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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services [CMS-3254-N] Medicare Program; Request for Nominations for Members for the Medicare Evidence Development & Coverage Advisory Committee

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

SUMMARY: This notice announces the request for nominations for membership on the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). Among other duties, the MEDCAC provides advice and guidance to the Secretary of the Department of Health and Human Services (the Secretary) and the Administrator of the Centers for Medicare & Medicaid Services (CMS) concerning the adequacy of scientific evidence available to CMS for "reasonable and necessary" determinations under Medicare. We are requesting nominations for both voting and nonvoting members to serve on the MEDCAC. Nominees are selected based upon their individual qualifications and not as representatives of professional associations or societies. We wish to ensure adequate representation of the interests of both women and men, members of all ethnic groups and physically challenged individuals. Therefore we encourage nominations of qualified candidates who can represent these interests. The MEDCAC reviews and evaluates medical literature, technology assessments, and hears public testimony on the evidence available to address the impact of medical items and services on health outcomes of Medicare beneficiaries. CMS-3254-N 2

DATES: Nominations will be considered if postmarked by Monday, January 30, 2012 and mailed to the address specified in the ADDRESSES section of this notice.

ADDRESSES: You may mail nominations for membership to the following address: Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality, Attention: Maria Ellis, 7500 Security Boulevard, Mail Stop: South Building 3-02-01, Baltimore, MD 21244.

FOR FURTHER INFORMATION CONTACT: Maria Ellis, Executive Secretary for the MEDCAC, Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality, Coverage and Analysis Group, S3-02-01, 7500 Security Boulevard, Baltimore, MD 21244 or contact Ms. Ellis by phone (410-786-0309) or via e-mail at Maria.Ellis@cms.hhs.gov.

SUPPLEMENTARY INFORMATION:

I. Background

The Secretary signed the initial charter for the Medicare Coverage Advisory Committee (MCAC) on November 24, 1998. A notice in the Federal Register (63 FR 68780) announcing establishment of the MCAC was published on December 14, 1998. The MCAC name was updated to more accurately reflect the purpose of the committee and on January 26, 2007, the Secretary published a notice in the Federal Register (72 FR 3853), announcing that the Committee's name changed to the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). The charter for the committee was renewed by the Secretary on November 24, 2010. The current charter is effective for 2 years. CMS-3254-N 3 The MEDCAC is governed by provisions of the Federal Advisory Committee Act, Pub. L. 92-463, as amended (5 U.S.C. App. 2), which sets forth standards for the formulation and use of advisory committees, and is authorized by section 222 of the Public Health Service Act as amended (42 U.S.C. 217A). The MEDCAC consists of a pool of 100 appointed members including: 94 voting members of whom 6 are designated patient advocates, and 6 nonvoting representatives of industry interests. Members generally are recognized authorities in clinical medicine including subspecialties, administrative medicine, public health, biological and physical sciences, epidemiology and biostatistics, clinical trial design, health care data management and analysis, patient advocacy, health care economics, medical ethics, or other relevant professions. The MEDCAC works from an agenda provided by the Designated Federal Official. The MEDCAC reviews and evaluates medical literature, technology assessments, and hears public testimony on the evidence available to address the impact of medical items and services on health outcomes of Medicare beneficiaries. The MEDCAC may also advise CMS as part of Medicare's "coverage with evidence development" initiative.

