ANA-Michigan - 2020 Annual Book of Reports

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2020 ANNUAL BOOK OF REPORTS 

Table of Contents 

ANA-Michigan Board of Directors. ............................................2 

Newly Appointed BOD Member Gerry Infante. ....................................3 

2020 Strategic Plan. .....................................................5 

Meeting, Rules and Parliamentary Procedure. ....................................7 

Annual Meeting Agenda. ................................................. 11 

2019 Minutes ........................................................ 13 

President's Report. ..................................................... 16 

2020 Year End Financial Statements. ......................................... 18 

2021 Budget ......................................................... 23 

Executive Director's Report ............................................... 25 

MHSA, Advocacy and Legislative Report ....................................... 27 

Committee Report: Nursing and Health Policy. .................................. 29 

Committee Report: Nursing Practice. ........................................ 30 

Committee Report: Education. ............................................ 31 

Committee Report: COVID-19 Task Force ..................................... 33 

Committee Report: Leadership Academy Task Force .............................. 34 

ANA Membership Assembly Representative Report ................................ 35 

Leadership Candidate Bios. ............................................... 37 

Bylaw Amendments. .................................................... 57 

Champions for Nursing Partnership Program . ................................... 64 

ANA-Michigan Leaders serving on SOM LARA Implicit Bias Training Rules Advisory 

Workgroup & Subgroups ................................................ 68 

2020 COVID-19 Pandemic. ................................................ 70 

COVID-19 Training Program for K-12 Schools .................................... 71 

Appendix 

ANA-Michigan Position Statements 

Policy on Position Statements. ........................................... 74 

Moral Distress. ...................................................... 76 

Preventing Workplace Violence in Healthcare Settings. ........................... 78 

Telehealth & Connected Health. .......................................... 81 

Mitigating Implicit Biases to Reduce Disparities in Patient Outcomes . ................. 84 

Safe Nurse Staffing to Improve Quality of Care. ................................ 87 

Enhanced Nurse Licensure Compact. ....................................... 91 

“Nurse” Title Protection. ............................................... 93 

2020 Nurse Award Winners. ............................................... 95 

ANA-Michigan Bylaws Current. ............................................ 109 

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Printed and published for ANA-Michigan by: 

Arthur L. Davis Publishing Agency 

P.O. Box 216 | Cedar Falls, Iowa 50613 

(319) 277-2414


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ANA-Michigan Board of Directors 

Newly-Licensed Director Appointed 

ANA-Michigan is honored to announce that Mr. Gerardo Infante, BSN, RN, has been appointed by the 

ANA-Michigan Board of Directors to fill the Newly-Licensed Director position. Mr. Infante will serve 

in this position until the spring of 2022. 

We are so excited that he has accepted this role and look forward to his enthusiasm, ideas and 

diverse cultural perspectives which will help advance our mission and to have him join us in the 

evolution of our amazing profession. 

Per the Bylaws, the ANA-Michigan Board of Directors appointed Mr. Infante to serve in this position 

for the remaining term as the elected Newly-Licensed Director position was vacated by Megan 

Piotrowski. 

Gerardo O. Infante BSN, RN 

Gerardo has the honor of being the current President of the National Association 

of Hispanic Nurses Michigan Chapter (NAHN-MI) where he has served for the 

last four years. He has been actively participating in community events and 

research projects that benefit the Latino population in Michigan. 

Since January 2020 Gerardo is currently the charge nurse and clinical 

coordinator in a DaVita Dialysis Clinic in Monroe, Michigan. Prior to joining 

DaVita Dialysis, Gerardo was a nurse for CHASS (Community Health and Social 

Services) a FQHC in Detroit Michigan. He was part of a $1.5 Million grant from 

the U.S. Department of Health and Human Services Health Resources and 

Services Administration lead by the University of Michigan School of Nursing. 

The objective was to improve chronic care coordination for underrepresented and underserved 

populations utilizing bilingual-bicultural registered nurses serving as leaders to interdisciplinary 

teams. Gerardo is also part of the Michigan Nursing Action Coalition working on the “Nursing 

Workforce Diversity Project." 

He has also been apart of the “ANA-Michigan Networks of Support Virtual Meet-Ups" as a discussion 

moderator and thought leader, and participates on the Implicit Bias Training Rules Advisory Workgroup 

headed by LARA. 

Gerardo received his bachelor of science in nursing from American Sentinel University, Colorado, 

graduating Magna cum laude. 

His short nursing career has been dedicated to bringing culturally appropriate care to the Hispanic 

population. 

Dios te Bendiga / God Bless 

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Membership Meeting Rules and Parliamentary Procedure 

Meeting Rules 

Rule 1: Registered members must wear their 

name badges during the business session. 

All membership in good standing may 

vote. 

Rule 2: In making a motion or speaking to a 

question, a delegate shall move to the 

floor microphone, address the Chair, 

await recognition of the Chair, and give 

the delegate’s name and region. 

Rule 3: The correct form to use in making a 

motion is “I move that...” 

Rule 4: All motions and amendments should be 

written and signed by the maker of the 

motion or amendment and then given to 

the Chair. 

Rule 5: A member may not speak against her/his 

own motion, but may vote against it. 

Rule 6: No member shall speak more than once, 

or longer than three minutes, on the 

same question until all have spoken who 

wish to express and opinion. 

Rule 7: All reports and supplements to reports 

shall be written and shall not be read. 

Rule 8: Only currently paid members of the 

Association are entitled to vote at the 

polls upon verification of their current 

dues being in good standing according 

to the most current membership rosters 

provided to the tellers. 

Rule 9: The Association staff shall report the 

number of members registered after 

the opening ceremonies. Supplementary 

reports may be given later as the Chair 

may direct. 

Rule 10: A member should raise her/his hand to 

indicate she/he cannot hear. 

Rule 11: The member will act only on the 

resolves of a resolution. Questions of 

clarification will be handled according 

to parliamentary procedure. 

Rule 12: All sessions of the Annual Business 

Meeting shall be open to the public 

unless the Chair declares an executive 

question. 

Parliamentary Information 

Robert’s Rules of Order, Newly Revised is the 

parliamentary authority that shall govern the 

ANA-MI Business Meeting. The chair, as the 

presiding officer, rules on all matters relative 

to parliamentary law and procedures. The 

Parliamentarian serves only in an advisory 

capacity to the presiding officer and members. 

Member participation in the business session is 

governed by the standing rules. 

The motions that follow are defined in terms of 

action a delegate may desire to propose. Rules 

governing these motions are listed in Table 1. 

A main motion introduces a subject to the 

Business Meeting for consideration and is stated: 

“I move that....” 

FILLING OUT A MOTION FORM 

Motion forms are at the registration table 

and will be available on tables during the 

Business Meeting. Please fill them out 

completely before bringing forward a motion 

for consideration at the Business Meeting for 

discussion. 

You must sign your name and Region and 

get the signature of a person to second the 

motion before bringing it up. 

An amendment (primary) is a motion to modify 

the working of a motion. The motion to amend 

may be made in one of the following forms, 

determined by the action desired: “I move to 

amend by....” 

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• striking (word(s), phrase, paragraph).” 

• inserting (word(s), phrase, paragraph).” 

• adding (word(s), phrase, or paragraph at the 

end of the motion).” 

• substituting (paragraph or entire text of 

a resolution or main motion and inserting 

another that is germane). 

An amendment to an amendment is a motion to 

modify the wording of the proposed amendment 

and is made as follows: “I move to amend the 

amendment by....” The same forms for making 

an amendment are applicable for making a 

secondary amendment. 

The motion to commit or refer is generally 

used to send a pending motion (also called “the 

question”) to a small group of selected persons 

- a committee, board, or cabinet, for example 

- so that the question may be studied and put 

in better condition for the assembly to consider. 

The motion is stated: “I move to commit the 

question to..........for further study.” 

The motion to close a debate (previous question), 

if seconded and approved by a two-thirds vote, 

stops discussion on the pending question and is 

stated: “I move the previous question.” 

A division of the assembly may be called by any 

member if the chair’s decision on a voice vote 

is in question. The member proceeds to the 

microphone and states: “I call for a division of 

the house.” The chair then takes a standing or 

roll call vote. 

A division of the question may be called when 

a pending motion relates to a single subject but 

contains several parts, each capable of standing 

as a complete proposition. The parts can be 

separated, and each considered and voted on as 

a distinct question. The motion is stated: “I move 

to divide the question........as follows....” 


The motion to reconsider enables a majority 

of the assembly to bring back for further 

consideration a motion that has already been 

voted. The purpose of reconsidering a vote 

is to permit correction of hasty, ill-advised, 

or erroneous action, or to consider added 

information or a situation that has changed since 

the vote was taken. (Note exception on the Table 

-Rules Governing Motions) 

Parliamentary inquiry is a question directed to 

the presiding officer to obtain information on 

parliamentary law or the rules of the organization 

as relevant to the business at hand. A member 

addresses the chair and states: “I rise to a (point) 

of parliamentary inquiry.” 

Point of information is a request, directed to 

the chair or through the chair to another officer 

or member for information relevant to the 

business and hand. The request is not related 

to parliamentary procedure. The member 

addresses the chair and states: “I rise to a point 

of information.” 

The motion to appeal the decision of the chair 

is made at the time the chair makes a ruling. If 

it is made by a member and seconded by another 

member, the question is taken from the chair 

and vested in the voting body for a ANA-Michigan 

decision. The motion is stated: “I move to appeal 

the decision of the chair.” 

Before a member can make a motion or address 

the assembly on any question, it is necessary that 

he or she obtain the floor through recognition by 

the presiding officer. The member must: 

• rise and proceed to the microphone. 

• address the chair by saying, “Madam 

Chairperson” 

• await recognition 

• give name and region 

• state immediately the reason for rising 

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Interrupt 

Speaker 


Rules Governing Motions 

Recognized by 

Chair 

Requires a 

Second 

Debated 

Main motion NO YES YES YES Majority 

Amendment NO YES YES YES Majority 

Amendment to NO YES YES YES Majority 

amendment 

Limit Debate NO YES YES NO Two-thirds 

Close debate NO YES YES NO Two-thirds 

(previous 

quest.) 

Divide the NO YES YES NO Majority 

Question 

Reconsider NO YES YES YES Majority* 

Point of YES NO NO NO Chair Decides 

parliamentary 

inquiry 

Point of 

Information 

YES NO NO NO Chair Decides 

*Majority vote except when the motion being reconsidered required a two-thirds vote for its 

passage; then the motion to reconsider requires a two-thirds vote. 

Vote 

9


ANA-Michigan Annual Assembly Meeting 

(virtual) 

March 24, 2021 | 12:30-1:30 pm est | Zoom 

AGENDA 

Time Agenda Item Presenter 

12:30 Call to Order: 

• Roll Call of the Board of Directors 

• Roll Call of Membership 

• Declaration of Quorum 

• Review and Approval of the Agenda 

• Annual Assembly Meeting Minutes from 

March 1, 2019 

Julia Stocker Schneider, 

President 

12:35 Address from President Julia Stocker Schneider, 

President 

12:45 ANA-Michigan Financial Road Map Nancy Martin, Treasurer 

12:50 Address from Executive Director Tobi Lyon, Executive Director 

12:55 Proposed 2021 Bylaw Amendments 

• Amendment #1 




1:05 Address from Michigan Nursing Students 

Association 

Vineta Mitchell, Chair Bylaws 

Committee 

Nicholas Cooper, MNSA 

President 

1:10 Membership Comment and Open Forum Julia Stocker Schneider, 

President 

1:15 Recognition of Outgoing Board Members 

• Nikeyia Davis, Secretary 

• Nancy Martin, Treasurer 

• Margaret Calarco, Director 

• Suzanne Keep, Director 

1:20 Teller’s Report 

• Secretary 

• Treasurer 

• Director (2) 

• Nominations Committee (2) 

• ANA Membership Assembly Representative 

Julia Stocker Schneider, 

President 

Carole Stacy, Chair 

Nominations Committee 

1:25 Announcements and Adjournment Julia Stocker Schneider, 

President 

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MINUTES 

BOARD MEETING 

March 1, 2019, 8:30 a.m. – 9:22 a.m. 

GVSU L.V. Everhard Center Grand Rapids, MI 

Executive Board: Carole Stacy; Stacy Slater; Julia Stocker Schneider; Bridget Leonard; 

Directors: 

Lynne Harris; Suzanne Keep; 

Executive Director: Tobi Lyon Moore 

Excused: 

_____________________________________________________________________________________ 

Peggy Ursuy; Kathy Dontje; Edith English 

8:30 Call the Meeting to Order 

President Stacy called the meeting to order at 0830. 

Roll Call 

Stacy: Present; Slater: Present; Leonard: Present; Julia Stocker Schneider: Present; Harris: 

Present; Keep: Present; Ursuy: Excused; Dontje: Excused; English: Excused; Moore: Present. 

President Stacy declared a quorum (36 members in attendance). 

Corrections or additions to the Agenda 

None Stated. 

Approval of Agenda 

Motion #1: Approval of Agenda 

Made by: Stocker Schneider. 

Agenda approved. 

No additional correction to October annual meeting minutes noted. 

Motion #3: Approve 10.26.2018 Annual meeting minutes. 

Made by L. Harris. PASSED 

_____________________________________________________________________________________ 

8:33 President’s Message 

• 2019 Strategic Plan presented, pillars discussed 

• Policy influence- letter sent to Governor Whitmer regarding ANA-MI stance on nursing in MI 

• Task force to write ANA-MI statement, sent to membership expert to bring a grounded 

perspective, 

• Appointments to committee and state agencies discussed: Legislation, Policy, Education, 

Finance, and Practice. 

_____________________________________________________________________________________ 

8:37 ANA- MI Financials 

• Treasurer Stacy Slater presented the financial statements. 

• Membership dues budget was $15413.67, in January took in $16,844.71 

• 1 month into operating budget $9843.74 was January net gain 

Motion #2: Accept ANA-MI January financials report as corrected 

Made by Klemczak. PASSED 

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8:45 Introduction of MNSA Board 

• Megan Piotrowski, President of MNSA discussed goals: 

o Increase membership engagement to approximately 3000 members 

o Offer creative community service activities, Social media/new technology 

o Convention planning early and more advertising 

o Strategic plan and value to local chapters for members and nursing students 

o Relying on faculty to build connections and guide the way, working with and learning 

from ANA-MI 

_____________________________________________________________________________________ 

08:48 Deborah Bach-Stante- Director of Nursing Office Policy 

• SB 111- Modifies allegation process, more requirements for the reporter and accused. 

