I. CEO Update [PDF] - American Nurses Association

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Open Session Item Agenda #3 

ANA Board of Directors 

December 12, 2008 

Executive Services 

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AMERICAN NURSES ASSOCIATION 

Report to the Board of Directors 

on 

REPORT OF CHIEF EXECUTIVE OFFICER 

As of December 4, 2008 

CONSENT INFORMATION 

EXECUTIVE SUMMARY: The content addressed in this report to the ANA Board covers ANA’s 

strategic activities and relationship issues that the ANA Board of Directors must be kept apprised of in 

order to fulfill their fiduciary responsibilities. Since the October 2008 ANA BOD Meeting, there has 

been activity regarding the following strategic activities and relationships. 

Strategic Imperative #1: Professional Practice and Excellence 

Cover the Uninsured Week 2008; National Healthcare Decisions Day 2008; Substance Abuse and 

Mental Health Services Administration Minority Fellowship Program; Publishing; Ethics and Human 

Rights (EHR); Institute of Medicine Roundtable on Translating Genomic-Based Research for Health; 

American Association of Colleges of Nursing (AACN) Baccalaureate Essentials; Continuing Nursing 

Education Program; Pay-for-Performance (P4P)/Value-Based Purchasing (VBP); Congress on 

Nursing Practice and Economics; The Joint Commission; National Coordinating Council for 

Medication Error Reporting and Prevention (NCC MERP/The Council) 

Strategic Imperative #2: Healthcare and Public Policy 

Coalition for Patients Rights (CPR); Safe Staffing Saves Lives Campaign and Health Systems Reform; 

Disaster Preparedness; Federal Legislative & Regulatory Update; State Legislative Update; 

Presidential Endorsement; Congressional Endorsements; Environmental Health Issues; Legal 

Advocacy; Health System Reform; Advanced Practice Issues; APRN/NCSBN Joint Dialogue Group; 

Scope of Practice for Certified Registered Nurse Anesthetists; Industry Trade Advisory Committees 

(ITACs) 

Strategic Imperative #3: Knowledge & Research 

Content Management System (CMS) and NursingWorld.org; Members Only on 

www.NursingWorld.org; National Database for Nursing Quality Indicators ® (NDNQI ® ); American 

Nurse Today (ANT); Informatics and Electronic Health Record Initiatives; American Board of 

Medical Specialties ® (ABMS); American Medical Association – Physician Consortium for 

Performance Improvement ® (AMA-PCPI); AQA (formerly the Ambulatory Quality Alliance); 

Hospital Quality Alliance (HQA); Institute for Healthcare Improvement (IHI); National Quality 

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December 2008 Board of Directors Consent Information Report Page 1 

CEO Report

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Forum (NQF); URAC; Quality Alliance Steering Committee (QASC) 

Strategic Imperative #4: Unification 

International Council of Nurses; One Strong Voice: Nurses Making a Difference Together 

(Partnership Plan); Nurse Competence in Aging; Tobacco Cessation; Procedural Sedation; Member 

Benefits; External Relationships; American Public Health Association (APHA) – Governing Council 

Quad Council of Public Health Nursing Organizations (Quad Council); Association of State and 

Territorial Directors of Nursing (ASTDN); United States Pharmacopeia (USP); Health Resources and 

Services Administration (HRSA) Patient Safety and Pharmacy; Collaborative: Leadership 

Coordinating council (LCC) 

Strategic Imperative #5: Advocacy for Workforce & Workplace Issues 

Nurse Migration; Handle With Care Campaign; Occupational and Environmental Health; Healthy 

Nurse; Legal Advocacy; Sex Discrimination in Application of Leave Policies on Pension 

computations; Nursing’s Agenda for the Future (NAF) Economic Value of Nursing. 

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Table of Contents 

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American Nurses Association 

A Global Enterprise. . . . 

Caring For Those Who Care 

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Core Ideology 

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Core Purpose 

Nurses advancing our profession to improve health for all. 

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Core Values 

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Excellence Diversity 

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Unity Integrity 

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Respect 

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Envisioned Future 

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19Overarching Goal 

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21Nursing will be the acknowledged unifying force advancing quality health for all. 

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23Outcomes 

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25 Nurses are universally valued as central to optimal health. 

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27 Nurses are a recognized political force with a prominent seat at health policy tables. 

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29 Nurses are actively shaping safe and secure practice environments. 

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Nurses, nursing organizations, and the public value ANA as the indispensable primary voice of 

nursing and builder of coalitions for health advocacy. 

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34 Every nurse has a connection to ANA. 

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36 Nursing is among the most frequently chosen careers. 

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ANA’s Cornerstone Work 

39ANA’s commitment to advance the profession’s foundational work revolves around ethics and 

40standards. In this role, ANA owns and promotes the Code of Ethics for Nurses with Interpretive 

41Statements and develops and maintains standards of practice. 

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43Code of Ethics for Nurses 

44This is a succinct statement of the ethical obligations and duties of every registered nurse. It is available 

45on NursingWorld.org and through Nursesbooks.org. 

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2Scope and Standards of Practice 

3ANA currently publishes 21 standards in cooperation with specialty nursing organizations. They are 

4updated at least every five years by the Congress of Nursing Practice and Economics (CNPE). We are 

5working on incorporating aging into all scopes and standards. In addition, ANA publishes Nursing’s 

6Social Policy Statement – which reflects the current definition of nursing. 

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ANA Core Issues 

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10Nursing Shortage 

11ANA actively addresses the complex factors that affect the supply and demand for nurses. ANA works 

12to retain and recruit nurses by improving work environments, increasing educational opportunities, 

13increasing compensation and advocating laws that strengthen the profession. 

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15Appropriate Staffing 

16ANA leads the way in research, policy & practice, and workplace strategies to ensure that the number 

17and mix of staff are appropriate – protecting patients and nurses. 

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19Workplace Rights 

20ANA protects, defends and educates nurses about their rights as employees under the law. 

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22Workplace Health and Safety 

23ANA fights for a safer workplace by addressing the growing number of hazards that threaten nurses, 

24such as chronic stress, needlestick injuries, latex allergy, ergonomic injuries, chemical exposures 

25(including mercury) and workplace violence. 

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27Patient Safety/Advocacy 

28ANA advances its ultimate goal, quality patient care, by effecting positive change around issues that are 

29critical to nursing and its future. Today’s environment demands action to ensure that patient safety and 

30quality are priorities. 

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ANA Strategic Imperatives 

STRATEGIC IMPERATIVE #1 

Professional Practice and Excellence 

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5ANA successfully champions professional nursing excellence through standards, code of ethics, 

6and professional development, such as credentialing and lifelong learning. 

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Healthcare & Public Policy 

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11ANA is an acknowledged leader in the formulation of effective healthcare and public policy as 

12they affect the profession and the public. 

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Knowledge & Research 

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17ANA is the recognized source for accurate, comprehensive health policy information based on 

18knowledge from research. 

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Unification 

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23ANA facilitates unification and advancement of the profession. 

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Advocacy for Workforce & Workplace Issues 

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28ANA with its partners and through its organizational relationships is a leader in promoting 

29improved work environments and the value of nurses as professionals, essential providers and 

30decision makers in all practice settings. 

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Organizational Effectiveness 

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35ANA improves its organizational structure and resources to pursue its vision, achieve its 

36mission, and address the needs of its constituents, structural units, related entities, and associate 

37organizational members. 

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ANA Strategic Imperatives 

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STRATEGIC IMPERATIVE #1: PROFESSIONAL PRACTICE AND 

EXCELLENCE 

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4Cover the Uninsured Week 2008 

5Background: 

6ANA is a coalition representative in the Cover the Uninsured Week (CTUW) campaign, an annual event 

7designed to focus attention on the plight of the nearly 46 million Americans who lack health coverage, 

8as well as to highlight the efforts being made by various states and communities to cover persons who 

9lack health insurance and their families. The campaign also works to ensure that people who are 

10uninsured get enrolled if they are eligible for public coverage programs. 

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12Organizers of Cover the Uninsured Week – the largest campaign in history to focus attention on the need 

13to secure health coverage for Americans – encourage people from all walks of life to talk with their 

14friends and neighbors and get involved. An interactive Web site, www.CoverTheUninsured.org, helps 

15people organize and participate in CTUW activities and express their concern for the uninsured by 

16instantly sending an email to their member of Congress. 

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18In past years, forums held in Washington, D.C., and around the nation have featured high-profile 

19business leaders talking about how rising health care costs are affecting their business, their ability to 

20provide health insurance for employees, and the need for national solutions. In addition, hundreds of 

21Cover the Uninsured Week enrollment events are held every year during CTU week at hospitals, medical 

22centers, malls, community centers, and in places of worship nationwide. Volunteers have enrolled 

23uninsured adults and children in public programs that provide low-cost or free coverage to those who 

24are eligible. In addition, information about local resources has been distributed. 

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26ANA has been a partner in the Cover the Uninsured Campaign since its inception in 2000 and to date 

27remains the only nursing organization involved in this coalition. In addition to ANA, nine other original 

28coalition members include the campaign’s sponsor, the Robert Wood Johnson Foundation, as well as 

29the American Hospital Association, American Medical Association, AFL-CIO, Families USA, 

30America’s Health Insurance Plans, (formerly Health Insurance Association of America), Catholic 

31Health Association of the United States, Service Employees International Union and the U.S. Chamber 

32of Commerce. Other organizations that have joined the CTUW coalition in recent years include 

33Healthcare Leadership Council, AARP, United Way of America, National Medical Association, Blue 

34Cross and Blue Shield Association, Federation of American Hospitals, The California Endowment, 

35National Alliance for Hispanic Health, and the W.K. Kellogg Foundation. 

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37January 2008 Update: 

38This year’s Cover the Uninsured Week will be held April 27-May 3, 2008. It provides an opportunity to 

39galvanize support for the reauthorization of the State Children’s Health Insurance program (SCHIP). 

40SCHIP was scheduled to expire in October of 2007, but Congress voted to extend the program, at its 

41current funding levels through March of 2009. To date, ANA has contributed to the message testing 

42being conducted which will serve as the basis for the 2007 campaign. The first meeting of the Cover the 

43Uninsured Week partners has not yet been scheduled. Independently of the CTUW activities, ANA 

44included SCHIP reauthorizations in a press release dated December 19, 2007. 

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46March 2008 Update: 

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1This year, the dates for Cover the Uninsured Week have been set for April 27-May 3. ANA took part in 

2a CTU Partner conference call on February 12, 2008 and conveyed our plans to communicate the 

3week’s messages and opportunities for involvement through our various channels of communication. 

4No plans for a nationwide event were discussed. 

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6June 2008 Update: 

7ANA incorporated Cover the Uninsured Week message into a list serve announcement analyzing 

8Senator John McCain’s health care plan, and reaffirming ANA’s commitment to health care coverage 

9for all. The announcement was distributed to all list serves and posted to nursingworld.org, ANA also 

10sent out an item in Nursing Insider, urging participation in Cover the Uninsured Week activities, 

11including a link to the Cover the Uninsured Week site. 

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13December 2008 Update: 

14There were no updates this month for the Cover the Uninsured Week partners. However, independently 

15of our involvement in CTUW activities, ANA acknowledged the election results with a press release 

16congratulating President –elect Obama, and resolving to work with him and lawmakers on health 

17reform. Additionally, ANA disseminated a release announcing the Senate and House election results, 

18also pledging work with new and re-elected lawmakers. ANA submitted a written statement to the 

19Senate Finance Committee hearings (11/19) on Sen. Max Baucus’ health care reform plan. 

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22National Healthcare Decisions Day 2008 

23Background: 

24The American Nurses Association (ANA) along with a broad array of other organizations has partnered 

25with the National Hospice and Palliative Care Organization (NHPCO) in promoting National Healthcare 

26Decisions Day, which is April 16, 2008. The National Healthcare Decisions Day Initiative is a 

27collaborative effort of national, state and community organizations committed to ensuring that all adults 

28with decision-making capacity in the United States have the information and opportunity to 

29communicate and document their healthcare decisions. 

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31On April 16, 2008, throughout the country, health care providers, professionals, chaplains, attorneys, 

32and others will participate in a massive effort to highlight the importance of advance health care 

33decision-making. All ANA members should consider what their health care choices would be if they are 

34unable to speak for themselves. 

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36The following national organizations have already committed to participating in this event by 

37encouraging their members and chapters to engage in various education initiatives on National Health 

38care Decisions Day: AARP, Administration on Aging, Aging with Dignity, American Association of 

39Critical-Care Nurses, American Association of Homes and Services for the Aging, 

40American Health Care Association, American Health Decisions, American Health Lawyers Association, 

41American Hospital Association, American Medical Directors Association, 

42American Nurses Association, Association of Professional Chaplains, American Society of Directors of 

43Volunteer Services, Catholic Health Association of the United States, Center for Medicare Advocacy, 

44Center for Practical Bioethics, Center for Social Gerontology, Duke Institute on Care at the End of Life, 

45Federation of American Hospitals, Financial Planning Association, McGuireWoods, LLP, National 

46Academy of Elder Law Attorneys, National Association of Catholic Chaplains, National Association of 

47Social Workers, National Association on Directors of Nursing Administration in Long Term Care, 

48National Hospice and Palliative Care Organization, National POLST Paradigm Initiative Task Force and 

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1The Hastings Center. 

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4As of February 24, 2008, ANA has distributed a listserv announcement advertising NHDD to its 

5members and the public. Also, an article has been included in the February CMA Insider, which is 

6distributed to the CMAs on a monthly basis. 

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8Communications is participating in conference calls to work together to coordinate media outreach for 

9NHDD. The next conference call is scheduled for Thursday, February 28, 10:00 – 11:00 EST to discuss 

10a communications plan for NHDD. 

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12ANA plans to publicize National Healthcare Decisions Day by producing the following communication 

13tools: produce a press release, contribute to a joint release, link to the NHDD Web site from NW. Also, 

14there is talk of a press event on April 16, 2008. We hope to learn more on the February 28 call. 

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16Furthermore, initiative organizers have provided clear, concise, and consistent information and tools for 

17the public to execute written advance directives (health care power of attorney and/or living will) in 

18accordance with their applicable state laws. These resources are available at: 

19http://www.nationalhealthcaredecisionsday.org/. Also, a variety of ideas for events and activities can be 

20found on the Web site under “Organize Your Community.” This is a wonderful opportunity to work 

21collaboratively with other healthcare organizations and a great chance to gain increased recognition for 

22your organization. 

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25The American Nurses Association (ANA) fulfilled its commitment in communicating NHDD by 

26producing the following through all our communication channels: a listserv announcement, a press 

27release, two articles were published in the February 2008 CMA Insider, The American Nurse ran an 

28article in the March/April issue of TAN, a listserv announcement for the CE webinar was distributed. 

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30Also, an article was published in Nurse Zone and in The Maryland Nurse state newsletter, the February, 

31March, April 2008 edition. 

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33The National Healthcare Decisions Day committee sent out a request for participating organizations to 

34complete an evaluation to evaluate this year’s NHDD. ANA completed the evaluation and submitted it 

35on April 18, 2008. 

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37Overall, NHDD was a big success nationwide – there was participation in all 50 states, DC, Puerto Rico 

38and internationally. There were 75 national organizations and at least 375 community/state 

39organizations that engaged in events and outreach activities to improve the lives and care of millions of 

40patients and individuals in advance care planning. 

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42The NHDD Executive Committee provided the following closing stats on their conference call on 

43Friday, May 9, 2008: 76 national organizations participated, 392 state and local organizations, 3 

44proprietary, 1 International Navy Hospital and 31 states with state liaisons. According to NHDD, there 

45were over 100 news articles on NHDD. Furthermore, NHDD Googled “National Healthcare Decisions 

46Day” the day after NHDD and there were around 3,000 media hits. 

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1As of November 14, 2008, we are four months from the second annual National Healthcare Decisions 

2Day, April 16, 2009. The goal for NHDD 2009 is still the same, to provide increased focus on the 

3importance of advance care planning and advance directives for both the public and providers in every 

4state. 

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6On October 1, 2008 a conference call was held to discuss plans for next year. NHDD is in the process of 

7updating their web site to get ready for 2009. A request for financial support from participating 

8organizations for 2009 was mentioned on the call. ANA contributed $1,000 for the coming year’s 

9activities – national media events and educational outreach on advance directives. NHDD will hold a 

10conference call in the coming weeks to discuss next steps for the 2009 campaign. 

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13Substance Abuse and Mental Health Services Administration Minority Fellowship 

14Program 

15Background: 

16The Substance Abuse and Mental Health Services Administration (SAMHSA) supports the Minority 

17Fellowship Program (MFP) at the American Nurses Association. It was formerly referred to as the 

18Ethnic Minority Fellowship Program (EMFP). It is one of the most innovative and effective models in 

19the United States for the education of ethnic minority nurses and other professionals in substance abuse 

20and mental disorders prevention and treatment. One of the many unique features of this program is its 

21concentration on doctoral education for nurses in this specialty. The MFP Model is recognized in 

22national and international communities for its outstanding graduates, and their contributions to the 

23reduction of morbidity and mortality and the enhancement of well being. 

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25The World Health Organization has reported that substance abuse and mental illness remain two of the 

26world’s major public health problems. These truths are the keystone on which the MFP is built and 

27nurtured. The MFP Fellows have opportunities to develop and test culturally sensitive prevention, early 

28detection, and treatment interventions for both of these maladies. They also carefully explore the 

29overlap between the social determinants of health and substance abuse and mental health disorders. 

30They recognize that vulnerable groups can be and are present in many settings, including the 

31community, acute care facilities, and primary care service organizations. The Fellows also understand 

32the necessity to transcend traditional and restrictive intellectual and physical boundaries that could be 

33barriers to culturally competent healthcare services to individuals and families. In order for evidence- 

care to proliferate within the services that are provided in health systems, knowledge and skill sets 

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35must include research, practice, health policy, and education. 

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38The MFP has had an active and productive period. The strategies that have been implemented to 

39address the goals and objectives of this innovative program are, by design, diverse and pithy. Please see 

40the following: 

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42Appointment of New Fellows 

43The MFP is proud to announce the appointment of Fellow Beverly Patchell, RN, MS, CNS. Ms. 

44Patchell is a doctoral student at the New Mexico State University and the immediate past president of 

45the National Alaska Native American Indian Nurses Association (NANAINA). Her research area of 

46interest relates to health beliefs and practices and its influence on perceived susceptibility and severity 

47of illness among American Indian children and youth who are at risk for substance abuse and/or mental 

48health disorders. Ms. Patchell is a member of the Cherokee Nation Tribe. Four additional fellowships 

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1are pending completion of contingencies. 

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3Intensive Winter Institute 

4The MFP was the guest of the Honorable Lt. Governor James “Duke” Aiona, Jr., during the 4 th Annual 

5Intensive Winter Institute (IWI), January 23-27, 2008, in Honolulu, Hawaii. The IWI theme, “Exploring 

6Hawaii: It’s People, Culture, and Health Care” highlighted key elements in substance abuse and mental 

7health practice, research, education, and policy. Cultural competence, core knowledge and skills, and 

8the application of research in health policy and practice were the concepts that were the primary 

9underpinnings of the IWI. Relevant continuing education for the substance abuse and mental health 

10services workforce, within the context of best practices and cultural competence was also emphasized. 

11The Fellows had an opportunity to gain an in-depth understanding of the Hawaiian people and their 

12culture. Importantly, a major focus was on the health programs that have been designed to assure that 

13there is a “Place in the Community for Everyone, “such as the Wai’anae Coast Comprehensive 

14Community Health Center, the Hale Imua Program, the Hale Na’au Pono and the Koolau Clubhouse, 

15and other transitional residential programs for conditional release of consumers from the Hawaii State 

16Hospital. 

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18Grant Application 

19Notice of Request for Application (RFA) has been received from SAMHSA for a three-year grant which 

20will be due on March 19, 2008. This new grant application announces that the Center for Mental Health 

21Services (CMHS) plans to sponsor the development of a MFP Coordination Center MFP CC) through 

22funds allocated to the MFP. The purpose of the Center will be to enhance the effectiveness of the MFP 

23programs across the five disciplines. The MFPCC will be charged with analyzing grantee reporting 

24methods and systems and how the programs might be strengthened; developing and coordinating a 

25multi-disciplinary (social work, psychology, psychiatry, nursing, marriage and family therapy) 

26workgroup to address findings in the MFP longitudinal evaluation findings; fostering multi-disciplinary 

27approaches to recruitment and retention of program participants, participant tracking and mental health 

28curriculum development; and addressing multi-disciplined approaches to improving the placement of 

29MFP participants in mental health and substance disorders prevention and treatment in underserved 

30areas and increasing program participant familiarity with National Outcome Measures for mental health. 

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32Research and Practice Initiative 

33The MFP has been invited to host its 5 th Annual Intensive Summer Institute in conjunction with the 

34National Black Nurses Association’s (NBNA) 36 th Annual Institute and Conference, August 1 – 3, 

3520008 in Las Vegas, NV. Additionally, ten MFP Fellows have submitted abstracts to present during the 

36NBNA Conference Mental Health Institute. 

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38MFP Fellows’ Contributions to Science and Service 

39Bridgette Brawner, PhDc, APRN successfully defended her dissertation proposal, “Depression and HIV 

40Risk-Related Sexual Behaviors among African American Adolescent Females,” on December 10, 2007. 

41Ms. Brawner attributes the fact that she “passed with no revisions” to her chair, Dr. Christopher L. 

42Coleman, a former SAMHSA EMFP/ANA Fellow. 

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44Michelle Decoux Hampton, PhD, RN, MS has recently published an article, “The role of treatment 

45setting and high acuity in the over diagnosis of schizophrenia in African Americans” was featured in 

46Archives of Psychiatric Nursing, 21 (6), 327-335, 2007. 

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48Doris M. Hill, PhD, RN, CNOR recently completed a two-year post doctoral fellowship under the 

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1auspice of the University Of Minnesota School Of Medicine in Duluth, MN. Most recently, Dr. Hill 

2was appointed to the position of Dean of Health Services at Normandale Community College in 

3Bloomington, MN. 

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5Kim Jolly, RN, MS had had her abstract, “Cultural-Sensitive Indicators for Studying Risk Behaviors in 

6Afro-Caribbean Adolescents,” accepted for poster presentation during the Southern Nursing Research 

7Society (SNRS) Conference, February 21 – 23, in Birmingham, AL. 

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9Christina Leal, PhDc, MSN, RN successfully defended her dissertation proposal, “The Occurrence of 

10Intimate Partner Violence Over Time in Men who are Dually Enrolled in a Batterers’ Intervention 

11Program and a Substance Abuse Treatment Program,” on January 14, 2008. Ms. Leal is poised to 

12complete her data collection and graduate by summer 2008. 

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14Robert Pope, RN, MSN and Mary Black, RN, MS participated in a panel presentation during the 

15Leadership Conference of the John A. Hartford Foundation Geriatric Nursing Initiative. They received 

16many accolades for their extraordinary leadership and strong influence on the success of the conference, 

17December 2007, in San Diego, CA. 

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19Robert Pope also presented on “Ethnicity, Culture and Chronic Illness Discourses: Challenges and 

20Opportunities in Research with Underserved Groups,” at the Gerontological Society of America’s 

21(GSA) 60 th Annual Convention and again during the National Coalition of Ethnic Minority Nurses 

22Association, Inc. (NCEMNA) 4 th National Conference, March 6 – 9, 2008 in San Diego, CA. 

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24Mayola Rowser, DNP, MSN, RN, CNS presented her research on “Depression and Obesity in African 

25American Women Transitioning from Welfare to Work,” during the December 2007 National Nursing 

26Center Consortium Conference in Washington, DC. 

27Ella M. Scott, PhD, RN, CNS,BC has been informed that her abstract, “Lived Mental Health 

28Experiences of Adolescents of Color in Foster Care,” was selected for podium presentation during the 

299 th Annual Evidence-Based Practice Conference, February 14 – 15, 2008 in Glendale, AZ. She will also 

30present a poster on the same theme at the National Coalition of Ethnic Minority Nurses Associations, 

31Inc. (NCEMNA) 4 th National Conference, March 6 – 9, 2008 in San Diego, CA. 

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34Five (5) SAMHSA MFP Fellows earned their doctorates in 2008, so far. One graduate was awarded the 

35National Institutes of Health (NIH), National Institute of Nursing Research, HIV/AIDS Nursing care and 

36Prevention Training Post-doctoral Fellowship; another graduate has been awarded a Fellowship from 

37the National Hispanic Network on Drug Abuse and; a third graduate has accepted a tenured track 

38Assistant Professor position at Kent State University. 

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40Fellows’ manuscripts have been accepted in more than four refereed journals and they have participated 

41in more than fifty (50) podium and poster presentations in national and international settings, including 

42Hawaii, Austria, Prague Czech Republic, and Padua Italy. 

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44The MFP Program Director has engineered a wide range of innovative programs that have helped to 

45establish the “MFP Virtual University.” One of the programs is the yearly Intensive Winter and 

46Summer Institutes where a Fellow spends an average of 12 hours a day, over four days learning about 

47research methods, statistics and mental health and substance abuse as it relates to specific themes that 

48are developed for each institute. For example, in January 2008, the MFP Fellows were invited to be the 

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1guest of the Lieutenant Governor, State of Hawaii, with the objective of learning about mental health 

2and substance abuse issues that confront the indigenous people of Hawaii. This objective was 

3accomplished by conducting field visits to mental health and substance abuse treatment facilities on the 

4Island, by meeting researchers, health practitioners, the lieutenant governor, lawyers and other 

5stakeholders that work with this population. One of the highlights of the experience was the Fellows’ 

6interactions with individuals who carry the burden of mental illness and/or substance abuse, and 

7communicating with practitioners who participate in their daily health care. 

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9Another example of an innovative program that is embedded in the MFP Virtual University is the 

10Statistics Study Group (SSG). The aim of the SSG is to strengthen the Fellows’ research and the 

11analytic potential that is the key element in robust science. The MFP approach includes weekly 

12teleconferences directed by the Executive Program Consultant/Director and the MFP 

13Statistician/Consultant with access to an online workroom in which questions, notes, and solutions 

14regarding statistical issues are posted, readings and assignments, and individual consultations. 

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16The MFP Program Manager disseminated information about substance abuse and mental health 

17disorders and information about the Minority Fellowship Program at the Asian American Pacific 

18Islander Nurses Association (AAPINA) conference, May 22 – 25, 2008 in Las Vegas. Plans are 

19underway to disseminate MFP program literature during the National Association of Hispanic Nurses 

20(NAHN) Conference, July 15 – 18, 2008 in Boston, MA. 

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22Plans for the Future 

23The MFP will conduct its 5 th Annual Intensive Summer Institute in conjunction with the National Black 

24Nurses Association (NBNA) Conference in August 2008 in Las Vegas. This Institute will feature Dr. 

25Brian Smedley, co-author of the book Unequal Treatment, the Institute of Medicine, Washington, 

26DC. Five Fellows will present their refereed research at the NBNA Mental Health and Women’s 

27Institute. 

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29Abstracts have been submitted for presentation at the XIV World Congress of Psychiatry Congress in 

30Prague Czech Republic in September 2008; and plans are under way to submit an abstract to the 

31International Council of Nursing Conference, Durban, South Africa, 2009. 

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33The MFP staff plans to develop a multilevel business plan to sustain the MFP should federal funding 

34cease. The Plan will consist of an executive summary that outlines the objectives and clearly articulates 

35the mission. It will encompass a 501 (c) 3 status that will provide an umbrella for fundraising and, at the 

36same time, allows the MFP to address its immediate needs – educating ethnic minority Fellows at the 

37doctoral level. 

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39MFP Directors Meeting Council on Social Work Education (CSWE) Minority Fellowship Program 

40(MFP) hosted the spring MFP Directors meeting, June 18, 2008 in Alexandria, VA. Participants 

41included all the core mental health professions: the American Nurses Association, American 

42Psychology Association, American Psychiatric Association, and Marriage and Family Therapy. Other 

43guest included the program staff from the American Sociological Association’s Minority Affairs and the 

44American Political Science Association’s Minority Initiatives. Topics ranged from diversity in science, 

45to legislative updates and funding, to the SAMHSA proposed MFP Coordinating Center. Many good 

46ideas and best practices were shared. CSWE Chief Executive Officer, Dr. Julia Waktins encouraged the 

47group to continue its collaboration efforts and asked an organization to volunteer to host the next 

48meeting. Nursing MFP agreed to host a meeting at the ANA headquarters in late summer or early fall 

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• Disseminated information about the Minority Fellowship Program at the National Association of 

Hispanic Nurses (NAHN) conference, July 15 – 18, 2008 in Boston, MA. MFP Fellow Rosa 

Gonzalez-Guarda, PhD, MPH, RN, presented an oral presentation from her dissertation research 

entitled “Sex, Drugs, and Violence: Factors Influencing Health in Hispanic Populations.” 

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41 

42 

43 

44 

45 

46 

• Convened the 5 th Annual Intensive Summer Institute in conjunction with the National Black 

Nurses Association (NBNA) conference, August 1 – 4, 2008 in Las Vegas, NV. The Institute 

featured Brian Smedley, PhD, co-author of the book Unequal Treatment, the Institute of 

Medicine, Washington, DC. Additionally, five Fellows presented podium presentations from 

their dissertation research during the NBNA Women’s and Mental Health Institutes. 

• Presented a podium presentation, “A Road Map for Success: Models for Educating Ethnic 

Minority Nurses in Substance Abuse and Mental Health Services in the United States,” during 

the XIV World Congress on Psychiatry Conference, September 20 – 25, 2008, in Prague, Czech 

Republic. Presenters included MFP Program Manager, Janet Jackson; MFP 

Evaluator/Statistician Hossein Yarandi, PhD and MFP Alumni, Michelle Hampton, PhD, RN. 

• Disseminated information about the MFP, the American Nurses Association (ANA), and the 

American Nurses Credentialing Center (ANCC) during the American Assembly for Men in 

Nursing (AAMN) Conference, October 24 – 25, 2008 in New Orleans, LA. MFP Fellow Bruce 

Kafer, RN, MS delivered an oral presentation on “Native American Nursing: Leading in a 

Warrior Tradition” and MFP Fellow Robert Pope assisted with the recruitment/retention efforts. 

• Participated in the National Alaska Native American Indian Nurses Association (NANAINA) 

Summit XIV, October 26 – 29, 2008 in Branson, MO. MFP Fellow Donna Grandbois, PhD, RN 

presented a poster presentation on the “Resilience of Native American Elders.” Beverly 

Patchell, RN, MS, MFP Fellow and the Immediate Past President of NANAINA, presented on 

the topic of “Nurses Partnering with Nurses” during a Plenary Session. MFP Alumni, Beverly 

Malone, PhD, RN, FAAN, and CEO, National League for Nursing, delivered the Keynote 

Address entitled “Forging Partnerships within Nursing.” Faye Gary, EdD, RN, FAAN, MFP 

Executive Program Consultant/Director was awarded an honorary membership in NANAINA 

and MFP Program Manager, Janet Jackson, was honored with a Native blanket for their abiding 

support of the Native American Fellows and NANAINA. 

• Sponsored two Fellows to participate in the 24 th Annual Rosalynn Carter Symposium on Mental 

Health, November 21 – 22, 2008 at the Carter Center in Atlanta, GA. The Symposium theme 

was “Unclaimed Children Revisited: Fostering a Climate to Improve Children’s Mental Health.” 

Featured speakers included Jane Knitzer, PhD, Executive Director of the National Center for 

Children in Poverty and author of Unclaimed Children and The Honorable Patrick Kennedy, (D- 

RI). 

• Disseminated information about the MFP during the 2 nd Annual National Conference on Health 

Disparities, December 4 – 7, 2008 at the University of the Virgin Islands in St. Croix, Virgin 

1 

2 



1 

2 

3 

4Plans for the Future 

Islands. This Conference was co-sponsored by the Congressional Black Caucus, the National 

Center on Minority Health and Health Disparities, and the Medical University of South Carolina. 

5 

6 

7 

8 

9 

10 

• Plan to participate in the National Institute of Health (NIH) Summit: The Science of Eliminating 

Health Disparities, December 16 – 18, 2008 at the Gaylord National Resort and Convention 

Center on the Potomac at the National Harbor, MD. This conference will allow participants to 

make recommendations that will shape the NIH health disparities strategic plan and establish a 

framework for ongoing dialogue and creation of innovative and unique partnerships to address 

disparities in health in all affected communities. 

11 

12 

13 

14 

15 

16 

• The MFP will convene its 5 th Annual Intensive Summer Institute (ISI), January 15 – 18, 2009 in 

Miami, FL in conjunction with the Florida International University. The ISI will focus on 

specific approaches to addressing substance abuse and mental health issues: prevention, 

treatment and rehabilitation interventions for Hispanics and others. Eighteen Fellows are 

expected to participate. 

17 

18 

19 

20 

21 

22 

23 

• Expansion of the MFP technology infrastructure which will allow for the recordings, 

videoconferencing and/or podcasts of all lectures and other learning strategies that are used in 

the MFP Virtual University. The purpose of the Virtual University is to enhance the Fellows’ 

opportunities for the acquisition of knowledge and skills that are essential for their success in 

providing services in prevention, treatment, and rehabilitation for those individuals and families 

who are at risk for or carry the burdens of mental and substance abuse disorders. 

24 

25 

26Publishing 

27Background: 

28Nursesbooks.org is the official publishing program of the American Nurses Association. Included in its 

29list of titles is the Code of Ethics for Nurses with Interpretive Statements, Nursing: Scope and Standards 

30of Practice, and Nursing’s Social Policy Statement, as well as 25 specialty Scopes and Standards of 

31Practice. Nursesbooks.org also publishes books on ANA core issues and programs, as well as on 

32cutting-edge healthcare topics. Today, the publications catalog carries 80 products and in 2007 the 

33program grossed ANA over $1.6 million in revenue. 

34 


36Two ANA books have received 2007 Awards of Excellence from the Washington, DC, Chapter of the 

37Society for Technical Communication (STC): Transforming Nursing Data into Quality Care: Profiles of 

38Quality Improvement in U.S. Healthcare Facilities, by Isis Montalvo, RN, MS, MBA, and Nancy 

39Dunton, PhD, and Teaching IOM: Implications of the IOM Reports for Nursing Education, by Anita 

40Finkelman, MSN, RN, and Carole Kenner, DNS, RNC, FAAN. The STC is the largest individual 

41membership organization in the world dedicated to promoting technical communication. In granting the 

42awards, the judges recognized the quality of the content, writing, editing, design, as well as the total 

43integrated quality of the ANA books. 

44 


46Since the January Update, Nursesbooks.org has published Informatics Nursing: Scope and Standards of 

47Practice. Also in the pipeline for 2008 are the Administration, Cardiovascular, Pediatric, and 

48Professional Development Standards, as well as Faith Community Nursing: Developing a Quality 

1 

2 



1Practice; Genetics and Ethics in Healthcare: New Questions in the Age of Genomic Health; Nursing and 

2Healthcare Ethics: A Legacy and a Vision; and a second edition of Teaching IOM to cover the most 

3recent IOM Reports. The spring publications catalog is about to go to the printer and will drop in March 

4to 50,000 people. Extensive other promotions for the latest publications are also being implemented. 

5 

6In other news, STC award winner Teaching IOM is starting to receive national recognition in the nursing 

7profession, especially among nursing educators, for its new ideas on how to reform nursing education. It 

8has recently received favorable book reviews, enthusiastic interest at meetings and workshops of the 

9American Association of Colleges of Nursing, and positive attention at other conferences where the 

10authors have been keynote speakers. The book’s basic premise is that improving the quality of nursing 

11education will improve the quality of nursing care nationwide. According to the authors, one way to 

12dramatically improve nursing education is to place the lessons of the IOM Reports at the center of all 

13nursing curricula. The book’s sales have exceeded expectations, and it has already gone into a second 

14printing. 

15 

16Nursesbooks.org is also about to publish two other important books for nursing students, educators, and 

17others in the profession. One of the books, Guide to the Code of Ethics for Nurses: Interpretation and 

18Application, explains provision by provision how to apply the ANA 2001 Code of Ethics for Nurses with 

19Interpretive Statements to nursing practice. In response to pre-publication publicity, Nursesbooks.org 

20has already received requests for review copies and bulk orders for course adoption from nursing 

21educators. 

22 

23The second book about to be published is Specialization and Credentialing in Nursing Revisited: 

24Understanding the Issues, Advancing the Profession. This book builds on and includes Margretta 

25Styles’ influential 1989 book, On Specialization in Nursing: Toward a New Empowerment. The new 

26book, co-authored by Styles, Mary Jean Schumann, Kathi White, and Carol Bickford, describes and 

27analyzes all issues involved with the current conflicting approaches to APRN regulation. The book 

28examines the history, current status, and issues of nursing accreditation, educational standards, 

29certification, and regulation, especially for advanced practice nursing. Also addressed are the current 

30single-continuum scope and standards of practice and the safeguards in place to ensure competent 

31advanced practice registered nurses. 

32 


34Since the March Update, Nursebooks.org has published three books: Guide to the Code of Ethics for 

35Nurses: Interpretation and Application; Specialization and Credentialing in Nursing Revisited: 

36Understanding the Issues, Advancing the Profession; and Cardiovascular Nursing: Scope & Standards 

37of Practice. 

38 

39Published in March, Guide to the Code of Ethics was written by the nurse ethicists who worked on the 

402001 ANA Code of Ethics. The book explains how to apply the ANA Code to nursing practice and 

41includes the full 2001 Code. It is being packaged with Nursing’s Social Policy Statement and Nursing: 

42Scope & Standards of Practice and this package is being promoted as the new, upgraded Foundation of 

43Nursing package. So far, sales and course adoption for the new book and upgraded Foundation package 

44have been going well and are expected to continue to grow in the coming months. 

45 

46The long-awaited Specialization and Credentialing in Nursing Revisited was published the week of 

47April 14, in time for the 2008 APRN Stakeholders Meeting. This book contains Dr. Margretta Styles’ 

48final thoughts on APRN issues and regulation, expanded upon by co-authors Mary Jean Schumann, 

1 

2 



1Carol Bickford, and Kathi White. The book has been well received so far and its influence is expected to 

2grow due to the numerous conferences and meetings being held on this topic in the coming months. 

3 

4Cardiovascular Nursing: Scope & Standards of Practice represents a major co-publishing venture 

5between the American College of Cardiology Foundation (ACCF) and American Nurses Association. 

6The two organizations will be promoting the book together at an ACCF 4-day workshop in the fall, 

7which will focus on the core curriculum required for the cardiovascular clinician. In addition to ANA 

8and ACCF’s co-publishing these Standards, 13 major related associations have endorsed them: 

9American Association of Cardiovascular and Pulmonary Rehabilitation, American Association of Heart 

10Failure Nurses, American College of Cardiovascular Nursing, American College of Nurse Practitioners, 

11American Heart Association, Heart Rhythm Society, International Transplant Nurses Society, National 

12Association of Clinical Nurse Specialists, National Gerontological Nursing Association, Preventive 

13Cardiovascular Nurses Association, Society of Vascular Nursing, Society of Invasive Cardiovascular 

14Professionals, and Society of Pediatric Cardiovascular Nurses. 

15 

16Next on the docket for publication is the Pediatric Nursing: Scope & Standards of Practice, which will 

17be published in June. For the first time, this book has been co-developed and is being co-published in 

18collaboration with both the Society for Pediatric Nurses and National Association of Pediatric Nurse 

19Practitioners. 

20 

21In other news, STC award winner Teaching IOM: Implications of the IOM Reports for Nursing 

22Education received an outstanding book review from Yale University nursing professor, Leslie Neal- 

23Boylan, PhD, RN, CRRN, APRN-BC. The reviewer recommends the book for all nursing educators 

24interested in improving nursing education nationwide. Authors Anita Finkelman, MSN, RN, and Carole 

25Kenner, DNS, RNC, FAAN, and Dean, University of Oklahoma School of Nursing, have been invited to 

26conduct training workshops on the book’s ideas and content for professors and graduate students at 

27various schools of nursing. Also, an article discussing the authors’ ideas on how to use the IOM Reports 

28to improve nursing education appeared in the May 2008 issue of American Nurse Today. 

29 

30On another front, Nursesbooks.org has been working hard to promote the new 2008 titles, including 

31articles and ads in The American Nurse and American Nurse Today; e-mail blasts to nursing educators 

32and past purchasers; press releases to the media; and several other promotions. The Spring 2008 

33Publications Catalog, featuring the new Guide to the Code of Ethics on its cover, mailed in March and 

34April to 60,000 people. Also being developed is an insert on new ANA books for mailings sent to new 

35members. This is a very cost-effective way to expose new members to ANA publications. 

36 

37In addition, so far this year, the publishing program has had a very successful bookstore at the NDNQI 

38Conference in Orlando and very successful booths at meetings of the American Association of Colleges 

39of Nursing, American Organization of Nurse Executives, and National Student Nurses Association. The 

40publishing staff is gearing up for the Bookstore at the 2008 ANA House of Delegates. Booths and 

41bookstores are also planned for meetings of the National League for Nursing in September, American 

42Association of Colleges of Nursing in October, and 2008 Magnet Conference also in October. 

43 


45Since the June update, Nursesbooks.org has published the following titles: Nursing and Health Care 

46Ethics: A Legacy and A Vision; Home Health Nursing: Scope & Standards of Practice; and Pediatric 

47Nursing: Scope & Standards of Practice. Also in the pipeline for publication in November and 

48December 2008 are Genetics and Ethics in Healthcare: New Questions in the Age of Genomic Health 

1 

2 



1and Faith Community Nursing: Developing a Quality Practice. 

2 

3 

4In development for 2009 publication and beyond are Scope & Standards of Practice for Nursing 

5Administration, Forensic, Professional Development, Transplant, and Respiratory Nursing. Also in 

6development for 2009 are the NDNQI 09 Monograph and the second edition of Teaching IOM: 

7Implications of the Institute of Medicine Reports for Nursing Education, which will include an 

8instructor’s manual and participant’s guide on CD-ROM. The first edition of this book has sold very 

9successfully to nursing professors. In fact, the authors continue to give workshops to entire faculties at 

10nursing schools where the dean is interested in using the ideas in this book to revise the school’s nursing 

11curriculum. 

12 

13Since the June update, Nursesbooks.org has also begun to work with ANA Online Services and Office 

14of Technology to redesign the ANA online bookstore. With this redesign, Nursesbooks.org plans to 

15achieve four goals: (1) update the store’s look and functionality; (2) integrate the store into the ANA 

16Content Management System; (3) integrate the store with TIMMS in order to sell e-books; and (4) 

17implement Web Services (e-business electronic interface with the ANA fulfillment vendor for order 

18processing and inventory management). Initial meetings have been very productive. To date, SFTP 

19(secure electronic) order file exchange has been implemented as part of the process of updating the 

20ANA online bookstore. 

21 

22In terms of marketing since the June update, Nursesbooks.org has issued its fall catalog, which was 

23mailed in September to over 60,000 people. This catalog featured ANA’s ethics titles, including Code of 

24Ethics for Nurses with Interpretive Statements, Guide to the Code of Ethics for Nurses: Interpretation 

25and Application, and the other new ethics titles listed above. To promote its publications, 

26Nursesbooks.org also published articles and ran advertisements in The American Nurse, American 

27Nurse Today, and other nursing publications; sent e-mail blasts to nursing educators and past 

28purchasers; issued press releases on new publications to the media; and implemented several other 

29promotions for new titles. 

30 

31Since June, Nursesbooks.org held bookstores or exhibits at the 2008 Magnet, American Society of 

32Bioethics and Humanities (ASBH), and National League for Nursing (NLN) Annual Conferences, the 

33fall meeting of the American Association of Colleges of Nursing as well as the ANA House of 

34Delegates. ANA publications were very well received at all of these conferences. 

35 

36ANA’s Foundation of Nursing package and ethics titles were especially well-received at the 2008 ASBH 

37and NLN Conferences, where many professors who teach ethics and scope and standards of practice at 

38nursing schools indicated that they either already require or are going to require their students to read 

39these ANA publications. These conference exhibits were the capstone to the 2008 promotional efforts to 

40increase the use of ANA publications in nursing classrooms. Under the successful ANA Course 

41Adoption Program, use of ANA publications in nursing schools grew by 35% in 2008 and is expected to 

42grow at a similar pace in 2009. 

43 

44 

45Ethics and Human Rights (EHR) 

46Background: 

47In September 1990, the Center for Ethics and Human Rights (EHRC) was established with the following 

48guiding objectives: 

1 

2 



1 • Promulgate in collaboration with ANA constituents, a body of knowledge, both theoretical 

2 and practical, designed to address issues in ethics and human rights at the state, national and 

3 international level; 

4 • Develop and disseminate information about and advocate for public policy to assure that 

5 ethics and human rights are addressed in health care; and 

6 • Assure that short and long-range objectives regarding ethics and human rights will be 

7 addressed within the Association, and expressed to appropriate bodies external to the 

8 Association 

9 

10Constituent Member Associations (CMAs), individual nurses, nurse administrators, educators, journal 

11editors, lawyers, physicians, human rights organizations and other health professionals frequently 

12contact the Center. Issues of interest include the creation and participation in ethics committees at the 

13institutional and state level, clarification of ANA position statements, policies and guidelines of the 

14Code of Ethics for Nurses With Interpretive Statements. The Center regularly receives calls from nurses 

15seeking information about ANA ethics related documents, advice on specific cases, references, citations, 

16and summaries of current literature. Information and guidance related to the implementation of the 

17Patient Self-Determination Act (PSDA), end-of-life care, and development of ethics courses and 

18programs are often sought. ANA Organizational Units receive consultation, dissemination of pertinent 

19information on an ongoing basis, as well as, assistance in ensuring that ethical and human rights issues 

20are addressed throughout the organization. 

21 

22The Center is staffed virtually with a Director, contributing one and a half days per week and an 

23assistant director contributing a half day per week who respond to e-mails, voicemails, interviews and to 

24staff inquiries. 

25 

26The Center for Ethics and Human Rights Advisory Board is a deliberative body of experts who focus on 

27providing guidance to the Center concerning issues of current ethical concern to nursing practice, 

28education, research, administration, and other matters of concern relating to the Center's mission and 

29goals. The Board recommends policy about issues of concern in Ethics and Human Rights to the ANA 

30Board of Directors. Members are appointed by the ANA Board for four year terms and meet at least 

31annually and conduct other business electronically and telephonically. 

32 

33EHR Advisory Board 

34Background: 

35EHR Advisory Board for 2008-2010 includes Dana Bjarnason, Anita Caitlin, Esther Condon, Marge 

36Hegge, Kevin Hook, Karen Iseminger, Vickie Lachman, Cynthia LaSala, John Murray, and Sharon 

37Sweeney Fee. 

38 


40Dana Bjarnason was elected chair by the group at the October face to face meeting and began as chair of 

41the Advisory Board in December. At the time of appointments this year, the Committee on 

42Appointments formalized their election. 

43 

44The Ethics Advisory Board has had two conference calls since the December Board meeting. 

45The group continues to revise and produce documents to support activities of the Ethics Center. In 

46February, the group met by conference call to discuss the following position statements: Cultural 

47Diversity, Discrimination & Racism, Assistance in Dying, Capital Punishment, and Nutrition and 

48Hydration. 

1 

2 



1 


3The last phone meeting of the Advisory Board was held on April 9, 2008. The Advisory Board 

4continues to revise several position statements including those related to end-of-life care. The terms of 

5half of the members (5 members) will expire in June 2008, one member (Susan Dickey) has served two 

6terms and is not eligible for reappointment. The call was sent to members requesting nominations for 

7appointments to the Ethics Advisory Board. 

8 


10The Board met in Cleveland Ohio for two days in October. Minutes from previous meetings 

11(teleconferences) were approved. New members were introduced. They worked on several position 

12statements and reviewed the contents of the ethics section of the NursingWorld website. Corrections and 

13improvements were suggested. Discussion about a national ethics conference resulted in 

14recommendations to the ANA CPO for possible sponsorship or co-sponsorship in 2009 or 2010. Reports 

15of the activities of the Director and Ass't Director included grant applications for Genetics education and 

16diffusion of the Genetic Competencies, responding to emails on multiple ethics questions through the 

17ANA ethics website, participating in interviews for articles on current issues and representing ANA at 

18national meetings addressing such diverse topics as medical use of marijuana, human trafficking and 

19interdisciplinary practice. 

20 

21Genetics Core Competencies 

22Background: 

23ANA partnered with the National Human Genome Research Institute, the National Cancer Institute, and 

24the Office of Rare Diseases of the National Institutes of Health to host a consensus panel to identify and 

25publish essential genetic and genomic competencies for all registered nurses. The document was created 

26by a group of nurse leaders based on the review of earlier peer-reviewed published work reporting 

27practice-based genetic and genomic competencies, guidelines, and recommendations. In January 2005, 

28these competencies were reviewed and revised by nurse representatives to the National Coalition for 

29Health Professional Education in Genetics (NCHPEG) followed by the solicitation of public comment 

30from the nursing community at large before being approved at a September 2005 Consensus Meeting. 

31The Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics were 

32endorsed by 47 representative nursing organizations. The Essential Nursing Competencies and 

33Curricula Guidelines for Genetics and Genomics were published in September 2006 by 

34Nursesbooks.org. The publication can be ordered from the ANA website. The document is also 

35available for download on www.nursingworld.org/ethics. 

36 


38ANA is continuing as a leader in the development of strategies to support the Nursing Genomics Core 

39Competencies. The EHR director participated in an American Association of Colleges of Nursing 

40(AACN) conference on nursing educators and implementation of the Genomics Core Competencies as 

41the ANA representative. The EHRC is actively seeking funding to assess current nursing knowledge 

42and practices around genomics and health care, as well as develop appropriate educational programs for 

43nurses. As part of the knowledge development, ANA publications are near publication of a book on 

44Genetics and Ethics which should be available soon. In conjunction with the ethics work of the Center 

45and the Core Competencies, the OJIN journal published a January 31, 2008 issue dedicated to Genomics 

46in which the lead article authored by the Director, Assistant Director and Jean Jenkins a primary author 

47of the Core Competencies outlined the history of ANA in leading genomics education for nurses. 

48 

1 

2 




2The next meeting of the genomics tool-kit takes place in mid June 2008. 

3 


5Following the mid June 2008 meeting another edition of the core competencies has been completed that 

6includes the outcome indicators. This edition will be published in conjunction with ANA and the 

7website will be updated to reflect the new edition. 

8 

9National Coalition on Health Professions Education in Genetics (NCHPEG) 

10Background: 

11Established in 1996 by the American Medical Association, the American Nurses Association, and the 

12National Human Genome Research Institute, the National Coalition for Health Professional Education 

13in Genetics (NCHPEG) is an "organization of organizations" committed to a national effort to promote 

14health professional education and access to information about advances in human genetics. NCHPEG 

15members are an interdisciplinary group of leaders from more than 140 diverse health professionals 

16organizations, consumer and volunteer groups, government agencies, private industry, managed care 

17organizations, and genetics professional societies. NCHPEG draws on the collective expertise and 

18experience of its members to accomplish a shared mission: 

19 The mission of NCHPEG is to promote health professional education and access to 

20 information about advances in human genetics to improve the health care of the nation. 

21ANA has served as a member of the NCHPEG Board of Directors since its inception. In 2007, 

22NCHPEG became a dues based membership organization. 

23 


25The annual February meeting of NCHPEG was postponed until budget issues could be resolved. The 

26primary funder of NCHPEG in the past was HRSA. Cuts in funding to NCHPEG from HRSA and the 

27late passage of the federal budget have impacted on NCHPEG’s ability to host the annual meeting. 

28 


30The NCPPEG annual meeting has now been scheduled for September 4-5, 2008. Since March, the 

31retirements of both Dr. Francis Collins, the Director of the NIH Human Genome Institute and Joe 

32McInerny, the Executive Director at NCHPEG have been announced. The timing of the retirements are 

33coincidental. A letter of congratulations will be sent to Dr. Collins from ANA in recognition of his 

34positive support of nursing as a key health provider in providing genetic and genomic health care to 

35patients. Dr. Collins for many years has maintained a close connection to nursing and in particular the 

36ANA. Dr. Collins was one of the initial founders of NCHPEG with ANA and the AMA. Dr. Collins 

37spoke both as a keynote at an ANA Convention, as well as, at the initial nursing genomic core 

38competency meeting held at the ANA offices in 2005. 

39 


41The annual NCHPEG meeting was held in Sept 08. This year's theme was Genetics and Common 

42Disease. ANA presented Joe McInerny, Executive Director, with a gift in honor of his retirement. ANA 

43also provided the Continuing Education credit for nurses. 

44 

45Institute of Medicine Roundtable on Translating Genomic-Based Research for 

46Health (IOM Roundtable) 

47Background: 

48Through the Institute of Medicine (IOM), Board on Health Sciences Policy, a Roundtable has been 

1 

2 



1formed to address translation of genomic-based research for health. According to their web sites, "The 

2Board on Health Sciences Policy has as its charge assuring that there is adequate attention to policy 

3issues relating to the science base underlying health and health care -- including the biomedical, 

4behavioral, physical, and social sciences. Of particular concern are the public and private policies and 

5institutional arrangements that shape the way in which these sciences are structured, funded, and 

6coordinated. This encompasses decisions on the availability and distribution of essential resources such 

7as funding, facilities, instrumentation, personnel, and information. The Board's goal is to consider the 

8near-term and long-range impacts of current policies and to suggest revisions, where needed; to call 

9attention to under-supported areas of research, those ripe for development, and those of special 

10importance because of national health problems; and, to foster productive interactions between health 

11scientists and policymakers. To achieve these goals, the Board identifies key problems, develops 

12concepts for specific studies or other activities, and oversees the ongoing program in health sciences 

13policy of the IOM. 

14 

15"The Institute of Medicine Roundtable on Translating Genomic-Based Research for Health brings 

16together leaders from academia, industry, government, foundations and associations who have a mutual 

17interest in addressing the issues surrounding the translation of genomic-based research. The mission of 

18the Roundtable is to advance the field of genomics and improve the translation of research findings to 

19health care, education, and policy. 

20 

21Translating genomic innovations involves many disciplines, and takes place within different economic, 

22social, and cultural contexts, necessitating a need for increased communication and understanding 

23across these fields. Furthermore, these innovations have produced a diversity of new issues to be 

24addressed including issues such as evidence of utility, economic implications, equal access, and public 

25perspectives. As a convening mechanism for interested parties from different perspectives to meet and 

26discuss complex issues of mutual concern in a neutral setting, the Roundtable fosters dialogue across 

27sectors and institutions and fosters collaboration among stakeholders. 

28 

29To achieve its objectives, the Roundtable conducts structured discussions, workshops, and symposia, 

30and will publish workshop summaries. Specific issues and agenda topics are determined by the 

31Roundtable membership, and span a broad range of issues relevant to the translation process. 

32 

33IOM is very well respected as demonstrated in part by the response to the reports they have published. 

34IOM generates media attention and visibility which is good for nursing when ANA is at the table. 

35Nursing is represented on the Board (Martha Hill, PhD) but not at the Roundtable. Specific issues and 

36agenda items will be determined by the membership thus, a nurse member could best represent what is 

37important to nurses and their patients. ANA has been at the forefront for about 10 years. This gathering 

38of individuals from academia, industry and associations should have a nurse at the table. Most nurse 

39specialty groups have either a generalized or focused interest in genomics but genomics impacts all 

40nurses so ANA is the best suited to sit at the table. 

41 


43An ANA staff representative, Dr. Martha Turner, attended the December 2007 meeting as a guest. 

44Following that meeting, a recommendation was made to the BOD for her to continue as a permanent 

45member. This recommendation was approved. She now represents ANA as a permanent member of the 

46Roundtable. 

47 

48The December 4-5 roundtable meeting on translating genomic based research for health met in 

1 

2 



1Washington D.C. Participants discussed the innovations and diffusion of health related technologies. 

2Following a welcome and overview by WYLIE BURKE, Roundtable Chair, Professor and Chair, 

3Department of Medical History and Ethics, University of Washington School of Medicine, there was a 

4panel addressing the translation of innovations and further discussion on: 

5 Understanding Types of Innovation and Implications for Policy, 

6 Lessons for Genomics from Other Technologies, 

7 Translating Medical Innovations with Appropriate Evidence, 

8 Assessing Technology for Use in Health and Medicine, 

9 Integrating Genetic Technology into a Health Care System 

10 Tasks and Challenges of Translation for Producers of New Services. 

11 A Primary Care Provider View of Translating Genomic Innovation 

12 Introducing a Genomic Innovation to Clinical Practice 

13 The Global Perspective and The U.S. Perspective. 

14 

15On the second day there was discussion of Secretary’s Advisory Committee on Genomics, Health and 

16Society (SACGHS) draft report on oversight and these questions were addressed: 

17 

18 

1. What are the main issues identified? 

19 

2. How do they relate to the steps of translation? 

20 

3. How do the presentations aid in the development of a framework for Roundtable 

21 

activity? 

22 

4. What are the priority topics for further exploration? 

23 

24The members decided to devote the July 2008 meeting to an in depth examination of the translation of 

25four different cases. The cases identified are CYP-450/SSRI, Thrombophilia testing, CGH array, both 

26prenatally and for developmental delay, and Abacavir. The plan is to devote a half day to each case with 

27a speaker invited to describe the process of translation for each case and the rest of the time spent in 

28delving deeply into the translation process for each. Individuals who would be knowledgeable about 

29one or more of the case topics will be invited to speak. There will be one primary speaker but others 

30may also be invited to help explore the translation process during the discussion. 

31 


33The roundtable meeting on translating genomic based research for health met in Dec. 2007 in 

34Washington D.C. We discussed the innovations and diffusion of health related technologies. Following 

35a welcome and overview by WYLIE BURKE, Roundtable Chair, Professor and Chair, Department of 

36Medical History and Ethics, University of Washington School of Medicine, there was a panel addressing 

37the translation of innovations and further discussion on: 

38Understanding Types of Innovation and Implications for Policy, 

39Lessons for Genomics from Other Technologies, 

40Translating Medical Innovations with Appropriate Evidence, 

41Assessing Technology for Use in Health and Medicine, 

42Integrating Genetic Technology into a Health Care System 

43Tasks and Challenges of Translation for Producers of New Services. 

44A Primary Care Provider View of Translating Genomic Innovation 

45Introducing a Genomic Innovation to Clinical Practice 

46The Global Perspective and The U.S. Perspective. 

47On the second day there was discussion of Secretary’s Advisory Committee on Genomics, Health and 

48Society (SACGHS) draft report on oversight 

1 

2 



1and these questions were addressed: 

2 

1. What are the main issues identified? 

3 

2. How do they relate to the steps of translation? 

4 

5 

3. How do the presentations aid in the development of a framework for Roundtable 

activity? 

6 

4. What are the priority topics for further exploration? 

7 

8The members decided to devote the April meeting to an in depth examination of the translation of 4 

9different cases. The cases identified are CYP-450/SSRI, Thrombophilia testing, CGH array both 

10prenatally and for developmental delay and Abacavir. The plan is to devote a half day to each case with 

11a speaker invited to describe the process of translation for each case and the rest of the time spent in 

12delving deeply into the translation process for each. Individuals who would be knowledgeable about 

13one or more of the case topics will be invited to speak. We will have one primary speaker but may also 

14invite others to help explore the translation process during the discussion. 

15Martha is a member of the planning group for the July meeting. 

16These are the objectives: 

17 • Overview of current status of genetic service delivery 

18 o What is the definition of genetic services? 

19 o What services are currently being delivered (e.g., tests, counseling, education)? 

20 o Look at a range of service delivery, from worst to best models 

21 

22 • Who is providing these services? 

23 o Who are the providers? (Counselors, nurses, physician assistants) 

24 o How many of each kind of provider is there and where are they located? 

25 

26 • What does the future of genetic service look like? 

27 o What types of services and tests are being developed? 

28 o How will these new services affect delivery? 

29 

30 

o What sort of issues will be exacerbated by expanding genetic technology? (access, 

education, barriers) 

31 

32 • Does the current and planned capacity of service delivery meet our current and future needs? 

33 o What is the educational pipeline for service providers? 

34 o How many and what kind of providers will we have/need? 

35 o Where are the gaps for current and future needs? 

36 

37 • New models for service delivery 

38 

39 

o What innovative models are currently being used (Cincinnati, DTC, telemedicine, nongenetic 

counselor models) 

40 o What are the benefits and drawbacks of these models? 

41 o What are other potential models that could be used? 

42 o How do these new models address the gaps identified in objective #4? 

43 


45The IOM roundtable met in April for its second meeting. At that meeting, the Roundtable identified the 

46need for a public workshop that will feature presentations and discuss strategies regarding service 

1 

2 



1delivery in the age of genomics, seeking to understand the current status of service delivery, how needs 

2will change as genomic innovation progresses, and what types of alternative practice models will be 

3needed. 

An ad hoc committee is currently planning the workshop and an individually authored 

4summary will be prepared by a designated reporter following the meeting. The IOM meeting and 

5workshop is scheduled for July 28-29 in Washington, DC. 

6 

7 


9The roundtable meetings on translating genomic based research for health met in April, July and 

10October 2008. They discussed innovations and diffusion of health related technologies. There was 

11further discussion on: 

12Translating Medical Innovations with Appropriate Evidence, 

13Tasks and Challenges of Translation for Producers of New Services. 

