ANA-Michigan - 2020 Annual Book of Reports
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<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
Table <strong>of</strong> Contents<br />
<strong>ANA</strong>-<strong>Michigan</strong> Board <strong>of</strong> Directors. ............................................2<br />
Newly Appointed BOD Member Gerry Infante. ....................................3<br />
<strong>2020</strong> Strategic Plan. .....................................................5<br />
Meeting, Rules and Parliamentary Procedure. ....................................7<br />
<strong>Annual</strong> Meeting Agenda. ................................................. 11<br />
2019 Minutes ........................................................ 13<br />
President's Report. ..................................................... 16<br />
<strong>2020</strong> Year End Financial Statements. ......................................... 18<br />
2021 Budget ......................................................... 23<br />
Executive Director's Report ............................................... 25<br />
MHSA, Advocacy and Legislative Report ....................................... 27<br />
Committee Report: Nursing and Health Policy. .................................. 29<br />
Committee Report: Nursing Practice. ........................................ 30<br />
Committee Report: Education. ............................................ 31<br />
Committee Report: COVID-19 Task Force ..................................... 33<br />
Committee Report: Leadership Academy Task Force .............................. 34<br />
<strong>ANA</strong> Membership Assembly Representative Report ................................ 35<br />
Leadership Candidate Bios. ............................................... 37<br />
Bylaw Amendments. .................................................... 57<br />
Champions for Nursing Partnership Program . ................................... 64<br />
<strong>ANA</strong>-<strong>Michigan</strong> Leaders serving on SOM LARA Implicit Bias Training Rules Advisory<br />
Workgroup & Subgroups ................................................ 68<br />
<strong>2020</strong> COVID-19 Pandemic. ................................................ 70<br />
COVID-19 Training Program for K-12 Schools .................................... 71<br />
Appendix<br />
<strong>ANA</strong>-<strong>Michigan</strong> Position Statements<br />
Policy on Position Statements. ........................................... 74<br />
Moral Distress. ...................................................... 76<br />
Preventing Workplace Violence in Healthcare Settings. ........................... 78<br />
Telehealth & Connected Health. .......................................... 81<br />
Mitigating Implicit Biases to Reduce Disparities in Patient Outcomes . ................. 84<br />
Safe Nurse Staffing to Improve Quality <strong>of</strong> Care. ................................ 87<br />
Enhanced Nurse Licensure Compact. ....................................... 91<br />
“Nurse” Title Protection. ............................................... 93<br />
<strong>2020</strong> Nurse Award Winners. ............................................... 95<br />
<strong>ANA</strong>-<strong>Michigan</strong> Bylaws Current. ............................................ 109<br />
1<br />
Printed and published for <strong>ANA</strong>-<strong>Michigan</strong> by:<br />
Arthur L. Davis Publishing Agency<br />
P.O. Box 216 | Cedar Falls, Iowa 50613<br />
(319) 277-2414
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
2
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
<strong>ANA</strong>-<strong>Michigan</strong> Board <strong>of</strong> Directors<br />
Newly-Licensed Director Appointed<br />
<strong>ANA</strong>-<strong>Michigan</strong> is honored to announce that Mr. Gerardo Infante, BSN, RN, has been appointed by the<br />
<strong>ANA</strong>-<strong>Michigan</strong> Board <strong>of</strong> Directors to fill the Newly-Licensed Director position. Mr. Infante will serve<br />
in this position until the spring <strong>of</strong> 2022.<br />
We are so excited that he has accepted this role and look forward to his enthusiasm, ideas and<br />
diverse cultural perspectives which will help advance our mission and to have him join us in the<br />
evolution <strong>of</strong> our amazing pr<strong>of</strong>ession.<br />
Per the Bylaws, the <strong>ANA</strong>-<strong>Michigan</strong> Board <strong>of</strong> Directors appointed Mr. Infante to serve in this position<br />
for the remaining term as the elected Newly-Licensed Director position was vacated by Megan<br />
Piotrowski.<br />
Gerardo O. Infante BSN, RN<br />
Gerardo has the honor <strong>of</strong> being the current President <strong>of</strong> the National Association<br />
<strong>of</strong> Hispanic Nurses <strong>Michigan</strong> Chapter (NAHN-MI) where he has served for the<br />
last four years. He has been actively participating in community events and<br />
research projects that benefit the Latino population in <strong>Michigan</strong>.<br />
Since January <strong>2020</strong> Gerardo is currently the charge nurse and clinical<br />
coordinator in a DaVita Dialysis Clinic in Monroe, <strong>Michigan</strong>. Prior to joining<br />
DaVita Dialysis, Gerardo was a nurse for CHASS (Community Health and Social<br />
Services) a FQHC in Detroit <strong>Michigan</strong>. He was part <strong>of</strong> a $1.5 Million grant from<br />
the U.S. Department <strong>of</strong> Health and Human Services Health Resources and<br />
Services Administration lead by the University <strong>of</strong> <strong>Michigan</strong> School <strong>of</strong> Nursing.<br />
The objective was to improve chronic care coordination for underrepresented and underserved<br />
populations utilizing bilingual-bicultural registered nurses serving as leaders to interdisciplinary<br />
teams. Gerardo is also part <strong>of</strong> the <strong>Michigan</strong> Nursing Action Coalition working on the “Nursing<br />
Workforce Diversity Project."<br />
He has also been apart <strong>of</strong> the “<strong>ANA</strong>-<strong>Michigan</strong> Networks <strong>of</strong> Support Virtual Meet-Ups" as a discussion<br />
moderator and thought leader, and participates on the Implicit Bias Training Rules Advisory Workgroup<br />
headed by LARA.<br />
Gerardo received his bachelor <strong>of</strong> science in nursing from American Sentinel University, Colorado,<br />
graduating Magna cum laude.<br />
His short nursing career has been dedicated to bringing culturally appropriate care to the Hispanic<br />
population.<br />
Dios te Bendiga / God Bless<br />
3
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
COLLEGE OF HEALTH & HUMAN SERVICES<br />
Nursing Programs:<br />
• RN to BSN - Debbie Gibson, RN to BSN Coordinator dkgibson@svsu.edu<br />
• BSN - Rachel Winter, HHS Advisor rmwinter@svsu.edu<br />
• MSN or Post Graduate Certificate Nurse Educator<br />
• MSN or Post Graduate Certificate Nurse Administrator<br />
• MSN or Post Graduate Certificate Primary Care Family Nurse Practitioner<br />
• Post Graduate Certificate for Psychiatric Mental Health Nurse Practitioner (APRNs only)<br />
• BSN to DNP (which includes Primary Care Family Nurse Practitioner)<br />
• MSN to DNP<br />
Contact - Dr. Cynthia Hupert, Graduate Coordinator cmhupert@svsu.edu<br />
4
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
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<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
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<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
Membership Meeting Rules and Parliamentary Procedure<br />
Meeting Rules<br />
Rule 1: Registered members must wear their<br />
name badges during the business session.<br />
All membership in good standing may<br />
vote.<br />
Rule 2: In making a motion or speaking to a<br />
question, a delegate shall move to the<br />
floor microphone, address the Chair,<br />
await recognition <strong>of</strong> the Chair, and give<br />
the delegate’s name and region.<br />
Rule 3: The correct form to use in making a<br />
motion is “I move that...”<br />
Rule 4: All motions and amendments should be<br />
written and signed by the maker <strong>of</strong> the<br />
motion or amendment and then given to<br />
the Chair.<br />
Rule 5: A member may not speak against her/his<br />
own motion, but may vote against it.<br />
Rule 6: No member shall speak more than once,<br />
or longer than three minutes, on the<br />
same question until all have spoken who<br />
wish to express and opinion.<br />
Rule 7: All reports and supplements to reports<br />
shall be written and shall not be read.<br />
Rule 8: Only currently paid members <strong>of</strong> the<br />
Association are entitled to vote at the<br />
polls upon verification <strong>of</strong> their current<br />
dues being in good standing according<br />
to the most current membership rosters<br />
provided to the tellers.<br />
Rule 9: The Association staff shall report the<br />
number <strong>of</strong> members registered after<br />
the opening ceremonies. Supplementary<br />
reports may be given later as the Chair<br />
may direct.<br />
Rule 10: A member should raise her/his hand to<br />
indicate she/he cannot hear.<br />
Rule 11: The member will act only on the<br />
resolves <strong>of</strong> a resolution. Questions <strong>of</strong><br />
clarification will be handled according<br />
to parliamentary procedure.<br />
Rule 12: All sessions <strong>of</strong> the <strong>Annual</strong> Business<br />
Meeting shall be open to the public<br />
unless the Chair declares an executive<br />
question.<br />
Parliamentary Information<br />
Robert’s Rules <strong>of</strong> Order, Newly Revised is the<br />
parliamentary authority that shall govern the<br />
<strong>ANA</strong>-MI Business Meeting. The chair, as the<br />
presiding <strong>of</strong>ficer, rules on all matters relative<br />
to parliamentary law and procedures. The<br />
Parliamentarian serves only in an advisory<br />
capacity to the presiding <strong>of</strong>ficer and members.<br />
Member participation in the business session is<br />
governed by the standing rules.<br />
The motions that follow are defined in terms <strong>of</strong><br />
action a delegate may desire to propose. Rules<br />
governing these motions are listed in Table 1.<br />
A main motion introduces a subject to the<br />
Business Meeting for consideration and is stated:<br />
“I move that....”<br />
FILLING OUT A MOTION FORM<br />
Motion forms are at the registration table<br />
and will be available on tables during the<br />
Business Meeting. Please fill them out<br />
completely before bringing forward a motion<br />
for consideration at the Business Meeting for<br />
discussion.<br />
You must sign your name and Region and<br />
get the signature <strong>of</strong> a person to second the<br />
motion before bringing it up.<br />
An amendment (primary) is a motion to modify<br />
the working <strong>of</strong> a motion. The motion to amend<br />
may be made in one <strong>of</strong> the following forms,<br />
determined by the action desired: “I move to<br />
amend by....”<br />
7
• striking (word(s), phrase, paragraph).”<br />
• inserting (word(s), phrase, paragraph).”<br />
• adding (word(s), phrase, or paragraph at the<br />
end <strong>of</strong> the motion).”<br />
• substituting (paragraph or entire text <strong>of</strong><br />
a resolution or main motion and inserting<br />