More power to LARA and changes to Attorney General 

• New Administrative rules proposed, need a lot of education 

o 2018 033LR- Changes to nursing administrative role, clinical placement ratios put 

control at the site level, no prescribing number being made to be more flexible 

o 2019 024LR- Public Health code which changed license expiration date from 3/31 to 

date of license issue date now will be expiration. The electronic process still has 

glitches and the nurse is still responsible for renewal even if they do not receive 

notification of expiration 

• Nursing Licensure Survey- All nurses should receive, if link not received information is 

located in the last ANA publication 

• Enactment of Nurse Licensure Compacto 

LARA- panels of medical marijuana, applications being accepted for emergency rules 

r/t poisoning. Public hearing on 3/12/19 

• State Innovation Model- Blueprint for Medicaid database for Health Innovation for MDHHS 

can sign up, need provider language 

• Section 298 Merging of mental health and physical health. All nurses should be aware, info 

on the website and call for participation in community hearings. 

_____________________________________________________________________________________ 

09:01 Recognition of Outgoing Board Members 

• Stacy Slater 

• Bridget Leonard 

• Lynne Harris 

• Suzanne Keep 

• Peggy Ursuy 

• Katherine Dontje 

• Edith English 

_____________________________________________________________________________________ 

09:05 Teller’s Report 

• 2019 Election Results 

o Secretary- Nikeyia Davis 

o Treasurer- Stacy Slater 

o Director At Large (2 Year Term)- Margaret Calarco & Suzanne Keep 

o Director At Large (1 Year Term)- Bridget Leonard & Kathy Dontje 

o Newly Licensed Director- Andrea Corrie 

o Nominations Committee- 1 Year term: MaryLee Pakieser 

o Membership Assembly- Stacy Slater 

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• Ballots will go out at the end of April to fill the (2) 2 year term positions for the Nominating 

Committee 

_____________________________________________________________________________________ 

09:10 Membership Comments 

• MOTION #4: ANA-MI to joining the MI Coalition to Prevent Gun Violence for $100.00. 

Made by Myrna Holland/2nd Kathleen Birdsall. PASSED 

• Discussion on other areas where ANA-MI pays for membership to support 

• Committee membership 

o ANA-MI member 

o Consent to Serve, Board approves 

o Bylaws defines number of positions, usually 9 

o At end of the year, fall 2019, call to membership for 1-2 year terms, there are openings 

on various committees 

• 2020 Conference in the Spring, 1 day event around Leadership/Advocacy in Lansing 

• May 2019- 1 day meeting at Northern MI University in the Upper Peninsula to work with 

Education Committee to plan 

_____________________________________________________________________________________ 

09:22 Adjournment 

Mission 

Advancing the nursing profession in Michigan. 

Vision 

ANA-Michigan is a vital community of professional nurses in Michigan. Together, we are the experts 

in nursing practice. Our strength is our solution-focused thought leadership, our long-term view of 

the nursing profession in a dynamic healthcare environment, and our impact on quality care and 

patient safety. 

15


President’s Report 

Julia Stocker Schneider, PhD, RN, CNL 

It has been one year since I began my term as ANA-Michigan President, and what a 

year it has been! Our Annual Conference and Meeting was cancelled last March due 

to the onset of the COVID-19 pandemic, so our 2020 leadership transition occurred 

remotely. While we have missed seeing one another, ANA-Michigan shifted work 

very effectively to the virtual environment without missing a beat. Our organization 

has continued to support our membership and to address issues that have emerged 

during this highly visible and challenging year for nurses. Below are some highlights of the work we 

engaged in during 2020: 

• COVID Support Strategies 

ANA-Michigan: 

o Initiated Networks of Support calls led by members to provide nurses with an opportunity 

to connect surrounding COVID pandemic experience, needs, and practice issues 

o Created a COVID-19 Task Force to examine the impact of the crisis on nursing practice 

and policy. The Task Force is planning to host a “Meeting of the Minds” with other 

nursing organizations in Michigan to enhance partnership and collaboration to support 

nurses’ well being 

o Participated in a study to examine PPE and mental health symptoms among nurses 

during the COVID pandemic https://journals.lww.com/joem/Fulltext/2020/11000/ 

Personal_Protective_Equipment_and_Mental_Health.2.aspx 

o 

o 

Created COVID-19 Training Program for K-12 Schools 

Gathered nurses’ PPE and COVID practice stories to support advocacy efforts to address 

nurses needs 

• Diversity, Equality, & Inclusion Support 


o Provided education & networks of support to promote health equity and cultural 

humility. 

o Sent representatives to participate in LARA’s Implicit Bias Training Rules Advisory Work 

Group 

o Initiated development of a Nurses of all Kinds recognition program 

o Prepared to develop implicit bias education/training offerings with nurse contact hours 

once LARA has released the program requirements 

o Developed a position paper on mitigating implicit bias 

• Member Engagement 


o Shifted educational offerings to virtual, continued development of the ANA-MI Leadership 

Academy postponed until Fall 2021 

o Developed an Ad Hoc Member Engagement Steering Committee (MI-SQUAD) to increase 

member networking opportunities, enhance social media presence, and other approaches 

that support engagement with nurses in Michigan 

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o 

o 


Implemented the Champions for Nursing Partnership Program pilot to enhance our 

Organizational Affiliate Program 

Is finalizing the development of a Foundation for nurse funding, so that we can apply 

for and accept funds that can be used to support members and initiatives. 

• Legislative 


o Interviewed and hired a new lobby firm, Muchmore, Harrington, Smalley, and Associates 

(MHSA) that has significantly enhanced our legislative presence at the Michigan capital 

o Hosted a Town Hall Meeting with Senator Gary Peters 

o Took action to support passage of the enhanced Nursing Licensure Compact (eNLC) 

bill in Michigan including meeting with Governor Whitmer’s policy director, appointed 

members for eNLC Task Force to support passage of eNLC 

• Advocacy & Coalition Building 

ANA-Michigan was represented at: 

• APRN Alliance of Michigan (AAOM) to work towards the removal of barriers to APRN 

Practice 

• Coalition of Michigan Organizations of Nursing (COMON) to network, share educational 

opportunities, and work toward mutual goals with 32 other Michigan nursing organizations 

• Informatics & Telehealth 


o Developed a position paper on telehealth & connected health 

o Entered into a partnership with the Texas Nurses Association, the Texas Organization of 

Nursing Leadership, and the Michigan Organization of Nurse Leaders (MONL) to support 

a statewide comparison study to understand nurses’ experience with electronic health 

records. The findings will be used to implement strategies that can lessen the burden 

of EHRs on nurses. Link to Complete the Survey: https://nursing.ttuhsc.edu/surveys/ 

ehr-michigan/ 

Despite this unusual and difficult year, it has been my honor to serve as your President. We have much 

to be proud of, including growing our membership, remaining financially sound, expanding member 

engagement strategies, and increasing our visibility and influence on nursing issues in Michigan. It 

has only been through the contributions of our many dedicated members, and to the support of 

our staff that these achievements have been realized. I am confident that we can build on these 

accomplishments in the coming year as we emerge from the pandemic with stronger recognition of 

the importance of our role, and a renewed commitment to advocate for our profession. I encourage 

each of you to become involved as we grow in nursing leadership together at ANA-Michigan. 

17


Financial Statements 

The 2020 Year-End Written Financial Summary 

Operating Revenues: 

Membership Dues: 2020 monthly budget was $18,600.00 to bring in for membership revenue. We 

ended the year with $19,769.41. 

Conference Income: The association had a net loss of $9,221.13 due to having to cancel the March 

2020 annual conference. 

Non-Dues Revenue: We hit our non-dues revenue by 104.7%. 

Operating Expenses: 

We end the fiscal year being over budget in the following areas: 

Board Insurance was over by $1,629.12 per 2019 quote. For 2021, we have found a new provider 

that will bring this cost back to what it was in 2018 and 2019. 

Marketing and Promotion by $2,650.89 as this is the expenses related to nurse’s month gifts, 

membership promotion and year-end holiday card. 

Postage is over by $2,997.95 related to the nurse’s month gifts mailing and all the outreach we have 

been doing related to membership promotions, which have resulted in our increase in membership. 

Technology Hosting is over by $3,585.90; as part of this is the contracts related to 2021 renews on 

the website and legislative action center. 

Net Loss: 

We ended the year with a net loss of $5,484.88. This is due to not having the conference and the hotel 

contract that we had to pay related to canceling the event and the leadership institute not occurring 

in the fiscal year. We never had to move money from savings or investment account throughout the 

year and always maintained a cash flow of $15,000 to $25,000 in the checking account. In November, 

we moved an additional $15,000 from savings to the investment account. 

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Executive Director Report 

Tobi Lyon, MBA, CAE 

To Remain Silent is to be Complicit. – President Ernst Grant, ANA President 

The year 2020 was an unexpected and unprecedented challenge for many, and 

when it began we had no idea to the extent of how it truly it would be the, “Year 

of the Nurse.” It will forever be remembered as a year that made history and 

changed life as we knew it, not only as nurses but as a country. On March 10, 2020, 

in accordance with Governor Whitmer’s first “Stay-at-Home” Executive Order, ANA- 

Michigan strategically pivoted operations to fully support the needs of nurses during 

this time of great uncertainty. ANA-Michigan’s innovative approach and ability to proactively switch 

gears to respond to COVID-19 was nationally recognized for establishing new modern practices and 

has expanded our outreach and engagement to include more front-line nurses and potential members. 

Due to the nature of the nursing profession and the frontline position nurses took from the very 

beginning of the pandemic, an obvious top priority for ANA-MI was support as a direct response to 

the fight against COVID-19 and the effect it was having on nurses. Tools and educational offerings 

included a COVID-19 resources webpage, multiple webinars including, “Mitigating the Effects of 

Trauma in Current Crisis” and “Psychological First Aid for Nurses,” strategically positioned “Thank 

You” Nurse billboards and over 5,000 KN95 masks donated to members, nurses and health facilities in 

need. I remain both humbled and in awe of the sacrifice nurses made in 2020 to fight this pandemic 

and throughout the year. 

Throughout the year, ANA-Michigan also continued its mission to advance nursing practice in Michigan. 

ANA-MI developed position statements on Mitigating Implicit Bias, Telehealth & Connected Health, 

the Enhanced Nurse Licensure Compact, Nurse Title Protection and Safe Nurse Staffing. Moving 

forward, ANA-MI is in-progress of finalizing position statements in regard to the COVID-19 vaccination 

and whistleblowing that aligns with the nurses’ code of ethics. 

Advocacy was another key initiative in 2020, as dedicated nurses were tested to their personal limits. 

For the first time ever, ANA-MI contracted its first lobbying firm, Muchmore Harrington Smalley & 

Associates, LLC (MHSA). MHSA has earned the reputation as one of Michigan’s leading lobbying firms 

and has a sterling reputation. ANA-MI was proud to provide our Strengthening the Voice of Nursing 

campaign, featuring a webinar series, social media toolkit, tips on reaching out to Legislators and 

a virtual town hall event with Representative Mary Whiteford. Our goal for this campaign was to 

help decision-makers recognize the essential voice of nursing in current healthcare debates and 

discussions. Because the ideals and mission of ANA-MI come to life through the real nursing stories 

of our members, we know it’s critical for the voice of the nurse to be heard and ANA-MI is there to 

support those voices every step of the way. ANA-MI in partnership with the Michigan Council for 

Nurse Practitioners, held a virtual Town Hall with U.S. Senator Gary Peters as well. 

25


As important as education is to ANA-MI, this too was significantly impacted by the COVID-19 pandemic. 

While the 2020 Annual Conference and Assembly Meeting was cancelled, ANA-MI was proactive and 

responsive with interactive virtual programming and creative opportunities for nurses to connect 

virtually. A majority of the virtual programs were offered complimentary to all nurses. ANA-MI 

recognized our 2020 Nurse Recognition Award Winners virtually as well. 

As it turns out, the pandemic would make it the perfect year to unveil the ANA-Michigan Champions 

for Nursing Partnership Program (CNPP). With the need for educational and emotional support for 

nurses at an all-time high, it was the right time to reach out to partnering organizations to join us 

and help support the advancement of the nursing profession. CNPP benefits are designed to provide 

a mutually beneficial and long-term partnership between ANA-MI and the supporter, designed 

strategically as a one-stop-shop for both supporting nurses and providing visibility and recognition for 

the partnering organization. Whether through subscriptions to ANA-MI newsletters and publications 

or new sponsorship opportunities and special annual conference benefits, the program is sure to 

connect organizations that care with ANA-MI nurses in need. CNPP offers multiple levels of support 

to allow for different tiers of engagement, from as low as one $250 annual contribution, all the 

way to our Gold Partner for a $2,000 contribution. By becoming a part of the CNPP, partnering 

organizations are standing with ANA-MI as we stand beside our nurses. 

Lastly, I’m pleased to report record membership growth for ANA-MI for spring and summer 2020. It 

is my sincere hope that this growth is a true reflection of the quality of the many services, support 

tools and educational opportunities provided by our organization. 

Never have I been more proud to be part of this organization. Through the most difficult parts of this 

pandemic, nurses stood strong and stood together, dedicated and focused on patient care, amidst 

nearly intolerable circumstances. As we begin to see light at the end of the tunnel of COVID-19 

may that same hope and determination lead us to a better tomorrow. Thank you for your continued 

support of ANA-Michigan and the nursing profession. 

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ANA-Michigan's First Official Registered Lobby Firm: MHSA 

ANA-Michigan reaches a new milestone in our association's storied history; beginning July 

1st, ANA-Michigan will have its first official registered lobby firm! 

ANA-Michigan has retained Muchmore Harrington Smalley & Associates, LLC (MHSA) as our new 

multi-client lobbying firm. The firm possesses substantial experience, professional approach, unique 

problem-solving skills, and unmatched creative energies while focusing on providing superior client 

service in the development and implementation of successful strategies. 

MHSA will provide weekly special reports and ANA-Michigan will be update our Advocacy page on our 

website with this information as well as including links to the special reports in our newsletters to 

keep members up to date. 

MHSA works aggressively to shape public policy and weave client interests into the Michigan 

Legislature’s agendas and initiatives; this includes the Executive and Administrative branches, 

agencies, bureaus of the State of Michigan, the Michigan Economic Development Corporation, and 

local and county governments. 

MHSA was founded in 1988 and has earned the reputation as one of Michigan's leading lobbying firms. 

MHSA was recently named Michigan's "Number 1" multi-client lobbying firm and "Number 1" lobbying 

organization (including corporations, trade associations, non-profit organizations, and multi-client 

lobbying firms); this according to a comprehensive survey conducted by Inside Michigan Politics 

(IMP). 

With more than 4,100 registered lobbyist agents in Michigan, five MHSA lobbyists earned honors 

and ranked in the category of "Individual Lobbyists: The Top 10." MHSA's five lobbyists earning a 

top 10 individual power ranking include Pat Harrington and Jon Smalley, both of whom will support 

ANAMichigan. 

To determine the power ranking of organizations and individuals who are both "players" and "effective," 

the IMP survey was distributed to all members of the Michigan Legislature, selected legislative and 

administration staff members, members of the capitol news media, and others. 