14ANA's representative was a member of the planning group for the July workshop. Proceedings will be 

15published in early 2009. The topic was Innovations in Service Delivery in the Age of Genomics. The 

16ANA rep chairs the Education sub-committee and will be coordinating educational activities over the 

17next 18 months. 

18 

19EGAPP Stakeholders Group (ESG) 

20 

21Background: 

22Evaluation of Genomic Applications in Practice and Prevention (EGAPP) is a pilot project initiated by 

23the CDC National Office of Public Health Genomics in the fall of 2004. The project’s goal is to 

24establish and evaluate a systematic, evidence-based process for assessing genetic tests and other 

25applications of genomic technology in transition from research to clinical and public health practice. 

26 

27EGAPP aims to integrate: 

28 -existing recommendations on implementation of genetic tests from professional organizations and 

29advisory committees. 

30 -knowledge and experience gained from existing processes for evaluation and appraisal (e.g., US 

31Preventive Services Task Force, CDC’s Task Force on Community Preventive Services), previous CDC 

32initiatives (e.g., the ACCE process for assembling and analyzing data on genetic tests; 

33http://www.cdc.gov/genomics/gtesting/ACCE/fbr.htm) and the international health technology 

34assessment experience. 

35 

36The primary focus of the EGAPP Project is an independent, non-federal Working Group established in 

37April, 2005. The Working Group is composed of 13 multidisciplinary experts in areas such as evidence- 

review, clinical practice, public health, laboratory practice, genomics, epidemiology, economics, 

38based 

39ethics, policy, and health technology assessment. 

40 


42Martha Turner was recently nominated by ANA and appointed by EGAPP as a member of the 

43Stakeholders Group (ESG). ESG members were selected in Fall 2007 by a six person ESG steering 

44committee. The members were chosen from a pool of qualified nominees submitted by organizations 

45and individuals. The ESG includes representation interested in the development, evaluation and 

46integration into clinical practice of genetic tests and other applications of genomic technologies. ESG 

47was established with the support of the EGAPP steering committee to formally engage stakeholders in 

48EGAPP processes and products. ESG is composed of a broad range of stakeholders with the expertise, 

1 

2 



1experience, and ability to represent the perspectives of their stakeholder categories. 

2 

3 

4There are five activities for ESG members and they include but are not limited to Assisting EGAPP in 

5identifying the central points from evidence reports and helping to frame and deliver the key messages 

6in ways that are useful to the stakeholder groups. 

7 

8The first report to be reviewed was "Testing for cytochrome P450 polymorphisms in adults with 

9nonpsychotic depression treated with selective serotonin reuptake inhibitors". 

10Other reports will be addressed as they are published. 

11 


13The next meeting of the EGAPP group is scheduled for July 30-31, 2008 in Seattle, Washington. The 

14EHR Assistant Director, Martha Turner, will attend. 

15 


17Evaluation of Genomic Applications in Practice and Prevention (EGAPP) is a pilot project initiated by 

18the CDC National Office of Public Health Genomics in the fall of 2004. The project’s goal is to 

19establish and evaluate a systematic, evidence-based process for assessing genetic tests and other 

20applications of genomic technology in transition from research to clinical and public health practice. 

21An ANA representative is a member of the Stakeholders Group (ESG). There are five activities for 

22ESG members and they include but are not limited to assisting EGAPP in identifying the central points 

23from evidence reports and helping to frame and deliver the key messages in ways that are useful to the 

24stakeholder groups. 

25 

26The first report reviewed was "Testing for cytochrome P450 polymorphisms in adults with nonpsychotic 

27depression treated with selective serotonin reuptake inhibitors". The group met in Jan and July 2008. 

28The next meeting is scheduled for Jan 2009. The Topics Subcommittee met by phone in Oct to discuss 

29the feedback from the working group on the topics submitted in September. Due to the change in 

30membership on the EWG there will be a delay in decisions regarding the future topics to be developed 

31into full reports with recommendations. 

32 

33 

34The International Society of Nurses in Genetics (ISONG) 

35 

36Background: 

37ANA recognizes the importance of genetics in nursing practice and the increasing impact that genetics is 

38having on health care. ISONG, the International Society of Nurses in Genetics, is a global nursing 

39specialty organization dedicated to fostering the scientific and professional growth of nurses in human 

40genetics and genomics worldwide. The ISONG vision is: Caring for people's genetic and genomic 

41health. Their mission is to foster the scientific, professional, and personal development of members in 

42the management of genomic information. Their goals are to provide a forum for education and support 

43for nurses providing genetic healthcare; to promote the integration of the nursing process into the 

44delivery of genetic healthcare services; to encourage the incorporation of the principles of human 

45genetics into all levels of nursing education; to promote the development of standards of practice for 

46nurses in human genetics; to advance nursing research in human genetics; to provide a forum for 

47dialogue with others. ISONG's members collectively have the greatest and broadest nursing expertise 

48related to genetics. ANA has worked collaboratively with ISONG members in the development of 

1 

2 



1Nursing and Genetics Practice Standards and in the development of the Nursing and Genetics Core 

2Competencies. ANA expects that it will continue to work collaboratively with ISONG in an effort to 

3promote the inclusion of genetic information in nursing education and the appropriate application of 

4genetics in nursing practice. 

5 

6December 2008 Update 

7The annual meeting was held in Philadelphia in November. ANA was represented and participated in 

8subcommittee discussion/work on ethics and public policy. Follow up work will include contacting 

9nursing organizations worldwide to identify and invite nurses who are working in the field of ethics and 

10genetics to join in the discussion. 

11 

12 

13Human Trafficking 

14 

15Background: 

16ANA was invited by HHS to participate in a National Symposium on the health needs of Human 

17Trafficking victims. High level professionals gathered from many disciplines to discuss this timely and 

18important issue. Human trafficking is a form of exploitation in which men, women, or children are 

19forced into commercial sex work and/or involuntary labor. HHS seeks to better understand the physical 

20and mental health needs of the victims of human trafficking in order to ensure that the HHS programs 

21and services are meeting the needs of this vulnerable population. HHS believes that through increased 

22understanding and awareness of human trafficking in the health community, the likelihood of victims 

23being identified and successfully connected to necessary services will be improved. 

24 


26The meeting was held in September is Washington, D.C. ANA was invited by HHS to participate in a 

27National Symposium on the health needs of Human Trafficking victims. High level professionals 

28gathered from many disciplines to discuss this timely and important issue. Human trafficking is a form 

29of exploitation in which men, women, or children are forced into commercial sex work and/or 

30involuntary labor. HHS seeks to better understand the physical and mental health needs of the victims of 

31human trafficking in order to ensure that the HHS programs and services are meeting the needs of this 

32vulnerable population. HHS believes that through increased understanding and awareness of human 

33trafficking in the health community, the likelihood of victims being identified and successfully 

34connected to necessary services will be improved. The agenda included: 

35 - an introduction to trafficking as an health issue, understanding the law, victim's rights and the 

36 role of the health community. 

37 - encountering victims: identification, disclosure and other issues 

38 - providing health services to victims 

39 - resources and tools: lessons learned and best practices 

40 - especially highlighted was the National Human Trafficking Resource Center Hotline: 

41 1-888-373-7888 

42A continuing education program will soon be available from the International Forensic Nurses 

43Association. . A link will be posted on the Nursing World website. 

44 

45 

46 

47Therapeutic Marijuana 

48 

1 

2 



1Background: 

2In 2003 the ANA House of Delegates passed a resolution, Providing Patients Safe Access to Therapeutic 

3Marijuana/Cannabis, which encourages the education of registered nurses regarding current, evidence- 

therapeutic use of marijuana/cannabis. ANA joined the American Pain Foundation and other 

4based 

5groups in filing an amicus brief in support of a man who used marijuana pursuant to his physician’s 

6recommendation and consistent with California’s “Compassionate Use Act of 1996.” The man was fired 

7after failing a standard drug test, even though he explained his marijuana use and provided a doctor’s 

8statement to his employer. There was no evidence of on-the-job impairment. The lower court had 

9determined that the federal criminal law making marijuana use illegal gave the employer a legitimate 

10reason to fire the man, regardless of state law that permits the use of marijuana for medical reasons. 

11ANA and the other parties on the brief presented research results that support the use of marijuana for a 

12variety of health reasons. In ANA’s view, an employment policy that does not permit review of 

13underlying circumstances for medically necessary marijuana use denies meaningful access to a 

14prescribed treatment by forcing the employee to make a decision between the treatment and his job. The 

15appeal is pending in the California Supreme Court. 

16 


18The Fifth National Clinical Conference on Cannabis Therapeutics will be held at the Asilomar 

19Conference Grounds – Pacific Grove, CA from April 4-6, 2008. The EHR director has been invited to 

20address Nursing, Ethics and Medical Cannabis from the perspective of the ANA. The 2003 ANA HOD 

21Resolution specifically supports providing patients safe access to therapeutic medical cannabis, 

22controlled investigational trials, evidence based therapeutic use of cannabis, the ability of health care 

23providers to discuss medicinal use of cannabis without the threat of intimidation or penalties, legislation 

24to remove criminal penalties against bona fide patients and pre-scribers of therapeutic cannabis, 

25legislation to exclude cannabis from classification as a Schedule I drug, and the education of registered 

26nurses regarding current, evidence based therapeutic use of cannabis. ANA has been asked to consider 

27co-sponsorship of the conference that could be in the form of a statement of support, the continuing 

28education provider for nurses, and/or other agreed upon support for the conference. 

29 

30Oral argument was held in November 2007, and the court ultimately decided against the employee. 

31 


33The Fifth National Clinical Conference on Cannabis Therapeutics was held at the Asilomar Conference 

34Grounds – Pacific Grove, CA from April 4-6, 2008. The EHR director presented the perspective of the 

35ANA on Nursing, Ethics and Medical Cannabis. The conference was attended by over 250 health 

36professionals and patients from the US, Canada, and Europe. A meeting summary is in preparation and 

37will be posted on the Ethics Website when completed. 

38 

39 

40AMA Ethical Force Oversight Body 

41 

42Background: 

43ANA participates as an invited member to the AMA Ethical Force Oversight Body (E-Force) since its 

44beginning in 2000. E-Force is an independent body however is financially supported by AMA and grant 

45funding. The Ethical Force program is a credible means for developing mutual and multilateral 

46accountability in ethics among all participants in the health care delivery system. It is charged with 

47creating, testing, and disseminating performance measures for domains of ethics in health care. It is 

48directed by a 23-member Oversight Body, which includes representatives from numerous relevant 

1 

2 



1groups, including patients, practitioners, health plans, purchasers, government, and accrediting 

2organizations. The Ethical Force Program Oversight Body is responsible for selecting topics for 

3performance measure development as well as reviewing and approving all research programs and 

4products. Oversight Body members have been selected to share their diverse perspectives on the health 

5care delivery system, but at Oversight Body meetings each member is asked to set their "institutional 

6hat" aside and participate in improving the health care system on behalf of everyone. Therefore, 

7Oversight Body members are not official representatives of the organizations from which they have 

8been drawn. Ethical Force Program products should not be construed as official policy positions of 

9these organizations. 

10 


12The Ethical Force Oversight Body (EFOB) will host an invitational meeting on Ethical and 

13Measurement Evaluation in April prior to the Oversight Body meeting. The EHR Director is serving on 

14the conference planning committee. Following the creation of an opportunity and process for key 

15organizations to be granted a standing seat on the EFOB ANA submitted a request for a standing seat 

16The seat currently held by the EHR Director does not expire until 2009; however, ANA is preparing a 

17request to be submitted to the nominations committee to request a standing seat to represent the interests 

18of nurses on the EFOB. 

19 


21The Ethical Force Oversight Body (EFOB) hosted a successful invitational meeting on Ethical and 

22Measurement Evaluation in April prior to the Oversight Body meeting. At the April meeting the EFOB 

23voted to assure a standing seat on the Oversight Body would always be held by a registered professional 

24nurse. The EFOB has decided to revisit and consider deletion of term limits at its fall meeting prior to 

25the expiration of the seat held by the EHR Director. 

26 


28At the November Ethical Force Oversight Body (EFOB) meeting a decision was made to continue all 

29terms of the current members for an additional year while the EFOB determined whether or not 

30arrangements could be made to develop or merge with a current 501c3 group in order to sustain and 

31continue the work of the EFOB. The current financial crisis, along with the evolution of the group has 

32made the continuing financial support by the AMA unlikely beyond 2009. The work of the committee 

33related to projects other than the grant funded work around Patient Communication will be suspended 

34and all efforts will be directed toward exploring relationship and means for the sustainability of the 

35group beyond 2009. The creation of a pay to play organization, like IOM groups is also being 

36considered if other potential avenues do not work. 

37 

38E-mail Inquiries 

39 

40The ethics@ana.org e-mail is a recipient of a minimum of three inquiries per week related to ethical 

41issues and information related to nursing practice. Some e-mails are forwarded to appropriate in house 

42staff to assist in a broader response, e.g. legal, practice and policy, as well as other departments. This e- 

43mail address was the source of the majority of the Katrina comments and inquiries. The inquiries do 

44reflect what tends to be currently happening in the practice environment. Recent topics in inquiries 

45from members include stem cell, capital punishment, influenza, and work place violence. 

46 


48The ethics@ana.org e-mail continues to be the recipient of approximately three inquiries per week. 

1 

2 



1Since the change in the website an increase in the number of requests and concerns about the availability 

2of the Code and the position statements continues along with comments about the ability to print the 

3Code from the website. The Code continues to be available as read only; however, full view of the 

4ethics position statements are no longer available to non ANA members. Some of the concern about the 

5Code availability came from a change in the web-link and the need for those organizations with links to 

6the old web page to update their link. 

2 



5Questions about the Code and the position statements continue to be the primary focus of the requests. 

5 



8Questions about the Code and the participation of ANA in the political process were the primary focus 

9during the last quarter of the year. 

8 

9 

10American Association of Colleges of Nursing (AACN) Baccalaureate Essentials 

11 

12Background: 

13The American Association of Colleges of Nursing (AACN) is the national voice for America's 

14baccalaureate- and higher-degree nursing education programs. AACN's educational, research, 

15governmental advocacy, data collection, publications, and other programs work to establish quality 

16standards for bachelor's- and graduate-degree nursing education, assist deans and directors to implement 

17those standards, influence the nursing profession to improve health care, and promote public support of 

18baccalaureate and graduate education, research, and practice in nursing— the nation's largest health care 

19profession. 

14 

15Baccalaureate Essentials Regional Meetings are in the process of being conducted to inform the revision 

16of the Essentials of Baccalaureate Education for Professional Nursing Practice. Stakeholders have been 

17provided the opportunity to review and provide feedback regarding the draft Baccalaureate Essentials 

18document, including the end-of-program competencies for baccalaureate nursing education. AACN 

19members, faculty, students, practicing nurses, and representatives of other healthcare and education 

20organizations have been invited to attend. 

16 


18Baccalaureate Essentials Regional Meetings are underway to review and comment on the revised draft 

19Essentials of Baccalaureate Education for Professional Nursing Practice. ANA is planning to attend 

20the Nashville, TN- March 13-14, 2008 session and if additional input is needed, we will also attend in 

21Boston, MA- April 24-25, 2008. The CNPE Committee on Nursing Standards and Guidelines has begun 

22the process of reviewing the proposed draft of the BSN Essentials and will provide written feedback to 

23AACN. 

19 


21ANA reviewed and solicited comment from members regarding the proposed revised Baccalaureate 

22Essentials for during the revision process conducted by the American Association of Colleges of 

23Nursing (AACN). ANA submitted comments and recommendations to AACN in April regarding the 

24proposed essentials document. 

1 

2 



1 


3The AACN finished their series of discussions regarding the BSN Essentials and proposed adoption of 

4the final document to their membership. This document was endorsed by the AACN membership 

5October 20th. The Essentials of Baccalaureate Education for Professional Nursing Practice may be 

6downloaded online at http://www.aacn.nche.edu/Education/pdf/BaccEssentials08.pdf. The AACN task 

7force is developing an online tool kit for nursing faculty which will help to integrate the new Essentials 

8into baccalaureate curriculum. This tool kit will be posted on the AACN Web site by January 2009. The 

9essentials do contain multiple expectations for informatics and quality outcomes learning experiences 

10for BSN students. 

4 

5 

6Continuing Nursing Education Program 

7 

8Background: 

9The Center for Continuing Education and Professional Development provides a wide variety of CNE 

10activities, both live/provider-paced and independent study/learner-paced, for ANA members, 

11nonmembers, and nursing students. Included are topics such as clinical practice, nursing issues, 

12certification preparation, test-item writing, and topics related to Magnet Hospital Recognition. The 

13number of activities and learners and the variety of topics and formats, e.g., conferences, seminars, 

14books, Webinars/teleconferences, online independent studies, etc., grows annually in response to the 

15learning needs of ANA’s audience and new technologies available. ANA is accredited as a provider of 

16continuing nursing education by the American Nurses Credentialing Center’s Commission on 

17Accreditation. The Center serves as the accredited provider unit for all the structural units in the ANA 

18Enterprise. 

10 


12ANA’s application for re-accreditation as a provider of CNE was submitted to ANCC on January 30, 

132008, along with a self-study report and supporting documentation. An accreditation appraiser site visit 

14is scheduled for May. The previous provider accreditation was granted to ANA in 2002 for six years. 

15During the interim, the number of live activities offered has grown from 33 to 184 and independent- 

modules from 10 to 63. The articles for CNE in American Nurse Today, one in each monthly 

16study 

17issue, were completed by a total of 3079 learners in 2007, with 1099 mailed in and 1980 completed 

18online. The growth of ANA’s CNE activities can be attributed in large part to the appointment of 19 

19nurse planners on staff, in addition to the one nurse planner on staff 6 years ago, and to their cooperation 

20and collaboration with the Center in providing CNE. ANA’s CNE program continues to grow and 

21develop. 

13 


15ANCC conducted their accreditation site visit on May 5, 2008. Renewal of our accreditation status is 

16due by the end of August 2008. So, ANA expects to hear the ANCC Commission on Accreditation’s 

17decision soon. 

16 


18The ANA Center for Continuing Education and Professional Development has received ANCC 

19accreditation as a provider for four years. The number of online learning activities has grown to 76 and 

20the number of users continues to grow. 

19 

1 

2 



1 

2Pay-for-Performance (P4P)/Value-Based Purchasing (VBP) 

3 

4Background: 

5Pay for Performance (P4P) and Value Based Purchasing (VPB) are terms used to identify various 

6methods linking payments to some measure of individual, group or organizational performance. An 

7increasing number of purchasers/payers of health care services, including the Centers for Medicare and 

8Medicaid Services (CMS) are embracing P4P/VPB strategies in an effort to improve the quality and cost 

9effectiveness of care while achieving high value for their health care dollars. The move toward greater 

10use of P4P/VPB systems in the current health care environment presents a unique set of opportunities 

11and challenges for health care providers including registered nurses. Registered nurses, individually and 

12collectively, confront the complex issues related to value based purchasing. ANA is currently working 

13to gather additional information about P4P/VBP programs and the projected implications for nursing. 

14This information is intended to guide future ANA action related to policy development and to inform 

15registered nurses regarding implications for nursing practice, reimbursement, and professional integrity. 

16Recognizing that registered nurses will be increasingly challenged by the growing prevalence of 

17P4P/VPB initiatives in both the private and public sectors of today’s health care system, the ANA Board 

18of Directors introduced an action proposal at the 2006 ANA House of Delegates addressing a number of 

19issues surrounding P4P/VBP. Delegates at he House discussed the ANA BOD proposal and 

20subsequently voted to refer it back to the Board of Directors asking for additional exploration of the 

21P4P/VBP programs and the implications for registered nurses. The ANA Board of Directors has 

22delegated this work to the Congress on Nursing Practice and Economics asking for a report back to the 

23Board prior to the next House of Delegates. To carry out this work, the Congress authorized the 

24establishment of the P4P/VBP Workgroup in September 2006. 

6 


8The initial work of the CNPE workgroup focused on exploration and descriptions of the multiple 

9P4P/VBP programs in both the public and private sectors. The second phase of the work to date has 

10focused on projections of the P4P/VBP Workgroup related to the implications and considerations for 

11registered nurse related to the development and implementation of various P4P/VBP initiatives. Further 

12discussion and refinement of these implications has narrowed the focus to considerations in 4 areas: 

13administrative issues for the chief nursing officers, clinical considerations for staff nurses, practice 

14considerations for advanced practice nurses and educational considerations for the community as a 

15whole. What became apparent to the workgroup at the February 2008 meeting is that regardless of P4P 

16or VBP program, all of the considerations provide the foundation for nursing quality literacy which is 

17applicable for any P4P or VBP program. Recognition of this foundation is important, since public 

18reporting and pay for performance continues to evolve and nursing’s contribution is not readily 

19acknowledged. Nursing’s role in nursing quality is the underpinning for any quality improvement 

20initiative regardless of public or private sector. 

9 

10ANA was invited to participate and provide comments to the Senate Finance Committee on the “Plan to 

11Implement a Medicare Hospital Value-Based Purchasing Program Report” by CMS. The roundtable 

12will be held on March 6 on Capital Hill. Various stakeholders from the healthcare community were 

13invited to participate. Written comments will be provided in advance of the meeting with questions and 

14answers following presentations by various government agency representatives. ANA’s comments 

15focuses on sharing the association’s experience with nursing quality measures and the importance of 

16including nursing measures in any quality related activity. 

11 

1 

2 




2CMS is moving forward with the VBP program and outlining future quality measures that could be 

3considered for inclusion in the program. CMS is currently soliciting comments regarding the various 

4measures that are being considered in their Hospital Inpatient Prospective Payment System (IPPS) 

5which has implications for hospitals getting reimbursed for care. ANA submitted comments advocating 

6for nursing measures and adding additional ICD codes that would aid in identifying the various pressure 

7ulcer stages. ANA also has been in communication with Dr. Barry Straube’s office to determine how 

8nurses can get more involved in CMS initiatives and work with the CMS nurses. 

3 


5ANA has had several meetings with CMS nurses to share information. Comments were provided from 

6the Congress of Nursing Practice & Economics regarding current practice and use of standard orders 

7and clinical protocols in the respective settings. 

6 

7The information gleaned from the work of the CNPE workgroup on pay-for-performance/value-based 

8purchasing has been posted on ANA NurseSpace for feedback and discussion to guide ANA policy. 

8 

9A presentation to CMS staff on ANA’s 10 year experience with NDNQI is scheduled for December 3, 

102008. 

10 

11Congress on Nursing Practice and Economics 

12 

13Background: 

14The Congress on Nursing Practice and Economics (CNPE) is an organized, deliberative body of the 

15ANA, which brings together the diverse experiences and perspectives of ANA members. The Congress 

16focuses on establishing nursing’s approach to emerging trends within the socioeconomic, political and 

17practice spheres of the health care industry by identifying issues and recommending policy alternatives 

18to the Board of Directors. CNPE includes organizational affiliates among its voting members and 

19numbers nearly 60. 

15 

16The ANA Congress on Nursing Practice and Economics (CNPE) which focuses on establishing 

17nursing’s approach to emerging trends within the socioeconomic, political and practice spheres of the 

18health care industry by identifying issues and recommending policy alternatives to the Board of 

19Directors (BOD) met once thus far in 2008 on February 8 th and 9 th , at the ANA Headquarters. Among 

20taken were recommendations that the ANA BOD adopt, endorse and sunset a number of position 

21statements. In addition, CNPE reaffirmed its earlier decision to recommend that the ANA BOD endorse 

22the ENA Position Statement on Procedural Sedation. Working in small groups CNPE addressed topics 

23including: the continuum of nursing practice, retail clinics, competence, electronic health records, health 

24system reform, credentials, value based purchasing and the revision of Nursing’s Social Policy 

25Statement. Discussions on the issue of RNs reporting to LP/VNs, the continuum of nursing practice and 

26care coordination took place. 

17 


19CNPE met at the ANA headquarters on February 8 th and 9 th , 2008. Among actions taken were 

20recommendations that the ANA BOD adopt, endorse and sunset a number of position statements. In 

21addition, CNPE reaffirmed its earlier decision to recommend that the ANA BOD endorse the ENA 

22Position Statement on Procedural Sedation. Working in small groups CNPE addressed topics including: 

23the continuum of nursing practice, retail clinics, competence, electronic health records, health system 

1 

2 



1reform, credential, value based purchasing and the revision of Nursing’s Social Policy Statement. 

2Discussions on the issue of RNs reporting to LP/VNs, the continuum of nursing practice and care 

3coordination took place. 

2 


4CNPE met at the ANA headquarters on September 21 st and 22 nd , 2008. In addition, an orientation was 

5scheduled for new members on Saturday, September 20 th . The orientation focused on an ANA overview 

6and CNPE processes with an emphasis on the review of scopes and standards. At the full meeting, 

7CNPE members, again, working in small groups considered topics including: the continuum of nursing 

8practice, retail clinics, electronic health records, health system reform, credentials and the revision of 

9Nursing’s Social Policy Statement. In addition, CNPE engaged in discussion of the ANA position on 

10the Doctorate of Nursing Practice and the role of the Clinical Nurse Leader. Also taking place was 

11consideration of HIPAA relative to the patient safety and the rights of Registered Nurses when 

12considering a patient assignment. The scope and standards of forensic nursing were 

13acknowledged/approved. In addition, recognition criteria for nursing terminologies were approved. 

14CNPE will next meet at the ANA headquarters in Silver Spring, MD on February 22 nd and 23 rd , 2009. 

5 

6The Joint Commission 

7 

8Background: 

9The Joint Commission evaluates and accredits more than 15,000 health care organizations and programs 

10in the United States. An independent, not-for-profit organization, the Joint Commission is the nation’s 

11predominant standards-setting and accrediting body in health care. Since 1951, the Joint Commission 

12has maintained state-of-the-art standards that focus on improving the quality and safety of care provided 

13by health care organizations. The Joint Commission’s comprehensive accreditation process evaluates an 

14organization’s compliance with these standards and other accreditation requirements. The Joint 

15Commission’s mission is: To continuously improve the safety and quality of care provided to the public 

16through the provision of health care accreditation and related services that support performance 

17improvement in health care organizations. 

10 


12Testing of the NQF Nursing 15 Measures, supported by the Robert Wood Johnson Foundation (RWJF), 

13will be ongoing throughout 2008. ANA participates on the Technical Advisory Panel overseeing the 

14testing. Data transmission is a challenge because of the variability between and among the measures. 

15The testing is in month 15 of a 24 month time frame. Pilot sites have had to reallocate staff to engage in 

16data collection. As a result there has been drop out of sites. There are 56 sites currently involved. 

17Much one-one support has been provided to the sites in particular in regards to data transmission. 

18Webcasts are held monthly with project coordinators. Reliability of the measures is the current focus. 

19Administrative data will be the source of nursing hours information. A qualitative survey has been 

20developed to elicit information regarding usefulness of the measure set. Data collection will conclude 

21on July 31, 2008. 

13 


15Testing of the NQF Nursing 15 Measures (which is supported by the Robert Wood Johnson Foundation 

16(RWJF) has been completed. ANA participates on the Technical Advisory Panel which oversees the 

17testing. That group reviewed the report of the testing in early November. 

16 

17Joint Commission Nursing Advisory Council (NAC) 

1 

2 



1Background: 

2The Nursing Advisory Council was established in 2003 to counsel the Joint Commission on present and 

3evolving nursing-related issues that are affecting health care quality and patient safety. The council 

4provides input to the Joint Commission on initiatives that affect the nursing profession and seeks to 

5advance solutions to the nurse staffing crisis. It was originally established to address recommendations 

6emanating from the Joint Commission's white paper, Health Care at the Crossroads: Strategies for 

7Addressing the Evolving Nursing Crisis. The paper proposed solutions that focused on transforming the 

8nursing workplace; creating a clinical foundation for nursing educational preparation and advancement; 

9and providing financial incentives for health care organizations to invest in high quality nursing care. 

10ANA participated in conference calls and face-to-face meeting of the NAC throughout 2007. ANA has 

11shared The Value of Measuring Nursing Care talking points with the NAC. 

3 


5The Joint Commission Nursing Advisory Council (NAC) has had no activity thus far in 2008. A 

6conference call is scheduled for March 13, 2008. 

6 


8The Joint Commission (TJC) Nursing Advisory Council (NAC) met by conference call on March 13, 

92008 where the status of and steps needed to complete the revision of the nursing white paper were 

10discussed. An update on performance measurement related to nursing was provided along with an 

11overview of the nursing measures set testing which is ongoing. 

9 

10Staff of the Joint Commission with nursing and nurse leadership experience reviewed the chapter for 

11language and flow. Preliminary recommendations have been reviewed by some NAC and BOC 

12members. The Nursing Chapter has undergone field engagement. In addition to soliciting input on the 

13standards as presented, ANA staff called attention to proposed standard NR.4.10 which states: 

11 The nursing service must have adequate numbers of licensed registered nurses, licensed 

12 practical nurses, and other personnel to provide nursing care to all patients as needed. 

13 There must be registered nurse supervisors, registered nurses, and other personnel for 

14 each department and nursing unit to ensure, when needed, the immediate availability of 

15 a registered nurse for bedside care of any patient. 

12 

13NAC members were encouraged to express support of NR.4.10 directly to Robert A. Wise, MD, Vice 

14President, Division of Standards and Survey Methods, The Joint Commission, One Renaissance Blvd, 

15Oakbrook Terrace, IL 60181 or via e-mail: rwise@jointcommission.org. All chapters will be completed 

16in the spring. All revised chapters will be presented to the field 6 months prior to implementation. 

14 

15The Joint Commission (TJC) Nursing Advisory Council (NAC) met at the Joint Commission 

16headquarters on June 9 th. During the meeting, an update on Legislative Initiatives Related to Nursing was 

17provided. An overview of the Joint Commission Center for Transforming Healthcare and a discussion 

18of the impact of robust process improvement tools on nursing took place. The status of testing of the 

19NQF-endorsed nursing sensitive measures was reviewed. Transforming Care at the Bedside (TCAB) 

20and the RWJF Building Nurse Education Capacity Effort were highlighted. A series of nursing related 

21research efforts were considered. An update on the ANA Lawsuit against DHHS was offered by ANA 

22CEO Stierle. Finally, NAC provided input on future JCR educational conferences. 

16 


18The Joint Commission Nursing Advisory Council (NAC) met by conference call on September 25 th , 

1 

2 



12008. During the call, a report was received from The Joint Commission President. An overview of 

2revision to the Nursing Standards Chapter was provided. An update on NQF-Endorsed Nursing 

3Sensitive Measures and the CMS Final Rule was offered. The Effects of Hospital Care on Surgical 

4Mortality was reviewed. Evidence linking nursing care and outcomes was highlighted. 

5 

6 

7The Joint Commission PTACs 

8Background: 

9The Professional and Technical Advisory Committees (PTACs) are an integral part of the Joint 

10Commission’s advisory structure. By representing the views of a diverse group of professional 

11organizations and other interests and by providing expert advice, PTAC members assist the Joint 

12Commission in the development and refinement of standards, elements of performance, and survey 

13processes. In addition, each PTAC provides observations regarding environmental trends, educational 

14needs, and other important issues facing each of the fields in which the Joint Commission offers 

15accreditation services. The value of the PTACs stems from the diversity of perspectives and the 

16discussion and debate that occurs at the PTAC meetings. In the final analysis, PTAC members are 

17expected to be proponents of their respective bodies of knowledge to the Joint Commission, and 

18proponents of the Joint Commission to their constituents. There are six PTACs, as follows: 

19 

20 

21 

22 

23 

24 

• Ambulatory Care PTAC 

• Behavioral Health Care PTAC 

• Home Care PTAC 

• Hospital PTAC 

• Laboratory PTAC 

• Long Term Care PTAC 

25 

26ANA is represented on all but the Laboratory PTAC. 

27 

28The PTACs: 

29 

30 

1. Provide advice and make recommendations to the Joint Commission regarding new or revised 

standards, elements of performance, and survey processes. 

31 

32 

2. Provide advice as to the educational needs of the field and offer suggestions concerning the 

development of new education programs, publications, and other media. 

33 

34 

3. Provide information and advice regarding current or anticipated developments in the field which 

may have standards or survey process implications. 

35 

36 

4. Provide a representative to participate in meetings of the Standards and Survey Procedures (SSP) 

Committee. 

37 

38 

5. Serve as a resource for appointees to accreditation decision Appeal Hearing Panels, as described 

in Joint Commission accreditation manuals. 

39 


41Each of the PTAC (Professional Technical Advisory Committee) meetings included a Program Update 

42provided by the respective Executive Directors which amplified comments made in the plenary session. 

43ANA regularly provides input on proposed standards through the Professional Technical and 

44Advisory Committee (PTAC). 

45 



48provided by the respective Executive Directors which amplified comments made in the plenary session. 

1 

2 



1There was discussion of certification of programs in non-accredited organizations. There is a need to 

2move more fully to evidence based standards. The role of The Joint Commission and the value of 

3accreditation are of concern to the Board of Commissioners (BOC). All numbers for standards and 

4elements of performance will be changed as a result of the reorganization of the requirements under 

5review through the Standards Improvement Initiative. Because all numbers for all requirements will be 

6changed from the current numbers, this is an opportune time to modify the numbering system. This 

7numbering system will benefit organizations in a couple key ways: 

8 

9 • The new numbering system will accurately sort when the standards are in electronic 

10 documents that an organization might create for internal use; 

11 • When new requirements are added in the future, the new numbering system will be able to 

12 accommodate the new requirements, preserving a logical order and minimizing the need for 

13 frequent renumbering. 

14 

15The current Nursing Standard NR.1.10 has been split into three separate standards in order to better 

16describe the different responsibilities and role of the nurse executive. Defining the nursing services 

17(revised NR.1.01.01), directing the nursing services (revised NR.01.02.01), and having authority within 

18the organization (NR.01.03.01) are three distinct concepts pertaining to the nurse executive. It was 

19noted that any changes to the content of the standards (such as consideration of ANA's proposed 

20standard) are outside the scope of the Standards Improvement Initiative and will be accomplished 

21through the Joint Commission’s regular process for standards development. 

22 

23The next PTAC meeting will be held on June 24, 2008. The agenda for the meeting includes: overview 

24of web analytics; overview on pediatric medication safety; permission requests for the Council’s work 

25products; request for reinstatement of the National Association of Chain Drug Stores; and consideration 

26of alternate means for disposal of drugs. In addition, the statement from the Council Use of Medication 

27Error Rates to Compare Health Care Organizations is of No Value will be discussed in relationship to 

28current accepted thinking regarding error rates. 

29 



32provided by the respective Executive Directors. ANA regularly provides input on proposed standards 

33through the Professional Technical and Advisory Committee (PTAC). During the August meetings 

34ANA representatives provided nursing's technical expertise to the revision and development of 

35Surveillance, Prevention, and Control of Infection (IC); Improving Organization Performance (PI); 

36Information Management (IM)); and, Restraint and Seclusion standards. 

37 

38 

39National Coordinating Council for Medication Error Reporting and Prevention 

40(NCC MERP/The Council) 

41 

42Background: 

43The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP/The 

44Council) is an independent body comprised of 22 national organizations, including ANA. In 1995, USP 

45(the Secretariat for NCC MERP) spearheaded the formation of the National Coordinating Council for 

46Medication Error Reporting and Prevention. Leading national health care organizations, including ANA 

47are for the first time, meeting, collaborating, and cooperating to address the interdisciplinary causes of 

48errors and to promote the safe use of medications. The mission of the NCC MERP is to maximize the 

1 

2 



1safe use of medications amongst all stakeholders and to increase awareness of medication errors through 

2open communication, promotion of medication error prevention strategies, and increased reporting. 

3 

4The Council meets at United States Pharmacopeia, the Secretariat, in Rockville, MD. A survey for 

5practitioners on drug modifier use has been developed. The intent of the survey is to assess 

6practitioners’ experience with the use of drug name suffixes. USP participates in group looking at 

7tubing misconnections which was called together at the request of ASPEN. As a result their efforts are 

8directed solely at the connections between eternal and parenteral tubing. The Council received the 2007 

9Pinnacle Award in the Voluntary Health Agencies, Non-profit Organizations, Associations, Government 

10Agencies and Public/Private Partnerships category. Special emphasis in this category is placed on 

11submissions that assist patients and their caregivers in achieving better outcomes from their 

12medications. The American Pharmacist’s Association (APhA) Foundation's Quality Center established 

13the Pinnacle Awards to celebrate significant contributions to the medication use process. 

14 


16ANA staff member Rita Munley Gallagher, PhD, RN was elected Vice Chairperson of the Council. 

17Recommendations on the use of drug suffixes and sample medications were finalized at the February 

18Council meeting. The Council is exploring projects related to: 

19 • medication reconciliation 

20 • in-house reporting tools 

21 • curriculum training 

22 • developing recommendations to implement technology related to the prevention of medication 

23 errors 

24 • bar coding 

25 

26In addition, the Eisenberg Award application is under development. 

27 


29During a meeting to be held on June 24, 2008, reports are scheduled to be received from the Chair and 

30Secretary. An overview of web analytics will be provided. Permission requests for the Council’s work 

31products are to be considered as a request for reinstatement of the National Association of Chain Drug 

32Stores. The statement from the Council Use of Medication Error Rates to Compare Health Care 

33Organizations is of No Value will be discussed in relationship to current accepted thinking regarding 

34error rates. A working group to evaluate responses and recommend actions on drug suffixes will be 

35empanelled. An overview on pediatric medication safety will be provided. Whether ASHRM’s survey 

36questions provide a basis for future Council recommendations relating to drug samples in practitioners’ 

37offices will be considered. Discussion of draft questions to be included in a survey of Council 

38stakeholder members to determine why bar coding is not being more broadly adopted in hospitals will 

39take place. A report of the Subcommittee on the Implementation of Technology will be received. 

40Finally, alternate means for disposal of drugs will also be considered. 

41 


43The Council is turning its attention to issues of pediatric medication safety. ANA and NCSBN staff 

44polled the nursing community as to their efforts in the area. The Council is one of the 2008 John M. 

45Eisenberg Patient Safety and Quality Award recipients. The Eisenberg Awards were launched in 2002 

46by the Joint Commission and the NQF in memory of the highly respected national leader in healthcare 

47quality, Dr. John M. Eisenberg, who dedicated his career to ensuring that healthcare is based on a strong 

1 

2 



1foundation of research and that the services provided reflect the needs and perspectives of patients. Dr. 

2Eisenberg, who died in 2002, spearheaded national efforts to reduce medical errors and improve patient 

3safety as director of the federal Agency for Healthcare Research and Quality. The awards, given 

4annually, recognize individuals and healthcare organizations that have made significant contributions to 

5improving patient safety. 

1 

2 



1 

2 

3 

STRATEGIC IMPERATIVE #2: HEALTHCARE AND PUBLIC 

POLICY 

4 

5Coalition for Patients Rights (CPR) 

6 

7Background: 

8The Coalition for Patients Rights (CPR) was formed to ensure that the growing needs of the American 

9health system can be met and that patients have access to quality health care providers of their choice. 

10The CPR represents more than three million licensed professionals from 35 national and state health 

11care organizations that provide a diverse array of safe, effective and affordable health care services. 

12 

13The CPR came together in response to divisive efforts by the American Medical Association (AMA) 

14and other physician groups to limit the ability of licensed health care professionals to provide care to 

15millions of patients. The CPR is calling on the AMA and other physician groups aligned with the AMA 

16to cease their divisive efforts to oppose the established practice rights of CPR members. 

17 

18The CPR also seeks an end to legislation at the state level that would reduce provider options for 

19patients. 

20 


22After several meetings and conference calls of the CPR, the work of developing operating guidelines 

23was referred to the Steering Committee. The Steering Committee last met via conference call in July 

242007 and has refined a document which will be shared with the broader Coalition for approval. A face- 

meeting is currently being planned and is scheduled to take place during the first quarter of the 

25to-face 

26year. CPR members continue to monitor activities at the state and federal level which may seek to 

27restrict the scope of practice of recognized licensed health professionals who are not medical doctors 

28(MDs) or doctors of osteopathy (DOs) from providing care and services to patients which they are 

29qualified and licensed to provide. 

30 


32A Steering Committee meeting is scheduled for March 7, 2008, at ANA headquarters in Silver Spring, 

33MD. A meeting of the entire CPR membership is scheduled for April 2, 2008 at the ANA headquarters. 

34(Note: see March 2008 APRN update on Scope of Practice activities for additional CPR content - pp. 

3581-83.) 

36 


38On May 28, ANA hosted a conference call of the CPR Steering Committee, which then approved the 

39CPR Operating Guidelines. These are now posted on the CPR website. In addition, ANA staffs are 

40interviewing PR firms for a CPR media campaign. (Note: see June 2008 APRN update on Scope of 

41Practice activities for additional CPR content – pp. 81-83). 

42 

43 


45The CPR public relations campaign is now under way. Over the summer, ANA hosted a quarterly 

46conference call of the CPR Steering Committee, and the PR work group – consisting of representatives 

1 

2 



1from ANA, the American Association of Nurse Anesthetists, and the American Psychological 

2Association – extensively interviewed four public relations firms. The work group recommended, and 

3the CPR Steering Committee approved, selection of the Jones, PA firm of Washington, DC. Jones has 

4extensive experience with PR campaigns for health care entities, particularly coalitions of varying 

5interests. 

6 

7From August to October, we worked to obtain funding for the PR campaign; each CPR member was 

8asked to contribute $5,000 towards the annual budget of $100,000. We exceeded our goal in late 

9October, with varying levels of commitments from twenty CPR members, and some organizations still 

10considering additional contributions. There are optional plans for second and third phases to occur in 

11years two and three, pending sufficient future contributions from CPR members. 

12 

13The Jones firm signed the contract in late October, and in early November conducted the initial 

14conference call with CPR members who contributed to the campaign. ANA will participate in the 

15expanded PR work group – of eight CPR members – to conduct the ongoing business of the PR 

16campaign through bimonthly teleconferences. Jones has contacted CPR members to ask their 

17availability for a December in-person meeting, as well as collect resources on scope of practice issues. 

18Jones is handling/coordinating communications for the PR campaign. Jones plans to develop a tool-kit 

19by early 2009. There are also plans to enhance the CPR website to allow posting of scope of practice 

20developments as well as a members-only section, which ANA plans to support through funding and staff 

21support. 

22 

23ANA is hosting a CPR Steering Committee conference call on December 2, 2008, to discuss the PR 

24campaign and several other pending issues, including procedures and dues for new members. Several 

25groups have expressed interest in joining CPR. Per the Operating Guidelines, all contributors of $5,000 

26or more were invited to join the Steering Committee. 

27 

28In October, Rose Gonzalez gave a presentation on CPR to the Health Professionals Network (HPN), and 

29in November Linda Stierle gave a presentation on CPR to Nursing Organization Alliance (NOA). 

30 

31 

32Safe Staffing Saves Lives Campaign and Health System Reform 

33 

34Background: 

35In December 2007, ANA began folding into the Branding and Membership campaign our contribution 

36to health care reform where we have unique expertise -- safe staffing. The campaign goal is to garner 

37support for the introduction and enactment of federal legislation on safe staffing. The target audience 

38consists of ANA members and potential members. 

39 

40As ANA surveyed the groups involved in health care reform, many with millions of dollars to devote, 

41we knew we must focus on an area for which ANA is already known and can support with data and 

42research. Staffing is such an issue. ANA has long been known for its work in support of universal health 

43care, but our efforts are being overshadowed by bigger and wealthier organizations. 

44 

45In December 2007, ANA launched a Web microsite at www.safestaffingsaveslives.org, that is designed 

46to interest potential members and current ANA members on this issue and demonstrate ANA’s 

47considerable track record on safe staffing and patient safety issues. The site features a specially designed 

48logo and imagery which conveys both the ANA brand and the initiative. 

1 

2 



1 

2ANA’s messaging clearly connects with the association’s priority issue of health care reform addressing 

3quality of care, saving lives through safe staffing, and cost of care through up front investment. The 

4campaign is highlighting and building on ANA’s history as the acknowledged leader in health system 

5reform -- dating back to our 1992 Nursing’s Agenda for Health Care Reform -- and culminating in the 

6House of Delegates (2005) document. As part of the campaign, ANA is re-releasing its Nursing’s 

7Agenda for Health Care Reform in 1Q 2008 and posting it on www.safestaffingsaveslives.org 

8 

9ANA’s site serves as a one-stop source of helpful information on safe staffing with user-friendly tools. 

10This information includes: 

11 • ANA “Principles on Safe Staffing”, 

12 • Background research on safe staffing, 

13 • Federal legislation and state legislation, 

14 • ANA’s legislative and legal actions, 

15 • “What You Can Do”: A Safe Staffing action center for nurses to send letters to members of 

16 Congress, to share stories and to stay informed with updates and alerts as they occur. 

17 

18As was reported in the October 2007 Board Report, ANA’s Contribution to Health Care Reform: ANA’s 

19“Safe Staffing Saves Lives” Campaign, ANA will host a private by invitation-only summit on safe 

20staffing on March 3, 2008 at the association's headquarters. In late December, ANA sent letters 

21invitation to a range of key stakeholders in the nursing community, including consumers, unions, 

22AONE, AHA, AMA, specialty nursing organizations, and business leaders. The goal of the summit will 

23be to develop either a consensus or an understanding of the dynamics of multiple approaches to 

24legislation that will lead to passage of national legislation to ensure progress on RN staffing levels. 

25 

26The Safe Staffing Saves Lives Campaign and Health Systems Reform are part of the overall “Relevancy, 

27Recruitment and Retention” Campaign. 

28 


30Since the soft launch of site www.safestaffingsaveslives.org, in December 2007, more than 140 visitors 

31have signed up to receive ANA safe staffing updates and alerts. Staff is now building in appropriate 

32linkages from Nursing World pages and searches and links to other resources that will increase exposure 

33to the site and build activity. An online poll has been launched to compile concerns on safe staffing 

34issues. Photos and images have been placed on the site to make it more appealing as well. 

35The messaging of the safe staffing campaign is action oriented and engages nurses around the issues of 

36patient safety, quality and health care reform. The ultimate long-term campaign goal is garnering 

37support for the introduction and enactment of federal legislation on safe staffing. 

38 

39Regarding the summit, ANA is designing the event as a “Listening Session” on the critical national 

40public health issue of safe staffing. Susan Dentzer, Health Care Correspondent for PBS’ The News 

41Hour, will serve as moderator. Staff will be working with Ms. Dentzer to prepare questions to stimulate 

42the panel discussion. 

43 

44The audience will potentially include registered nurses, nurse executives, AFL-CIO reps, health 

45insurance companies, healthcare trade associations, consumer organizations and business leaders. 

46Criteria set for the audience is: 

47 Organizations with a vested interest in advancing nursing’s agenda 

48 Organizations with an aggressive presence on Capitol Hill 

1 

2 



1 

2Additionally, ANA is reaching out to multiple potential panelists with diverse backgrounds to engage in 

3a lively discussion, Individuals including a nurse researcher, a health policy expert, a staff nurse, an 

4economist, and a consumer advocate. 

5 

6Lastly, ANA seeks to achieve the following outcomes from the summit: 

7 Better understanding of positions and areas of mutual agreement. 

8 Creating Allies. 

9 Identifying opportunities for further discussion. 

10 Determining individuals who may be interested in working with ANA to develop a 

11 

proposal. 

12 Agreeing to disagree with some and making a commitment to ongoing dialogue. 

13 


15As part of ANA’s “Relevancy, Recruitment and Retention” (3R) campaign and a key ANA national 

16initiative, staff designed and launched a microsite in December 2007 at www.safestaffingsaveslives.org 

17to engage nurses to help fight for the enactment of federal legislation on safe staffing. Since the launch, 

18the Safe Staffing site has been augmented with appropriate links from Nursing World and expanded 

19resources are now available throughout. A safe staffing poll is in development and is expected to be 

20deployed in March. In terms of metrics, through mid-February more than 7,000 visits to the site’s 

21homepage have been tabulated, while nearly 400 visitors have signed up to receive updates and alerts; 

22through the site more than 600 letters have been sent to members of Congress to garner support on 

23pending legislation; and 43 stories on safe staffing have been submitted. 

24 

25In February, staff continued to advance the summit by working with Susan Dentzer and the panelists to 

26finalize the program for ANA's Conversation and Listening Session on Safe Staffing, which occurred on 

27March 3, 2008. An invited audience of nursing leaders, union representatives, hospital association 

28representatives, health plan and health insurance representatives, consumer advocates, specialty nursing 

29organization representatives, ANA state nurses’ association executives, health advocacy organization 

30representatives and others participated in the conversation. Additionally, Dr. Chessare, Janet Gorman, 

31RN and Dr. Litvak presented a case study highlighting their critical work at Boston Medical Center on 

32staffing. As well as panel presentations by Joyce Dubow from AARP provided the consumer 

33perspective, Linda Warino provided the staff nurse perspective, and Dr. Ann Rogers provided the 

34research perspective regarding safe staffing. 

35 


37A May 22 nd CMA programmatic call in which at least 16 states (AL, AZ, AR, GA, IL, ID, IA, NY, NC, 

38OK, OR, SC, TN, TX, WA and WI) plus the Virgin Islands participated, ANA’s Safe Staffing Summit 

39and state staffing legislative / regulatory initiatives with lessons learned were discussed. Participants 

40were provided a summary of the panel presentations delivered during the Summit, introducing 

41alternatives to legislation and regulation to address staffing. Three speakers presented their experience at 

42Boston University Medical Center with managing variability in patient flow as a way to improve nurse 

43staffing in surgical units. Dr. Ann Rogers reviewed available data on the relationship between staff nurse 

44fatigue and patient safety, while an ANA member presented a case study of quantifying nursing value 

45for the employer in order to achieve improved staffing levels. A panelist from AARP also spoke to the 

46need for patient safety. 

47 

1 

2 



1Of particular value were the stories from Oregon and Washington as to lessons learned with the 

2legislative approach. OR’s first nurse staffing law was passed in 2001 and amended in 2005, with WA’s 

3enactment just this year. It was reported by ONA that their nursing practice staff continues to invest a 

4great deal of ongoing education and support to nurses serving on staffing committees. WA reports 

5remarkable progress in achieving legislative success within such a short time, largely attributed to an 

6outside arbitration firm to assist with the negotiations between the three nurse unions, the hospital 

7association, and nurse execs. Since enactment, the real work has begun: education of nurses as to the 

8law, and how to serve on a staffing committee; much like OR. The Texas reports mixed reviews with 

9their regulatory approach: regulations were adopted in 2002 requiring hospitals (under the 

10administrative authority of a chief nursing officer and in accordance with an advisory committee with 

11nurse members) to adopt, implement, and enforce a written safe staffing plan. In spite of TNA efforts, 

12many nurses are still not educated as to the staffing requirements. In spite of nurses’ failure to report 

13non-compliance with the regulations, some facilities have been fined for failure to have an advisory 

14committee for staffing as identified during routine survey. 

15 

16The Safe Staffing pages at www.safestaffingsaveslives.org have been updated so to refresh its homepage 

17with new imagery and a central update box, and features new content and developments, such as the 

18topical one minute essays and poll results. The site itself has generated a great deal of interest as of June 

199, 2008: 

20 

21 • 9000 letters sent to Members of Congress 

22 • 660 individual stories on safe staffing have been submitted 

23 • more than 11,000 have taken the Safe Staffing poll 

24 • more than 18,000 visitors to the site’s homepage per month 

25 


27 

28 

29 

30 

31 

32 

33 

• ANA is compiling a state specific insert to its brochure, "Improving the Quality of Care for 

Millions of Americans", that will focus on safe staffing "stories" from the State of New York. 

This insert will be used to assist ANA in its advocacy efforts. ANA's strategy involves targeting 

stories from the home states of Energy and Commerce and Ways and Means Committee 

Members (NY - Rangel, NJ -- Pollone) to arm them with information. Goal is to create a one 

page insert with just stories, and eventually create inserts with new statistics and demographic 

information from the upcoming HRSA Sampling Survey. 

34 

35 

36 

37 

38 

• The Safe Staffing microsite at www.safestaffingsaveslives.org has been recently revised and 

enhanced; highlights of these updates are featured in the site’s central update box on the 

homepage. Since the site was launched in December 2007 here are the cumulative activity 

statistics: (as of November 17, 2008) 

39 o 11,500 letters sent to Members of Congress 

40 o 775 individual stories on safe staffing have been submitted 

41 o nearly 14,000 have taken the Safe Staffing poll 

42 o more than 16,000 visitors to the site in October 

43 

44 

45Disaster Preparedness 

46 

47Background: 

48The American Nurses Association (ANA) has been actively involved in disaster preparedness since 

1 

2 



11998 when we participated on the Nuclear, Biological and Chemical Task Force established by the 

2American College of Emergency Physicians under a grant from the Department of Health and Human 

3Services. The purpose of this task force was to examine the level of preparedness of emergency medical 

4technicians, emergency nurses and emergency physicians to respond to a major disaster and the barriers 

5to improving the overall level of preparedness of the health professions. Since that time – and certainly 

6post-9/11 – ANA’s involvement in disaster preparedness and response has substantially increased both 

7in scope and organizational priority. 

8 

9Through a variety of projects and initiatives, ANA is actively involved in creating a stronger disaster 

10response system that facilitates the appropriate use of registered nurses and their skills, knowledge, and 

11ability during any type of disaster or pandemic event. ANA’s primary work is focused on: 

12 

13 

14 

15 

1. strengthening surge capacity of health human resources through the development and promotion 

of volunteer registries and other policies/processes that speak to the allocation of scarce 

resources during a response; 

16 

17 

2. creating a better legal and regulatory environment for the movement of health professionals 

during a disaster; 

18 

19 

3. collaborating with multiple federal departments and agencies around the development of broad 

disaster response plans as well as event specific planning; 

20 

21 

4. partnering with multiple stakeholders around disaster preparedness and response education and 

training; 

22 

23 

5. examining policy issues related to nursing ethics and scopes of practice and the standard of care 

provided during an emergency; 

24 6. promoting the occupational safety and health of disaster responders; and 

25 

26 

27 

7. identifying strategies that promote the integration of the public health, the acute care health 

system, and the disaster response system to create a seamless health response network to 

disasters. 

28 


30On January 22-23, ANA attended the second meeting of the IOM Preparedness Forum. Forum members 

31considered a request from the White House Homeland Security Council, the Department of Homeland 

32Security and the Department of Health and Human Services to hold a series of workshops focused on 1) 

33countermeasure distribution; 2) mass casualty care; and 3) community resilience. The goal of the 

34workshops would be to highlight potential short term strategies that could be put into place to move 

35preparedness forward in a particular area. It was decided to focus on countermeasure distribution first 

36with additional discussions on mass casualty care at the next meeting. Forum members raised concerns 

37about the breadth of these topics without a defined focal point to drive the workshops. An ANA 

38representative was appointed to both working groups (countermeasure distribution and mass casualty 

39care) to begin to develop a plan for how to proceed. 

40 

41February 2008 Update: 

42As a member of the Health Sector Coordinating Council, a partnership with the Departments of 

43Homeland Security and Health and Human Services, ANA submitted comments to the Assistant 

44Secretary for Preparedness and Response (ASPR) regarding a draft taxonomy guide that describes the 

45health sector’s physical and human resources. This document will ultimately be used to guide the 

46Department of Homeland Security as it does its risk assessment and vulnerabilities analysis of the health 

47sector. ANA focused on the accurate depiction of registered nurses as significant providers within a 

48variety of settings that will be impacted by a major disaster. 

1 

2 



1 


3On March 3-4, a workshop was held, Medical Countermeasures Dispensing. Dialogue focused on the 

4current plan for dispensing medical countermeasures, strategies for integrating current distributions 

5systems like FedEx and other private sector assets into this process, and discussion of the workforce 

6requirements for mass countermeasure distribution. Proceedings from this workshop will be shared 

7with the federal government and other policy makers as they consider this issue. 

8 

9In the beginning of March, ANA publicly released Adapting Standards of Care under Extreme 

10Conditions: Guidance for Professionals During Disasters, Pandemics, and Other Extreme Emergencies. 

11This policy paper is the result of ANA’s policy conference held in June 2007, Nursing Care in Life, 

12Death and Disaster. This document is the result of consultations with an expert panel, considering 

13feedback from the conference participants, and further public review on Nursingworld.org. 

14 


16In April, ANA nominated two ANA members for positions on advisory groups related to disaster 

17preparedness. The first nominee was for the Mental Health Working Group that will be advisory to the 

18National Biodefense Science Board. The second nominee was for the National Biosurveillance 

19Advisory Committee at the CDC. Both of these advisory groups are being established as a result of the 

20Homeland Security Presidential Directive 21 (HSPD-21) regarding public health and medical 

21preparedness. HSPD-21 is the current guiding document for policy development on health and disaster 

22preparedness for the Departments of Homeland Security and Health and Human Services. ANA staff is 

23also participating on a similar working group that is reviewing recommendations related to the National 

24Disaster Medical System. 

25 

26In May, ANA participated in a meeting, Pandemic and H5N1 Flu: A Prescription for Preparedness, 

27hosted by the American Health Lawyers Association (AHLA), the Department of Health & Human 

28Services’ Office of Inspector General, the CDC, and George Washington University. The purpose of 

29the meeting was to consider a draft of AHLA’s publication, Community Pan-Flu Preparedness: A 

30Checklist of Key Legal Issues for Healthcare Providers. The participants considered the legal 

31impediments, gaps and implementation challenges for healthcare professionals during disaster response. 

32 

33The Institute of Medicine Forum on Medical and Public Health Preparedness held its third meeting to 

34discuss issues related to mass casualty events, altered standards of care and surge capacity. ANA staff 

35served as a member of planning committee for this meeting. ANA’s policy document, Adapting 

36Standards of Care Under Extreme Conditions: Guidance for Professionals During Disasters, 

37 

38Pandemics, and Other Extreme Emergencies was discussed by the IOM Forum attendees as a model for 

39all disciplines and a statement that had relevance for the other disciplines. 

40 

41On June 12, 2008, the University of Albany, School of Public Health hosted an educational offering 

42discussing ANA’s policy document, Adapting Standards of Care Under Extreme Conditions: Guidance 

43for Professionals During Disasters, Pandemics, and Other Extreme Emergencies. Drs. Kristine Gebbie 

44and Kathleen White, authors of ANA’s document, participated in the educational session. 

45 


47ANA participated in the fourth meeting of the Institute of Medicine’s Forum on Medical and Public 

48Health Preparedness, where the agenda focused on issues related to the pending change in federal 

1 

2 



1administration and the need to develop strategies for how to maintain support for issues related to 

2disaster preparedness. The Forum is planning to host 3 briefings for Congressional staff on issues 

3related to disaster preparedness. In addition, the Forum is planning 3 regional forums dedicated to 

4discussing issues related to surge capacity. 

5 

6ANA has been invited to serve on the planning committee for the 3 rd National Congress on Health 

7System Readiness, Building Disaster Medical and Public Health Preparedness Systems for the 21 st 

8Century. The meeting is scheduled to be held in September 2009. 

9 

10ANA participated in the MEDKIT SUMMIT, a joint meeting of the Antiviral Drugs Advisory 

11Committee and the Nonprescription Drugs Advisory Committee to “provide advice on types of studies 

12and trial designs needed for an influenza antiviral MedKit for treatment and prophylaxis during an 

13influenza pandemic.” This is relevant to nursing practice due to issues on how licensure of these kits 

14will affect pandemic response plans, considerations for access and cost. If licensed, consumer education 

15will be needed from prescribing APRNs and other community outreach RNs around storage and 

16handling, indications, timing of use, and adverse event reporting. ANA will continue to attend future 

17meetings where results of clinical studies of consumer use, monitor for any steps toward product 

18licensure. 

19 

20ANA attended the quarterly meeting of the Healthcare Infection Control Practices Advisory Committee, 

21which advises the Centers for Disease Control and Prevention around infection control practices in 

22healthcare facilities. Discussed at the meeting was the Department of Health & Human Services’ plan 

23for elimination of healthcare acquired infections, such as MRSA and CDifficile. They also discussed 

24guideline revisions for elimination of catheter-related UTIs and reviewed data on recent disease 

25outbreaks, legislative involvement, and research gaps. The next steps are to provide comment on the 

26HHS plan and work with the CNPE workgroup on infectious disease on other ANA action around 

27infection control. 

28 

29ANA also attended the Advisory Commission on Childhood Vaccines. The purpose of meeting was to 

30receive reports from federal groups that deal with immunization from CDC, NIH, and FDA. During this 

31meeting, there was a major discussion on Vaccine Injury Compensation Program (established in 1985 

32by congress), including proposals to eliminate this program and to push legislation to make needed 

33revisions. ANA would oppose this because it could leave nurses vulnerable to civil or even criminal 

34lawsuits if this federal program is relinquished. ANA’s next steps are to monitor for any legislative 

35action to make revisions to this program and to oppose any effort to eliminate it. ANA will also continue 

36activities to promote childhood vaccination and healthcare provider education around immunization 

37practices and informed consent. 

38 

39 

40Federal Legislative and Regulatory Update 

41 

42Background: 

43ANA’s Department of Government Affairs influences the development and implementation of health, 

44economic and social policy through the legislative and regulatory processes. 