another that is germane).<br />
An amendment to an amendment is a motion to<br />
modify the wording <strong>of</strong> the proposed amendment<br />
and is made as follows: “I move to amend the<br />
amendment by....” The same forms for making<br />
an amendment are applicable for making a<br />
secondary amendment.<br />
The motion to commit or refer is generally<br />
used to send a pending motion (also called “the<br />
question”) to a small group <strong>of</strong> selected persons<br />
- a committee, board, or cabinet, for example<br />
- so that the question may be studied and put<br />
in better condition for the assembly to consider.<br />
The motion is stated: “I move to commit the<br />
question to..........for further study.”<br />
The motion to close a debate (previous question),<br />
if seconded and approved by a two-thirds vote,<br />
stops discussion on the pending question and is<br />
stated: “I move the previous question.”<br />
A division <strong>of</strong> the assembly may be called by any<br />
member if the chair’s decision on a voice vote<br />
is in question. The member proceeds to the<br />
microphone and states: “I call for a division <strong>of</strong><br />
the house.” The chair then takes a standing or<br />
roll call vote.<br />
A division <strong>of</strong> the question may be called when<br />
a pending motion relates to a single subject but<br />
contains several parts, each capable <strong>of</strong> standing<br />
as a complete proposition. The parts can be<br />
separated, and each considered and voted on as<br />
a distinct question. The motion is stated: “I move<br />
to divide the question........as follows....”<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
The motion to reconsider enables a majority<br />
<strong>of</strong> the assembly to bring back for further<br />
consideration a motion that has already been<br />
voted. The purpose <strong>of</strong> reconsidering a vote<br />
is to permit correction <strong>of</strong> hasty, ill-advised,<br />
or erroneous action, or to consider added<br />
information or a situation that has changed since<br />
the vote was taken. (Note exception on the Table<br />
-Rules Governing Motions)<br />
Parliamentary inquiry is a question directed to<br />
the presiding <strong>of</strong>ficer to obtain information on<br />
parliamentary law or the rules <strong>of</strong> the organization<br />
as relevant to the business at hand. A member<br />
addresses the chair and states: “I rise to a (point)<br />
<strong>of</strong> parliamentary inquiry.”<br />
Point <strong>of</strong> information is a request, directed to<br />
the chair or through the chair to another <strong>of</strong>ficer<br />
or member for information relevant to the<br />
business and hand. The request is not related<br />
to parliamentary procedure. The member<br />
addresses the chair and states: “I rise to a point<br />
<strong>of</strong> information.”<br />
The motion to appeal the decision <strong>of</strong> the chair<br />
is made at the time the chair makes a ruling. If<br />
it is made by a member and seconded by another<br />
member, the question is taken from the chair<br />
and vested in the voting body for a <strong>ANA</strong>-<strong>Michigan</strong><br />
decision. The motion is stated: “I move to appeal<br />
the decision <strong>of</strong> the chair.”<br />
Before a member can make a motion or address<br />
the assembly on any question, it is necessary that<br />
he or she obtain the floor through recognition by<br />
the presiding <strong>of</strong>ficer. The member must:<br />
• rise and proceed to the microphone.<br />
• address the chair by saying, “Madam<br />
Chairperson”<br />
• await recognition<br />
• give name and region<br />
• state immediately the reason for rising<br />
8
Interrupt<br />
Speaker<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
Rules Governing Motions<br />
Recognized by<br />
Chair<br />
Requires a<br />
Second<br />
Debated<br />
Main motion NO YES YES YES Majority<br />
Amendment NO YES YES YES Majority<br />
Amendment to NO YES YES YES Majority<br />
amendment<br />
Limit Debate NO YES YES NO Two-thirds<br />
Close debate NO YES YES NO Two-thirds<br />
(previous<br />
quest.)<br />
Divide the NO YES YES NO Majority<br />
Question<br />
Reconsider NO YES YES YES Majority*<br />
Point <strong>of</strong> YES NO NO NO Chair Decides<br />
parliamentary<br />
inquiry<br />
Point <strong>of</strong><br />
Information<br />
YES NO NO NO Chair Decides<br />
*Majority vote except when the motion being reconsidered required a two-thirds vote for its<br />
passage; then the motion to reconsider requires a two-thirds vote.<br />
Vote<br />
9
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
<strong>ANA</strong>-<strong>Michigan</strong> <strong>Annual</strong> Assembly Meeting<br />
(virtual)<br />
March 24, 2021 | 12:30-1:30 pm est | Zoom<br />
AGENDA<br />
Time Agenda Item Presenter<br />
12:30 Call to Order:<br />
• Roll Call <strong>of</strong> the Board <strong>of</strong> Directors<br />
• Roll Call <strong>of</strong> Membership<br />
• Declaration <strong>of</strong> Quorum<br />
• Review and Approval <strong>of</strong> the Agenda<br />
• <strong>Annual</strong> Assembly Meeting Minutes from<br />
March 1, 2019<br />
Julia Stocker Schneider,<br />
President<br />
12:35 Address from President Julia Stocker Schneider,<br />
President<br />
12:45 <strong>ANA</strong>-<strong>Michigan</strong> Financial Road Map Nancy Martin, Treasurer<br />
12:50 Address from Executive Director Tobi Lyon, Executive Director<br />
12:55 Proposed 2021 Bylaw Amendments<br />
• Amendment #1<br />
• Amendment #2<br />
• Amendment #3<br />
• Amendment #4<br />
1:05 Address from <strong>Michigan</strong> Nursing Students<br />
Association<br />
Vineta Mitchell, Chair Bylaws<br />
Committee<br />
Nicholas Cooper, MNSA<br />
President<br />
1:10 Membership Comment and Open Forum Julia Stocker Schneider,<br />
President<br />
1:15 Recognition <strong>of</strong> Outgoing Board Members<br />
• Nikeyia Davis, Secretary<br />
• Nancy Martin, Treasurer<br />
• Margaret Calarco, Director<br />
• Suzanne Keep, Director<br />
1:20 Teller’s Report<br />
• Secretary<br />
• Treasurer<br />
• Director (2)<br />
• Nominations Committee (2)<br />
• <strong>ANA</strong> Membership Assembly Representative<br />
Julia Stocker Schneider,<br />
President<br />
Carole Stacy, Chair<br />
Nominations Committee<br />
1:25 Announcements and Adjournment Julia Stocker Schneider,<br />
President<br />
11
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
MINUTES<br />
BOARD MEETING<br />
March 1, 2019, 8:30 a.m. – 9:22 a.m.<br />
GVSU L.V. Everhard Center Grand Rapids, MI<br />
Executive Board: Carole Stacy; Stacy Slater; Julia Stocker Schneider; Bridget Leonard;<br />
Directors:<br />
Lynne Harris; Suzanne Keep;<br />
Executive Director: Tobi Lyon Moore<br />
Excused:<br />
_____________________________________________________________________________________<br />
Peggy Ursuy; Kathy Dontje; Edith English<br />
8:30 Call the Meeting to Order<br />
President Stacy called the meeting to order at 0830.<br />
Roll Call<br />
Stacy: Present; Slater: Present; Leonard: Present; Julia Stocker Schneider: Present; Harris:<br />
Present; Keep: Present; Ursuy: Excused; Dontje: Excused; English: Excused; Moore: Present.<br />
President Stacy declared a quorum (36 members in attendance).<br />
Corrections or additions to the Agenda<br />
None Stated.<br />
Approval <strong>of</strong> Agenda<br />
Motion #1: Approval <strong>of</strong> Agenda<br />
Made by: Stocker Schneider.<br />
Agenda approved.<br />
No additional correction to October annual meeting minutes noted.<br />
Motion #3: Approve 10.26.2018 <strong>Annual</strong> meeting minutes.<br />
Made by L. Harris. PASSED<br />
_____________________________________________________________________________________<br />
8:33 President’s Message<br />
• 2019 Strategic Plan presented, pillars discussed<br />
• Policy influence- letter sent to Governor Whitmer regarding <strong>ANA</strong>-MI stance on nursing in MI<br />
• Task force to write <strong>ANA</strong>-MI statement, sent to membership expert to bring a grounded<br />
perspective,<br />
• Appointments to committee and state agencies discussed: Legislation, Policy, Education,<br />
Finance, and Practice.<br />
_____________________________________________________________________________________<br />
8:37 <strong>ANA</strong>- MI Financials<br />
• Treasurer Stacy Slater presented the financial statements.<br />
• Membership dues budget was $15413.67, in January took in $16,844.71<br />
• 1 month into operating budget $9843.74 was January net gain<br />
Motion #2: Accept <strong>ANA</strong>-MI January financials report as corrected<br />
Made by Klemczak. PASSED<br />
13
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
8:45 Introduction <strong>of</strong> MNSA Board<br />
• Megan Piotrowski, President <strong>of</strong> MNSA discussed goals:<br />
o Increase membership engagement to approximately 3000 members<br />
o Offer creative community service activities, Social media/new technology<br />
o Convention planning early and more advertising<br />
o Strategic plan and value to local chapters for members and nursing students<br />
o Relying on faculty to build connections and guide the way, working with and learning<br />
from <strong>ANA</strong>-MI<br />
_____________________________________________________________________________________<br />
08:48 Deborah Bach-Stante- Director <strong>of</strong> Nursing Office Policy<br />
• SB 111- Modifies allegation process, more requirements for the reporter and accused.<br />
More power to LARA and changes to Attorney General<br />
• New Administrative rules proposed, need a lot <strong>of</strong> education<br />
o 2018 033LR- Changes to nursing administrative role, clinical placement ratios put<br />
control at the site level, no prescribing number being made to be more flexible<br />
o 2019 024LR- Public Health code which changed license expiration date from 3/31 to<br />
date <strong>of</strong> license issue date now will be expiration. The electronic process still has<br />
glitches and the nurse is still responsible for renewal even if they do not receive<br />
notification <strong>of</strong> expiration<br />
• Nursing Licensure Survey- All nurses should receive, if link not received information is<br />
located in the last <strong>ANA</strong> publication<br />
• Enactment <strong>of</strong> Nurse Licensure Compacto<br />
LARA- panels <strong>of</strong> medical marijuana, applications being accepted for emergency rules<br />
r/t poisoning. Public hearing on 3/12/19<br />
• State Innovation Model- Blueprint for Medicaid database for Health Innovation for MDHHS<br />
can sign up, need provider language<br />
• Section 298 Merging <strong>of</strong> mental health and physical health. All nurses should be aware, info<br />
on the website and call for participation in community hearings.<br />
_____________________________________________________________________________________<br />
09:01 Recognition <strong>of</strong> Outgoing Board Members<br />
• Stacy Slater<br />
• Bridget Leonard<br />
• Lynne Harris<br />
• Suzanne Keep<br />
• Peggy Ursuy<br />
• Katherine Dontje<br />
• Edith English<br />
_____________________________________________________________________________________<br />
09:05 Teller’s Report<br />
• 2019 Election Results<br />
o Secretary- Nikeyia Davis<br />
o Treasurer- Stacy Slater<br />
o Director At Large (2 Year Term)- Margaret Calarco & Suzanne Keep<br />