To learn more about the three team members from MHSA dedicated to ANA-Michigan, visit https:// 

mhsa.com/lobbyists to view their profile. 

To view this week's special reports from MHSA for ANA-Michigan, click here. 

To learn more about MHSA visit https://mhsa.com/ 

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Nurse Licensure Compact Update 

By Evelyn Sweeney, ANA-Michigan Legislative Consultant, 

Muchmore Harrington Smalley & Associations (MHSA) 

Although many policies are of great interest to nurses, perhaps one of the most significant and 

impactful to the profession is legislation enacting the enhanced Nurse Licensure Compact (eNLC). 

As many know, the eNLC enables registered nurses and licensed practical/vocational nurses to hold 

one multi-state license, with the privilege to practice in his or her home state and other NLC states. 

There are currently 34 member states in the current NLC and, as you all know, Michigan is not one 

of them. 

On January 15, 2019, Representative Mary Whiteford, a nurse by trade, introduced House Bill 4042 

which would have enabled Michigan to join the compact. The bill enjoyed wide support from a 

diverse set of interest groups which included the Michigan Health and Hospital Association, AARP, 

Leading Age Michigan, the Michigan Primary Care Association and of course, ANA-Michigan, to name 

just a few. Representatives from ANA-MI testified in support of the bill in February 2020 before 

the House Health Policy Committee. The bill was opposed by the Michigan Nurses Association as 

well as the Michigan Department of Licensing and Regulatory Affairs. Concerns expressed by the 

department largely focused on their responsibility of regulating health professionals in Michigan. 

The department contends they would be ceding their authority and oversight to an out-of-state 

compact body. Concerns regarding an inequitable “level of care” were also expressed pointing to 

education requirement differences between states. 

None the less, the bill was successfully reported from the House Health Policy Committee and out 

of the full House by a vote of 55-50 with four members not voting in February 2020. With COVID-19 

ravaging the state during the spring and late fall, plus an increased emphasis on the need and use of 

telehealth services throughout the state, the Senate discharged the bill from committee and passed 

it on December 10, 2020 despite the same concerns from the administration. 

The bill was presented to the Governor on December 22, but was ultimately vetoed on December 

30. In her veto letter the Governor specifically stated, “The Constitution of 1963 provides that “[t] 

he public health and general welfare of the people of the state are hereby declared to be matters 

of primary public concern. The legislature shall pass suitable laws for the protection and promotion 

of the public health.” Art. 4, sec. 51. While I value interstate cooperation, especially around issues 

that are peculiarly interstate in nature, these compacts require Michigan to cede its sovereign 

interest in regulating health professions to an outside body. Forfeiting our prerogative as a state to 

set the standard of care required of nurses practicing in our state would violate the command of 

section 51 of article 4. I am therefore vetoing this bill.” 

The administration’s opposition to all compact legislation remains an on-going concern. However, 

with the start of the new legislative session on January 13, 2021 there is renewed hope that through 

education, member engagement and persistence, we can address the Governor’s concerns. We 

anticipate the reintroduction of an eNLC bill soon. We also believe Representative Whiteford will 

sponsor the bill. She is coordinating a work group where interested stakeholders along with the 

administration will work closely, share ideas and attempt to forge a compromise. 

ANA-MI leadership will be part of these workgroups and looks forward to soliciting members for 

feedback as well as engaging members in discussions with their local elected officials. 

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ANA-Michigan Committee Reports 

ANA-Michigan Nursing and Health Policy Committee 

Chair: Katherine Kessler, MSN, MSA, RN 

Beth Ammerman, DNP, FNP-BC 

Kristin Castine, MSN, RN, ANP-BC 

Nikeyia Davis, MBA-HCM, BSN, RN, CNN 

Cheryl LaPlaunt, RN, MPA, BSN 

Barbara Medvec, DNP, RN, NEA-BC 

Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC 

Linda Sarantis, MSN, RN, S.A.N.E. 

Nadine Wodwaski, DNP, MSN-ed, CNS, RN 

Committee Duties & Assignments 

• Develop nursing and health policy initiatives related to ANA-Michigan’s Policy Platform. 

• Monitor and analyze nursing and health policy issues; collaborate with other health and 

nursing organizations in relevant nursing and health policy. 

• Educate and collaborate with public policy makers, relevant private and organizational 

policy makers. 

• Monitor and address nursing and healthcare regulatory policy issues. 

• Recommend and refer policy issues requiring legislative action or initiative to the Legislative 

Committee. 

• Assume other responsibilities for health policy as provided for in these bylaws and in policies 

and procedures as established by the Board of Directors. 

2020 Report 

• Monitored the COVID-19 pandemic. 

• Developed ANA-Michigan position statement on Moral Distress developed by the AACN 

(American Association of Critical Care Nurses) and adopted by ANA-Michigan. 

• Developed ANA-Michigan position statement on Reducing Violence in Healthcare Settings. 

• Developed ANA-Michigan position statement on Telehealth and Connected Health. 

• Developed ANA-Michigan position statement on Implicit Bias. 

• Member participation is consistent and engaged with members representing a range of 

geographic, rural, urban and practice areas. 

• Shared articles with members on nursing and health policy related topics via the ANA- 

Michigan newsletter. 

Acknowledgements 

On behalf of ANA-Michigan, we would like to recognize and thank the following out-going committee 

members for their dedication and service to members: 

• Kristin Castine, MSN, RN, ANP-BC 

• Katherine Kessler, MSN, MSA, RN 

• Cheryl LaPlaunt, MPA, BSN, RN 

• Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC 

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ANA-Michigan would also like to recognize and welcome new, in-going committee members who 

were appointed to serve members on this committee for a two-year term: 

• Alexa Andersen, MA, BSN, RN 

• Ramona Berry, MSA, BSN, RN 

• Wanda Chukwu, DNP, MA, CNEcl, RN 

• Holly Thalman, BSN, RN 

Chair: Katherine Dontje, PhD, FNP-BC, FAANP 

Margaret Calarco, PhD, RN, NEA-BC 

Linda Dunmore, MSN, RN, NE-BC, CPHQ, CPHS 

Nadia Farhat, RN, MSN, AGCNS-BC 

Marge Freundl, MSN 

Julie Powell, MSN, RN, AGCNS-BC 

Molly Stapish, MSN, CMSRN 

Marnie VanDam, MSN, RN 

ANA-Michigan Nursing Practice Committee 


• Identify and address nursing practice issues in Michigan. Collaborate with related nursing 

organizations with specific clinical expertise in developing initiatives. 

• Bring focus to the health and safety of nurses in all practice settings. 

• Develop programs that broadly address the personal health and well-being of nurses. 

• Collaborate with the Nursing and Health Policy Committee in addressing regulatory issues 

affecting nursing practice. 

• Address ethical issues in practice. 

• Assume other responsibilities for nursing practice as provided for in these bylaws and in 

policies and procedures as established by the Board of Directors. 


• Solicited nursing practice needs/feedback from membership. 

• Monitored COVID-19 pandemic. 

• Supported efforts to bring information to nurses related to COVID-19 and the potential 

for the adverse emotional/psychological impact on nurses by recommending the offering 

of education on PTSD and psychological first aid in response to the COVID-19 pandemic 

response. 

o Complimentary webinar provided in May for members and all nurses. 

• Discussed opportunities to prepare for next steps and/or a second “wave” of the pandemic. 

• Provided information on relevant nursing practice related topics, issues and innovations via 

the weekly newsletter to enhance and expand nurses knowledge. 

• Recommended to Board of Directors to convene an Adhoc COVID-19 Task Force; this 

recommendation was approved by the Board of Directors in May. 

• Responsible for convening nurse experts to develop a training program to educate K-12 

school teachers and faculty on COVID-19. 

o Reviewed and selected member nurse applicants to develop the curriculum and serve 

trainers. 

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o Provided oversight on the development of the COVID-19 school teacher/faculty virtual 

training videos. 

o Reviewed and approved the developed training materials that were provided as a 

complimentary resource to K-12 Michigan school teachers and faculty. 

o Training program videos and materials are available at no charge on ANA-Michigan 

website. 

• Discussed the current nursing practice environment and opportunities to provide resources to 

members on vaccinations, health care worker resilience and ensuring graduation of nursing 

students. 

• Recommended assembling a potential adhock work group/task force to address vaccinations 

and to develop materials related to vaccinations. 




• Margaret Calarco, PhD, RN, NEA-BC 

• Katherine Dontje, PhD, FNP-BC, FAANP 

• Marge Freundl, MSN 



• Nichole Budnick, BSN, RN 

• Ruth Kechnie, RN, BSN, MSA, OCN NE-BC 

• BethAnn Perkins-Simmons, BSN, RN 

• Erin Sudheimer, MSN, RN 

Chair: Bridget Leonard, DNP, MBA, RN 

April Liberty, BSN, RN 

Nancy Martin, DNP, RN 

Jennifer Mecomber, MSN, RN 

Mihaela Reed, MSN 

Mary Zugcic, RN, ACNS-BC, CRNI 

ANA-Michigan Education Committee 


• Seek input from Members on educational topics and speakers to plan educational offerings. 

• Plan the annual educational conference. 

• Develop an annual Membership Assembly and conference budget to be submitted to the Board 

of Directors for prior approval for the following year’s Assembly program and conference. 

• Assume other responsibilities for conference as provided for in these bylaws and in policies 

and procedures as established by the Board of Directors. 


• Planned the 2020 ANA-Michigan Annual Conference 

o Event was cancelled due to state’s executive order to quarantine due to the COVID-19 

pandemic. 

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o Full refunds provided to all registrants. 

• Developed and offered the Networks of Support Virtual Meet-Up Series for all nurses, not 

just ANA-Michigan members, to connect routinely and have a safe-place among nursing 

peers for support during the COVID-19 pandemic and to discuss other timely and relevant 

issues affecting or impacting nurses. 

o Series received national recognition. 

o Open discussions and specific topic discussions were both offered. 

o Each Networks of Support’s discussion was lead by a thought leader (ANA-Michigan 

leadership including board and committee members). 

• Developed and offered the “Strengthening the Voice of Nursing Virtual Event” based on 

topics recommendations from the Nursing Practice Committee and discussions from the 

Nursing Health & Policy and Legislative Committees that promoted nurses using their voices 

to speak-up on issues that matter to them most. Interactive education included: 

o Leveraging the Power of Nurses: Promoting Health Equity through a Framework of 

Cultural Humility. 

o Event included a town hall with Representative Mary White. 

o Storytelling and how to articulate your nursing story. 

o Recommendations for meeting with legislators & legislative update. 

o Do 1 thing activity and reporting. 

• Offered town hall with US Senator Gary Peters in partnership with MICNP. 

• Provided multiple complimentary and/or low cost webinars for all nurse on self-care during 

the early on-set of the COVID-19 pandemic to help support nurses’ well being and resiliency. 

o Stress Management and Self-Care for Nurses (multiple). 

o Stress First Aid. 

• Planned the first time ever, virtual, 2021 Annual Conference & Membership Assembly 

scheduled for March 24-25, 2021. 

• Monitors planning for the Leadership Academy by way of Leadership Academy Task Force 

updates. 

• Monitors the SOM Implicit Bias Training Advisory Workgroup to stay apprised of implicit bias 

training requirements for nurses and other health care licensures. 

o Executive Directive 2020.07 is an order requires LARA, in consultation with relevant 

boards and task forces, to promulgate rules to establish implicit bias training standards 

as part of the knowledge and skills necessary for licensure, registration, and renewal of 

licenses and registrations to 26 health professions, this workgroup will work together to 

o 

establish this training. 

Education Committee Chair Bridget Leonard, Nikeyia Davis and Gerry Infante appointed 

to sub workgroups on behalf of ANA-Michigan. 

• Planned two-part virtual workshop for January 2021 on “Advancing Your Idea & Creating a 

Successful Side Hustle” as a joint provided event with ONA, INA & WNA. 

• Planning a “Nurse Appreciation/Pride Celebration” as an in-person networking event at end 

of year and will include the 2021 nurse recognition awards. 

• Planning quarterly 2021 virtual education calendar for quarters 2-4 with nurse contact hours. 

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• April Liberty, BSN, RN 

• Nancy Martin, DNP, RN 

• Mihaela Reed, MSN 



• Ruth Duffy, BSN 

• Gerardo Infante, BSN, RN 

• Patrick Joswick, DNP, AGNP-C, RN 

Chair: Suzanne Keep, PhD, RN 


Katherine Dontje, PhD, FNP-BC, FAANP 

Bridget Leonard, DNP, MBA, RN 

Imana Minard, RN 

Mary White, RN 

ANA-Michigan Adhoc COVID-19 Task Force 


• Convened by the Nursing Practice Committee to discuss how can ANA members address 

health disparities/ social determinants of health related to the COVID-19 pandemic. 

• Focus efforts on nurses and the pandemic, and direct efforts to promote self-care among 

nurses. It is known that nurses are experiencing burn-out, PTSD and other stressors in which 

young and older nurses are deciding to leave the profession. 

• Facilitating a Meeting of the Minds with other nursing organizations to collaborate on 

discussing what effect COVID-19 has had on nurses, and what measures can be taken to 

support nurses. 

• The objective is to understand what stressors nurses are experiencing related to the 

pandemic, and how can ANA nurses help in addressing this issue. The goal is to have this 

collaborative meeting in April of 2021. 

• Discussed the current COVID-19 environment nationally and for Michigan. 

• Reviewed COVID-19 related issues identified by the Nursing Practice and Education 

Committees. 

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ANA-Michigan Adhoc Leadership Academy Task Force 

Chair: Jeanette Klemczak, RN 

Shari Carson, BSN, RN, CDP, CDONA, FACDONA, IP-BC 

Katherine Kessler, MSN, MSA, RN 

Nancy Martin, DNP, RN 

Barbara Medvec, DNP, RN, NEA-BC 

Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC 

Carole Stacy, MSN, MA, RN 


• Series rescheduled from 2020 to 2021 due to COVID-19 pandemic. 

• Task Force continued to research potential funding sources for Leadership Academy 

scholarships. 

• Determined the methods of delivery (in-person only and/or combination with virtual 

components). 

• Seeking consultation on energized approaches to online learning. 

• Adjusted curriculum to reflect emerging issues (leading in crisis, implicit bias, etc.). 

• Nurse leaders across the state participated in focus groups to identify key concepts and 

desired skills for the succession of nursing leadership in their organizations including 

hospitals, home health, and long term care settings. 

• Tentative content experts (faculty/speakers) have been identified. 

• Identifying additional sources of funding. 

• Considered the impact of the pandemic and economic situation of healthcare systems. 

• Assessed the environment for evidence to support moving forward with event. 

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2020 MEMBERSHIP ASSEMBLY REPORT 

SUBMITTED BY: JULIA STOCKER SCHNEIDER, 

STACY SLATER, BRIDGET LEONARD 

On Monday, June 1st ANA Virtual Special Meeting of the Membership Assembly voted on a proviso to 

the ANA Bylaws to allow the Annual Membership Assembly to be held virtually and national elections 

to be conducted remotely. The three-hour Membership Assembly meeting was scheduled for June 

19, 2020 from 5:00-8:00pm. 