45 

46The 110 th Congress convened on January 4, 2007 amid the pomp and circumstance of a historic first in 

47American government. Democrats elected Representative Nancy Pelosi (D-CA) as the first woman 

48Speaker of the U.S. House of Representatives. The Speaker of the House is the third-ranking position in 

1 

2 



1the federal government, next in line to the Presidency after the Vice-President. The second session of 

2the 110 th convened on January 15, 2008 and has set September 26 as the date for target adjournment. 

3 

4Nursing’s strength on Capitol Hill is based on the collaboration and coordination of three critical 

5components of the ANA’s federal legislative program: lobbying, grassroots advocacy, and political 

6action. Each of these elements is integral. The success of nursing’s legislative agenda is due to the fact 

7that ANA has crafted and maintained well-rounded and complementary programs that are effective in 

8influencing policy makers at all levels of government. 

9 

10Appropriations 

11Background: 

12Current Title VIII funding: 

13President Bush signed the Consolidated Appropriations Act of 2008 (P.L. 110-161) into law on 

14December 26, 2007. This law contains 11 of the 12 annual funding bills that must be enacted yearly to 

15keep the Federal government operating (the Defense Appropriations Act was enacted in November). 

16The signing of this $555 billion package concluded a lengthy show-down between Congress and 

17President Bush, who had vetoed earlier legislation funding health care programs. In the end, the Title 

18VIII nursing workforce development programs received a $6.4 million increase over 2007 funding 

19levels, bringing FY 2008 funding levels to $156.05 million. This 4.3 percent increase stands in stark 

20contrast to the President’s proposal to cut FY 08 funding by $44 million (30%). The table below details 

21the history and specific break-down of the funding levels for the Title VIII programs: 

22 

23 

24 

25 

26 

27 

28 

29All numbers in millions 

President's FY Conference FY 2008 

2008 Budget Report 11/2/07 Consolidated 

PROGRAM FY 2007 

(versus 07) (versus 07) Funding Bill (versus 

07) 

Total: Nursing 

$105.3 (-$44, 30%) $167.7 (+$18, 12%) $156.05 (+$6.4, 4.3%) 

Workforce Development $149.68 

(Title VIII) 

-Advanced Education 

$0 (-$57, 100%) $62.98 ($5.9, 10%) $61.88 (+$4.8, 8%) 

$57.06 

Nursing 

-Nursing Workforce 

$16.1 $16.1 (flat) $15.83 (-$.27, 1.7%) 

$16.1 

Diversity 

-Nurse Education, Practice, 

$37.3 $37.29 (flat) $36.64 (-.65, 1.7%) 

$37.29 

and Retention 

-Loan Repayment and 

$43.7 (+$13, 42%) $40.0 (+$8.9, 29%) $30.51 (-.55, 1.7%) 

$31.06 

Scholarship Programs 

-Nurse Faculty Loan 

$4.77 $7.89 (+$3.1, 65%) $7.86 (+3.1, 65%) 

$4.77 

Program 

1 

2 



-Comprehensive Geriatric 

$3.39 $3.39 (flat) $3.33 (-.06, 1.7%) 

$3.39 

Education 

1 

2The consolidated appropriations act did not include an amendment supported by Representative Roger 

3Wicker (R-MS) that would have continued to ban the Occupational Safety and Health Administration 

4(OSHA) from enforcing the annual fit-test requirement for respirators used in health care settings. This 

5dangerous ban had been placed on OSHA by the then Republican-controlled Congress for the last three 

6years (FYs 2005-2007). This year, ANA members were successful in convincing Democrats to beat- 

this proposal in committee. This means that health care facilities are now required to conduct 

7back 

8annual fit-testing (in addition to initial fit-testing) of respirators used to protect health care workers from 

9TB. In addition, the Centers for Disease Control and Prevention (CDC) and OSHA have both issued 

10guidelines that recommend the annual fit-testing of respirators used to protect nurses from pandemic flu. 

11 

12Working with our Congressional champions, ANA was able to secure language in the House and Senate 

13Labor, HHS Appropriations bills requesting the Agency for Healthcare Research and Quality (AHRQ) 

14to study the benefits of safe patient lifting technology. Specifically, the Senate report, "Urges AHRQ to 

15study the impact of utilizing assistive devices and patient lifting equipment on patient injuries and 

16outcomes, as well as the health and safety of nurses." ANA will work with AHRQ to ensure that this 

17study is completed in a timely fashion and well publicized. 

18 


20The President’s proposed budget for FY 09, released on Feb 4, recommends $109,853 

21million in funding for Title VIII Nursing workforce development programs. This proposal represents a 

22decrease of $46,193 million, or 29.6%, from current funding levels. 

23 

24ANA and the nursing community are now working to convince Congress to increase funding for the 

25Nursing Workforce Development programs in fiscal year (FY) 2009, with a uniform request of $200 

26million. 

27 

28On February 25, Representatives Lois Capps, RN (D-CA) and Steven LaTourette (R- OH), the Co- 

29Chairs of the Congressional Nursing Caucus, circulated a letter in the U.S. House of Representatives 

30supporting $200 million in FY 2009 appropriations for the Title VIII Nursing Workforce Development 

31programs. Senators Barbara Mikulski (D-MD) and Susan Collins (R-ME) are expected to circulate a 

32similar letter this spring. ANA will work to secure co-signers for these letters to support the 

33appropriations request. 

34 

35Both ANA and the Tri-Council for Nursing have submitted requests to testify on Title VIII funding at 

36upcoming Appropriations Hearings. 

37 


39In March, letters were circulated in both the House and Senate urging support for $200 million in Fiscal 

40Year 09 funding for Title VIII Nursing Workforce Development Programs. These letters, commonly 

41referred to as "Dear Colleague" letters, are sent from one Member of Congress to another, and are used 

42to demonstrate support for federal programs. The more Representatives and Senators who sign the 

43letters, the more likely the programs are to receive funding increases. 

44 

45In the House, a bipartisan group of 156 members signed the Dear Colleague letter circulated by Reps. 

46Lois Capps, RN (D-CA) and Steven LaTourette (R-OH), the Co-Chairs of the Congressional Nursing 

1 

2 



1Caucus. The letter was delivered to the House Appropriations Committee on March 19. The Senate 

2letter, circulated by Sens. Barbara Mikulski (D-MD) and Susan Collins (R-ME), received 52 signatures 

3and was delivered to the Senate Appropriations Committee on April 4. 

4 


6In June, the House Labor, Health and Human Services, and Education Subcommittee approved an 

7increase of $18 million for the Title VIII Programs, which would bring FY 2009 funding to $174.4 

8million. The Senate Appropriations Committee approved an increase of $11.6 million, which would 

9bring FY 2009 spending to $167.7 million. Both the House and Senate would increase funding for the 

10National Institute for Nursing Research (NINR) at the NIH by roughly $4 million. 

11 

12Democratic leaders in Congress then put off finalizing the majority of the FY 2009 funding bills in 

13hopes that a new President would be more accommodating to their funding priorities. President Bush 

14has clashed repeatedly with Congress over domestic spending. House Appropriations Committee 

15Chairman David Obey (D-WI) has made it clear that he finds the negotiating stance of the Bush 

16Administration to be untenable and that he preferred to wait for a new President. 

18On September 27, the Senate passed a stop-gap spending bill that continues FY 2008 funding levels for 

19nursing programs through March 6, 2009. The House had passed the bill (H.R. 2638) earlier in the 

20week. This legislation, known as a 'continuing resolution' (CR) was needed to keep the federal 

21government operating past the October 1, 2008 start of the new fiscal year. President Bush signed the 

22CR into law on September 30. 

23 

24The CR continues funding for the Title VIII Programs at the FY 2008 level of $156 million through 

25March 6, 2009. Similarly, the National Institute for Nursing Research is temporarily flat-funded at $137 

26million. As long as the government is operating on a CR, the Department of Health and Human Services 

27will keep operating but new programs will not be initiated and grant programs will not be completed 

28until the FY 2009 funding amounts are finalized. ANA is now working to convince Congress to adopt 

29the higher level of funding included in the House Appropriations package when they finish these bills 

30next year. 

31 

32Budget FY 2009 

33Background: 

34President Bush released his fiscal year (FY) 2009 Budget on Monday, Feb 4, 2008. This $3.1 trillion 

35spending plan outlines the Administrations priorities. President Bush's continued efforts to cut taxes 

36while increasing funding for the military and domestic security have necessarily led him to propose cuts 

37to domestic healthcare programs. As in FY 2008, nursing has been targeted in these cuts. 

39The President’s proposal recommends $109,853 million in funding for Title VIII Nursing workforce 

40development programs. This represents a decrease of $46,193 million, or 29.6%, from current funding 

41levels. Further, as reflected in the chart below, the funding cut is achieved by the elimination of funding 

42for Advanced Education programs. These Advanced Education Nursing programs support schools of 

43nursing and academic health centers that prepare clinical nurse specialists, nurse practitioners, nurse 

44midwives, nurse anesthetists, nurse educators, nurse administrators, and public health nurses. These 

45programs also fund traineeships awarded to individual nursing students. 

46 

FY 2008 Final * FY 2009 

Percent Change 

President’s Budget (compared to FY 2008) 

1 

2 



Advanced Education 

61,875 0 -100% 

Nursing 

Nurse education, practice 

36,640 37,291 1.8% 

and retention 

Workforce diversity 15,826 16,107 1.8% 

Loan Repayment and 

30,512 43,744 43.4% 

Scholarship 

Comprehensive geriatric 

3,333 3,392 1.8% 

education 

Nursing faculty loan 

7,860 9,319 18.6% 

program 

Total, Title VIII Nursing 156,046 109,853 -29.6% 

1 

2The President’s Budget also includes sweeping reductions in Medicare and Medicaid, which the 

3proposal would cut by $14.2 Billion in 2009. Under the proposal, Medicare spending growth would be 

4reduced by 12.4 Billion in FY 09 and by $178.2 Billion over 5 years. Medicaid is targeted for smaller 

5cuts. The President’s plan calls for cuts totaling $1.8 billion in 2009, and $17.4 billion over 5 years. 

6Many of those savings come from reduction in the government’s payments to the states. 


4ANA is actively opposing these proposed cuts. ANA Government Affairs has been in communication 

5with Congressional leaders to explain that now is not the time to cut the already meager appropriations 

6for Nursing Workforce Development programs. ANA signed on to a letter to the House and Senate 

7Budget Committees requesting a $5.3 billion increase in overall budget authority for domestic health 

8care. 

5 

6This letter highlighted the fact that this funding is desperately needed to 1) restore funding to public 

7health programs cut in FY 2006; 2) restore lost purchasing power that flat-funding for at least five years 

8has eroded and 3) provide investments that begin to truly meet health challenges facing the nation. 

7 

8ANA will continue to fight for increased Title VIII funding in FY 09, and along with the nursing 

9community will be requesting $200 million for these programs and the appropriations process moves 

10forward. 

9 


11In mid-March, the House and Senate adopted $3 trillion budget resolutions for Fiscal Year 2009 by 

12votes of 212-207 and 51-44, respectively. While the resolutions are similar in terms of broad policy 

13outlines and priorities, they differ on a few major points. Foremost among these are overall FY 2009 

14discretionary spending levels, where the chambers are about $4 billion apart, and whether to offset the 

15cost of a one-year patch to the Alternative Minimum Tax (AMT). The House version mandates offsets 

16while the Senate version does not. 

12 

13In terms of the specific authorizations for Function 550/ Health Discretionary spending, there is good 

14news in both bills. The Senate would authorize $58.908 Billion in discretionary spending for Function 

15550/Health-- a $5.27 billion increase over FY 2008, and close to the $5.3 Billion increase recommended 

16by the Health Community, including ANA, in February. The House bill contains a $4.4 billion increase. 

14 

15The congressional budget resolution is a non-binding blueprint for the direction of budget policy over 

16the next five fiscal years and sets the overall amount of money the twelve appropriations subcommittees 

17will have to allocate to individual programs under their jurisdiction in each chamber. Before a final 

1 

2 



1version is passed by Congress, the Democratic leadership will need to reconcile the differences between 

2the two versions. So far there has been little movement toward such reconciliation. If agreement is not 

3reached soon, Congress will likely move directly into appropriations process without a budget blueprint. 

2 


4Congress reached agreement on the FY 2009 Budget Resolution which included an additional $21 

5Billion in Discretionary Domestic Funding over the President’s request. The Labor-HHS Subcommittee 

6was provided $153.121 billion, which is $7.973 billion over FY 2008 and $7.765 billion over the 

7President's budget request. This concluded the budget resolution process. 

5 

6Kid Safe Chemical Act 

7Background: 

8On May 20, Senator Frank Lautenberg (D-NJ) and Reps. Hilda Solis (D-CA) and Henry Waxman (D- 

9CA) introduced the Kid Safe Chemicals Act (S. 3040 / H.R. 6100). This ANA-supported legislation 

10would protect Americans, especially children, from toxic chemicals in everyday consumer products. 

11ANA believes that protection from exposure to toxic chemicals is fundamental both to public health and 

12to the protection of nurses in the workplace. 

13 

14Under existing federal law, the Environmental Protection Agency (EPA) has little authority to gather 

15necessary data or to take action to protect workers, consumers or children from dangerous chemicals. 

16Growing scientific evidence of human exposure to hazardous chemicals underscores the importance of 

17prompt Congressional action. 

18 

19The Kid Safe Chemicals Act places the burden of proof on chemical makers, rather than EPA, to 

20demonstrate the safety of the products that they manufacture and import to the United States. It will 

21force critical information into the public domain about chemical hazards, and contains a strict safety 

22standard that would be applied to thousands of industrial chemicals. In addition, the legislation expands 

23the Center for Disease Prevention and Control's (CDC) national survey of chemicals through human 

24biomonitoring. 

8 

9Specifically the Kid Safe Chemical Act will: 

10 • Require Basic Data on Industrial Chemicals. Chemical companies must demonstrate the 

11 safety of their products, backed up with credible evidence. Chemicals that lack minimum data 

12 could not be legally manufactured in or imported into the United States. 

11 • Place the Burden on Industry to Demonstrate Safety. EPA must systematically review 

12 whether industry has met this burden of proof for all industrial chemicals within 15 years of 

13 adoption. 

12 • Restrict the Use of Dangerous Chemicals Found in Newborn Babies. Hazardous chemicals 

13 detected in human cord blood would be immediately targeted for restrictions on their use. 

13 • Use New Scientific Evidence to Protect Health. EPA must consider and is authorized to 

14 require additional testing as new science and new testing methods emerge, including for health 

15 effects at low doses or during fetal or infant development and for nonmaterials. 

14 • Establish a National Program to Assess Human Exposure. The federal government's Center 

15 for Disease Control and Prevention (CDC) is to expand existing analysis of pollutants in people 

16 to help identify chemicals that threaten the health of children, workers, or other vulnerable 

17 populations. 

1 

2 



1 • Expand the Public Right to Know on Toxic Chemicals. A new, Internet-accessible public 

2 database on chemical hazards and uses will inform companies, communities, and consumers. 

3 EPA is to rein in excessive industry claims of confidentiality. 

2 • Invest in Long-Term Solutions. New funding and incentives are provided for development of 

3 safer alternatives and technical assistance in "green chemistry." 

3 

4In 2006, the ANA House of Delegates affirmed our commitment to reducing the use of toxic chemicals. 

5This resolution recognized the need to better understand the relationship between health and the 

6environment, especially for vulnerable populations such as infants, children, pregnant women, and the 

7elderly. Further, ANA endorses efforts to ensure the right-to-know about potentially hazardous 

8chemicals to which nurses, other healthcare workers, patients, and the public are exposed. 

9 

10The facts regarding exposures and current lack of regulation are striking. Out of the 80,000 chemicals 

11used to produce the products in our homes, the EPA has only required testing of 200. In fact, a 2006 

12GAO report cites the weakness of the current Toxic Substances Control Act (TSCA), highlighting that 

13only five chemicals that existed 29 years ago when Congress passed TSCA have ever been restricted by 

14EPA. Recent revelations about the link between the chemical "Bisphenol A," found in many plastics 

15including baby and water bottles and cancer and reproductive issues only underscores that the current 

16lack of regulation and testing is putting the public at risk. 

5Nurses in particular confront daily low-level but repeated exposures to mixtures of hazardous materials 

6that include residues from medications, anesthetic gases, sterilizing and disinfecting chemicals, 

7radiation, latex, cleaning chemicals, hand and skin disinfection products, and even mercury escaping 

8from broken medical equipment. 

9 

10A first-ever national survey of nurses' exposures to chemicals, pharmaceuticals and radiation on the job 

11released in December of 2007 suggests there are links between serious health problems such as cancer, 

12asthma, miscarriages and children's birth defects and the duration and intensity of these exposures. The 

13survey included 1,500 nurses from all 50 states. 

14 


6ANA is pleased to support the Kid Safe Chemicals Act (KSCA), which represents a major step toward 

7vital reforms in U.S. Chemical Policy, and we will continue to work to advance the bill and ensure the 

8health and safety of nurses and their patients. 

7 


9In the late summer and early fall ANA staff joined with environmental community partners in making 

10educational visits with hill staff on the bill, which to date has 11 co-sponsors in the House and 6 in the 

11Senate. In addition, on September 9, ANA Government Affairs Director Rose Gonzalez represented 

12ANA in a panel discussion on KSCA at the annual Congressional Hispanic Caucus Institute Policy 

13Institute. ANA will continue to partner with the environmental community and other stakeholders to 

14advance the bill as it is reintroduced in the upcoming 111 th Congress. 

10 

11Genetic Nondiscrimination 

12Background: 

13The American Nurses Association (ANA) supports the enactment of federal legislation that protects 

14individuals from discriminatory treatment and adverse consequences on the basis of their genetic 

15information by employers and/or insurers. A proposed way to prevent discrimination of genetic 

1 

2 



1information in the workplace and in health insurance is to enact federal laws banning such practices and 

2enforce stiff penalties to violators. ANA has supported genetic anti-discrimination legislation ever since 

3its initial introduction in the 104th Congress in 1996. 

2 

3ANA supports the Genetic Information Nondiscrimination Act of 2007 (S. 358/H.R. 493), which would: 

4 

5 Set limits on genetic testing to prevent genetic discrimination by health insurance companies 

6 and employers, 

6 Prohibit mandated testing, and 

7 Stop insurance companies from setting premiums or deciding on eligibility based on genetic 

8 information. 

8 

9 


11On April 24, 2008, the Senate passed the Genetic Information Nondiscrimination Act (GINA). This 

12amended version of H.R. 493 (which was passed by the House of Representatives on April 25, 2007 by a 

13vote of 420-3) was approved by unanimous consent. On May 1 the House agreed to the Senate’s 

14changes by a vote of 414-1, and the bill now awaits the President’s signature. 

12 


14President Bush signed the Genetic Non-Discrimination Act (P.L. 110-343) into law on May 31, 2008. 

15The final version of this law makes it illegal for employers to base hiring, firing, and promotion 

16decisions on genetic test results. In addition, health insurers are forbidden from basing coverage or 

17premiums on genetic test results. 

15 

16Immigration 

17Background: 

18ANA has been involved in conversations with House and Senate leaders who support proposals to 

19increase nurse immigration. Unfortunately, the American Hospital Association (AHA) continues to 

20pursue immigration as their primary means of addressing the nursing shortage. The AHA currently is 

21attempting to build upon their successful 2005 effort which recaptured 50,000 permanent employment- 

visas, and reserved these visas for RNs and physician therapists. 

22based 

19 

20ANA has been working to educate Congress about the many perils of immigration, while urging support 

21for efforts to improve the recruitment and retention of domestic RNs. At the same time, ANA has 

22entered into discussions with interested Members of Congress in order to ensure that the best interests of 

23domestic and immigrant nurses are included in any new visa recapture. These negotiations resulted in a 

24compromise amendment offered by Senator Richard Durbin (D-IL) during negotiations over the FY 

252008 Labor, Health and Human Services, and Education Appropriations Act. At this time, Senators 

26Charles Schumer (D-NY) and Kay Bailey Hutchinson (R-TX) had introduced an amendment that would 

27increase nurse immigration, without any regard for the need to invest in domestic nurse education. The 

28Durbin amendment improved upon the Schumer/Hutchinson effort by: 

21 • Limiting the number of recaptured visas to a one-time total of 60,000. 

22 • Authorizing the ANA-supported Nurse Education, Expansion, and Development (NEED) Act of 

23 2007 (H.R. 772, S. 446), which establishes a capitation program to support domestic schools of 

24 nursing. 

23 • Placing a fee of $1500 on each recaptured visa used by a RN, to be paid by the health care 

24 facility attesting for the immigrant nurse. 

1 

2 



1 • Investing the fees into an account used to fund the NEED Act. 

2 

3ANA agreed not to oppose the Schumer/Hutchinson effort as long as the Durbin proposals were 

4included. Ultimately, all immigration-related proposals were stripped from the final FY 2008 funding 

5legislation. 

4 


6AHA’s efforts to increase nurse immigration have continued unabated. ANA has been working with the 

7House Judiciary Subcommittee on Immigration, Citizenship, Refugees, Border Security, and 

8International Law to make sure that nursing’s interests are represented in these efforts. These 

9negotiations have resulted in the introduction of the Emergency Nursing Supply Relief Act of 2007 

10(H.R. 5924). This bill would increase the number of permanent employment-based visas offered to RNs 

11and physical therapists by 20,000 per year for three years. Like the Durbin amendment described above, 

12H.R. 5924 would place a $1,500 fee on each visa issued to an RN – to be paid by the nurse’s employer. 

13These funds would then be invested in the newly-authorized NEED Act programs. In addition, this bill 

14would establish a grant program at the Department of Labor to be used to create nursing career ladders. 

15These grants could be used by state nursing associations or joint labor union/employer committees to 

16support nursing pre-entry programs, provide tuition assistance and stipends for nursing students, and to 

17establish mentorship programs for new nursing graduates. ANA has remained neutral on H.R. 5924 

18which had 10 cosponsors as of June 11, 2008. 

7 

8ANA secured an invitation to testify before the House Judiciary Subcommittee on Immigration at a 

9hearing on “The Need for Green Cards for Highly Skilled Workers” held on June 12, 2008. ANA Senior 

10Policy Fellow Cheryl Peterson, MSN, RN provided public witness testimony on behalf of the ANA. 

11Cheryl Peterson’s remarks drew upon her extensive experience in international nursing migration. She 

12expressed dismay that some Members of Congress were “contemplating large-scale nurse immigration 

13yet again, when we have been down this road many times before without success.” Ms. Peterson 

14expressed ANA’s position that it is, “inappropriate to look overseas for nursing workforce relief when 

15the real problem is the fact that Congress does not provide sufficient funding for domestic schools of 

16nursing, the U.S. health care industry has failed to maintain a work environment that retains experienced 

17U.S. nurses in patient care, and the U.S. government does not engage in active health workforce 

18planning to build a sustainable nursing and health professions workforce for the future.” Instead, Ms. 

19Peterson urged the committee to invest in domestic nursing education and to support efforts to improve 

20the nursing work environment. 

9 

10On three separate occasions in the month of September, The House Judiciary Committee was scheduled 

11to consider but failed to move forward on the Emergency Nursing Supply Relief Act of 2008 (H.R. 

125924). ANA has been closely monitoring this complex bill which would provide for a temporary 

13increase in nurse immigration while also providing a new funding source for domestic schools of 

14nursing. 

15 

16The committee was scheduled to consider H.R. 5924 on September 10, September 17 and September 23, 

17but in each instance, action on the bill was delayed by consideration of other legislation. While ANA 

18remains opposed to the use of immigration to solve our domestic workforce shortages, we have 

19remained neutral, neither supporting nor opposing this targeted bill. ANA provided our complete 

20position on immigration in testimony delivered to the House Judiciary Subcommittee on Immigration in 

21June. 

22 

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1The Emergency Nursing Supply Relief Act would allow an additional 20,000 individuals to receive 

2permanent employment based visas in each year 2009-2011. Totaling 60,000; these visas could only be 

3used for registered nurses and physical therapists. Health care facilities using these newly available visas 

4to employ foreign-trained RNs would be assessed a fee of $1,500 per visa. The fees generated through 

5this initiative would then be invested in a newly authorized program that provides capitation grants to 

6domestic schools of nursing. Through this ANA-developed fee program, $90 million would be made 

7available to nursing schools to hire faculty, increase class room space, and improve capacity. ANA also 

8worked with supporters on the committee to prepare an amendment that would have provided for 

9significant new data collection on nurse immigration--something we will continue to advance. 

10 

11ANA expects reintroduction of the Emergency Nursing Supply Relief Act in the 111 th Congress and will 

12remain very much involved in the ongoing negotiations and in education of Congress on the many 

13pitfalls associated with nurse immigration. 

2 

3Mandatory Overtime 

4Background: 

5To counter staffing insufficiencies that are already occurring, many health care facilities have 

6increasingly imposed mandatory overtime. Typically, an employer may insist that a nurse work an extra 

7shift (or more) or face dismissal for insubordination, as well as being reported to the state board of 

8nursing for patient abandonment, a charge that could lead to a loss of license. At the same time, ethical 

9nursing practice prohibits nurses from engaging in behavior they know could harm patients, thus leading 

10to a dilemma for many nurses. 

6 

7The ANA has warned that mandatory overtime is dangerous for patients and nurses, and that the practice 

8is exacerbating a growing nursing shortage that is expected to worsen dramatically over the next 10 

9years. 

8 

9On May 3, 2007 Reps. Pete Stark (D-CA) and Stephen LaTourette (R-OH) reintroduced the Safe 

10Nursing and Patient Care Act (H.R. 2122), a bill which would prohibit the use of mandatory overtime as 

11a staffing tool. On August 20, 2007 Senators Kennedy (D-MA) and Kerry (D-MA), along with 14 

12additional co-sponsors, re-introduced the bill, S. 1842, in the Senate. 

10 

11H.R. 2122 / S.1842 would address the current nurse staffing crisis in the U.S. by strictly limiting 

12mandatory overtime for nurses, a dangerous practice that has contributed to a recent exodus of nurses 

13from the nation’s hospitals and a decline in safe, quality patient care. ANA has been at the forefront of 

14the push for this legislation, which was first introduced in the 107 th Congress (2001-2002), and worked 

15collaboratively on its development with members of Congress and other organizations representing 

16nurses including labor unions. 

12 

13Specifically, the legislation would prohibit health care facilities that receive Medicare funding from 

14requiring a Registered Nurse (RN) or Licensed Practical Nurse (LPN) to work beyond an agreed to, 

15predetermined, regularly scheduled shift. In no instance could a nurse be required to work more than 12 

16hours in a 24-hour period or for more than 80 hours in a two-week period. The bill includes an 

17exemption for declared local, state, or national emergencies, and the provisions would not apply to 

18voluntary overtime. 

14 

15To protect nurses who refuse overtime or who report information or cooperate with investigations 

16regarding the use of overtime, the bill explicitly prohibits providers of services from penalizing, 

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1discriminating, or retaliating in any manner towards a nurse who, acting in good faith, avails themselves 

2of these protections. 

2 

3ANA continues to support efforts of Constituent Member Associations across the country to enact 

4protections at the state level. The trend of forced overtime amongst nurses is such a significant threat to 

5patients’ and nurses’ safety that we are also calling on Congress to protect the public by taking federal 

6action. 

4 


6ANA continues to work to build co-sponsorship for H.R. 2122/ S. 1842, these bills currently have 81 

7and 17 cosponsors respectively. 

7 


9ANA continues to work to build co-sponsorship for H.R. 2122/ S. 1842, these bills currently have 83 

10and 17 cosponsors respectively. 

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12At the close of the 110 th Congress, H.R. 2122/S. 1842 had 86 and 18 cosponsors respectively. 

13 

14Medicaid Reimbursement for Advanced Practice RNs 

15Background: 

16ANA has been working for many years to remove barriers to APRN practice in Medicaid law. To this 

17end, ANA has supported the Medicaid Advanced Practice Nurses and Physician Assistants Access Act 

18(S.59/H.R. 2066), introduced in the Senate on January 4, 2007, by Sen. Daniel Inouye (D-HI), and in the 

19House by Rep. John Olver (D-MA) on April 26, 2007. 

17 

18S. 59/H.R. 2066 would require Medicaid to cover the services of all APRNs under fee-for-service 

19coverage. It would also require Medicaid to recognize nurse practitioners and certified nurse-midwives 

20as primary care case managers in their targeted case management plans. In addition, it would require 

21Medicaid managed care panels to enroll nurse practitioners, certified nurse-midwives, certified 

22registered nurse anesthetists, and clinical nurse specialists. 

19 

20ANA maintains that the Medicaid APN Access Act will improve the Medicaid program by expanding 

21access to cost-effective health care services. Each year millions of Americans go without the health care 

22services that they require because physicians simply are not available to care for them. This problem 

23plagues rural and urban areas alike. Medicaid beneficiaries are particularly vulnerable, since in recent 

24years a number of health professionals have chosen not to care for them or have been unwilling to locate 

25in the communities where these beneficiaries live. APRNs are an exception to this trend; they frequently 

26accept patients that others will not treat and serve in provider shortage areas. The appropriate utilization 

27of APRNs will increase access to health care and decrease preventable acute care admissions and 

28emergency room visits. 

20 

21In addition, to existing challenges facing APRNs and their patients under Medicaid, ANA is monitoring 

22changes to the program being sought by the Bush Administration. Through proposed regulations and 

23the President’s FY 2009 budget proposal, the Administration has sought to shift billions of dollars to 

24states and localities for key Medicaid services. These proposals threaten access to health care for 

25millions of our most vulnerable citizens in the midst of a fiscal downturn which already strains states’ 

26abilities to maintain critical education, public health and social services. Children and adults with 

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1disabilities and children in foster care are particularly at risk, and some consider this effort an improper 

2attempt to rewrite the Medicaid program, without Congressional input or oversight. Registered nurses 

3as well as APRNs would be directly affected by decreased federal Medicaid reimbursement for 

4rehabilitation services, psychiatric-mental health services, school-based services, outpatient services, 

5and case management. Last year, Congress passed legislation temporarily delaying implementation of 

6the proposed Medicaid regulations. 

2 


4ANA Continues to educate members of Congress and build co-sponsorship for this important 

5legislation. As of Feb 29, 2007, the House bill had 49 bipartisan cosponsors, and the Senate bill had two 

6cosponsors. 

5 

6In February 2008, the ANA lent its support to extending the current legislative moratorium on the 

7Administration’s Medicaid regulations. ANA agreed to go on record as a co-signer of a letter sent to 

8the leadership of the House of Representatives, including House Speaker Nancy Pelosi. 

7 


9ANA Continues to educate members of Congress and build co-sponsorship for this important 

10legislation. As of Feb 29, 2007, the House bill had 51 bipartisan cosponsors, and the Senate bill had 

11three cosponsors. 

10 


12As of November 6, 2008 the House bill had 56 bipartisan cosponsors, and the Senate bill continued to 

13have three. ANA is working to get the legislation scored by the Congressional Budget Office in hopes of 

14including the Medicaid APN and PA Access Act in either overarching health care reform legislation, or 

15in SCHIP reauthorization in the 111 th Congress. 

13 

14Medicaid Regulations Moratorium 

15Background: 

16In February 2008, the ANA lent its support to extending the current legislative moratorium on the 

17Administration’s Medicaid regulations. ANA agreed to go on record as a co-signer of a letter sent to the 

18leadership of the House of Representatives, including House Speaker Nancy Pelosi. 

17 

18On April 23, the House passed the Protecting the Medicaid Safety Net Act of 2008 (H.R. 5613), ANA- 

legislation that would place a moratorium on seven Medicaid regulations issued by the 

19supported 

20Department of Health and Human Services. The 349-62 vote demonstrates bipartisan concern about the 

21effect of the regulations on providers and beneficiaries, and gives the bill more than the two-thirds 

22majority necessary to override President Bush's veto threat. The bill has now been "fast-tracked" for a 

23Senate vote the week of April 28th. 

24 

25Introduced by Reps. John Dingell (D-MI) and Tim Murphy (R-PA), H.R. 5613 would delay until Apri1 

262009 implementation of seven regulations (detailed below) which together would reduce Federal 

27Medicaid funding to the states by nearly $20 billion over the next five years. The moratorium would 

28give Congress time to evaluate the merits of the proposed changes. The National Governors Association 

29and the National Association of State Medicaid Directors have both issued statements decrying the 

30regulations and the effect they are expected to have on Medicare beneficiaries. A number of the 

31regulations covered by the bill have already been temporarily blocked by Congress; however the last of 

32these deals will expire in June of this year. 

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2Currently, the federal government covers 57 percent of Medicaid's costs - an estimated $204 billion in 

3fiscal 2008. Tension between the federal government and the states over the funding balance is not new. 

4The Administration argues that the regulations close loopholes that allow states to receive extra federal 

5funding to cover costs that the administration asserts are not Medicaid-related. The National Governor's 

6Association counters that the regulations "effectively end the federal government" participation in many 

7crucial components of the Medicaid program and inappropriately shift those costs to states." 

2Given the current budget difficulties already facing most states, a cost shift of this magnitude will force 

3states to either pare back on Medicaid services or compensate for the lost funding with reductions to 

4other state budget items. For this reason, the rules stand to threaten access to health care for millions of 

5our most vulnerable citizens. Medicaid is a key component of the United States health care system. One 

6out of every three births, one out of every four children, eight million disabled citizens, and seventy 

7percent of all nursing home care is funded by this program. Medicaid rolls have expanded over the last 

8five years due to a dramatic increase in the number of Americans lacking health insurance, and in a time 

9of economic downturn, the safety net that Medicaid provides is even more vital. 

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The regulations targeted for a moratorium by H.R. 5613 include: 

Coverage of Rehabilitation Services 

(Rule Status: proposed rule issued Aug 13 207; current moratorium through June 2008) 

This rule amends the definition of Medicaid rehabilitative services and explicitly excludes from 

coverage services provided under foster care programs, child care, education, vocational 

services, and certain other social services. The rule contains a number of new definitions 

including the qualification of providers of rehabilitation services, more narrow definition of 

rehabilitative services, a requirement for a written plan of care, documentation requirements, and 

non-coverage for services that are covered under other programs to which the individual is 

eligible. This rule would affect services delivered by those nurses and other practitioners 

involved with patients with significant health or mental health impairments. Coverage for these 

services would be reduced and responsibility shifted to other social service or educational 

programs. Most reviewers of the regulation believe that it would result in a significant reduction 

in Medicaid coverage or rehabilitation services. 

Targeted Case Management 

(Rule status: interim final rule issued December 4, 2007; effective March 3, 2009; no current 

moratorium) 

The intent of the case management services is to assist individuals with disabilities, chronic 

illnesses or special needs gain access to the full spectrum of health care and support services by 

arranging and coordinating care. States may provide case management for adults, but must 

provide it for children. Under the rule, which is designed to clarify when Medicaid payment will 

be made for case management services, states would no longer be able to receive funding for 

important care coordination activities. The new restrictions on targeted case management would: 

impose an arbitrary limit of one case manager per child; impact efforts to integrate school-based 

services for children with disabilities; fragment services for children in foster care; and roll back 

efforts to transition people from nursing homes by limiting assistance available to people with 

disabilities to secure needed services in a community setting. 

School-based Transportation and Outreach (Rule status: final rule issued December 28, 

2007; current moratorium through June 2008) Under current practices, schools may be 

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reimbursed for their administrative activities associated with the Medicaid program, including 

outreach, assistance with enrollment and referral of children to Medicaid providers and services. 

Schools may also be reimbursed for limited, specialized medical transportation to get children to 

and from school. The rule eliminates federal Medicaid matching funds for the costs of certain 

school-based administration and transportation activities. Medicaid payments would not be 

available for activities performed by school employees or contractors, or for transportation to 

and from school. Medicaid would continue to cover the costs of covered Medicaid services 

delivered in school-based settings and for transportation to a site where the covered services are 

available if not offered on the school campus. Many believe that the rule would seriously disrupt 

services to children with critical needs. 

Provider taxes 

(Rule status: final rule issued February 22, 2008; effective April 22, 2008; no current 

moratorium) Under current law, states are allowed to tax providers as a way to cover Medicaid 

expenses. These provider taxes are used to improve provider payment rates and quality. CMS 

wants to make it more difficult for states to raise the non-federal share of Medicaid expenditures 

through a provider tax that holds the provider "harmless" for the cost of the tax. This change in 

the definition of provider tax will put current, long-standing state programs in jeopardy. While 

this rule does not directly reduce eligibility, services or provider payment rates, its indirect 

effects could lead to reductions in some or all of these categories. 

Hospital Outpatient 

(Rule status: proposed rule issued September 28, 2007; no current moratorium) 

This rule would significantly impact the types of hospital outpatient services Medicaid can 

cover. Medicaid would be prohibited from covering services such as dental and vision, 

commonly provided to Medicaid patients through outpatient clinics. It would also restrict the 

ability of states to cover services in outpatient clinics that are separate from hospitals-a common 

way states have served people in communities and reduced emergency room use. Finally the rule 

would lower the amount states can pay for outpatient services. The rule has the potential to 

severely diminish access, particularly in light of Medicaid's already low reimbursement rates. 

Graduate Medical Education 

(Rule status: proposed rule issued May 23, 2007; current moratorium through May 25, 

2008) 

The proposed rule states that costs and payments under Medicaid attributable to graduate 

medical education would no longer be eligible for federal matching payments. CMS believes the 

graduate medical education is not a "health service" that is included in the Medicaid statute. 

Many believe that this prohibition on payment for graduate medical programs will diminish the 

number of providers with the necessary skills and experience available to meet the unique needs 

of Medicaid beneficiaries, particularly those with disabilities. 

Intergovernmental Transfer 

(Rule status: final rule issued May 29, 2007; current moratorium through May 25, 2008) 

This rule places strict limits on Medicaid payments to critical safety net institutions such as 

hospitals and nursing homes. This rule imposes a new definition of "unit of government" for 

purposes of having their contributions count toward the non-federal share of Medicaid 

expenditures - whether such contributions are in the form of inter-governmental transfers (IGTs) 

to the state or are expenditures they make to pay for care to Medicaid eligible patients. The rule 

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1 also limits Medicaid payments to public hospitals to no more than their costs of providing care, 

2 and requires public hospitals to retain the full amount of their Medicaid payments. The purpose 

3 of this rule is to limit state options for recycling funds that are paid to public providers that in 

4 turn are eligible for federal matching payments. These arrangements have allowed states to shift 

5 some of the costs of Medicaid back to the federal government. While the rule does not explicitly 

6 reduce benefits, eligibility, or provider participation, it would force states to make adjustments to 

7 their Medicaid programs that could lead to cuts in all three areas. 

2 


4While the bill received overwhelming bipartisan support in the House, the Senate appears much more 

5divided. Senate Leadership unexpectedly announced on April 25 that H.R. 5613 would be "fast tracked" 

6for a vote the week of April 29th, but key Senate Republicans including Finance Committee Ranking 

7member Charles Grassley (R-IA), and Minority Leader Mitch McConnell (R-KY) have argued that the 

8regulations should be allowed to take effect. This opposition will have made it difficult to secure a veto 

9proof majority, and the bill has not been brought to the floor for a vote. The Senate instead will likely 

10attempt to add at least some of the moratorium provisions to the Supplemental Appropriations bill 

11which the president will be unlikely to veto. 

5Changes that jeopardize Medicaid have real implications, not just for beneficiaries, but for all members 

6of the community. It is vital that the implementation of these regulations be postponed until their 

7implications can be thoroughly weighed. For this reason ANA will continue to advocate for a 

8moratorium on the Medicaid Regulations. 

6 


8On May 22, a veto-proof majority of the Senate to include the ANA-supported moratorium on six of the 

9seven of the Medicaid regulations in the supplemental wartime funding bill. The House of 

10Representatives had passed the same moratorium, which would delay the Medicaid regulations until 

11April 1, 2009, by a similar veto-proof majority one week earlier. President Bush has signed the 

12moratorium into law (P.L. 110-252) on June 30, 2008. 

9 

10Medical Homes – Recognizing APRNs as Primary Care Providers 

10Background: 

11The "medical home" concept rewards primary care providers (PCPs) for providing ongoing care and 

12coordination of care, particularly for complex patients. These services are extremely valuable in keeping 

13healthcare costs down, by avoiding complications and the unnecessary use of specialists. Yet primary 

14care services are widely recognized to be both time-intensive and undervalued, contributing to a 

15shortage of PCPs, particularly among physicians. 

16 

17In the Medicare Improvement and Extension Act of 2006, Congress created the Medicare Medical 

18Home Demonstration Project, the first attempt to create medical homes at the federal level. 

19Unfortunately, the 2006 Act’s definition of a "medical home" for primary care was limited strictly to a 

20"board certified physician," thus excluding nurse practitioners -- and other health care providers who 

21currently provide primary care. While the Medicare demonstration project is somewhat narrow in its 

22scope, there is concern that its definition of medical home could become the rule for all of Medicare, 

23and then all of health care. 

24 

25Many nurse practitioners serve as PCPs, and their background and nursing perspective often lead them 

26to excel in this role, as recognized by patients and many other health care providers. As providers of 

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1high quality, safe, coordinated care, NPs meet the National Committee for Quality Assurance (NCQA) 

2standards for a medical home. In rural and underserved areas, NPs can be the only PCPs available. 

3Unfortunately, their valuable contributions to primary care have not been fully acknowledged, both 

4within the states and at the federal level, particularly when "primary care" and "medical home" are 

5defined in terms of physicians only. 


3The Senate Finance Committee has been developing legislation to expand the Medicare Medical Home 

4Demonstration Project, which is likely to become part of a comprehensive bill addressing Medicare in 

5general. The ANA has been working with Senate Finance Committee Chairman Max Baucus (D- 

6Montana), and other nursing organizations, to specifically include nurse practitioners within the 

7definition of "medical home." MedPAC, the Medical Payment Advisory Commission, recently 

8approved the inclusion of nurse practitioners within the definition of primary care providers eligible to 

9become medical homes – and to receive incentive payments for providing primary care. ANA members 

10have been encouraged to contact members of the Senate Finance Committee, to show their support for 

11including APRNs in the medical home concept. In related action, the AMA RUC committee issued its 

12approval of the Medicare project (see Strategic Imperative #4: Unification: American Medical 

13Association.) 


5On July 15th the House and Senate voted to override President Bush's veto of the Medicare 

6Improvements for Patients and Providers Act (MIPPA, P.L. 110-175), a Medicare package which 

7includes a number of provisions important to beneficiaries and providers. With the House vote of 

8383-41, and the Senate vote of 70-26 both bodies secured the 2/3 vote necessary to enact the bill into law 

9despite Presidential objections. 

6 

7A provision in the new law would allow Medicare to expand the current "medical homes" 

8demonstration project if it is determined that the project improves the quality of care without increasing 

9costs to Medicare. The medical homes demonstration provides incentive payments to primary care 

10physicians that coordinate care for high need Medicare beneficiaries with certain chronic conditions. 

11ANA continues to maintain that this demonstration project should be opened to APRNs as well as 

12physicians. 

8 

9ANA staff attended an October meeting of the Patient-Centered Primary Care Collaborative (PCPCC), 

10created by the American College of Physicians (ACP), the American Association of Family 

11Practitioners (AAFP), other primary care physician groups, health insurers, and corporations such as 

12IBM. PCPCC is dedicated to furthering the concept of the medical home, and its principles specifically 

13define medical homes as being led by physicians. However, PCPCC staff publicly stated at the meeting 

14that they “did not intend to exclude nurse practitioners” from the medical home concept, and several 

15panelists (particularly those from state and local programs) said they use and support medical homes led 

16by NPs. 

10 

11At the November interim House of Delegates meeting of the American Medical Association, medical 

12homes were the subject of several resolutions as well as heated debate – particularly regarding 

13reimbursement. The AMA adopted Resolution 804, the “Joint Principles of the Patient-Centered 

12 

13Medical Home” developed by the PCPCC – and therefore limited specifically to medical homes led by 

14personal physicians. The AMA HOD referred additional issues concerning medical homes for further 

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1study, for report back at the June 2009 meeting. 

2 

3Mental Health Parity – Group Health Insurance 

4Background: 

5Legislation under consideration in the U.S. House and Senate would require group health insurers to 

6cover mental health care at the same level as physical health care. The bills, S. 558, “The Mental Health 

7Parity Act of 2007,” and H.R. 1424, “The Paul Wellstone Mental Health and Addiction Equity Act,” 

8take slightly different approaches, but both bills aim to end longstanding insurance discrimination and 

9remove barriers to care for those facing mental illness. In addition, another bill introduced in the House 

10would tackle mental health parity within the Medicare program. Taken together these bills offer hope 

11for major progress on mental health parity in the 110 th Congress. 

6 

7Currently, insurers who cover mental health commonly apply stricter limits and higher co-payments on 

8mental health coverage. The Mental Health Parity Act of 1996 established a more limited form of 

9parity, stating that annual or lifetime limits on mental health benefits may be no lower than similar 

10limits on medical or surgical benefits. With this existing mandate set to expire this year, and a clear need 

11for more defined protections, it’s important that Congress passes mental health parity legislation this 

12session. 

8 

9S. 558, introduced by Sens. Peter Domenici (R-NM), Edward Kennedy (D-MA), and Michael Enzi (R- 

10WY), is the result of long-term negotiation among businesses, insurers, and mental health advocacy 

11groups. H.R. 1424 was introduced on March 9 by Reps. Kennedy (D-RI) and Ramstad (R-MN). The 

12bill is named after the late Senator Paul Wellstone, who championed parity legislation prior to his death 

13in a plane crash in 2002. 

10 

11While neither bill mandates insurance coverage of mental health care, the bills would prohibit insurers 

12that offer mental health benefits from imposing financial requirements (such as deductibles, co- 

and annual and lifetime limits) or treatment limitations (including limits on treatment 

13payments, 

14frequency, number of visits and length of stay) that are more restrictive than those applied to medical 

15and surgical coverage. 

12Both bills provide exemptions for small employers (50 or fewer employees) and both bills include a 

13cost exemption provision that would allow group health plans to opt out of the coverage requirement for 

14one plan year if, if actual costs increased by more than a specified amount (two percent in the first year 

15or one percent in each subsequent year) in any plan year. The following plan year, the requirements 

16would again be in force. 

13 

14On September 1, 2007, the Senate passed by unanimous consent an amended version of S. 558, that 

15included changes made by its sponsors to ensure it will not pre-empt existing state mental health parity 

16laws. While the S. 558 still differs from the House mental health parity bill, H.R. 1424, the changes to 

17Senate pre-emption language diminish one of the sharpest contrasts between the two bills. 

15H.R. 1424 has been approved by all three committees of jurisdiction, but has not yet been brought up for 

16a vote by the full House. While mental health parity legislation has come further this Congress than any 

17time in recent memory, a few key differences between the bills, along with difficulty identifying funding 

18sources to offset the bill's price tag ($3.8 billion over 10 years), have stalled the bills’ progress. 

16ANA is committed to ensuring access to quality health care for all, and has expressed support for both 

17the House and Senate parity bills. It is critical that we end the longstanding insurance discrimination and 

18barriers to care experienced by those facing mental illness, and ANA will work to advance mental health 

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1parity legislation that achieves this goal. 

2 


4Supporters of the bill continue to work to resolve the differences and identify the "pay-for" to cover the 

5bill's costs. Speaker Pelosi has stated that the House Bill will be brought up for a vote no later than 

6March 15. ANA will continue to urge Congress to pass meaningful mental health parity legislation 

7before the close of the 110 th Congress. 

5 


7On March 5, the House approved legislation requiring health plans offering mental health coverage to 

8provide the same benefits for mental illness as they do for other medical conditions. The Paul Wellstone 

9Mental Health and Addiction Equity Act of 2007 (H.R. 1424), which passed by a vote of 268-148, still 

10differs in a few important ways from S. 558, the Mental Health Parity Bill passed by the Senate in 

11September of last year. 

8 

9The House "paid for" H.R. 1424 in part by including provisions that would prohibit physicians in 

10Medicare from referring patients to hospitals in which they have an ownership interest, with the ability 

11to grandfather existing physician-owned hospitals. A second funding measure would increase the size of 

12prescription drug rebates pharmaceutical companies must provide state Medicaid programs. Neither 

13provision is universally favored by members of Congress, and the White House has openly opposed the 

14controls on physician-owned hospitals. In fact, in a March 5 statement the Administration expressed 

15opposition to H.R. 1424 because of the funding provisions as well as the mandated conditions covered 

16in what it calls "confusing pre-emption provisions." 

10 

11Mental health parity legislation has come further this Congress than any time in recent memory, but 

12with a few key differences between the House and Senate bills, some difficulty identifying funding 

13sources to offset the bill's price tag ($4.3 Billion over 10 years), and political dynamics between the two 

14chambers, it has been difficult to achieve final compromise legislation that could pass both chambers 

15and be signed by the President. 

12 

13Parity proponents in both chambers have expressed commitment sending parity legislation to the 

14President before the end of the 110th Congress, both chambers have been engaged in discussions to 

15resolve these differences. Bolstering this effort, a bipartisan group of 25 senators have signed a letter to 

16Senate leadership expressing support for the intent of both bills and urging the passage of a compromise 

17before Congress adjourns. 

14 

15On March 18, two of the three lead Senate parity bill sponsors, Sens. Kennedy (D-MA) and Dominici 

16(R-NM) offered draft compromise legislation to the House. The offer included the Senate-passed small 

17employer exemption, language on out-of-network coverage that is more in keeping with the House 

18approach, and used the House bill language on transparency. However it did not incorporate the House's 

19DSM-IV coverage provision. 

16 

17On April 24, the House proponents announced that they had prepared a counteroffer to the Senate 

18proposal, but did not release the details. Senate sponsors have made it clear that the offer put forth in 

19March is very close to the best offer that the Senate could approve. Negotiations are ongoing. 

18 


20On October 1 st and 3 rd respectively, the Senate and House passed the Paul Wellstone and Pete Domenici 

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1Mental Health and Equity Act of 2008—compromise Mental Health Parity legislation that was included as 

2part of the 700 billion dollar financial market rescue package. The bill was signed into law by the President 

3on October 3. 

2 

3Medicare Mental Health Parity 

4Background: 

5On March 23, Rep. Pete Stark (D-CA), along with introducing co-sponsors Kennedy and Ramstad, 

6introduced the Medicare Mental Health Modernization Act (H.R. 1663). The bill, which has 12 

7additional co-sponsors to date, would require mental health parity in the Medicare program by reducing 

8the co-payment for outpatient mental health benefits from 50% to the 20% (the rate charged for most 

9physical health services), and by eliminating a 190-day limit on inpatient mental health treatment. ANA 

10co-Signed a Mental Health Liaison Group letter of support for H.R. 1663 on April 23, 2007. 

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8Although the bill seems unlikely to move as freestanding legislation, its proponents are exploring ways 

9to include Medicare mental health parity language in the broader mental health parity legislation 

10currently under consideration. ANA will continue to support Medicare mental health parity 

11legislation. 

9 


11As of June 9, the bill had 53 cosponsors. To date no progress has been made on including the bill’s 

12provisions in Mental Health Parity or Medicare legislation. 

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14The bill did not advance and support remained at 53 cosponsors at the close of Congress. 

15 

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18Medicare Coverage of APRN Services 

19Background: 

20ANA worked with the APRN specialty organizations and the U.S. Senate to support the drafting and 

21introduction of the Home Health Care Planning Improvement Act of 2007 (S. 1678). This bill was 

22introduced by Senators Susan Collins (R-ME), Kent Conrad (D-ND), Daniel Inouye (D-HI), Barbara 

23Mikulski (D-MD), and Gordon Smith (R-OR) on June 21. This ANA endorsed legislation would change 

24Medicare law to grant Nurse Practitioners, Clinical Nurse Specialists, and Certified Nurse Midwives the 

25ability to order and certify home health services and to sign home health plans of care. 

21 

22Under current Medicare law, only physicians and podiatrists may sign plans of care or certify a patient 

23for home health services. 

23 


25ANA supported the House introduction of the Home Health Care Planning Improvement Act (H.R. 

266826). This companion to S. 1678 was introduced on August 1, 2008 by Representative Allyson 

27Schwartz (D-PA), and it has received the support of 42 cosponsors. 

26 

27ANA also launched a successful campaign to include APRNs as qualified electronic prescribers in a 

28Medicare demonstration. The first draft of the Medicare Improvements for Patients and Providers Act 

29(MIPPA, P.L. 110-275) would have denied APRNs access to this demonstration. ANA argued that all 

1 

2 



1qualified prescribers should be included, and our argument won the day. Participating APRNs will now 

2receive an additional 2 percent payment increase in fiscal years 2009 and 2010. 

2 

3House Nursing Caucus 

4Background: 

5In order to educate Congress on all aspects of nursing, in 2003 ANA worked with Representatives Lois 

6Capps (D-CA) and Ed Whitfield (R-KY) to encourage the establishment of a Nursing Caucus in the U.S. 

7House of Representatives. In 2005, Representative Steven LaTourette (R-OH) took over as Caucus Co- 

8Chair for Rep. Whitfield. Representatives Capps (D-CA) and LaTourette (R-OH) once again co-chair 

9the Nursing Caucus for the current, 110 th Congress. 

6 

7The Caucus provides Members of Congress an open forum to address issues affecting the nursing 

8community. It also serves as a clearinghouse for information and a sounding board for ideas brought 

9forth by the nursing community. The Caucus holds regular briefings on matters such as the nurse 

10shortage, barriers to practice for Advanced Practice Registered Nurses, bioterrorism preparedness, 

11health care reform, and patient safety issues. Every Member of Congress who belongs to the House 

12Nursing Caucus identifies a staff person dedicated to the Caucus and its issues. This increases the 

13number of staff on Capitol Hill knowledgeable of nursing issues. 

8 


10ANA is working to build Caucus membership; all members of Congress are eligible to join the Caucus, 

11125 members have signed on so far. 

11 

12 

13 


15In conjunction with National Nurses Week, the Congressional Nursing Caucus and the American Nurses 

16Association (ANA) sponsored a luncheon briefing on Thursday, May 8th for congressional health staff 

17to highlight the importance of safe RN staffing and the solutions being developed and implemented in 

18the states. 

19Rebecca M. Patton, MSN, RN, CNOR, President of the American Nurses Association moderated the 

20briefing which featured a panel of expert speakers including: 

16 

17 

17 

18 

• Anne Tan Piazza - Director of Governmental Affairs & Communications 

Washington State Nurses Association 

• Sue Clark, RN - Lobbyist 

Illinois Nurses Association 

18 • Jan Lanier, RN, JD - Deputy Executive Director 

19 Ohio Nurses Association 

19 


21The Caucus remained at 125 members at the close of Congress. 

22 

23Proposal to Create an Office of the National Nurse 

24Background: 

25The Office of the National Nurse (ONN) initiative originated with a May 2005 New York Times Op-Ed 

26piece by Oregon Nurses Association Member Teri Mills, MS, RN, ANP. Efforts to advance the proposal 

1 

2 



1have included the introduction of federal legislation during previous, 109 th Congress (H.R. 4903) and 

2the development of a blog site (www.nationalnurse.blogspot.com) and grassroots campaign. Although 

3the legislation has not been reintroduced for the new, 110 th Congress, proponents continue to promote 

4the initiative and seek support from legislators, nursing and public health organizations, and individual 

5nurses. 

2 

3Since the initiative’s inception, ANA has held concerns about the practicality and efficacy of the 

4proposed creation of an office of the national nurse. While the ONN proposal continues to evolve, 

5ANA’s concerns that it is duplicative of, and could potentially divert funds from, the existing public 

6health infrastructure remain. To continue to monitor and respond appropriately to the issue, ANA 

7formed an informal coalition with the Association of State and Territorial Directors of Nursing 

8(ASTDN), the Association of Community Health Nursing Educators (ACHNE), the Commissioned 

9Officers Association (COA) and the American Association of Colleges of Nursing (AACN), the 

10American Public Health Association (APHA), and the immediate past Chief Nurse, Mary Pat Couig. 

4 

5In response to increased inquiries from organizations and individuals, the coalition elected to craft an 

6open letter of concern. On October 2, ANA, along with other nursing and public health organizations, 

7sent this letter, with the goals of: articulating shared concerns about the national nurse proposal; 

8reflecting our strong desire to address the very real issues facing nursing and public health; and 

9providing added perspective on the issue for individuals or organizations considering the merits of the 

10national nurse initiative. 

6 

7Signers as of Feb 29, 2008 include: 

8American Association of Colleges of Nursing (AACN) 

9American Association of Critical-Care Nurses (AACN) 

10American Association of Occupational Health Nurses, Inc. (AAOHN) 

11American Nurses Association (ANA) 

12American Organization of Nurse Executives (AONE) 

13American Public Health Association (APHA) 

14Association of Community Health Nursing Educators (ACHNE) 

15Association of State and Territorial Directors of Nursing (ASTDN) 

16Association of State and Territorial Health Officials (ASTHO) 

17Association of Women's Health, Obstetric & Neonatal Nurses (AWHONN) 

18Commissioned Officers Association (COA) 

19Mary Pat Couig, MPH, RN, FAAN 

20National Association of Pediatric Nurse Practitioners (NAPNAP) 

21National League for Nursing (NLN) 

22Public Health Nursing Section, American Public Health Association 

23Quad Council of Public Health Nursing Organizations 

9 


11To date, the national nurse legislation has not yet been reintroduced in the 110 th Congress, but advocates 

12have continued a grassroots campaign for the post. ANA continues to monitor the National Nurse issue. 

12 


14On April 15 ANA joined a dozen other Nursing and Public Health Organizations and two former Public 

15Health Service Chief Nurse Officers in sending a letter to HHS Secretary Michael Leavitt urging him to 

16upgrade the position of the PHS Chief Nurse Officer to a two-star ranking. The letter urged the 

1 

2 



1Secretary, who can take such action unilaterally without the approval of Congress, to act now, by 

2promoting the current PHS Chief Nurse Officer, Carol Romano, RN, PhD, FAAN. 

3 

4ANA believes that this promotion is important to bring the ranking of the PHS Chief Nurse Officer in 

5line with that of the other CNOs in the uniformed services, as well as to recognize the increased 

6leadership responsibilities of the PHS Chief Nurse and the entire PHS Nurse Corps, particularly in the 

7areas of emergency preparedness and response. Since 2004, the nursing category has been the largest 

8within the PHS Commissioned Corps-at present, there are 1,400 PHS nurses. 

2Signers of the letter to Secretary Leavitt are: 

3American Nurses Association (ANA) 

4American Organization of Nurse Executives (AONE) 

5American Public Health Association (APHA) 

6Association of Community Health Nursing Educators (ACHNE) 

7Association of PeriOperative Registered Nurses (AORN) 


9Association of Women's Health, Obstetric & Neonatal Nurses (AWHONN) 

10Commissioned Officers Association (COA) 

11Julia R. Plotnick, MPH, RN, FAAN, USPHS CNO 2/1992-2/1996 

12Mary Pat Couig, MPH, RN, FAAN, USPHS CNO 12/2000-10/2005 

13National Association of Pediatric Nurse Practitioners (NAPNAP) 

14National Student Nurses' Association, Inc. 

15Public Health Nursing Section, American Public Health Association 

16Quad Council of Public Health Nursing Organizations 

3 


5On July 2, the Tri Council for Nursing, which brings together the four professional 

6organizations of the American Association of Colleges of Nursing (AACN), the American 

7Nurses Association (ANA), The American Organization of Nurse Executives (AONE), and the 

8National League for Nursing (NLN), sent a letter to the President of the National Nursing 

9Network Organizing Network expressing continued opposition to the proposal to create an 

10office of the National Nurse. 

11 

12While the ONN proposal has continued to evolve, ANA and many other nursing and public 

13health organizations remain concerned that the establishment of an Office of the National 

14Nurse is simply not an effective means of accomplishing the NNO's stated goals. ANA 

15certainly agrees that increased emphasis on public health is necessary and that nursing must 

16play a strong role in promoting a shift to a culture of prevention, however, we believe that our 

17efforts and resources are better invested in policies and legislation that promise more 

18immediate and tangible advances for nurses, their patients, and public health overall. 

6Reproductive Health Care Access 

7Background: 

8In August, the Department of Health and Human Services proposed a rule purporting to interpret three 

9federal laws that allow providers to refuse to perform abortions or sterilizations. In reality, the 

10implications are potentially much more far-reaching and could compromise women's access both to 

11health care and to the complete and accurate information that they need to make important health care 

12decisions. If adopted the proposed new regulations stand to limit patients’ access to both health care 

1 

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1services and important information about their health care options by significantly expanding the ability 

2of health care providers to withhold treatment, counseling, or medical information (including referral to 

3other practitioners who are willing to provide information and services) based on religious and moral 

4beliefs—without any regard for the needs of patients. The regulations would leave the door open for 

5entire health care organizations, including insurance plans and hospitals, to deny access to or even 

6information about birth control. And it could effectively upend hard won protections at the state level 

7intended to help individuals and families access basic health care. 

2 

3HHS formally proposed the regulation despite strong opposition from members of Congress, state 

4elected officials, health care providers and advocates. When a draft of the regulations was leaked in 

5July, ANA joined 120 members of Congress and over More than 60 organizations including the 

6American Medical Association, the American College of Obstetricians and Gynecologists, the 

7American Public Health Association, and the National Association of City and County Health Officials 

8in urging the Administration not to move forward proposal. 