o Director At Large (1 Year Term)- Bridget Leonard & Kathy Dontje<br />
o Newly Licensed Director- Andrea Corrie<br />
o Nominations Committee- 1 Year term: MaryLee Pakieser<br />
o Membership Assembly- Stacy Slater<br />
14
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
• Ballots will go out at the end <strong>of</strong> April to fill the (2) 2 year term positions for the Nominating<br />
Committee<br />
_____________________________________________________________________________________<br />
09:10 Membership Comments<br />
• MOTION #4: <strong>ANA</strong>-MI to joining the MI Coalition to Prevent Gun Violence for $100.00.<br />
Made by Myrna Holland/2nd Kathleen Birdsall. PASSED<br />
• Discussion on other areas where <strong>ANA</strong>-MI pays for membership to support<br />
• Committee membership<br />
o <strong>ANA</strong>-MI member<br />
o Consent to Serve, Board approves<br />
o Bylaws defines number <strong>of</strong> positions, usually 9<br />
o At end <strong>of</strong> the year, fall 2019, call to membership for 1-2 year terms, there are openings<br />
on various committees<br />
• <strong>2020</strong> Conference in the Spring, 1 day event around Leadership/Advocacy in Lansing<br />
• May 2019- 1 day meeting at Northern MI University in the Upper Peninsula to work with<br />
Education Committee to plan<br />
_____________________________________________________________________________________<br />
09:22 Adjournment<br />
Mission<br />
Advancing the nursing pr<strong>of</strong>ession in <strong>Michigan</strong>.<br />
Vision<br />
<strong>ANA</strong>-<strong>Michigan</strong> is a vital community <strong>of</strong> pr<strong>of</strong>essional nurses in <strong>Michigan</strong>. Together, we are the experts<br />
in nursing practice. Our strength is our solution-focused thought leadership, our long-term view <strong>of</strong><br />
the nursing pr<strong>of</strong>ession in a dynamic healthcare environment, and our impact on quality care and<br />
patient safety.<br />
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President’s Report<br />
Julia Stocker Schneider, PhD, RN, CNL<br />
It has been one year since I began my term as <strong>ANA</strong>-<strong>Michigan</strong> President, and what a<br />
year it has been! Our <strong>Annual</strong> Conference and Meeting was cancelled last March due<br />
to the onset <strong>of</strong> the COVID-19 pandemic, so our <strong>2020</strong> leadership transition occurred<br />
remotely. While we have missed seeing one another, <strong>ANA</strong>-<strong>Michigan</strong> shifted work<br />
very effectively to the virtual environment without missing a beat. Our organization<br />
has continued to support our membership and to address issues that have emerged<br />
during this highly visible and challenging year for nurses. Below are some highlights <strong>of</strong> the work we<br />
engaged in during <strong>2020</strong>:<br />
• COVID Support Strategies<br />
<strong>ANA</strong>-<strong>Michigan</strong>:<br />
o Initiated Networks <strong>of</strong> Support calls led by members to provide nurses with an opportunity<br />
to connect surrounding COVID pandemic experience, needs, and practice issues<br />
o Created a COVID-19 Task Force to examine the impact <strong>of</strong> the crisis on nursing practice<br />
and policy. The Task Force is planning to host a “Meeting <strong>of</strong> the Minds” with other<br />
nursing organizations in <strong>Michigan</strong> to enhance partnership and collaboration to support<br />
nurses’ well being<br />
o Participated in a study to examine PPE and mental health symptoms among nurses<br />
during the COVID pandemic https://journals.lww.com/joem/Fulltext/<strong>2020</strong>/11000/<br />
Personal_Protective_Equipment_and_Mental_Health.2.aspx<br />
o<br />
o<br />
Created COVID-19 Training Program for K-12 Schools<br />
Gathered nurses’ PPE and COVID practice stories to support advocacy efforts to address<br />
nurses needs<br />
• Diversity, Equality, & Inclusion Support<br />
<strong>ANA</strong>-<strong>Michigan</strong>:<br />
o Provided education & networks <strong>of</strong> support to promote health equity and cultural<br />
humility.<br />
o Sent representatives to participate in LARA’s Implicit Bias Training Rules Advisory Work<br />
Group<br />
o Initiated development <strong>of</strong> a Nurses <strong>of</strong> all Kinds recognition program<br />
o Prepared to develop implicit bias education/training <strong>of</strong>ferings with nurse contact hours<br />
once LARA has released the program requirements<br />
o Developed a position paper on mitigating implicit bias<br />
• Member Engagement<br />
<strong>ANA</strong>-<strong>Michigan</strong>:<br />
o Shifted educational <strong>of</strong>ferings to virtual, continued development <strong>of</strong> the <strong>ANA</strong>-MI Leadership<br />
Academy postponed until Fall 2021<br />
o Developed an Ad Hoc Member Engagement Steering Committee (MI-SQUAD) to increase<br />
member networking opportunities, enhance social media presence, and other approaches<br />
that support engagement with nurses in <strong>Michigan</strong><br />
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Implemented the Champions for Nursing Partnership Program pilot to enhance our<br />
Organizational Affiliate Program<br />
Is finalizing the development <strong>of</strong> a Foundation for nurse funding, so that we can apply<br />
for and accept funds that can be used to support members and initiatives.<br />
• Legislative<br />
<strong>ANA</strong>-<strong>Michigan</strong>:<br />
o Interviewed and hired a new lobby firm, Muchmore, Harrington, Smalley, and Associates<br />
(MHSA) that has significantly enhanced our legislative presence at the <strong>Michigan</strong> capital<br />
o Hosted a Town Hall Meeting with Senator Gary Peters<br />
o Took action to support passage <strong>of</strong> the enhanced Nursing Licensure Compact (eNLC)<br />
bill in <strong>Michigan</strong> including meeting with Governor Whitmer’s policy director, appointed<br />
members for eNLC Task Force to support passage <strong>of</strong> eNLC<br />
• Advocacy & Coalition Building<br />
<strong>ANA</strong>-<strong>Michigan</strong> was represented at:<br />
• APRN Alliance <strong>of</strong> <strong>Michigan</strong> (AAOM) to work towards the removal <strong>of</strong> barriers to APRN<br />
Practice<br />
• Coalition <strong>of</strong> <strong>Michigan</strong> Organizations <strong>of</strong> Nursing (COMON) to network, share educational<br />
opportunities, and work toward mutual goals with 32 other <strong>Michigan</strong> nursing organizations<br />
• Informatics & Telehealth<br />
<strong>ANA</strong>-<strong>Michigan</strong>:<br />
o Developed a position paper on telehealth & connected health<br />
o Entered into a partnership with the Texas Nurses Association, the Texas Organization <strong>of</strong><br />
Nursing Leadership, and the <strong>Michigan</strong> Organization <strong>of</strong> Nurse Leaders (MONL) to support<br />
a statewide comparison study to understand nurses’ experience with electronic health<br />
records. The findings will be used to implement strategies that can lessen the burden<br />
<strong>of</strong> EHRs on nurses. Link to Complete the Survey: https://nursing.ttuhsc.edu/surveys/<br />
ehr-michigan/<br />
Despite this unusual and difficult year, it has been my honor to serve as your President. We have much<br />
to be proud <strong>of</strong>, including growing our membership, remaining financially sound, expanding member<br />
engagement strategies, and increasing our visibility and influence on nursing issues in <strong>Michigan</strong>. It<br />
has only been through the contributions <strong>of</strong> our many dedicated members, and to the support <strong>of</strong><br />
our staff that these achievements have been realized. I am confident that we can build on these<br />
accomplishments in the coming year as we emerge from the pandemic with stronger recognition <strong>of</strong><br />
the importance <strong>of</strong> our role, and a renewed commitment to advocate for our pr<strong>of</strong>ession. I encourage<br />
each <strong>of</strong> you to become involved as we grow in nursing leadership together at <strong>ANA</strong>-<strong>Michigan</strong>.<br />
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Financial Statements<br />
The <strong>2020</strong> Year-End Written Financial Summary<br />
Operating Revenues:<br />
Membership Dues: <strong>2020</strong> monthly budget was $18,600.00 to bring in for membership revenue. We<br />
ended the year with $19,769.41.<br />
Conference Income: The association had a net loss <strong>of</strong> $9,221.13 due to having to cancel the March<br />
<strong>2020</strong> annual conference.<br />
Non-Dues Revenue: We hit our non-dues revenue by 104.7%.<br />
Operating Expenses:<br />
We end the fiscal year being over budget in the following areas:<br />
Board Insurance was over by $1,629.12 per 2019 quote. For 2021, we have found a new provider<br />
that will bring this cost back to what it was in 2018 and 2019.<br />
Marketing and Promotion by $2,650.89 as this is the expenses related to nurse’s month gifts,<br />
membership promotion and year-end holiday card.<br />
Postage is over by $2,997.95 related to the nurse’s month gifts mailing and all the outreach we have<br />
been doing related to membership promotions, which have resulted in our increase in membership.<br />
Technology Hosting is over by $3,585.90; as part <strong>of</strong> this is the contracts related to 2021 renews on<br />
the website and legislative action center.<br />
Net Loss:<br />
We ended the year with a net loss <strong>of</strong> $5,484.88. This is due to not having the conference and the hotel<br />
contract that we had to pay related to canceling the event and the leadership institute not occurring<br />
in the fiscal year. We never had to move money from savings or investment account throughout the<br />
year and always maintained a cash flow <strong>of</strong> $15,000 to $25,000 in the checking account. In November,<br />
we moved an additional $15,000 from savings to the investment account.<br />
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Executive Director Report<br />
Tobi Lyon, MBA, CAE<br />
To Remain Silent is to be Complicit. – President Ernst Grant, <strong>ANA</strong> President<br />
The year <strong>2020</strong> was an unexpected and unprecedented challenge for many, and<br />
when it began we had no idea to the extent <strong>of</strong> how it truly it would be the, “Year<br />
<strong>of</strong> the Nurse.” It will forever be remembered as a year that made history and<br />
changed life as we knew it, not only as nurses but as a country. On March 10, <strong>2020</strong>,<br />
in accordance with Governor Whitmer’s first “Stay-at-Home” Executive Order, <strong>ANA</strong>-<br />
<strong>Michigan</strong> strategically pivoted operations to fully support the needs <strong>of</strong> nurses during<br />
this time <strong>of</strong> great uncertainty. <strong>ANA</strong>-<strong>Michigan</strong>’s innovative approach and ability to proactively switch<br />
gears to respond to COVID-19 was nationally recognized for establishing new modern practices and<br />
has expanded our outreach and engagement to include more front-line nurses and potential members.<br />
Due to the nature <strong>of</strong> the nursing pr<strong>of</strong>ession and the frontline position nurses took from the very<br />