President Julia Stocker Schneider, Membership Assembly Representative Stacy Slater, Presidentelect 

Bridget Leonard, and NEC candidate Marylee Pakieser attended the 2020 virtual membership 

assembly meeting. It was a great opportunity to see the ANA Board seamlessly and successfully 

execute the meeting in a virtual format. It was valuable to observe the Board at work, to hear some 

of the discussions of the Board and contributions of members. 

Friday, June 19, 2020 

The Virtual Session of the Membership Assembly was held. The Membership Assembly is comprised 

of representatives from ANA’s constituent and state nurses’ associations, the Individual Member 

Division, and specialty nursing organizational affiliates as well as the ANA Board of Directors. Annual 

updates and reports were presented, and attendees participated in the virtual format. 

Much discussion centered around the effects of COVID-19 on nursing advocacy, nursing education, 

and racial disparities made glaringly visible by the pandemic. 

Debbie Hatmaker reported on ANA Enterprise and the strategic goals to Elevate the profession of 

nursing globally, to Engage all nurses to ensure professional success, to Evolve the practice of nursing 

to transform health and healthcare, and to Enable transformational capabilities through operational 

excellence. 

• Passage of the Home Health Care Act and Title VIII as part of the CARES Act. 

• Call to Action for Congress to rebuild public health nursing workforce. 

• Direct aid to nurses using short-term grants (Hilton 236,000 room nights used). 

• Media opportunities to position nurses as the Voice of Nursing. 

• Social Media presence. 

• Credentialing Center has been very customer focused in responding to challenges presented 

by the closing of testing centers. 

• COVID work is focused on ANA’s relevance and driving membership. Original goal was a net 

gain of 10,000+ members but the relevance of ANA’s work was so well demonstrated that by 

the end of May the net gain was 14,000 new members. 

• Dialogue forum updates – specifically Visibility of Nurses in the Media from the 2019 

Membership Assembly – a Nurse Expert Data Base is being created. 

• New Business Item – To create an ad hoc committee to exam nurse suicide research. More to 

report later on this important committee. 

• It takes an Enterprise to battle a pandemic – speed over elegance. 

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Professional Policy Committee – All dialogue forums were canceled for 2020 but will all be considered 

for the 2021 assembly. Proposed revisions to the execution of the dues escalation of membership 

dues and change from labor organization to non-labor organization. 

• Dues escalation policy revision – voting to be conducted remotely after the meeting. 

• President Grant opened the chat for comments/clarification regarding the Dues Escalation 

Policy. 

o No comments. 

Statement on Racial Justice for Communities of Color – Emergent Proposal 

• This was approved as it met the requirements for an emergent proposal. 

• The emergent proposal was disseminated on 6/16/2020. 

• The statement and pledge were approved. 

o No additional comments. 

Nominations and Elections Committee – Voting instructions 

• The proviso adopted 6/1/20 will be administered by an independent vendor under the 

supervision of the NEC and the ANA Office of General Counsel. 

• Voting opened immediately after the meeting through 11:59 p.m. EST 6/25/20. 

• President Grant opened for questions. 

o No additional comments. 

Closing comments by President Grant regarding the impact of COVID-19 on nursing and to use our 

influence to educate others. Imagine a world where all voices are heard and respected. Change is 

needed and to take action at the ballot box! 

Virtual Day of Advocacy - #RNAction – 6/25/20 

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Candidates of Integrity: 

Meet Your ANA-Michigan Future Leaders 

This year, ANA-MI Members will elect: 

• Secretary 

• Treasurer 

• Director (2) 

• Nominations Committee (2) 

• ANA Membership Assembly Representative 

On Tuesday, February 9, ANA-Michigan members had the opportunity to “Meet the Candidates” 

via an interactive virtual forum to connect with the 2021 leadership election candidates and ask 

questions before voting. 

The “Meet the Candidate” Forum was recorded and can be viewed on our website at www.anamichigan.org. 

Ballots were mailed out on Thursday, February 18, 2021 and voting remained open until 5:00 p.m. 

Thursday. 

This year’s leadership candidates of integrity by position 

included on the 2021 ANA-Michigan election ballot: 

Secretary – (Elect 1) 


Henry Ford Health System 

Home Dialysis Therapies Registered Nurse 

Ypsilanti, MI 

Vanessa Riley, BSN, RN 

Advantis 

Occupational Health Nurse 

Clio, MI 

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Treasurer – (Elect 1) 

Julie Bulson, DNP, MPA, RN, NE-BC 

Spectrum Health 

Director, Business Assurance 

Grand Rapids, MI 

Director – (Elect 2) 

Barbara R. Medvec, DNP, RN, MSA, MSN NE-BC 

University of Michigan School of Nursing 

Clinical Assistant Professor and MSN Program Lead 

Saline, MI 

Joshua Meringa, MPA, MHA, MBA, BSN, RN, NPD-BC 

Spectrum Health System 

Nurse Educator & Academic Liaison 

Grandville, MI 

Julie Powell, MSN, RN, AGCNS-BC, CNEcl, EBP(CH) 

Michigan State University 

Nursing Faculty 

Temperance, MI 

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Christine W. Saltzberg, PhD, MSHCE, MS, PHCNS-BC, RN 

Self 

Consultant 

Highland Township, MI 

Nominations Committee – (Elect 2) 

Linda John, MSN, RN, PhD (c) 

Oakland University 

Clinical Nursing Instructor 

Troy, MI 

Suzanne Keep, PhD, RN 

University of Detroit Mercy 

Site Director of Pre-Licensure Program: Associate Professor 


Beth VanDam, MSN, GERO-BC, CNL 

Mercy Health Saint Mary's 

Clinical Nurse Leader 


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ANA Membership Assembly Representative – (Elect 1) 

Anne R. Kreft, BSN, RN 

Munson Medical Center 

Behavioral Health - Clinical Practice RN 

Traverse City, MI 

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ANA-Michigan Announces NEW Champions for Nursing Partnership Program 

Creating a One Stop Shop for Supporting Nurses of All Kinds 

During these unpresented times, uniting nurses and organizations of all kinds for collaboration is 

more important than ever. ANA-Michigan has designed a new Champions for Nursing Partnership 

Program (CNPP) to promote alignment of collaborative efforts to advance the nursing profession and 

to provide a network of diverse resources for nurses. 

Schools of nursing, nursing and health care organizations, professional networks, health care systems, 

health care vendors, nursing consultants and all other champions for nursing are encouraged to 

partner with us! 

By becoming a part of the CNPP, ANA-Michigan members will receive enhanced, diverse and more 

inclusive resources that support our mission, vision and strategic plan. 

To discuss how ANA-Michigan and your organization could partner together, please visit the anamichigan.org. 

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ANA-Michigan Members Serving on State of 

Michigan’s Workgroups to Develop New Implicit 

Bias Licensure Requirements and Training 

The COVID-19 pandemic has illustrated, with brutal proof, the persistence of racial disparities in 

our society. As of July 5, 2020, Black Michiganders represented 14% of the state population, but over 

35% of confirmed COVID-19 cases where the race of the patient was known. COVID-19 is over four 

times more prevalent among Black Michiganders than among white Michiganders. And Michigan is 

no outlier. According to the Centers for Disease Control and Prevention (CDC), “non-Hispanic Black 

persons have a [COVID-19 associated hospitalization] rate approximately 4.7 times that of non- 

Hispanic White persons.” Moreover, Black and Latino people have been nearly twice as likely to die 

from the virus as white people, according to CDC data. Indigenous populations have experienced a 

hospitalization rate even higher than that of Black Americans. 

This disparity is not limited to COVID-19. People of color face disparities in terms of morbidity, 

mortality, and health status. Black, Hispanic, and Indigenous Americans have higher infant mortality 

rates than white and Asian Americans. The premature death rate from heart disease and stroke is 

highest among Black Americans. 

Race and ethnicity are not the only demographic factors associated with disparity in health outcomes. 

For example, women are more likely to experience delayed diagnosis of heart disease compared to 

men, as well as inferior heart attack treatment. Sometimes, these disparities intersect, as in the 

case of childbirth, where the United States is one of the few countries experiencing a rise in the 

maternal mortality rate, and Black women are nearly four times as likely to die during childbirth as 

are white women. 

Faced with these disparities during the COVID-19 pandemic, Michigan has led the way in identifying 

and addressing the problem. Michigan was one of the first states to report COVID-19 data by race and 

ethnicity. When it became clear the virus had devastated communities of color with particular force, 

Governor Gretchen Whitment issued Executive Order 2020-55, creating the Michigan Coronavirus 

Task Force on Racial Disparities—a group dedicated to studying, reporting on, and finding solutions 

to the disparate effects of COVID-19 on people of color. 

But much work remains. To be sure, the causes of these disparities are multiple and complex. Social 

determinants of health such as education, employment, and environmental factors—all of which 

correlate with race and ethnicity—are part of the explanation. Research also shows that disparities 

result in part because of differences in the delivery of medical services to people of different races. 

The National Healthcare Disparities Report concluded that white patients received care of a higher 

quality than did Black, Hispanic, Indigenous, and Asian Americans. People of color face more barriers 

to accessing health care than do white people, and are generally less satisfied with their interactions 

with health care providers. 

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These disparities can arise even when not intended because of the prevalence of what is sometimes 

called implicit bias: thoughts and feelings that, by definition, often exist outside of conscious 

awareness, and therefore are difficult to control. But they can shape behavior, including the behavior 

of health care professionals. One way to reduce disparities in health outcomes, therefore, is to seek 

to eliminate the unconscious biases, misconceptions, and stereotypes that can lead to disparities in 

how health care is provided. 

Michigan’s front-line health-care workers have been its greatest heroes in the fight against COVID-19. 

Without their selfless and courageous service, many more lives would be lost and disrupted due to 

this pandemic. Nevertheless, we—all of us—need to do better, and training health-care workers 

how to recognize and mitigate implicit bias will only help these workers carry out their mission 

of providing the best health care to all they serve. 

For this reason, and on the recommendation of the Michigan Coronavirus Task Force on Racial 

Disparities, the Department of Licensing and Regulatory Affairs (LARA) has convened an Implicit Bias 

Stakeholders Workgroup and Subgroups to establish new rules requiring all health care professionals, 

including nurses, to receive training on implicit bias and the way it affects delivery of health care 

services. This type of training has value for all Michiganders in all professions and walks of life and 

ANA-Michigan is fully committed to supporting this. 

We are honored and grateful to have the following dedicated and passionate ANA-Michigan leaders 

serving on the LARA Implicit Bias Stakeholders Workgroup and Subgroups: 

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Supporting Nurses During the 

2020 COVID-19 Pandemic 

Upon Governor Whitmer’s first Executive Order 2020-04 to “stay at home” on March 10, 2020 in 

response to the COVID-19 pandemic, ANA-Michigan strategically pivoted operations to fully respond 

to and support the needs of nurses during this time of uncertainty, setting aside routine, daily 

operations and the status quo. ANA-Michigan’s aggressive pivot and innovative, proactive approach 

has been nationally recognized, at the forefront for establishing new modern practices and has 

expanded our outreach and engagement to include more front-line nurses and potential members. 

Here are some ways that ANA-Michigan supported nurses during the on-set of the pandemic: 

• Donated more than 5,000 KN95 masks to nurses and health facilities in need during the onset 

of the pandemic and early PPE shortages. 

• Donated Billboards of Gratitude for Nurses displayed across the state. 

• COVID-19 Webpage: ANA-Michigan created the COVID-19 Resources webpage for members 

and all nurses to have a “one stop shop” for up to date, evidence-based data and information 

on COVID-19. 

• ANA-Michigan and our members shared stories from the front-line with Senators, key 

government officials and the community to help advocate for PPE and participated in both 

state and national interviews with various media outlets. ANA-Michigan members also 

participated in multiple Town Halls with key state and US representatives. 

• Throughout these unprecedented times, ANA-Michigan provided multiple opportunities 

for members and all nurses to connect for opportunities that support their well-being. 

Opportunities include but were not limited to: 

o Networks of Support Virtual Meet-Ups for Nurses (multiple) 

o Webinars on Stress Management and Self-Care for Nurses 

o Webinar on Stress First Aid for Nurses 

• Recognizing Year of the Nurse: No one could have predicted that how 2020 would truly be 

the Year of the Nurse. Despite the pandemic, ANA-Michigan and members still found ways 

to recognize and celebrate being a nurse. 

70


COMPLIMENTARY RESOURCE AVAILABLE 

ANA-Michigan COVID-19 Training Program for K-12 School Teachers, Faculty and Staff 

Developed as a proactive response to the growing needs of K-12 Schools amid the COVID-19 pandemic 

the American Nurses Association of Michigan (ANA-Michigan) is proud to offer a FREE online 

comprehensive four-part training program for teachers, faculty and staff. With so much information 

circulating that is constantly changing or completely inaccurate, ANA-Michigan is determined to 

secure the facts and share appropriate safety measures to help schools support their worried staff 

and concerned parents. 

The comprehensive virtual training course includes the following sections: 

• Part 1: Introduction to Coronavirus 

• Part 2: Maintaining Safety Practices During COVID-19 

• Part 3: Managing Stress During COVID-19 

• Part 4: Tool kit for School Faculty and Personnel Resources 

Schools that would like to work with one of our nurse trainers for specific questions, or for an 

online Q&A chat can schedule now through ANA-Michigan. Please direct specific questions about the 

COVID-19 Training Program to Nurse@ana-michigan.org or (517) 325-5306 or online on our website 

at ana-michigan.org. 

About ANA-Michigan 

American Nurses Association-Michigan (ANA-Michigan) is the premier organization representing the 

interests of registered nurses (RNs) across the state. ANA-Michigan brings nurses together to advance 

their careers and the profession through standard-setting, advocacy, and professional development. 

71


ANA-Michigan COVID-19 Training Program for K-12 School Teachers, Faculty & Staff: 

AUTHORS & TRAINERS 

The ANA-Michigan COVID-19 Training Program was developed by the following ANA-Michigan 

members on behalf of ANA-Michigan in response to the 2020 COVID-19 Pandemic. This Training 

Program, and all its included materials, are the property of ANA-Michigan. Authors and Trainers 

are listed below in alphabetical order by last name. 

Dayna Bennett, MSN, APRN, FNP-C 

Dayna Bennett is a Family Nurse Practitioner who works with 

Opdyke Medical, a family medical practice where she treats individuals through 

the lifespan. She has a special interest in women’s health, child health, diabetes, 

hypertension and weight management. She graduated with her Bachelor of Science 

in Nursing from the University of Windsor and Master of Science in Nursing from 

Ursuline College. She is a member of the ANA-Michigan and Michigan Council of 

Nurse Practitioners. She enjoys living in Michigan with her three children and 

husband. 