4 

5The Department claims that these regulations are needed to educate the public and the health care 

6industry about the scope of certain existing federal refusal clauses. (Proponents would argue that the 

7regulations would ensure that individuals are not coerced to engage in or discriminated against for 

8refusing to participate in actions that are counter to their moral or religious beliefs). However, contrary 

9to Congress’ intent, the draft proposed regulations essentially rewrite those laws to permit institutions as 

10well as individuals to refuse to provide women access to contraceptive services and information. 

6 

7In addition, the draft rule seeks to limit access by deliberately confusing contraception with abortion. 

8According to HHS’s proposal, abortion can now be defined to include “any of the various procedures— 

9including prescription, dispensing, and administration of any drug or the performance of any procedure 

10or any other action—that results in the termination of the life of a human being in utero between 

11conception and natural birth, whether before or after implantation.” Under this broad definition, a range 

12of hormonal contraceptives as well as some non-hormonal devices approved by the FDA to prevent 

13pregnancy fall within the scope of the rule because they may work by interfering with implantation. 

8 

9Finally, the regulations openly call into question and are intended to trump state laws regarding women's 

10reproductive health care--among laws specifically cited in the regulations as problematic are CT's 

11requirement that hospitals make plan B emergency contraception available to victims of rape, and NY 

12and CA's law requiring employers offering employee prescription drug plans to include coverage for 

13contraception. 

10 


12ANA’s policy on Reproductive health, adopted in 1989, states that "ANA believes that the health care 

13client has the right to privacy and the right to make decisions about personal health care based on full 

14information and without coercion. It is the obligation of the health care provider to share with the client 

15all relevant information about health choices that are legal and to support that client regardless of the 

16decision the client makes. Abortion is a reproductive alternative that is legal and that the health care 

17provider can objectively discuss when counseling clients. If the state limits the provision of such 

18information to the client, an unethical and clinically inappropriate restraint will be imposed on the 

19provider and the provider-client relationship will be jeopardized." 

13 

14In light of this policy and our belief that the Regulations stand to have a serious, damaging and 

15potentially far-reaching impact on reproductive heath care, in September, ANA joined in two sets of 

1 

2 



1comments opposing the regulations, one set originating with Planned Parenthood Federation of America 

2the other with Physicians for Reproductive Choice and Health. 

2 

3On November 18 ANA learned that the Administration does plan to move forward this week with a 

4Final Rule despite the enormous call for withdrawal from Members of Congress, state officials, and 

5concerned groups and individuals. If and when this happens, it is likely that Congress will take 

6corrective action in the New Year to address the issue. 

4 

5Respirator Fit-Testing 

6Background: 

7The FY 2008 consolidated appropriations act did not include an amendment supported by 

8Representative Roger Wicker (R-MS) that would have continued to ban the Occupational Safety and 

9Health Administration (OSHA) from enforcing the annual fit-test requirement for respirators used in 

10health care settings. This dangerous ban had been placed on OSHA by the then Republican-controlled 

11Congress for the last three years (FYs 2005-2007). This year, ANA members were successful in 

12convincing Democrats to beat-back this proposal in committee. This means that health care facilities are 

13now required to conduct annual fit-testing (in addition to initial fit-testing) of respirators used to protect 

14health care workers from TB. In addition, the Centers for Disease Control and Prevention (CDC) and 

15OSHA have both issued guidelines that recommend the annual fit-testing of respirators used to protect 

16nurses from pandemic flu. 

8 


10Rep. Wicker, who has been the leading opponent of fit-testing, has been appointed to fill the seat vacated 

11by now retired Republican Senator Trent Lott. ANA will be on the alert for potential attempts to 

12reinstate the ban, particularly as Rep. Wicker takes on this new role. 

11 


13No activity since March 2008. 

14 


16Rep. Roger Wicker won his bid to keep the Mississippi Senate seat. He will remain in the Senate for at 

17least the next six years. ANA will monitor his committee assignments and amendment offerings to 

18ensure that the fit test requirement is not placed in jeopardy. 

17 

18Safe Patient Handling and Movement (SPHM) 

19Background: 

20Nurses have long suffered from disabling back injuries and other musculoskeletal disorders that result 

21primarily from lifting, transferring, and repositioning patients by using manual techniques. Speakers at 

22the briefing discussed the scientific basis behind the SPHM program and how it can decrease injuries 

23and health care costs while increasing the quality of patient care. 

24 

25The extent of musculoskeletal disorders among the U.S. nursing workforce is particularly distressing 

26when considered in the context of the current nursing shortage. Estimates report that 12 percent of 

27nurses leave the profession annually due to back injuries and greater than 52 percent complain of 

28chronic back pain. Specifically, injuries secondary to patient handling tasks compound factors driving 

29the shortage such as aging of the nursing workforce, declining retention and recruitment rates, and 

30lowering social value of nursing. 

1 

2 



1Over the past decade, much attention has been given to the health and safety concern among health care 

2workers. Despite the recognition that manual patient handling is a high-hazard task, the incidence of 

3musculoskeletal disorders persists at high rates for nurses and other health care personnel - signaling the 

4need for continued action. Emerging efforts to prevent musculoskeletal injuries have concentrated on 

5reducing injuries through the use of assistive equipment and devices for patient handling. Many studies 

6have shown that this equipment pays for itself through lower worker compensation claims and 

7decreased health care worker absenteeism. 

2 


4Working with our Congressional champions, ANA was able to secure language in the FY 2008 House 

5and Senate Labor, HHS Appropriations bills requesting the Agency for Healthcare Research and Quality 

6(AHRQ) to study the benefits of safe patient lifting technology. Specifically, the Senate report, "Urges 

7AHRQ to study the impact of utilizing assistive devices and patient lifting equipment on patient injuries 

8and outcomes, as well as the health and safety of nurses." ANA will work with AHRQ to ensure that this 

9study is completed in a timely fashion and well publicized. 

5 


7On April 16 th , Janet Haebler presented state and national legislative initiatives at the second Annual Safe 

8Patient Handling and Movement Conference sponsored by the University of North Carolina, School of 

9Nursing / Chapel Hill. In addition to nursing, individuals from the insurance industry and lift vendors 

10were also in attendance. The University’s school of nursing was one of the 26 schools accepted to 

11participate in the ANA, Veterans Administration, and The National Institute for Occupational Safety and 

12Health (NIOSH) demonstration project in which safe patient handling and movement is integrated in the 

13nursing curriculum, including how to utilize various assistive devices. 

8 


10ANA staff is meeting with Congressional champions to shape our approach to SPHM legislation in the 

11111 th Congress. 

11 

12Safe RN Staffing 

13Background: 

14In the 108th Congress Sen. Daniel Inouye (D-HI) and Rep. Lois Capps (D-CA) worked with ANA to 

15develop and introduce legislation to ensure adequate registered nurse (RN) staffing in health care 

16facilities in response to the current nursing crisis. 

15On January 4, 2007 Senator Inouye reintroduced ANA's safe staffing bill the Registered Nurse Safe 

16Staffing Act of 2007 (S. 73). On Friday, November 9, Reps. Capps (D-CA) and Brown-Waite (R-FL) 

17introduced the House companion bill, HR 4138. The bill was introduced with 14 additional co-sponsors 

18including a second Republican, Rep. LaTourette of OH. 

16 

17The RN Safe Staffing Act (H.R. 4138/ S. 73) would hold hospitals accountable for the development and 

18implementation of unit-by-unit RN staffing plans, in direct coordination with direct care nurses and 

19based on each unit's unique needs. S. 73/ H.R. 4138 would mandate the development of staffing 

20systems in hospitals aimed at ending the widespread practice of health care facilities stretching their 

21nursing staff with unsafe patient loads, "floating" to specialty units without training and orientation, and 

22other practices that undermine the delivery of safe, quality care. 

18The bill amends the conditions of participation for hospitals in the Medicare program and establishes a 

19requirement for minimum staffing ratios. Rather than establishing a specific numeric ratio, the act 

1 

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1requires the establishment of a staffing system that "ensures a number of registered nurses on each shift 

2and in each unit of the hospital to provide for appropriate staffing levels for patient care." 

2 

3This is not a “one size fits all” approach to staffing. Instead, S. 73 / H.R. 4138 ensures that nurse 

4staffing can be tailored to the specific needs of each unit, based on factors including how sick the patient 

5is, the experience of the nursing staff, available technology, and the support services available to the 

6nurses. 

4 

5Most importantly, this approach treats nurses as professionals and empowers them at last to have a 

6decision-making role in the care they provide. 

6 

7Specifically the staffing system must: 

8 - Be created with input from direct-care RNs or their designated 

9 representative; 

9 - Be based on the number of patients and level of intensity of care to be 

10 provided, with consideration given to patient admissions, discharges and 

11 transfers on each shift; 

10 - Reflect the level of preparation and experience of those providing care; 

11 - Reflect staffing levels recommended by specialty nursing organizations; and 

12 - Provide that an RN not be forced to work in a particular unit without 

13 having first established that he or she is able to provide professional care 

14 such a unit. 

13 

14Another key provision of the bill is the requirement of public reporting of staffing information. Under 

15the legislation, hospitals would be required to post daily the number of licensed and unlicensed staff 

16providing direct patient care on each unit and each shift, while specifically noting the number of RNs. 

17Finally, the bill provides whistle-blower protections for RNs and others who may file a complaint 

18regarding staffing. The bill establishes procedures for receiving and investigating complaints, and 

19creates enforcement mechanisms, including civil monetary penalties, that can be imposed by the 

20Secretary of Health and Human Services for each knowing violation. 

15 


17ANA continues to educate members of Congress about safe staffing and build co-sponsorship for the 

18RN Safe Staffing Act. Bipartisan co-sponsorship of the House bill has grown to include two additional 

19Republicans, Rep. Christopher Shays (CT) and Rep. Patrick Tiberi (OH) bringing the total number of 

20republicans to 4 and the total co-sponsorship to 22. The Senate bill currently has no additional co- 

18 

21sponsors. 

19In December 2007, ANA launched www.safestafingsaveslives.org, a website that highlights ANA’s safe 

20staffing work. ANA’s national grassroots campaign on safe staffing is for potential members and ANA 

21members so they can become engaged in this issue and, at the same time, demonstrate ANA’s 

22perspective and advocacy on the issue. 

20 


22Co-sponsorship of HR 4138 has risen to 30 members, including Rep. Mark Kirk (R-IL), bringing the 

23number of republicans on the bill to 5. 

23ANA continues outreach and education on the issue, and hosted a Congressional Nursing Caucus 

24Briefing on May 8 titled, Safe RN Staffing States Prove Solutions are Possible to highlight the 

1 

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1stakeholder collaboration on staffing plan legislation that is taking place, particularly in OH, WA and 

2IL, and that we are hopeful can be duplicated at the federal level. (See the House Nursing Caucus 

3section of this report for additional details). 

2 


4As the 110 th Congress closes, H.R. 4138 has 47 co-sponsors, including nine Republicans. This is a 

5strong improvement over last Congress, which concluded with support for the House bill at 22 co- 

two Republicans. 

6sponsors, 

5 

6Staffing legislation was one of the major topics of discussion at the annual ANA/CMA lobbyist meeting 

7in which twenty eight states were represented. Four CMAs present were able to share their success in 

8enacting staffing legislation within the past year, modeled after ANA’s principles for safe staffing: IL, 

9WA, OH, and CT. They attributed the enactment of staffing laws in large part to the collaboration 

10between key stakeholders: the state nurses association with the hospital associations, nurse executives, 

11and labor. At least two other CMAs are intent on pursuing like legislation in 2009. 

7 

8Scope of Practice Issues – APRNs 

9Background: 

10Two resolutions from the 2006 American Medical Association (AMA) House of Delegates (902) titled, 

11“Need for Active Medical Board Oversight of Medical Scope of Practice Activities by Mid Level 

12Practitioners” and (904) titled, “Diagnosis of Disease and Diagnostic Interpretation of Tests Constitutes 

13Practice of Medicine to be Performed by or Under the Supervision of Licensed Physicians” make 

14assumptions and claims without merit and threaten the continued development and success with 

15collegial relationships between physicians and other licensed health care professions at a time when 

16access to quality multidisciplinary care is at a premium. 

11 

12The Coalition for Patients’ Rights (CPR) was formed in spring 2006 to counter the AMA’s Scope of 

13Practice Partnership (SOPP) initiative to limit the scope of practice of non-physician healthcare 

14providers. The CPR’s goal is to improve access to a wide variety of healthcare professionals who 

15deliver safe, affordable, and effective health care to patients. CPR members are committed to working 

16with SOPP organizations to enhance patient access to quality care – rather than limiting access to 

13quality health care. Over 35 organizations representing over 3 million licensed healthcare professionals 

14have endorsed CPR’s joint statement. A website has been created and can be found at 

15http://www.patientsrightscoalition.org/. 

14 

15At the federal level, ANA is working to counteract the AMA’s message on the Healthcare Truth and 

16Transparency Act (H.R. 2260), which was reintroduced on May 10, 2007. Original co-sponsors include 

17Representatives John Sullivan (R-OK), Jim McDermott (D-WA), Joe Pitts (R-PA) and David Scott (D- 

18GA). This bill would make it illegal for any licensed health care provider who is not a medical doctor 

19(MD) or doctor of osteopathic medicine (DO) to make any statement or engage in any act that would 

20lead patients or the public to believe that they have the same or equivalent education, skills, or training 

21as an MD or DO. This bill brings these activities under the purview of the Federal Trade Commission 

22(FTC) and instructs the FTC to identify specific acts and practices that would violate this act, and to 

23identify instances where any state or public policy has permitted such acts and practices to occur. If this 

24bill were enacted, nurses and other licensed health care providers could be found by the FTC to have 

25engaged in unfair trade practices, which can result in fines of up to $10,000 per violation. 

16ANA maintains that this imposition of federal trade law on health care practice is unprecedented and 

17unnecessary. The bill asserts that "ample evidence exists of providers who are not medical doctors or 

1 

2 



1doctors of osteopathic medicine holding themselves out as such" but fails to provide any evidence of 

2these practices. It also fails to recognize that such activity, if it were to exist, is already governed by the 

3state boards of nursing. 

4 

5The Healthcare Truth and Transparency Act is also inconsistent in its approach to the issue of false 

6representation of health care education and clinical training. The legislation seeks to impose significant 

7criminal penalties on a select group of licensed providers, while ignoring many others. The bill fails to 

8address the actions and representations of MDs and DOs that fall outside of their education, skills, and 

9clinical training. The erroneous assumption that these providers should be exempt from the provisions 

10of this bill does not serve today’s patients and does not fulfill the stated intent of this legislation. 

2 

3On September 4, 2007, ANA distributed a letter to the co-sponsors of the Healthcare Truth and 

4Transparency Act outlining our objections to the bill. In addition to the ANA, this letter was signed by 

5the American Association of Colleges of Nursing, the National Association of Clinical Nurse 

6Specialists, and the National Organization of Nurse Practitioner Faculties. 

4 


6On March 7, 2008 ANA hosted a meeting of the Steering Committee of the CPR. The purpose of the 

7meeting was to finalize the CPR operating guidelines and request for public relations proposals, identify 

8key components of the response tool kit, review organizations’ responsibilities, and set the date and 

9agenda for the CPR Membership Meeting on April 2, 2008, at ANA headquarters. Representatives from 

10key members of the nursing and healthcare community – nurse practitioners, nurse anesthetists, 

11psychologists, etc.—participate in the CPR. 

7 


9ANA has been working with the American Association for Nurse Anesthetists (AANA) to formalize the 

10membership and operations of the CPR. On April 2, 2008, ANA hosted an in-person general meeting of 

11organizations interested in participating in CPR, which was very well-attended. There was widespread 

12support for a public relations campaign about CPR and its message, and a request for proposals was 

13issued in April 2008. General agreement was reached on several significant areas: goals, membership 

14categories, financial support, use of official documents, and a method to collect and disseminate reports 

15of attacks on scope of practice. CPR operating guidelines have been revised, with input from ANA’s 

16Office of General Counsel, and was discussed during a May 28 steering committee conference call. 

10 

11On May 2, 2008, the AMA presented a summary of current SOPP activities to the Federation of State 

12Medical Boards. On the question of “Who do you trust on the issue of health care reform?” the AMA 

13noted that “Nurses are front and center,” with a 78% trust rating, versus 56% for doctors. Current SOPP 

14membership was listed as 49 state medical associations + D.C.; 14 national medical specialty societies; 

15the AMA and the American Osteopathic Association; and 16 state osteopathic associations – with 

16“interest from several nonphysician groups.” 

12For 2008, the SOPP plans legislative, regulatory, judicial, and informational activities, and financial and 

13other support for campaign action plans by members. SOPP resources include the SOPP Data Series, 

14listservs, and a planned “Geographic Mapping Initiative.” Phase I, mapping U.S. practice locations for 

15practicing MDs and Dos, state-by-state, has been completed. Phase II, mapping practice locations for 

16“desired professions of actively practicing nonphysicians” should be completed later this month. The 

17AMA Scope of Practice Data Series comprises individual reports – regarding demographics, education 

18and training, licensure and regulation, professional organization, and current literature – on various 

19healthcare providers. The planned reports & their stage or progress: (a) Completed: Psychologists, 

1 

2 



1Podiatrists and Naturopaths; (b) Under final review: Nurse Practitioners; and (c) In progress: 

2Optometrists, Pharmacists, Nurse Anesthetists, Audiologists, Physical Therapists, Oral Surgeons. 

2 

3The AMA believes “most nonphysicians practice in the same urban/suburban corridors as do 

4physicians; distribution of rural providers is at the crux of these scope battles.” The SOPP is also 

5undertaking a “Truth in Advertising Campaign” at the federal and state levels (specifically Florida, 

6Massachusetts and New York) to distinguish MDs from “limited license health care providers.” Other 

7SOPP initiatives include: creating rapid response coalitions; studying potential collaboration with 

8“certain nonphysician groups,” and work groups on clinical doctorates & naturopaths. 

4 

5On May 28, the ANA hosted a conference call of the CPR Steering Committee, which then approved the 

6CPR Operating Guidelines. These are now posted on the CPR website. The AMA HOD, which meets 

7June 14-18, will consider several resolutions relating to the scope of practice of APRNs. ANA 

8submitted written comments responding to these resolutions, and GOVA staff will attend the AMA 

9HOD and monitor and report on their progress. ANA’s letters to the AMA were shared with ANA’s 54 

10CMAs, 20 Organizational Affiliates, and the 35 organizational CPR members. ANA, AANA, and the 

11APA staff interviewed two PR firms for a CPR media campaign, on June 12. A third firm will be 

12interviewed in July. 

6 


8Please see the previous section entitled “Coalition for Patients’ Rights” for a complete update on CPR 

9activities, particularly the public relations campaign now in progress. Information about the AMA’s 

10SOPP (Scope of Practice Partnership) is no longer publicly available on AMA’s website, nor are SOPP 

11activities discussed in public sessions at the AMA House of Delegate meetings. However, in October 

12the AMA posted on their website a Board of Trustees Report, dated June 2008, which states: 

9 

10 Scope-of-practice issues 

11 

12 Through the Scope of Practice Partnership (SOPP), the AMA is leading the effort 

13 to contest scope-of-practice expansions that threaten patient safety, serving as a watchdog of 

14 legislative, regulatory, and legal efforts that seek to expand the scope of practice of nonphysician 

providers into the practice of medicine. The SOPP has grown to include the AMA, the 

15 

16 American Osteopathic Association, 14 national medical societies, 49 state medical associations, 

17 and the Medical Society of the District of Columbia, and 17 state osteopathic societies. The 

18 SOPP created task forces to address such issues as licensure of naturopaths, doctor of nursing 

19 practice programs, and truth-in-advertising pilot programs—all to counteract the more than 200 

20 scope-of-practice bills and regulations tracked by the AMA’s Advocacy Resource Center. The 

21 SOPP is also overseeing the completion of the AMA Scope of Practice Data Series, a 

22 compendium of information and resources for medical associations on 10 non-physician 

23 providers, and the creation of a tool that will allow Federation partners the ability to map, on a 

24 state-by-state basis and by specialty, the practice location of not only physicians and doctors of 

25 osteopathic medicine but also various non-physician providers. 

14 

15GOVA staff attended the AMA House of Delegates meeting on June 14-18, where three resolutions 

16were adopted which seek to limit nursing education and practice. Resolution 214, "Doctor of Nursing 

17Practice," would require physician supervision for DNPs. Resolution 303 (subsequently renumbered 

18232), "Protection of the Titles 'Doctor,' 'Resident' and 'Residency,'" would limit the use of these terms to 

19physicians, dentists and podiatrists. Resolution 716, "AMA Model Agreement with Advanced Practice 

1 

2 



1Nurse Clinicians, Nurse Practitioners and/or Clinical Nurse Specialists," recommends that such 

2agreements address "quality of care, continuity of care, and scope of practice" of Advance Practice 

3Registered Nurses. 

2 

3ANA President Becky Patton and CEO Linda Stierle submitted letters to the AMA recommending 

4rejection of Resolutions 214 and 303, as did several fellow nursing organizations and CMAs. While 

5these resolutions are policy statements, they set the agenda for state medical associations as well as the 

6AMA itself, to advocate for state and federal action. Also at the June AMA meeting, the AMA Board of 

7Trustees issued Report 27, "Nursing Shortage Leadership for Patient Safety; Reducing the Hospital 

8Registered Nurse Shortage at the Bedside," calling for physicians to lead the effort to reduce the nursing 

9shortage. 

4 

5On November 8-11, GOVA staff attended the AMA’s interim House of Delegates meeting. Nancy 

6Nielsen, MD, PhD, the new AMA president, set a new tone, by urging AMA members to embrace 

7“fundamental change – for ourselves, for our patients, and for our nation.” When we met Dr. Nielsen, 

8she expressed interest in working together with other health care providers toward healthcare reform 

9(and noted that her son is a nurse). 

6 

7At the November meeting, the AMA HOD voted to refer Resolution 211, “Limiting the Number of 

8Nurse Practitioners,” for report back at the next meeting. Res. 211 seeks to limit the number of nurse 

9practitioners supervised by a physician to a level which maintains “good quality medical care.” The 

10Council on Legislation noted that the AMA Advocacy Center had mapped the distribution of NPs as the 

11same as that of MDs. AMA members supported the general concept – and objected to NPs practicing 

12independently – but many believed this was an issue best left to the states and/or further study. 

8 

9Resolution 212, “State Legislative Response to NBME Practice of Using USMLE Step 3 Physician 

10Licensing Exam Questions for Doctors of Nursing Practice Certification,” was adopted with 

11amendments. So “that no person is misled that the training of allied health professionals through 

12programs or certification is equivalent to the education, skills and training of physicians,” this calls for 

13model state legislation prohibiting the use of NBME (National Board of Medical Examiners) and 

14NBOME ( National Board of Osteopathic Medicine Examiners) exam questions in certification exams 

15for DNPs and other non-physician providers. In committee, two dozen AMA members expressed 

16support for the resolution’s main idea, many on behalf of their state, specialty society, or AMA section. 

10Resolution 846, “Clarification of the Title ‘Doctor’ In the Hospital Environment,” was adopted. This 

11time around AMA members acknowledged that PhD’s, etc., are considered “doctors” in academia, thus 

12the use of “hospital environment.” The resolution calls for working with Joint Commission to 

13implement this policy. 

11 

12As noted in greater detail in the section about APRNs and Medical Homes, the AMA HOD also adopted 

13Resolution 804, which defines a medical home as led by a physician. The AMA will hold its 2009 

14annual meeting next June. 

13 

14 

15 

16Title VIII Nursing Workforce Development Programs Re-Authorization 

17Background: 

18Congress is preparing to review the underlying authority for Title VIII Nursing Workforce Development 

19programs, which are administered by the Health Resources and Services Administration (HRSA) and 

1 

2 



1support the supply and distribution of qualified nurses to meet our nation’s health care needs and 

2provide care to individuals in all health care settings. Although Congress added authorities to Title VIII 

3with the passage of the Nurse Reinvestment Act in 2002, the Title has not been re-authorized in full 

4since 1998. 

2 

3Over the last 45 years, the Title VIII programs have addressed each aspect of nursing shortages- 

4education, practice, retention, and recruitment. The programs provide the largest source of federal 

5funding for nursing education, offering financial support for nursing education programs, individual 

6students, and nurses. 

4 

5Title VIII programs bolster nursing education from entry-level preparation through graduate study, 

6favoring institutions that educate nurses for practice in rural and medically underserved communities. 

7According to HRSA, these programs provided loans, scholarships, and programmatic support to 71,729 

8nursing students and nurses in FY 2007. 

6 

7Title VIII Programs include: 

8 

9 

10 

11 

12 

• Advanced Education Nursing—Provides grants to nursing schools, academic health centers, and 

other entities to enhance education and practice for nurses in master’s and post-master’s 

programs. Also supports traineeships to prepare nurse practitioners, clinical nurse specialists, 

nurse midwives, nurse anesthetists, nurse educators, nurse administrators, and public health 

nurses. 

9 

10 

11 

12 

• Workforce Diversity Grants—Provides grants to increase nursing educational opportunities for 

individuals who are from disadvantaged backgrounds (including students from economically 

disadvantaged families as well as racial and ethnic minorities underrepresented in the nursing 

profession). 

10 

11 

12 

13 

14 

• Nurse Education, Practice, and Retention Grants—Supports schools and nurses at the associate 

and baccalaureate degree level. Grants are provided to schools of nursing, academic health 

centers, nursing centers, state and local governments and other public or private nonprofit 

entities. Some grants (such as grants promoting the Magnet Hospital best practices for nursing 

administration) are also available to health care facilities. 

11 

12 

13 

14 

15 

16 

• Loan Repayment and Scholarship—The Nurse Education Loan Repayment Program repays 60 

to 85 percent of nursing student loans in return for at least two years of practice in a facility 

designated to have a critical shortage of nurses. The Nursing Scholarship Program supports 

students enrolled in nursing school. Upon graduation, scholarship recipients are required to 

work full-time for at least two years in a facility designated to have a critical shortage of nurses. 

13 

14 

15 

16 

• Nurse Faculty Loan Program—Establishes loan programs within schools of nursing to support 

students pursuing masters and doctoral degrees. Upon graduation, loan recipients are required to 

teach at a school of nursing in exchange for cancellation of up to 85 percent of their educational 

loans, plus interest, over four years. 

14 

15 

16 

• Comprehensive Geriatric Education Grants—Provides grants to train nurses who provide direct 

care for the elderly, to support geriatric nursing curriculum, to train faculty in geriatrics, and to 

provide continuing education to nurses who provide geriatric care. 

15 


17In preparation for Congressional Action on Title VIII, representatives of over 25 Nursing Organizations 

18came together at the request of Sen. Mikulski (D-MD) to develop a consensus document reflecting 

1 

2 



1shared principles and goals for the process. This document, signed by 32 organizations including ANA 

2and the Tri-Council for Nursing, was finalized and shared with Sen. Mikulski’s staff on February 22. 

3The over-arching principle emphasized in the document is the belief that Title VIII programs are already 

4strong, but are in need of additional funding in order to realize congressional intent and full potential. 

2 

3Hearings on the re-authorization are expected later this spring. 

4 


6While Sen. Mikulski’s office expressed interest in holding a Title VIII hearing this spring, it seems that 

7other Congressional issues and priorities have intervened and it now seems unlikely that Title VIII re- 

will be taken up this Congress. 

8authorization 

7 


9The reauthorization of the Title VII and VIII programs remain on the agenda for the 111 th Congress. 

10Senate aides tell GOVA that they will probably be distracted with national healthcare reform and SCHIP 

11reauthorization in 2009, and that Title VIII will likely wait until 2010. House aides, on the other hand, 

12are indicating that they may get to Title VIII in 2009. 

10 

11 

12State Legislative Update 

13 

14Nursing Education Advancement 

15Background: 

16ANA House of Delegates’ support for baccalaureate education of nurses dates back to 1964 when adopting the 

17motion that “ANA continue to work toward baccalaureate education as the educational foundation for 

18professional nursing practice.” During the 2008 House, a near unanimous vote resulted in the adoption of the 

19nursing education advancement resolution. Delegates asked that ANA affirm that increased numbers of 

20registered nurses with a baccalaureate degree are needed to address the ongoing challenges of an 

21increasingly complex health care delivery system and a critical nursing faculty shortage; support 

22initiatives to require registered nurses (RNs) to obtain a baccalaureate degree in nursing within ten years 

23after initial licensure, exempting (grandparenting) those individuals who are licensed or are enrolled as 

24a student in a nursing program at the time legislation is enacted; and advocate for and promote 

25legislative and educational activities that support enhanced advanced degrees in nursing. 

17 


19To date, New York and New Jersey have introduced legislation that would require RNs to attain a 

20baccalaureate degree within ten years of initial licensure. This issue was the topic of the New Jersey 

21State Nurses Association, Nurses in Trenton Day in October and to which ANA staff provided a 

22briefing. Other CMAs have expressed interest in pursuing. State Government Affairs is creating a tool 

23kit including recommended strategies to consider when launching a campaign, model bill and sample 

24message points for nurses/legislators; with the intent of having it ready for resumed/new legislative 

25sessions in 2009. 

20 

21Chemical Policy Reform Advocacy 

22Background: 

23Organizational commitment to chemical policy reform was solidified with the establishment of the 

24ANA Center for Occupational & Environmental Health program in 2005 followed by member 

25resolution at the 2006 House of Delegates, entitled “Nursing Practice, Chemical Exposure and Right-to- 

1 

2 



1Know”. This landmark resolution, directs that: ANA advocate a course of action both nationally and 

2through the nationwide state legislative agenda that reduces the use of toxic chemicals requiring less 

3harmful chemicals be substituted whenever possible; supports labeling and full disclosure mechanisms; 

4demands adequate information on the health effects of chemicals and chemicals in products before they 

5are introduced on the market; and creates more streamlined methods for chemicals to be removed from 

6use. It encompasses “green chemistry” which is the design of environmentally sustainable chemical 

7products and processes that result in: safer products; reduced waste and contamination; elimination of 

8costly “end of pipe” pollution reduction measures; and reduced use of energy and resources. 

9Furthermore, it resolved that ANA will monitor chemicals policy activities and educate legislators about 

10the links between chemical exposures and public health. ANA has been in receipt of grant funding from the 

11Beldon Foundation for the past five years, enabling the expansion of advocacy for environmental health in many 

12states. 

2 


4A number of accomplishments have resulted from the work of the past few months and have been 

5mentioned in the Outreach section of this report. 

5 

6Additionally, ANA president Rebecca Patton joined representatives of state and national coalition 

7partners in an open letter to Stephen Johnson, Administrator, U.S. Environmental Protection Agency to 

8ban all uses of the toxic pesticide Endosulfan. ANA also joined state and national coalition partners in 

9the submission of a letter to Senators Obama and McCain identifying Bush administration actions most 

10detrimental to environmental health that will require immediate action. 

7 

8Several CMAs are members of coalitions advocating for the removal of toxics in toys. To augment 

9these efforts ANA submitted comment and testified at a public hearing urging the FDA to ban the toxic 

10chemical Bisphenol A in food, health care, and children’s products. ANA also advocated for Consumer 

11Product Safety Commission Reform Act provisions related to toxics in toys and other children’s 

12products. 

9 

10Utilizing Beldon funds, mini grants have been awarded to the Connecticut and Rhode Island CMAs to 

11support and enhance environmental health advocacy activities. Other CMAs currently being considered 

12for mini-grants are Delaware, New York, and Oregon. 

11 

12An abstract focusing on the expanded ANA environmental health resolutions and efforts to increase 

13grassroots capacity of the nursing profession has been submitted for presentation at the “CleanMed 2009 

14conference: Creating Healing Environments”. Over 800 leaders representing diverse disciplines across 

15the health care sector are expected to attend. 

13 

14With the Beldon fund coming to a close in June 2009, other potential sources are being sought to 

15supplement current ANA efforts or for future activities. Four funders have been approached with one 

16viable possibility at this time. 

15 

16Nurse Licensure Compact 

17Background: 

18The National Council for State Boards for Nursing (NCSBN)’s Nurse Licensure Compact was first 

19introduced at ANA’s 1998 House of Delegates (HOD) and resulted in a resolution outlining fourteen 

20issues the HOD believed must be addressed for ANA to support the Compact model. Delegates 

21reaffirmed their beliefs at the 1999 ANA House. Dialogue between ANA and NCSBN continued. On 

1 

2 



1February 24, 2005, members of the ANA Board of Directors Task Force related to the Compact, ANA 

2staff, three compact administrators, and NCSBN staff participated on a conference call to discuss the 

3ANA’s remaining issues with the interstate compact model. Following a thorough review of the 

4information provided by the NCSBN and thoughtful consideration, the task force recommended to the 

5ANA Board that ANA maintain its’ position on interstate practice. Given that ANA and NCSBN 

6continue to have philosophical differences related to the Compact model, the two organizations have 

7“agreed to disagree”. 

2 


4To date, 23 states have enacted legislation to participate in an interstate compact for nurse licensure. 

5Twenty-two states have implemented a compact: AZ, AR, CO, DE, ID, IA, KY, ME, MD, MS, NE, NH, 

6NM, NC, ND, SC, SD, TN, TX, UT, VA, WI; while RI plans to implement in July 2008. Five states have 

7introduced legislation (KS, IL, NJ, and VT; IA applies to APRNs only) thus far in 2008. A copy of ANA 

8talking points were sent to each state in which legislation was introduced and are posted at 

9http://www.nursingworld.org/mainmenucategories/ANAPoliticalPower/State/IssuesResources.aspx The IL 

10Speaker’s Office reached out to ANA for further clarification of the associated issues as described by 

11INA. 

5 


7Since the March 2008 report, two states enacted legislation authorizing participation in the interstate 

8nurse licensure compact: IA (APRNs added to existing statute) and VT, resulting in 24 states. RI has yet 

9to implement; planed for July 2008. A bill introduced in FL died in the Committee on Judiciary. Other 

10states with active bills at the time of this report include IL, KS, MA, MN, and NJ. ANA continues to 

11provide talking points to CMAs wishing to halt the legislation in their state. 

8 


10The last state to implement the Compact is Rhode Island, effective July; resulting in 23 participating 

11states. Although the Indiana General Assembly passed legislation to permit Indiana to join the Nurse 

12Licensure Compact, included in the legislation was an amendment which was not approved by the 

13Nurse Licensure Compact Administrators, and thus the denial to be part of the Compact. At issue was a 

14disagreement over the investigation process for complaints regarding licensees. 

11 

12 

13 

14Workplace Violence 

15Background: 

16A resolution entitled “Workplace Abuse and Harassment of Nurses” was passed during the American 

17Nurses Association House of Delegates in 2006. Members resolved that among other approaches, the 

18American Nurses Association address workplace abuse and harassment through its nationwide state 

19legislative agenda.” At the time of this report, legislation calling for a program, study of the issue or 

20reporting of incidents was signed into law in: IL, ME, NJ, NY, OR, and WA. HI passed a resolution 

21urging employers to develop and implement standards of conduct and policies for managers and 

22employees to reduce workplace bullying and promote healthful and safe work environments. States 

23which enacted legislation to strengthen or increase penalties for acts of workplace violence affecting 

24nurses include: AL, AZ, CO, IL, NV, NC, and NM. 

17 

18A model “Workplace Violence Prevention” bill was crafted by the Government Affairs program 

19(GOVA) and distributed to CMAs via Lobbynet and posted on www.nursingworld.org . The model bill 

1 

2 



1is intended for states to use to work with legislators in seeking legislative approaches to reducing 

2violence in health care settings by requiring employers to implement programs aimed at prevention. 

3Janet Haebler, Associate Director, State Government Affairs mentored a graduate nursing student from 

4John Hopkins School of Nursing who as part of the public health nursing course requirements, 

5developed a workplace violence assessment tool and possible strategies for use. There are three 

6components to the tool: (1) An employee survey that reports the employee’s belief about the “safe-ness” 

7of the work environment; (2) Data elements from OSHA’s log of work related injury and wellness 

8(OSHA Form 300); and (3) The workplace incident report form. The use of the tool could enhance the 

9systematic collection of data, to better understand and address workplace violence. 

2 


4During the spring 2008 semester, GOVA staff member, Janet Haebler is mentoring another student in 

5the Johns Hopkins public health graduate nursing program. This student is building upon the work of a 

6student from summer session 2007 and contributing to a workplace violence tool kit for CMAs that will 

7include a health and safety committee workplace analysis with guide for identifying root cause; model 

8staff survey for use in comprehensive data collection / research; literature review; list of known training 

9resources; and the existing model workplace violence bill. 

5 


7GOVA’s student intern is currently wrapping up the spring semester course project which will provide 

8ANA with an updated workplace violence literature review, sample questions and recommended 

9process for a facility to use in assessing their environment for violence. It is expected that staff will need 

10to work on formatting the questions into a survey tool. 

8 

9ANA COEH has been invited to participate in Phase II of the Workplace Violence Training for Nurses 

10project with the National Institute for Health in collaboration with Vida Health Communications. ANA 

11will be responsible to recruit 250 registered nurses from the ANA membership to register for either the 

12control or test group. ANA will be assisting to develop continuing education credits for the five modules 

13of the program. The project will take 24 months starting in 2009, if funding is received. 

10 


12No activity to report at this time. 

13Outreach 

14Background: 

15The ANA Government Affairs department continues to reach out by speaking to the members and 

16nurses in a variety of settings. 

16 


18GOVA staff met with the National Association of School Nurses (NASN) in December and twice in 

19January with the American College of Nurse Practitioners (ACNP) in an effort to collaborate on issues 

20of mutual concern. 

19 

20On January 22, Janet Haebler, Associate Director for State Government Affairs joined nursing 

21colleagues from the American Association of Colleges of Nursing (AACN) and Health Services and 

22Resources Administration (HRSA) for a taping addressing the nursing shortage for Iowa constituents at 

23the request of Iowa Congressman Tom Latham. Although all agreed a multi pronged approach is 

24needed, dialogue was directed at ways in which to increase the number of nursing faculty. 

21 

1 

2 




2GOVA staff continues regular dialogue on issues of mutual concern with organizational affiliates; in 

3particular the National Association of School Nurses (NASN), having last met in April and the 

4American College of Nurse Practitioners (ACNP). Of great concern for school nurses is a trend towards 

5removing school nurses when there has been an identified conflict between the Nurse Practice Act 

6delegation authority and the request of nurses to train assistive / school personnel in the administration 

7of medications. In April, GOVA staff provided information to support Tennessee Nurses Association 

8testimony related to legislation that would authorize school personnel to administer asthma medications. 

9Work with ACNP has revolved around a number of issues, primarily at the federal level but has also 

10included state patterns and challenges for NPs. Issues at the federal level include efforts to secure 

11recognition of qualified APRNs to serve as primary care provider in the Centers for Medicare and 

12Medicaid medical homes demonstration project; inclusion of authorized APRN in e-prescribing 

13legislation; and recognition of APRNs to certify home care. 

3 

4Government Affairs staff has been visible in the states. Janet Haebler MSN RN, Associate Director for 

5State Government Affairs delivered a briefing, “National Legislation and the Impact on Nursing” to 

61100 nurses and student nurses during the annual legislative summit held by the Tennessee Nurses 

7Association on April 2 nd in Nashville. 

5 

6At the request of the Rhode Island State Nurses Association (RISNA), GOVA staff member, Janet 

7Haebler participated in a number of RISNA events celebrating Nurse’s Week. The RISNA government 

8affairs theme kicked off the celebration with Janet participating on a panel on May 7 th with a 

9representative from the RI State Medical Society, a member of the AMA Board of Directors, and a nurse 

10/ EMT and former RI state representative; the program entitled “Do Politics Matter to you?: You bet 

11their practice they do!” The health policy program – campaign school is in its third year, having grown 

12each year with a broad audience of health care professionals in attendance. Nurse’s Day began with a 

13policy breakfast at which Janet was asked to inform attendees about the Nursing Education 

14Advancement legislative initiatives in NY and NJ and followed by a briefing at the state house 

15capturing state activity with regard to ANA’s nationwide state legislative agenda. RISNA nurses and 

16ANA were recognized on the floor of both the Senate and the House. While present, the Senate passed a 

17resolution to study the nursing shortage (S2955) and the House passed a bill that would permit certified 

18nurse practitioners to prescribe in accordance with the state formulary (HB7961) both of which were 

19RISNA initiatives. The day was topped off with an evening reception of 180 attendees (compared to 40 

20last year) honoring nurses and legislators who have been instrumental in advancing nursing legislation. 

7 

8GOVA’s director, Rose Gonzalez was key note speaker for OH District 3 Nurses Association Nurse’s 

9Week celebration in Youngstown, OH on May 9 th . 

9 

10On April 16 th , Janet Haebler presented state and national legislative initiatives at the second Annual Safe 

11Patient Handling and Movement Conference sponsored by the University of North Carolina, School of 

12Nursing, Chapel Hill. In addition to nursing, individuals from the insurance industry and lift vendors 

13were also in attendance. The University’s school of nursing was one of the 26 schools accepted to 

14participate in the ANA, VA and NIOSH demonstration project in which safe patient handling and 

15movement is integrated in the nursing curriculum, including how to utilize various assistive devices. 

11 

12Janet Haebler represented ANA again this year as a member of the Council of State Government’s 

13Health Policy task force at their spring meeting in Lexington, KY, the end of May. 

13 

1 

2 




2ANA’s State Government Affairs again had an exhibit booth at the National Conference of State 

3Legislatures’ (NCSL) Annual Legislative Summit, held in New Orleans, LA from July 21 st through 25 th . 

4The theme this year was safe staffing legislation. Also during the Summit, ANA hosted a breakfast 

5briefing about toxic toys legislation as a platform for a discussion on state and national chemicals policy 

6reform during which on-site testing for toxic contaminants in toys was performed. ANA has begun 

7collaboration with the National Caucus of Environmental Legislators (NCEL) and the State Alliance for 

8Federal Chemicals Policy Reform (SAFER) to develop a chemicals policy action resolution for the 2009 

9NCSL annual summit. 

3 

4Staff from ANA State Government Affairs and Nursing Practice and Policy attended the annual meeting 

5of the National Council of State Boards of Nursing (NCSBN) August 5 th – 8 th in Nashville, TN. There 

6was also an opportunity to meet with nursing leaders from organizations outside the NCSBN, as well as 

7meet with the Executive Director for the Tennessee Nurses Association. 

5 

6Janet Haebler spoke to the University of Pittsburgh DNP Health Policy class on September 4 th on 

7political competence, advocacy and advocacy assumptions using a case study of title “nurse” protection. 

7 

8Janet Haebler represented ANA at the Virginia Nurses Association’s (VNA) Safe Staffing Advisory 

9Council in Richmond, VA on September 15 th . This group was assembled to collect information about 

10staffing from a variety of stakeholders. In addition to ANA, representatives were there from the Virginia 

11Hospital Association, Long term care Association and AARP. The Council is being asked to provide 

12recommendations to the VNA Board related to safe staffing. 

9 

10Government Affairs Director, Rose Gonzalez and Associate Director, Janet Haebler are mentoring a 

11George Mason University graduate nursing student for the current academic year. ANA is serving as the 

12site for her leadership practicum. Using the congruence leadership model, she is analyzing ANA and 

13ANCC utilizing ANA’s rich history, interviewing of select leaders and staff and observation at meetings. 

11 

12On September 11 th , Janet Haebler provided an education session on legislative and regulatory initiatives 

13addressing core issues affecting nursing to about 700 nurses at the 8 th annual Nursing Leadership 

14Conference hosted by the Texas Nurses Association held in Austin. 

13 

14On September 15, 2008, Rose Gonzalez provided a lecture to undergraduate nursing students at 

15Georgetown University regarding ANA’s legislative and political activities. 

15 

16ANA’s State Government Affairs hosted the ninth annual ANA/CMA lobbyist meeting, September 24 th 

17– 26 th in Washington, DC. Thirty-eight representatives, from twenty eight states were in attendance. 

18(AK, AL, CO, CT, DE, FL, GA, IL, IA, LA, MA, MS, MO, NJ, NM, NY, NC, OH, OK, OR, PA, RI, SC, 

19TN, TX, VA, WA, WY. In addition to sharing legislative challenges and successes specific to each of 

20their states, lessons learned and strategies were discussed related to staffing, nursing education 

21advancement and title “nurse” protection. 

17 

18On October 6 th , Janet Haebler briefed the American Nurses Nephrology Association (ANNA) on the 

19status of legislation within ANA’s nationwide state legislative agenda. Of particular interest were 

20staffing, mandatory overtime prohibition, and the newest initiative of nursing education advancement. 

19 

20Janet Haebler briefed attendees during the October 16 th Nurses in Trenton Day, on nursing education 

1 

2 



1advancement legislation: “BSN in ten” sponsored by the New Jersey State Nurses Association. 

2 

3On October 22-24, 2008 Rose Gonzalez, represented ANA at the Health professions Network Fall 

4Conference held in St. Louis, MO. The focus of their meeting was a discussion on “Evolving Scopes of 

5Practice and their Implications.” Along with AMA who provided an overview of the Scope of Practice 

6Partnership, Rose provided an overview of the Coalition on Patients Rights. 

4 

5An education session, “There Ought to Be a Law” was delivered by Janet Haebler to attendees of the 

6Iowa Nurses Association’s Annual Convention, held October 26-28 th in Coralville, Iowa. 

6 

7On November 14, 2008 Erin Mckeon, Rachel Conant, and Rose Gonzalez provided a virtual lecture to 

8graduate nursing students in a health policy class at the Blessing-Rieman College of Nursing in Quincy, 

9Illinois. Lecture covered legislative and political advocacy work of ANA. 

8 

9Since the last report, ANA’s Government Affairs Environmental Health Liaison, Rebecca Clouse 

10delivered presentations: 

10 • Nurses Environmental Health Writers Retreat presentation/discussion June 2008, in Baltimore, 

11 MD 

11 • Two sessions on chemical policy and pediatric environmental health during the October Advanced 

12 Practice Nursing Midwest Conference in Chicago. 

12 

13 

14 

15Presidential Endorsement 

16Background: 

17The American Nurses Association (ANA) has endorsed a candidate in each presidential election since 

181984. For the 2008 election, ANA continued to follow the 1985 House of Delegates (HOD) resolution 

19directing the Association to engage presidential contenders of all parties in endorsement considerations. 

18 

19Beginning in the summer of 2007, ANA sent candidate questionnaires to all of the Presidential 

20candidates on both sides of the aisle – Democrat and Republican. In addition, each candidate was 

21invited to participate in interviews with representatives of the ANA Political Action Committee (PAC) 

22Presidential Endorsement Task Force and ANA government affairs staff. 

23 

24ANA received completed candidate questionnaires from Senator Joe Biden, Senator Hillary Clinton, 

25Senator Christopher Dodd, Senator John Edwards, Representative Dennis Kucinich, Senator Barack 

26Obama and Governor Bill Richardson. In addition, ANA conducted interviews with Senator Hillary 

27Clinton, Representative Dennis Kucinich and Governor Bill Richardson. 

20 

21The candidates' questionnaire responses, as well as additional background information on their positions 

22on issues relating to nursing and health care were made available on the ANA’s 2008 Election Action 

23Center, and from January 3 – January 17, 2008, ANA members weighed in by voting for the candidate 

24of their choice online in ANA’s "virtual voting booth." 

21This call for member input on the endorsement was met with an unprecedented level of response, and 

22the voting results were conclusive. Senator Clinton garnered the strongest support, receiving 42% of the 

23vote; Barack Obama received 21%; John Edwards received 9%. 

24 

1 

2 



1Based on all of the information gathered in the endorsement process, the ANA-PAC Board voted to 

2recommend that the full ANA Board endorse Senator Clinton. 

2 


4On January 23, 2008, the ANA Board approved the ANA-PAC Board recommendation to endorse Sen. 

5Clinton. Since that recommendation was made the Clinton campaign was contacted and provided 

6clarification regarding ANA’s position regarding staffing and how to best discuss that issue with nurses. 

5 

6The Government Affairs and Public Relations & Communications staffs have been working closely with 

7the Clinton campaign to execute a press event. Although there were tentative plans for an event to take 

8place in Tucson, AZ and possibly Boston, MA, those plans, due to campaign priorities, did not 

9materialize. At the time of the writing of this report, staff was working with the Clinton campaign and 

10attempting to plan an event in MD which was cancelled Wednesday afternoon (February 6, 2008). 

7 

8Government Affairs staff is busy working with communications staff to develop graphics to be used to 

9create Hillary signs as well as tee shirts and buttons and a Hillary button for the ANA web. In addition, 

10staff is planning a call with the CMAs to review legal aspects of endorsement as well as to discuss 

11campaign support and member involvement. Staff will also be working on establishing a website 

12regarding the Clinton endorsement which will include ways members can get involved in campaign 

13activities. 

9 

10Other grassroots activities planned include: 

11 • Organizing CMA members particularly N-PALS to engage in Clinton campaign activities; 

12 • Encouraging CMA members to register to vote and engage in Get Out The Vote (GOTV) 

13 initiatives; and 

13 • Encouraging CMA members to write letters to the editor of their local paper about the 

14 importance of nursing and health care issues. 

14 


16On January 23, 2008, the ANA Board approved the ANA-PAC Board recommendation to endorse Sen. 

17Clinton. Since that recommendation was made the Clinton campaign was contacted and provided 

18clarification regarding ANA’s position regarding staffing and how to best discuss that issue with nurses. 

17 

18The Government Affairs staff worked closely with the Clinton campaign to execute a press event. 

19Although there were tentative plans for an event to take place in Tucson, AZ, Boston, MA, and Bowie, 

20MD those plans due to campaign priorities, did not materialize. On February 8, 2008, President Rebecca 

21Patton, MSN, RN, CNOR participated in a rally held in Tacoma, WA and announced ANA’s 

22endorsement of Sen. Clinton before a crowd of approximately 5,000 people. Washington State Nurses 

23Association members were on stage and in the audience holding RNs for Hillary signs. President Patton 

24also participated in two Health Care Events with Senator Clinton’s senior health policy advisor, in Ohio 

25prior to the March 4th primary. Pre-recorded messages urging members to vote for Hillary went out to 

26OH, TX, VT, and RI. 

19 

20Government Affairs staff worked with communications staff to develop graphics for Hillary signs, tee 

21shirts and buttons, as well as a Hillary “button” for the ANA website. In addition, Government Affairs 

22staff sent the CMAs an e-mail providing a review of legal considerations surrounding the endorsement, 

23as well as information regarding campaign support and member involvement. Staff has been working 

24on establishing a website regarding the Clinton endorsement which will include ways members can get 

1 

2 



1involved in campaign activities. 

2 

3Other grassroots activities planned include: 

4 • Organizing CMA members particularly N-PALS to engage in Clinton campaign activities; 

5 • Encouraging CMA members to register to vote and engage in GOTV initiatives thru N-STAT 

6 alerts and robo-calls; 

6 • Encouraging CMA members to write letters to the editor of their local paper about the 

7 importance of nursing and health care issues; 

7 • Organizing nurses in key primary states to attend rallies and other events for Senator Clinton. 

8 


10Due to FEC guidelines, ANA staff was not able to coordinate events with Sen. Clinton’s staff starting in 

11the beginning of April. However, FEC guidelines did permit staff to communicate with ANA members 

12and engage them in GOTV initiatives thru recorded robo-calls that were delivered in the primary states. 

11 

12September 2008 Update: 

13Recognizing his longstanding commitment to nursing and healthcare, the American Nurses Association 

14has endorsed Sen. Barack Obama (D-IL) for president in the 2008 election. 

14 

15During his time in the U.S. Senate, Sen. Obama has supported Title VIII Nurse Reinvestment Act 

16programs which provide much needed funding for nurse education. He is a cosponsor of the ANA- 

mandatory overtime legislation, the Safe Nursing and Patient Care Act of 2007 (S. 1842) and 

17supported 

18is a staunch supporter and cosponsor of the ANA-back RESPECT Act (S. 969), which challenges the 

19National Labor Relations Board ruling classifying charge nurses as supervisors. Sen. Obama’s current 

20health care plan emphasizes the need to reduce costs, improve quality and ensure affordable health care 

21for all Americans. 

22 

23The ANA Board's decision to endorse Senator Obama came only after careful consideration and 

24analysis of a variety of factors including: candidate positions and past records on nursing and health care 

25issues; candidate viability in the election; the relationship the candidate has with ANA members and 

26staff, both in DC and in the relevant constituent member associations (CMAs); and the feedback of 

27individual ANA/CMA members. This deliberate, inclusive, and non-partisan endorsement process is 

28rooted in the 1985 House of Delegates resolution directing ANA to engage presidential contenders of all 

29parties in endorsement considerations. 

30 

31The candidates' questionnaire responses, as well as additional background information on their positions 

32on issues relating to nursing and health care were made available online at the ANA’s 2008 Election 

33Action Center, and from August 1 –August 31, 2008, ANA members weighed in by voting for the 

34candidate of their choice online in ANA’s "virtual voting booth." 

35 

36This call for member input on the endorsement was met with an unprecedented level of response, and 

37the voting results were conclusive. Senator Obama received 64% of the vote, while Senator John 

38McCain received 36%. 

39 

40Based on all of the information gathered in the endorsement process, the ANA-PAC Board voted to 

41recommend that the full ANA Board endorse Sen. Obama, a recommendation approved by the ANA 

42Board on September 10, 2008. 

15 

1 

2 




2The ANA Presidential Endorsement process concluded with the endorsement of Sen. Obama in 

3September 2008. See the section below for updates on ANA activities supporting the endorsement. 

3 

4Democratic and Republican Convention and Presidential Debate Activities 

5Background: 

6The American Nurses Association, along with The Creative Coalition, the American Association of 

7Nurse Anesthetists (AANA), American Physical Therapy Association (APTA), American Health Care 

8Association (AHCA), National Center for Assisted Living (NCAL), and AARP, hosted town hall 

9meetings during both the Democratic and Republican National Conventions to discuss vital health care 

10issues. 

7 

8The events entitled "From Hollywood to the Hill: Speak Out on Health Care- If I had one minute with 

9the Next President" was an overwhelming success, bringing together professionals from the fields of 

10health care, policy, media, and entertainment to share ideas and views on health system reform. ANA 

11members attending included ANA President Rebecca Patton, MSN, RN, CNOR, the ANA-PAC Chair 

12Sara Jarrett, RN, MS,MA, EdD, the ANA-PAC Secretary Patricia Messmer, PhD, RN-BC, FAAN and 

13ANA Board of Trustee Mary Maryland, PhD, APRN-BC, ANP. 

9Both venues in Denver and in St. Paul exceeded maximum capacity. Over 40 different national and 

10international media outlets covered the events which were attended by several members of the U.S. 

11House and Senate as well as state and local elected officials from across the country. Nurses who also 

12serve as delegates were in attendance at both town halls. The Association of periOperative Registered 

13Nurses (AORN) and the Colorado Nurses Association attended and provided volunteer support in 

14Denver. 

15 

16In St. Paul, Sen. Arlen Specter (R-PA) joined the panel of experts discussing the issue of health care 

17reform. More than 300 people attended the event at the St. Paul Hard Rock Café. Members of the 

18Association of Nurse Anesthetists provided volunteer support. The ANA contingent had an opportunity 

19to speak at length with the panelists about nurses' role in health care reform at a post-event gathering. 

10The American Nurses Association continued the fight to bring health care back to the forefront of the 

11Presidential election by co-sponsoring a health care focused luncheon before the Presidential debate at 

12Hofstra University in Hempstead, NY. Modeled after two hugely successful health care events held at 

13the Democratic and Republican Conventions, “America’s Health Care on Life Support: How should the 

14Presidential Candidates Respond”, the bipartisan event was attended by many ANA members, staff, 

15policy experts and Hollywood celebrities. Additional co-sponsors included American Association of 

16Nurse Anesthetists, American Healthcare Association, National Center for Assisted Living, American 

17Colleges of Nursing and the Creative Coalition. 

11The moderator of the event was Catherine Crier, of Catherine Crier Live. Panelists included health care 

12experts, Jim Frogue, State Project Director for the Center for Health Transformations, Daniel Gotoff, 

13Partner at Lake Research and Tom Scully, Senior Counsel at Alston & Bird. 

12The event provided attendees the opportunity to speak out and say how the next President should 

13address healthcare in America for the next four years. ANA members asked several questions regarding 

14nursing such as the solutions to the ongoing nursing shortage and the use of more funding for 

15community health care nurses. 

13 


1 

2 



1Earlier this year, ANA endorsed Senator Hillary Rodham Clinton for President. In accordance with the 

21985 ANA Resolution, ANA Government Affairs reached out to Democratic nominee Barack Obama 

3and Republican nominee John McCain to exercise ANA’s right to endorse another candidate after both 

4parties’ political conventions end on September 4, 2008. 

2 

3The ANA Government Affairs staff built on their prior outreach to both of these campaigns during the 

4primary season and updated the materials where necessary to reflect any updates. It should be noted that 

5the Presidential Endorsement process started in July 2007. While ANA was not able to subject the 

6candidates to the full breadth of our endorsement process, ANA-PAC was able to compile an extensive 

7endorsement portfolio on the Democratic and Republican nominees for the White House. A notebook 

8was provided to the ANA and ANA-PAC Board which provided a detailed and thoughtful analysis of 

9the presidential hopefuls, offering a record of the candidates’ responses to our questionnaire, their 

10healthcare position papers, the most recent fundraising and polling data available, and in a few 

11instances, the healthcare and nursing perspectives shared during meetings with candidates themselves. 

4 

5The candidates’ questionnaire responses, as well as additional background information on their 

6positions on issues relating to nursing and health care were made available on the ANA Government 

7Affairs website, www.anapoliticalpower.org and, from August 1 - 31, 2008, ANA members weighed in 

8by voting online in ANA’s Virtual Voting Booth. This call for member input on the endorsement met 

9with an unprecedented level of response, and the voting results were conclusive. Senator Obama 

10garnered the strongest support, receiving 64% of the vote. The vote for Sen. John McCain: 36%. Based 

11on the body of information gathered throughout the endorsement process, the ANA-PAC Board voted to 

12recommend that the ANA Board endorse Senator Obama on September 9, 2008. On September 10, 

132008, the ANA Board of Trustees voted in favor of approving the ANA-PAC Board recommendation to 

14endorse Senator Barack Obama for President. 

6 

7With our endorsement, the ANA organized nurses throughout the country to help engage their 

8colleagues through phone banking, canvassing and postcard writing. Further, ANA developed the 

9“Nurses for Obama Biden” website – www.nursesforobamabiden.com – where ANA members could 

10purchase “Nurses for Obama Biden” gear and learn more about ANA’s presidential endorsement 

11process. Also on the site was a video message from Sen. Obama to ANA nurses, thanking them for their 

12support. 

8 

9Many ANA members organized phone bank parties in their homes, where they called fellow nurses to 

10explain why they were supporting Sen. Obama for President. Others stood in line for hours to attend 

11Obama rallies, wearing their “Nurses for Obama Biden” t-shirts proudly. 

10 

11Email Alerts 

129/22/2008: Email Alert – Torchbearers – Sent to 80,318 people 

1310/2/2008: Email Alert – Unveil Obama-Biden Website – Sent to 79,366 people. 

1410/2/2008: Email Alert – Voter Registration Deadline – Sent to 14,216 people in CO, FL, IN, OH, PA, 

15VA 

1510/9/2008: Email Alert – Voter Registration Deadline – Sent to 1,025 people in NC. 

1610/23/2008: Email Alert – Early Voting / Obama Gear – Sent to 80,711 people. 

1711/06/08: Email Alert – Thank You – Sent to 79,904 

17 

18Recorded Phone Calls 

1910/3/2008: Robo Call for October 6 Voter Registration Deadline to CO, OH, PA, VA (Delivered 9,188 

1 

2 



1messages out of a total universe of 11,694.) 

2Completed Calls by State: 

3OH – 5,846 

4PA – 1,055 

5CO – 1,036 

6VA – 1,251 

7 

810/9/2008: Robo Call for October 10 Voter Registration Deadline to NC (Delivered 1,972 messages out 

9of a total universe of 2,690.) 

9Completed Calls: 

10NC – 1,972 

11 

12 

1310/14/2008: Robo Calls for Early Voting in CO, NM, OH. (Delivered 7,185 messages out of a total 

14universe of 9,155.) 

14OH – 5,820 

15NM - 323 

16CO – 1,042 

17 

1810/23/2008: Robo Calls for Early Voting in CO, NM, OH, VA. (Delivered 8,438 messages out of a total 

19universe of 10,771.) 

19CO – 1,047 

20NM – 332 

21OH – 5,812 

22VA – 1,247 

23 

24Website 

25Unveiled Nurses for Obama-Biden website on September 29, 2008. 

26Nurses for Obama-Biden Gear – T-Shirts, Bumper Sticker, Buttons, Signs available for purchase. 

27 Members who purchased gear: 461 

28 $ Raised for ANA-PAC: $6,191.16 

29 

30Congressional Endorsements 

31Background: 

32Each election cycle, ANA-PAC endorses candidates who have demonstrated strong support for nursing 

33and healthcare issues. 