beginning <strong>of</strong> the pandemic, an obvious top priority for <strong>ANA</strong>-MI was support as a direct response to<br />
the fight against COVID-19 and the effect it was having on nurses. Tools and educational <strong>of</strong>ferings<br />
included a COVID-19 resources webpage, multiple webinars including, “Mitigating the Effects <strong>of</strong><br />
Trauma in Current Crisis” and “Psychological First Aid for Nurses,” strategically positioned “Thank<br />
You” Nurse billboards and over 5,000 KN95 masks donated to members, nurses and health facilities in<br />
need. I remain both humbled and in awe <strong>of</strong> the sacrifice nurses made in <strong>2020</strong> to fight this pandemic<br />
and throughout the year.<br />
Throughout the year, <strong>ANA</strong>-<strong>Michigan</strong> also continued its mission to advance nursing practice in <strong>Michigan</strong>.<br />
<strong>ANA</strong>-MI developed position statements on Mitigating Implicit Bias, Telehealth & Connected Health,<br />
the Enhanced Nurse Licensure Compact, Nurse Title Protection and Safe Nurse Staffing. Moving<br />
forward, <strong>ANA</strong>-MI is in-progress <strong>of</strong> finalizing position statements in regard to the COVID-19 vaccination<br />
and whistleblowing that aligns with the nurses’ code <strong>of</strong> ethics.<br />
Advocacy was another key initiative in <strong>2020</strong>, as dedicated nurses were tested to their personal limits.<br />
For the first time ever, <strong>ANA</strong>-MI contracted its first lobbying firm, Muchmore Harrington Smalley &<br />
Associates, LLC (MHSA). MHSA has earned the reputation as one <strong>of</strong> <strong>Michigan</strong>’s leading lobbying firms<br />
and has a sterling reputation. <strong>ANA</strong>-MI was proud to provide our Strengthening the Voice <strong>of</strong> Nursing<br />
campaign, featuring a webinar series, social media toolkit, tips on reaching out to Legislators and<br />
a virtual town hall event with Representative Mary Whiteford. Our goal for this campaign was to<br />
help decision-makers recognize the essential voice <strong>of</strong> nursing in current healthcare debates and<br />
discussions. Because the ideals and mission <strong>of</strong> <strong>ANA</strong>-MI come to life through the real nursing stories<br />
<strong>of</strong> our members, we know it’s critical for the voice <strong>of</strong> the nurse to be heard and <strong>ANA</strong>-MI is there to<br />
support those voices every step <strong>of</strong> the way. <strong>ANA</strong>-MI in partnership with the <strong>Michigan</strong> Council for<br />
Nurse Practitioners, held a virtual Town Hall with U.S. Senator Gary Peters as well.<br />
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As important as education is to <strong>ANA</strong>-MI, this too was significantly impacted by the COVID-19 pandemic.<br />
While the <strong>2020</strong> <strong>Annual</strong> Conference and Assembly Meeting was cancelled, <strong>ANA</strong>-MI was proactive and<br />
responsive with interactive virtual programming and creative opportunities for nurses to connect<br />
virtually. A majority <strong>of</strong> the virtual programs were <strong>of</strong>fered complimentary to all nurses. <strong>ANA</strong>-MI<br />
recognized our <strong>2020</strong> Nurse Recognition Award Winners virtually as well.<br />
As it turns out, the pandemic would make it the perfect year to unveil the <strong>ANA</strong>-<strong>Michigan</strong> Champions<br />
for Nursing Partnership Program (CNPP). With the need for educational and emotional support for<br />
nurses at an all-time high, it was the right time to reach out to partnering organizations to join us<br />
and help support the advancement <strong>of</strong> the nursing pr<strong>of</strong>ession. CNPP benefits are designed to provide<br />
a mutually beneficial and long-term partnership between <strong>ANA</strong>-MI and the supporter, designed<br />
strategically as a one-stop-shop for both supporting nurses and providing visibility and recognition for<br />
the partnering organization. Whether through subscriptions to <strong>ANA</strong>-MI newsletters and publications<br />
or new sponsorship opportunities and special annual conference benefits, the program is sure to<br />
connect organizations that care with <strong>ANA</strong>-MI nurses in need. CNPP <strong>of</strong>fers multiple levels <strong>of</strong> support<br />
to allow for different tiers <strong>of</strong> engagement, from as low as one $250 annual contribution, all the<br />
way to our Gold Partner for a $2,000 contribution. By becoming a part <strong>of</strong> the CNPP, partnering<br />
organizations are standing with <strong>ANA</strong>-MI as we stand beside our nurses.<br />
Lastly, I’m pleased to report record membership growth for <strong>ANA</strong>-MI for spring and summer <strong>2020</strong>. It<br />
is my sincere hope that this growth is a true reflection <strong>of</strong> the quality <strong>of</strong> the many services, support<br />
tools and educational opportunities provided by our organization.<br />
Never have I been more proud to be part <strong>of</strong> this organization. Through the most difficult parts <strong>of</strong> this<br />
pandemic, nurses stood strong and stood together, dedicated and focused on patient care, amidst<br />
nearly intolerable circumstances. As we begin to see light at the end <strong>of</strong> the tunnel <strong>of</strong> COVID-19<br />
may that same hope and determination lead us to a better tomorrow. Thank you for your continued<br />
support <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong> and the nursing pr<strong>of</strong>ession.<br />
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<strong>ANA</strong>-<strong>Michigan</strong>'s First Official Registered Lobby Firm: MHSA<br />
<strong>ANA</strong>-<strong>Michigan</strong> reaches a new milestone in our association's storied history; beginning July<br />
1st, <strong>ANA</strong>-<strong>Michigan</strong> will have its first <strong>of</strong>ficial registered lobby firm!<br />
<strong>ANA</strong>-<strong>Michigan</strong> has retained Muchmore Harrington Smalley & Associates, LLC (MHSA) as our new<br />
multi-client lobbying firm. The firm possesses substantial experience, pr<strong>of</strong>essional approach, unique<br />
problem-solving skills, and unmatched creative energies while focusing on providing superior client<br />
service in the development and implementation <strong>of</strong> successful strategies.<br />
MHSA will provide weekly special reports and <strong>ANA</strong>-<strong>Michigan</strong> will be update our Advocacy page on our<br />
website with this information as well as including links to the special reports in our newsletters to<br />
keep members up to date.<br />
MHSA works aggressively to shape public policy and weave client interests into the <strong>Michigan</strong><br />
Legislature’s agendas and initiatives; this includes the Executive and Administrative branches,<br />
agencies, bureaus <strong>of</strong> the State <strong>of</strong> <strong>Michigan</strong>, the <strong>Michigan</strong> Economic Development Corporation, and<br />
local and county governments.<br />
MHSA was founded in 1988 and has earned the reputation as one <strong>of</strong> <strong>Michigan</strong>'s leading lobbying firms.<br />
MHSA was recently named <strong>Michigan</strong>'s "Number 1" multi-client lobbying firm and "Number 1" lobbying<br />
organization (including corporations, trade associations, non-pr<strong>of</strong>it organizations, and multi-client<br />
lobbying firms); this according to a comprehensive survey conducted by Inside <strong>Michigan</strong> Politics<br />
(IMP).<br />
With more than 4,100 registered lobbyist agents in <strong>Michigan</strong>, five MHSA lobbyists earned honors<br />
and ranked in the category <strong>of</strong> "Individual Lobbyists: The Top 10." MHSA's five lobbyists earning a<br />
top 10 individual power ranking include Pat Harrington and Jon Smalley, both <strong>of</strong> whom will support<br />
<strong>ANA</strong><strong>Michigan</strong>.<br />
To determine the power ranking <strong>of</strong> organizations and individuals who are both "players" and "effective,"<br />
the IMP survey was distributed to all members <strong>of</strong> the <strong>Michigan</strong> Legislature, selected legislative and<br />
administration staff members, members <strong>of</strong> the capitol news media, and others.<br />
To learn more about the three team members from MHSA dedicated to <strong>ANA</strong>-<strong>Michigan</strong>, visit https://<br />
mhsa.com/lobbyists to view their pr<strong>of</strong>ile.<br />
To view this week's special reports from MHSA for <strong>ANA</strong>-<strong>Michigan</strong>, click here.<br />
To learn more about MHSA visit https://mhsa.com/<br />
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Nurse Licensure Compact Update<br />
By Evelyn Sweeney, <strong>ANA</strong>-<strong>Michigan</strong> Legislative Consultant,<br />
Muchmore Harrington Smalley & Associations (MHSA)<br />
Although many policies are <strong>of</strong> great interest to nurses, perhaps one <strong>of</strong> the most significant and<br />
impactful to the pr<strong>of</strong>ession is legislation enacting the enhanced Nurse Licensure Compact (eNLC).<br />
As many know, the eNLC enables registered nurses and licensed practical/vocational nurses to hold<br />
one multi-state license, with the privilege to practice in his or her home state and other NLC states.<br />
There are currently 34 member states in the current NLC and, as you all know, <strong>Michigan</strong> is not one<br />
<strong>of</strong> them.<br />
On January 15, 2019, Representative Mary Whiteford, a nurse by trade, introduced House Bill 4042<br />
which would have enabled <strong>Michigan</strong> to join the compact. The bill enjoyed wide support from a<br />
diverse set <strong>of</strong> interest groups which included the <strong>Michigan</strong> Health and Hospital Association, AARP,<br />
Leading Age <strong>Michigan</strong>, the <strong>Michigan</strong> Primary Care Association and <strong>of</strong> course, <strong>ANA</strong>-<strong>Michigan</strong>, to name<br />
just a few. Representatives from <strong>ANA</strong>-MI testified in support <strong>of</strong> the bill in February <strong>2020</strong> before<br />
the House Health Policy Committee. The bill was opposed by the <strong>Michigan</strong> Nurses Association as<br />
well as the <strong>Michigan</strong> Department <strong>of</strong> Licensing and Regulatory Affairs. Concerns expressed by the<br />
department largely focused on their responsibility <strong>of</strong> regulating health pr<strong>of</strong>essionals in <strong>Michigan</strong>.<br />
The department contends they would be ceding their authority and oversight to an out-<strong>of</strong>-state<br />
compact body. Concerns regarding an inequitable “level <strong>of</strong> care” were also expressed pointing to<br />
education requirement differences between states.<br />
None the less, the bill was successfully reported from the House Health Policy Committee and out<br />
<strong>of</strong> the full House by a vote <strong>of</strong> 55-50 with four members not voting in February <strong>2020</strong>. With COVID-19<br />
ravaging the state during the spring and late fall, plus an increased emphasis on the need and use <strong>of</strong><br />
telehealth services throughout the state, the Senate discharged the bill from committee and passed<br />