Dr. Donna Cassidy, DHSc, MSN, RN 

Donna Cassidy has been an RN for 26 years. During her career 

Donna has worked in a variety of roles with increasing responsibilities. Donna 

spent 11 years working in education before moving into a nurse leadership role. 

Donna currently serves as the Hospital Administrator for a small community 

hospital in Southwest Michigan. Donna earned her Associates Degree in Nursing 

in 1994 and her BSN in 2002. Donna has a MSN from Walden University with a 

focus on Nursing Education and a Doctorate of Health Sciences with a focus on 

Organizational Leadership and Behavior earned from AT Still University. 

Dr. Wanda Chukwu, DNP, MA, CNEcl, RN 

Wanda Chukwu, DNP, MA, CNEcl, RN, is a proud member of ANA-Michigan. Dr. 

Chukwu is currently taking time out of her daily routine to incorporate new 

strategies to manage stress and build resilience during the COVID-19 pandemic. 

She is currently employed as a fulltime nursing faculty member; and also works as 

an independent consultant helping individuals create policies and procedures for 

their health-related ventures. In her spare time she enjoys watching old movies 

and listening to good music. 

Linda Dunmore, MSN, RN, NE-BC, CPHQ, CHSP 

Linda Dunmore serves as the Senior Director of Clinical Services for Mercy Health 

in Muskegon. She has been with the organization for over 30 years and is currently 

responsible for the leadership in Quality, Accreditation, Patient Safety, Infection 

Prevention and Control (IPC), Clinical Education and Employee Health. Linda is 

an adjunct faculty for Indiana Wesleyan University. Linda is a member of ANA- 

Michigan and sits on the Nursing Practice Committee. 

72


Noor Khalil M.Ed., BSN, RN 

Noor Khalil is a family nurse practitioner student interested in community 

nursing, holistic health care, transcultural health and reducing health disparities 

among vulnerable populations. During the pandemic, she has cared for COVID-19 

patients providing patient-family centered care. Her clinical background is in 

medical surgical nursing. She earned a Master of Education in health education 

concentrating on community health education from Wayne State University and 

a Bachelor of Science in Nursing from Oakland University with summa cum laude 

distinction. 

Kristin Mahler, MPH, RN, NCSN 

Kristin Mahler, RN,BSN, MPH, NCSN, is a proud member of ANA-Michigan. Kristin 

works as a school nurse in Ann Arbor Public Schools since 2007. Prior to school 

nursing worked in a variety of inpatient and out patient settings. Active member 

of the Michigan Association of School Nurses Board of Directors. Nationally 

Certified School Nurse. 

Joshua Meringa, MPA, MHA, MBA, BSN, RN, NPD-BC 

Joshua Meringa is a Nurse Educator and Academic Liaison at Spectrum Health 

in Grand Rapids, Michigan. His responsibilities include facilitating orientation 

training for new RNs and Nurse Technicians, managing academic affiliations with 

nursing programs at colleges and universities throughout West Michigan and 

providing leadership and oversight for the Spectrum Health nursing continuing 

education program. Mr. Meringa has been a Registered Nurse since 2002 and 

is certified in nursing professional development through the American Nurses 

Credentialing Center and as a certified Basic Life Support Instructor through the 

American Heart Association. He is a member of ANA-Michigan and the Wisconsin Nurses Association 

Continuing Education Approval Committee. Mr. Meringa is the immediate past Chair of the Michigan 

Board of Nursing. He holds a Bachelor of Science in Nursing from Calvin College, and Master’s degrees 

in Public Administration, Healthcare Administration and Business Administration from Grand Valley 

State University. Meringa lives in Grandville, Michigan with his wife and three school-aged children. 

Marnie VanDam, RN, BSN, MSN 

Marnie VanDam, RN, BSN, MSN earned her Bachelor of Science degree from 

Oakland University and her Master of Science in nursing education from Capella 

University. She has 27 years of nursing experience with the last 10 years in 

emergency medicine. Mrs. VanDam is also employed by her local school district 

as a nurse consultant. Marnie is an active member of the ANA-Michigan Nursing 

Practice Committee. 

To request a meeting with one of the ANA-Michigan Authors/Trainers so that they may address any 

specific questions or concerns that your teachers, faculty or staff may have, please contact ANA- 

Michigan directly at: Nurse@ana-michigan.org Office: (517) 325-5306 

73


ANA-MICHIGAN POLICY ON PUBLIC POSITION STATEMENTS 

POLICY 

ANA-Michigan shall take public positions on legislation and health policy proposals, and recommend 

actions based on the following Platform and process. 

PURPOSE 

ANA-Michigan’s position statements articulate the Association’s stand on health care policy 

proposals of importance to its membership and the public it serves. Positions are generated in 

response to trends and best practices in health care and health policy related to current and 

emerging issues that impact the health of the citizens of Michigan, their access to care, standards 

and excellence in nursing practice; and the profession of nursing. 

All proposed policy positions are first benchmarked to the ANA-Michigan Mission, Vision and 

Strategic Values. The Criteria below are also applied to the analysis and recommendation of 

policy positions to the Board of Directors. 

Platform Issues 

Access to Quality Care 

1. Promote accessibility to healthcare for all residents of Michigan. 

2. Support services for vulnerable populations. 

3. Ensure nursing care by appropriate licensed providers. 

4. Assure basic human needs services that impact individual health status. 

5. Support programs that enhance health literacy. 

Human Rights/Social Justice 

1. Provide for informed healthcare choices through evidence-based education of Michigan residents. 

2. Support legislative proposals that positively impact the health and welfare of Michigan residents. 

3. Educate legislators when proposals would negatively impact the health and well-being of 

Michigan residents. 

4. Oppose discrimination in health policies/regulations and delivery of care. 

5. Support competent care for diverse Michigan populations. 

6. Protect the privacy of Michigan residents in issues of healthcare. 

Quality and Safety of Health Care 

1. Maintain state policies and regulations consistent with national nursing standards. 

2. Support for programs that address health promotion and maintenance and prevention of disease/ 

disability. 

3. Actively collaborate with healthcare organizations within the state for purposes of quality care, 

patient safety and nursing input. 

74


Advances in the Practice and/or Profession of Nursing 

1. Promote the viability of professional nursing organizations. 

2. Promote statewide communication within the profession. 

3. Encourage occupational health and safety of nurses. 

4. Support public funding for nursing research and education. 

Process for Position Statement Review 

1. Requests for development of an Association position statement on a policy, issue or legislation 

may be made by the Board of Directors, an individual member, or based on member survey 

results. 

2. The request is sent to the Public Policy Council for consideration. 

3. The Public Policy Council reviews the issue, evaluates the issue in relation to the ANA-Michigan 

Mission, Values and Impact Statement and the Platform criteria. 

4. The Public Policy Council makes a recommendation to the Board using an evidence-based review 

of the issue and its relevance to the above Platform Criteria. Topic experts may be used to 

develop the position statement. 

5. The Board determines whether the proposed position statement is adopted by the Association 

and made public. 

6. The Association positions are reviewed by the Public Policy Council annually. 

7. Recommendations for policy changes are made to the Board. 

8. Joint positions (e.g. with other healthcare groups) may be developed. 

Approved by the ANA-Michigan Board of Directors on September 19, 2015 

75


POSITION STATEMENT 

MORAL DISTRESS IN TIMES OF CRISIS 

Background 

Moral distress is “knowing the right thing to 

do but being in a situation in which it is nearly 

impossible to do it.” 1 

Critical care teams wrestle daily with moral 

challenges in the context of their normal 

professional activities. 2 During a crisis, such as 

the COVID-19 pandemic, everyday challenges 

are compounded. For example, patient surge 

results in shortages of lifesaving equipment 

needed to keep patients alive 3 and a lack of 

personal protective equipment necessary to 

protect nurses, their patients, their families, and 

their communities. 4,5 Team members struggle 

to maintain their professional, emotional, 

and moral equilibrium when caught in tragic 

situations beyond their control. 

Nurses, and all members of the healthcare 

team, must protect their personal integrity 

and sense of justice to be effective in their 

work. Too often, nurses are pressured to 

compartmentalize emotions, and to rapidly and 

stoically “do your duty.” Sustaining a strong 

sense of duty maintains order, serves patients, 

and preserves the respect of coworkers and 

loved ones. However, discerning one’s duty may 

not take the linear path of simply following 

orders and regulations. Those who apply a carebased 

morality prioritize relationships with 

others in making moral decisions. 1,6 Embracing 

a care-based perspective recognizes that nurses 

live in a web of moral duties that includes their 

duty to protect themselves, their patients, their 

families, and their communities. 

Recommended Actions for 

Healthcare Institutions 

Every organization must: 

• Provide the vital supplies and equipment 

that nurses need to protect themselves and 

others. 

• Establish evidence-based, consistent, 

procedures for equitably allocating scarce 

resources and use them in a way that 

maximizes value without endangering 

safety. 8,9 

• Consider creating an interdisciplinary 

triage committee composed of respected 

volunteers to provide unbiased opinions in 

difficult situations. This preserves each direct 

caregiver’s ethical duty for beneficence. 3 

• Ensure that administrators are accessible to 

those performing direct patient care, and 

that they maintain clear communication 

and transparency regarding institutional 

challenges. 

• Guarantee that nurses are included as 

decision makers on all institutional ethics 

committees. 

• Monitor the clinical and organizational 

climate to identify situations that could 

create moral distress. 

• Provide tools to help clinicians recognize 

the experience of moral distress. 

• Create interdisciplinary forums to discuss 

patient goals of care and divergent opinions 

regarding those goals of care in an open, 

respectful environment. 

• Ensure institutional support systems include 

easy access to: 

• Ethics committees 

76

• Critical stress debriefings 

• Protocols for end-of-life care 

• Readily available crisis counseling 

• Employee assistance programs 

• Grief counseling 

Recommended Actions for Nurses 

Nurses must: 

• Pay attention to your inner voice and 

recognize when it conflicts with what you 

are being asked to do or what circumstances 

demand that you do. 

• Create a moral compass for yourself by 

expanding your ethical knowledge. Seek out 

professional and institutional resources that 

can provide ethical guidance, such as: 

• American Nurses Association Code of Ethics 

for Nurses 10 

• International Council of Nurses Code of 

Ethics for Nurses 11 

• Your hospital’s ethics committee or moral 

distress consulting team. 

• Learn the signs and symptoms of moral 

distress. They include: 

• Feelings of frustration, anger, and guilt 12 

• Physical manifestations such as heart 

palpitations, insomnia, and fatigue 

• Psychological consequences such as 

withdrawal, emotional exhaustion, and 

depersonalization of patients. 13 

• Seek out a trusted mentor. 

• Use employee assistance resources and see a 

qualified professional counselor or therapist 

when needed. 

• Lean on coworkers, friends, and loved ones. 

They are all in the mix as you balance your 

personal and professional duties, and they 

need to know when you are experiencing 

moral distress. 

• Practice self-care, and keep a reflection 

journal. 

References 

1. Jameton A. What moral distress in nursing history 

could suggest about the future of health care. AMA J 

Ethics. 2017;19(6):617-628. 

2. Savel RH, Munro CL. Moral distress, moral courage. 

Am J Crit Care. 2015;24(4):276-278. doi: 10.4037/ 

ajcc2015738 


77 

3. Truog RD, M.D., Christine Mitchell C, Daley GQ. 

The toughest triage — Allocating ventilators in a 

pandemic. NEJM. Published online March 23, 2020. 

doi: 10.1056/NEJMp2005689 https://www.nejm.org/ 

doi/full/10.1056/NEJMp2005689 

4. Interim Infection Prevention and Control 

Recommendations for Patients with Suspected or 

Confirmed Coronavirus Disease 2019 (COVID-19) in 

Healthcare Settings. Centers for Disease Control and 

Prevention. https://www.cdc.gov/coronavirus/2019- 

ncov/infection-control/control-recommendations. 

html 

5. Interim Guidance: Rational use of personal protective 

equipment for coronavirus disease 2019 (COVID-19). 

World Health Organization. Accessed March 25, 

2020. https://apps.who.int/iris/bitstream/ 

handle/10665/331215/WHO-2019-nCov-IPCPPE_use- 

2020.1-eng.pdf 

6. van Nistelrooij I, Leget C. Against dichotomies: 

On mature care and self-sacrifice in care 

ethics. Nurs Ethics. 2017;24(6):694-703. doi: 

10.1177/0969733015624475 

7. Barden C, Cassidy L, Cardin S, eds. AACN Standards 

for Establishing and Sustaining Healthy Work 

Environments: A Journey to Excellence. 2nd ed. 

Aliso Viejo, CA: American Association of Critical- 

Care Nurses; 2016. https://www.aacn.org/ 

nursing-excellence/standards/aacn-standardsfor-establishing-and-sustaining-healthy-workenvironments. 

Accessed March 25, 2020. 

8. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation 

of scarce medical resources in the time of covid-19. 

N Engl J Med. Published online March 23, 2020. doi: 

10.1056/NEJMsb2005114 

9. Daugherty Biddison EL, Faden R, Gwon HS, et al. 

Too many patients…a framework to guide statewide 

allocation of scarce mechanical ventilation 

during disasters. Chest. 2019;155(4):848-854. doi: 

10.1016/j.chest.2018.09.025 

10. American Nurses Association. Code of Ethics for 

Nurses With Interpretive Statements. Silver Spring, 

MD: Nursesbooks.org Retrieved from https:// 

www.nursingworld.org/practice-policy/nursingexcellence/ethics/code-of-ethics-for-nurses/coeview-only/ 

11. The ICN Code of Ethics. Revised. Geneva Switzerland: 

International Council of Nurses; 2012. 

12. Epstein EG, Delgado S. “Understanding and 

Addressing Moral Distress.” Online J Issues Nurs. 

Published online September 30, 2010. doi: 10.3912/ 

OJIN.Vol15No03Man01. 

13. Rushton CH, Caldwell M, Kurtz M. Moral Distress: 

A catalyst in building moral resilience. Am J 

Nurs. 2016;116(7):40-49. doi: 10.1097/01. 

NAJ.0000484933.40476.5b



PREVENTING WORKPLACE VIOLENCE IN HEALTHCARE SETTINGS 

Background 

The ANA Nurses Bill of Rights maintains that 

nurses have the right to a work environment 

that is safe for themselves and for their patients 

regardless of the setting of care. 

According to reports from National Institute 

for Occupational Safety and Health (NIOSH), 

individuals who are injured and who miss work 

as a result of violence in healthcare settings 

is increasing (U.S. Department of Labor [DOL], 

Bureau of Labor Statistics, 2014). 

Violence in healthcare facilities is complex and 

multiple factors may contribute to the problem. 

Nurses and other caregivers have a personal and 

professional duty to “do no harm” to patients. 