33 


35In the 2007-2008 election cycle, ANA-PAC endorsed 101 candidates for Federal Office—this 

36endorsement represents the ANA’s highest seal of approval. Several races are still being decided as 

37election officials count absentee ballots, and some races are so close that state law requires automatic 

38recounts automatic recounts before the result is final. However, of the races decided to date, 88% of 

39ANA’s endorsed candidates won. One of ANA-PAC’s-endorsed candidates’ race is still too close to 

40call. 

36 

37While a few of our staunchest supporters, including Reps. Phil English (R-PA) and Chris Shays (R-CT), 

38lost their races, ANA is thrilled that so many of our endorsed candidates retained their seats and will 

39join the 111 th Congress when it convenes in January. We look forward to working with long-time 

1 

2 



1champions of nursing such as Nursing Caucus co-chairs Reps. Lois Capps (D-CA) and Steven 

2LaTourette (R-OH), as well as newly elected members of Congress like Jeff Merkley (D-OR) and 

3Debbie Halvorson (D-IL) to advance issues of importance to nurses and patients. 

2 

3 

4Here is a complete listing of ANA-PAC’s endorsements for the 2007-2008 election cycle: 

5 

1. Parker Griffith D AL-05 Challenger Won 

2. Lynn Woolsey D CA-06 Incumbent Won 

3. Nancy Pelosi D CA-08 Incumbent Won 

4. Jerry McNerney D CA-11 Incumbent Won 

5. Jackie Speier D CA-12 Incumbent Won 

6. Pete Stark D CA-13 Incumbent Won 

7. Lois Capps D CA-23 Incumbent Won 

8. Henry Waxman D CA-30 Incumbent Won 

9. Hilda Solis D CA-32 Incumbent Won 

10. Lucille Roybal-Allard D CA-34 Incumbent Won 

11. Bob Filner D CA-51 Incumbent Won 

12. Mark Udall D CO-Senate Challenger Won 

13. Joan Fitz-Gerald D CO-02 Challenger Lost Primary 

14. Betsy Markey D CO-04 Challenger Won 

15. Ed Perlmutter D CO-07 Incumbent Won 

16. Joe Courtney D CT-02 Incumbent Won 

17. Chris Shays R CT-04 Incumbent Lost 

18. Ginny Brown-Waite R FL-05 Incumbent Won 

19. Christine Jennings D FL-13 Challenger Lost 

20. Burt Saunders I FL-14 Challenger Lost 

21. Joe Garcia D FL-25 Challenger Lost 

22. Jim Martin D GA-Senate Challenger Pending 

23. Sanford Bishop, Jr. D GA-02 Incumbent Won 

24. John Lewis D GA-05 Incumbent Won 

25. Richard Durbin D IL-Senate Incumbent Won 

26. Rahm Emanuel D IL-05 Incumbent Won 

27. Danny Davis D IL-07 Incumbent Won 

28. Jan Schakowsky D IL-09 Incumbent Won 

29. Mark Kirk R IL-10 Incumbent Won 

30. Debbie Halvorson D IL-11 Challenger Won 

31. Phil Hare D IL-17 Incumbent Won 

1 

2 



32. Bruce Braley D IA-01 Incumbent Won 

33. Dave Loebsack D IA-02 Incumbent Won 

34. Leonard Boswell D IA-03 Incumbent Won 

35. Tom Harkin D IA-Senate Incumbent Won 

36. Dennis Moore D KS-03 Incumbent Won 

37. John Kerry D MA-Senate Incumbent Won 

38. John Olver D MA-01 Incumbent Won 

39. Richard Neal D MA-02 Incumbent Won 

40. Dale Kildee D MI-05 Incumbent Won 

41. Mark Schauer D MI-07 Incumbent Won 

42. Gary Peters D MI-09 Incumbent Won 

43. Sander Levin D MI-12 Incumbent Won 

44. John Conyers D MI-14 Incumbent Won 

45. John Dingell D MI-15 Incumbent Won 

46. Kay Barnes D MO-06 Challenger Lost 

47. Judy Baker D MO-09 Challenger Lost 

48. Tim Walz D MN-01 Incumbent Won 

49. Ashwin Madia D MN-03 Challenger Lost 

50. Betty McCollum D MN-04 Incumbent Won 

51. Keith Ellison D MN-05 Incumbent Won 

52. Max Baucus D MT-Senate Incumbent Won 

53. Earl Pomeroy D ND-At 

Large 

Incumbent 

Won 

54. Jeanne Shaheen D NH-Senate Challenger Won 

55. Frank Lautenberg D NJ-Senate Incumbent Won 

56. Frank LoBiondo R NJ-02 Incumbent Won 

57. John Adler D NJ-03 Challenger Won 

58. Chris Smith R NJ-04 Incumbent Won 

59. Frank Pallone D NJ-06 Incumbent Won 

60. Donald Payne D NJ-10 Incumbent Won 

61. Rush Holt D NJ-12 Incumbent Won 

62. Tim Bishop D NY-01 Incumbent Won 

63. Carolyn McCarthy D NY-04 Incumbent Won 

64. Carolyn Maloney D NY-14 Incumbent Won 

65. Charles Rangel D NY-15 Incumbent Won 

66. Kirsten Gillibrand D NY-20 Incumbent Won 

67. Maurice Hinchey D NY-22 Incumbent Won 

1 

2 



1 

2 

3 

4 

68. Michael Arcuri D NY-24 Incumbent Won 

69. Dan Maffei D NY-25 Challenger Won 

70. Eric Massa D NY-29 Challenger Won 

71. Steve Driehaus D OH-01 Challenger Won 

72. Dennis Kucinich D OH-10 Incumbent Won 

73. Pat Tiberi R OH-12 Incumbent Won 

74. Betty Sutton D OH-13 Incumbent Won 

75. Steven LaTourette R OH-14 Incumbent Won 

76. Mary Jo Kilroy D OH-15 Challenger Lost 

77. Tim Ryan D OH-17 Incumbent Won 

78. Earl Blumenauer D OR-03 Incumbent Won 

79. Kurt Schrader D OR-05 Challenger Won 

80. Jeff Merkley D OR-Senate Challenger Won 

81. Robert Brady D PA-01 Incumbent Won 

82. Phil English R PA-03 Incumbent Lost 

83. Patrick Murphy D PA-08 Incumbent Won 

84. Chris Carney D PA-10 Incumbent Won 

85. Allyson Schwartz D PA-13 Incumbent Won 

86. Joe Sestak D PA-17 Incumbent Won 

87. Jack Reed D RI–Senate Incumbent Won 

88. Patrick Kennedy D RI-01 Incumbent Won 

89. James Langevin D RI-02 Incumbent Won 

90. Tim Johnson D SD-Senate Incumbent Won 

91. Stephanie Herseth Sandlin D SD-AL Incumbent Won 

92. Bart Gordon D TN-02 Incumbent Won 

93. Al Green D TX-09 Incumbent Won 

94. Nick Lampson D TX-22 Incumbent Lost 

95. Eddie Bernice Johnson D TX-30 Incumbent Won 

96. Gerry Connolly D VA-11 Challenger Won 

97. Dave Reichert R WA-08 Incumbent Won 

98. Tammy Baldwin D WI-02 Incumbent Won 

99. Ron Kind D WI-03 Incumbent Won 

100.Gwen Moore D WI-04 Incumbent Won 

101.Dave Obey D WI-07 Incumbent Won 

Seats Won: 89 

Seats Lost: 11 

Pending: 1 

1 

2 



1 

2 

3Environmental Health Issues 

4 

5Health Environments Research Summit 

6Background: 

7The Robert Wood Johnson Foundation and the Association of Healthcare Research and Quality 

8sponsored an invitation only meeting in February 2006 in Atlanta, Georgia at the Georgia Institute of 

9Technology on the impact of physical building design on nurses/staff/patients. National and 

10international experts on hospital design were included in this important summit. The summit addressed 

11the impact of design on patient safety, staff work and on the family experience in addition to assessing 

12the current state of the “pipeline” from research to application. Voluntary workgroups were to be 

13formed to address various areas, share information and develop tools in the future. ANA was not 

14informed about the follow up workgroups. 

15 


17No date has been released for the Health Environments Research Summit II tentatively planned for early 

182008. 

19 


21No date has been released for the Health Environments Research Summit II meeting. 

22 



25 

26Practice Greenhealth -Formerly Hospitals for a Healthy Environment (H2E) 

27Background: 

28In 1998, the American Hospital Association (AHA) and the US Environmental Protection Agency 

29(EPA) signed a landmark agreement to advance pollution prevention efforts in our nation's health care 

30facilities. As a result of the agreement Hospitals for a Healthier Environment (H2E) was created. 

31Funding had primarily been from the EPA. In 2000 ANA and Health Care Without Harm (HCWH) 

32joined as partners. H2E became an independent organization in 2006. Plans for financial stability fell 

33short and led to the formation of a new organization, with the assistance of Healthcare Without Harm. 

34The new organization will be known as “Practice Greenhealth”. Changes to the articles of incorporation 

35and bylaws were filed in Chicago, Illinois on January 11, 2008. The former H2E Board of Directors is 

36being replaced with a new board of directors for the Practice Greenhealth organization. ANA will be a 

37non-voting member on the new board of directors. Part of the plan for the new organization is in the 

38joining of forces with the Green Guide for Health Care, the premiere green building tool for health care 

39facilities; and the Healthcare Clean Energy Exchange, a program to help hospitals reduce their climate 

40footprint. This new organization will offer a full range of tools, resources, technical assistance and 

41networking opportunities to engage all sectors within the health care industry in shifting the market 

42toward environmentally preferable products and safer, healthier practices. 

43 


45Practice Greenhealth held their first board of directors’ call on February 18, 2008. A new executive 

46director was hired. A face to face board of directors meeting is being planned in early March. ANA will 

47be reviewing Practice Greenhealth award applications shortly. Awards will be presented at the 2008 

48Clean Med conference in May. ANA will be attending the awards banquet. 

1 

2 



1 


3ANA reviewed nine Practice Greenhealth award applications and made the appropriate 

4recommendations to the committee. ANA presented a poster and was part of a panel on global climate 

5change at CleanMed 2008. ANA also attended the CleanMed 2008 nursing preconference. (May 8, 

62008). 

7 

8ANA attended the Practice Greenhealth face to face board of directors meeting in Chicago on April 

928-29, 2008. This was the first meeting of the board of directors for this new organization. 

10 


12ANA attended the Practice Greenhealth face to face board of directors meeting in Alexandria, Virginia 

13on September 3-4,2008. The next board of directors meeting is scheduled for January 13-14, 2009 in 

14Alexandria, VA. Additional meetings are planned in 2009 with dates to be determined. There have been 

15several phone calls as issues arose in the interim since the September meeting. 

16 

17ANA updated and streamlined the ANA president’s welcome to Practice Greenhealth (PGH) letter 

18which is sent to new PGH members. 

19 

20Principles of Environmental Health for Nursing Practice 

21Background: 

22In response to the 2004 HOD Resolution on Environmental Health Principles in Nursing Practice, the 

23Congress on Nursing Practice and Economics (CNPE) early in 2006 formulated a workgroup to develop 

24Environmental Health Principles for Nursing Practice based on the Precautionary Principle to provide a 

25foundation for implementation within nursing practice. The document was approved by the ANA Board 

26of Directors in March, 2007. The “ANA’s Principles of Environmental Health for Nursing Practice with 

27Implementation Strategies” were published in October 2007. 

28 


30An abstract had been has been accepted for a panel presentation at the Clean Med conference to be held 

31in May 2008. An abstract has also been submitted to the American Public Health Association (APHA) 

32for presentation at their annual convention to be held in October 2008. 

33 


35ANA presented a poster on the Principles of Environmental Health for Nursing Practice at Clean Med 

362008 held in Pittsburgh on May 8, 2008. 

37 


39The APHA abstract was rejected for presentation at the convention. ANA submitted an abstract to ICN 

40for a poster and to participate in a symposium presentation at the ICN meeting in Durban, South Africa 

41in June, 2009. 

42 

43ANA submitted an abstract on ANA’s Principles of Environmental Health for Nursing Practice with 

44Implementation Strategies for CleanMed 2009. 

45 

46Environmental Issues in Health Care 

47Background: 

48ANA continues involvement in environmental health related issues partially funded through a grant 

1 

2 



1received from the Beldon Fund. The work supported by the grant included a lobbyists meeting with a 

2special session devoted to chemical policy held in September 2005, followed by an environmental 

3health educational session held in September 2006, update of the speaker’s bureau, and formation of 

4environmental health task force/committees within ANA/CMAs to develop environmental health tools. 

5 

6The ANA communication vehicles such as the American Nurse Today, the Nurse Insider and The 

7American Nurse have been utilized to disseminate information. ANA continues the collaborative 

8relationship with Health Care Without Harm and Practice Greenhealth (formerly Hospitals for a Healthy 

9Environment). ANA participates in the Nurses Work Group of Health Care Without Harm monthly 

10conference calls to offer opportunities for nurses to be advocates in environmental health and is 

11providing continuing nursing education hours for the educational calls. ANA has signed on to policy 

12letters, position statements, amendments and other vehicles when opportunities to offer support 

13consistent with ANA positions are presented. Other actions by ANA in advocating for environmental 

14health include development of the following resolutions: 

15 

16 Reduction of Healthcare Production of Toxic Pollutants (1997) 

17 Inappropriate use of Antimicrobials in Agriculture (2004) 

18 Environmental Health Principles in Nursing Practice (2004) 

19 Nursing Practice, Chemical Exposures and Right-to-Know (2006) 

20 


22ANA’s COEH provided comments regarding Green Seal, an organization that certifies environmentally- 

cleaners, proposed revised environmental standard for General-Purpose, Bathroom, Glass and 

23friendly 

24Carpet Cleaner Used for Industrial and Institutional Purposes. Health Care Without Harm also 

25requested ANA’s input. ANA recommended advocating for chemicals to be evaluated in their non- 

status and for Green Seal to remain vigilant in preventing neurotoxic chemicals from entering 

26diluted 

27GS-37 products. 

28 

29ANA’s COEH commented on the EPA regarding the Endocrine Disruptor Screening Program in 

30chemicals used in pesticides. ANA encouraged expediency on testing the chemicals for endocrine 

31disrupting properties, preventing these chemicals from detection when they come in from foreign 

32countries and not allowing exemptions for confidential business information or proprietary mixtures. 

33ANA also advocated for focusing on knowing chemicals’ health effects prior to release to the public; 

34providing for the testing of all chemicals and ingredients of pesticides, active and inert; halting 

35production of chemicals that are endocrine disruptors in pesticides; and supporting labeling and full 

36disclosure mechanisms. ANA supported the EPA in not issuing pre-determined or blanket exemptions 

37for endocrine disruptor testing. 

38 


40ANA became a supporter of the SMARxT Disposal Initiative, along with the US Fish and Wildlife 

41Service, the American Pharmacists Association and the Pharmaceutical Research and Manufacturers of 

42America. This initiative educates the public on proper pharmaceutical waste disposal. 

43 

44ANA’s COEH commented to the FDA on how to combat antimicrobial resistance. ANA advocated for 

45the reduction of use of the antimicrobial, triclosan, in personal use products and household cleaners. 

46ANA encouraged full disclosure-labeling on antibiotics and products that contain antimicrobials; this 

47labeling should include safe disposal instructions and environmental impacts of the product. ANA also 

48advocated for increased environmental health research to improve wastewaster filtration systems to 

1 

2 



1thoroughly remove chemical and pharmaceutical contaminants. 

2 

3ANA’s COEH department plans a presentation for ANA staff at an upcoming 2008 All Staff Meeting on 

4incorporating green, sustainable practices here at ANA. 

5 

6ANA’s COEH department continues to administer the RN no harm speakers’ bureau listserve. Several 

7key invitations and announcements have been forwarded onto this listserve’s members. 

8 

9ANA’s COEH department, Physicians for Social Responsibility and the SAFER states are working 

10together to conduct a biomonitoring project to determine the body burden of nurses and physicians. 

11This will highlight the chemicals health care professionals are subjected to and assist with advocacy 

12“chemical trespass” issues. COEH currently participates in twice monthly calls for this project. 

13 

14July 2008 Update: 

15Center for Occupational and Environmental Health (COEH) added a link to the SMARxT Disposal 

16Initiative on COEH’s website. 

17 

18ANA’s COEH department commented in response to a request from the FDA regarding Safe Cosmetics 

19and Personal Care Products in preparation for the International Cooperation on Cosmetics Regulations 

20meeting. ANA encouraged stricter labeling requirements, ensuring that all cosmetics and personal care 

21products are free of extremely toxic materials and that safer alternatives are used, requiring rigid pre- 

safety testing, eliminating self-regulating industry oversight and supporting industry research to 

22market 

23develop safer products. 

24 

25ANA’s COEH department commented in response to a request from the EPA regarding Climate Change 

26and the National Water Program. ANA recommended the EPA consider nanotechnology and 

27nanoparticles be added to a list of contaminants that may need national drinking water regulation, 

28additional research on wastewater filtration systems to remove chemical, pharmaceutical and other 

29potentially harmful contaminants, further education of the public on protecting and conserving drinking 

30water and finally advising use of the Precautionary Principle. 

31ANA’s COEH department submitted two articles for the upcoming TAN publication in this area. They 

32included an article on nurse participation with CleanMed 2008 and one on nurses’ contributions to 

33environmental health and awareness with heavy emphasis on “The Luminary Project”. 

34 


36ANA testified at a hearing before the US Food and Drug Administration in September in Rockville, 

37MD. following the release of a research report about the safety of Bisphenol A. ANA is opposed to 

38FDA’s lack of action on this issue. 

39 

40ANA presented a program entitled, “Nurses Go Green with the American Nurses Association” at the 

41Green Hospitals 2 Conference in Austin, TX in October. 

42 

43ANA staff participated in the final Pharmaceutical Take Back program conducted by the Delaware 

44Nurses Association in Georgetown, DE in October. 

45 

46ANA formed a plan and green team to assist its employees and operations based in Silver Spring MD to 

47become more sustainable. This plan was presented to employees at an All Staff Meeting on October 14, 

482008 to incorporate sustainable products and practices, including the principles of reuse, reduce and 

1 

2 



1recycle. 

2 

3ANA presented to Maryland nursing students and nurses on October 2, 2008 for Maryland Hospitals for 

4a Healthy Environment. The topic was ANA and its environmental health involvement. 

5 

6ANA presented at the Western Maryland Area Health Education Center’s annual conference on Nursing 

7and Global Warming on November 13, 2008. 

8 

9COEH represented ANA at the annual APHA convention on October 26 through 30, 2008. 

10 

11ANA submitted comments to the FDA on their Voluntary Cosmetic Registration Program in October, 

122008. ANA commented that this program should be mandatory and that cosmetic manufacturers 

13should have to disclose all ingredients, including confidential business information. ANA reiterated 

14their stance on requiring stricter label requirements, cosmetics free from harmful toxins, pre-market 

15product safety testing, eliminating industry self-regulation and supporting industry research on 

16developing safe cosmetics. 

17 

18ANA submitted comments to the EPA addressing the EPA’s upcoming survey on how veterinary and 

19medical facilities dispose of their unused pharmaceuticals. ANA’s comments centered on what types of 

20facilities should be included in the survey and further refining of the term “unused pharmaceuticals”. 

21 

22ANA has joined and participates in the American Public Health Association's (APHA) Climate Change 

23Committee. This committee works with the interplay of climate change and human health, and will 

24collaborate on projects. A list of priorities for the Obama administration's first 100 days was reviewed 

25by the committee, as well as a response to the EPA's request for comments on whether greenhouse gases 

26are a danger to human health and welfare. 

27 

28Green Health Champions 

29Background: 

30ANA participated in the first of a series of meetings to be held by health-industry trade groups, 

31consumer advocates and health care organizations to advance the greening of health care in America on 

32September 12, 2007. More than 30 leading healthcare industry trade groups, consumer advocates and 

33healthcare companies attended the meeting hosted by Health Research and Educational Trust, an 

34affiliate of the American Hospital Association in Chicago, IL. 

35 


37No additional meetings planned at this time. 

38 



41 


43No additional meetings are planned at this time. 

44Global Health and Safety Initiative 

45Background: 

46An influential group of leading health care systems joined together to create the Global Health and 

47Safety Initiative (GHSI) to join sector wide partners to green the health care industry and improve 

48worker and health safety while improving patient safety. The initiative is led by Kaiser Permanente in 

1 

2 



1partnership with leading health care organizations and the non profit groups Health Care Without Harm, 

2Center for Health Design and Hospitals for a Health Environment. The Global Health and Safety 

3Initiative identified four first-year goals at the kick-off meeting in October 2007: 1) Create widely 

4accepted green purchasing guidelines with the goal of using health care’s purchasing clout to drive 

5markets toward cleaner energy, safer products, and innovative green technologies; 2) Develop a shared 

6research agenda to prioritize research for the improvement of environmental, patient and worker health 

7and safety; 3) Open source sharing of information and best practices across the industry; 4) Develop an 

8eco-footprint tool tailored specifically to the health care industry. 

9 



12 


14GHSI is currently developing an initial business plan and is proceeding with plans to secure an initial 

15investment from the 18 founding partner healthcare systems as well as seek legal status as a non-profit 

16tax exempt organization. The goal is to pool the resources and expertise of the leading health systems to 

17create a sector wide movement to accomplish what no one organization could individually. An 

18executive director has been hired. 

19 


21No additional meetings are planned at this time. 

22 

23International Chemical Union Workers Consortium 

24Background: 

25The International Chemical Worker Union, Center for Workers Health and Safety received a grant 

26through the funding cycle of the National Institute for Environmental Health Sciences (NIEHS) Hazmat 

27Disaster Preparedness Training Program. ANA is a member of the International Chemical Workers 

28Union Council (ICWUC) consortium and subsequently a sub-contractor on the ICWU grant. This 

29project started its funding period during August of 2005. 

30 

31As a consortium member ANA is participating in two ICWU training programs. The first training 

32program is the Hazardous Waste Worker Training Program (HWWTP). This is a HAZMAT training 

33program that specializes in chemical emergency response by delivering training to thousands of workers 

34to safely respond to the spills and releases of toxic chemical that frequently occur within the United 

35States. Nurses have been recognized by OSHA as first receivers in the Hazardous Waste Operations and 

36Emergency Response (HAZWOPER) standard. As first receivers, nurses could be expected to 

37decontaminate and provide care for patients after catastrophic unintentional chemical incidents. 

38 

39ANA’s deliverable as part of the ICWU grant, Hazardous Waste Worker Training Program (HWWTP) 

40is to recruit ANA/CMA members to attend 4-day training HAZMAT classes tailored to train hospital 

41workers to respond to spills that could occur in the health related workplace. Another deliverable of the 

42HWWTP is to educate ANA/CMA members on the proper personal protection for health care workers 

43coming in contact with contaminated patients from unintentional catastrophic chemical releases. These 

44classes are categorized as training for health care workers acting as first responders to victims of “Non- 

45Weapons of Mass Destruction (WMD)” incidents. Additional programs are under development related 

46to this consortium membership. 

47 


1 

2 



1A three day planning meeting was held at ANA with the educator with ICWUC, in January. Equipment 

2was inventoried. Agendas and program content were created and reviewed, as well as upcoming 

3programs to be offer to ANA/CMAs. 

4 

5A first receiver program including a 6.5 contact hour continuing education program had been developed 

6and will be presented at Geisinger Medical Center, Danville, PA on June 4, 2008 being sponsored by the 

7Pennsylvania State Nurses Association. 

8 


10On April 1, 2008 the educator with ICWUC met with ANA to formalize June 4 program and to set up a 

11three day Master Trainer Reconvene Class in August, 2008. The June 4 program was cancelled by 

12Pennsylvania State Nurse Association due to low enrollment two days before the program. Plans were 

13also begun to offer the 6.74 contact hour program to CMAs regionally beginning September, 2008. 

14 


16In June and July, ANA’s First Receiver Continuing Education (CE) program was presented on two 

17occasions to the nurses at the Veterans Administration Hospital in Cincinnati, Ohio by Bruce Mahan of 

18the International Chemical Workers Union presented the program. Eighteen nurses participated. 

19 

20An article highlighting this CE program will be in an upcoming TAN publication. 

21 


23COEH presented about the Chemical First Receiver programs to CNPE on September 21, 2008, which 

24has generated great interest in bringing the Chemical First Receiver programs to various state 

25associations, organizations and/or workplaces. 

26 

27COEH represented ANA at a two day meeting in October 2008, hosted by ICWUC and UFT held in 

28New York City. Various nursing and labor groups discussed ways of enhancing the First Receivers 

29course and making it more available and attractive to their various members 

30 

31COEH presented for the Texas Nurses Association in Austin and Houston, TX on November 17 and 19, 

322008. The initial schedule for this education was to occur in September but was postponed due to 

33Hurricane Ike. 

34 

35Future prospects for additional training and collaborations include: Wisconsin Nurses Association, 

36Ohio Nurses Association and the Evidence Based Practice Council at the University Hospital in 

37Cincinnati, Charlotte AHEC and NCNA, Florida Nurses Association and Jackson Memorial Hospital, 

38Emergency Nurses Association, Rutland Regional Medical Center and the Vermont Nurses Association, 

39Delaware Nurses Association, and the Oklahoma Nurses Association. 

40 

41COEH developed a 3 day First Receivers program for continuing education, which has been presented 

42twice in Ohio by Bruce Mahan of ICWUC. A brochure highlighting both the one and three day 

43programs has been developed. 

44 

45Sign Ons 

46Background: 

47ANA frequently is asked to “sign on” to various initiatives such as letters or policy statements to support 

48a particular issue that is consistent with the values and positions of ANA. 

1 

2 



1 


3ANA sent a letter to the National Institute for Occupational Safety and Health supporting the proposed 

4project, “Occupational Surveillance in the National Healthcare Safety Network (NHSN) to perform 

5surveillance of traumatic injuries, contact dermatitis, work-related asthma, and workplace transmission 

6of tuberculosis among healthcare personnel by having healthcare facilities collect and use data using an 

7internet based to establish and evaluate prevention activities for common occupational health problems. 

8The project is planned to take place over a 4 year timeframe. 

9 


11In April 2008, ANA signed on to support a letter to mutual fund’s support of two shareholder proposals 

12to Avon Products and Dow Chemical Company related to their use of nanomaterials and pesticides 

13linked to asthma.(kes May 7, 2008). 

14 

15In April, 2008, ANA signed on to support a letter initiated by the Environmental Health Fund to cancel 

16endosulfan (a pesticide) use in the United States. (hec May 8, 2008). 

17 

18In May, 2008, ANA signed on to support a letter requesting that US representative support chemical 

19plant security legislation that includes safer technologies to decrease chemical threats. (hec May 8, 

202008). 

21 

22In May, 2008, ANA signed on to support an open letter to Congress requesting that policy-makers 

23support vaccination, particularly of children, to reduce the spread of vaccine-preventable diseases. (kes 

24June, 2, 2008). 

25 


27In June and July, ANA’s First Receiver Continuing Education (CE) program was presented on two 

28occasions to the nurses at the Veterans Administration Hospital in Cincinnati, Ohio by Bruce Mahan of 

29the International Chemical Workers Union presented the program. Eighteen nurses participated. 

30 

31An article highlighting this CE program will be in an upcoming TAN publication. 

32 


34In December, 2008, ANA co-released HealthyToys.org’s 2008 toy database release statement. This 

35release leads to a database showing consumers which toys contain lead, cadmium, chlorine/PVC, 

36arsenic and mercury. Toys are listed by name, brand and type and assist consumers in buying safe toys 

37for the holiday season and beyond. 

38 

39Joint Commission Reducing Waste and Improving Efficiency Roundtable 

40Background: 

41The Joint Commission conducted a new public policy roundtable addressing the subject of reducing 

42waste and improving efficiency in hospitals and other health care settings. The initiative would 

43systematically categorize and describe opportunities for waste reduction and improved patient care, 

44identify accountabilities for their pursuit and frame approaches to measuring success in these areas. A 

45conference surrounding this issue will follow the roundtables meetings to be held in early 2008. 

46 


48The third meeting of the Joint Commission reducing waste and improving efficiency roundtable was 

1 

2 



1held on February 6 th in Oakbrook, Illinois. This meeting was an exercise in determining priorities in the 

2area of waste to serve as a focus for this work. Due to inclement weather, the meeting was cut short prior 

3to the work being completed. Another roundtable meeting is scheduled to be held in early March as a 

4make-up session prior to the conference. The conference based on the roundtable entitled 

5 

6“Overuse, Underuse, Misuse: Reducing Waste and Improving Efficiency in Health Care” will be held 

7on March 27-28 in Chicago, Illinois. 

8 


10The conference was held in March with ANA in attendance. This item is concluded. 

11 

12CDC BioSafety Steering Committee 

13Background: 

14The Office of Health and Safety of the Centers for Disease Control and Prevention (CDC) is planning 

15for the 10 th International Symposium on Biosafety to be held February 9-13, 2008 in Atlanta, Georgia. 

16The Office of Health and Safety is partnering with the Eagleson Institute and the American Biological 

17Safety Association (ABSA) to sponsor this event. The focus of this symposium is “Biosafety Issues in 

18Public Health, Research, and Health Care Communities.” The goal is to address new safety challenges 

19confronting occupational health providers and safety concerns of health care and diagnostic 

20laboratories. ANA was represented on the steering committee by invitation. 

21 


23The CDC’s 10 th International Symposium on Biosafety: Protecting Workers in Clinical Laboratories, 

24Research, Animal Care and Public Health Communities was held February 9-13, 2008 in Atlanta, GA. 

25 


27This is a concluded item following the conference in February. 

28 

29Review Board Opportunity 

30Background: 

31The American Nurses Association received an invitation through ICN to represent nursing on the review 

32board of the Global Healthcare User Group (HUG). HUG developed out of a 2005 global manufacturing 

33company meeting coordinated by GS1. GS1 is a leading global organization dedicated to the design and 

34implementation of global standards and solutions to improve the efficiency and visibility of supply and 

35demand chains globally and across sectors. (www.gs1.org), GS1, an international non-governmental 

36agency, is based in Brussels. ANA’s role is to represent nursing on the review board to look at barcodes, 

37packaging of medicines, medical equipment, and other medical products to develop a series of standards 

38designed to improve supply chain management and patient safety with the goal of development of global 

39standards to improve patient safety by automatic identification and act as the leading voice for the 

40healthcare industry. The work will consist of one monthly conference call with an annual face to face 

41meeting. The work is being performed on a voluntary basis. 

42 


44ANA continues to work on this international project. 

45 


47ANA continues to work on this project with limited involvement due to scheduling conflicts on 

48conference calls. 

1 

2 



1 


3There has been no involvement in this project to report. 

4 

5 

6Legal Advocacy 

7 

8Mercury Litigation 

9Background: 

10The Environmental Protection Agency (EPA) issued regulations that permitted power plants to emit 

11more mercury than is safe by allowing the aggregation (and averaging) of emissions beyond the 

12particular site. Since mercury is deposited where it is emitted, the EPA approach allowed certain power 

13plants to pollute the immediate area at dangerous levels. ANA and other health organizations (the 

14American Public Health Association, the American Academy of Pediatrics, Physicians for Social 

15Responsibility) intervened in pending challenges and also filed a separate petition for review in 

16connection with the EPA’s regulatory approach and violations of the Clean Air Act. 

17 


19On February 8, 2007, in a unanimous three judge decision, the Court held that EPA improperly removed 

20coal-fired power plants from the hazardous air pollution source list and vacated EPA’s “Delisting Rule.” 

21 The decision is a clear and complete victory, as the D.C. Circuit judges unanimously concurred in 

22ANA’s reading of the Clean Air Act: EPA violated the Act when it removed power plants from the 

23hazardous air pollution source list without making the health and environmental risk-based findings 

24required by section 112(c)(9) of the Act. The Clean Air Act requires EPA to develop within two years 

25hazardous air pollution emissions standards (Maximum Achievable Control Technology or “MACT” 

26standards) reflecting the best level of hazardous air pollutant control technologically achievable; sources 

27then have three years to comply. In the interim, while EPA develops MACT standards, any proposed 

28new oil- or coal-fired power plants would have to perform and comply with a case-by-case MACT 

29analysis and achieve a level of pollution control at least equivalent to the best controlled similar source 

30—i.e., the maximum reduction of hazardous air pollutants achievable by the best technology. To put 

31this into perspective, the Court’s decision vacating EPA’s Delisting Rule requires the roughly 120 new 

32coal-fired power plants currently proposed in the U.S to comply with case-by-case MACT requirements. 

33 

34Finally, industry (and less likely, EPA) may try to delay the impact of this decision by further appeals. 

35First, industry may file a petition for rehearing before the entire D.C. Circuit Court of Appeals. Such a 

36petition would be at the Court’s discretion. The only other recourse would be a petition for a writ of 

37certiorari to the U.S. Supreme Court. The Supreme Court grants far less than 1% of writ petitions and 

38would be unlikely to do so in this case. 

39 


41EPA and industry groups did seek additional review of the district court’s decision. The D.C. Circuit 

42issued an order on May 20, 2008 denying EPA’s and Utility Air Regulatory Group’s (UARG’s) request 

43for rehearing en banc and UARG’s petition for panel rehearing. The only remaining recourse for EPA 

44and industry groups is seeking certiorari to the U.S. Supreme Court. Industry has stated that it would 

45file a petition for certiorari, but the likelihood of the Supreme Court granting the request is remote. 

46Meanwhile, the mandate has been issued, and EPA must begin to develop MACT standards for all the 

47hazardous air pollutants emitted from coal-fired power plants, and new sources must obtain a case-by- 

MACT 48case determination. 

1 

2 



1 


3UARG filed a petition for certiorari (request for review) with the U.S. Supreme Court. 

4 

5 

6Health System Reform 

7 

8Background: 

9For much of its history, the American Nurses Association (ANA) has advocated, both within the nursing 

10community and to decision-makers and the public, for the principle that all persons are entitled to 

11affordable, readily accessible, high quality health care services. The latest articulation of this mission 

12was approved by the 2005 House of Delegates: ANA’s Health Care Agenda, a policy guide updating 

13ANA’s previous 1991 Nursing’s Agenda for Health Care Reform. Following the defeat in 1993 of the 

14last significant national effort to address reform of the health care system, ANA has continued to seek 

15incremental reforms at the state and federal levels. 

16 

17The 2005 House of Delegates charged the Association with a multi-year mission of reinvigorating its 

18leadership role in shaping social policy to drive reform of the health care system. ANA has pursued this 

19mission through an integrated series of public and private sector advocacy and education efforts using, 

20as its foundation, the tenets of ANA’s Health Care Agenda. 

21 

22ANA pursued a vigorous effort in 2006 to organize nurses to testify at dozens of community meetings 

23throughout the country and to provide nursing’s input on recommendations crafted by the Citizens’ 

24Health Care Working Group (CHCWG). The CHCWG was a congressionally backed initiative to 

25gather opinions and feedback from American citizens to assist in the creation of a national “roadmap” to 

26health system reform. Several of ANA’s key agenda items were included in the CHCWG 

27recommendations to Congress and the President, and participants were educated about the economic 

28value and clinical expertise of nurses. Although the report itself has been temporarily shelved, ANA’s 

29grassroots activity created a strong foundation of interest and knowledge among the nursing community 

30and others, which will prove useful as the Association moves forward in its public campaign. 

31 

32In 2007, multiple tracks of activity marked ANA’s progress on the health system reform front. These 

33include: 

35 (1) political and substantive analysis of each of the Presidential candidates’’ health reform plans, 

36 as part of ANA’s Presidential endorsement consideration process; 

37 (2) ANA’s continuing coalition work with organizations supporting universal care; 

38 (3) ANA’s strong legislative support of SCHIP expansion; 

39 (4) development of a Congress on Nursing Practice and Economics (CNPE) report addressing 

40 ANA potential policy gaps in the area of health system reform; 

41 (5) an ANA communications plan, approved by the Board in June 2007; and 

42 (6) tracking, research and analysis of reform plans, scholarly publications, and popular press 

43 regarding trends and activity in the arena of US health system reform. 

44 

45As the presidential campaign season has gained momentum, so too has the public’s interest and concern 

46regarding health system reform. In the last quarter of 2007, ANA used its prior successes in multiple 

47departments of the Association as a springboard for a new initiative designed to focus attention on those 

48issues to which nursing could apply its unique expertise and perspective in the health system reform 

1 

2 



1debate. These pieces of any reform blueprint include nursing workforce recruitment, education and 

2retention, as well as prevention, wellness, health education, chronic care management, disease 

3management, and continuity of care. These concerns are focused in particular on promoting safe 

4staffing and the recognition, utilization and reimbursement of nurse practitioners as primary care 

5providers. 

6 


8While external events in Washington slowed somewhat during the recent holidays, ANA staff continued 

9to pursue intelligence and information on several fronts in health system reform. Also, ANA provided 

10additional opportunities for its membership to educate themselves regarding the positions on health 

11reform taken by presidential candidates. 

12 

13The point by point comparison of each candidate’s health system reform “plan” with ANA policy, 

14prepared by the Department of Nursing Practice and Policy, was posted at the beginning of January as 

15part of ANA’s 2008 Election Action Center on NursingWorld. A similar point-by-point comparison 

16with ANA policy has been prepared for internal purposes, reflecting the positions of other organizations 

17and associations pertinent to the health reform debate, with an eye toward possible partnerships in the 

18future. 

19 

20Further, ANA’s Organizational Affiliates were surveyed in December to compile a listing of each 

21group’s position and/or priorities on health system reform. This data forms the starting point to evaluate 

22the potential for ANA to organize nursing specialty societies around a unified health system reform 

23message. 

24 

25ANA represented the interests of nurses and their patients in a January 2008 teleconference of the 

26Herndon Alliance. The Alliance is comprised of a broad spectrum of members – patient advocates, 

27unions, faith-based organizations, health reform advocates, and providers -- who are allied in their 

28grassroots advocacy for universal health care. The meeting focused on access to health care for the 

29immigrant population, particularly illegal or undocumented immigrants. 

30ANA emphasized its policy supporting universal care for all people who are residents of the United 

31States, without discrimination against patients based on their citizenship status. While most participants 

32echoed ANA’s position, many acknowledged that advocates have an uphill battle in fighting for 

33immigrants’ rights in any forthcoming health reform proposal. In addition, none of the leading 

34candidates for president on either the Republican or Democratic side have included such a broad 

35guarantee of access in their health reform plans. Polling data on this issue was shared with participants, 

36and will be useful as ANA prepares its advocacy segment on the immigration issue. ANA 

37will continue to be a strong advocate for patient safety and the value of nurses to the health care system 

38at the next Herndon Alliance meeting, scheduled for January 26, 2007, on the heels of the large annual 

39FamiliesUSA conference on health system reform. 

40 

41In addition to these coalition activities, ANA also participated with a variety of health disciplines and 

42representatives of business in a two-day discussion (on January 16 th -17 th ), facilitated by the principals of 

43the Wye River Group’s Foundation for Health Care Leadership. In this meeting, the group discussed 

44how best to methodically improve the health of communities, exploring the potential benefits of 

45promoting robust community collaboration in tackling health related social issues. Among the strategies 

46reviewed is the potential to build out an internet based platform to collect, and distribute successful 

47community initiatives addressing contemporary health and healthcare challenges. The end result of 

48these discussions is to be a shared long term vision and blueprint to share with decision-makers and to 

1 

2 



1stimulate community partnerships. In addition, the group’s collaboration builds on the platform recently 

2created through www.leadinghealthycommunities.com and explores how this internet library of better 

3practices could be the fulcrum for large scale health improvements at the community level. These 

4efforts have the potential to dovetail well with ANA’s “Safe Staffing Saves Lives” web initiative. 

5 


7The greater part of ANA’s health system reform activities in the last month have gone toward 

8coordinating the Association’s health reform agenda with its “Safe Staffing Saves Lives” campaign and 

9its efforts to address APRN utilization and reimbursement. These elements are integrated into ANA’s 

10membership efforts represented by the “3R Campaign: Relevancy, Recruitment & Retention.” In 

11addition, ANA staff moved forward quickly with the Board’s January approval of the updated and newly 

12renamed ANA’s Health System Reform Agenda, and managed the copyediting, graphic design, and 

13printing of the document. 

14 

15ANA responded quickly to President Bush’s final State of the Union address the night of January 29, 

162008. Communications and Policy staff, in collaboration with CEO Stierle and President Patton, 

17produced a hard-hitting news release the following morning taking the president to task for an 

18inadequate response to the country’s health care crisis. In February, ANA staff also brought together the 

19Texas Nurses Association and William Rasco, MD, who is organizing a Nursing Executive Forum in 

20San Antonio later in the month, addressing the nursing education and shortage issue. 

21 

22In addition to significant internal activity, ANA participated in the Herndon Alliance annual meeting, 

23dovetailed with the conclusion of the January FamiliesUSA meeting in Washington, D.C. The Alliance 

24has an ongoing working relationship with Celinda Lake, prominent national issues and political pollster, 

25to seek out and analyze the American public’s views and values regarding health system reform. Ms. 

26Lake, in a presentation with political expert Drew Weston, informed participants that public messaging 

27on guaranteed access to care needs to be made as simple as possible, and should seek to trigger 

28emotional responses from the public. Surprisingly, they noted that the phrase “Universal health care,” 

29for example, does not have much meaning for the average person, according to Ms. Lake’s research. 

30“Affordable health care for all,” or “Guaranteed access to high-quality, affordable health care for all” 

31are more direct phrases that gain traction with the typical person, who can then apply the idea to his or 

32her self and family. ANA has volunteered to work with the newly formed Providers Committee of the 

33Alliance. 

34 


36During the first quarter of 2008, ANA has continued to pursue intelligence and information on several 

37fronts in health system reform. Also, ANA provided additional opportunities for its membership to 

38educate themselves regarding the positions on health reform taken by presidential candidates. 

39 

40ANA responded quickly to President Bush’s final State of the Union address the night of January 29, 

412008, and produced a hard-hitting news release the following morning taking the president to task for an 

42inadequate response to the country’s health care crisis. 

43 

44ANA represented the interests of nurses and their patients through continuing active participation in the 

45Herndon Alliance. The Alliance is comprised of a broad spectrum of members – patient advocates, 

46unions, faith-based organizations, health reform advocates, and providers -- who are allied in their 

47grassroots advocacy for universal health care. ANA has volunteered to work with the newly formed 

48Providers Committee of the Alliance. 

1 

2 



1 

2In January 2008, a teleconference of the Herndon Alliance focused on access to health care for the 

3immigrant population, particularly illegal or undocumented immigrants. ANA emphasized its policy 

4supporting universal care for all people who are residents of the United States, without discrimination 

5against patients based on their citizenship status. While most participants echoed ANA’s position, many 

6acknowledged that advocates have an uphill battle in fighting for immigrants’ rights in any forthcoming 

7health reform proposal. 

8 

9ANA participated in the Herndon Alliance annual meeting, dovetailed with the conclusion of the 

10January FamiliesUSA meeting in Washington, D.C. The Alliance has an ongoing working relationship 

11with Celinda Lake, prominent national issues and political pollster, to seek out and analyze the 

12American public’s views and values regarding health system reform. Ms. Lake, in a presentation with 

13political expert Drew Weston, offered seasoned advice on crafting health reform “messaging” in a way 

14to capture the public’s attention. 

15 

16The meeting held in January was initiated by a group representing non-profit hospitals; the meeting 

17began with the assumption that the hospital provides the “home base” for community health care. ANA 

18provided a competing vision wherein nursing, organized through community-based delivery platforms, 

19could be a successful way to increase access and reduce the cost of health care. 

20 

21The greater part of ANA’s health system reform activities in the first quarter of 2008 have gone toward 

22coordinating the Association’s health reform agenda with its “Safe Staffing Saves Lives” campaign and 

23its efforts to address APRN utilization and reimbursement. These elements are integrated into ANA’s 

24membership efforts represented by the “3R Campaign: Relevancy, Recruitment & Retention.” In 

25addition, ANA updated its health reform policy, newly renamed ANA’s Health System Reform Agenda. 

26 


28ANA represented nursing in a two-day “National Symposium on Health Care Reform” convened by the 

29Mayo Clinic, involving priority setting for patient-centered health care. AONE (Association of Nurse 

30Executives) and individual RNs spoke up, as well, on nursing-related issues, particularly the capacity of 

31APRNs to serves as primary caregivers. 

32Presentations and appearances were made by health policy luminaries (for ex., Karen Davis, Don 

33Berwick, Michael Cascone, Denis Cortese), renowned members of the media (for ex., Tom Brokaw, 

34Cokie Roberts, Joanne Silberner), the business community (for ex., Helen Darling of the National 

35Business Group on Health/Business Roundtable), and health care provider organizations (for ex., ANA, 

36AMA, AHA). Small groups worked in progressively larger groups until the few hundred attendees 

37agreed on a new consensus-based “vision for health care in America,” based on four cornerstones – 

38insurance for all, coordinated care, value and payment reform – as the foundation to create a true system 

39of health care in America. An informal review of 27 publicly available documents showed that many 

40other reform proposals incorporate similar concepts. The large group concluded that there is common 

41ground – at the macro level – about these elements of a common vision. The following 

42recommendations were identified as top priorities in health reform. Many of these are well aligned with 

43ANA policy. 

44Private sector action steps: 

45 • Payment Reform 

46 Make the case for payment reform with properly aligned incentives (outcomes, prevention, 

47 wellness, "virtual" appointments, etc.). 

1 

2 



1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

• Universal Clinical IT 

Universal use of interoperable electronic clinical information technology systems (systems that 

can share information). 

• High-Cost Service Program 

Develop care programs for high-impact/high-cost services (end-of-life care, chronic diseases, 

etc.) 

• Coordinating Care Team 

Incent delivery model which provides defined care coordinator for chronic and acute conditions 

(i.e. health care home). 

• Benefits to Improve Health 

Define a minimum standard benefit package that realigns the health system toward improving 

health in addition to treating disease. 

13 

14Government sector action steps: 

15 

16 

• Insurance For All 

Ensure/mandate insurance coverage for all. 

17 

18 

19 

• Interoperable EMR 

Require all providers to have interoperable electronic medical records within a certain time (4-5 

years) with patient accessibility. 

20 

21 

• Pay For Value 

Direct Medicare to pay for value/outcomes/prevention using innovative payment models. 

22 

23 

24 

• Federal Health Reserve 

Implement an independent "Federal Health Reserve Board" to set rules/standards to promote 

value in health care. 

25 

26 

• Care Coordination 

Reward care coordination (whether provided by primary care, specialist or other caregiver). 

27 

28The Mayo Clinic Health Policy Center plans to share symposium recommendations with participants, 

29Congress, the new president and other interested parties. In addition, it will gather "a group of groups" 

30with reform proposals to discuss common ground, and create cross-sector work groups to implement 

31symposium recommendations for the private and public sectors. 

32 

33ANA is an original partner in the newly formed Health Care First Collaborative, organized by 

34FamiliesUSA chief, Ron Pollack. Within the last three months, there will have been seven meetings 

35(thus far) of a broad range of health care provider organizations coming together with the goal to 

36influence presidential and congressional candidates to take up health system reform among their very 

37first actions when they take office next year. The group includes, among others, the American Hospital 

38Association (AHA), the Catholic Health Association (CHA), the Service Employees International Union 

39(SEIU), the American Medical Association (AMA), the American Cancer Society (ACS), 

40AARP, the American Academy of Family Physicians (AAFP), the Medical Group Management 

41Association (MGMA) and, of course, FamiliesUSA and ANA. 

42 

43The group has discussed programmatic goals and potential activities to be undertaken by the 

44Collaborative. The first agreed upon step is that Ron Pollack will draft a group sign-on letter to the 

45presidential campaigns, urging them to “put health care first” and to tell them about our health reform 

46collaborative. This letter – broadly phrased and designed for high impact -- will be circulated among the 

47Collaborative’s partners for signature. 

48 

1 

2 



1The Collaborative discussed how it might handle the fact that health reform has slipped from the #1 

2domestic priority, having been overtaken since the beginning of the year by the issue of the economy, 

3and gas and food prices (Iraq, of course, remains first overall.) The Kaiser Family Foundation released 

4a nationwide poll in April asking “what is your biggest concern about the economy?” Right after “gas 

5prices,” people responded “losing my job/losing health coverage.” The Collaborative’s consensus is that 

6advocates should highlight health care security as an essential piece of economic security. 

7 

8Partners expressed some concern about the Congress’s and the Presidential candidates’ willingness to 

9tackle comprehensive health system reform in 2009. Conversations with campaign staffs, and 

10Congressional leaders seem to suggest a ratcheting down of expectations on health care reform in 2009. 

11The following interactions were noted: 

12 • Rep. “Pete” Stark (D-CA) predicted that HSR is not attainable in 2009 and that it would have to 

13 be done in pieces. 

14 

15 

16 

17 

• An April article in The Hill (a Capitol Hill daily newspaper) quoted Senators Rockefeller (D- 

WV), Baucus (D- MT) and others as saying that HSR is too big and too complex to take up right 

away in the 111 th Congress. SEIU wrote a letter criticizing this approach and urging the highest 

priority for Health System Reform. 

18 • When Hillary Clinton was asked at a campaign stop what she would do in her first 100 days, her 

19 only mention about health care was about passing SCHIP. She said nothing else on Health 

20 System Reform for the first 100 days or in the future. 

21 

22In contrast, another group’s members participated in a recent “lobby day” and reported that the “rank 

23and file” Members of Congress seemed to think that tackling HSR first would be a good thing. Also, 

24Sen. Ron Wyden has been going personally to every single senator asking for co-sponsors for his 

25recently introduced bipartisan S. 334, the “Healthy Americans Act” (with Sen. Robert Bennett (R-UT)), 

26and it was noted that senators are seeking feedback on that. According to one partner, conversations with 

27Barack Obama’s campaign about the primacy of Health System Reform confirmed that it is still 

28Obama’s “Number One” domestic priority. 

29 

30Various partners of the Collaborative will be hosting official and unofficial events and activities during 

31the presidential nominating conventions and the subsequent elections (presidential, as well as 

32congressional). The Collaborative partners brainstormed other activities to pursue individually or as a 

33group throughout the campaign season, and up through the Inauguration. In addition, the Collaborative 

34will develop an online calendar to enable each group to support or parallel the others’ events calling for 

35health care first. 

36 

37SEIU and FamiliesUSA are doing “put health care first” activities at the Democratic convention; SEIU 

38has also scheduled an event at the GOP Convention. Pollack acknowledged that some groups present 

39could afford to pitch in monetarily and some groups offer strengths other than monetary, such as 

40membership and established communications networks. 

41 

42The Collaborative recommended that groups talk to their chapters in battleground states to target 

43campaigns – local and presidential – about how important HSR is to the people in the state. We will be 

44seeking consistency of our group’s public and internal messaging; the work of Celinda Lake and Drew 

45Weston (also affiliated with the Herndon Alliance) will continue to be integral for crafting messages. 

46In other Health System Reform developments, during National Cover the Uninsured Week, ANA issued 

47a press release in response to Senator and Presidential candidate John McCain’s newly unveiled health 

1 

2 



1care reform proposal. While ANA applauded Senator McCain’s emphasis on the importance of 

2increasing quality and controlling costs, the news release criticized McCain’s overall health care 

3platform, which is based on the idea that the nation’s health care system can be reformed through 

4competition in the marketplace. The release read, in part, “ANA contends that two decades of market 

5based reform has only resulted in a health care system that continues to be fragmented and costly.” 

6 


8Since the June meeting of the ANA House of Delegates, two major areas of focus have characterized 

9ANA’s health system reform advocacy. First, is our national coalition activity, and second, is ANA’s 

10discussion with the Republican Platform Committee on health reform issues for the Republican 2008 

11Convention in September. 

12 

13On July 8th, Health Care for America Now! (HCAN!), a health reform activist coalition of which ANA 

14is a member, launched a new $40 million advocacy campaign to push for quality, affordable health care 

15for every American. In a press conference at the National Press Club in downtown Washington, DC, 

16representatives from HCAN! outlined their campaign plans and unveiled their first ad buy - $1.5 million 

17in national TV, print, and online. Along with the event in D.C., the campaign hosted launch events in 52 

18cities (including 37 state capitals) across the country. Between now and election day, the group plans to 

19spend $25 million in paid media and have 100 organizers in 45 states. 

20 

21Although ANA does not have sufficient financial resources to contribute to the campaign, the 

22Association has the numbers and grassroots outreach to make nurses a valued member of the team. 

23ANA is participating in HCAN! Field Committee meetings, to enable ANA staff to assist CMAs in 

24participating in state and local activities. 

25 

26Secondly, on July 10 th , ANA President Rebecca M. Patton, MSN, RN, CNOR, accompanied by two 

27ANA staff, participated in a small group discussion with the Executive Director of the Republican 

28Platform Committee, and aide to one of the Committee co-chairs, and representatives from two other 

29health professionals’ organizations. The meeting was part of the Republican Party’s larger effort to 

30gather input from across the country as they work to establish their health reform priorities. ANA 

31submitted a written statement to the Committee describing in detail nursing’s national goal of 

32guaranteed, high quality, affordable health care for all. The Association followed up with a second 

33lengthy letter to the Platform Committee further articulating nursing’s goal of including quality, patient 

34safety and nursing workforce development in any health reform plan. 

35 

36In addition, the Party has launched a new web based initiative to create a forum where “voters from all 

37walks of life can provide ideas, submit comments and actively participate in the development of the 

382008 Republican Party Platform.” ANA is using NursingWorld and various listserv announcements to 

39encourage member nurses to make their voices heard on their vital role in shaping health reform. 

40 

41As a final note, ANA CEO Linda J. Stierle, MSN, RN, CNAA,BC, was invited to submit an article for 

42Modern Healthcare’s “From the C-Suite” column, in which CEOs from various health related 

43organizations provide their views on current health issues. Her article describing the importance of 

44health reform, with a particular focus on nursing issues and patient-centered care, has been accepted for 

45publication, with a print date of July 28, 2008. 

46 


48ANA has continued to seek ways to advocate for comprehensive health reform throughout the 

1 

2 



1Presidential Primary season. In the pursuit of this goal, NursingWorld.org has been an important 

2education and communications tool for ANA membership. An updated chart is available, comparing 

3Senator McCain’s and Senator Obama’s latest versions of their health reform plans to key elements of 

4ANA’s health reform policy statement (ANA’s Health System Reform Agenda). The speeches of both 

5Senators Barack Obama and Hillary Clinton to the ANA House of Delegates have been transcribed and 

6are also posted on NursingWorld.org., in addition to other information on Senators McCain and Obama. 

7 

8On the coalition front, ANA’s partnership with HCAN! (Health Care for America Now) has provided 

9multiple dividends, including an early preview of the draft Democratic Party Platform, and grassroots 

10organizing capacity. ANA will be promoting HCAN’s “house party” event on September 14 th . People 

11who support guaranteed, high-quality, affordable health care for all are given the tools and format for 

12hosting community get-togethers in their homes to provide education on the issues and write letters to 

13their Members of Congress and other elected officials. www.healthcareforamericanow.org 

14HCAN has also hired the individual who created the Mastercard “Priceless” ad campaign to develop TV 

15and print spots promoting guaranteed health care for all. 

16 

17Others of ANA’s partner groups are taking advantage of the campaign season to air additional ads 

18seeking to bring the public’s attention to the urgent need for health reform in the new Administration 

19and Congress. Among these is Health Care First’s revival of the “Harry and Louise” characters that 

20were used in a 1994 advertising campaign that opposed President Bill Clinton's plan for universal health 

21coverage. In a turnabout, they have returned to the airwaves asking the presidential contenders to make 

22health care their top domestic priority. www.standupforhealthcare.org 

23 

24Another ANA partner is “Divided We Fail,” the health reform coalition launched by AARP, SEIU. 

25NFIB (National Federation of Independent Businesses) and the Business Roundtable. It continues its 

26electronic and print media ad campaign urging the next Congress and Administration to tackle health 

27reform, to strengthen American’s health care and economic security. 

28 

29All of these coalitions sent representatives to the Democratic and Republic nominating conventions. 

30Several attended the successful Creative Coalition health care event sponsored by ANA, the American 

31Association of Nurse Anesthetists, AARP and others on August 28 th , at the Democratic Convention in 

32Denver. Also, Health Care First, a coalition in which ANA is a founding member, sponsored an 

33education session at the Democratic Convention. Hillary Clinton addressed the group regarding her 

34commitment to health reform, and the steps she feels are necessary to move it forward in the next 

35Administration. The video can be viewed at http://www.modernhealthcare.com/apps/pbcs.dll/article? 

36AID=/20080828/VIDEO/653331114. More information is available in the Government Affairs update 

37elsewhere in this Strategic Imperatives Report. 

38 

39CEO Stierle was featured in the webcast interview series “Viewpoints: the Health Care Debate,” with 

40Kaiser Family Foundation’s Jackie Judd. A video and transcript of the September 4 th interview will be 

41available at http://www.kaisernetwork.org/health_cast/health2008hc.cfm?hc=2599, 

42and will be linked to NursingWorld.org. 

43 

44The July 28th issue of Modern Healthcare also featured CEO Stierle in their regular column, “From the 

45C-Suite.” The column discussed nursing’s role in health system reform, noting that nurses’ education 

46and experience emphasize the holistic framework in which nurses view patient, their families and 

47communities. Stierle went on to say that this is precisely the knowledge and abilities that have been 

48undervalued in the health care system for too long, and that greater attention on primary care, 

1 

2 



1prevention, health education, disease management and coordination of care should be the hallmarks of 

2patient-centered care in a newly reformed health system. 

3 

4October 2008 update: 

5ANA continues its multi-pronged activities to push health system reform into the national spotlight. The 

6dramatic events on Wall Street in September has further diverted Americans’ attention from the pressing 

7issue of health reform, and ANA is working in tandem with other organizations to keep the pressure on 

8candidates for office to address the issue once elected. 

9 

10ANA staff was among select invitees to a “Stakeholder Summit” in Philadelphia on September 10-11, on 

11the topic of out-of-pocket health care costs for people with chronic diseases and conditions. This 

12meeting provided an excellent opportunity for nursing to communicate its health reform message to 

13patient advocacy groups (National Health Council and its member organizations), providers, employers, 

14insurers, and pharmaceutical companies. ANA successfully incorporated nursing workforce issues into 

15the group’s draft recommendations on health reform, and had the opportunity to learn more from 

16employers (in particular) about how nursing might fit into their view of reform. The group will continue 

17to meet, with the goal of offering recommendations on the specific topic of assuring that out-of-pocket 

18costs for chronic care are equitable and affordable in any health reform schema. 

19 

20ANA staff also participated in a 3-day National Health Reform Congress on September 22 nd -24th, 

21providing another high-profile opportunity to insert and highlight the health care workforce issue in 

22reform discussions among knowledge leaders in the arena. 

23 

24In addition, ANA is continuing coalition activities with the Herndon Alliance, Healthcare for America 

25Now, Health Care First, and others. ANA is also participating in what has been termed a “Strange 

26Bedfellows” discussion among normally adversarial parties in the health care debate to seek common 

27ground on select health reform issue. 

28 

29The September/October issue of The American Nurse will offer a special “wraparound” section devoted 

30to health reform. It outlines some of the major concerns with the healthcare system and describes how 

31nurses can become involved as advocates, especially in the waning days of the campaign season and at 

32the beginning of the new Congress and Administration in 2009. 

33 

34ANA President Patton is scheduled to address the School of Nursing at the University of Wisconsin- 

35Madison on September 26 th on the subject of health reform and nurse leadership. In addition, President 

36Patton will be appearing as a panelist on October 14 th at the Nevada Health Care Forum, to discuss 

37health reform. 

38 

39CEO Stierle was featured in the webcast interview series “Viewpoints: the Health Care Debate,” with 

40Kaiser Family Foundation’s Jackie Judd. A video and transcript of the September 4 th interview is 

41available at http://www.kaisernetwork.org/health_cast/health2008hc.cfm?hc=2599, 

42and is linked to NursingWorld.org. 

43 


45With the November ’08 election results in, ANA has redoubled its efforts on multiple fronts to push for 

46early action on health system reform by the new Congress and President. The nation’s faltering 

47economy has resulted in some commentators opining that job security issues will push health reform to 

48the “back burner,” such that Congress would not consider comprehensive reform until the summer of 

1 

2 



12009, at the earliest. Many stakeholders, including the ANA, and Members of Congress have pushed 

2back hard with the message that health reform is inextricably linked with the nation’s economy, and that 

3the economy cannot be addressed without addressing health reform. This message has been the 

4predominant advocacy work ANA has pursued through the several coalitions in which it participates. 

5 

6Several Senators have confronted the priority issue head-on, indicating their intention to introduce 

7health reform legislation early in the 111 th Congress, perhaps as early as January. ANA has 

8communicated with the leaders of this effort, Senator Max Baucus (Chairman, Senate Finance 

9Committee) and Senator Edward Kennedy (Chairman, Senate Health Education Labor and Pensions 

10Committee), offering robust support for early consideration. 

11 

12On November 19 th , Senator Baucus released a fairly detailed “white paper” articulating his “vision” for 

13health reform. The release of the paper was accompanied by a Finance Committee hearing on the same 

14day, signaling the Chairman’s intention to play a leading role in health reform in the 111 th Congress. 