it on December 10, <strong>2020</strong> despite the same concerns from the administration.<br />
The bill was presented to the Governor on December 22, but was ultimately vetoed on December<br />
30. In her veto letter the Governor specifically stated, “The Constitution <strong>of</strong> 1963 provides that “[t]<br />
he public health and general welfare <strong>of</strong> the people <strong>of</strong> the state are hereby declared to be matters<br />
<strong>of</strong> primary public concern. The legislature shall pass suitable laws for the protection and promotion<br />
<strong>of</strong> the public health.” Art. 4, sec. 51. While I value interstate cooperation, especially around issues<br />
that are peculiarly interstate in nature, these compacts require <strong>Michigan</strong> to cede its sovereign<br />
interest in regulating health pr<strong>of</strong>essions to an outside body. Forfeiting our prerogative as a state to<br />
set the standard <strong>of</strong> care required <strong>of</strong> nurses practicing in our state would violate the command <strong>of</strong><br />
section 51 <strong>of</strong> article 4. I am therefore vetoing this bill.”<br />
The administration’s opposition to all compact legislation remains an on-going concern. However,<br />
with the start <strong>of</strong> the new legislative session on January 13, 2021 there is renewed hope that through<br />
education, member engagement and persistence, we can address the Governor’s concerns. We<br />
anticipate the reintroduction <strong>of</strong> an eNLC bill soon. We also believe Representative Whiteford will<br />
sponsor the bill. She is coordinating a work group where interested stakeholders along with the<br />
administration will work closely, share ideas and attempt to forge a compromise.<br />
<strong>ANA</strong>-MI leadership will be part <strong>of</strong> these workgroups and looks forward to soliciting members for<br />
feedback as well as engaging members in discussions with their local elected <strong>of</strong>ficials.<br />
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<strong>ANA</strong>-<strong>Michigan</strong> Committee <strong>Reports</strong><br />
<strong>ANA</strong>-<strong>Michigan</strong> Nursing and Health Policy Committee<br />
Chair: Katherine Kessler, MSN, MSA, RN<br />
Beth Ammerman, DNP, FNP-BC<br />
Kristin Castine, MSN, RN, ANP-BC<br />
Nikeyia Davis, MBA-HCM, BSN, RN, CNN<br />
Cheryl LaPlaunt, RN, MPA, BSN<br />
Barbara Medvec, DNP, RN, NEA-BC<br />
Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC<br />
Linda Sarantis, MSN, RN, S.A.N.E.<br />
Nadine Wodwaski, DNP, MSN-ed, CNS, RN<br />
Committee Duties & Assignments<br />
• Develop nursing and health policy initiatives related to <strong>ANA</strong>-<strong>Michigan</strong>’s Policy Platform.<br />
• Monitor and analyze nursing and health policy issues; collaborate with other health and<br />
nursing organizations in relevant nursing and health policy.<br />
• Educate and collaborate with public policy makers, relevant private and organizational<br />
policy makers.<br />
• Monitor and address nursing and healthcare regulatory policy issues.<br />
• Recommend and refer policy issues requiring legislative action or initiative to the Legislative<br />
Committee.<br />
• Assume other responsibilities for health policy as provided for in these bylaws and in policies<br />
and procedures as established by the Board <strong>of</strong> Directors.<br />
<strong>2020</strong> Report<br />
• Monitored the COVID-19 pandemic.<br />
• Developed <strong>ANA</strong>-<strong>Michigan</strong> position statement on Moral Distress developed by the AACN<br />
(American Association <strong>of</strong> Critical Care Nurses) and adopted by <strong>ANA</strong>-<strong>Michigan</strong>.<br />
• Developed <strong>ANA</strong>-<strong>Michigan</strong> position statement on Reducing Violence in Healthcare Settings.<br />
• Developed <strong>ANA</strong>-<strong>Michigan</strong> position statement on Telehealth and Connected Health.<br />
• Developed <strong>ANA</strong>-<strong>Michigan</strong> position statement on Implicit Bias.<br />
• Member participation is consistent and engaged with members representing a range <strong>of</strong><br />
geographic, rural, urban and practice areas.<br />
• Shared articles with members on nursing and health policy related topics via the <strong>ANA</strong>-<br />
<strong>Michigan</strong> newsletter.<br />
Acknowledgements<br />
On behalf <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong>, we would like to recognize and thank the following out-going committee<br />
members for their dedication and service to members:<br />
• Kristin Castine, MSN, RN, ANP-BC<br />
• Katherine Kessler, MSN, MSA, RN<br />
• Cheryl LaPlaunt, MPA, BSN, RN<br />
• Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC<br />
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<strong>ANA</strong>-<strong>Michigan</strong> would also like to recognize and welcome new, in-going committee members who<br />
were appointed to serve members on this committee for a two-year term:<br />
• Alexa Andersen, MA, BSN, RN<br />
• Ramona Berry, MSA, BSN, RN<br />
• Wanda Chukwu, DNP, MA, CNEcl, RN<br />
• Holly Thalman, BSN, RN<br />
Chair: Katherine Dontje, PhD, FNP-BC, FAANP<br />
Margaret Calarco, PhD, RN, NEA-BC<br />
Linda Dunmore, MSN, RN, NE-BC, CPHQ, CPHS<br />
Nadia Farhat, RN, MSN, AGCNS-BC<br />
Marge Freundl, MSN<br />
Julie Powell, MSN, RN, AGCNS-BC<br />
Molly Stapish, MSN, CMSRN<br />
Marnie VanDam, MSN, RN<br />
<strong>ANA</strong>-<strong>Michigan</strong> Nursing Practice Committee<br />
Committee Duties & Assignments<br />
• Identify and address nursing practice issues in <strong>Michigan</strong>. Collaborate with related nursing<br />
organizations with specific clinical expertise in developing initiatives.<br />
• Bring focus to the health and safety <strong>of</strong> nurses in all practice settings.<br />
• Develop programs that broadly address the personal health and well-being <strong>of</strong> nurses.<br />
• Collaborate with the Nursing and Health Policy Committee in addressing regulatory issues<br />
affecting nursing practice.<br />
• Address ethical issues in practice.<br />
• Assume other responsibilities for nursing practice as provided for in these bylaws and in<br />
policies and procedures as established by the Board <strong>of</strong> Directors.<br />
<strong>2020</strong> Report<br />
• Solicited nursing practice needs/feedback from membership.<br />
• Monitored COVID-19 pandemic.<br />
• Supported efforts to bring information to nurses related to COVID-19 and the potential<br />
for the adverse emotional/psychological impact on nurses by recommending the <strong>of</strong>fering<br />
<strong>of</strong> education on PTSD and psychological first aid in response to the COVID-19 pandemic<br />
response.<br />
o Complimentary webinar provided in May for members and all nurses.<br />
• Discussed opportunities to prepare for next steps and/or a second “wave” <strong>of</strong> the pandemic.<br />
• Provided information on relevant nursing practice related topics, issues and innovations via<br />
the weekly newsletter to enhance and expand nurses knowledge.<br />
• Recommended to Board <strong>of</strong> Directors to convene an Adhoc COVID-19 Task Force; this<br />
recommendation was approved by the Board <strong>of</strong> Directors in May.<br />
• Responsible for convening nurse experts to develop a training program to educate K-12<br />
school teachers and faculty on COVID-19.<br />
o Reviewed and selected member nurse applicants to develop the curriculum and serve<br />
trainers.<br />
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o Provided oversight on the development <strong>of</strong> the COVID-19 school teacher/faculty virtual<br />
training videos.<br />
o Reviewed and approved the developed training materials that were provided as a<br />
complimentary resource to K-12 <strong>Michigan</strong> school teachers and faculty.<br />
o Training program videos and materials are available at no charge on <strong>ANA</strong>-<strong>Michigan</strong><br />
website.<br />
• Discussed the current nursing practice environment and opportunities to provide resources to<br />
members on vaccinations, health care worker resilience and ensuring graduation <strong>of</strong> nursing<br />
students.<br />
• Recommended assembling a potential adhock work group/task force to address vaccinations<br />
and to develop materials related to vaccinations.<br />
Acknowledgements<br />
On behalf <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong>, we would like to recognize and thank the following out-going committee<br />
members for their dedication and service to members:<br />
• Margaret Calarco, PhD, RN, NEA-BC<br />
• Katherine Dontje, PhD, FNP-BC, FAANP<br />
• Marge Freundl, MSN<br />
<strong>ANA</strong>-<strong>Michigan</strong> would also like to recognize and welcome new, in-going committee members who<br />
were appointed to serve members on this committee for a two-year term:<br />
• Nichole Budnick, BSN, RN<br />
• Ruth Kechnie, RN, BSN, MSA, OCN NE-BC<br />
• BethAnn Perkins-Simmons, BSN, RN<br />
• Erin Sudheimer, MSN, RN<br />
Chair: Bridget Leonard, DNP, MBA, RN<br />
April Liberty, BSN, RN<br />
Nancy Martin, DNP, RN<br />
Jennifer Mecomber, MSN, RN<br />
Mihaela Reed, MSN<br />
Mary Zugcic, RN, ACNS-BC, CRNI<br />
<strong>ANA</strong>-<strong>Michigan</strong> Education Committee<br />
Committee Duties & Assignments<br />
• Seek input from Members on educational topics and speakers to plan educational <strong>of</strong>ferings.<br />
• Plan the annual educational conference.<br />
• Develop an annual Membership Assembly and conference budget to be submitted to the Board<br />
<strong>of</strong> Directors for prior approval for the following year’s Assembly program and conference.<br />
• Assume other responsibilities for conference as provided for in these bylaws and in policies<br />
and procedures as established by the Board <strong>of</strong> Directors.<br />
<strong>2020</strong> Report<br />
• Planned the <strong>2020</strong> <strong>ANA</strong>-<strong>Michigan</strong> <strong>Annual</strong> Conference<br />
o Event was cancelled due to state’s executive order to quarantine due to the COVID-19<br />
pandemic.<br />
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o Full refunds provided to all registrants.<br />
• Developed and <strong>of</strong>fered the Networks <strong>of</strong> Support Virtual Meet-Up Series for all nurses, not<br />
just <strong>ANA</strong>-<strong>Michigan</strong> members, to connect routinely and have a safe-place among nursing<br />
peers for support during the COVID-19 pandemic and to discuss other timely and relevant<br />
issues affecting or impacting nurses.<br />
o Series received national recognition.<br />
o Open discussions and specific topic discussions were both <strong>of</strong>fered.<br />
o Each Networks <strong>of</strong> Support’s discussion was lead by a thought leader (<strong>ANA</strong>-<strong>Michigan</strong><br />
leadership including board and committee members).<br />
• Developed and <strong>of</strong>fered the “Strengthening the Voice <strong>of</strong> Nursing Virtual Event” based on<br />
topics recommendations from the Nursing Practice Committee and discussions from the<br />
Nursing Health & Policy and Legislative Committees that promoted nurses using their voices<br />
to speak-up on issues that matter to them most. Interactive education included:<br />
