2020Next >