15ANA submitted a statement to the Committee and to the media applauding the Chairman’s urgent call 

16for action on health reform, as well as his emphasis on prevention and screening, health education, 

17cultural competency, chronic disease management, coordination of care, and the provision of 

18community-based primary care. At the same time, ANA’s statement noted deep concern that that the 

19Chairman’s “vision” does little to acknowledge registered nursing’s essential role in providing the exact 

20services he would emphasize in a reformed health care system. In addition, ANA highlighted the 

21proposal’s failure to address the nursing shortage and nursing education, particularly in light of its 

22significant attention to physician education and shortages of primary caregivers. For its internal 

23purposes and posting on its website, ANA has prepared a “side-by-side, comparing Chairman Baucus’ 

24“vision” for health reform with its own policy. 

25 

26Congress will certainly take up S-CHIP (State Childrens’ Health Insurance Program) reauthorization by 

27March of 2009, as that is when the program is due to expire. It is widely believed that the S-CHIP 

28reauthorization and expansion bill passed by the 110 th Congress, but vetoed (twice) by President Bush, 

29will be reintroduced and slated for expedited passage. ANA supported that effort strongly in 2008, 

30through legislative action alerts and letters to the Hill, and will repeat that support in 2009. Sponsors 

31have expressed some concern that parties may attempt to attach multiple new health reform provisions 

32to the S-CHIP bill. However, due to concern that “loading up” the bill would delay or endanger its 

33passage, it is thought that strong pressure will be brought to bear to assure that S-CHIP will pass and be 

34signed by the President promptly as a “clean” bill. 

35 

36ANA has been particularly successful in its continuing work to assure inclusion of nursing’s key issue— 

37workforce development and deployment and utilization of registered nurses to the full extent of their 

38scope of practice in all roles and settings – in any health reform proposal. ANA has also provided 

39continuing input on quality, effectiveness and prevention, among other issues. Much of this work has 

40been pursued through frequent and repetitive formal and informal communication among ANA’s 

41coalition partners, at health reform seminars and conferences, and in individual conversations with 

42stakeholders. 

43 

44ANA is working on a Providers Committee with Health Care for America Now (HCAN), in addition to 

45plenary work with the organization. ANA has teamed with FamiliesUSA in several of its efforts to 

46promote reform, and also continues its informal discussions with various stakeholder groups in an effort 

47to find common ground on previously divisive issues. 

48 

1 

2 



1On top of its coalition work, ANA has used multiple communications vehicles to get its message on 

2reform out to the nursing community and the public at large. For example, President Patton’s column in 

3the January issue of The American Nurse calls on nurses to add their expert voices to the national debate 

4and get engaged in the push for reform that guarantees high-quality, affordable health care for all. ANA 

5also was interviewed for national publications on its response to President-elect Obama’s plans for 

6health reform. 

7 

8ANA’s internal vehicles have also provided an opportunity for discussion and work on health reform by 

9ANA’s member volunteers. A bimonthly CMA Policy Network conference call in October highlighted 

10health reform, and a session at the November Constituent Assembly was devoted to health reform in the 

11states. ANA used the opportunity to redistribute a copy of ANA’s Health System Reform Agenda booklet 

12to attendees. Lastly, a Congress on Nursing Practice and Economics (CNPE) workgroup on health 

13reform has divided itself into 2 sub-committees to evaluate, respectively, the potential for ANA policy 

14on coordination of care (including the “health care home”), and ANA’s list of “Essential Elements” for 

15health reform, which requires updating from its original version in 1991, to parallel ANA’s current 

16reform policy. 

17 

18 

19Advanced Practice Issues 

20 

21AACN APRN Consensus Work Group 

22Background: 

23The American Association of Colleges of Nursing (AACN) initiated activity in 2004 through its 

24Alliance for Nursing Accreditation to review and recommend a set of commonly agreed upon processes 

25of educating, accrediting, certifying and regulating advanced practice registered nurses in the US. 

26Representatives of twenty-one nursing organizations, including a representative of the National Council 

27of State Boards of Nursing (NCSBN) have met over the past three years as the AACN hosted APN 

28Consensus Workgroup. In late 2004 the Work Group took on the task of meeting the need of the larger 

29nursing stakeholder community to delineate a series of recommendations to bring back to the 

30stakeholders that were future-oriented, could be endorsed and implemented. ANA joined the APRN 

31Consensus Work Group in 2005. Starting in December 2004, ANA has hosted at the ANA headquarters 

32three APRN stakeholders meetings (December 2004, September 2005, and June 2006). In Spring 2006 

33the group provided to the larger stakeholder community a draft document that identified how the various 

34processes needed for advanced practice could be improved. In February 2006, NCSBN put forward a 

35vision paper document identifying their view of the future of advanced practice nursing regulation. ANA 

36and many other organizations and individuals responded negatively to the content of that paper. As a 

37result, the APN consensus group and NCSBN have agreed to a joint discussion regarding the disparity in 

38the two documents and have committed to attempting to come to having either one paper or 

39complementary papers. 

40 

41The discussion of the appropriate representation of the APRN Consensus Work Group at the upcoming 

42joint dialogue meetings with NCSBN was resolved with the following organizations at the joint table. 

43AANA, ANA, ACNM, AANP, NONPF, NACNS, NLNAC, AACN (colleges), and AONE. Since 

44January 2007 the Joint dialogue has met repeatedly, and has agreed to the development of one paper 

45representing all interests regarding Future APRN regulation. This paper in draft form has become the 

46major topic of discussion in the Consensus work group in the effort to get differences resolved. 

47 


1 

2 



1The APRN consensus Work Group met by conference call on January 10 th to review the latest draft 

2document from the APRN/ NCSBN Joint Dialogue Group. Much alternative language was suggested 

3and discussed. The document will under go yet another draft which will reflect those discussions and 

4will be shared with the Joint Dialogue Group. Dates for the next National APRN stakeholder meeting 

5are being considered, to be either in February or March. At that time the final draft document will be 

6presented to the larger nursing community for dialogue prior to being finalized for endorsement by the 

7stakeholder organizations. 

8 


10The APRN consensus Work Group has continued to meet by conference call to review the latest draft 

11documents from the APRN/ NCSBN Joint Dialogue Group. Alternative language continues to be 

12considered. The group will meet by conference call on February 25 to further discuss details of the 

13document. It is expected that results of that discussion will be included in another draft which will be 

14shared with the Joint Dialogue Group and ultimately the APRN Stakeholders. The next National APRN 

15stakeholder meeting is set for April 14 in Silver Spring, MD. At that time the final draft document will 

16be jointly presented to the larger nursing community for dialogue prior to being finalized for 

17endorsement by the stakeholder organizations. 

18 


20The APRN Consensus Work Group finished its review and comment regarding the Joint Dialogue 

21Document subsequent to the APRN Stakeholder meeting held in April 2008 at the ANA Headquarters. 

22The document is expected to be released soon for endorsement by the APRN Stakeholder organizations. 

23 


25The APRN Consensus Work Group has essentially finished their immediate task. They will continue to 

26meet ad hoc to provide input into the inplementation plan for the model and to achieve implementation 

27as it relates to each particular entity's work. It is anticipated that the group will continue to collaborate 

28regarding concerns that may arise during implementation among the APRN stakeholder 

29community. The group will meet by conference call on December 18th to discuss implementation 

30strategies. Many organizations represented by members of the work group have endorsed the document 

31at this time, but not all. 

32 

33 

34APRN/NCSBN Joint Dialogue Group 

35 

36Background: 

37As a result of significant feedback and discussions among the APRN Consensus Work Group members 

38and NCSBN relative to the APRN consensus paper and NCSBN’s paper on the future of APRN 

39regulation, both groups agreed in September 2006 to a joint discussion regarding the disparity in the two 

40documents and committed to attempting to come to having either one paper or complementary papers. 

41Ultimately, representatives from the APRN Consensus Group included the following organizations at 

42the joint table. American Association of Nurse Anesthetists (AANA), ANA, American Association of 

43Nurse Midwives (ACNM), American Association of Nurse Practitioners (AANP), National 

44Organization of Nurse Practitioner Faculty (NONPF), National Association of Clinical Nurse Specialists 

45(NACNS), National League for Nurses Accreditation Council (NLNAC), American Association of 

46Colleges of Nursing (AACN), and American Organization of Nurse Executives (AONE). They were 

47joined by members of the NCSBN APRN Advisory Committee. Dialogue began in January 2007 with a 

48meeting in Washington, DC and continued with multiple face-to-face meetings and conference calls 

1 

2 



1through out the year. During summer meetings, the representatives agreed conceptually to a single joint 

2paper and have since worked to that end. 

3 


5The Joint Dialogue Group which is represented by members from the APRN Advisory Committee and 

6the APRN Consensus Work Group, met in Chicago on December 18-19, 2007. At that time the whole 

7Joint Dialogue Group draft paper was reviewed for discussion of controversial language and concepts. 

8Language was changed and clarified and the group agreed and met early in January to review changes. 

9The group also proposed that all aspects of the model be fully implemented by 2015. Dates are under 

10consideration for an ANA/AACN sponsored National APRN Stakeholder Meeting in order to present 

11the final draft paper to the larger nursing community for clarification, after which each organization will 

12be asked to consider it for endorsement by their board. The timeline provides for the NCSBN Board to 

13review at their May meeting for consideration by the House of Delegates at their August Annual 

14Meeting. 

15 


17The APRN Consensus Work Group, in concert with the NCSBN.APRN Joint Dialogue Group continue 

18to work to refine the joint document that will go forward to the stakeholder community representing the 

19best thinking of the future APRN model for regulation. Efforts continue to be focused upon trying to 

20schedule a 3rd National Nursing Stakeholder Meeting hosted by ANA to present the document for 

21discussion and clarity. This meeting will invite representatives from all interested nursing organizations 

22and state boards of nursing. Dates are still being determined. The goal is to have this accomplished 

23prior to the May meeting of the NCSBN's Board, and to allow time for the Boards of the various nursing 

24organizations to seek to endorse the document as well. It is expected that the document would go 

25forward to the NCSBN House of Delegates in August 2008 for approval by that body. Recommended 

26date for full implementation of the model would be by 2015. 

27 

28The CNS Competencies Work Group continues to meet electronically, with the facilitation by ANA and 

29ABNS staff leadership. This group has the goal of putting the draft competencies and framework out for 

30public comment by March 1, 2008, on Nursing World, for vetting by the CNS nursing community. It is 

31expected that a final document for endorsement, by the nursing specialty organizations that have a stake 

32in the CNS practice, will be available by mid summer. 

33 


35The group will meet again by conference call on February 25 to review language modifications. The 

36date of the next ANA/AACN sponsored National APRN Stakeholder Meeting has been set for April 14. 

37The purpose of this meeting will be to present the final draft paper to the larger nursing community for 

38clarification, after which each organization will be asked to consider it for endorsement by their board. 

39This timeline provides for the NCSBN Board to review at their May meeting for consideration by the 

40House of Delegates at their Annual August Meeting. 

41 


43ANA and AACN hosted the 4 th National APRN Stakeholder Meeting in Silver Spring at ANA 

44Headquarters on April 14, 2008. Approximately 70 attendees reviewed and discussed the latest draft of 

45the Joint Dialogue Document. Suggestions were made for further consideration by the Joint NSCBN 

46APRN Dialogue Group. Since then the Joint Dialogue Group has continued to meet to resolve any 

47remaining issues. It is expected that this group will release the final version of the document later this 

48month for endorsement by the APRN Stakeholder organizations. This document has also stimulated the 

1 

2 



1development of a companion Model APRN Statutes/Rules for adoption by the NCSBN House of 

2Delegates at its annual meeting in August. Next steps will include some discussion of Implementation 

3and a meeting of this group is planned for July 24-25 in Washington DC for this purpose. 

4 


6The final version of the Consensus Model for APRN Regulation: Licensure, Accreditation, 

7Certification and Education has been released and is available. The ANA Board of Directors which 

8approved the June 18th version of the document, will find this version modified only slightly. The 

9document has been disseminated for endorsement by all nursing stakeholder organizations. 

10 

11The modifications are provided in order to better position the description of the value of specialty 

12education and certification, though not used for regulatory purposes. No substantive changes were made 

13to the document or to its intent. Page 9 of the new version delineates this language in a box directly 

14below the model, rather than as simply a footnote, as was provided in the earlier version. A second 

15modification was made in the foundational Requirements for Certification to clearly describe that 

16specialty competencies would be assessed separately from the APRN core, role and population 

17competencies if appropriate. Again, this language and intent was in the previous document but has been 

18reformatted. 

19 


21The Joint Dialogue Group has met twice, in July and again in November, to discuss the structure 

22moving forward to achieve implementation of the model by 2015. A consultant, Michael Bleich, has 

23met with the group to assist in sorting out the needs for an organizational approach that is inclusive of all 

24stakeholder groups. The group made a decision at its November 10-11 meeting to appoint a 4-5 

25member transition team that would support the implementation via development of technological 

26vehicles such as a website, a road show and talking points, and other vehicles for communication and 

27coordination. This transition team would push out to the stakeholder organizations, the tools that might 

28be required for implementation, and would facilitate collaboration among entities to solve 

29implementation issues, identify strategies and so forth. The plan for implementation will next be 

30provided to the Consensus Work Group and to the NCSBN APRN Advisory Board for comment. As of 

31November 10th, 35 nursing stakeholder organizations have endorsed the model. In addition, in August 

32the NCSBN Delegate Assembly voted to support the model Statutes and Rules that would put the model 

33into effect at the state level in each jurisdiction. 

34 

35Clinical Nurse Specialist (CNS) Role Competencies 

36Background: 

37During the work of the AACN APRN Consensus Work Group, it became evident that there is much 

38confusion around the role competencies expected in CNS practice, as well as the lack of minimum 

39educational standards for the preparation of CNSs as APRNs. As a result, ANA and the American Board 

40of Nursing Specialties (ABNS) agreed to be co-conveners/facilitators of a process to address this 

41confusion and gain consensus around a set of role competencies and educational standards for CNS 

42Practice across the nation. 

43 

44Representatives from twenty national nursing organizations with a substantial investment in the 

45development and maintenance of CNS practice were identified and convened on May 30-31, 2006 at 

46ANA headquarters to begin a review and discussion of role competencies. During the two day meeting, 

47the group identified those competencies that most seemed to match the expectations for the CNS role 

48across all specialties and began to consolidate and redraft them to meet a similar standard. In the short 

1 

2 



1term, subgroups will continue this work by electronic means and conference calls, with 

2another face-to-face meeting at some point in the process to confirm the final set of core competencies 

3before dissemination and endorsement to the larger nursing stakeholder community. Once that is 

4accomplished, the group will be reconvened to identify educational curricular standards for all CNS 

5programs in order to meet those competencies. 

6 


8This group has continued to meet by conference call, both in January and multiple times in February to 

9finalize the set of competencies for public posting on nursingworld.org. The goal is for this document to 

10be posted by the beginning of March with comments solicited from the larger nursing community as 

11well as the CNS Stakeholder community for 60 days. The Group has agreed to meet face-to-face in 

12Silver Spring on May 29-30 to review all comments and deal with outstanding “parking lot” issues and 

13next steps. It is expected that the final document will be put out for endorsement by the CNS stakeholder 

14community during Summer 2008, with the understanding that these will then be used to develop 

15educational program criteria for accreditation. The timeline for this phase will need to be determined at 

16that meeting. 

17 


19During April and May a survey detailing the core competencies that had been developed was posted on 

20www.nursingworld.org and disseminated via a variety of listservs by ANA and other CNS stakeholder 

21organizations. This posting generated over 2100 responses, with overall agreement and in particular 

22agreement by CNSs and CNS educators in excess of 90% on all major competencies. Similar levels of 

23agreement were documented on nearly all behavioral statements as well. The CNS Core Competency 

24work group met for two days in Silver Spring at ANA Headquarters on May 29-30 to discuss the 

25feedback from the Public Comment period A final document has been drafted and the group is 

26finishing a list of definitions will be meeting by call at the end of June. It is anticipated that the final 

27document will be available for CNS Stakeholder organizations to endorse in July 2008. 

28 


30The document delineating the CNS Core Competencies for the role have been completed via a 

31consensus process of the CNS stakeholder organizations. They have been distributed to the larger 

32nursing Stakeholder community for endorsement by the beginning of January. At this time the process 

33has been relinquished to the National Association of Clinical Nurse Specialists (NACNS), and it is 

34expected that they will continue to manage this process. Several organizations have already endorsed the 

35competencies. These competencies will be utilized in the development of a certification exam by the 

36American Nurses Credentialing Center for CNSs who do not have an exam otherwise available by 

37which to demonstrate competence at the APRN level. 

38 

39 

40Scope of Practice for Certified Registered Nurse Anesthetists 

41 

42Background: 

43The American Nurses Association (ANA), for itself and on behalf of the Louisiana State Nurses 

44Association (LSNA) and the Louisiana Alliance of Nursing Organizations (LANO), filed an amicus 

45brief in the First Circuit Court of Appeal in the state of Louisiana in November 2008. ANA’s brief 

46supports the arguments advanced by the Appellant, the Louisiana State Board of Nursing (LSBN) which 

47was prohibited from taking further action on an Advisory Opinion request regarding whether it was 

48within the scope of practice for a Certified Registered Nurse Anesthetist (CRNA) practicing in 

1 

2 



1Louisiana to perform procedures involving the injection of local anesthetics, steroids, and analgesics for 

2interventional pain management purposes. The prohibition was as a result of a petition for injunctive 

3relief and declaratory judgment filed by Spine Diagnostics Center of Baton Rouge, Inc., seeking to 

4enjoin the Nursing Board from taking any further procedural action on the Advisory Opinion request 

5and seeking to prevent the CRNA from practicing interventional pain procedures or practicing 

6anesthesia related management unless under a physician’s order and supervision. 

7 

8The appeal is focused on the January 10, 2008 decision of the 19 th Judicial District Court in Louisiana in 

9which the court erred in holding that LSBN had substantively expanded the scope of practice for 

10CRNAs into areas where they have not traditionally practiced and that interventional pain management 

11is not within the scope of practice for CRNAs but is instead the practice of medicine. 

12 

13Also, the court incorrectly found that the Louisana State Board of Nursing’s Advisory Opinion was an 

14improper attempt at rulemaking. As a consequence, the court issued a permanent injunction prohibiting 

15the LSBN from enforcing its position statement, prohibiting the CRNA involved in the case from 

16performing interventional pain management (even under the order and supervision of a physician) and 

17directed the LSBN to remove the Advisory Opinion from its Web site. 

18 

19ANA pointed out in its brief that historically, CRNAs have provided pain management as an inherent 

20part of the administration of anesthetics. CRNAs are trained through graduate level education to provide 

21anesthesia and associated care. The Trial Court heard testimony from CRNAs who, for many years, 

22have safely injected local anesthetics, steroids, and analgesics, peripheral nerve blocks, epidural 

23injections and spinal facet joint injections for chronic pain management for their patients. The LSBN 

24testimony and evidentiary submissions prove that the CRNAs in Louisiana have the documented 

25education, training, and experience to safely perform procedures involving the injection of anesthetics, 

26steroids, and analgesics; therefore, making interventional pain management a long-standing element of a 

27Louisiana CRNA’s scope of practice. 

28 


30The case is pending. 

31 

32 

33 

34Industry Trade Advisory Committees (ITACs) 

35 

36Background: 

37In December 2005, ANA and a coalition of other health and public health professionals seeking a voice 

38in global trade policies, filed a lawsuit demanding that corporate interests be balanced with public 

39interest representation on US Industry Trade Advisory Committees (ITACs) that advise the US Trade 

40Representative (USTR) on trade policies affecting public health. 

41 

42ITACs advise the USTR on trade policies on a variety of public and environmental health protections, 

43affecting millions in the U.S. and around the world. These range from standards for healthy food, water, 

44health care services, and hazardous waste disposal services to patenting of plants. For example, trade 

45policies have limited consumer access to affordable generic drugs, and could remove protections for the 

46privacy of medical records, and promote privatization of public water supplies. 

47 

48The coalition includes the Center for Policy Analysis on Trade and Health (CPATH), California Public 

1 

2 



1Health Association-North, the Chinese Progressive Association, and Physicians for Social 

2Responsibility. The groups are represented by Earthjustice. 

3 

4The current makeup of advisory committees used by the Bush administration to establish trade policy 

5favors pharmaceutical, tobacco and other corporate interests, and illegally excludes public health 

6advocates. The administration declined to reappoint the ANA’s policy fellow, Cheryl Peterson, to her 

7long-standing position on a labor trade advisory committee, following the ANA’s support for the ITAC 

8lawsuit. 

9 

10The district court dismissed the coalition’s lawsuit on the basis that the Trade Act did not provide 

11sufficient legal standards for the court to assess what an appropriate balanced ITAC must look like. The 

12coalition appealed. 

13 


15The U.S. Court of Appeals for the Ninth Circuit held an oral argument on May 16, 2008. The case is 

16pending. 

17 


19The Court of Appeals denied the appeal. The 9 th Circuit panel agreed with ANA that the Federal 

20Advisory Committee Act’s (FACA) fair balance requirement does apply to the advisory committees. 

21However, the court held that, in its view, courts cannot apply the requirement as there is insufficient 

22statutory guidance. A request for rehearing was also denied, and no further actions are anticipated. 

1 

2 



STRATEGIC IMPERATIVE #3: KNOWLEDGE & RESEARCH 

ANA is the recognized source for accurate, comprehensive health policy information based on 

knowledge from research. 

1 

2 

3 

4 

5Content Management System (CMS) and NursingWorld.org 

6 

7Background: 

8The American Nurses Association (ANA) launched its new and improved Web site, 

9www.nursingworld.org in August 2007. The site is driven by a content management system (CMS) that 

10features distributed publishing and ensures consistent and accurate Web site pages and consistent “look 

11and feel” throughout. The CMS, which was installed earlier in 2007, markedly improves the 

12management of NursingWorld and its universe of affiliated sites; it facilitates a distributed online 

13publishing model for more rapid and accurate posting of information; where appropriate, integrates the 

14Web site with ANA’s database management system, TIMSS and with GetActive/Convio for advocacy 

15and grassroots work; features single-sign-on, so that members and other key groups will need only one 

16user name and password; improves the online and e-commerce experience for members and customers 

17and, implements a more efficient structure to support ANA’s hosting of CMA Web sites and other 

18enterprise sites. 

19 

20The Web site has been totally redesigned with completely new information architecture and a robust 

21search engine which improves site navigation and usability. The site has an updated and modern look 

22that makes all its information and services easier to find. It is all there, whether it is online continuing 

23education, taking action on Capitol Hill, purchasing the latest Scope and Standards of Practice, viewing 

24the latest nursing news or linking to the member’s state nurses association. 

25 

26The new homepage features a central story element and image that makes the work of ANA more 

27relevant to the member and other constituents and will display a selected ANA activity or product on a 

28rotating basis. This central message, which may be an event, new ANA product, legislation on safe 

29staffing or other hot item of import, is changed on a weekly basis. 

30 


32NursingWorld will feature a new “join ANA” page that is livelier and more compelling and is also a 

33component feature of the online membership campaign. It quickly funnels prospective members who 

34are ready to join to the appropriate member category and illustrates ANA membership value 

35proposition. 

36 

37Another initiative underway is the re-launch of the Geronurseonline.org Web site, which is the Web site 

38and central resource for the Nurse Competence in Aging project. It is scheduled to go live in March. 

39 


41The new “join ANA” pages, a component feature of the ongoing online membership campaign, were 

42developed and launched in mid-April and are now fully integrated with ANA’s database system, 

43TIMSS. Prospective members see the benefits of each member category and easily click through to the 

44online shopping cart to fulfill the membership order. While the new Web pages improve the customer 

45experience, the database integration improves internal efficiencies and database accuracy. 

46 

47The Safe Staffing pages at www.safestaffingsaveslives.org have been updated so to refresh its homepage 

48with new imagery and a central update box, and features new content and developments, such as the 

1 

2 



1topical one minute essays and poll results. The site itself has generated a great deal of interest as of June 

29, 2008: 

3 • 9,000 letters sent to Members of Congress 


5 • more than 11,000 have taken the Safe Staffing poll 

6 • more than 18,000 visitors to the site’s homepage per month 

7 

8To increase awareness of ANA programs, services, events and where and how the association is 

9representing the interests of nursing, ANA is now working with a search engine marketing vendor to 

10increase prominence of the site and its content on the major search engines. The major search engines 

11Google, Yahoo and MSN together comprise over 80 percent of all search engine searches on the Web. 

12Visibility on these search engines, especially on the first page of results, is key to attracting nurses and 

13other constituents to the site. Though the current visibility of NursingWorld on the search engines is 

14good, it can be improved through targeted pay-per-click buys and “organically” by tweaking the site and 

15its content so it matches the interests of site visitors and improves the search engine ranking. 

16 


18The Safe Staffing microsite at www.safestaffingsaveslives.org has been recently revised and enhanced; 

19highlights of these updates are featured in the site’s central update box on the homepage. Since the site 

20was launched in December 2007 here are the cumulative activity statistics (as of November 17, 2008): 

21 • 11,500 letters sent to Members of Congress 


23 • nearly 14,000 have taken the Safe Staffing poll 

24 • more than 16,000 visitors to the site in October 

25 

26ANA continues to employ search engine marketing and optimization through a vendor to increase the 

27awareness and visibility of the Safe Staffing site as well as NursingWorld, ANA’s Website. As a result 

28of these efforts about 6,000 users have been drawn to Safe Staffing in the last two measured months, 

29September and October. These search engine referrals from Google, Yahoo and MSN and others, link 

30either through targeted pay-per-click buys or “organically” by editing the page content to match the 

31interests of site visitors. Both sites also score high on the Visibility Score reports for October, 77% for 

32Safe Staffing and 70% for NursingWorld. This score is determined by the positioning on the major 

33search engines. 

34 

35Staff is now implementing RSS (real simple syndication) on key segments of the Safe Staffing site and 

36NursingWorld. RSS allows users to subscribe to “newsfeeds” and receive updates automatically from 

37the Website whenever there are updates. These newsfeeds are available in popular news readers such as 

38MyAOL, My Yahoo or through the Internet Explorer and Firefox Web browsers. This initiative, which 

39will begin to be available in 2009, is another method to draw interest to ANA and its activities, programs 

40and key updates through the Website. 

41 

42The re-designed and updated www.GeroNurseOnline.org Website was launched in early November. 

43The site is designed to serve as a comprehensive resource for nurses, who provide care for older adults. 

44Departmental staff worked closely with Programs & Policy staff to include new features such as career 

45opportunities in geriatric nursing, links to 55 specialty organizations and their offerings in geriatrics and 

46ANA’s advocacy work on behalf of geriatric nurses. 

47 

1 

2 



1Members Only on www.NursingWorld.org 

2 

3Background: 

4Since its inception in June 2004, the Members Only section of the ANA’s Web site has offered an 

5expanding array of exclusive information, services and member discounts. Members use specific user 

6names and passwords to access this special section of NursingWorld. The homepage is also 

7personalized so that members are recognized and can change their password or other account 

8information. 

9 

10In order to make Members Only more attractive to ANA members and prospective members, ANA 

11offers through an arrangement with EBSCO Publishing, the Cumulative Index to Nursing and Allied 

12Health Literature (CINAHL) online database, free of charge, to authorized users of Members Only. The 

13CINAHL service provides authoritative coverage of the literature related to nursing and health issues. In 

14total, more than 500 journals and newsletters, including The American Nurse, are regularly indexed and 

15online abstracts are available for more than 150 of these titles. 

16 

17Another value added benefit to members is access on the site to a growing array of online CE modules. 

18Members may complete any of the modules free of charge. 

19 

20Members Only also delivers the ANA Publications Archive, which features more than 200 ANA 

21publications that have been taken out of circulation that members can view or print. The collection can 

22be accessed by subject category or by keyword using a search engine unique to the collection. Members 

23now enjoy exclusive access to the most current topic of OJIN: the Online Journal of Issues in Nursing, 

24which ANA purchased in November 2006. The archival topics and issues of OJIN are still available in 

25its entirety on Nursing World. This model is consistent with the most current issue of The American 

26Nurses, which is also available only for members. 

27 

28The Member page posts headlines from the new ANA initiative launched in 2007, the ANA SmartBrief, 

29the daily email newsletter for members that provides a concise update on nursing and healthcare issues 

30as well as information on association conferences and activities. Members who click on any headline 

31will link to the ANA SmartBrief subscription page. A link to the new online professional and social 

32network, ANANurseSpace.org is available on the homepage as well. 

33 

34As part of the site’s redesign in August 2007, ANA introduced a new dynamic section on the Members 

35Only homepage that features individual members of ANA on a rotating basis. The purpose of this 

36section is to put a face on ANA by profiling members and posting their picture and personal story on the 

37homepage. These profiles rotate on a weekly basis. 

38 


40To provide more value to the site and its users, Members Only continues to be enhanced. Beginning 

41with the October 2007 issue, the site now offers exclusive member access to the most current topic of 

42OJIN: the Online Journal of Issues in Nursing. 

43 

44Members can now also enter into, with their unique user name and password, ANA’s new online social 

45network, ANANurseSpace.org, which offers a variety of communication and networking features where 

46nurses establish a profile and collaborate on blogs, discussion boards and documents and the 

47opportunity to enlarge their personal and professional network. 

48 

1 

2 



1The page continues to feature headlines from the new ANA communication initiative, the ANA 

2SmartBrief, the daily email newsletter for members that provides a concise update on nursing and 

3healthcare issues as well as information on association programs and activities. Members can click on 

4any headline to link to the ANA SmartBrief subscription page. Almost 22,000 members have now opted 

5to receive the email newsletter on a daily basis. 

6 

7Between last August 2007 and through mid-February 2008 more than 14,000 members and subscribers 

8had entered the new Members Only site. 

9 

10Future plans for the site include a new alert service on the site to keep members abreast of current 

11nursing literature. Every month members will be able to access “current contents” from the Medline/Pub 

12Med database at the National Library of Medicine. These bibliographic citations—many with abstracts 

13—will be divided into eleven topic areas, such as workplace, patient safety, ethics, informatics and 

14occupational. 

15 


17Staff is working to prepare for the AORN members who will become ANA Individual Affiliate 

18members in July; these new members will have access to the Web resources and services in Members 

19Only. 

20 

21By early June, more than 21,000 members had accessed Members Only and the site itself averages 

22approximately 15,000 visits by members per month. 

23 

24Other updates: 

25 • The new edition of OJIN: the Online Journal of Issues in Nursing on international nurse 

26 migration will be available exclusively for members on the site in June; 

27 • members use the Members Only doorway to access the activities on ANANurseSpace, the 

28 association’s social and professional network; 

29 • As part of the personalization efforts on the site, members are now alerted on the site when their 

30 renewal is pending and can then link directly to the “shopping cart” to complete the transaction. 

31 


33New items and resources have been added to the Members Only site to provide more value to ANA 

34members. The site now offers the current topic/issue of OJIN: the Online Journal of Issues of Nursing, 

35entitled Professional Pathways in Nursing: Options to Seek, Start, and Sustain a Career. Another 

36addition is a link to HEALTHmap, a Web-based resource that provides information on the global state 

37of infectious diseases and aggregates news sources from a variety of news organizations and official 

38alerts. HEALTHmap is a product of Harvard-MIT Division of Health Sciences & Technology and the 

39Children’s Hospital Informatics Program. 

40 

41In December, there will be a new offering on the site for nurses who work in various workplace settings: 

42a link to U.S. Pharmacopeia’s (USP) drug error online finder database, that allows a user to search more 

43than 1,400 drugs involved in look-alike and/or sound-alike errors. USP is an official public standards- 

body for all prescription and over-the-counter medicines manufactured or sold in the United 

44setting 

45States. 

46 

47As an exclusive member benefit, the site features headlines from SmartBrief, and members can click on 

48the headline item to launch the subscription page. More than 27,000 members have now opted-in to 

1 

2 



1receive to receive the e-newsletter on a daily basis. 

2 

3Since last year, when the site was re-launched, more than 30,000 members and subscribers have entered 

4Members Only to access the exclusive benefits, services and links. 

5 

6 

7National Database for Nursing Quality Indicators ® (NDNQI ® ) 

8 

9Background: 

10The National Database for Nursing Quality Indicators (NDNQI ® ) was established after the American 

11Nurses Association (ANA) launched the Safety & Quality Initiative in 1994 to explore and identify the 

12linkages between nursing care and patient outcomes. A series of pilot studies were performed to test 

13selected indicators, definitions, data collection methodology and instrument development. NDNQI ® was 

14then established in 1998 as part of ANA’s National Center for Nursing Quality (NCNQ ® ) and is 

15currently housed at the University of Kansas School of Nursing under the auspices of the KUMC 

16Research Institute (RI), with oversight by ANA. Enhancement to the program has continued over the 

17years and in 2007, nurse voluntary turnover and 3 nosocomial infection indicators were added. The 

18inaugural NDNQI National Data Use Conference held January 2007 was very successful, the initial 

19NDNQI monograph was published and won a publishing award and multiple presentations were 

20provided promoting the program. All of these efforts contributed to the continued growth of NDNQI in 

212007 which reached the milestone of 1,200 participating hospitals late in the year. 

22 


24Membership 

25As of January 2, 2008, 1215 hospitals were enrolled in NDNQI. 

26 

27Recognition 

28The 2007 NDNQI Monograph received a publishing award by the Society for Technical 

29Communication (STC). International in its membership and the largest such group in the world, the STC 

30grants its awards based on the total integrated quality of print or electronic publication, thus recognizing 

31team work across department line. 

32 

33 

34 

35 

36Conference 

37The 2 nd annual NDNQI National Data Use Conference – “Workforce Engagement in Using Data to 

38Improve Outcomes is scheduled for January 30 thru February 1, 2008 in Orlando, Florida. The 

39following plenary speakers are confirmed: 

40 

41 • Matt Weinstein and Fran Soloman from PlayFair – Motivational Speakers 

42 • Eileen T. Lake, PhD, RN 

43 • Sandra Bergquist-Beringer, PhD, RN, CWCN 

44 • Judith Warren, PhD, RN, FAAN, BC, FACMI 

45 • Mary Smolenski, EdD, APRN-BC, FAANP, CAE 

46 • Ann E. Rogers, PhD, RN, FAAN 

47 • Nancy Dunton, PhD 

1 

2 



1 

2 

3 

4 

• Marybeth Farquhar, RN, MSN, CAGS 

• Barry Straube, MD 

• Mary Naylor, PhD, RN, FAAN 

• Becky Patton, MSN, RN, CNOR – ANA President 

5 

6Sixty-eight poster presentations will be provided covering National Spotlights, Nurse Satisfaction and 

7Retention, Nurse Staffing, Quality Improvement in Action and the Business Case for Quality. Twelve 

8panels session with 45 presentations will be provided on QI in Action, RN Satisfaction, National 

9Spotlights, Workforce Engagement, Patient Safety and Leadership. New to the 2008 conference are two 

10pre-conferences focused on providing basic and advanced training to the NDNQI Site & Survey 

11Coordinators. The pre-conference workshops initially sold-out, but additional spacing was secured and 

12re-opened. Pre-conference registration has increased. Primary conference registration has nearly 

13reached the same attendance as last year and over 1000 attendees are anticipated. 

14 

15RN Survey & Quarterly Reports 

16As new indicators are added, the reports expand. The national summary statistic report alone was 736 

17pages for quarter 3. A new project is underway to provide facilities the ability to access additional 

18benchmarks and the ability to run the report in sections as needed. The RN Survey enrollment continues 

19to grow we have 85 more hospitals enrolled for 2008 than last year at this time. The RN Survey for 2007 

20had over 200,000 RN’s respond to the survey and that number is expected to be surpassed in 2008. 

21 


23The 2 nd annual NDNQI conference was very successful with over 900 attendees and participants 

24obtaining valuable information on how to engage staff and use data to improve practice. The pre- 

workshops which were a new addition to the conference were highly successful with over 

25conference 

26400 attending. The conference remains one of the most needed offerings since its data driven in the 

27presentations providing tools and techniques for the nurse at the bedside to improve practice in their 

28nursing measures and patient outcomes. Preliminary feedback received from the conference continues 

29to be positive with participants saying the conference was “terrific…definitely the best I attended”. 

30 

31Plans are underway for next year’s conference which is scheduled for Dallas, Texas from January 21 – 

3223, 2009. 

33 

34As 2/1/08 the number of enrolled hospitals in NDNQI is 1252. RN Survey enrollment also continues to 

35grow as there are currently 583 hospitals enrolled for 2008 which is 180 more hospitals compared to last 

36year at this time. 

37 


39As of June 10, there are 1,338 active hospitals in the database with 32 in the pipeline of joining. The 

40goal for hospital participation for 2008 is 1,350 hospitals. The database is not only growing in the 

41number of participants but in the number who participate in the RN survey on an annual basis. Currently 

42757 hospitals have signed up to participate in the RN Survey for 2008. That is increased by 134 new 

43hospitals compared to last year at this time of 523. 

44 

45Multiple presentations have been provided on NDNQI so far this year by the NDNQI & ANA Staff. 

46 • Introducing Bayesian Data Analysis to Non-Statisticians in a Frequentist Course: Illustration 

47 with NDNQI Data. 7 th International Conference on Health Policy Statistics, 1/17/08 

1 

2 



1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

• Benchmark Review of Qtrly and RN Survey. NDNQI National Data Use Conference, 1/31/08 

• Understanding the Impact on Reporting Nursing Outcomes. University of Tennessee, College of 

Nursing, 4/15/08 and Colorado Organization of Nurse Leaders, 2/6/08 

• Improving Healthcare Performance Through Data Collection and Reporting. Performance 

Management Institute 2/19/08 

• Building a Data Collaborative: The Development of NDNQI. Sigma Theta Tau, Collaborative 

Research Council Day, 2/29/08 

• Work Group Level Measurement Model for RN Intent to Stay in Current Job. Midwest Nursing 

Research Society, 3/28/08 

• Beyond Staffing Ratios--Nursing's Influence on Fall and Pressure Ulcer Rates, AONE, 4/25/08 

• Work Hours, Meal Breaks, Quality of Care, and Job Intention in Critical Care and Progressive 

Care Nurses. AACN/NTI, 5/3/08. This presentation has the distinction of being a podium and 

poster presentation as invited by AACN. 

• NDNQI, Magnet Recognition & Nursing Expertise. National Association of Orthopedic Nurses, 

5/19/08 

16 

17The 2009 NDNQI Data Use Conference planning is well underway. The conference will be held at the 

18Hyatt Regency Dallas on January 21-23, 2008. The call for abstracts opened May 19, 2008. 

19 


21As of July 14, 2008 there are 1348 active hospitals in NDNQI. The database continues to grow in the 

22number of participating hospitals and in the number who participate in the RN survey on an annual 

23basis. Currently 738 hospitals have signed up to participate in the RN Survey for 2008, an increase of 

24143 new hospitals compared to last year at this time. It is anticipated that 250,000-300,000 RNs will 

25have participated in the survey by the end of the 2008 survey period. 

26 

27October 2008 Update: 

28As of September 29, 2008 there are 1380 active hospitals in NDNQI. The database continues to grow in 

29the number of participating hospitals and in the number who participate in the RN survey on an annual 

30basis. Currently 702 hospitals have signed up to participate in the RN Survey for 2008, an increase of 

31145 new hospitals compared to last year at this time. It is anticipated that 250,000-275,000 RNs will 

32have participated in the survey by the end of the 2008 survey period. 

33 

34The NDNQI Conference registration – New Frontiers in Quality Care will be opening up in September. 

35Conference objectives are to recognize how high reliability organizations undertake organizational 

36change to improve quality; identify how quality data are used to improve nurse staffing and patient 

37outcomes; describe changes in nursing processes that improve patient outcomes and recognize how RN 

38Survey data can improve the nursing work environment. Distinguished invited speakers include: 

39 • Dr. Linda Aiken, Impact of Hospital Care Environment on Patient and Nurse Outcomes 

40 • Dr. Nancy Dunton, ”CMS” Never Events in NDNQI Hospitals 

41 • Dr. Caryl-Goodyear Bruch, Healthy Work Environments 

42 • Dr. Michael Simon, Across the Pond – the European NEXT study on Nurses Leaving the 

43 Profession 

44 • Donna Poduska & Craig Luzinski, The Poudre Valley Experience – 2007 NDNQI Award Winner 

1 

2 



1 

2 

3 

4 

5 

6 

• Ellen Kurtzman, Impact on Nursing: Trends in Performance Measurement, Public Reporting 

and Value-Based Purchasing 

• Dr. Linda Obrien-Pallas, Implications of Violence in the Workplace 

• Dr. Diane Boyle, Longitudinal Look at RN Satisfaction 

• Kathie Kendrick, High Reliability Organizations: New Opportunities for Patient Safety 

• Magnet Panel (TBD), Quality in a Magnet Environment 

7 

8NDNQI presentations by ANA & NDNQI staff have continued since last reported in May 2008. 

9 

10 

• A Multilevel Model of RN Workgroup Intent to Stay in Current Job (Poster 

dissertation),Academy Health 6/9/08 

11 

12 

• NDNQI Overview, Vermont Nurses Association Grand Rounds, 8/28/08 &, Veterans 

Administration Magnet Workshop – Houston, TX, 9/11/08 

13 

14 

• The Relationships Between Organization Support and Work Unit Support on Hospital Patient 

Safety (poster), National Association of Healthcare Quality (NAHQ) 9/14/08 

15 

16 

• Is the Sky Really Falling? Model-Based Report Cards for Nursing Outcomes, National 

Association of Healthcare Quality (NAHQ) 9/15/08 

17 

18 

• Association of Unit Prevalence of Foreign Educated Nurses with Nursing Processes & Patient 

Outcomes (poster), Academy Health 6/9/08 

19 

20 

• A Multilevel Factor Analysis of Practice Environment Scale (PES): Within and Between Nursing 

Units, CANS, 10/2/08 

21 

22NDNQI has a standing column in Nursing Management and has published to date the following: 

23 • NDNQI Overview, 4/08 

24 • What do we mean by nurse turnover? (NQF vs Magnet), 6/08 

25 • What is a Hospital? Issues and Implications, 8/08 

26 


28As of November 17, 2008 there are 1396 active hospitals in NDNQI. The database continues to grow in 

29the number of participating hospitals and in the number who participate in the RN survey on an annual 

30basis. The final number of hospitals that participated in the RN Survey for 2008 is 696, which is an 

31increase of 143 new hospitals compared to last year. Over 234,000 RNs participated in the 2008 survey 

32period, which is an increase of 14,000 nurses compared to the previous year. The average nursing unit 

33response rate remained high at 68%. 

34 

35NDNQI presentations by ANA & NDNQI staff have continued since last reported in October 2008. 

36 • RN Certification, Nursing Processes & Patient Outcomes, (Magnet Conference) 10/15/08 

37 

38 

• From Confusion to Fusion – Using NDNQI Data, (National Conference on Professional Nursing 

Education and Development) 10/17/08 

39 • Safe Staffing Practices (Maine Nurses Association Convention) 10/23/08. 

40 

41 

• Pressure Ulcers in Elder Hospitalized Patients: Report from NDNQI® (61 st Annual Scientific 

meeting of the Gerontological Society of America) 11/08 

42 

43 

• Practice Environment Subscales and the Incidence of Patient Falls (Kansas Nursing Research 

Exchange) 11/08 

1 

2 



1 

2 

3 

4 

• Is the Sky Really Falling? Model-Based Report Cards for Nursing Outcomes. (Kansas Nursing 

Research Exchange) 11/08 

• Association of Unit Prevalence of Foreign Educated Nurses with Nursing Processes and patient 

Outcomes. (Kansas Nursing Research Exchange) 11/08 

5 

6NDNQI’s most recent standing column in Nursing Management: 

7 • Apples to Apples, 10/08 

8 • Why should you care about CAUTI: An underrated never event, 12/08 

9Additional NDNQI Publications: 

10 • Bergquist-Beringer, S., Davidson, J., Agosto, C., Linde, N., Searles, M., Spurling, K., Dunton, 

11 N. & Christopher, A. (Submitted). Evaluation of the National Database of Nursing Quality 

12 Indicators® (NDNQI®) Training Program on Pressure Ulcers. Journal of Continuing 

13 Education. 

14 • Gajewski, B., Mahnken, J., & Dunton, N. (2008). Improving quality indicator report cards 

15 through Bayesian modeling. Bio Medical Central Medical Research Methodology, 8:77. 

16 • Gajewski, B., Hart, S. ? , Bergquist-Beringer, S., & Dunton, N. (In press). Inter-rater reliability of 

17 pressure ulcer staging: Ordinal probit Bayesian hierarchical model that allows for uncertain rate 

18 response. Statistics in Medicine. 

19 

20When searching for any research publication or presentation on NDNQI, Nancy Dunton as the principal 

21investigator is always listed along with the respective team members. 

22 

23 

24American Nurse Today (ANT) 

25 

26Background: 

27American Nurse Today is the official journal of the ANA. As a fresh, evidence-based voice of nursing, 

28American Nurse Today, covers cutting-edge issues in nursing practice and keeps nurses abreast of the 

29American Nurses Association's (ANA) advocacy on behalf of the profession. The journal also provides 

30practical, clinical, and career management information that nurses can use to stay up-to-date on best 

31practices, enhance patient outcomes, and advance their professional careers. 

32 


34ANA and HealthCom Media have received overwhelmingly positive responses from readers. The four 

35ANA dedicated columns are available on NursingWorld; access to features from the current issue is 

36restricted to ANA members or NursingWorld subscribers. Members can earn free contact hour credit 

37for each CE article in American Nurse Today, which are also available on NursingWorld and American 

38Nurse Today Web sites. 

39 

40HealthCom launched a digital version of American Nurse Today in 2007, which is located on the 

41journal’s newly redesigned Web site, www.AmericanNurseToday.com. The digital version is 

42interactive, with four-color images and rich-media content. 

43 

44CE topics to be featured in 2008 include Anterior Wall MI in January; Osteoporosis in February; Basic 

45Ostomy Care in March; and Alzheimer’s Update in April. 

46 


48ANA and HealthCom Media have received overwhelmingly positive responses from readers. The four 

49ANA dedicated columns are available on NursingWorld; access to features from the current issue is 

1 

2 



1restricted to ANA members or NursingWorld subscribers. Members can earn free contact hour credit 

2for each CE article in American Nurse Today, which are also available on NursingWorld and American 

3Nurse Today Web sites. 

4American Nurse Today has been notified that it has received the 2008 Silver Award for Best How-To 

5Article in a health care publication from the American Society of Healthcare Publication Editors 

6(ASHPE). The award was for the continuing education (CE) article in the July 2007 issue, “Keeping 

7cardiac arrest patients alive with therapeutic hypothermia.” 

8HCM and ANA held a face-to-face meeting on May 29 at HCM headquarters in Pennsylvania. This was 

9in lieu of a regularly scheduled quarterly call. 

10CE topics to be featured in 2008 include Anterior Wall MI in January; Osteoporosis in February; Basic 

11Ostomy Care in March; Alzheimer’s Update in April; and Preventing and Treating Osteoporosis in 

12May. 

13 


15HCM and ANA will held its final quarterly call for 2008 on November 24. Mary Jean Schumann 

16participated in the meeting in her new role as CPO. ANA and HCM will begin working on schedule of 

17meetings in 2009. 

18 

19ANA began offering the digital edition of American Nurse Today as a membership benefit in June, 

20which was announced at the June HOD. 

21CE topics featured in 2008 include Anterior Wall MI in January; Osteoporosis in February; Basic 

22Ostomy Care in March; Alzheimer’s Update in April; and Preventing and Treating Osteoporosis in 

23May; Childhood Obesity in June; Chronic Wounds in July; Atrial Fibrillation in August; Community 

24Acquired Pneumonia in September; Handling Sentinel Events in October; Acute Liver Failure in 

25November. 

26 

27 

28Informatics and Electronic Health Record Initiatives 

29 

30Background: 

31ANA has been monitoring and addressing information systems, computer-based patient record, 

32electronic health record, standardized terminologies, confidentiality and security of data and 

33information, and associated informatics issues and content for many years. A recent flurry of diverse 

34public-private activities complement the current president’s national focus on implementation of 

35healthcare information technology solutions, such as the electronic health record, personal health 

36record, National Health Information Infrastructure (NHII), and National Health Information Network 

37(NHIN) initiatives. 

38 

39The Health Information Technology Standards Panel (HITSP), sponsored by the American National 

40Standards Institute (ANSI) in cooperation with strategic partners such as the Healthcare Information and 

41Management Systems Society (HIMSS), the Advanced Technology Institute (ATI), and Booz Allen 

42Hamilton, is funded via the Office of the National Coordinator for Health Information Technology 

43(ONCHIT) contract award from the U.S. Department of Health and Human Services. Its mission is to 

44serve as a cooperative partnership between the public and private sectors for the purpose of achieving a 

45widely accepted and useful set of standards specifically to enable and support widespread 

46interoperability among healthcare software applications, as they will interact in a local, regional and 

1 

2 



1national health information network for the United States. HITSP technical committees include small 

2numbers of nurse stakeholders. 

3 

4The newly established International Health Technology Standards Development Organization 

5(IHTSDO) housed in Denmark is responsible for maintenance and further development of SNOMED 

6CT, a terminology to support the communication of nursing terms and data between information 

7systems. A US nurse is a seated member on the IHTSDO Quality Assurance Committee. 

8 


10The Committee on Nursing Practice Information Infrastructure (CNPII), a standing committee of the 

11Congress on Nursing Practice and Economics, continues to address the inclusion of standardized 

12nursing terminologies in the national and international standards and health information system arenas. 

13The CNPII is developing more robust content for ANA’s new website to enhance the educational 

14resources about these topics for nurses and healthcare consumers. 

15 


17CNPII members provided numerous comments about the use of standardized nursing terminologies for 

18inclusion in the ANA's response to the call for public comments on the draft Essentials for 

19Baccalaureate Education for Professional Nursing Practice. Individual members continue to publish 

20and present about this topic in numerous venues. ANA continues to assist in recruitment of nurse 

21members to participate in the various HITSP and other related work efforts. 

22 


24The draft ANA position statement on electronic health records, created by a Congress on Nursing 

25Practice and Economics workgroup, is now posted for public comment. Responses to date have spanned 

26the continuum from don’t proceed with such product development and implementation to firm advocacy 

27based on long term experience in the use and support for this data and information management 

28strategy. Several members of the CNPII participated in panel sessions about the development and 

29implementation of standardized terminologies at the American Medical Informatics Association 

30(AMIA) fall conference. ANA staff attended the biennial NANDA, International conference in Miami, 

31Florida. ANA was represented at the eHealth Initiative's (eHI) Fifth Annual Conference, Taking the 

32Pulse of Health IT: A Critical Review of Progress Over the Last Five Years and Key Recommendations 

33for 2009 and Beyond. 

34 

35American Health Information Community (AHIC) 

36Background: 

37The American Health Information Community (AHIC), established in 2005, by Health and Human 

38Services (HHS) Secretary Mike Leavitt continues its very aggressive schedule to recommend "potential 

39breakthroughs" that will make significant impact in advancing efforts to achieve President Bush’s goal 

40for most Americans to have access to secure electronic health records by 2014. A transition team is 

41developing a plan and structure to ensure sustainability of such work beyond 2008 and the end of the 

42current administration’s term of office. 

43 


45AHIC will be meeting in conjunction with the 2008 HIMSS Conference on February 26, 2008, in 

46Orlando, FL. ANA put forth the effort to ensure that a nurse was appointed to serve on the commission 

47and encouraged the nursing community to rally around one nurse nominee, Lillee Gelinas. ANA has 

1 

2 



1contributed to the perspectives represented on the Commission and continues to monitor its progress 

2through ongoing attendance as an observer. 

3 


5Registered nurses continue to contribute to AHIC Chronic Care; Confidentiality, Privacy, and Security; 

6Consumer Empowerment, Electronic Health Records, Personalized Health Care, Population Health, and 

7Quality Workgroups Transition plans are well underway to move the current AHIC structure to a 

8sustainable private-public entity that remains viable after the new federal administration assumes office 

9in January 2008. Lillee Gelinas, MSN, RN, FAAN, has been named co-chair for the AHIC 2.0 

10Transition Planning Group. AHIC and its work efforts are referenced throughout the recently released 

11report “The ONC-Coordinated Federal Health Information Technology Strategic Plan: 2008-2012”. 

12 


14The final AHIC meeting on November 12 th served as a transition meeting that addressed the 

15accomplishments of this initiative and defined the legacy for the newly established AHIC Successor, 

16Inc. The AHIC Successor, Inc., board of directors held its inaugural meeting on November 13 th . 

17Although a nursing representative was not named to the initial board of directors, ANA joined members 

18of the Alliance for Nursing Informatics (ANI) leadership team in a meeting with AHIC Successor, Inc., 

19leaders to address this oversight and identify next steps to mitigate any unintended consequences. ANA 

20has provided comments on the draft AHIC Successor, Inc., bylaws and the process for establishing 

21nationwide health information technology priorities documents. Membership criteria and accompanying 

22fee structures have not yet been published. 

23 

24 

25 

26National Committee on Vital and Health Statistics (NCVHS) 

27Background: 

28The National Committee on Vital and Healthcare Statistics (NCVHS) is the Department of Health and 

29Human Services statutory public advisory body on health data, statistics and national health information 

30policy. The NCVHS serves as a national forum on health data and information systems and is intended 

31to serve as a forum for the collaboration of interested parties to accelerate the evolution of public and 

32private health information systems toward more uniform, shared data standards, operating within a 

33framework protecting privacy and security. The NCVHS is tasked with monitoring the implementation 

34of HIPAA and other components of the Social Security Act. Meeting transcripts, reports, letters, and 

35audio files are available http://www.ncvhs.hhs.gov/. 

36 


38Various NCVHS Subcommittees have received extensive testimony and comment on diverse topics over 

39the past year and were presented action reports and letters about sensitive information in electronic 

40health records and surge capacity at the February 20-21, 2008 meeting. 

41 

42 


44Because of schedule conflicts ANA staff could not attend the May 2008 meetings of the full NCVHS 

45committee and its subcommittees. The May 2008 meeting transcript (available at 

46http://www.ncvhs.hhs.gov/lastmntr.htm) identified which seated members, including the chairperson, 

47will end their terms as of July 1st. Judith Warren, PhD, RN-BC, FAAN, FACMI, from the University of 

48Kansas School of Nursing, has been reappointed to the NCVHS for a second four-year term and has 

1 

2 



1been named co-chair of the Subcommittee on Standards and Security. ANA had submitted her 

2nomination for her initial appointment. 

3 

4The recently published Department of Health and Human Services (DHHS) FY 2007-2012 Strategic 

5Plan (available at http://aspe.hhs.gov/hhsplan/2007/) reflects significant NCVHS influence as overall 

6goals and a number of objectives rely on health information technology. During the May meeting the 

7NCVHS approved a letter to the Secretary of Health and Human Services with several 

8recommendations to facilitate the implementation of e-prescribing within long-term care settings and 

9heard a presentation about extensive work related to standardized terminologies from Betsy Humphreys 

10from the National Library of Medicine. The NCVHS resumes its meeting schedule in September. 

11 


13ANA staff attended the NCVHS September 16-17, 2008 meeting, but could not attend the October and 

14November meetings because of schedule conflicts. The National Conference on State Legislatures 

15update provided insights about the widespread state initiatives addressing health information technology 

16implementations. NCVHS is beginning plans for its 60 th anniversary celebration in 2009. The NCVHS 

17sent a letter on September 24, 2008, to the Secretary of Health and Human Services urging HHS work 

18with the Drug Enforcement Agency (DEA) on alternative solutions to security and authentication for e- 

19prescribing that reflect a more balanced, risk-based approach that balances security with functionality and 

20clinical practice—an approach that is more consistent with capabilities present in effective e- prescribing 

21systems today. ANA submitted comments on the DEA's notice of proposed ruling for e-prescribing. 

22American Board of Medical Specialties ® (ABMS) 

23 

24Background: 

25The American Board of Medical Specialties (ABMS), a not-for-profit organization, assists 24 approved 

26medical specialty boards in the development and use of standards in the ongoing evaluation and 

27certification of physicians. ABMS, recognized as the "gold standard" in physician certification, believes 

28higher standards for physicians means better care for patients. ABMS is focused on improving the 

29safety and quality of medical care by working with our Member Boards to set the standards for 

30physician specialty certification and continuous education. Part of this focus involves providing 

31products and services for public and professional use to verify physician board certification. 

32 

33Medical specialty certification in the United States is a voluntary process. While medical licensure sets 

34the minimum competency requirements to diagnose and treat patients, it is not specialty specific. Board 

35certification—and the Gold Star—demonstrate a physician’s exceptional expertise in a particular 

36specialty and/or subspecialty of medical practice. The Gold Star signals a board certified physician’s 

37commitment and expertise in consistently achieving superior clinical outcomes in a responsive, patient- 

setting. Patients, physicians, healthcare providers, insurers and quality organizations look for 

38focused 

39the Gold Star as the best measure of a physician’s knowledge, experience and skills to provide quality 

40healthcare within a given specialty. 

41 

42Certification by an ABMS Member Board involves a rigorous process of testing and peer evaluation that 

43is designed and administered by specialists in the specific area of medicine. Learn more about how a 

44physician becomes board certified. 

45 

46At one time, physicians were awarded certificates that were not time-limited and therefore did not have 

47to be renewed. Later, a program of periodic recertification (every six to 10 years) was initiated to ensure 

48physicians engaged in continuing education and examination to keep current in their specialty. 

1 

2 



1However, in 2006, ABMS’ 24 Member Boards adopted a new gold standard for re-certification with a 

2continuous ABMS Maintenance of Certification (MOC) program for all specialties. MOC uses 

3evidence-based guidelines and national standards and best practices in combination with customized 

4continuing education so physicians demonstrate their leadership in the national movement for 

5healthcare quality. MOC also requires proof of continuing education and experience in between testing 

6for re-certification. 

7 


9ABMS enlisted the assistance of The American Medical Association (AMA)-convened Physician 

10Consortium for Performance Improvement® (PCPI) with the nomination process for Work Groups on 

11Characterizing Episodes and Costs of Care that is part of a new Robert Wood Johnson Foundation 

12initiative, High Value Healthcare Through Better Information and Quality Improvement. As part of this 

13initiative, the American Board of Medical Specialties (ABMS), under the direction of Kevin Weiss, 

14MD, received funding to develop and test episode-based cost measures for a number of common 

15conditions. The work products are intended to be available for general public use. The Work Groups 

16will focus on cost, not quality nor efficiency. 

17 

18As part of the grant activities, Workgroups will be convened for each clinical condition. Each 

19Workgroup will include 3-4 physicians with clinical knowledge and 3-4 persons with technical 

20knowledge in performance measurement. Ideally, participants will have both clinical knowledge and 

21administrative experience. Work Group participants will be expected to attend an in-person meeting in 

22Chicago, take part in monthly conference calls during a 3-5 month period, and join a kick-off 

23conference call in advance of the in-person meetings. Travel expenses will be covered by the grant. 

24PCPI began by asking for nominations for Workgroups on Congestive Heart Failure, Low Back Pain 

25and Breast Cancer. ANA submitted candidates for all three workgroups and all three nominees were 

26appointed. 

27 

28 

29American Medical Association – Physician Consortium for Performance 

30Improvement ® (AMA-PCPI) 

31 

32Background: 

33The American Medical Association (AMA)-convened Physician Consortium for Performance 

34Improvement® (PCPI) is committed to enhancing quality of care and patient safety by taking the lead in 

35the development, testing, and maintenance of evidence-based clinical performance measures and 

36measurement resources for physicians. 

37 

38The Consortium is comprised of over 100 national medical specialties and state medical societies; the 

39Council of Medical Specialty Societies; American Board of Medical Specialties and its member-boards; 

40experts in methodology and data collection; the Agency for Healthcare Research and Quality; and 

41Centers for Medicare & Medicaid Services. The 23-member Executive Committee of the Consortium 

42has broad representation. Consortium Advisory Committees address issues related to measures 

43implementation and evaluation; measure development, methodology and oversight; and planning. 

44 


46Consortium activities are carried out through cross-specialty work groups established to develop 

47performance measures from evidence-based clinical guidelines for select clinical conditions. 

48Membership is open to any organization or individual committed to health care quality improvement 

1 

2 



1and/or patient safety, and participates in the development, review, dissemination, or implementation of 

2performance measures and measurement resources. ANA has representatives on the Preventive Care 

3and Wound Care Workgroups. 

4 

5At its last meeting PCPI discussed current measure development, testing, and endorsement processes 

6and identified new challenges in these areas. The evolution of the PCPI portfolio was considered. New 

7opportunities for PCPI work were reviewed. Finally a recommendation on expansion: That a new 

8membership category, “health care professional member,” with specified privileges, be established for 

9the health care professional organizations listed in Table I (i.e., American Chiropractic Association, 

10American Dental Association , American Optometric Association, American Association of Oral and 

11Maxillofacial Surgeons, American Podiatric Medical Association, American Academy of Physician 

12Assistants, American Nurses Association (Membership in the American Nurses Association includes 

13several types of advanced practice registered nurses (nurse practitioners, certified nurse-midwives, 

14clinical nurse specialists, and certified registered nurse anesthetists) that are eligible to participate in the 

15PQRI.), National Association of Social Workers, American Psychological Association, American 

16Dietetic Association, American Physical Therapy Association, American Occupational Therapy 

17Association, American Speech-Language Hearing Association). This new membership category will 

18comprise organizations that represent health care professionals other than doctors of medicine (MDs) 

19and osteopathic physicians (DOs) was adopted. 