o Leveraging the Power <strong>of</strong> Nurses: Promoting Health Equity through a Framework <strong>of</strong><br />
Cultural Humility.<br />
o Event included a town hall with Representative Mary White.<br />
o Storytelling and how to articulate your nursing story.<br />
o Recommendations for meeting with legislators & legislative update.<br />
o Do 1 thing activity and reporting.<br />
• Offered town hall with US Senator Gary Peters in partnership with MICNP.<br />
• Provided multiple complimentary and/or low cost webinars for all nurse on self-care during<br />
the early on-set <strong>of</strong> the COVID-19 pandemic to help support nurses’ well being and resiliency.<br />
o Stress Management and Self-Care for Nurses (multiple).<br />
o Stress First Aid.<br />
• Planned the first time ever, virtual, 2021 <strong>Annual</strong> Conference & Membership Assembly<br />
scheduled for March 24-25, 2021.<br />
• Monitors planning for the Leadership Academy by way <strong>of</strong> Leadership Academy Task Force<br />
updates.<br />
• Monitors the SOM Implicit Bias Training Advisory Workgroup to stay apprised <strong>of</strong> implicit bias<br />
training requirements for nurses and other health care licensures.<br />
o Executive Directive <strong>2020</strong>.07 is an order requires LARA, in consultation with relevant<br />
boards and task forces, to promulgate rules to establish implicit bias training standards<br />
as part <strong>of</strong> the knowledge and skills necessary for licensure, registration, and renewal <strong>of</strong><br />
licenses and registrations to 26 health pr<strong>of</strong>essions, this workgroup will work together to<br />
o<br />
establish this training.<br />
Education Committee Chair Bridget Leonard, Nikeyia Davis and Gerry Infante appointed<br />
to sub workgroups on behalf <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong>.<br />
• Planned two-part virtual workshop for January 2021 on “Advancing Your Idea & Creating a<br />
Successful Side Hustle” as a joint provided event with ONA, INA & WNA.<br />
• Planning a “Nurse Appreciation/Pride Celebration” as an in-person networking event at end<br />
<strong>of</strong> year and will include the 2021 nurse recognition awards.<br />
• Planning quarterly 2021 virtual education calendar for quarters 2-4 with nurse contact hours.<br />
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Acknowledgements<br />
On behalf <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong>, we would like to recognize and thank the following out-going committee<br />
members for their dedication and service to members:<br />
• April Liberty, BSN, RN<br />
• Nancy Martin, DNP, RN<br />
• Mihaela Reed, MSN<br />
<strong>ANA</strong>-<strong>Michigan</strong> would also like to recognize and welcome new, in-going committee members who<br />
were appointed to serve members on this committee for a two-year term:<br />
• Ruth Duffy, BSN<br />
• Gerardo Infante, BSN, RN<br />
• Patrick Joswick, DNP, AGNP-C, RN<br />
Chair: Suzanne Keep, PhD, RN<br />
Nikeyia Davis, MBA-HCM, BSN, RN, CNN<br />
Katherine Dontje, PhD, FNP-BC, FAANP<br />
Bridget Leonard, DNP, MBA, RN<br />
Imana Minard, RN<br />
Mary White, RN<br />
<strong>ANA</strong>-<strong>Michigan</strong> Adhoc COVID-19 Task Force<br />
<strong>2020</strong> Report<br />
• Convened by the Nursing Practice Committee to discuss how can <strong>ANA</strong> members address<br />
health disparities/ social determinants <strong>of</strong> health related to the COVID-19 pandemic.<br />
• Focus efforts on nurses and the pandemic, and direct efforts to promote self-care among<br />
nurses. It is known that nurses are experiencing burn-out, PTSD and other stressors in which<br />
young and older nurses are deciding to leave the pr<strong>of</strong>ession.<br />
• Facilitating a Meeting <strong>of</strong> the Minds with other nursing organizations to collaborate on<br />
discussing what effect COVID-19 has had on nurses, and what measures can be taken to<br />
support nurses.<br />
• The objective is to understand what stressors nurses are experiencing related to the<br />
pandemic, and how can <strong>ANA</strong> nurses help in addressing this issue. The goal is to have this<br />
collaborative meeting in April <strong>of</strong> 2021.<br />
• Discussed the current COVID-19 environment nationally and for <strong>Michigan</strong>.<br />
• Reviewed COVID-19 related issues identified by the Nursing Practice and Education<br />
Committees.<br />
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<strong>ANA</strong>-<strong>Michigan</strong> Adhoc Leadership Academy Task Force<br />
Chair: Jeanette Klemczak, RN<br />
Shari Carson, BSN, RN, CDP, CDONA, FACDONA, IP-BC<br />
Katherine Kessler, MSN, MSA, RN<br />
Nancy Martin, DNP, RN<br />
Barbara Medvec, DNP, RN, NEA-BC<br />
Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC<br />
Carole Stacy, MSN, MA, RN<br />
<strong>2020</strong> Report<br />
• Series rescheduled from <strong>2020</strong> to 2021 due to COVID-19 pandemic.<br />
• Task Force continued to research potential funding sources for Leadership Academy<br />
scholarships.<br />
• Determined the methods <strong>of</strong> delivery (in-person only and/or combination with virtual<br />
components).<br />
• Seeking consultation on energized approaches to online learning.<br />
• Adjusted curriculum to reflect emerging issues (leading in crisis, implicit bias, etc.).<br />
• Nurse leaders across the state participated in focus groups to identify key concepts and<br />
desired skills for the succession <strong>of</strong> nursing leadership in their organizations including<br />
hospitals, home health, and long term care settings.<br />
• Tentative content experts (faculty/speakers) have been identified.<br />
• Identifying additional sources <strong>of</strong> funding.<br />
• Considered the impact <strong>of</strong> the pandemic and economic situation <strong>of</strong> healthcare systems.<br />
• Assessed the environment for evidence to support moving forward with event.<br />
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<strong>2020</strong> MEMBERSHIP ASSEMBLY REPORT<br />
SUBMITTED BY: JULIA STOCKER SCHNEIDER,<br />
STACY SLATER, BRIDGET LEONARD<br />
On Monday, June 1st <strong>ANA</strong> Virtual Special Meeting <strong>of</strong> the Membership Assembly voted on a proviso to<br />
the <strong>ANA</strong> Bylaws to allow the <strong>Annual</strong> Membership Assembly to be held virtually and national elections<br />
to be conducted remotely. The three-hour Membership Assembly meeting was scheduled for June<br />
19, <strong>2020</strong> from 5:00-8:00pm.<br />
President Julia Stocker Schneider, Membership Assembly Representative Stacy Slater, Presidentelect<br />
Bridget Leonard, and NEC candidate Marylee Pakieser attended the <strong>2020</strong> virtual membership<br />
assembly meeting. It was a great opportunity to see the <strong>ANA</strong> Board seamlessly and successfully<br />
execute the meeting in a virtual format. It was valuable to observe the Board at work, to hear some<br />
<strong>of</strong> the discussions <strong>of</strong> the Board and contributions <strong>of</strong> members.<br />
Friday, June 19, <strong>2020</strong><br />
The Virtual Session <strong>of</strong> the Membership Assembly was held. The Membership Assembly is comprised<br />
<strong>of</strong> representatives from <strong>ANA</strong>’s constituent and state nurses’ associations, the Individual Member<br />
Division, and specialty nursing organizational affiliates as well as the <strong>ANA</strong> Board <strong>of</strong> Directors. <strong>Annual</strong><br />
updates and reports were presented, and attendees participated in the virtual format.<br />
Much discussion centered around the effects <strong>of</strong> COVID-19 on nursing advocacy, nursing education,<br />
and racial disparities made glaringly visible by the pandemic.<br />
Debbie Hatmaker reported on <strong>ANA</strong> Enterprise and the strategic goals to Elevate the pr<strong>of</strong>ession <strong>of</strong><br />
nursing globally, to Engage all nurses to ensure pr<strong>of</strong>essional success, to Evolve the practice <strong>of</strong> nursing<br />
to transform health and healthcare, and to Enable transformational capabilities through operational<br />
excellence.<br />
• Passage <strong>of</strong> the Home Health Care Act and Title VIII as part <strong>of</strong> the CARES Act.<br />
• Call to Action for Congress to rebuild public health nursing workforce.<br />
• Direct aid to nurses using short-term grants (Hilton 236,000 room nights used).<br />
• Media opportunities to position nurses as the Voice <strong>of</strong> Nursing.<br />
• Social Media presence.<br />
• Credentialing Center has been very customer focused in responding to challenges presented<br />
by the closing <strong>of</strong> testing centers.<br />
• COVID work is focused on <strong>ANA</strong>’s relevance and driving membership. Original goal was a net<br />
gain <strong>of</strong> 10,000+ members but the relevance <strong>of</strong> <strong>ANA</strong>’s work was so well demonstrated that by<br />
the end <strong>of</strong> May the net gain was 14,000 new members.<br />
• Dialogue forum updates – specifically Visibility <strong>of</strong> Nurses in the Media from the 2019<br />
Membership Assembly – a Nurse Expert Data Base is being created.<br />
• New Business Item – To create an ad hoc committee to exam nurse suicide research. More to<br />
report later on this important committee.<br />
• It takes an Enterprise to battle a pandemic – speed over elegance.<br />
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Pr<strong>of</strong>essional Policy Committee – All dialogue forums were canceled for <strong>2020</strong> but will all be considered<br />
for the 2021 assembly. Proposed revisions to the execution <strong>of</strong> the dues escalation <strong>of</strong> membership<br />
dues and change from labor organization to non-labor organization.<br />
• Dues escalation policy revision – voting to be conducted remotely after the meeting.<br />
• President Grant opened the chat for comments/clarification regarding the Dues Escalation<br />
Policy.<br />
o No comments.<br />
Statement on Racial Justice for Communities <strong>of</strong> Color – Emergent Proposal<br />
• This was approved as it met the requirements for an emergent proposal.<br />
• The emergent proposal was disseminated on 6/16/<strong>2020</strong>.<br />
• The statement and pledge were approved.<br />
o No additional comments.<br />
Nominations and Elections Committee – Voting instructions<br />
• The proviso adopted 6/1/20 will be administered by an independent vendor under the<br />
supervision <strong>of</strong> the NEC and the <strong>ANA</strong> Office <strong>of</strong> General Counsel.<br />
• Voting opened immediately after the meeting through 11:59 p.m. EST 6/25/20.<br />
• President Grant opened for questions.<br />
o No additional comments.<br />
Closing comments by President Grant regarding the impact <strong>of</strong> COVID-19 on nursing and to use our<br />
influence to educate others. Imagine a world where all voices are heard and respected. Change is<br />
needed and to take action at the ballot box!<br />
Virtual Day <strong>of</strong> Advocacy - #RNAction – 6/25/20<br />
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Candidates <strong>of</strong> Integrity:<br />
Meet Your <strong>ANA</strong>-<strong>Michigan</strong> Future Leaders<br />
This year, <strong>ANA</strong>-MI Members will elect:<br />
• Secretary<br />
• Treasurer<br />
• Director (2)<br />