Many will put their own safety at risk to help a 

patient and some consider violence “part of the 

job.” Many excuse attacks as being unintentional 

and due to an individual’s illness or impairment. 

In addition to physical harm, individuals who 

experience or witness violence in the healthcare 

workplace are at risk for emotional consequences 

that can lead to time away from work, burnout, 

job dissatisfaction, and decreased productivity. 

These and other consequences compromise both 

worker and patient safety. 

As of June, 2019, 36 states have established 

or increased legal penalties for the assault of 

nurses and other healthcare providers and nine 

states require healthcare organizations to run 

workplace violence programs (ANA, 2019). As 

of this writing, Michigan has NEITHER specific 

legal penalties nor workplace violence program 

requirements for healthcare organizations. 

Definition of Workplace Violence 

NIOSH defines workplace violence as physically 

and psychologically damaging actions that occur 

in the workplace or while on duty. (NIOSH, 2002). 

This can include verbal violence – threats, verbal 

abuse, hostility, harassment which can cause 

psychological trauma and stress even though 

there is no physical injury (OSHA, 2015) 

NIOSH describes four basic types of workplace 

violence: 

Type 1 – Involves “criminal intent” In this type 

of violent encounter, individuals with criminal 

intent have no relationship to the business or 

employees. 

Type II: Involves a customer, client, or patient. 

In this type “individual has a relationship with 

the business and becomes violent when receiving 

services.” 

Type III: Involves a “worker on worker” 

relationship and includes employees who attack 

or threaten another employee. 

Type IV: Violence involves personal relationships 

and includes “individuals who have interpersonal 

relationships with the intended target but no 

relationship to the business” 

Types II and III are the most common types in 

health care settings. 

78

Evidence 

According to The Occupational Safety and 

Health Administration (OSHA), healthcare 

workers, including nurses, are at 4x higher risk 

of experiencing workplace violence than those 

who work in other industries. Registered nurses 

experienced 14 violent injuries resulting in days 

away from work per 10,000 full time employees 

compared with a rate of 4.2 per 10,000 in private 

industry as a whole. Psychiatric aides are at 

highest risk (590 per 10,000) followed by nursing 

assistants (55 per 10,000). (U.S. Department of 

Labor [DOL], Bureau of Labor Statistics, 2014). 

The statistics underpinning this statement are 

drawn solely from reported incidents and OSHA 

notes that many incidents that could be included 

are NOT reported for a variety of reasons. Part 

of the problem is that because violent incidents 

are so common, they have become normative 

and among victims, only 30% of nurses and 26% 

of physicians actually reported the incidences 

(OSHA, 2015). 

Core Components 

ANA-MI concurs with ANA regarding interventions 

and supports the following: 

Primary prevention strategies that include 

development of workplace violence prevention 

programs, development of relevant policies, and 

education programs specifically designed for 

nurses and frontline caregivers. Students should 

also learn about the issue in nursing education 

programs. Employers and educational institutions 

must support work environments that are safe 

and align with OSHA’s “Guidelines for Preventing 

Workplace Violence for Healthcare and Social 

Service Workers” (OSHA, 2015; Lipscomb & 

London, 2015.) 

Secondary prevention strategies that include 

interventions designed to reduce and/or 

minimize the negative impact of workplace 

violence. Reporting incidences of violence is 

paramount so that accurate data can be gathered 

and analyzed. 

Tertiary prevention strategies that are designed 

to reduce the consequences of workplace 


79 

violence and may include incident debriefing, 

counseling programs, root cause analysis and 

confidentiality assurances. Legislative and legal 

strategies that protect all healthcare providers 

should be considered and supported. 

References 

American Nurses Association. (2019) Workplace violence. 

Retrieved from https://www.nursingworld.org/practicepolicy/advocacy/state/workplace-violence2/ 

American Nurses Association. (2016). American Nurses 

Association calls for a culture of safety in all health 

care settings [Press release]. Retrieved from https:// 

www.nursingworld.org/news/news-releases/2016/ 

americannurses-association-calls-for-a-culture-of-safetyin-all-health-care-settings/ 

xxii 

American Nurses Association. Position Statement on 

Incivility, Bullying, and Workplace Violence. 2015. Web: 

https://www.nursingworld.org/practice-policy/workenvironment/violence-incivility-bullying/ 

The Joint Commission. (2010). Preventing violence in the 

health care setting. Sentinel Event Alert, Issue 45. Web: 

https://www.jointcommission.org/assets/1/18/SEA_45. 

PDF 

The Joint Commission. Sentinal Event Alert: Physical and 

verbal violence against healthcare workers. Retrieved 

from: https://www.jointcommission.org/assets/1/18/ 

SEA_59_Workplace_violence_4_13_18_FINAL.pdf 

National Institute of Occupational Safety and Health 

(NIOSH). Division of Safety Research. (2002) Violence: 

occupational hazards in hospitals. Cincinnati, Ohio: U.S. 

Department of Health and Human Services, Public Health 

Services, Center for Disease Control and Prevention, NIOSH 

Division of Safety Research. 

National Institute for Occupational Safety and Health. 

(2013). Workplace violence prevention for nurses. CDC 

Course No. WB1865—NIOSH Pub. No. 2013-155. Retrieved 

from https://www.cdc.gov/niosh/topics/ violence/ 

training_nurses.html. 

Occupational Safety and Health Administration. (2015). 

“Guidelines for preventing workplace violence for 

healthcare and social service workers” (Publication No. 

OSHA 3148-04R 2015). Retrieved from https://www.osha. 

gov/Publications/osha3148.pdf. 

Occupational Safety and Health Administration. (2015). 

“Workplace violence in healthcare: understanding 

the challenge.” https://www.osha.gov/Publications/ 

OSHA3826.pdf 

U.S. Government Accountability Office. (2016). Additional 

Efforts Needed to Help Protect Health Care Workers from 

Workplace Violence. Retrieved from tps://www.gao.gov/ 

products/GAO-16-11 xxviii Occupational Safety and Health

Administration (OSHA). 2015. Retrieved from https:// 

www.osha.gov/Publications/OSHA3827.pdf xxix 

U.S. Department of Labor, Bureau of Labor Statistics. 

(2014). Nonfatal occupational injuries and illnesses 

requiring days away from work, 2013. (No. USDL-14-2246). 

Retrieved from http://www.bls.gov/news.release/pdf/ 

osh2.pdf. 


Approved: November 8, 2019 by the ANA-Michigan 

Board of Directors To be reviewed: November 8, 

2021 

Contact www.ana-michigan.org nurse@anamichigan.org 

(517) 325-5306 

80



TELEHEALTH AND CONNECTED HEALTH 

BACKGROUND 

The United States is in the midst of a global 

pandemic from Covid-19, a highly contagious 

disease that has caused severe social, economic 

and cultural disruptions to everyday life in 

America. Telehealth, also referred to as 

Connected Health, has grown exponentially 

during this time as more services are being 

delivered and are eligible for reimbursement 

from public and private insurers. The Center for 

Medicare and Medicaid Services (CMS) released 

new guidelines for telehealth in April, 2020 that 

encourage expansion of services to populations 

they cover. Examples from major Michigan 

healthcare systems include Michigan Medicine 

which conducted 444 virtual visits in February, 

2020 and increased those to more than 20,000 

visits by the end of April, 2020. Henry Ford 

Health System went from conducting 150 virtual 

visits per week to 10,000 virtual visits and report 

high patient satisfaction with this option. 

Nearly 20% of Americans live in rural areas 

where there is a shortage of both providers and 

healthcare facilities. “The health consequences 

for communities that lack resources can be dire” 

states Joelle Fathi DNP RN ARNP CTTS, an expert 

on biobehavioral nursing and health informatics 

and a member of the 2018 ANA Steering 

Committee to revise its Core Principles of 

Telehealth. Fathi further states that connected 

health has value for patients in urban and major 

metropolitan areas. The expansion of healthcare 

services through connected health creates the 

opportunity to serve populations with care that 

is “necessary, timely, efficient, convenient and 

effective.” (Moore & Trainum, 2019, p. 32). 

The Affordable Care Act and the 2017 Health 

Care Act both support the use of telehealth and 

technology to expand access to care delivery. 

Tamara Broadnaux DNP RN NEA-BC, Clinical 

Operations, Department of Veterans Affairs 

states that “As providers move toward more 

value-based, shared saving, and accountable 

care models as required in healthcare reform, 

connected health provides better care 

coordination, management and communication 

with patients.” (Moore & Trainum, 2019, p. 32). 

In 2019, ANA released Core Principles on 

Connected Health (Principles) as a guide for 

healthcare professionals who use telehealth 

technologies to provide quality care. This 

document is an update to the 1998 ANA Core 

Principles on Telehealth and reflect the evolution 

of healthcare using a more interdisciplinary 

approach. There are 13 Principles within the 

guide that identify unique issues related to 

practice, regulatory, privacy, reimbursement, 

documentation and competencies. (ANA, 2019). 

The Centers for Disease Control and Prevention 

(CDC) has issued Guidelines on using Telehealth 

to expand access to essential healthcare services 

during and beyond the COVID-19 pandemic. 

ANA recognizes that connected health provides 

a method of healthcare delivery that can 

improve access to quality health care when 

implementation is conducted using accepted 

standards and best available evidence. Nurses 

play an essential role in the adoption and use of 

connected health across care settings and roles 

and are well-positioned to lead in the adoption 

and use of care via these technologies. 

81

DEFINITIONS 

The American Nurses Association defines 

telehealth and Connect Health as “the use of 

electronic information and telecommunications 

technologies to support and promote long 

distance clinical health care, patient and 

professional health-related education, public 

health and health administration. Technologies 

include: videoconferencing, the internet, storeand-forward 

imaging, streaming media, and 

terrestrial and wireless communication” ANA, 

n.d. While telehealth has been in existence for 

many years, it has grown exponentially recently 

due in part to need to deliver care virtually 

during the coronavirus pandemic. 

Centers for Medicare & Medicaid Services (CMS) 

(2020) define telehealth as “a two-way, real- time 

interactive communication between a patient 

and a physician or practitioner at a distant 

site through telecommunications equipment 

that includes, at a minimum, audio and visual 

equipment.” 

Several telehealth modalities allow providers 

and patients to connect using technology to 

deliver health care: 

• Synchronous: This includes real-time 

telephone or live audio-video interaction 

typically with a patient using a smartphone, 

tablet, or computer. 

• In some cases, peripheral medical 

equipment (e.g., digital stethoscopes, 

otoscopes, ultrasounds) can be used 

by another HCP (e.g., nurse, medical 

assistant) physically with the patient, 

while the consulting medical provider 

conducts a remote evaluation. 

• Asynchronous: This includes “store and 

forward” technology where messages, 

images, or data are collected at one point 

in time and interpreted or responded to 

later. Patient portals can facilitate this type 

of communication between provider and 

patient through secure messaging. 


• Remote patient monitoring: This allows 

direct transmission of a patient’s clinical 

measurements from a distance (may or 

may not be in real time)to their healthcare 

provider. 

• Mobile Health (mHealth): This includes the 

use of mobile devices to support health care 

and public health information exchange. 

Information exchange using mHealth may 

include general educational information, 

targeted texts, and disease outbreak 

notifications. 

Nurses have the background, skills and creative 

ingenuity to help patients effectively 

navigate and engage in telehealth modalities 

across the continuum of care. 

Nurses have the background, skills and creative 

ingenuity to help patients effectively navigate 

and engage in telehealth modalities across the 

continuum of care. 

RECOMMENDATIONS: 

1. Endorse the term telehealth and Connected 

Health, as this is the most widely used and 

accepted term used in national guidelines, 

by third party payors and most professional 

organizations 

2. Adopt the 2019 ANA Core Principles on 

Connected Health. 

3. Advocate to make permanent recent policy 

changes that reduce barriers to telehealth 

services and reimbursement at the state and 

national level. 

4. Advocate for registered nurses (RN) and 

advance practice registered nurses (APRN) 

to be included in any legislation and to 

have access to telehealth platforms used by 

organizations 

5. Advocate for the inclusion of telehealth 

content and experiences at all levels of 

registered nursing education. 

82

REFERENCES: 

American Nurses Association (2019, June 6). ANA 

core principles on connected health. Retrieved 

from https://www.nursingworld.org/~4a9307/ 

globalassets/docs/ana/practice/ana-coreprinciples- 

on-connected-health.pdf 

American Nurses Association. (n.d.). Telehealth. 

https://www.nursingworld.org/practice-policy/ 

advocacy/telehealth/ 


Moore, E., & Trainum, B. (2019). Connected 

health: ANA’s updated principles put nursing at 

the forefront. American Nurse Today, 14(12), 32- 

33. 

U.S. Centers for Medicare & Medicaid Services 

(2020, April 24). Telehealth. Retrieved from 

https://www. cms.gov/Medicare/Medicare- 

General-Information/ Telehealth 

83



MITIGATING IMPLICIT BIAS TO REDUCE DISPARITIES IN PATIENT OUTCOME 

The purpose of this statement is to explore 

implicit bias and the role it plays in healthcare 

disparities and to identify what nurses can do to 

encourage equality of care for all patients. 

BACKGROUND 

Our United States Declaration of Independence 

assures equality, life, liberty and the pursuit 

of happiness as fundamental rights for all 

(Jefferson, 1776), yet there is nothing in the 

document that promises healthcare as a right for 

all citizens. For this and other reasons, healthcare 

imbalances and disadvantages are present in our 

country. Citizens with steady incomes, better 

health insurance, healthy food, clean water and 

greater access to care often experience better 

healthcare opportunities than citizens with less 

money, lesser or no health insurance coverage, 

inadequate food and water resources and less 

access to care (Probst, et. al, 2020; Oppel, et 

al, 2020) . Healthcare disparities have been 

defined by Healthy People 2020 as “a particular 

type of health difference that is closely linked 

with social, economic, and/or environmental 

disadvantage” (ODPHP). With the onset of the 

COVID-19 pandemic, healthcare disparities have 

become more obvious. 

Citizens of color are even at a greater risk for 

healthcare disparities. While African American 

citizens made up 14% of Michigan’s population, 

they accounted for 35% of the COVID-19 cases 

by July 2020 and were noted to be four times 

more likely to die a COVID-19 related death than 

their Caucasian counterparts (Michigan.gov). 

Several studies have shown that implicit bias by 

healthcare providers is associated with lower 

quality of care (FitzGerald & Hurst, 2020). 

Healthcare disparities such as these sparked 

Michigan’s governor, Gretchen Whitmer, to form a 

task force to advise her on strategies to eliminate 

these racial disparities. One recommendation is 

to mandate healthcare providers to participate in 

implicit bias training as a condition of relicensure 

in an effort to eliminate discrimination against 

all citizens, especially those from disadvantaged 

backgrounds (executive order 2020). ANA-MI 

strongly supports Governor Whitmer’s stance on 

eradication of racism and healthcare disparities. 