20 


22Consortium activities are carried out through cross-specialty work groups established to develop 

23performance measures from evidence-based clinical guidelines for select clinical conditions. 

24Membership is open to any organization or individual committed to health care quality improvement 

25and/or patient safety, and participates in the development, review, dissemination, or implementation of 

26performance measures and measurement resources. ANA has been represented on the Preventive Care, 

27Wound Care and Medication Reconciliation Workgroups. The AMA-PCPI met in late September, 2008. 

28During the meeting, votes were taken on Consortium Measures (Preventive Care and Services; Child 

29and Adolescent Major Depressive Disorder; and, Obstructive Sleep Apnea). A DRAFT PCPI Position 

30Statement: The Evidence Base Required for Measures Development was tabled. Finally, PCPI priorities 

31for 2009 were detailed. 

32 

33 

34AQA (formerly the Ambulatory Quality Alliance) 

35 

36Background: 

37In September 2004, the American Academy of Family Physicians (AAFP), the American College of 

38Physicians (ACP), America’s Health Insurance Plans (AHIP), and the Agency for Healthcare Research 

39and Quality (AHRQ), joined together to lead an effort for determining, under the most expedient 

40timeframe, how to most effectively and efficiently improve performance measurement, data 

41aggregation, and reporting in the ambulatory care setting. Originally known as the Ambulatory Care 

42Quality Alliance, the coalition is now known as the AQA alliance because its mission has broadened to 

43incorporate all areas of physician practice. The mission of this effort, a broad based collaborative of 

44physicians, consumers, purchasers, health insurance plans and others, is to: 

45 improve health care quality and patient safety through a collaborative process in which key 

46 stakeholders agree on a strategy for measuring performance at the physician or group level; 

47 collecting and aggregating data in the least burdensome way; and reporting meaningful information 

48 to consumers, physicians, and other stakeholders to inform choices and improve outcomes. 

1 

2 



1 

2AQA’s goals are to reach consensus as soon as possible on: 

3 •A set of measures for physician performance that stakeholders can use in private health insurance 

4 plan contracts and with government purchasers; 

5 •A multi-year strategy to roll-out additional measurement sets and implement measures into the 

6 marketplace; 

7 •A model (including framework and governing structure) for aggregating, sharing and stewarding 

8 data; and 

9 •Critical steps needed for reporting useful information to providers, consumers and purchasers. 

10 

11AQA’s mission and goals focus on key areas that can help identify quality gaps, control skyrocketing 

12cost trends, reduce confusion over redundant measures and alleviate administrative burdens in the 

13marketplace. The four founding organizations have been strongly encouraged by the support and 

14participation by a broad range of stakeholder groups in moving toward this goal. AQA’s leadership 

15expanded to include new steering group members and supporting organizations, which have expressed 

16interest and been actively involved in AQA activities. As a result of discussions during the initial AQA- 

17HQA Steering Committee Meeting that took place on August 4, 2006, five work groups (Pilot 

18Expansion, Pilot Infrastructure, Measure Harmonization, Efficiency/Episodes of Care, Cost-Pricing 

19Transparency) were established that will help focus attention on particular efforts that are needed to 

20accomplish the goals set forth by the Committee. ANA participates in the review and approval of AQA 

21measures and parameters for selecting measures for physician performance and principles on cost of 

22care and appropriateness criteria. Use of a number of the approved measures is encouraged by health 

23care professionals in addition to physicians, where appropriate. 

24 


26No activities to report. The next AQA meeting is April 2008. 

27 


29The following new procedures (which were provisionally approved at the October, 2007 meeting) are 

30being implemented: 

31 • Consumer, payors, health insurance plans, physicians and other clinicians ( which includes 

32 ANA) must be present to meet quorum requirements 

33 • Reports are to discuss issues considered since the last meeting. 

34 • The chair of a workgroup must make a motion which must be seconded for an issue to be 

35 considered. 

36 • Each organization has one vote 

37 • If a majority of stakeholders in a sector approve, the sector votes affirmatively 

38 • Three of the five stakeholder sectors must vote affirmatively for a motion to pass 

39ANA participated in the approval process for a series of measures including those for: Nuclear 

40Medicine, Geriatrics, Osteoarthritis, and Depression. 

41 


43During the fall AQA meeting, an update on governance processes in particular in regards to issues 

44related to voting were considered. Appointments of “Other” Clinician Organizations (American 

45Psychological Association and American Physical Therapy Association) to the Steering Committee 

46were made. Additional measures (Substance Use Disorders, Chronic Wound Care, and Palliative Care) 

1 

2 



1were considered. In addition, reports from the Chartered Value Exchanges (CVE) and Better Quality 

2Information to Improve Care for Medicare Beneficiaries sites were received. 

3 

4 

5Hospital Quality Alliance (HQA) 

6 

7Background: 

8The Hospital Quality Alliance (HQA): Improving Care through Information is a public-private 

9collaboration to improve the quality of care provided by the nation's hospitals by measuring and 

10publicly reporting on that care. This collaboration includes the Centers for Medicare and Medicaid 

11Services (CMS), the American Hospital Association, the Federation of American Hospitals, and the 

12Association of American Medical Colleges, and is supported by other organizations such as the Agency 

13for Healthcare Research Quality, National Quality Forum, Joint Commission on Accreditation of 

14Healthcare Organizations, American Medical Association, American Nurses Association, National 

15Association of Children's Hospitals and Related Institutions, Consumer-Purchaser Disclosure Project, 

16AFL-CIO and American Association for Retired Persons. The goal of the program is to identify a robust 

17set of standardized and easy-to-understand hospital quality measures. An important element of the 

18collaboration, Hospital Compare, is a website/web-tool developed to publicly report credible and user- 

information about the quality of care delivered in the nation's hospitals. 

19friendly 

20 

21The Hospital Quality Alliance (HQA) Principals, including CEO Stierle, meet at least quarterly face-to- 

and intermittently by conference call. ANA actively participates in a number of HQA subgroups 

22face 

23focused on the inclusion of additional measures into Hospital Compare; revision of the Hospital 

24Compare display; and, membership expansion. 

25 


27The Principals met at the Washington, DC headquarters of the U.S. Chamber of Commerce in February. 

28Consideration has been given to posting payment and volume information with the addition of 

29HCAHPS data on Hospital Compare. The Quality Alliance Steering Committee (QASC) will be 

30meeting to develop a quality measurement and reporting roadmap that will span the next five years. The 

31Principals worked to identify the potential activities and issues that QASC is best positioned to address. 

32The Measurement Work Group offered an overview of the measures recommended for adoption for 

33posting to Hospital Compare in 2010 and the value of adding efficiency measures (i.e., Average Length 

34of Stay) to the website. Supportive strategies that the HQA could undertake to advance the NQF 

35Priorities were detailed. An overview of HQA’s goals, challenges, and opportunities was presented and 

36the Principals engaged in discussion to ensure that all the critical questions and issues were accurately 

37captured and articulated. CMS presented a timeline for the rulemaking process for both inpatient and 

38outpatient including an overview of ambulatory surgery center quality measurement and reporting. 

39Efforts to improve the operations and process involving the data collection and reporting for the hospital 

40Annual Payment Update (RHQDAPU) were reviewed. A critical access hospital update was provided 

41and the 9th Scope of Work was highlighted. In Executive Session, issues related to HQA budget and 

42membership was discussed by the Principals. 

43 


45The Short Term Measures Workgroup received a report on the HCAHPS launch. Two rounds of 

46technical briefings were held and were well attended. Secretary Leavitt presentation later in the day 

47which was more focused on healthcare quality and cost. The Charter Value Exchanges were highlighted 

48in his remarks. The nursing shortage was noted as an issue. CEO Stierle offered a quote which was 

1 

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1included in the press release which was disseminated. Refinements to the HQA measure selection 

2criteria are under discussion. The Hospital Quality Alliance (HQA) facilitates continuous improvement 

3in patient care through implementing measures that portray the quality, cost and value of hospital care; 

4developing and using measure reporting in the nation’s hospitals; and sharing useful hospital 

5performance information with the public. The HQA relies on the National Quality Forum (NQF) to 

6endorse performance measures that are important, scientifically acceptable, usable, and feasible. One of 

7the HQA’s key activities is to review NQF-endorsed measures to determine which ones enjoy broad, 

8multi-stakeholder support and can be implemented on a national basis in the near-term. 

9 

10The Display Workgroup has considered available guidance on external linkage. At the February 

11meeting, the Principals asked the workgroup to work on guidelines for determining external links to 

12which Hospital Compare (or more specifically, the resources page on HC) should link. As a first step, 

13guidelines relative to linking with outside websites were gathered. A number of general guidelines to 

14evaluate the quality and reliability of health information Web sites have been published. The guidelines 

15combine criteria from several external sources and existing guidelines with considerations relevant to 

16the Department of Health and Human Services (HHS) agencies whose missions include a public 

17information component determine which information should be included in their HHS Web sites. These 

18criteria can also be used to narrow the field of candidate sites for links to avoid information overload for 

19users and reduce link maintenance. At the June Principals’ meeting the criteria were further revised 

20regarding inclusion of an exception criterion and the Principals will be exercising that criterion by ballot 

21by referendum to select additional links to be recommended to CMS for inclusion in Hospital Compare. 

22 

23Also at the June meeting, the Principals engaged in strategic planning which included a review of HQA 

24tactics and consideration of its strategic direction. The hospital value-based purchasing plan was 

25discussed. The IPPS rule and potential changes to measure specifications were reviewed. Updates on 

26HQA membership and budget were considered. Day two of the meeting was open to the public. 

27 

28Implications for HQA of the Quality Alliance Steering Committee (QASC) Road Map were considered. 

29The availability of outpatient measures for inclusion in the Medicare Annual Payment Update (APU) 

30was discussed. Criteria for selecting websites were reviewed. And a CMS update was provided. 

31 


33During a meeting held in early September, a new member with expertise in issues related to disparities 

34was added to the list of Principals. An update on HQA progress to date was provided. Expectations of 

35HQA and CMS were discussed. The potential for a common advocacy agenda was considered. A 

36timeline for measure implementation was detailed. CMS provided updates on the measurement 

37infrastructure and data display. Efficiency measure development efforts were highlighted. 

38 

39 

40Institute for Healthcare Improvement (IHI) 

41 

42Background: 

43The Institute for Healthcare Improvement (IHI) is a non-for-profit organization leading the 

44improvement of health care throughout the world. IHI was founded in 1991 and is based in Cambridge, 

45Massachusetts. IHI is a reliable source of energy, knowledge, and support for a never-ending campaign 

46to improve health care worldwide. The Institute helps accelerate change in health care by cultivating 

47promising concepts for improving patient care and turning those ideas into action. IHI’s customers, 

48partners, faculty, and staff are unified in pursuit of these five aims: No needless deaths; No needless 

1 

2 



1pain or suffering; No helplessness in those served or serving; No unwanted waiting; and No waste. IHI, 

2with the support of the Rx Foundation and the Robert Wood Johnson Foundation, is working to identify 

3best practices and promising system changes that enable patient-centered care. IHI’s goal is to articulate 

4patient-centered care designs that “raise the bar” compared with the healthcare systems’ current 

5performance. 

6 

7The Institute for Healthcare Improvement (IHI) 5 Million Lives Campaign actively seeks more hospitals 

8to take part in this massive improvement in care practices; the goal is to enroll 4,000 American hospitals 

9(building on the more than 3,100 facilities enrolled in the preceding initiative, the 100,000 Lives 

10Campaign and to continue to nurture the national learning network of partners, field offices (nodes), and 

11hospitals that has begun to take shape. The campaign will run for 24 months, from December 12, 2006, 

12until December 9, 2008. IHI and its partners in the campaign, which include ANA, are encouraging 

13hospitals and other health care providers to take steps to reduce harm and deaths. There are IHI field 

14offices in all 50 states. A pediatric affinity group has been established and mentor hospitals are 

15growing. National conference calls have numbered from 200 to 540 callers. The campaign has shifted 

16from being driven by IHI and the Partners to the field taking charge and pushing the agenda. Current 

17campaign efforts are focused on: 

18 • Education 

19 • Exchange between and among organizations 

20 • Measurement of the change in harm utilizing proxy measures 

21 


23There are IHI field offices in all 50 states. A pediatric affinity group has been established and mentor 

24hospitals are growing. National conference calls have numbered from 200 to 540 callers. 

25Approximately 40,000 media hits have been counted. A medication reconciliation challenge has been 

26let. The campaign has shifted from being driven by IHI and the Partners to the field taking charge and 

27pushing the agenda. There is a need to move to ensuring a critical mass in each state. Current campaign 

28efforts are focused on: 

29 

30 

31 

32 

33 


• Education 

• Exchange between and among organizations 

• Measurement of the change in harm utilizing proxy measures 

35The 20th Annual IHI National Forum on Quality Improvement in Health Care will be held December 

368-11, 2008, in Nashville, Tennessee. The National Forum on Quality Improvement in Health Care is 

37the premier "meeting place" for people committed to the mission of improving health care. This annual 

38event draws approximately 6,500 health care leaders from around the world in person and thousands 

39more via satellite broadcast. The campaign’s 2009 priorities will center on: 

40 • Implementing a National Learning Network 

41 • Moving to transformation at the system level 

42 • Exploration of the continuum of care 

43 • MRSA’s challenge 

44 • The ethics of quality improvement 

45 

46ANA staff will be meeting independently with IHI staff in early June to discuss potential collaborative 

1 

2 



1efforts around the campaign. 

2 


4The 20th Annual IHI National Forum on Quality Improvement in Health Care was held December 8-11, 

52008, in Nashville, Tennessee. The National Forum on Quality Improvement in Health Care is the 

6premier "meeting place" for people committed to the mission of improving health care. This annual 

7event draws approximately 6,500 health care leaders from around the world in person and thousands 

8more via satellite broadcast. The campaign’s 2009 priorities will center on: 

9 • Implementing a National Learning Network 

10 • Moving to transformation at the system level 

11 • Exploration of the continuum of care 

12 • MRSA’s challenge 

13 • The ethics of quality improvement 

14 

15ANA staff met with IHI staff to discuss potential collaborative efforts around the campaign. In addition, 

16IHI sought input on a 90-day project to define the primary and secondary drivers of outstanding levels of 

17inpatient patient experience and to then introduce content to effectively influence those drivers. 

18 

19 

20National Quality Forum (NQF) 

21 

22Background: 

23The National Quality Forum is a private, not-for-profit membership organization created to develop and 

24implement a national strategy for healthcare quality measurement and reporting. The mission of the 

25NQF is to improve American healthcare through endorsement of consensus-based national standards for 

26measurement and public reporting of healthcare performance data that provide meaningful information 

27about whether care is safe, timely, beneficial, patient-centered, equitable and efficient. In a report issued 

28in 1998, the President's Advisory Commission on Consumer Protection and Quality in the Health Care 

29Industry proposed creation of the Forum as part of an integrated national quality improvement agenda. 

30Leaders from consumer, purchaser, provider, health plan, and health service research organizations met 

31as the Quality Forum Planning Committee throughout 1998 and early 1999 to define the mission, 

32structure, and financing of the Forum. The Forum was incorporated as a new organization in May 1999. 

33There are approximately 400 members currently and ANA, joining in 2000 was the first and is one of 

34only thirteen nursing organizations that are members. Other nursing organizational members (in order 

35of longevity) include the American Association of Nurse Anesthetists (AANA), the American Academy 

36of Nursing (AAN), the American Association of Colleges of Nursing (AACN), the Hartford Institute for 

37Geriatric Nursing (Hartford), the Infusion Nurses Society (INS), the American Organization of Nurse 

38Executives (AONE), the Hospice and Palliative Nurses Association (HPNA), AORN (Association of 

39periOperative Nurses), the Academy of Medical-Surgical Nurses (AMSN), American College of Nurse- 

40Midwives (ACNM), Association of Women's Health, Obstetric and Neonatal Nurses. (AWHONN) and 

41the National Council of State Boards of Nursing (NCSBN). 

42 


44ANA President Rebecca M. Patton, MSN, RN, CNOR serves on the NQF Steering Committee on 

45Establishing Priorities, Goals and a Measurement Framework for Assessing Value Across Episodes of 

46Care. The group is engaged in a number of activities including: 

1 

2 



1 

2 

3 

4 

5 

6 

7 

8 

9 

• Develop a comprehensive measurement framework for chronic care episodes; 

• Identify a small subset of priority conditions to serve as a starting point for a national effort 

to measure, report, and improve the value of care across an episode of illness; 

• Assess the current state of efficiency in the selected priority conditions including availability 

of measures and data; 

• Establish national performance goals—measurable targets for the two priority conditions— 

over the next three to five years; and 

• Lay out a future vision and research agenda for an evolving measurement and monitoring 

system focused on achieving value across episodes of care. 

10 

11ANA Chief Executive Officer Linda J. Stierle, MSN, RN, CNAA,BC serves on the National Priorities 

12Partners where she chairs the Continuity of Care -- Medication Reconciliation working group. NQF has 

13proposed a 3-year Initiative that would result in a National Priorities Agenda that includes: 

• Six Chronic Conditions. In addition to the two pilot project conditions, four additional high 

volume and/or high-cost conditions will be selected. The six conditions in total should 

account for a very sizable proportion of healthcare services and expenditures. 

14 

15 

16 

17 

18 • Six Crosscutting Areas. To complement the focus on specific conditions, the Initiative will 

19 also identify a limited number of crosscutting performance areas that impact patients with 

20 many different chronic conditions (e.g., care coordination, medication management). 

21 

22In March, the NQF Priority Partners worked to identify concrete action steps that must be undertaken to 

23operationalize the NQF Priorities. 

24 


26ANA, as a member of the Health Professional Council, regularly provides comment on measures under 

27consideration for endorsement. Staff monitors the work of the Steering Committees and TAPS. ANA 

28meets quarterly with representatives of the NQF Nursing Organizational Members and more frequently 

29with those of the American Academy of Nursing to develop strategies to increase nursing visibility in 

30the work of NQF. ANA continues to spearhead the collaborative nomination of nurses to relevant NQF 

31Steering Committees and Technical Advisory Panels (TAPs). 

32 

33ANA President Rebecca M. Patton, MSN, RN, CNOR serves on the NQF Steering Committee on 

34Establishing Priorities, Goals and a Measurement Framework for Assessing Value Across Episodes of 

35Care which seeks to achieve consensus on a measurement framework for assessing “value” associated 

36with the care of people over the course of a chronic episode of illness (e.g. 6-8 months). It also working 

37to establish a limited set of priorities and national performance goals, and to set forth a vision and a 

38research agenda to guide ongoing efforts. The Committee’s initial report presents its proposed 

39measurement framework for evaluating efficiency across extended episodes of care. This framework is 

40intended to provide guidance to help key stakeholder groups move forward along a path towards a high 

41performing health care system that is patient-centered, focused on quality, mindful of costs, and 

42intolerant of waste. An additional report for laying a migration pathway for evaluating “efficiency” 

43across episodes of care based on the NQF framework is currently under development by the Steering 

44Committee. 

45 

46ANA Chief Executive Officer Linda J. Stierle, MSN, RN, CNAA,BC serves on the National Priorities 

47Partners which the NQF BOD established to identify a set of “high-leverage” priorities for national 

48quality measurement and reporting. It is expected that Priority Partners will take action within their own 

1 

2 



1organizations to implement strategies for effecting necessary changes. Leaders representing 27 

2organizations—seen as “effector arms” for implementation—are serving on the Priority Partners to 

3identify a core set of priorities and goals for national action—in areas where compelling evidence 

4indicates opportunities to produce sizable improvements in health and health care. CEO Stierle chairs 

5the Continuity of Care -- Medication Reconciliation working group and was invited to provide an 

6overview of the group’s activities during the NQF Spring Membership Meeting in Atlanta, Georgia. 

7Stierle called attention to the impact of the need for medication reconciliation. Nineteen percent of 

8patients discharged from the hospital experience an adverse event within 3 weeks; 60% of which are 

9adverse drug events. Warfarin, insulin and digoxin account for one third of all ED visits for adverse 

10drug events in the elderly. There is merit in broadcasting the various elements of the medication 

11reconciliation definitions across the NQF Generic Episode of Care Framework. 

12The workgroup has coined the following definition: Medication reconciliation is the process of 

13obtaining, maintaining and communicating to the patient and next provider of service an accurate and 

14detailed listing of all prescription and non-prescription drugs and attendant tests to maintain an optimal 

15medication safety threshold throughout the episode of care. “Medication safety threshold” is defined as: 

16the point at which a therapeutic intervention produces a beneficial effect free from harm. 

17 

18Medication reconciliation should occur at key transition points across the episode of care: 

19 o Admission 

20 o Transfer within care facility 

21 o Discharge 

22 o Outpatient settings 

23 

24Goals addressing measurement gaps related to Medication Reconciliation include: 

25 o The need to retool current measures to address other vulnerable populations in addition to the 

26 elderly 

27 o Identification of a parsimonious set of measures that are most sensitive to achieving desired 

28 patient outcomes (i.e. minimizing harm) 

29 o Harmonization of medication reconciliation measures so that they are “portable” across all 

30 settings of care 

31 o Accelerated development and adoption of standards that allow for data elements to be 

32 transferred seamlessly in an electronic format 

33 

34On June 11 th , the group worked to finalize priority areas and their accompanying goals. The steps which 

35NPP members can take to act on priority areas were identified. A communication strategy for roll out of 

36the priority areas was detailed. 

37 


39On July 3rd the National Quality Forum presented the National Priorities Partnership’s seven priority 

40areas and their corresponding goals to the 378 NQF member organizations and to 1,774 public contacts. 

41NQF requested feedback on the complete set of priority areas and goals as well as on specific priority 

42areas according to the respondents’ level of interest and expertise. A total of 260 comments and 8 letters 

43from 64 groups, indicating significant interest in the priorities were received. At that point in time, CEO 

44Stierle sought input from the larger nursing community which was shared with NQF. 

45 

46In general, the responses to the priority areas and goals were favorable and many respondents applauded 

47and commended the NPP for its efforts and its thoughtful consideration of areas that would have “far- 

and beneficial consequences.” One respondent noted that “overall, the seven priorities cover 48reaching an 

1 

2 



1extensive, yet essential, set of topics challenging the quality of today's health care system.” Comments 

2were synthesized and shared by NQF staff with the Workgroups. Stierle once again reached out to the 

3greater nursing community to solicit their input. The following comments are reflective of nursing’s 

4perspectives and concerns regarding the priority areas and goals: NQF’s efforts at setting national 

5priorities and goals to achieve real healthcare reform in the next five years through convening the 

6National Priorities Partners are to be commended. The nursing community concurs with the Partners’ 

7focus on achievable goals that would, if implemented broadly, reduce harm, improve patient-centered 

8care, eliminate healthcare disparities, and remove waste from the system. There are however issues 

9which require attention. 

10 • There continues to be a need for utilization of language inclusive of all disciplines. 

11 

12 

• As a component of planning for goal attainment, consideration must be given to ensuring that all 

those involved in the provision of care take an active part in the implementation. 

13 

14 

• The goals are very aggressive and there is a lack of knowledge regarding the current state of 

practice as it relates to benchmarks. 

15 

16 

• Emphasis should be placed on measurement across the episode of care (including beyond the 

acute care setting) of cross-cutting, systemic issues as opposed to those that are disease-specific. 

17 

18 

19 

20 

• The following verbiage should be used the first time the word "patient" is used within the 

document: the recipients of care are individuals, groups, families, or communities. The 

individual recipient of care can be referred to as patient, client, or person. The term "patient" is 

used throughout to provide consistency and brevity. 

21 

22 

• Included within the statements are terms and phrases (many of which are subjective in nature) 

which may not be universally understood and hence, require clarification. 

23 

24 

• Consideration should be given to differentiation between “organization(s)” and “clinician(s)” in 

the use of the term “provider(s).” 

25 

26 

• The IOM aims around equity should be threaded throughout the goals to ensure sensitivity to 

racial/ethnic issues and beyond to socioeconomic status, literacy and hearing. 

27 • In a redesigned system of care the family must be an active participant in the process of care. 

28 

29 

• Additional attention should be given to the following which appear to be underrepresented in the 

priorities, goals and actions: 

30 o Family involvement 

31 o Surgical patients 

32 o Environmental- and pathogenic-exposure 

33 o Electronic health records 

34 o Advance directives 

35 

36 

37 

• Finally, the need for adequate numbers of appropriately prepared healthcare practitioners (in 

particular registered nurses in any setting, but especially within the hospital, hospice and 

palliative care settings), necessary to accomplish the goals must be acknowledged. 

38 

39During the September meeting, an NPP DRAFT “Launch” document, including the specific priority 

40areas and their accompanying goals, was finalized. Key “drivers” and initial “actions” for each of the 

41priority areas were discussed. Discussion of messaging around “tough issues we should not duck” 

42based on public comments took place. As a result, the document was once again revised and CEO 

43Stierle convened representatives of nursing organizations and others interested in nursing measurement 

44to receive their comments. Those invited to participate, over time, included representatives of the 

45following: 

46 

1 

2 



1American Nurses Association 

2 

3Representative of the American Nurses Association Board of Directors and the Congress on Nursing 

4Practice and Economics (CNPE), an organized, deliberative body which brings together the diverse 

5experiences and perspectives of ANA members and its Organizational Affiliates took part. 

6 

7NQF Nursing Organizational Members 

8 

9Currently there are 14 Nursing Organizational Members (including The American Nurses Association) 

10of NQF. Those listed in RED are also Organizational Affiliates of ANA: 

11 • American Association of Nurse Anesthetists 

12 • American Academy of Nursing 

13 • American Association of Colleges of Nursing 

14 • Hartford Institute for Geriatric Nursing 

15 • Infusion Nurses Society 

16 • American Organization of Nurse Executives 

17 • Hospice and Palliative Nurses Association 

18 • AORN (the Association of periOperative Nurses) 

19 • Academy of Medical-Surgical Nurses 

20 • American College of Nurse-Midwives 

21 • Association of Women’s Health, Obstetric and Neonatal Nurses 

22 • National Council of State Boards of Nursing 

23 • American Psychiatric Nurses Association 

24 

25ANA Organizational Affiliates 

26 

27An organizational affiliate of ANA is an association that 1) is a national nursing organization that meets 

28criteria established by the ANA House of Delegates. 2) has been granted organizational affiliate status 

29by the Board of Directors. ANA Organizational Affiliates include: 

30 • Academy of Neonatal Nursing, LLC 

31 • American Association of Colleges of Nursing (AACN) 

32 • American Association of Critical-Care Nursing (AACN) 

33 • American Association of Nurse Anesthetists (AANA) 

34 • American Association of Occupational Health Nurses (AAOHN) 

35 • American Nephrology Nurses' Association) (ANNA) 

36 • American Psychiatric Nurses Association (APNA) 

37 • Association of Nurses in AIDS Care (ANAC) 

38 • Association of periOperative Registered Nurses (AORN) 

39 • Association of Rehabilitation Nurses (ARN) 

40 • Association of Women's Health, Obstetric & Neonatal Nurses (AWHONN) 

41 • Emergency Nurses Association (ENA) 

42 • Infusion Nurses Society (INS) 

43 • International Nurses Society on Addictions (INTNSA) 

44 • National Association of Clinical Nurse Specialists (NACNS) 

45 • National Association of Neonatal Nurses (NANN) 

46 • National Association of School Nurses (NASN) 

47 • National Nursing Staff Development Organization (NNSDO) 

48 • Oncology Nursing Society (ONS) 

1 

2 



1 

2 

• Preventive Cardiovascular Nurses Association (PCNA) 

• Wound, Ostomy, Continence Nurses Society (WOCN) 

3 

4Workplace Advocacy Affiliate 

5 

6The Center for American Nursing a national professional nursing organization that partners with its 42 

7organizational members (comprised of over 47,000 registered nurses nationwide) and ANA’s 

8Workplace Advocacy Affiliate also participated. 

9 

10Nursing Measurement Group 

11 

12The Nursing Measurement Group has come together over time to address issues of general concern 

13related to measurement of nursing care quality and is hosted by ANA. Involved organizations involved 

14include: 

15 • AARP Center to Champion Nursing in America 

16 • Banner Health and The Joint Commission Board of Commissioners 

17 • Cedars Sinai Health System and National Quality Forum Leadership Network 

18 • George Washington University 

19 • The Joint Commission 

20 • Kaiser Permanente and The Joint Commission Board of Commissioners 

21 • Robert Wood Johnson Foundation (RWJF) 

22 • University of Pennsylvania 

23 • University of Wisconsin – Milwaukee and National Quality Forum Board of Directors 

24 • VHA, Inc. 

25 

26The nursing community concurs with the Partners’ focus on achievable goals that would, if 

27implemented broadly, reduce harm, improve patient-centered care, eliminate healthcare disparities, and 

28remove waste from the system. However there continue to be areas which require attention and 

29amendment. 

30 

31 

32 

33 

34 

35 

• The document needs to use more inclusive language when describing the universe of healthcare 

professionals. This broader construct is vital if the National Priorities and Goals are to speak to 

a reformed healthcare system in which a full spectrum of healthcare professionals are fully 

utilized to provide care for patients, their families and communities. Anything less has the 

potential to adversely affect the level of support. 

36 

37 

• The document should address the critical need for healthcare leaders to be accountable for 

ensuring adequate resources for the provision of safe patient care. 

38 

39 

• The document should encourage development of incentives for healthcare organizations to 

support innovative models of care. 

40 • Given the need for common understanding, the document should include a glossary of terms. 

41 • Several specific terms require modification: 

42 o “Primary healthcare home” should replace “medical home” 

43 o “Persons” should replace “Americans” 

44 o “Interprofessional” should replace “inter/multi disciplinary” 

1 

2 



1 

2 

o “Healthcare” as a single word should be used as an adjective, i.e., healthcare system; 

“Health care” can also be a noun (care) modified by an adjective (health) 

3 

4 

• Within the “Population Health” section, there is a need for clarification as to whether 75% of 

ALL people receive some, or 75% receive ALL, preventive services. 

5 

6 

7 

• The document should address the safety of healthcare providers, as it relates to occupational 

hazards, in the section entitled “National Priority: Improve the safety and reliability of 

America’s healthcare system”. 

8 

9 

• Within the same section, there is a disconnect between the graphic on page 13 (“Percentage Who 

Receive Cancer Screening…”) and subsequent text on page 14. 

10 

11 

12 

13 

• The nursing community feels strongly that the disparities in care quality and access due to 

practice variations, in addition to those due to race, ethnicity, gender and geographic area, are 

insufficiently addressed by the National Priorities and require greater emphasis throughout the 

document. 

14 

15 

• The Priority section entitled “Guarantee appropriate and compassionate care…” elicits concern 

as to whether the Partners can actually “guarantee” actions. Another term is warranted here. 

16 • The citations in the section on “overuse” and “elimination of waste” require clarification. 

17 

18In order to facilitate consideration by NQF, the nursing community’s specific suggestions for revision of 

19the National Priorities were incorporated into a revised document using the “track changes” feature 

20which was forwarded to NQF. 

21 

22In mid-October, CEO Stierle provided an update on the activities of the NPP at the NQF 2008 National 

23Policy Conference: Quality at the Crossroads. This 2.5-day event was comprised of the NQF Annual 

24Fall Policy Conference, NQF Membership and Board of Directors Meetings. During the Board meeting 

25the NQF membership of the American Psychiatric Nurses Association (APNA) was approved. 

26 

27A number of suggested examples of nursing actions were included in the final document released 

28November 17, 2008 at an event at the Washington, DC Freedom Forum at the Newseum in which CEO 

29Stierle participated. The document (which is available at 

30http://www.nationalprioritiespartnership.org/uploadedFiles/NPP/08-253-NQF%20ReportLo(1).pdf ) 

31acknowledges the input from the NQF member nursing associations (a number of which are ANA 

32Organizational Affiliates) as well as the broader nursing community: American Nurses Association 

33(ANA), American Association of Nurse Anesthetists, American Academy of Nursing, American 

34Association of Colleges of Nursing, Hartford Institute for Geriatric Nursing, Infusion Nurses Society, 

35American Organization of Nurse Executives, Hospice and Palliative Nurses Association, AORN (the 

36Association of periOperative Nurses), Academy of Medical-Surgical Nurses, American College of 

37Nurse-Midwives, Association of Women’s Health, Obstetric and Neonatal Nurses, National Council of 

38State Boards of Nursing, and the American Psychiatric Nurses Association. 

39URAC 

40 

41Background: 

42URAC, formerly known as the Utilization Review Accreditation Commission is an independent, 

43nonprofit organization, and is known for promoting health care quality through its accreditation and 

44certification programs. URAC's initial mission was to improve the quality and accountability of health 

45care organizations using UR programs and in later years, expanded to cover a larger range of service 

46functions found in various health care settings including the accreditation of integrated systems such as 

47health plans to smaller organizations offering specialty services. URAC ensures that all stakeholders are 

1 

2 



1represented in establishing meaningful quality measures. ANA is a nursing provider representative on 

2its 23 member Board of Directors (BOD). Board representatives consist of members from various 

3health provider organizations: American College of Physician’s (ACP), America’s Health Insurance 

4Plans (AHIP), American Health Quality Association (AHQA), American Hospital Association (AHA), 

5American Insurance Association (AIA), American Medical Association (AMA), American Nurses 

6Association (ANA), American Psychiatric Association (APA), American Association of Preferred 

7Provider Organizations (AAPPO), Blue Cross and Blue Shield Association (BCBSA), Case 

8Management Society of America (CMSA), National Association of Insurance Commissioners (NAIC), 

9National Business Coalition on Health (NBCH), a Public Representative and several at-large members. 

10 


12ANA is represented by Isis Montalvo, RN, MS, MBA, Assistant Director and was reappointed to a 3 

13year term in 2008 to continue to serve on URAC’s BOD. Quarterly meetings are held annually with the 

14BOD, covering the spectrum of various standards for review and strategic planning for the organization. 

15New standards that have been recently vetted and approved are Pharmacy Benefits Management and 

16Comprehensive Wellness Accreditation standards. URAC’s portfolio of standards also includes Case 

17Management, Claims Processing, Consumer Education and Support, Core Accreditation, Credentials 

18Verification, Disease Management, Health Call Center, Health Content Provider, Health Network, 

19Health Plan, Health Utilization, HIPAA Privacy HIPAA Security, Medicare Advantage Deeming, 

20Workers Compensation Health, Worker’s Compensation UM. 

21 

22 

23Quality Alliance Steering Committee (QASC) 

24 

25Background: 

26In 2006, the Quality Alliance Steering Committee (QASC) was created. A $15.8 million dollar grant 

27from the Robert Wood Johnson Foundation has funded the QASC to: (1) aggregate private-sector and 

28Medicare claims data and provide regional collaboratives with physician/medical group performance 

29information; (2) ensure that aggregated data can identify racial and ethnic disparities of care; and (3) 

30develop episodes of care and evaluate provider cost and efficiency across an episode. 

31 

32At its February 29, 2008 meeting, QASC endorsed operating rules that are now guiding critical 

33processes and procedures, such as QASC membership, agenda setting, appointment of workgroups, 

34appointments of QASC and workgroup chair-persons, etc. At the same meeting, the QASC 

35recommended that a road-map should be created to clarify critical tasks and needed functionalities to 

36move aggressively forward in ensuring wide-scale availability of provider performance information 

37across the care continuum based on NQF endorsed measures. 

38 

39To facilitate the design of the road-map, Brookings staff was asked to develop discussion documents to 

40allow for ongoing input and feedback. Staff was aided in this effort by Nancy Wilson (AHRQ), Chris 

41Queram (WI Collaborative), John Tooker (ACP), and Peter Lee (PBGH). Thus, multiple feedback 

42mechanisms were built into the design process to arrive at the current draft of the road-map. In June, 

432008, the QASC roadmap was reviewed. Reports were received from the various workgroups. 

44Discussion focused on ways to collaborate effectively with the regional activities took place. The 

45operating rules regarding membership clarify membership when individuals leave the organization or 

46entity with which they are affiliated were revised. Finally, updates from the Chartered Values 

47Exchanges, Aligning Forces for Quality, and CMS were provided. 

48 

1 

2 




2The Quality Alliance Steering Committee met on September 17 th , 2008. During the meeting, approval 

3of action steps to promote further coordination with regional collaboratives took place. Membership 

4changes were also approved. Discussion of key findings from the MARS survey of regional 

5collaboratives took place. Deliverables and progress from QASC workgroups were highlighted. 

6Further alignment efforts between QASC, NQF, and sector-specific alliances were considered. 

1 

2 



1 STRATEGIC IMPERATIVE #4: UNIFICATION 

2 

3 

4International Council of Nurses 

5 

6Background: 

7The International Council of Nurses is a federation of national nurses’ association, representing nurses 

8in more than 128 countries. Founded in 1899, ICN is the world’s first and widest reaching international 

9organization for health professionals. ICN works to ensure quality nursing care for all, sound health 

10policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected 

11nursing profession and a competent and satisfied nursing workforce. ANA is one of the founding 

12members of the ICN and serves as the National Nursing Association (NNA). 

13 

14The Council of Nurse Representatives (CNR) is the governing body of ICN and sets policy at the macro 

15level, including admission of members, election of the Board of Directors, amendments to the 

16constitution, and setting of fees. A National Representative is a nurse selected by a member association 

17to be its representative, who may or may not be the president of that association, but who meets the ICN 

18definition of nurse. The nurse accompanying the National Representative of a member association may 

19participate in meetings of the CNR but has no right to vote except when acting as the authorized proxy 

20for the national representative. At meetings of the CNR the right to speak is limited to: 

21 

• members of the CNR, ICN Board of Directors, the ICN Chief Executive Officer and the 

22 

accompanying person from the member association; 

23 

• official observers designated by the ICN Board of Directors, on selected topics as 

24 

determined by the chairperson of the meeting; 

25 

• guests invited by ICN to speak on specific topics for the time allowed by the presiding 

26 

officer of the meeting. 

27 

28The CNR meets every two years at a venue decided by the Board after considering applications from 

29countries expressing an interest in hosting a CNR meeting. The ICN Congress is attached to the CNR 

30every four years. 

31 


33President Patton has been appointed to the ICN Congress Scientific Programme Committee for planning 

34for the 2009 ICN meeting to be held in Durbin, South Africa. Planning has also begun for ANA 

35leaderships’ participation in upcoming ICN meetings and the World Health Assembly scheduled for 

36May 2008. ANA will be attending several meetings including a meeting of government chief nursing 

37officers, national nurses associations and nursing regulators from around the world; a meeting convened 

38by the World Health Professions Association that includes nurses, physicians, pharmacists and dentists; 

39an international regulatory conference and the annual World Health Assembly convened by the World 

40Health Organization. 

41 

42ANA submitted the candidate package for Dr. William Holzemer. He currently sits on the ICN Board of 

43Directors. He will be challenged by the current President of the Canadian Nurses Association during the 

44ICN elections in June 2009. 

45 


47In May 2008, ANA provided ICN with comments on three ICN position statements under revision: 

48 - Elimination of Substance Abuse in Young People 

1 

2 



1 - Universal Access to Clean Water 

2 - Mental Health 

3 

4ANA also provided feedback to ICN on a draft document, Nursing Human Resources Planning and 

5Management Competencies. 

6 

7ANA’s President and CEO attended meetings held in Geneva, Switzerland in connection with annual 

8World Health Assembly (WHA) convened by the World Health Organization. ICN held two meetings 

9in conjunction with the WHA. The first was a meeting of member National Nurses Associations were 

10participants discussed issues related to models of health care delivery, task shifting, positive practice 

11environments and education trends. The second was a meeting of national nurses associations, 

12government chief nursing officers, and nursing regulators to discuss issues of common concern. In 

13addition to the ANA President and CEO, Admiral Carol Romono from USPHS was in attendance as 

14were NCSBN President Faith Fields and CEO Kathy Apple. The third meeting was a meeting of the 

15World Health Professions Alliance involving nurses, pharmacists, dentists, physicians and physical 

16therapists. The meeting focused on professional self-regulation, the impact of international trade in 

17services agreement, and the increasing cross-border movement of both patients and health professionals. 

18 

19ANA President, Becky Patton, attended the 2008 World Health Assembly (WHA) meeting held May 

2019-23 in Geneva, Switzerland. Held under the auspices of the World Health Organization (WHO), 

21delegations from 193 countries participate to discuss significant health issues. Of particular interest to 

22nursing, was a technical report on WHO efforts to strengthen nursing and midwifery by improving 

23nursing education, regulation and overall workforce capacity. Reports regarding the global health 

24workforce have been considered at previous WHA meetings in 2004, 2005 and 2006. A representative 

25from the International Council of Nurses (ICN) spoke (Link to statement) in support of ongoing efforts 

26to address nursing’s contribution to health systems. ICN called on the WHO to join a major five year 

27campaign dedicated to improving the work environments and staff recruitment and retention. In 

28addition, ICN noted that the percentage of nurse specialists within the WHO was less than 1%. ICN 

29requested further information on plans to increase the number nurses within the WHO structure. As a 

30result of the previous reports considered at the WHA, the WHO created the Global Health Workforce 

31Alliance (GHWA). At this meeting, the GHWA released a document, Guidelines: Incentives For 

32Health Professionals (http://www.ghwa.org/). ICN was a participant in the development of this 

33document. The document describes various incentives that can be considered in the recruitment, 

34motivation and retention of health care professionals. 

35 


37ANA hosted the annual meeting of the ICN Workforce Forum. Participating countries included 

38representatives from Canada, Germany, Iceland, Japan, New Zealand, Sweden, United Kingdom, and 

39the United States. The purpose of the Forum is to discuss issues and strategies related to the work 

40environment for nurses. This year’s agenda included discussions related to: pandemics; employment 

41benefits; work in nursing homes/long term care; presentations on recent industrial action in Sweden, 

42Germany, U.K. and USA; association membership concerns; and vision of the future health workforce. 

43ICN also announced that David Benton has been appointed the new ICN CEO. Mr. Benton has been a 

44Consultant in Nursing and Health Policy at ICN since 2005, specializing in regulation, licensing and 

45education. 

46 

47October 2008 Update: 

48ANA submitted comments to ICN regarding health workers access to infrastructure and materials to 

1 

2 



1promote the use of standard precautions, injection safety, lab safety, TB infection control, waste 

2management and post exposure prophylaxis. 

3 


5There is no December action to be reported for ICN. Issues related to the ICN membership discussion 

6are Executive Business and will be covered at the March 2009 meeting. 

7 

8 

9American Medical Association 

10 

11Background: 

12As the nation’s largest physician group, the AMA, founded in 1847 by Nathan Davis, advocates on the 

13issues vital to the nation’s health. The AMA’s envisioned future is to be an essential part of the 

14professional life of every physician and an essential force for progress in improving the nation’s health. 

15 

16The AMA created the Current Procedural Terminology (CPT) codes, for reporting outpatient services 

17and procedures by physicians and other healthcare providers – including NPs, CNSs, and sometimes 

18CRNMs. The AMA retains legal rights to the CPT codes, and its CPT committee makes 

19recommendations for code revisions. The AMA RUC (Relative Value Scale Update Committee) 

20makes recommendations on the relative costs of each service or procedure. (Nurse staffing costs are a 

21factor in the “practice expense” component of these costs.) If the Centers for Medicare and Medicaid 

22(CMS) accept the recommendations, they become part of Medicare reimbursement policy, and are often 

23adopted by private health insurers and providers as well. 

24 

25ANA is the only nursing organization to hold official observer status at the CPT and RUC meetings, and 

26to have representatives on the CPT and RUC Health Care Professionals Advisory Committees 

27(HCPAC). ANA also participates in an informal RUC subgroup of medical specialties & primary care 

28providers -- who are outnumbered by surgeons on the RUC committee. We also have an opportunity to 

29provide input on ongoing communications from the committees. Proceedings of the CPT and RUC 

30committees are confidential. 

31 


33In January and February 2008, ANA staff attended quarterly meetings of the American Medical 

34Association’s two committees that review Medicare coding and reimbursement issues for outpatient 

35services of physicians – which also apply to APRNs, CNSs, and sometimes CNMs. Nurse staffing costs 

36are also a factor in the “practice expense” component of the reimbursement formula. The Current 

37Procedural Technology (CPT) committee establishes and revises codes for procedures and services. 

38The Relative Value Update Committee (RUC) calculates the relative costs of one procedure versus 

39another. 

40 

41The ANA is an official observer to these proceedings. It also represents the entire nursing profession – 

42and is the only nursing member – on advisory committees of non-physician health care providers (the 

43Health Care Professionals Advisory Committees). In addition, our RUC representative (Katherine 

44Bradley, PhD, RN) is appointed to several subcommittees and working groups that play a crucial role in 

45this process. 

46 

1 

2 



1Debate of specific issues of both CPT and RUC are confidential, and are subject to the approval of the 

2Centers for Medicare and Medicaid Services (CMS). ANA is also involved in providing ongoing input 

3into issues that arise on upcoming proceedings. 

4 

5CMS staff are seeking input into the Medicare Medical Home Demonstration Project, under which 

6board-certified physicians’ direct care for complex Medicare patients with chronic illnesses. While at 

7this time, APRNs are not included as possible “medical homes,” our ANA RUC representative is 

8seeking to get involved in the RUC component of this project, in the hopes of educating others about the 

9need to include APRNs as future possible “medical homes.” There is also a developing effort within the 

10psychotherapy community to improve reimbursement for psychotherapy services – including those 

11provided by NPs and other nurses – and the ANA’s RUC representative and staff plan to take part in that 

12developing initiative. In addition, ANA staff are working to identify individuals within the APRN 

13community to serve as support and guidance for future reimbursement issues. 

14 


16ANA staff attended the RUC April 2008 quarterly meeting, along with Katherine Bradley, PhD, RN. On 

17several occasions, Katherine spoke -- or was asked to address – the viewpoint of APRNs and staff nurses 

18on various issues. ANA had an opportunity to share our strong support for the inclusion of APRNs in 

19the medical home concept, particularly in the meeting of the subgroup of medical specialties/primary 

20care providers, and in discussions with MedPAC staff who were attending the RUC meeting. 

21 

22The AMA has publicly announced the RUC’s decision to support the Medicare medical home 

23demonstration project, stating that “[t]he support of the full RUC is a testament to the willingness of 

24physicians from all specialties to support the evolution of primary care, and to help primary care 

25physicians provide comprehensive and coordinated patient centered medical care.” 

26 

27ANA also had an opportunity to meet with representatives from several organizations representing 

28psychiatrists, psychologists, and social workers, to start developing a strategy for correcting imbalances 

29in the reimbursement for psychotherapy codes. This will be an ongoing process, with further details to 

30come. 

31 

32The AMA House of Delegates plans to consider resolutions that would place limits on nursing 

33education and practice, at is meeting June 14-18. Resolution 214, "Doctor of Nursing Practice," would 

34require physician supervision for DNPs. Resolution 303 (subsequently renumbered 232), "Protection of 

35the Titles 'Doctor,' 'Resident' and 'Residency,'" would limit the use of these terms to physicians, dentists 

36and podiatrists. Resolution 716, "AMA Model Agreement with Advanced Practice Nurse Clinicians, 

37Nurse Practitioners and/or Clinical Nurse Specialists," recommends that such agreements address 

38"quality of care, continuity of care, and scope of practice" of Advance Practice Registered Nurses. 

39 

40While these resolutions are policy statements, they set the agenda for state medical associations as well 

41as the AMA itself, to advocate for state and federal action. The AMA Board of Trustees also issued 

42Report 27, "Nursing Shortage Leadership for Patient Safety; Reducing the Hospital Registered Nurse 

43Shortage at the Bedside," which calls for physicians to lead the effort to reduce the nursing shortage. 


45rejection of Resolutions 214 and 303. We provided copies of these letters to the CMAs, organizational 

46affiliates, and the Coalition for Patients Rights. We strongly encouraged our fellow organizations to 

47submit comments to the AMA as well, and have heard back from several who did so. GOVA staff are 

1 

2 



1attending the AMA HOD as official observers, and will monitor the progress of these 

2resolutions, present verbal comments when appropriate, and report back on these and other actions that 

3affect the nursing community. 

4 


6GOVA staff attended the AMA House of Delegates meeting on June 14-18, where three resolutions 

7were adopted which seek to limit nursing education and practice. Resolution 214, "Doctor of Nursing 

8Practice," would require physician supervision for DNPs. Resolution 303 (subsequently renumbered 

9232), "Protection of the Titles 'Doctor,' 'Resident' and 'Residency,'" would limit the use of these terms to 

10physicians, dentists and podiatrists. Resolution 716, "AMA Model Agreement with Advanced Practice 

11Nurse Clinicians, Nurse Practitioners and/or Clinical Nurse Specialists," recommends that such 

12agreements address "quality of care, continuity of care, and scope of practice" of Advance Practice 

13Registered Nurses. 

14 


16rejection of Resolutions 214 and 303, as did several fellow nursing organizations and CMAs. While 

17these resolutions are policy statements, they set the agenda for state medical associations as well as the 

18AMA itself, to advocate for state and federal action. Also at the June AMA meeting, the AMA Board of 

19Trustees issued Report 27, "Nursing Shortage Leadership for Patient Safety; Reducing the Hospital 

20Registered Nurse Shortage at the Bedside," calling for physicians to lead the effort to reduce the nursing 

21shortage. 

22 

23On November 8-11, GOVA staff attended the AMA’s interim House of Delegates meeting. Nancy 

24Nielsen, MD, PhD, the new AMA president, set a new tone, by urging AMA members to embrace 

25“fundamental change – for ourselves, for our patients, and for our nation.” When we met Dr. Nielsen, 

26she expressed interest in working together with other health care providers toward healthcare reform 

27(and noted that her son is a nurse). 

28 

29At the November meeting, the AMA HOD voted to refer Resolution 211, “Limiting the Number of 

30Nurse Practitioners,” for report back at the next meeting. Res. 211 seeks to limit the number of nurse 

31practitioners supervised by a physician to a level which maintains “good quality medical care.” The 

32Council on Legislation noted that the AMA Advocacy Center had mapped the distribution of NPs as the 

33same as that of MDs. AMA members supported the general concept – and objected to NPs practicing 

34independently – but many believed this was an issue best left to the states and/or further study. 

35 

36Resolution 212, “State Legislative Response to NBME Practice of Using USMLE Step 3 Physician 

37Licensing Exam Questions for Doctors of Nursing Practice Certification,” was adopted with 

38amendments. So “that no person is misled that the training of allied health professionals through 

39programs or certification is equivalent to the education, skills and training of physicians,” this calls for 

40model state legislation prohibiting the use of NBME (National Board of Medical Examiners) and 

41NBOME ( National Board of Osteopathic Medicine Examiners) exam questions in certification exams 

42for DNPs and other non-physician providers. In committee, two dozen AMA members expressed 

43support for the resolution’s main idea, many on behalf of their state, specialty society, or AMA section. 

44Resolution 846, “Clarification of the Title ‘Doctor’ In the Hospital Environment,” was adopted. This 

45time around AMA members acknowledged that PhD’s, etc., are considered “doctors” in academia, thus 

46the use of “hospital environment.” The resolution calls for working with Joint Commission to 

47implement this policy. 

48 

1 

2 



1As noted in greater detail in the section about APRNs and Medical Homes, the AMA HOD also adopted 

2Resolution 804, which defines a medical home as led by a physician. The AMA will hold its 2009 

3annual meeting next June. 

4 

5 

6One Strong Voice: Nurses Making a Difference Together (Partnership Plan) 

7 

8Background: 

9The ANA Partnership Plan is designed as a ten year plan, divided into two year foci. The overall goal of 

10this plan is to strengthen both ANA and the CMAs to ensure our overall stability and future growth. The 

11ANA portion of the ANA dues escalator passed in 2004 at the ANA HOD has been utilized to fund the 

12Partnership Plan. The current focus for 2007-2008 is on membership growth and financial stability for 

13the CMAs, as well as ANA, with the following objectives: 

14 

15 

Strengthen the ANA/CMA connection and the affinity to each other to ensure all are stronger 

member organizations that have a proven value to our members. 

16 

17 

Grow all categories of membership and ensure a variety of ways for individuals and 

organizations to participate in the CMAs and ANA. 

18 Strengthen and optimize ANA and the CMAs as associations and businesses. 

19 

20 

Increase communication about ANA’s Programs and initiatives to ensure national leadership, 

presence, and relevance to the CMAs and the profession. 

21 

22 

Prepare the CMAs and ANA to anticipate, identify, and strategically respond to internal and 

external threats. 

23 


25Membership: 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

42 

43 

44 

45 

46 

47 

48 

ANA’s Online Social Network: ANANurseSpace has been growing, with over 630 members 

logging on. Most continue to be observers, rather than active participants, but the number of 

participants is growing rapidly. The most popular discussion thus far is on the ANA video, 

which was created in 2007, but just posted on ANANurseSpace. Public Health Nursing, Nurse 

Entrepreneurs and Mental Health/Psych are currently the most active communities. 

ANANurseSpace was upgraded to a new and more advanced platform, with additional features, 

in early March 2008. 

The first Wrap for The American Nurse (TAN) 2008 in 2008 will feature ANA’s new Safe 

Staffing Saves Lives Web site. 

ANA continues to solicit member statements and pictures which are featured in the Members 

Only section. This feature will continue to grow. 

ANA hosted the 9 th annual Executive Enterprise Conference titled Journey to the Wild: Going 

Innovative, held January 7-11, 2008 in Orlando, FL. The Executive Enterprise Conference is 

designed for the executive directors and chief executive officers (EDs) for ANA’s Constituent 

Member Associations. This meeting provides the EDs with a professional development 

opportunity where they discuss business best practices, ask critical questions about business 

implementation and identify new resources available, in order to provide the best service 

possible to their leaders and members, and maximize the performance of the associations. 

In the first quarter of 2008 CMAs have used a number of ANA Drop-In Articles for CMA 

1 

2 



1 

2 

3 

4Operations Support for CMAs: 

 

 

 

 

newsletters, circulating to an audience of just under 500,000 nurses and nursing students in the 

first quarter of 2008. 

5 

6 

7 

8 

9 

10 

11 

12 


14Membership: 

 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 

32 

33 

34 

35 

36 

37 

38 

39 

40 

41 

ANA, working with a CMA selection team, selected Meeting Expectations, of Atlanta, GA, 

to work with ANA to provide discounted association management services to CMAs. ANA 

held two calls to introduce Meeting Expectations to the CMAs and allow questions about the 

broad range of available services. 

ANA provided a bulk purchasing option for CMAs that use Lexis Nexis, offering the CMAs 

significant discounts. 

ANA provided all 54 CMAs with lists of student nurses in their state who are preparing to 

graduate this semester. This contact information was received by ANA making the Members 

Only section of ANA’s website accessible to student nurses, and included a total of over 12,000 

individuals. 

ANA was a sponsor and exhibitor at the spring 2008 National Student Nurses Association 

conference. 

ANA’s Online Social Network: ANANurseSpace 

o Over 2,500 people have logged onto the site. 

o Participants have created more than 25 interest groups with a wide variety of foci, as well 

as continuing to contribute blogs, discussions, photos and journal entries to connect with 

other nurses within the community. 

o The most popular discussions currently are titled “Public health nursing as a profession” 

and “Certification – what does it do?” 

The March/April 2008 TAN wrap focused on ANA’s Campaign to Promote Patient Safety and 

Quality Care. The purpose of the TAN Wrap was to raise awareness for safe staffing legislation 

and included research on patient outcomes, as well as what nurses can do to get involved and 

ensure that safe staffing legislation becomes a national reality. 

In the second quarter of 2008, CMA used ANA drop in articles and information as follows: 

o 12 CMAs used 1-2 ANA articles, circulated to 665,900 nurses 



o 3 CMAs used 7 + ANA articles, circulated to 403,100 nurses 

42 

43Leadership Tools: ANA provided New CMA President and New CMA Executive Director Orientation 

44 Manuals online to orient CMA leaders to the structure and programmatic work of ANA as well 

45 as resources available to CMAs. 

46 

47Teleconferences for CMAs: During the second quarter of 2008 ANA offered: 

48 CMA Programmatic Call: Safe Staffing 

1 

2 



1 

2 

CMA Operations Call: Legal Issues Related to the Proposed Bylaws Amendments – For CMA 

Executive Directors and/or key legal staff 

3 CMA Operations Call: Foundations – For CMA Executive Directors and/or key foundation staff 

4 

5Operations Support for CMAs: ANA continued to promote CMAs connecting with Meeting 

6 Expectations for consultations regarding operational support. 

7 


9Membership 

Updated the ANA join pages to be more visually attractive and useful. Prospective members 

can now see the different types of membership, their exact rates by state and the benefits of each 

membership type. In addition, the “join” process is fully integrated with the membership 

system, allowing individuals to have access to Members Only immediately and streamlining 

back of the house efforts. 

10 

11 

12 

13 

14 

15 

16 

17 

ANA’s Online Social Network: ANANurseSpace has had over 4,500 people have logged onto 

the site and continues to add blogs, groups and polls to enhance the participant’s experience. 

18 

19Teleconferences for CMAs 

20During the third and fourth quarters of 2008 ANA offered: 

CMA Programmatic Calls: 

o ANA's Endorsement of Sen. Barack Obama 

o Nursing Practice Network 

o Feedback on Proposed Changes to the ANCC Accreditation Manual 

21 

22 

23 

24 

25 

26 

27 

28 

29 

CMA Operations Calls: 

o CMA Environmental Scanning 

o Using ANANurseSpace to Engage Members 

o Membership – Central Billing (December) 

30 

31Other Tools and Information 

32 ANA provided a LexisNexis National Discount Plan for eight CMAs in 2008. 

33 

34 

New ED Orientation was held for four new CMA executive directors and three key staff, just 

prior to the November Constituent Assembly. 

35 

36 

37 

ANA also sought feedback on the proposed 2009-2010 Partnership Plan, including a listening 

session and survey and elicited numerous comments to ensure that the third version of the plan 

will be as responsive as possible to the CMAs. 

38 

39Nurse Competence in Aging 

40 

41Background: 

42Begun in September 2002, Nurse Competence in Aging (NCA) is a five-year initiative funded by The 

43Atlantic Philanthropies (USA) Inc., awarded to the American Nurses Association (ANA) through the 

44American Nurses Foundation (ANF), and represents a strategic alliance between the ANA, the 

45American Nurses Credentialing Center (ANCC) and the John A. Hartford Foundation Institute for 

46Geriatric Nursing, New York University College of Nursing. Designed to promote best practices in 

47geriatric care that yield positive outcomes for older adults, NCA has three components: 1) Enhancing 

48geriatric activities of national specialty nursing associations by awarding grants and providing technical 

1 

2 



1assistance. Recipients are designated ANA-SNAPGs (ANA-Specialty Nursing Association Partners in 

2Geriatrics); 2) Providing a Web-based comprehensive geriatric nursing resource center; and 3) 

3Promoting gerontological nursing certification. 

4 

5NCA has as one of its goals the promotion of geriatric activities for national specialty nursing 

6organizations. The completed NCA funding cycle resulted in five grantee cohorts, comprised of 55 

7national specialty nursing associations in geriatrics (ANA-SNAPGs) and related healthcare 

8organizations, and representing 430,000 members (not including ANA’s membership of 150,000), 

9having received 60 ANA-SNAPG and Technical Assistance grants totaling $672,570. The final grants 

10were completed in May 2007. Official NCA programmatic activities ended in September 2007. A final 

11report was submitted for this phase of the work to Atlantic Philanthropies in December 2007. 

12 


14Since the official completion of the first phase of the grant, ANA has been actively working to reformat 

15and rebuild geronurseonline.org. This site is due to be relaunched at the beginning of March. While it 

16will not have the topic content areas, it will continue to provide much needed resources and information 

17for geriatric nursing certification and geriatric resources for nurses. Efforts continue to find content 

18experts who would be willing to produce topical content relevant to the care of older adults. 

19 

20ANA still has at its goal to seek further funding to continue to develop a virtual Center for the Care of 

21Older Adults at ANA. Atlantic Philanthropies has been in the process of restructuring its organization 

22efforts and was unwilling to address further funding until this had been accomplished. ANA at this time 

23has upcoming appointments with both AP and the Hartford Foundation to discuss further funding of 

24such work. 

25 

26In conversation with The Hartford Foundation the week of February 26, 2008, the program officer 

27indicated that there would be interest in either jointly funding ANA’s work on Nurse Competence in 

28Aging in conjunction with The Atlantic Philanthropies, or in funding separately. He indicated that this 

29might take six to twelve months on Hartford Foundations part, since ANA hasn’t been a previous 

30grantee, and the Hartford Foundation would need to create a placeholder in their process for ANA as a 

31new grantee. We also discussed ANA’s efforts on quality, NDNQI and relevance to older adults. The 

32Hartford Foundation does have interest in this aspect of improving care and this could be a second 

33possible way to consider new funding. 