II. Provisions of the Notice

As of June 2012, there will be 30 membership terms expiring. Of the 30 memberships expiring, 1 is a nonvoting industry representative, 4 are voting patient advocates and the remaining 25 membership openings are for the general MEDCAC voting membership. CMS-3254-N 4 Accordingly, we are requesting nominations for both voting and nonvoting members to serve on the MEDCAC. Nominees are selected based upon their individual qualifications and not as representatives of professional associations or societies. We wish to ensure adequate representation of the interests of both women and men, members of all ethnic groups and physically challenged individuals. Therefore, we encourage nominations of qualified candidates from these groups. All nominations must be accompanied by curricula vitae. Nomination packages must be sent to Maria Ellis at the address listed in the ADDRESSES section of this notice. Nominees for voting membership must also have expertise and experience in one or more of the following fields:

• Clinical medicine including subspecialties

• Administrative medicine

• Public health

• Biological and physical sciences

• Epidemiology and biostatistics

• Clinical trial design

• Health care data management and analysis

• Patient advocacy

• Health care economics

• Medical ethics

• Other relevant professions

We are looking for experts in a number of fields. Our most critical needs are for experts in hematology; genomics; Bayesian statistics; clinical epidemiology; clinical trial CMS-3254-N 5 methodology; knee, hip, and other joint replacement surgery; ophthalmology; psychopharmacology; rheumatology; screening and diagnostic testing analysis; and vascular surgery. We also need experts in biostatistics in clinical settings, cardiovascular epidemiology, dementia, endocrinology, geriatrics, gynecology, minority health, observational research design, stroke epidemiology, and women's health. The nomination letter must include a statement that the nominee is willing to serve as a member of the MEDCAC and appears to have no conflict of interest that would preclude membership. We are requesting that all curricula vitae include the following:

• Date of birth

• Place of birth

• Social security number

• Title and current position

• Professional affiliation

• Home and business address

• Telephone and fax numbers

• E-mail address

• List of areas of expertise

In the nomination letter, we are requesting that the nominee specify whether they are applying for a voting patient advocate position, for another voting position, or as a nonvoting industry representative. Potential candidates will be asked to provide detailed information concerning such matters as financial holdings, consultancies, and research grants or contracts in order to permit evaluation of possible sources of conflict of interest. CMS-3254-N 6 Members are invited to serve for overlapping 2-year terms. A member may serve after the expiration of the member's term until a successor is named. Any interested person may nominate one or more qualified persons. Self-nominations are also accepted. The current Secretary's Charter for the MEDCAC is available on the CMS website at: http://www.cms.hhs.gov/FACA/Downloads/medcaccharter.pdf, or you may obtain a copy of the charter by submitting a request to the contact listed in the FOR

FURTHER INFORMATION section of this notice. CMS-3254-N

Authority: 5 U.S.C. App. 2, section 10(a)(1) and (a)(2). (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare--Supplementary Medical Insurance Program.)

Dated: October 18, 2011

___________________________

Patrick Conway

CMS Chief Medical Officer and Director

Office of Clinical Standards and Quality

Centers for Medicare & Medicaid Services

BILLING CODE: 4120-01-P

[FR Doc. 2011-29784 Filed 11/17/2011 at 8:45 am; Publication Date: 11/18/2011]

Motivating Nursing Staff: The Power Within Our Reach

Michele E. Gaguski, MSN, RN, AOCN^®, CHPN, APN-C
Somers Point, NJ
megcns@comcast.net

As clinical nurse specialists (CNSs), we frequently are the driving force behind many nursing staff initiatives, including integrating new technology into clinical practice, championing nursing certification and clinical ladder climbing, and elevating involvement in the performance improvement process and evidence-based practice and research projects. These responsibilities present the CNS with the ever-challenging task of motivating staff to embrace these opportunities as building blocks to personal and professional development.

Abraham Maslow’s hierarchy is the most widely known theory on motivation and can be summarized as follows (Wikipedia, 2007).

• Human beings have wants and desires that influence their behaviors; only unsatisfied needs can influence behavior, satisfied needs cannot.
• Because needs are many, they are arranged in order of importance, from the basic to the complex.
• The person advances to the next level of needs only after the lower-level need is at least minimally satisfied.
• The further the progress up the hierarchy, the more individuality, humanness, and psychological health a person will demonstrate.

As CNSs, we have the power to influence staff members to reach their full potential as professional nurses.