The mission statement which drives the American 

Nurses Association is to “Lead the profession to 

shape the future of nursing and health care.” 

As nurses, it is up to us to facilitate increased 

opportunities for those experiencing disparities 

in healthcare due to bias. It is up to us to help 

even the playing field and to progress toward full 

equality in healthcare. 

IMPLICIT BIAS 

Implicit bias, also known as unconscious bias, 

as been defined as “thoughts and feelings that, 

by definition, often exist outside of conscious 

awareness, and therefore are difficult to control,” 

(Hall, Implicit Racial/Ethnic Bias Among Health 

Care Professionals and Its Influence on Health 

Care Outcomes: A Systematic Review, 105 AM. J. 

PUBLIC HEALTH 2588 (Dec. 2015). Furthermore, 

implicit bias includes any preconceived thoughts 

that can result in disparities and it is the duty of 

the healthcare provider to become aware of our 

own biases to help embrace the changes needed 

to eliminate healthcare disparities (ANA, 2018; 

Fitzgerald & Hurst, 2016). It has been noted 

when people experience discrimination based 

on personal characteristics, it can impact their 

84

physical and psychological health (Sutin, Stephan 

& Terracciano, 2016). Racism has been described 

as a public health crisis which affects the mental 

as well as physical health of all people (ANA, 

2018). In the past, the ANA has also taken the 

position there should be no discrimination in 

nursing practice nor in health care and that all 

patients should be viewed as equal and nurses 

should be treat them with impartiality, respect, 

and civility (2018). 

RECOMMENDATIONS: 

Strategies to mitigate implicit bias include 

building upon previous work of the ANA- 

Michigan (2018) based on opposing all racism 

and discrimination and being an advocate for 

all patients, regardless of their gender, race, 

ethnicity, etc. 

• Acknowledge that implicit biases do exist 

and becoming aware these biases can result in 

disparities in health outcomes associated with 

many demographic factors. (As nurses it is 

imperative to be aware of demographic factors 

which can undermine our patient’s success for 

health. Some of these factors might include 

questioning if there are safe living situations, 

availability for safe places to walk, feasibility of 

obtaining fresh produce and other healthy food 

choices, and obtaining fresh clean water for 

drinking.) 

• Follow the Nursing Code of Ethics, 

which advises nurses to band together 

as patient advocates against racism, 

discrimination and injustice. 

• Participate in the required implicit bias 

training. While this will be a part of the 

next license renewal, it will also expand 

knowledge on this subject. 

• Assume the responsibility for recognizing 

your own implicit biases. 

• Commit to treat all patients equally 

regardless of their race, ethnicity, 

economic status, sexual identity, or 

gender. 


• Become an advocate for all patients, for 

issues of diversity, equity and inclusion. 

As nurses it is our duty to uphold the values 

and mission of the ANA-Michigan by 

treating all patients equally and fairly. 

REFERENCES: 

Michigan.gov. Michigan Data, Cases by 

Demographic Characteristics, Mich. 

Coronavirus, https://www.michigan.gov/ 

coronavirus/0,9753,7-406-98163_98173---,00. 

html, (last visited July 5, 2020). 

Sutin, A., Stephan, Y. & Terracciano, A. (2016). 

Perceived discrimination and personality 

development in adulthood. Developmental 

Psychology, 52(1), 155-163. doi: 10.1037/ 

dev000069 American Nurses Association (ANA) 

(2018). Position statement on The Nurse’s 

Role in Addressing Discrimination: Protecting 

and Promoting Inclusive Strategies in Practice 

Settings, Policy, and Advocacy. Found at: https:// 

www.nursingworld.org/~4ab207/globalassets/ 

practiceandpolicy/nursing-excellence/ 

ana-position-statements/social-causes-andhealth-care/the-nurses-role-in-addressingdiscrimination.pdf 

Center for Disease Control & Prevention. 

COVIDView, A Weekly Surveillance Summary of 

U.S. COVID-19 Activity, (July 5, 2020). https:// 

www.cdc.gov/ coronavirus/2019-ncov/coviddata/covidview/index. 

html, (last visited July 5, 

2020). 

Oppel, R.A., et al., The Fullest Look Yet at the 

Racial Inequity of the Coronavirus, N.Y. TIMES 

(Jul. 5, 2020), https://www.nytimes.com/ 

interactive/2020/07/05/us/coronavirus-latinosafrican-americans-cdc-data.html. 

William J. Hall , et al., Implicit Racial/Ethnic 

Bias Among Health Care Professionals and Its 

Influence on Health Care Outcomes: A Systematic 

Review, 105 AM. J. PUBLIC HEALTH 2588 (Dec. 

2015), https://www. ncbi.nlm.nih.gov/pmc/ 

articles/PMC4638275/#bib1. 

85

Id. (observing that “Non-Hispanic American 

Indian or Alaska Native persons have an ageadjusted 

hospitalization rate approximately 5.7 

times that of non-Hispanic White persons.”) 

CDC Health Disparities and Inequalities Report 

– United States, 2013, 62 MNWR (Supp. 3) 1, 

1-187 (2013), https://www.cdc.gov/mmwr/ 

pdf/other/ su6203.pdf. Id. at 157-160. 

The Heart Attack Gender Gap, U. EDINBURGH: 

EDINBURGH FRIENDS (Oct. 29, 2019), 

https://www.ed.ac.uk/edinburgh-friends/ 

supplements/the-heart-attack-gender-gap. 

Deadly Delivery: The Maternal Health Crisis in 

the USA, AMNESTY INT’L. (May 7, 2011),https:// 

www.amnestyusa.org/reports/deadly- deliverythe-maternal-health-care-crisis-in-the-usa/. 

Agency For Healthcare Res. And Quality, U.S. 

Dep’t Of Health And Human Serv., Pub No. 14- 

0006, National Healthcare Disparities Rep. 

(2013). 

FitzGerald C, Hurst S. (2017). Implicit bias in 

healthcare professionals: a systematic review. 

BMC Med Ethics. 2017 Mar 1;18(1):19. doi: 

10.1186/s12910- 017-0179-8. PMID: 28249596; 

PMCID: PMC5333436. 


Jefferson, T. (1776). The Declaration of 

Independence, preamble. Retrieved from 

https://etc.usf.edu/ lit2go/133/historicamerican-documents/4957/the- 

declaration-ofindependence/ 

American Nurses Association. Mission Statement. 

https://www.nursingworld.org/ana/about-ana/ 

Probst, J. C., Zahnd, W. E., Hung, P., Eberth, J. 

M., Crouch, E. L., & Merrell, M. A. (2020). Rural- 

Urban Mortality Disparities: Variations Across 

Causes of Death and Race/Ethnicity, 2013–2017. 

American Journal of Public Health, 110(9), 

1325– 1327. https://doi-org.proxy.lib.umich. 

edu/10.2105/ AJPH.2020.305703 

Office of Disease Prevention and Health 

Promotion (ODPHP). (internet accessed 

11/02/2020). Disparities. Healthy People 2020. 

U.S. Department of Health and Human Services: 

Washington, DC. https://www.healthypeople. 

gov/2020/about/foundation-health- measures/ 

Disparities#6 

86



SAFE NURSE STAFFING TO IMPROVE QUALITY OF CARE 

It is the position of the ANA-Michigan that: 

1. Optimal nurse staffing is essential for quality and safe patient care in all health care 

settings. 

2. Determination of optimal nurse staffing requires a framework and policies that inform 

organizational decision making through analysis of the many factors that impact the 

delivery of safe patient care. 

3. Optimal nurse staffing is a complex determination and cannot be achieved through 

application of simple patient to nurse ratios. 

4. Safe nurse staffing models should be selected that most closely match the characteristics 

of the institution and include active and substantive input from the nurses who are closest 

to patient care. 

Background 

Medical errors are now the third leading cause of 

death in the United States (US). The persistent 

nature of medical errors is documented in 

the Institute of Medicine (IOM) report, To Err 

Is Human, which pointed to nearly 100,000 

preventable deaths in US hospitals annually 

(IOM, 1999). This work shaped decades of 

research with focus on patient safety. Nurses 

are the largest clinical group of providers in 

hospitals and other health care settings; thus, 

nurses’ impact on patient safety is significant. 

A large body of evidence exists documenting 

the relationship between nursing care, nurse 

staffing, and patient safety. Risks associated 

with suboptimal professional nurse staffing in 

the patient care setting include medication 

errors, compromised ability to “rescue” patients 

at risk for death, increased incidence of patient 

falls, hospital-acquired pressure ulcers, physical 

restraint use, and missed care. 

87 

Optimal nurse staffing is a complex process 

not being amenable to simple division or nurse 

patient ratios; straightforward ratios do not 

result in safe care. Moving toward a professional 

model that empowers registered nurse (RN) 

decision-making regarding their practice requires 

a framework focused on the analysis of multiple 

factors affecting patient care delivery. To create 

a work environment that allows professional RNs 

to meet the demands and complexity of patient 

care, sufficient professional nursing staffing care 

models are crucial to the delivery of high quality 

safe patient care. Shifting the nursing culture 

towards a professional model that empowers 

RNs with decision-making involvement and 

includes a framework for organizations’ decision 

making about staffing based on the analysis of 

multiple factors affecting patient care versus 

a one-dimensional standardized nurse-patient 

ratios approach is vital to “ensuring the right 

staff are in the right place at the right time” 

(Bolvin, 2017, p. 31). Harmonious with the 

American Nurses Association (ANA) position, ANA- 

MI is committed to creating dynamic solutions

that support context dependent, optimal 

nurse staffing necessary to meet the needs of 

healthcare recipients. 

This paper presents the outcomes evidence about 

recent approaches to nurse staffing and identifies 

the principles, concepts, and framework for 

determining optimal nurse staffing for safe 

patient care. While the referenced studies 

on safe nurse staffing are hospital-based, the 

principles and methods may also be applied to 

nurse staffing in other health care settings. 

Evidence 

The impasse between nurses and administrators 

about the solution to the complex issue of 

ensuring the delivery of safe care within the 

context of increasing patient acuity and fiscal 

constraints of hospitals has moved the issue of 

adequate staffing to the political arena (Hertel, 

2012). In 2004, nurse staffing took center 

stage when California became the first state to 

mandate nurse-to-patient ratios in acute care 

settings. By 2009, 14 states had enacted nurse 

staffing legislation and, as of September 2010, 

24 states have enacted or proposed legislation to 

mandate staffing ratios, staffing acuity systems, 

or staffing plans and committees (Douglas, 2010). 

Subsequent studies examining the relationship 

between mandatory staffing ratios and nurse 

satisfaction and patient safety and outcomes 

have demonstrated mixed results (Aiken et al., 

2010; Bolton, et al., 2007; Hertel, 2012) 

Research on nurse staffing ratios’ impact on 

patient safety has demonstrated higher nurse 

to patient ratios are associated with decreased 

mortality rates, fewer failure to rescue events, 

and lower hospital–acquired pneumonia rates 

(Douglas, 2010). Mandated ratios in California 

were associated with lower mortality and better 

nurse retention; 74% of nurses reported they felt 

the quality of care had improved since mandated 

ratios (Aiken et al., 2010). 

Conversely, individual studies and systematic 

reviews have reported difficulty in consistently 

detecting statistically significant associated 

improvements in a variety of nurse-sensitive 

patient outcomes with increased nurse staffing 


88 

(Hickam et al., 2003; Kane, Shamliyan, Mueller, 

Duval, & Wilt, 2007; Lake & Chung, 2006; Lang 

et al., 2004; Seago,2001: all as cited in Bolton 

et al., 2007). In a large-scale study, Bolton and 

colleagues (2007) examined patient outcomes 

from 2004 to 2006 in 185 hospitals in California 

compared to 2002 (pre-mandated staffing ratios) 

and found no statistical significance in the 

association between increased nurse staffing and 

key indicators of falls, hospital-acquired pressure 

ulcers, and restraint use rates (Bolton et al., 

2007). The inconsistency in outcomes associated 

with increased nurse staffing underscores the 

complexity of determining optimal staffing. 

A survey of administrators about strategies 

to accommodate mandated ratios lends to 

potential insight about why mandated ratios 

do not consistently result in improved patient 

safety and outcome measures. Respondents 

reported ancillary support staff layoffs (thus 

shifting non-RN work to the professional nurse) 

and use of contingent nurses to provide break 

coverage; both strategies could have a negative 

impact on patient safety and continuity of care 

(Douglas, 2010). Similarly, Bolton and colleagues 

(2007) found that with mandated staffing ratios 

came a change in staff mix with a reduction in 

care provided by LPN and other non-licensed 

staff, suggesting that administration leaders 

used RN hours to meet the regulatory staffing 

requirements. These approaches raise concerns 

about the unintended consequence of negating 

the potential positive impact of mandated higher 

RN to patient ratios by 1) effectively reducing RN 

time to attend to RN activities and 2) increasing 

the risk for mistakes related to the potential 

for communication errors during handoffs to 

contingent nurses along with variability of the 

skills and competencies of contingent nurses in 

unfamiliar settings. 

Definition of Safe Staffing, 

Core Components and Staffing Models 

Definitions 

The ANA defines staffing as … “a match of 

registered nurse expertise with the needs of the 

recipient of nursing care services in the context

of the practice setting and situation“(ANA, 2012, 

p. 6). Staffing is done in the present – day to day 

and sometimes shift to shift. Staffing work can 

be centralized (one department is responsible 

for staffing all the units) or decentralized 

(units manage their own staffing needs) or a 

combination of both. 

Core Components 

ANA Core Components of Nurse Staffing: 

1. All settings should have well-developed 

staffing guidelines with measurable nursesensitive 

outcomes specific to that setting 

and healthcare consumer population, which 

are used as evidence to guide daily staffing. 

2. RNs are full partners working with other 

healthcare professionals in collaborative, 

interdisciplinary partnerships. 

3. RNs, including direct care nurses, must have 

a substantive and active role in staffing 

decisions to ensure the necessary time with 

patients to meet care needs and overall 

nursing responsibilities. 

4. Staffing needs must be determined based on 

an analysis of healthcare consumer status 

(e.g., degree of stability, intensity, and 

acuity) and the environment in which the 

care is provided. Additional considerations 

include professional characteristics, skill 

set, and mix of the staff and previous staffing 

patterns that have been shown to improve 

outcomes. 

5. Appropriate nurse staffing should be based 

on allocating the appropriate number of 

competent practitioners to a care situation, 

pursuing quality of care indices, meeting 

consumer-centered and organizational 

outcomes, meeting federal and state laws 

and regulations, and attending to a safe, 

quality work environment. 

6. Cost-effectiveness is an important 

consideration in delivery of safe, quality 

care. 


89 

7. Reimbursement structure should not 

influence nurse staffing patterns or the level 

of care provided. 