• Nominations Committee (2)<br />
• <strong>ANA</strong> Membership Assembly Representative<br />
On Tuesday, February 9, <strong>ANA</strong>-<strong>Michigan</strong> members had the opportunity to “Meet the Candidates”<br />
via an interactive virtual forum to connect with the 2021 leadership election candidates and ask<br />
questions before voting.<br />
The “Meet the Candidate” Forum was recorded and can be viewed on our website at www.anamichigan.org.<br />
Ballots were mailed out on Thursday, February 18, 2021 and voting remained open until 5:00 p.m.<br />
Thursday.<br />
This year’s leadership candidates <strong>of</strong> integrity by position<br />
included on the 2021 <strong>ANA</strong>-<strong>Michigan</strong> election ballot:<br />
Secretary – (Elect 1)<br />
Nikeyia Davis, MBA-HCM, BSN, RN, CNN<br />
Henry Ford Health System<br />
Home Dialysis Therapies Registered Nurse<br />
Ypsilanti, MI<br />
Vanessa Riley, BSN, RN<br />
Advantis<br />
Occupational Health Nurse<br />
Clio, MI<br />
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Treasurer – (Elect 1)<br />
Julie Bulson, DNP, MPA, RN, NE-BC<br />
Spectrum Health<br />
Director, Business Assurance<br />
Grand Rapids, MI<br />
Director – (Elect 2)<br />
Barbara R. Medvec, DNP, RN, MSA, MSN NE-BC<br />
University <strong>of</strong> <strong>Michigan</strong> School <strong>of</strong> Nursing<br />
Clinical Assistant Pr<strong>of</strong>essor and MSN Program Lead<br />
Saline, MI<br />
Joshua Meringa, MPA, MHA, MBA, BSN, RN, NPD-BC<br />
Spectrum Health System<br />
Nurse Educator & Academic Liaison<br />
Grandville, MI<br />
Julie Powell, MSN, RN, AGCNS-BC, CNEcl, EBP(CH)<br />
<strong>Michigan</strong> State University<br />
Nursing Faculty<br />
Temperance, MI<br />
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Christine W. Saltzberg, PhD, MSHCE, MS, PHCNS-BC, RN<br />
Self<br />
Consultant<br />
Highland Township, MI<br />
Nominations Committee – (Elect 2)<br />
Linda John, MSN, RN, PhD (c)<br />
Oakland University<br />
Clinical Nursing Instructor<br />
Troy, MI<br />
Suzanne Keep, PhD, RN<br />
University <strong>of</strong> Detroit Mercy<br />
Site Director <strong>of</strong> Pre-Licensure Program: Associate Pr<strong>of</strong>essor<br />
Grand Rapids, MI<br />
Beth VanDam, MSN, GERO-BC, CNL<br />
Mercy Health Saint Mary's<br />
Clinical Nurse Leader<br />
Grand Rapids, MI<br />
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<strong>ANA</strong> Membership Assembly Representative – (Elect 1)<br />
Anne R. Kreft, BSN, RN<br />
Munson Medical Center<br />
Behavioral Health - Clinical Practice RN<br />
Traverse City, MI<br />
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<strong>ANA</strong>-<strong>Michigan</strong> Announces NEW Champions for Nursing Partnership Program<br />
Creating a One Stop Shop for Supporting Nurses <strong>of</strong> All Kinds<br />
During these unpresented times, uniting nurses and organizations <strong>of</strong> all kinds for collaboration is<br />
more important than ever. <strong>ANA</strong>-<strong>Michigan</strong> has designed a new Champions for Nursing Partnership<br />
Program (CNPP) to promote alignment <strong>of</strong> collaborative efforts to advance the nursing pr<strong>of</strong>ession and<br />
to provide a network <strong>of</strong> diverse resources for nurses.<br />
Schools <strong>of</strong> nursing, nursing and health care organizations, pr<strong>of</strong>essional networks, health care systems,<br />
health care vendors, nursing consultants and all other champions for nursing are encouraged to<br />
partner with us!<br />
By becoming a part <strong>of</strong> the CNPP, <strong>ANA</strong>-<strong>Michigan</strong> members will receive enhanced, diverse and more<br />
inclusive resources that support our mission, vision and strategic plan.<br />
To discuss how <strong>ANA</strong>-<strong>Michigan</strong> and your organization could partner together, please visit the anamichigan.org.<br />
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<strong>ANA</strong>-<strong>Michigan</strong> Members Serving on State <strong>of</strong><br />
<strong>Michigan</strong>’s Workgroups to Develop New Implicit<br />
Bias Licensure Requirements and Training<br />
The COVID-19 pandemic has illustrated, with brutal pro<strong>of</strong>, the persistence <strong>of</strong> racial disparities in<br />
our society. As <strong>of</strong> July 5, <strong>2020</strong>, Black <strong>Michigan</strong>ders represented 14% <strong>of</strong> the state population, but over<br />
35% <strong>of</strong> confirmed COVID-19 cases where the race <strong>of</strong> the patient was known. COVID-19 is over four<br />
times more prevalent among Black <strong>Michigan</strong>ders than among white <strong>Michigan</strong>ders. And <strong>Michigan</strong> is<br />
no outlier. According to the Centers for Disease Control and Prevention (CDC), “non-Hispanic Black<br />
persons have a [COVID-19 associated hospitalization] rate approximately 4.7 times that <strong>of</strong> non-<br />
Hispanic White persons.” Moreover, Black and Latino people have been nearly twice as likely to die<br />
from the virus as white people, according to CDC data. Indigenous populations have experienced a<br />
hospitalization rate even higher than that <strong>of</strong> Black Americans.<br />
This disparity is not limited to COVID-19. People <strong>of</strong> color face disparities in terms <strong>of</strong> morbidity,<br />
mortality, and health status. Black, Hispanic, and Indigenous Americans have higher infant mortality<br />
rates than white and Asian Americans. The premature death rate from heart disease and stroke is<br />
highest among Black Americans.<br />
Race and ethnicity are not the only demographic factors associated with disparity in health outcomes.<br />
For example, women are more likely to experience delayed diagnosis <strong>of</strong> heart disease compared to<br />
men, as well as inferior heart attack treatment. Sometimes, these disparities intersect, as in the<br />
case <strong>of</strong> childbirth, where the United States is one <strong>of</strong> the few countries experiencing a rise in the<br />
maternal mortality rate, and Black women are nearly four times as likely to die during childbirth as<br />
are white women.<br />
Faced with these disparities during the COVID-19 pandemic, <strong>Michigan</strong> has led the way in identifying<br />
and addressing the problem. <strong>Michigan</strong> was one <strong>of</strong> the first states to report COVID-19 data by race and<br />
ethnicity. When it became clear the virus had devastated communities <strong>of</strong> color with particular force,<br />
Governor Gretchen Whitment issued Executive Order <strong>2020</strong>-55, creating the <strong>Michigan</strong> Coronavirus<br />
Task Force on Racial Disparities—a group dedicated to studying, reporting on, and finding solutions<br />
to the disparate effects <strong>of</strong> COVID-19 on people <strong>of</strong> color.<br />
But much work remains. To be sure, the causes <strong>of</strong> these disparities are multiple and complex. Social<br />
determinants <strong>of</strong> health such as education, employment, and environmental factors—all <strong>of</strong> which<br />
correlate with race and ethnicity—are part <strong>of</strong> the explanation. Research also shows that disparities<br />
result in part because <strong>of</strong> differences in the delivery <strong>of</strong> medical services to people <strong>of</strong> different races.<br />
The National Healthcare Disparities Report concluded that white patients received care <strong>of</strong> a higher<br />
quality than did Black, Hispanic, Indigenous, and Asian Americans. People <strong>of</strong> color face more barriers<br />
to accessing health care than do white people, and are generally less satisfied with their interactions<br />
with health care providers.<br />
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These disparities can arise even when not intended because <strong>of</strong> the prevalence <strong>of</strong> what is sometimes<br />
called implicit bias: thoughts and feelings that, by definition, <strong>of</strong>ten exist outside <strong>of</strong> conscious<br />
awareness, and therefore are difficult to control. But they can shape behavior, including the behavior<br />
<strong>of</strong> health care pr<strong>of</strong>essionals. One way to reduce disparities in health outcomes, therefore, is to seek<br />
to eliminate the unconscious biases, misconceptions, and stereotypes that can lead to disparities in<br />
how health care is provided.<br />
<strong>Michigan</strong>’s front-line health-care workers have been its greatest heroes in the fight against COVID-19.<br />
Without their selfless and courageous service, many more lives would be lost and disrupted due to<br />
this pandemic. Nevertheless, we—all <strong>of</strong> us—need to do better, and training health-care workers<br />
how to recognize and mitigate implicit bias will only help these workers carry out their mission<br />
<strong>of</strong> providing the best health care to all they serve.<br />
For this reason, and on the recommendation <strong>of</strong> the <strong>Michigan</strong> Coronavirus Task Force on Racial<br />
Disparities, the Department <strong>of</strong> Licensing and Regulatory Affairs (LARA) has convened an Implicit Bias<br />
Stakeholders Workgroup and Subgroups to establish new rules requiring all health care pr<strong>of</strong>essionals,<br />
including nurses, to receive training on implicit bias and the way it affects delivery <strong>of</strong> health care<br />
services. This type <strong>of</strong> training has value for all <strong>Michigan</strong>ders in all pr<strong>of</strong>essions and walks <strong>of</strong> life and<br />
<strong>ANA</strong>-<strong>Michigan</strong> is fully committed to supporting this.<br />
We are honored and grateful to have the following dedicated and passionate <strong>ANA</strong>-<strong>Michigan</strong> leaders<br />
serving on the LARA Implicit Bias Stakeholders Workgroup and Subgroups:<br />
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Supporting Nurses During the<br />
<strong>2020</strong> COVID-19 Pandemic<br />
Upon Governor Whitmer’s first Executive Order <strong>2020</strong>-04 to “stay at home” on March 10, <strong>2020</strong> in<br />
response to the COVID-19 pandemic, <strong>ANA</strong>-<strong>Michigan</strong> strategically pivoted operations to fully respond<br />
to and support the needs <strong>of</strong> nurses during this time <strong>of</strong> uncertainty, setting aside routine, daily<br />
operations and the status quo. <strong>ANA</strong>-<strong>Michigan</strong>’s aggressive pivot and innovative, proactive approach<br />
has been nationally recognized, at the forefront for establishing new modern practices and has<br />
expanded our outreach and engagement to include more front-line nurses and potential members.<br />
Here are some ways that <strong>ANA</strong>-<strong>Michigan</strong> supported nurses during the on-set <strong>of</strong> the pandemic:<br />
• Donated more than 5,000 KN95 masks to nurses and health facilities in need during the onset<br />
<strong>of</strong> the pandemic and early PPE shortages.<br />
• Donated Billboards <strong>of</strong> Gratitude for Nurses displayed across the state.<br />
• COVID-19 Webpage: <strong>ANA</strong>-<strong>Michigan</strong> created the COVID-19 Resources webpage for members<br />