Defining Motivation

People will pursue an action if they deem it important to them. Motivation has been defined as a reason or set of reasons for engaging in a particular behavior. Adult learners are motivated to learn something largely by internal factors, such as their desire for self-esteem, recognition, job satisfaction, improved quality of life, and increased self-confidence (Knowles, 1990). CNSs can use these internal factors as a catalyst for motivating staff to perform at their best in both institutional and professional activities. For example, a CNS is charged with integrating a new computer-based documentation system on the inpatient unit. Oftentimes, this level of change is met with resistance from staff; however, the CNS can attempt to improve job satisfaction by presenting the key “time saver” elements of the new system, such as saved patient histories and health records. A major motivator is to present the positive aspects first when presenting and or advocating for change; to spend time on the barriers may discourage participation and hinder the implementation of the proposed change.

Focus on what the staff members have control over in the process. When implementing a change, take time to ask them: “What are your thoughts on this?” “What do you perceive as barriers or constraints?” “What are the positives?” (positives always exist; help them to find them.) Now, guide them to develop a two-column list—“Control” and “No Control”—and tell them to let everything in the “No Control” column go and focus on their “Control” column. This will enhance their ability as a team to increase self-confidence and build self-esteem. Additionally, the CNS can select a nurse who has an interest in informatics and capitalize on his or her skills to serve as a unit champion for his or her peers during the educational process to further engage staff in the process while building the nurse’s personal self-esteem.

Generate Enthusiasm

Adults learn best when convinced of the need for knowing the information (Russell, 2006). Generating enthusiasm is a crucial step in convincing staff members to act on their internal factors of motivation to bring about making a difference. As CNSs, we should be tuned into capturing the “teachable moment” that may lead staff members to embrace the change, involve themselves in the effort, and ultimately become nurse leaders. As CNS role models, we should have a “can do attitude” because our presence and support can instill self-confidence and foster a willingness in staff members to achieve great things. The CNS connects with staff members on varying levels and may serve as a main guide to building their self-reliance while strengthening clinical skills and critical thinking abilities. The CNS is in a position to motivate staff members to promote self-direction, autonomy, goal setting, education, and research.

For example, after several years of a CNS mentoring a nurse on preparing for the oncology certification, the nurse achieves this goal. In turn, the nurse champions the value of certification to her peers and discusses her personal success story. She partners with the CNS in developing a power point presentation regarding certification and spreads the enthusiasm, which all began with the CNS. Be passionate and visible about your work, and people will follow.
 
Create a Path for Success

The CNS role is critical to the success of integrating change and advancing practice in the healthcare setting. CNSs use their skills and knowledge to help staff members feel confident that someone is there for them to field questions to, express ideas with, and at times, vent their frustrations to.

As most of us have traveled this path before, sharing our own stories conves to staff members that they are not alone on their career paths and helps them to understand that with support, planning, and time they can make their goals a reality. By creating a path for success, the CNS is allowing staff to feel that they are understood and that their opinions are valued, especially by people that affect their day-to-day lives and work. As the CNS, development of a strong and trusting relationship with staff members empowers them to think outside the box and to bring concerns and issues to the forefront without apprehension. The CNS’s knowledge base can greatly enhance the ability to exert a positive influence over staff members that cultivates a non-threatening environment in which to grow.

The CNS serves as a visionary for “what could be” and mentors staff on traveling the path to create this vision in the workplace. By providing challenging opportunities for self-development, the CNS provides staff members with a realistic view of situations while allowing for risk taking, reflections of lessons learned, and review of contributions to the work environment. The CNS should assist nurses with discovering their calling and transcend the trifling day-to-day problems and re-focus their energy on problems that they have the power, knowledge, and skill to improve and change for the better. Commit to being there for the nurse and accept the person for who he or she is; from really knowing the nurse’s limitations and aptitudes, the CNS will know what to build upon and discover the potential that lies within.