34 


36As a result of its work, ANA was invited to participate in a “Multi-Stakeholder Meeting to Explore the 

37Formation of a National Alliance to Improve Care for Older Adults” sponsored by the Meridian 

38Institute, who is interested in fostering the implementation of recommendations identified by the 

39Institute of Medicine Report, Retooling for an Aging America: Building the Healthcare Workforce. Also 

40at the table were major funders, The Atlantic Philanthropy and the Hartford Foundation. Goals of the 

41potential alliance are in concert with ANA’s interests in caring for older adults, including policy issues 

42related to increasing access to care. The participants indicated a strong interest in moving forward to 

43form such an alliance and are expected to come together again during the next two months to have 

44further discussions. 

45 

46Conversations continue with the Atlantic Philanthropies and the Hartford Foundation regarding future 

47funding. Both of these Foundations are now in the process of reconsidering their overall strategic 

48priorities. Although they are not in a position to accept new proposals at this time, ANA remains in 

1 

2 



1close contact with them. ANA is an active member of several coalitions (which include the Atlantic 

2Philanthropies and the Hartford Foundation) around caring for older adults. As an interim step, ANA is 

3also exploring new initiatives with the Meridian Institute. 

4 

5ANA has contracted with a website technical expert so that the geronurseonline.org site emulates the 

6rest of the NursingWorld site while retaining its own identity. ANA has also revised content areas on 

7the site so that they more accurately represent ANA and ANCC activities regarding nursing care of older 

8adults. All of the revised or new pages have been brought into ANA’s content management system 

9which features distributed publishing for easy editing and updating. ANA has solicited geriatric nursing 

10clinical faculty and experts to provide specific topics. At a recent May 30th meeting of Clinical Nurse 

11Specialists community, several participants offered up their services to look at topic list and identify 

12areas which they would be willing to provide. 

13 


15ANA in early November relaunched the Geronurseonline.org website for use as a resource by nurses 

16seeking information regarding care of older adults, certification in gerontology, or knowledge of 

17advocacy related to care of aging Americans. ANA continues to participate in the coalition developed 

18by the Meridian Institute to implement the findings of the recent IOM report, Retooling for an Aging 

19America. ANA continues to have discussions with potential funders regarding this area of focus, 

20although funders acknowledge that with the economic downturn, they are limiting commitments at this 

21time. 

22 

23Tobacco Cessation 

24 

25Background: 

26ANA through the American Nurses Foundation has been involved for several years in dissemination of 

27smoking cessation quit line information and other materials related to smoking cessation. ANA was 

28recently asked to endorse the latest U. S. Public Health Service Clinical Practice Guideline Update:- 

29Treating Tobacco Use and Dependence which were formally released on May 7, 2008. ANA was 

30represented along with 57 other organizations at the release of these guidelines at the American Medical 

31Association Headquarters in Chicago. ANA plans to post access to the guidelines and related 

32information now available from the new campaign on Smoking Cessation by the American Legacy 

33Foundation on www.nursingworld.org. 

34 


36ANA has been involved in addressing the issue of smoking cessation for several years, primarily 

37through grant funding received by the American Nurses Foundation. While funding for that work is no 

38longer available, ANA continues to provide limited information regarding quit lines and other 

39resources to assist nurses in supporting patients who are willing to quit smoking, or to eliminate their 

40own smoking habits. 

41 


43ANA is publicizing a new UCLA School of Nursing study which reveals the devastating consequences 

44of smoking on the nursing profession. Published in the November–December edition of the journal 

45Nursing Research, the findings describe smoking trends and death rates among U.S. nurses and 

46emphasize the importance of supporting smoking cessation programs in the nursing field. In this same 

47communication, ANA is underscoring its work on this issue through its support of Tobacco Free Nurses 

48and directing readers to the helpful resources available thru NursingWorld.org. 

1 

2 



1 

2Procedural Sedation 

3 

4Background: 

5The Emergency Nurses Association (ENA) has been involved with several state councils regarding 

6procedural sedation in the emergency care setting and related regulatory decisions being debated within 

7State Boards of Nursing. The primary goal in procedural sedation is the safe delivery of sedative and 

8analgesic medications for the purpose of patient comfort during potentially painful procedures. ENA 

9recognized that there are variations in organizational positions regarding this issue in the emergency 

10care setting and invited stakeholders to meet to develop consensus for evidence-based and safe patient 

11practice in the emergency care setting and provide clarity and recommendation for State Boards of 

12Nursing. Stakeholders included the Agency for Healthcare Research and Quality (AHRQ), Air & 

13Surface Transport Nurses Association (ASTNA), American Academy of Emergency Medicine (AAEM), 

14American Association of Critical Care Nurses (AACN), American Association of Nurse Anesthetists 

15(AANA), American College of Emergency Physicians (ACEP), American Nurses Association (ANA), 

16American Organization of Nurse Executives (AONE), American Radiological Nurses Association 

17(ARNA), American Society for Pain Management (ASPMN), Emergency Nurses Association (ENA), 

18National Association of Children’s Hospitals and Related Institutions (NACHRI), National Council of 

19State Boards of Nursing (NCSBN), Society of Critical Care Medicine (SCCM), The Joint Commission 

20(TJC) and the American Hospital Association (AHA). Stakeholders convened and a draft statement was 

21created and revised which included CNPE input. The final consensus statement focus by ENA is 

22procedural sedation in the emergency care setting. The statement was approved by the CNPE and 

23advanced to the BOD in January 2008 for endorsement. 

24 


26The ENA Procedural Sedation Consensus statement was reviewed by the BOD in January. Further 

27questions remained regarding the use of propofol. The statement was returned to the CNPE for further 

28discussion. At the face-to-face CNPE meeting in February, members presented their concerns as well as 

29support of the consensus statement with the final outcome being that the CNPE re-affirmed its 

30recommendation to endorse the statement and re-sending it to the BOD for ANA endorsement at the 

31March meeting. The ENA convened stakeholders that endorsed the final statement include: 

32 • Air & Surface Transport Nurses Association (ASTNA) 

33 • American Academy of Emergency Medicine (AAEM) 

34 • American Association of Critical Care Nurses (AACN) 

35 • American College of Emergency Physicians (ACEP) 

36 • American Radiological Nurses Association (ARNA) 

37 • American Society for Pain Management (ASPMN) 

38 • Emergency Nurses Association (ENA) 

39 • National Association of Children’s Hospitals and Related Institutions (NACHRI) 

40 


42The ANA Board of Directors at its March meeting once again reviewed the recommendation of the 

43Congress of Nursing Practice and Economics to endorse this position statement. The ANA Board voted 

44to endorse it. This concludes this activity. 

45 

46Member Benefits 

47 

48Background: 

1 

2 



1ANA offers a variety of member benefit programs to its members including Professional Liability 

2Insurance through Marsh Insurance. ANA works to ensure customer satisfaction with current programs 

3and adds new programs as appropriate. 

4 


6In early April, ANA will introduce a new member benefit offering discounts on wireless phones. The 

7online center will offer wireless plans from a variety of mobile companies such as Verizon, T-Mobile, 

8AT&T and other major companies. The phone purchase accompanying a new plan sign up will be 

9discounted below the current retail rate. ANA will earn revenue on every new wireless plan opened, 

10plan renewal, and accessories. 

11 



14 


16ANA will be introducing a discount from Elite Island Resorts to members in December. Members will 

17be able to get a discount of 50% off published rates at specific resorts on many islands in the Caribbean. 

18Members can qualify for a discount of 60% off rates if it can be booked two weeks in advance or less. 

19 

20A special promotion at 20% off (regularly 10% off) was recently announced from Lands’ End to 

21promote holiday shopping. The special offer is available until Jan. 31, 2009. 

22 

23ANA recently conducted focus groups at the 2008 Magnet Conference in Salt Lake City in Oct., 2008 

24among members and non-members in order to ascertain what types of products and/or services nurses 

25would be interested in from a professional and personal standpoint. Staff will be meeting to discuss 

26which ideas have potential as successful member benefits. Finally, the Nov/Dec edition of TAN will 

27have a cover wrap promoting all ANA member benefits. 

28 

29Members and customers voted on their favorite National Nurses Week theme. The theme for 2008 was 

30chosen – it will be “Nurses Building a Health America.” ANA is currently asking members and 

31customers to vote on the logo. Final results will be available at the December 2008 meeting. 

32 

33External Relationships 

34 

35Tri-Council 

36Background: 

37The Tri-Council is an alliance of four nursing organizations focused on leadership for education, 

38practice, and research. These four organizations are the American Association of Colleges of Nursing 

39(AACN), the American Nurses Association (ANA), the American Organization of Nurse Executives 

40(AONE), and the National League for Nursing (NLN). Together these organizations represent the 

41broadest spectrum of nursing roles and functions. 

42 


44The American Nurses Association (ANA) is hosting the meetings for 2008. The first Tri-Council 

45conference call was held on January 23, 2008 for the purpose of developing the agenda for the February 

4622, 2008 Winter Meeting. 

47 

48The agenda for the meeting included an update by the American Association of Colleges of Nursing’s 

1 

2 



1(AACN) Executive Director on the status of the meta-analysis on the use of APRN in this society to 

2provide affordable, more accessible, high quality care. The report will be completed before year end. 

3 

4The Government Affairs Staff of the four organizations joined the group for a discussion on 2008 

5Appropriations and Reauthorization of Title VIII funding. All four organizations have signed on to a 

6consensus document going to Senator Barbara Mikulski on Title VIII Reauthorization. 

7 

8The final discussion of the day addressed the need for increased nursing presence in the new 

9administration. To that end, we will talk with individuals who can advise us about which positions 

10should be targeted for nurses, and the Tri-Council will identify a bipartisan list of RNs qualified for 

11these positions. 

12 

13The meeting and conference call dates for the rest of 2008 have been established and they are: 

14 

15Conference Calls 

16March 5, 2008 (EDs/CEOs) 

17April 2, 2008 (EDs/CEOs) 

18May 7, 2008 (to include Presidents and Presidents Elect) 

19June 4, 2008 (EDs/CEOs) 

20July 2, 2008 (EDs/CEOs) 

21August 6, 2008 (to include Presidents and Presidents Elect) 

22September 3, 2008 (EDs/CEOs) 

23October 1, 2008 (EDs/CEOs) 

24November 5, 2008 (EDs/CEOs) 

25December 3, 2008 (EDs/CEOs) 

26 

27Face-to-Face Meetings 

28February 21-22, 2008 

29May 22-23, 2008 

30September 11-12, 2008 

31 


33ANA hosted the second in-person meeting of the Tri-Council for Nursing on May 23, 2008. The agenda 

34included: an overview of current work and priorities from each organization; concerns relating to 

35unlicensed personnel in health care; the importance of ensuring nursing’s presence on federally 

36appointed posts and task forces; and updates from the Government Affairs Staff of the four 

37organizations on the status of Nursing Workforce Development Funding, a letter recently sent to the 

38Secretary of the Health and Human Services Department requesting promotion of the current Chief 

39Nursing Officer to two-stars, and an update on recent communications from the campaign to create an 

40Office of the National Nurse. 

41 

42Government Affairs staff also took part in the in-depth discussion on how to position nurses for 

43appointment to posts within the federal government under a new Presidential Administration. Virginia 

44Trotter Betts, MSN, JD, RN, FAAN, Shirley Chater, PhD, RN, FAAN and Mary Wakefield, PhD, RN, 

45FAAN, all of whom served as appointees in past administrations joined the meeting by phone to offer 

46their valuable experiences and insights. All agreed on the importance of nursing presence in a new 

47administration, and the Tri-Council agreed to gather information and work to identify a bipartisan list of 

48RNs who might be interested in and qualified for these positions. 

1 

2 



1 

2The Tri-Council will have conference calls July 2, August 6, and September 3, with the next face-to-face 

3meeting scheduled for September 11-12, 2008. At these monthly conference calls, the agenda will be to 

4continue the work on a bipartisan list of RNs for possible appointment in the new administration. Also, 

5Ms. Terri Mills will be part of the July 2 conference call. Tri-Council will inform her of the Tri- 

6Council’s position on the Office of the National Nurse. 

7 


9On July 2, the Tri-Council convened via conference call with Ms. Terri Mills to inform her of the Tri- 

10Council’s non-support position on the Office of the National Nurse. A Tri-Council letter restating the 

11position of the Tri-Council was also sent to Ms. Mills as well as sent via the Nursing Organization 

12Alliance (NOA) Listserv to other national nursing organizations to make the Tri-Council’s position 

13known within the larger nursing community. 

14 

15A conference call on August 6 of the Tri-Council planned the agenda for the September 12 meeting. 

16AONE requested to bring one of the nursing fellows assigned to their office to the September meeting; 

17after discussion about the pros and cons, it was agreed the fellow could attend. 

18 

19ANA hosted the third and final in-person meeting in 2008 of the Tri-Council for Nursing on September 

2012 th . In keeping with our annual practice for the past four years, NCSBN staff and elected leadership 

21joined us for the morning. This agenda addressed: What NCSBN has funded thus far, share outcomes 

22of research agenda, NCSBN’s future funding plans, what were NCSBN’s most important issues at their 

23annual meeting, NCSBN’s mission and vision for their future. Each of the Tri-council organizations 

24also provided the same information for each of their organizations. 

25The afternoon agenda included: APRN Feedback & Analysis, Nursing Intensity Weights, Office of the 

26National Nurse, Feedback on Congress and Update on Legislature, Federal Appointments, Update on 

27Appropriations, BSN Statement, LPNs, and NCSBN Follow-up. 

28 

29Government affairs staff also took part in our continued conversation on how to successfully insure 

30appointment of nurses to posts within the federal government under the new Presidential 

31Administration. The Tri-Council unanimously indicated support for Dr. Mary Wakefield. AACN 

32volunteered to follow-up with Mary to determine what positions have the most interest for her in a new 

33administration. 

34 

35On October 1, 2008 a Tri-Council conference was held. All Tri-Council organizations were represented 

36except AONE. Discussions continued around strong bipartisan candidates who would be strong 

37prospects for appointment. Mary Wakefield continues to be the leading nurse candidate for a 

38democratic administration, while Ada Sue Hinshaw and Colleen Conway Welch were suggested as 

39possibilities in a republican administration. Tri-Council members volunteered to follow up with these 

40prospective appointees to ascertain their interests. 

41 

42On December 3, ANA hosted its final conference call of the year with Tri-council participants. All 

43organizations were represented. ANA will be drafting a Tri-council letter of support for Dr. Mary 

44Wakefield to be appointed as the Director of HRSA. This will be shared with the Obama transition team 

45and appropriate supporters in congress. Three other nurse candidates were also discussed. Follow up 

46will occur to see specifically what appointments/positions these candidates are interested in and how 

47much support they have within congress and/or the new administration. By email it will then be 

48determined if there is Tri-council support for any other candidate than Dr. Mary Wakefield. 

1 

2 



1 

2NLN will be hosting the 2009 meetings of Tri-Council. The first in person meeting is not until March 

318. Concern was expressed regarding the need for Tri-Council to be proactive with the new 

4administration. All Tri-Council members will be on all conference calls for the first six months of 

52009. The calendar will reflect this change. 

6 

7 

8 

9 

10 

11American Public Health Association (APHA) – Governing Council 

12 

13Background: 

14The American Public Health Association (APHA) is the oldest and largest organization of public health 

15professionals in the world, representing more than 50,000 members from over 50 occupations of public 

16health. APHA brings together researchers, health service providers, administrators, teachers, and other 

17health workers in a unique, multidisciplinary environment of professional exchange, study, and action. 

18APHA is concerned with a broad set of issues affecting personal and environmental health, including 

19federal and state funding for health programs, pollution control, programs and policies related to 

20chronic and infectious diseases, a smoke-free society, and professional education in public health. 

21 


23The Governing Council, which consists of voting and nonvoting members, met by conference call (in 

24which ANA participated) primarily to consider revisions to the association’s bylaws. The 19 

25amendments (paragraphs): to bring the APHA Action, Science, Education, Editorial and Publications Boards 

26into alignment with current practice; add a chair-elect; and recognize access to experts; give the Action 

27Board Representative a vote on one’s Section Council; and replace the reference to the former Program 

28Development Board with the Science Board; gives the Committee on Affiliates Action Board 

29Representatives a vote; and, correct the Student Assembly term to 1 year were considered. Once passed, 

30they will be incorporated into the combined Constitution and Bylaws which will be presented at the 

31November meeting. 

32 

33ANA staff serves on the APHA Governing Council which recently adopted the following new policies: 

34 • A3: Call for Education and Research into Vitamin D Deficiency/Insufficiency 

35 • LBA1: Food Crisis; Addressing the Current Crisis and Preventing the Next One 

36 • LBA2: Maintaining and Enforcing Age 21 as Legal Drinking Age 

37 • B3: Discouraging Smoking in Feature Films to Avoid Influencing Smoking 

38 • B4: Calling for a Global Ban on Lead Use in Residential Indoor and Outdoor Paints, Children’s 

39 Products, and all Nonessential Uses in Consumer Products 

40 • LBB1: Reducing the Burden of Poor Health and Health Inequalities Through Transportation 

41 and Land Use Policies 

42 • C1: The Need for State Legislation Protecting and Enhancing Women’s Ability to Obtain Safe, 

43 Legal Abortion Services without Delay or Government Interference 

44 • C3: Opposition to Prophylactic Removal of Third Molars (Wisdom Teeth) 

45 • LBC1: Access for Critical Medical Care for Gaza Residents 

46 D1: Patient’s Rights to Self-Determination at the End of Life 

1 

2 



1 • D2: Community Water Fluoridation in the U.S. 

2 • D3: Promoting Inter-professional Education 

3 • D4: Strengthening Health Systems in Developing Countries 

4 

5In addition, three (3) substantive proposed amendments to the APHA Bylaws were adopted. The 

6proposals, which took effect October 28, 2008, are: 

7 

8 

9 

10 

11 

• To modify the Bylaws on APHA Vice-Presidents to allow for three Honorary Vice President 

positions which are elected annually by the Governing Council. An important role for an 

Honorary Vice President is to collaborate with the Association leadership in promoting public 

health in the represented countries (the U.S., Canada and Latin America and the Caribbean) 

(97%/3%). 

To change the position of the APHA Speaker of the Council from non-voting to voting on the 

12 

13 

14Executive Board (88%/12%). 

15To clarify that a Section proxy must be from the respective Section (98%/2%). 

16To add the Chair of an eligible Caucus as determined by the Executive Board is an ex officio 

17member of the Governing Council without a vote (84%/16%). An amendment to postpone 

18discussion until the November, 2009 meeting of the Governing Council was defeated. 

19 

20The Governing Council also elected Carmen Rita Nevarez, MPH as President-Elect. Finally, on the first 

21round of voting, Social Justice: Public Health Imperative was selected as the theme for the 2010 meeting 

22in Denver, Colorado). 

23 

24Quad Council of Public Health Nursing Organizations (Quad Council) 

25 

26Background: 

27The Quad council of Public Health Nursing Organizations (Quad Council) consists of nursing 

28organizations, or organizations which have as a segment of their organization, a clearly defined sub-unit 

29in promoting public health/community health nursing. The members of the organization are the 

30Association of State and Territorial Directors of Nursing, the American Nurses Association Congress on 

31Nursing Practice and Economics, the Association of Community Health Nurse Educators, and the 

32American Public Health Association Public Health Nursing Section. The purpose of the Quad Council 

33is to: 

34 

35 

• Provide regular meetings for exchange of information about current and projected activities in 

each organization. 

36 

37 

• Provide a forum for developing ideas about issues and the education of nurses relevant to the 

practice of public health nursing. 

38 

39 

• Stimulate synergistic interactions promoting public health nursing and the health of the public 

through collaboration that builds on the strengths of the participating organizations. 

40 

41 

• Promote collaboration in the programs and activities of the participating organizations by leaders 

and members of each organization. 

42 

43 

44 

• Identify public health nurse experts to represent public health nursing on national and other 

committees concerned with public health and the education of nurses and to nominate for said 

positions. 

45 

46June 2008Update: 

1 

2 



1Activities of the Quad Council continue to center on engendering opposition to the Office of the 

2National Nurse Campaign and inclusion of population-focused concepts and practitioners within the 

3work of the APRN Consensus Panel is also of concern. Plans are developing for the annual Quad 

4Council Learning Institute which is held in conjunction with the American Public Health Association 

5Annual Meeting and Exposition. 

6 

7 


9Plans are developing for the annual Quad Council Learning Institute which is held in conjunction with 

10the American Public Health Association Annual Meeting and Exposition. 

11 


13 

14Background: 

15The Association of State and Territorial Directors of Nursing (ASTDN) began in 1935 as an advisory 

16group of state health department nurses. ASTDN continues today as an active association of public 

17health nursing leaders from across the United States and its territories. ASTDN is an affiliate of the 

18Association of State and Territorial Health Officials (ASTHO). ASTDN’s mission is to provide a 

19collegial forum to advance the public health nursing leadership role in protecting and promoting the 

20health of the public. Its vision is to foster healthy people in healthy communities through excellence in 

21public health nursing leadership. ASTDN values: 

22 • A universe where health is highly regarded 

23 • Optional pathways for achieving health 

24 • Universal access to health care 

25 • Prevention as the foundation for health promotion 

26 • An epidemiological base for decision-making 

27 • Cultural diversity 

28 • Community empowerment 

29 • Excellence in health services 

30 • Leadership as an essential public health skill 

31 


33From May 4 through 7, 2008, ANA was represented at the Annual Meeting of the Association of State 

34and Territorial Directors of Nursing (ASTDN): Achieving Health Equity: From Knowledge to Action in 

35Orlando, FL. During the meeting, presentations focused on emergency preparedness in particular 

36regarding vulnerable populations. Officers were elected for the next term. ASTDN presented a number 

37of awards. Finally, brief remarks were provided by the Acting Surgeon General in a surprise visit. 

38 


40There is no activity to report at this time. 

41 

42United States Pharmacopeia (USP) 

43 

44Background: 

45The United States Pharmacopeia (USP) is the official public standards-setting authority for all 

46prescription and over-the-counter medicines, dietary supplements, and other healthcare products 

1 

2 



1manufactured and sold in the United States. USP sets standards for the quality of these products and 

2works with healthcare providers to help them reach the standards. USP's standards are also recognized 

3and used in more than 130 countries. These standards have been helping to ensure good pharmaceutical 

4care for people throughout the world for more than 185 years. USP is an independent, science-based 

5public health organization. As a self-sustaining nonprofit organization, USP is funded through revenues 

6from the sale of products and services that help to ensure good pharmaceutical care. USP's contributions 

7to public health are enriched by the participation and oversight of volunteers representing pharmacy, 

8medicine, and other healthcare professions as well as academia, government, the pharmaceutical 

9industry, health plans, and consumer organizations. 

10 

11USP brought together Council of the Convention (CoC) association representatives of the three primary 

12healthcare disciplines: medicine (the American Medical Association); nursing (the American Nurses 

13Association); and, pharmacy (the American Pharmaceutical Association) as initial members of the 

14Quality of Patient Care (QPC) Section. ANA staff member Rita Munley Gallagher, PhD, RN has been 

15appointed to serve as Chair of QPC. 

16 


18The Council of the Convention (CoC) section chairpersons have been appointed by the USP Board of 

19Trustees. ANA staff member Rita Munley Gallagher, PhD, RN will serve as Chair of the Quality of 

20Patient Care Section. 

21 


23The Council of the Convention (CoC) is a conduit back to stakeholders for crafted valuing messages....a 

24meeting place between keeping ethylene glycol out of meds and providing information on the active 

25ingredients. The need for expansion of USP coupled with current financial reality presents challenges 

26for USP and the sections. Priorities must center on fostering USP's compendial work but consideration 

27must be given to the value of linkages to the practice of everyday clinicians and the needs of consumers. 

28It is critical that the practitioner-based membership of the convention understand and value the work of 

29USP. To facilitate this understanding the Board of Trustees empanelled the Council of the Convention 

30which has advanced the section concept which will see the membership organized around five themes: 

31 

32 • Quality of Manufactured Medicines (QMM) 

33 • Quality of Compounded Medicines (QPM) 

34 • Quality of Food Ingredients/Dietary Supplements (QFI/DS) 

35 • Quality of Patient Care (QPC) 

36 • Global Public Health (GPH) 

37 

38The QPC will be coordinating and communicating what USP is doing back to practitioners to heighten 

39their interest and involvement. In May, the chairs of all five sections traveled with a contingent of USP 

40executive staff and other elected leaders to Geneva, Switzerland to participate in the World Health 

41Professions Alliance (WHPA) Conference on Regulation: The Role and Future of Health Professions 

42Regulation. During the trip, the USP group visited the World Health Organization office and met with 

43leaders of the various member organizations of WHPA. Also participating in the regulation conference 

44were ANA Chief Executive Officer Linda J. Stierle, MSN, RN, CNAA,BC and ANA President 

45Rebecca M. Patton, MSN, RN, CNOR who had also participated in meetings of the National Nursing 

46Associations in membership to the International Council of Nurses (ICN) and the TRIAD. President 

47Patton also participated in the World Health Assembly (WHA). 

1 

2 



1 


3The Council of the Convention (CoC) will be coordinating and communicating what USP is doing back 

4to practitioners in the relevant sections to heighten their interest and involvement. CoC met in Kansas 

5City in late September in conjunction with the USP Annual Scientific meeting to further refine the 

6communication plan and develop preliminary plans for the section meeting to be held as a component of 

7the 2010 USP Quinquennial Meeting. The CoC meeting was centered on planning for the upcoming 

8Convention and the efforts needed to move fully to a sectionated convention. 

9 

10Health Resources and Services Administration (HRSA) Patient Safety and Pharmacy 

11Collaborative: Leadership Coordinating Council (LCC) 

12 

13Background: 

14The Center for Quality was established in the Health Resources and Services Administration (HRSA) 

15with the mission to strengthen and improve the quality of health care, especially as it relates to HRSA 

16programs and service populations. The Center for Quality (CQ) operates co-jointly with the Office of the 

17Chief Medical Officer (CMO). The Center conducts five primary functions: 1) coordinates quality 

18activities; 2) advises on medical and public health policy; 3) fosters and supports research; 4) promotes 

19public health programs; and 5) supports professional excellence. 

20 

21The HRSA Quality Strategy comes from Secretary Leavitt's goal to transform the health care system and 

22center on: 

23 

24 • Promoting clinical effectiveness 

25 • Patient safety 

26 • Health Literacy 

27 • Evidence-based methodologies 

28 

29The mission of the Center for Quality is to strengthen and improve the quality of health care, especially, 

30as it relates to HRSA programs and service populations. For HRSA, Quality health care means doing 

31the right thing, at the right time, in the right way, for the right person) and having the best possible 

32results. The goal of HRSA’s Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) is to 

33ensure that patient care delivered by safety-net organizations becomes the safest and best in the nation. 

34HRSA’s Collaborative will consist of teams of providers from multiple organizations who commit to 

35learning, testing, and implementing specific leading practices designed to improve: 

37 • patient safety; 

38 • effective use of clinical pharmacy services; and 

39 • patient health outcomes. 

40 

41The intention is to replicate these leading practices across HRSA-funded health care providers and their 

42partners using a collaborative model based on the methodology from the Institute for Health Care 

43Improvement. 

44 


46Approximately 60 leaders and staff from HRSA, from partnering federal agencies, and from national 

47leadership organizations (including ANA) attended the luncheon to hear from HRSA-funded programs 

1 

2 



1and other healthcare provider partners in the field who are generating exceptional results in the areas of 

2health care outcomes, pharmacy services, patient safety and health literacy. An overview of PSPC 

3activities from member organizations was provided. APhA is serving as a conduit between pharmacists 

4and the Collaborative. Their foundation has a toolkit for use by members. The rural pharmacists will 

5be hosting a conference. The Joint Commission is amplifying the Speak Up campaign. IHI is engaging 

6the nodes in the PSPC by informing them of ongoing activities. ANA will be providing collaborative 

7information utilizing its various communications strategies. 

8 



1 

2 



1 

STRATEGIC IMPERATIVE #5: ADVOCACY FOR WORKFORCE 

& WORKPLACE ISSUES 

2 

3 

4 

5Nurse Migration 

6 

7Background: 

8AcademyHealth, a non-partisan, scholarly society for health services researchers, policy analysts, and 

9practitioners, has launched an initiative to examine the growing practice of international nurse 

10recruitment that has emerged in response to the U.S. nurse shortage. This project seeks to reduce the 

11harm and increase the benefits of international nurse recruitment for source countries and to ensure that 

12the rights of migrants are considered throughout the recruitment process. This initiative is funded by the 

13MacArthur Foundation. AcademyHealth has convened the Task Force on the Ethical Recruitment of 

14Foreign Educated Nurses to advise them on this project. ANA is a member of the Task Force. 

15 


17The second meeting for the Task Force on the Ethical Recruitment of Foreign Educated Nurses was held 

18on January 16. Task Force members considered an initial draft of a “Code of Conduct” for the 

19international recruitment industry. It included laid out six ethical principles such as transparency, full 

20disclosure, fairness, etc with specific actions articulated under each principle. A revised draft is under 

21development in anticipation of the next meeting scheduled for March 12, 2008. 

22 


24A third meeting of the Task Force on the Ethical Recruitment of Foreign Educated Nurses was convened 

25to consider a final draft of the Voluntary Corporate Code of Ethical Conduct for the Recruitment of 

26Foreign Educated Nurses to the United States. The Task Force continued to improve the document and 

27believes that it is ready for endorsement by organizations. There was also significant discussion about 

28next steps toward the development of a mechanism for monitoring compliance with the Code for the 

29signatory organizations and companies. The Code is scheduled for public release in September 2008. 

30ANA is in the process of considering endorsing the document. 

31 


33ANA testified before the House Subcommittee on Immigration, Citizenship, Refugees, Border Security, 

34and International Law on addressing the nursing shortage through increased recruitment of foreign 

35educated nurses. ANA continues to stress that this is not a long term strategy to ending the nursing 

36shortage and that a substantial increase in investment is needed to build a sustainable nursing workforce. 

37 


39On September 4, CEO Stierle participated in a press conference to announce the development of the 

40Voluntary Corporate Code of Ethical Conduct for the Recruitment of Foreign Educated Nurses to the 

41United States. Other participants included representatives from labor, employers, recruiters and an 

42association that represents foreign educated nurses. Information is available at 

43www.fairinternationalrecruitment.org. 

44 


46ANA has been invited to participate in the next phase of this project as a member of the Stakeholder 

47Transition Group. This group will work to establish the governing entity for the monitoring of the 

1 

2 



1Code. 

2 

3Handle With Care Campaign 

4 

5Handle With Care ® Initiative 

6Background: 

7The Handle with Care ® initiative officially launched in September 2003 campaign mounted a 

8profession-wide effort to prevent back and other musculoskeletal injuries through greater education and 

9training, and increased use of assistive equipment and patient-handling devices. The campaign also 

10seeks to reshape nursing education and federal and state ergonomics policy by highlighting the ways 

11technology-oriented safe-patient handling benefits patients and the nursing workforce. The program has 

12expanded to include the following activities and initiatives: The Safe Patient Handling and Movement 

13School Curriculum Module, Annual Safe Patient Handling and Movement Conference and the 

14Veteran’s Administration Safe Patient Handling Imitative. 

15 



18 



21 


23ANA updated the Ergonomics/Handle with Care webpage of the ANA website. 

24 

25Safe Patient Handling and Movement Nursing School Curriculum Module 

26Background: 

27ANA received funding in 2004 from NIOSH to launch the Safe Patient Handling and Movement 

28Nursing School Curriculum pilot project. ANA partnered with the National Institute of Occupational 

29Safety and Health (NIOSH) and the Tampa Veterans Administration Patient Safety Center of Inquiry to 

30develop the curriculum and introduce safe patient handling and movement concepts in to the curriculum 

31of nursing schools. Twenty-six schools of nursing served as test sites and three served as control sites. 

32Invitations were extended to faculty to attend the 5th Safe Patient Handling and Movement Conference 

33(2005) as part of preparation to implement the curriculum which was developed as part of the grant. A 

34focused post- conference session prepared the nursing school faculty to implement the curriculum. The 

35project was initially planned to be completed within 24 months but due to delays of implementing the 

36test curriculum and to the timing of some of the test site programs, the project was been extended by 12 

37months. The project was completed in August 2007. Another phase of this project titled, “Diffusion and 

38Measurement of Impact of SPH&M Training”, has been approved internally at NIOSH for fiscal year 

392009 through fiscal year 2011 further addressing the National Occupational Research Agenda Health 

40Care And Social Assistance priority goal of reducing the risk of musculoskeletal disorders due to patient 

41handling for healthcare workers by widely diffusing and promoting state-of-the art, evidence-based safe 

42patient handling and movement training materials in schools of nursing. 

43 


45ANA has agreed to be a partner in the second phase of the school curriculum project and is awaiting 

46further details from NIOSH on the roll out of this project. 

47 


1 

2 



1No additional information to report at this time. 

2 


4ANA and its partners in this project received the NORA Partnering award for 2008. This is one of two 

5awards given in 2008. The award will be presented at the 2008 NORA Symposium in Denver, CO on 

6July 29th. Dr. Bonnie Rogers, Chair of the NORA Liaison Committee will be the presenter. ANA will 

7not be present to accept the award. 

8 


10ANA posted the Safe Patient and Handling and Movement Curriculum Toolkit on the ANA website. 

11There is no additional information about a second round of this project being funded by NIOSH at this 

12time. 

13 

148th Annual Safe Patient Handling and Movement Conference 

15Background: 

16Since 2000, an annual safe patient handling and movement conference hosted by the Department of 

17Veterans Affairs, James A. Haley Veterans Hospital, Patient Safety Center of Inquiry has been held to 

18provide participants with up to date information, feature best practices, display new technology 

19available and to present research findings related to safe patient handling and movement. ANA has been 

20a co-sponsor of the conference since 2003. 

21 


23The 8 th annual event is scheduled for March 10-14. ANA staff will be attending the conference 

24presenting sessions titled, “Registered Nurses Being a Change Agent for Safe Patient Handling” and 

25“The Legislative Route Pros and Cons” and facilitating a special interest group meeting for support with 

26safe patient handling programs in addition to moderating all beginner breakout sessions. Both ANA 

27Governmental Affairs and the Center of Occupational and Environmental Health staff are participating 

28and presenting. 

29 


31ANA attended the 8 th annual safe patient handling conference and participated as planned. ANA is 

32involved in the planning for the 9 th annual safe patient handling conference to be held March 31 – April 

332, 2009 in Lake Buena Vista, Florida. ANA will be presenting, “Handle with Care Update: ANA's 

34Journey in Safe Patient Handling “and “The State of the States” as well as co-sponsoring the conference. 

35 


37Plans are continuing on the upcoming 2009 SPH main conference on March 31 – April 2, 2009. ANA 

38President Rebecca Patton will be presenting opening remarks, a presentation entitled “”Handle with 

39Care: ANA Update,” and with COEH, will be conducting a special interest group with nurses. GOVA is 

40presenting a session entitled, “The Legislative Route: Pros and Cons”. 

41 

42Veterans Administration Safe Patient Handling Initiative 

43Background: 

44The Veterans Administration (VA) has funded a national safe patient handling initiative to develop a 

45“toolkit” to make it easier for a hospital to implement a safe patient handling program. These tools will 

46target Chief Executive Officers, Chief Nursing Officers, Nursing Directors, Nurse Managers, Hospital 

47Safety Committee members, Facility Champions, Unit Based peer leaders, staff nurses and other patient 

48handlers, and patient/families. There are 300 million dollars granted to support the development of this 

1 

2 



1project. The Department of Defense is a partner in the project. ANA was invited to also partner in the 

2project as well as to designate an ANA representative on all five of the workgroups developed to support 

3the project. Each workgroup is developing tools targeted to a specific segment impacting the project 

4such as senior leaders, facility champions, peer leaders, front line care providers, educators, nurse 

5managers and patients/families. ANA was pleased to be a partner and participate in this important work 

6by recruiting an ANA representative for each of the work groups. The project is expected to be 

7completed within one year. 

8 


10Many of the workgroups have had one face to face meeting at the VA Patient Safety Center of Inquiry. 

11ANA has representatives in all five of the workgroups. 

12 


14ANA continued to be represented on all five workgroups. Some workgroup 

15activities concluded in April 2008, based on a pre-set deadline by the VA. The VA will work to develop 

16training materials derived from workgroup outputs. 

17 


19All five workgroups have concluded. The VA is developing training materials based on the work of the 

20workgroups. No date has been established for completion. 

21 


23Workgroups have concluded the assignments and are no longer meeting. 

24 

25Occupational and Environmental Health 

26 

27Influenza Vaccination 

28Background: 

29Only 43% of nurses and other healthcare workers involved with direct patient care received the seasonal 

30influenza vaccine in the 2004-2005 influenza season according to the Centers for Disease Control and 

31Prevention. This number is typical of the dismal rate of vaccination for this group despite the Advisory 

32Committee on Immunization Practices rank of healthcare workers in the list of priority groups. Patients 

33are at risk of becoming infected with influenza from a healthcare worker with asymptomatic or 

34symptomatic influenza. Discussion is being generated to mandate seasonal influenza vaccination for 

35healthcare workers due to insufficient voluntary acceptance of the vaccine in this group, including 

36nurses. 

37 

38ANA launched a campaign entitled “Everyone Deserves a Shot at Fighting Flu” in November, 2005 to 

39address the unacceptably low rate of acceptance of seasonal influenza vaccine amongst nurses and other 

40health care workers. Media interviews and press releases were held to report on the results of a survey 

41ANA conducted with funding from GlaxoSmithKline to identify barriers to receiving and accepting the 

42vaccine. Additionally the 2006 ANA HOD adopted a resolution addressing influenza vaccination which 

43was further addressed by the ANA BOD in December 2006. 

44 


46The final report of the “2006-2007 Best Practices in Seasonal Influenza Immunization Programs” was 

47submitted to sanofi pasteur. An article describing the award and recipients’ programs was accepted for 

48publication by the American Association of Occupational Health Nurses Journal. Additionally, grant 

1 

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1funding for a second phase of the program was secured. The program announcement for this 

2“2007-2008 Best Practices in Seasonal Influenza Vaccination Programs” was released through ANA 

3listservs and the Nursingworld website. Applications are due April 18, 2008. 

4 


6ANA selected the top four programs in the “2007-2008 Best Practices in Seasonal Influenza Vaccination 

7Programs” in May 2008. The hospitals were: 

8 1. The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; 

9 2. Cook Children’s Health Care System, Fort Worth, Texas; 

10 3. EMORY HEALTHCARE, Atlanta, GA; and 

11 4. Genesis Health System, Davenport, Iowa. 

12 

13 ANA will publish an article describing the recognition campaign for the “Environment, Health, and 

14Safety” column of American Nurse Today. Letters and certificates will be sent to participants of the 

15campaign. ANA will offer the CMA in the state where the recognized program recipient is located to 

16participate in presenting the award to the recipient. 

17ANA remains committed to increasing the rates of seasonal influenza vaccination amongst registered 

18nurses and other healthcare personnel (HCP). In 2005, the "Everyone Deserves A Shot at Fighting Flu" 

19identified the issue. ANA President sent a letter to the individual nurse appealing to them to accept the 

20seasonal influenza vaccination. In 2006 through 2008, ANA focused on the partnership of the registered 

21nurse and the organizations providing workplaces for registered nurses. Through the "Best Practices in 

22Seasonal Influenza Vaccination" initiatives, ANA developed tools based on the concepts and successful 

23implementation strategies gathered from the applicants to assist other healthcare organizations to plan 

24their seasonal influenza programs for registered nurses and other HCP. In the future, ANA is planning to 

25assist the individual registered nurse to encourage their colleagues and co-workers to join them in 

26protecting themselves, their families and their patients from getting seasonal influenza by accepting the 

27seasonal influenza vaccination. 

28 


30ANA has been in contact with GNA, INA (Iowa), PSNA, and TNA (Tennessee) to offer them the 

31opportunity to arrange award presentations to the organizations in their respective states. 

32 

33 


35Recipients of the award have all received their awards at an award ceremony. ANA had invited the 

36CMA in the state of the award recipient to be involved in the presentation of the award. ANA is 

37completing the final report to the program funder, sanofi pasteur. 

38 

39ANA updated the annual Seasonal Influenza Backgrounder for the 2008-2009 influenza season on the 

40ANA website. ANA staff participates in weekly National Influenza Vaccine Summit calls. 

41 

42National Foundation for Infectious Diseases (NFID): Diabetes and Influenza 

43Background: 

44The National Foundation for Infectious Diseases (NFID) is calling for the medical and public health 

45community to increase alarmingly low influenza vaccination rates among persons with diabetes -- the 

46fifth deadliest disease in the United States. ANA has participated in annual roundtable discussion 

47leading to Call to Action documents such as the "Improving Influenza Vaccination Rates in Adults and 

48Children with Diabetes: Identifying and Overcoming Immunization Barriers in this High-risk 

1 

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1Population" developed following the 2006 meeting. ANA was represented at the 2007 roundtable 

2focused on best practices for vaccinating health care workers against influenza. 

3 


5NFID has updated its Call to Action on influenza immunization among healthcare personnel (HCP) and 

6has invited ANA to join those who support it. NFID plans to present the document developed as a result 

7of the roundtable meeting in late 2007 at the next meeting of the Advisory Committee on 

8Immunization Practices scheduled for February 27-28, 2008. The NFID report is titled Best Practices in 

9Immunizing Healthcare Personnel Against Influenza. 

10 


12The completed report will be available for distribution in the upcoming influenza season. 

13 


15There is no additional information to report at this time. 

16 

17Pandemic and Avian Influenza 

18Background: 

19Pandemic influenza is a virulent viral strain of influenza causing a global outbreak of influenza 

20spreading from human to human because there is little natural immunity in the human population. 

21Pandemic preparedness planning is critical to reduce the lethal impact a global pandemic can have on 

22human suffering and death. Avian influenza continues to threaten to be the next pandemic influenza if 

23the H5N1 influenza virus mutates to allow for human to human transmission. Even seasonal influenza is 

24an annual challenge as it claims an associated 36,000 deaths and approximately 200,000 hospitalizations 

25annually, predominantly among persons aged > 65 years and those < 2 years of age in addition to 

26persons of any age who have medical conditions placing them at risk of complications from influenza. 

27Respiratory protection for health care workers and others in the form of an N-95 respirator vs. surgical 

28masks had been the subject of great debate in guidelines for pandemic and avian influenza planning, 

29including the national pandemic plan. 

30 

31 


33ANA staff will attend the Seasonal and Pandemic Influenza 2008 conference sponsored by the 

34Infectious Diseases Society of America planned for May 18-20 in Arlington, VA. 

35 


37ANA staff attended the Seasonal and Pandemic Influenza 2008 conference sponsored by the Infectious 

38Diseases Society of America on May 18-20 in Arlington, VA. 

39 


41There is no update to report. 

42 

43National Occupational Research Agenda (NORA) 

44Background: 

45The National Institute for Occupational Safety and Health (NIOSH)-, in partnership with the National 

46Safety Council celebrated the success of the first decade of the National Occupational Research Agenda 

47(NORA) and launched its second decade at the NORA Symposium in April, 2006, in Washington 

48D.C. For the past nine years the National Occupational Research Agenda (NORA) has served as a 

1 

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1framework to guide national occupational safety and health research efforts. Town Hall Meetings have 

2been sponsored by the National Institute of Occupational Health and Safety (NIOSH) in preparation for 

3setting a new research agenda for the next decade. ANA, through its CMAs, contacted nurse members 

4across the country to testify at these Town Hall Meetings to ensure that the occupational safety and 

5health concerns of nurses be included. ANA’s priority topic areas for occupational research include: 

6musculoskeletal disorders; chemical exposures; worker fatigue; bloodborne pathogen exposure; 

7respiratory protection and workplace violence. ANA is represented on the NIOSH Health Care and 

8Social Assistance sector work group. The work group will write a technical report on the state of the 

9NIOSH Health Care and Social Assistance sector. The report will be divided into topic areas and 

10present what is known, and identify what knowledge gaps exist. This technical report will be written for 

11an audience of experts. From this technical report two shorter reports will be written, one being a 

12shorter document to target decision makers, and the other a bulleted “fact sheet” written for the general 

13public. ANA assisted in the “Chemicals and Other Hazards” section of this technical report and is 

14working on the Organization of Work and Stress work group division of the report. 

15 


17The next meeting of the NORA Health and Social Service Sector is scheduled for July, 2008. 

18 


20The next meeting of the NORA Health and Social Service Sector is to be rescheduled, tentatively for 

21September 9-10. The next meeting will be in D.C. over a day and a half. 

22 


24ANA participated in the NORA Health and Social Service Sector held on September 9-10, 2008 in 

25Washington, DC. ANA will host the next meeting of this group on February 3-4, 2009. An event on 

26Capitol Hill is also being coordinated by SEIU for this meeting. ANA is involved in workgroups on 

27sharps safety and safe patient handling. 

28 

29NIOSH Hazardous Drugs Work Group 

30Background: 

31The National Institute for Occupational Safety and Health (NIOSH) sponsored a multi-disciplinary work 

32group to review the existing guidance and, in light of new data accrued, make updated recommendations 

33on hazardous drug safe handling which is based on the industrial hygiene ‘hierarchy of control 

34technologies’. Since the work group’s inception ANA has taken an active part in the process and had a 

35representative at all work group meetings. The culmination of the first years of this group’s work was 

36the NIOSH produced Alert; Preventing Occupational Exposures to Antineoplastic and Other Hazardous 

37Drugs in Health Care Settings published in 2004. 

38 


40The NIOSH hazardous drug panel met on December 7, 2007 in Washington, DC to receive final input 

41regarding updating the list of drugs classified as hazardous from the 2004 Alert. An ANA representative 

42from COEH attended. NIOSH is in the final phase of completing the list and is receiving comments 

43from reviewers. 

44 



47 


1 

2 




2 

3NIOSH Workplace Fatigue Project 

4Background: 

5The ANA Health and Safety Survey conducted in September, 2001 revealed that health and safety 

6concerns have an impact on the kind of nursing work performed and on nurses continued practice in the 

7field of nursing. ANA has a long history of working with the National Institute for Occupational Safety 

8and Health (NIOSH) on occupational issues such as safe patient handling and movement. ANA has been 

9involved over the past two years to assist in the development of proposals with NIOSH staff to obtain 

10internal NIOSH funding to partner on projects that advance ANA’s initiatives. One such funded 

11proposal was the safe patient handling and movement curriculum development initiative that 

12complements ANA’s Handle with Care ® campaign. ANA is partnering with NIOSH on a project to 

13develop and evaluate a risk prevention training program to educate student nurses about the risks 

14associated with shift work and long work hours including strategies to reduce risks. Tailored training 

15projects will be developed for four audiences: miners/blue collar workers, nurses, retail workers and 

16truck drivers. ANA will serve on the Training Development Evaluation Committee for this project. The 

17project is scheduled to extend from August 17, 2007 to September 30, 2010. 

18 


20ANA has completed two tasks of the project, and will continue to complete tasks as received from 

21NIOSH. 

22 


24ANA is in the process of completing the third task of this project. 

25 

26 


28ANA has received no additional tasks from NIOSH since May. In 2008, ANA reviewed the results of 

29focus groups conducted with nurse managers who provided comments and suggestions. ANA also 

30provided written guidance and suggestions on the draft survey for pre and post test evaluation of the 

31work schedule training products for nurses which included the background used to develop the survey 

32items. 

33 

34NIOSH Personal Protective Technology Program 

35Background: 

36NIOSH is responsible for certifying respirators and other personal protective equipment utilized in 

37occupational health settings, including the N-95 respirators utilized in healthcare settings. 

38 


40As of this report, no public comment sessions have been scheduled. 

41 



44 



47 

48Health and Safety Presentations 

1 

2 



1Background: 

2ANA frequently is called upon to offer presentations at various meetings or other venues. This section 

3reports on the presentations that have been presented during the report period. 

4 


6COEH will be the keynote speaker at the Vermont State Nurses’ Association, Inc conference entitled, 

7“Promoting Excellence in Nursing” to be held on March 17, 2008 in Montpelier, Vermont. The topic 

8will be safety issues for nurses. 

9 


11No further information to update at this time. 

12 


14ANA will be presenting at the 2008 AOHP National Conference in September on Getting to Zero- Open 

15Forum on Reducing Needle Stick and Sharps Exposures, a two part forum providing for open discussion 

16following a brief presentation. This will be a co-presentation with Bob Williamson, Director of 

17Associate Safety for Ascension Health. 

18 


20ANA co-presented in September with Bob Williamson, Director of Association Safety for Ascension at 

21the 2008 AOHP National Conference. The presentation was well received. 

22 

23 

24Needlestick Safety 

25Background: 

26ANA participated in the invitational Center for Disease Control Sharps Injury Prevention meeting in 

27September 2005 where ANA’s preeminence in needlestick injury prevention was noted. Subgroups were 

28to continue discussion on this topic. ANA was to be involved in the “Human Factors” subgroup. In 

29August 2007, ANA participated in an evaluation to determine the feasibility of forming and maintaining 

30a national sharps injury prevention partnership based on the outcomes of the meeting in September. 

31 


33Data analysis from the survey revealed that 60% of participants thought sharps injury to be a 

34professional priority and 67% would be interested in actively participating in a partnership. Groups 

35needing more participation included front line workers. The 36 page report included recommendations 

36to CDC and the Department of Healthcare Quality Promotion. 

37 



40 


42ANA updated the Safe Needles Save Lives webpage of the ANA website. ANA created a backgrounder 

43regarding needlestick and sharps injuries. 

44 

45ANA/Inviro Medical Devices, Inc. 2008 Survey 

46Background: 

47ANA participated in a survey based on medication labeling and syringe use in 2007 funded by Inviro 

48Medical Devices, Inc. The survey included questions asked in ANA’s 2001 Health and Safety survey to 

1 

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1update findings. The 2008 survey will address the human factors issues related to needlestick safety and 

2will include additional health and safety questions to expand the database on these issues. The survey is 

3expected to be completed by July 1, 2008. 

4 


6The survey is currently being drafted for possible release for early April to ANA members only. 

7 

8April 2008 Update: 

9The draft of the survey has been finalized. The survey will be tested on April 7 th and if successful, will 

10be posted from April 9 , 2008 through April 23, 2008. The survey will be offered to ANA members only. 

11Five of the participants, chosen at random, will receive a $50 gift certificate to nursebooks.org as an 

12incentive to participate. Survey findings are anticipated to be released on June 11, 2008. Survey release 

13will include a press release and fast facts with a follow-up byline article. ANA’s President Rebecca M. 

14Patton has been identified as spokesperson for this project. 

15 


17The survey is completed. The findings of the survey are being analyzed with an anticipated press release 

18date of June 18, 2008. Results of the survey will be available on nursing world. 

19 


21The press release and fast facts on this survey were announced on June 24, 2008. ANA has had many 

22inquiries and interviews related to this project. 

23 


25The results of the ANA - Inviro Medical Devices Inc. survey have been added to the Safe Needles Save 

26Lives webpage of the ANA website. This project has been concluded. 

27 

28Healthy Nurse 

29 

30Background: 

31In July 2008, a discussion was held with the ANA Board of Directors concerning the unhealthy 

32lifestyles of registered nurses due to the nursing culture and factors at play within nursing profession 

33today, including workplace environments ANA has the ability to encourage registered nurses to lead a 

34healthier, balanced lifestyle and to encourage health care employers to offer healthier workplaces and 

35wellness programs to increase satisfaction in the workplace and enable registered nurses to experience a 

36healthier career in the nursing profession. ANA will prepare a program entitled “Healthy Nurse”. 

37 


39A business plan for the “Healthy Nurse” initiative is under development. 

40 

41Legal Advocacy 

42 

43HHS Lawsuit on RN Staffing Requirements 

44Background: 

45In June 2006, ANA, along with NYSNA and WSNA, sued the Department of Health and Human 

46Services to seek enforcement of the conditions of participation for the Medicare program regarding 

47registered nurse staffing. The lawsuit focuses on HHS’s failure to require the Joint Commission’s RN 

48staffing standards to be at least as high as those set by HHS in order for an accredited hospital to be 

1 

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1deemed to meet the Conditions of Participation in the Medicare Program. The government filed a 

2motion to dismiss the complaint, raising numerous grounds relating to the court's jurisdiction to review 

3the case. For example, the defendants claim that the associations have no standing and that HHS has 

4discretion over whether it will enforce its regulations in the manner ANA contends it should. ANA and 

5the state nurses associations filed an opposition to the motion, along with an amended complaint that 

6provides more specificity regarding staffing. The case was stayed for a period of time to permit ANA to 

7discuss the staffing standards with the Joint Commission. While the Joint Commission agreed that its 

8surveys needed improvement with respect to RN staffing, the Joint Commission representatives stated 

9that they were not going to take action to change the RN staffing standard. ANA has been promoting its 

10draft RN staffing standard for the Joint Commission’s use, and has sought the support of other nursing 

11organizations. The government’s motion to dismiss was denied as moot, because it focused on the first 

12complaint. 

13 

14March Update: 

15Briefing has been completed on the defendants’ second motion to dismiss and on plaintiffs’ motion for 

16jurisdictional discovery. The matter is pending before the judge. 

17 


19The motions are still pending. 

20 


22The motions are still pending. 

23 

24ANA v. Calif. State Department of Education - School Nurse Lawsuit 

25Background: 

26In October 2007, The American Nurses Association (ANA) and American Nurses 

27Association/California (ANA\C) filed a lawsuit in the Superior Court of the State of California against 

28the State Department of Education to remedy violations of law arising from the Department’s directive 

29that calls on unlicensed volunteer school employees to administer insulin to students with diabetes. The 

30directive, issued in the form of a “legal advisory,” is really a regulation that should have been published 

31for public comment prior to implementation. The lawsuit contends that the California State Department 

32of Education violated the state’s Administrative Procedure Act. 

33 

34The directive would permit unlicensed school personnel to administer insulin whenever a licensed 

35health care provider is not available. The lawsuit contends that this violates the state’s Nursing Practice 

36Act and endangers student’s health and well-being. In the lawsuit, ANA and ANA/C are asking the 

37court to order the State Department of Education to rescind the directive. 

38 

39The American Diabetes Association (ADA) intervened in the case on the basis that the “legal advisory” 

40was part of a settlement agreement between ADA and the California Department of Education. ADA 

41supports the State’s position. 

42 


44The California School Nurse Organization and the California Nurses Association have joined as 

45plaintiffs in the lawsuit. The parties will have a status conference with the Judge in June, to address the 

46procedural posture of the case. 

47 


1 

2 



1The American Nurses Association achieved a major victory in a California Superior court on November 

214, 2008 by obtaining a court order to stop the unlawful use of unlicensed personnel to administer 

3insulin to school children in California. Judge Lloyd G. Connelly issued a ruling in the case, American 

4Nurses Association, et al vs. Jack O'Connell, State Superintendent of Public Instruction, el al 

5immediately following an oral argument in which he stated that the Nursing Practice Act in California is 

6the specific statute that governs the scope of nursing practice and that the issuance of a California 

7Department of Education directive that was contrary to that Act cannot be implemented. Judge Connelly 

8stated that the Department of Education does not have concurrent authority over the administration of 

9medications and cannot override the Nursing Practice Act. Only persons specifically authorized to 

10administer insulin are allowed to do so. The court gave deference to the interpretation of the California 

11Board of Registered Nursing which was consistent with ANA’s view. The court further held that federal 

12law does not preempt state law. The judge declared that the actions of the Department of Education 

13violated the state’s Administrative Procedure Act by failing to publish for notice and comment the legal 

14advisory that attempted to permit unlicensed personnel to administer insulin. 

15 

16 

17Sentosa Nurses 

18Background: 

19The “Sentosa nurses” were brought to New York from the Philippines by the Sentosa employment 

20agency. The Sentosa nurses contend that they were brought to the U.S. under false pretenses and denied 

21the rights guaranteed by their employment contract. The RNs complained about short staffing among 

22other things. When the nurses resigned, their employer accused them of professional misconduct before 

23the state Office of Professional Discipline, which dismissed the charges. A more recent report by the 

24New York State Department of Health also found no evidence of patient harm resulting from the nurses’ 

25action. Regardless of these findings, in March 2007 ten of the RNs were indicted in Suffolk County 

26Supreme Court on charges of endangering their patients, and their attorney was indicted for conspiracy; 

27all pled not guilty. 

28 


30The American Nurses Association and its affiliate, the New York State Nurses Association (NYSNA), 

31filed an amicus brief with the New York State Supreme Court supporting a motion to drop the criminal 

32charges against the group Sentosa nurses. ANA argued that the criminal prosecution violated the RNs’ 

33constitutional rights and fostered involuntary servitude. ANA noted that, under the Code of Ethics for 

34Nurses, RNs may have to leave employment if nursing practice cannot be ethically done. In addition, 

35ANA pointed out that there was not patient abandonment under the circumstances of the case. 

36 


38The case is still pending, as the parties wait for the New York Supreme Court to rule on the motion to 

39drop the criminal charges against the Sentosa nurses. 

40 

41Maryland Whistleblower Protection 

42Background: 

43In this case of Lark v. Montgomery Hospice, Inc., the Maryland Circuit court considered the claims of an 

44employee who had repeatedly brought practices that she believed to be unsafe and illegal to the attention 

45of her employer. The employee was subsequently fired. The Circuit Court determined that the employer 

46was not liable because the employee did not go beyond her supervisory chain with the disclosures. 

47 


1 

2 



1The American Nurses Association (ANA) joined with the Public Justice Center, the American College 

2of Nurse-Midwives, and the Maryland Nurses Association, among others, to file an amicus brief on 

3April 11, 2008, in the case pending before the Court of Appeals of Maryland. As “friends of the court,” 

4ANA and the other groups argued that the Health Care Worker Whistleblower Protection Act was 

5intended to protect health care employees from retaliation when they disclose illegal activity internally 

6to their employer, and not just when an employee also makes a subsequent disclosure to an external 

7agency. ANA and the other amici contended that the linking of internal and external disclosures in the 

8Maryland law occurs in connection with the grant of whistleblower protection for external disclosures. 

9In other words, protection for an external disclosure is conditioned on the employee’s having made an 

10earlier internal disclosure, in order to give the employer a chance to correct the situation. However, the 

11law provides that whistleblowers are protected for the internal disclosure alone. 

12 


14The case is pending. 

15Sex Discrimination in Application of Leave Policies on Pension Computations 

16 

17Background: 

18ANA joined the National Women’s Law Center in an amicus brief filed in the U.S. Supreme 

19Court case of AT&T Corporation, v. Noreen Hulteen, et al.. AT&T has asked the Supreme 

20Court to review a Ninth Circuit Court of Appeals determination that it discriminated on the 

21basis of sex when it did not credit maternity leave time in the same manner that it credited 

22other types of disability leave for pension computations. The amicus brief supports the 

23women who suffered the unfair treatment and addresses application of anti-discrimination 

24laws prior to the adoption of the Pregnancy Discrimination Act. ANA’s policy concerns 

25include concern that women who take maternity leave for their own and baby’s health should 

26not be penalized or suffer illegal discrimination. 

27 


29The request for review by AT&T is pending. 

30 

31 

32Nursing's Agenda for the Future (NAF): Economic Value of Nursing 

33 

34Background: 

35In September 2001, ANA convened over 60 national nursing organizations to discuss the nursing 

36shortage and to develop a national nursing strategy to address the root cause of the shortage. A very 

37structural methodology called Hoshin Kanri enabled the 109 participants to identify 10 domains 

38impacting the nursing shortage which demonstrated the complexity of the shortage issue. Objectives for 

39each of the domains were also developed creating a comprehensive blue print to address the multiple 

40factors contributing to the shortage resulting in a report which was titled “Nursing’s Agenda for the 

41Future.” The NAF Steering Committee of 18 national nursing organizations prioritized the ten domains 

42and identified the economic value of nursing as the top priority. In 2005 The Lewin Group was 

43contracted to develop an economic model that could be overlaid on the increasing evidence of the 

44correlation between staffing and patient safety. Over 40 national nursing organizations and 43 ANA 

45CMAs contributed to the funding of this work ($185,000). 

46 

47An article describing the outcomes of the Economic Value of Nursing Report produced by Lewin was 

48drafted and was submitted to Health Affairs in April 2006. In addition, an orientation to the use of the 

1 

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1economic model itself took place in late March at ANA by Lewin with invitations to Steering 

2Committee organizations that might see themselves conducting research using this model in the near 

3future. One of the steering committee organizations participated with ANA in learning more about the 

4model. 

5 

6Ito date, Tim Dall on behalf of the Lewin Group and this commissioned work has not been successful in 

7getting an article accepted by Health Affairs. Subsequently, he has polled other relevant journals for 

8their interest in this work, and was encouraged to submit an article to Medical Care. 

9 


11An initial submission to Medical Care has been reviewed by journal reviewers, with a request by the 

12journal for a revised submission. After discussion with the subgroup of the NAF Steering committee, it 

13was agreed that Tim Dall would prepare a subsequent submission and this was provided to Medical 

14Care on February 21. 

15 


17ANA recently learned that a manuscript describing the economic value model and report based upon the 

18use of this model has been accepted for publication by Medical Care. ANA will post the publication 

19date of this article as soon as it is released. 

20 


22The manuscript submitted to Medical Care on the economic value of nursing report and model will be 

23published in the January 2009 issue of Medical Care. This issue will actually be released the afternoon 

24of December 24th. ANA is considering the strategy of a January Press Event to announce the release. 

25In addition, a press release to announce the release not only of the article in the January issue, but also 

26the release of the Economic Value report and model is being developed. 

1 

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