Staffing Models 

Shortcomings in current RN staffing models 

present opportunities for improvements that 

benefit patients, nurses, and healthcare 

organizations. No single staffing model is ideal 

in all care settings or situations. Staffing must 

be adjusted according to patient care needs 

within a specific unit or department. Fixed or 

rigid models do not provide flexibility essential 

to adapt to rapid and fluid changes in acute care 

environments. 

There is a difference between staffing and 

scheduling. Schedules are planning documents 

that are future focused. Factors that affect a 

schedule include: historical census for a time 

period, the surgical schedule, and seasonal 

or predictable issues such as the flu season. 

Schedules must also accommodate vacations, 

maternity leaves, staff illness and institutional 

policies. 

Various staffing models are used in healthcare 

settings. Three models follow; each has 

advantages and disadvantages. 

1. Budget Based Staffing: the number of nurses 

is determined according to nursing hours 

per patient days. Total patient days are the 

average number of patients on a particular 

unit for a 24-hour period. Nursing hours refers 

to the total number of hours nurses work on 

that unit for a specific amount of time. This 

model does not take into consideration the 

actual number of patients, the “churn” in 

patients – admissions, discharges, transfers 

in 24 hours, or patient acuity. 

2. Staffing by Nurse to Patient Ratios: This 

model dictates the number of patients one 

nurse can care for during a designated period 

of time. It does not take into consideration 

other unit staff such as CNA’s, housekeeping, 

unit clerks, etc. Also, it doesn’t take into 

account patient acuity or nurse driven 

care decisions. This model may also affect

patient throughput from areas such as the 

Emergency Department, Labor and Delivery, 

and the ICUs. 

3. Staffing by Patient Acuity: This model 

considers the acuity or complexity of each 

patient, which is often determined by the 

number of tasks and amount of time to 

complete them. Rather, this model should 

consider the full scope of nursing practice 

and time needed to maintain standards of 

care. This complex model also needs to 

consider individual patient characteristics 

such as age, diagnosis, comorbidities, 

socioeconomic status, cultural and family 

issues, and severity of illness. 

References 

Aiken, L. H., Sloane, D. M., Cimiotti, J. P., 

Clarke, S. P., Flynn, L., Seago, J. A., . . . & 

Smith, H. L. (2010). Implications of the California 

nurse staffing mandate for other states. Health 

services research, 45(4), 904-921. 

American Nurses Association. (2012). Principles 

for nurse staffing (2nd ed.). Silver Spring, 

MD: Nursesbooks.org. Retrieved from http:// 

www.nursesbooks.org/ebooks/download/ANA_ 

Principles_Staffing.pdf 

American Nurses Association. (2015). Optimal 

nurse staffing to improve quality of care and 

patient outcomes. Retrieved from http:// 

www.nursingworld.org/DocumentVault/ 

NursingPractice/Executive-Summary.pdf 


Bolvin, J. 2017) CNOs and CFOs partner to reap 

benefits of acuity-based staffing. American Nurse 

Today 12(9), 30-32. 

Buerhaus, P. I. (2009). Avoiding mandatory 

hospital nurse staffing ratios: An economic 

commentary. Nursing Outlook, 57(2), 107-112. 

Bolton, L. B., Aydin, C. E., Donaldson, N., Storer 

Brown, D., Sandhu, M., Fridman, M., & Udin 

Aronow, H. (2007). Mandated nurse staffing 

ratios in California: A comparison of staffing 

and nursing-sensitive outcomes pre-and postregulation. 

Policy, Politics, & Nursing Practice, 

8(4), 238-250. 

Douglas, K. (2010). Ratios-If it were only that 

easy. Nursing Economics, 28(2), 119-125. 

Hertel, R. (2012). Regulating patient staffing: 

A complex issue. Academy of Medical-Surgical 

Nursing, 21(1), 3-7. 

Institute of Medicine (IOM). (1999). To err is 

human. Washington, DC: National Academies 

Press. 

Mensik, J. (2014). What every nurse should know 

about staffing. American Nurse Today, 9(2), 1-11. 

Approved: December 15, 2017 

by the ANA-Michigan Board of Directors 

To be reviewed: December 14, 2018 

Contact 

www.ana-michigan.org 

nurse@ana-michigan.org 

(517) 325-5306 

90



ENHANCED NURSE LICENSURE COMPACT 

On April 13, 2018, the ANA-MI Board of Directors 

voted to support the Enhanced Nurse Licensure 

Compact, that would permit Michigan to join the 

current 30 states who are part of the “enhanced 

nurse licensure compact”. The Public Policy 

Council studied and discussed in-depth strengths 

and weaknesses. The Council and Board 

members held a “learning session” on the eNLC 

with a presentation by a representative from 

the National Council of State Boards of Nursing. 

The Council recommended SUPPORT with the 

provision that the MI Department of Licensing 

and Regulatory Affairs (MI-DLARA) does not pass 

on the costs of implementation of the eNLC 

through another increase in the nurse licensure 

fees. The legislature doubled Michigan nurse 

licensure renewal fees in 2017. 

WHAT IS THE NURSE LICENSURE COMPACT? 

The NLC allows a registered nurse (RN) or 

licensed practical nurse (LPN) to possess a 

multistate license, which permits practice 

in both their home state and other compact 

states, while maintaining the primary state of 

residence. Unless the nurse is under discipline or 

restriction, a multistate license permits practice 

(physically or telephonically/electronically) 

across state lines in all NLC states. 

WHAT IS THE RATIONALE FOR ANA-MI’s SUPPORT 

OF eNLC? 

The Council first considered: 

Is this bill consistent with the tenets of ANA-MI’s 

Policy Platform? 

FACTORS INFLUENCING SUPPORT FOR THE BILL 

• There is an increase in nursing practice and 

patient care access across state lines (care 

coordination, occupational health, etc.) 

91 

• Regional or national health crises require 

rapid deployment of nurses to areas of need. 

• There is need to move nurses with highly 

specialized skills to states with medical 

crises for patient populations. A recent 

example is the number of Michigan residents 

who required specialized care available 

only through nurses employed in multiple 

states across a national healthcare system 

who were experienced in this specialized 

care. This care was related to contaminated 

injections prepared at a compounding 

pharmacy in Massachusetts 

• There are increasing national and 

international infectious disease outbreaks 

that require movement of nurses to meet 

patient and community needs (Ebola, flu, 

etc.). 

• New nurse graduates will have more 

flexibility with a Michigan “home state” 

license if there are not sufficient available 

nursing positions in Michigan. 

• Nursing faculty and students are sometimes 

engaged in clinical placements across state 

lines. 

• Nurses move across states to support family 

care needs. These nurses may desire to 

continue nursing employment. They may be 

delayed in their ability to obtain a new state 

license. 

FACTORS INFLUENCING CHALLENGES OF THE 

BILL 

• Nurses are responsible to know multiple 

state requirements for ongoing licensure. 

For example, Florida requires continuing 

education for infection control.

• Nurses must be knowledgeable about and 

abide by varying state laws and regulations. 

• In cases of nurses providing care through 

technology (telephonic, web site, etc.), it is 

not clear in which state the nursing practice 

is located (the state of the nurse or the state 

of the patient receiving care). There does 

not appear to be ongoing monitoring, data 

collection, or an evaluation plan to inform 

policies related to eNLC. 

• eNLC membership does not provide assurance 

that nurses will in fact be knowledgeable of 

laws that pertain to nursing practice within 

those jurisdictions prior to engaging in 

practice in member states. 


OTHER INFORMATION 

• The Michigan Organization of Nurse Leaders 

(MONL) who are predominately hospital chief 

nursing officers are in support of HB4938. 

• Rep. Whiteford is awaiting ANA-MI’s position 

and a discussion prior to scheduling a House 

Health Policy Committee hearing. 

• If the bill is passed, Michigan nursing 

education programs will need to include 

information about nurse licensure compacts 

and, as importantly, prepare faculty with 

this information for teaching. 

• Legislators and organizations such as the 

AARP are interested in knowing ANA-MI’s 

position on this bill. 

NEED MORE INFORMATION? 

• For more information on the enhanced NLC, 

visit nursecompact@ncsbn.org 

• For a current map of eNLC states, visit www. 

nursecompact.com 

92



“NURSE” TITLE PROTECTION 

Written by Susan Wiers, DNP and Public Policy Council 

The 173,000 plus Registered Nurses in Michigan 

are essential to the health and safety of the state’s 

residents. 1 The title “Nurse” is not included 

in the list of protected titles in the Michigan 

Public Health Code (MPHC). Thus, the residents 

of Michigan cannot be assured that individuals 

calling themselves nurses possess the education 

and competencies required for licensure and 

safe practice. 2 At least 39 states have adopted 

language in their nurse practice acts restricting 

use of the title “Nurse” or language implying 

an individual is a nurse who is educated and 

licensed as authorized by the state. 3 Despite 

Recommendation 2a of the Michigan Department 

of Community Health Task Force on Nursing 

Practice that “Nurse” be included as a protected 

title in the MPHC and the Administrative Rules of 

the Michigan Board of Nursing, Michigan remains 

in the minority of states without title protection 

for ‘Nurse.” 2,3 

Nursing has been ranked as the most respected, 

ethical profession in Gallup polls for 16 

consecutive years since 2002. 4 This trust in 

nursing must be safeguarded from individuals 

and groups who misrepresent themselves as 

nurses thus threatening safety and health of the 

public. 5 Tolerating overt use of the title “Nurse” 

or misleading titles implying individuals other 

than those who have met the requirements for 

licensure from state boards of nursing lends 

itself to exploitation of vulnerable individuals 

and erosion of nursing’s well-earned public 

reputation and confidence. 

Nursing licensure and title protection are 

regulated with the primary purpose of protecting 

the public. 6 Nursing licensure requires specialized 

knowledge and independent decision-making 

and mandates a minimum level of demonstrated 

and documented competency for a specific 

scope of practice. 2,6 Title protection assures that 

individuals without the minimum education and 

competency for licensure cannot misrepresent 

themselves to the public as nurses. 

The title “Nurse” should be protected in the 

MPHC consistent with the titles “Physician”, 

“Dentist”, “Chiropractor”, and “Social Worker”. 2 

Individuals not licensed and registered by the 

state can and do use the title “Nurse.” 2 Legally 

tolerated arbitrary use of the title “Nurse” 

by those who do not possess the minimum 

education and competencies for licensure in the 

State of Michigan confuses public and places it 

at risk. 2 Just as has been done in the majority of 

other states, the title “Nurse” must be defined 

and protected in the MPHC so that patients and 

families can be assured that their nurse possesses 

legitimate education and competencies to safely 

care for them. 2 

93

References 

1. Michigan Public Health Institute. Michigan 

Annual Nurse Survey Project. Okemos, 

Michigan June 2018. 

2. Michigan Department of Community Health 

Task Force on Nursing Pratice. Final Report 

and Recommendations. 2012. 

3. American Nurses Association. Title “Nurse” 

Protection. December 10, 2013; https:// 

www.nursingworld.org/practice-policy/ 

advocacy/state/title-nurse-protection/. 

4. Brenan M. Nurses keep healthy lead as most 

honest, ethical profession. 2017; https:// 

news.gallup.com/poll/224639/nurses-keephealthy-lead-honestethicalprofession.aspx. 

5. McElroy S. Nurse Title Protection Bill passed 

in the 2008 West Virginia Legislative Session. 

Maryland Nurse. 2008;10(1):14-14. 


6. Flook DM. The professional nurse and 

regulation. Journal of perianesthesia 

nursing. 2003;18(3):160-167. 

7. Missouri State Board of Nursing. Nursing 

Practice Act and Rules. In. Jefferson City, 

MO2017. 

8. Services NDoHaH. Statues Relating to Nurse 

Practice Act. In: Unit DoPHL, ed. Lincoln, 

NE2017. 

9. New York State Education Law. Article 139, 

Nursing. 2010; http://www.op.nysed.gov/ 

prof/nurse/article139.htm. 

Approved: December 14, 2018 by the 

ANA-Michigan Board of Directors 

Contact 

www.ana-michigan.org 

nurse@ana-michigan.org 

(517) 325-5306 

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Since this year, ANA-Michigan couldn't celebrate the 2020 award winners in person, we wanted to 

take the opportunity to recognize them during Nurses Month, and even more fitting, Recognition 

Week. 

Please be sure to click on each award winner’s link to learn more about them or see included award 

winner spotlights. 

Dorthea Milbrandt Nurse Leader Award 

Kathy Stutzman, MSN, RN-BC, CCRN-K 

The Dorothea Milbrandt Nurse Leader Award has been created to honor nurses 

who have demonstrated excellence in building successful mentoring relationships 

with other nurses and/or nursing students. This award is presented on behalf of 

the late Dorothea Milbrandt, RN, MPS, MSN, who had an important and lasting 

impact on nursing in Michigan for nearly 40 years. 

View Kathy's Spotlight 

Lifetime Achievement Award 

Sally Decker, PhD, RN, CNE, CHSE 

The Lifetime Achievement Award recognizes an individual’s profound impact and 

longstanding commitment to nursing. 

View Sally's Spotlight 

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Public Policy Advocate Award 

Lynne Harris, MSN, RN 

The Public Policy Advocate Award accords a nurse who has demonstrated success 

in using public policy and advocacy as strategies in advancing nursing in Michigan. 

View Lynne's Spotlight 

Friend of Nursing Award 

Representative Mary Whiteford 

The Friend of Nursing Award is conferred on a non-nurse who has rendered 

valuable assistance to the nursing profession. Their contributions and assistance 

are of statewide significance to nursing. 

Future Nurse Leader Award 

Cierra Scott, BSN, RN 

The Future Nurse Leader Award is given yearly to a recent (within two years of 

graduation) nursing school (AD, BSN, Diploma) graduate who demonstrates great 

potential for leadership in the profession. The candidate for this award must 

be nominated by a dean and/or faculty member and must indicate his or her 

intention to reside in Michigan for the next year. 

View Cierra's Spotlight 

Exceptional Promise Award 

Myesha Hollins, CCHT, SN 

Exceptional Promise Award aims to spotlight aspiring nursing students for their 

skills today and promise for tomorrow. 

ANA-Michigan will recognize distinguished nursing students who exemplify 

leadership and achievement in their community and their scholarly efforts. The 

purpose is intended to celebrate and encourage exemplar dedication to the 

nursing profession. 

View Myesha's Spotlight 

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Marissa Loud, MSN, RN, RNC-NIC 







View Marissa's Spotlight 


Dominique Mones, SN 







View Dominique's Spotlight 


Shantiniqua Collins, BS, SN 







View Shantiniqua's Spotlight 

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Hyder Mirza, BSN, RN 







View Hyder's Spotlight 


Lesley Telfor, BSN, RN 







View Lesley's Spotlight 

Innovation Award 

Henry Ford Health System 

Innovation: Human Trafficking Screen Tool 

Created by: Danielle Bastien 

Innovation Award will identify a health system or individual hospital for an 

innovative practice/ approach which improves nursing and patient outcomes. 

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ANA-Michigan - 2020 Annual Book of Reports

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