Reward and Recognition

Reward and recognition can provide “the icing on the cake” for staff members in their professional journey. By taking the time and effort to recognize staff members for their hard work and efforts; outwardly state how proud you are of their accomplishment, in this way the CNS sets the tone for supporting others, the value of goal setting and sticking to the path.

As staff care for others on a daily basis, oftentimes self care and recognition become absent this may lead to decreased motivation, unmet lower level needs, and risk for burnout. The challenge for the CNS is to keep the tone upbeat and positive, relating statements to staff such as “Did you hear that our unit was number one in patient satisfaction scores for this month?,” or “I really value your presence on the unit, your willingness to share your knowledge with others is apparent in all that you do.” These types of verbal messages keep staff motivated to continue on the path to career success. Even small tokens of appreciation, such as sending a card, giving them a “well done” sticker, or posting announcements of staff accomplishments may begin to meet the staff’s need for recognition while creating a workplace where recognition is the norm. For example, staff achieved a bachelor’s or master’s degree, host a party on the unit, have fun, invite other staff to join in the planning process. This not only serves as a motivator for other staff, but also builds teamwork and camaraderie.

The journey of sustaining the staff members’ level of motivation is one that challenges the creative side of being in the CNS role. The CNS is called to be aware of the ever-changing staffing mix in their practice areas to adequately meet the needs of the various levels of staff (e.g., education, years of experience, etc.). Through gaining an understanding of what motivates each of your staff; we as the CNS are able to recognize the unique contributions of each and every nurse and position them on a path that uncovers their potential. To make oneself known as a highly motivated and high-energy presence permeates the culture of the staff and helps to sustain a rich learning environment with countless possibilities for professional and personal growth. Under the motivation of the CNS, staff members are encouraged to branch out and try new things; persevere through hardship; uncover inner strengths, reach goals, and ultimately experience success. The power is within our reach!

Editor’s Note: Michele was the 2007 Advanced Oncology Certified Nurse of the Year, and currently, she serves as an ONS Director at Large.

References

Knowles, M. (1990). The adult learner. A neglected species. (4th ed.). Houston, TX: Gulf Publishing.

Russell, S. (2006). An overview of adult learning processes. Urologic Nursing, 26(5), 349–370.

Wikipedia. (2007). Motivation. Retrieved September 27, 2007, from http://en.wikipedia.org/wiki/Motivation

The Management and Program Development SIG annual meeting at Congress was a great success. Mary Magee Gullatte PhD, RN, APRN, BC, AOCN, FAAMA presented a great presentation and as promised, here is the Tool-Kit to remind us what it is all about...

Toothpick: To remind you to pickout the good qualities in others.

Rubber Band: To remind you to be flexible, things might not always go the way you want, but it will work out.

Band Aid: to remind you to heal hurt feelings, yours or someone else's.

Pencil: To remind you to list your Blessings, everyday.

Eraser: To remind you that everyone makes mistakes, and it's OK. Failure in not the end, it is the Beginning.

Chewing Gum: To remind you to stick with it and you can accomplish Great things.

Mint: To remind you that you are a mint to our SIG and your leadership is appreciated.

Candy Kissess: To remind you that everyone needs a kiss and a hug everyday.

Candle: to remind you that as you let our own light shine, you unconsciously give other people the persmission to do the same.

Herb Tea: To remind you to relax and go over that list of your blessings, everyday.

This is my gift to you!

To the world you may just be somebody...

But, to somebody, you maybe their world.......

Mary Magee Gullatte PhD, RN, APRN, BC, AOCN, FAAMA

This web-based competency test covers all of the critical reimbursement skills required in oncology practice, to help you demonstrate your competency in these important nursing skills. This test is appropriate for anyone who has completed the Reimbursement for Nurses: The Keys to Successful Coding or the Reimbursement for Nurses and Managers: The Keys to Successful Practice courses, as well as for anyone who has experience with coding and would benefit from more practice or the desire to demonstrate competency in this skill.

http://www.ons.org/CourseDetail.aspx?course_id=30