and all nurses to have a “one stop shop” for up to date, evidence-based data and information<br />
on COVID-19.<br />
• <strong>ANA</strong>-<strong>Michigan</strong> and our members shared stories from the front-line with Senators, key<br />
government <strong>of</strong>ficials and the community to help advocate for PPE and participated in both<br />
state and national interviews with various media outlets. <strong>ANA</strong>-<strong>Michigan</strong> members also<br />
participated in multiple Town Halls with key state and US representatives.<br />
• Throughout these unprecedented times, <strong>ANA</strong>-<strong>Michigan</strong> provided multiple opportunities<br />
for members and all nurses to connect for opportunities that support their well-being.<br />
Opportunities include but were not limited to:<br />
o Networks <strong>of</strong> Support Virtual Meet-Ups for Nurses (multiple)<br />
o Webinars on Stress Management and Self-Care for Nurses<br />
o Webinar on Stress First Aid for Nurses<br />
• Recognizing Year <strong>of</strong> the Nurse: No one could have predicted that how <strong>2020</strong> would truly be<br />
the Year <strong>of</strong> the Nurse. Despite the pandemic, <strong>ANA</strong>-<strong>Michigan</strong> and members still found ways<br />
to recognize and celebrate being a nurse.<br />
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COMPLIMENTARY RESOURCE AVAILABLE<br />
<strong>ANA</strong>-<strong>Michigan</strong> COVID-19 Training Program for K-12 School Teachers, Faculty and Staff<br />
Developed as a proactive response to the growing needs <strong>of</strong> K-12 Schools amid the COVID-19 pandemic<br />
the American Nurses Association <strong>of</strong> <strong>Michigan</strong> (<strong>ANA</strong>-<strong>Michigan</strong>) is proud to <strong>of</strong>fer a FREE online<br />
comprehensive four-part training program for teachers, faculty and staff. With so much information<br />
circulating that is constantly changing or completely inaccurate, <strong>ANA</strong>-<strong>Michigan</strong> is determined to<br />
secure the facts and share appropriate safety measures to help schools support their worried staff<br />
and concerned parents.<br />
The comprehensive virtual training course includes the following sections:<br />
• Part 1: Introduction to Coronavirus<br />
• Part 2: Maintaining Safety Practices During COVID-19<br />
• Part 3: Managing Stress During COVID-19<br />
• Part 4: Tool kit for School Faculty and Personnel Resources<br />
Schools that would like to work with one <strong>of</strong> our nurse trainers for specific questions, or for an<br />
online Q&A chat can schedule now through <strong>ANA</strong>-<strong>Michigan</strong>. Please direct specific questions about the<br />
COVID-19 Training Program to Nurse@ana-michigan.org or (517) 325-5306 or online on our website<br />
at ana-michigan.org.<br />
About <strong>ANA</strong>-<strong>Michigan</strong><br />
American Nurses Association-<strong>Michigan</strong> (<strong>ANA</strong>-<strong>Michigan</strong>) is the premier organization representing the<br />
interests <strong>of</strong> registered nurses (RNs) across the state. <strong>ANA</strong>-<strong>Michigan</strong> brings nurses together to advance<br />
their careers and the pr<strong>of</strong>ession through standard-setting, advocacy, and pr<strong>of</strong>essional development.<br />
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<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
<strong>ANA</strong>-<strong>Michigan</strong> COVID-19 Training Program for K-12 School Teachers, Faculty & Staff:<br />
AUTHORS & TRAINERS<br />
The <strong>ANA</strong>-<strong>Michigan</strong> COVID-19 Training Program was developed by the following <strong>ANA</strong>-<strong>Michigan</strong><br />
members on behalf <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong> in response to the <strong>2020</strong> COVID-19 Pandemic. This Training<br />
Program, and all its included materials, are the property <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong>. Authors and Trainers<br />
are listed below in alphabetical order by last name.<br />
Dayna Bennett, MSN, APRN, FNP-C<br />
Dayna Bennett is a Family Nurse Practitioner who works with<br />
Opdyke Medical, a family medical practice where she treats individuals through<br />
the lifespan. She has a special interest in women’s health, child health, diabetes,<br />
hypertension and weight management. She graduated with her Bachelor <strong>of</strong> Science<br />
in Nursing from the University <strong>of</strong> Windsor and Master <strong>of</strong> Science in Nursing from<br />
Ursuline College. She is a member <strong>of</strong> the <strong>ANA</strong>-<strong>Michigan</strong> and <strong>Michigan</strong> Council <strong>of</strong><br />
Nurse Practitioners. She enjoys living in <strong>Michigan</strong> with her three children and<br />
husband.<br />
Dr. Donna Cassidy, DHSc, MSN, RN<br />
Donna Cassidy has been an RN for 26 years. During her career<br />
Donna has worked in a variety <strong>of</strong> roles with increasing responsibilities. Donna<br />
spent 11 years working in education before moving into a nurse leadership role.<br />
Donna currently serves as the Hospital Administrator for a small community<br />
hospital in Southwest <strong>Michigan</strong>. Donna earned her Associates Degree in Nursing<br />
in 1994 and her BSN in 2002. Donna has a MSN from Walden University with a<br />
focus on Nursing Education and a Doctorate <strong>of</strong> Health Sciences with a focus on<br />
Organizational Leadership and Behavior earned from AT Still University.<br />
Dr. Wanda Chukwu, DNP, MA, CNEcl, RN<br />
Wanda Chukwu, DNP, MA, CNEcl, RN, is a proud member <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong>. Dr.<br />
Chukwu is currently taking time out <strong>of</strong> her daily routine to incorporate new<br />
strategies to manage stress and build resilience during the COVID-19 pandemic.<br />
She is currently employed as a fulltime nursing faculty member; and also works as<br />
an independent consultant helping individuals create policies and procedures for<br />
their health-related ventures. In her spare time she enjoys watching old movies<br />
and listening to good music.<br />
Linda Dunmore, MSN, RN, NE-BC, CPHQ, CHSP<br />
Linda Dunmore serves as the Senior Director <strong>of</strong> Clinical Services for Mercy Health<br />
in Muskegon. She has been with the organization for over 30 years and is currently<br />
responsible for the leadership in Quality, Accreditation, Patient Safety, Infection<br />
Prevention and Control (IPC), Clinical Education and Employee Health. Linda is<br />
an adjunct faculty for Indiana Wesleyan University. Linda is a member <strong>of</strong> <strong>ANA</strong>-<br />
<strong>Michigan</strong> and sits on the Nursing Practice Committee.<br />
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Noor Khalil M.Ed., BSN, RN<br />
Noor Khalil is a family nurse practitioner student interested in community<br />
nursing, holistic health care, transcultural health and reducing health disparities<br />
among vulnerable populations. During the pandemic, she has cared for COVID-19<br />
patients providing patient-family centered care. Her clinical background is in<br />
medical surgical nursing. She earned a Master <strong>of</strong> Education in health education<br />
concentrating on community health education from Wayne State University and<br />
a Bachelor <strong>of</strong> Science in Nursing from Oakland University with summa cum laude<br />
distinction.<br />
Kristin Mahler, MPH, RN, NCSN<br />
Kristin Mahler, RN,BSN, MPH, NCSN, is a proud member <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong>. Kristin<br />
works as a school nurse in Ann Arbor Public Schools since 2007. Prior to school<br />
nursing worked in a variety <strong>of</strong> inpatient and out patient settings. Active member<br />
<strong>of</strong> the <strong>Michigan</strong> Association <strong>of</strong> School Nurses Board <strong>of</strong> Directors. Nationally<br />
Certified School Nurse.<br />
Joshua Meringa, MPA, MHA, MBA, BSN, RN, NPD-BC<br />
Joshua Meringa is a Nurse Educator and Academic Liaison at Spectrum Health<br />
in Grand Rapids, <strong>Michigan</strong>. His responsibilities include facilitating orientation<br />
training for new RNs and Nurse Technicians, managing academic affiliations with<br />
nursing programs at colleges and universities throughout West <strong>Michigan</strong> and<br />
providing leadership and oversight for the Spectrum Health nursing continuing<br />
education program. Mr. Meringa has been a Registered Nurse since 2002 and<br />
is certified in nursing pr<strong>of</strong>essional development through the American Nurses<br />
Credentialing Center and as a certified Basic Life Support Instructor through the<br />
American Heart Association. He is a member <strong>of</strong> <strong>ANA</strong>-<strong>Michigan</strong> and the Wisconsin Nurses Association<br />
Continuing Education Approval Committee. Mr. Meringa is the immediate past Chair <strong>of</strong> the <strong>Michigan</strong><br />
Board <strong>of</strong> Nursing. He holds a Bachelor <strong>of</strong> Science in Nursing from Calvin College, and Master’s degrees<br />
in Public Administration, Healthcare Administration and Business Administration from Grand Valley<br />
State University. Meringa lives in Grandville, <strong>Michigan</strong> with his wife and three school-aged children.<br />
Marnie VanDam, RN, BSN, MSN<br />
Marnie VanDam, RN, BSN, MSN earned her Bachelor <strong>of</strong> Science degree from<br />
Oakland University and her Master <strong>of</strong> Science in nursing education from Capella<br />
University. She has 27 years <strong>of</strong> nursing experience with the last 10 years in<br />
emergency medicine. Mrs. VanDam is also employed by her local school district<br />
as a nurse consultant. Marnie is an active member <strong>of</strong> the <strong>ANA</strong>-<strong>Michigan</strong> Nursing<br />
Practice Committee.<br />
To request a meeting with one <strong>of</strong> the <strong>ANA</strong>-<strong>Michigan</strong> Authors/Trainers so that they may address any<br />
specific questions or concerns that your teachers, faculty or staff may have, please contact <strong>ANA</strong>-<br />
<strong>Michigan</strong> directly at: Nurse@ana-michigan.org Office: (517) 325-5306<br />
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<strong>ANA</strong>-MICHIGAN POLICY ON PUBLIC POSITION STATEMENTS<br />
POLICY<br />
<strong>ANA</strong>-<strong>Michigan</strong> shall take public positions on legislation and health policy proposals, and recommend<br />
actions based on the following Platform and process.<br />
PURPOSE<br />
<strong>ANA</strong>-<strong>Michigan</strong>’s position statements articulate the Association’s stand on health care policy<br />
proposals <strong>of</strong> importance to its membership and the public it serves. Positions are generated in<br />
response to trends and best practices in health care and health policy related to current and<br />
emerging issues that impact the health <strong>of</strong> the citizens <strong>of</strong> <strong>Michigan</strong>, their access to care, standards<br />
and excellence in nursing practice; and the pr<strong>of</strong>ession <strong>of</strong> nursing.<br />
All proposed policy positions are first benchmarked to the <strong>ANA</strong>-<strong>Michigan</strong> Mission, Vision and<br />
Strategic Values. The Criteria below are also applied to the analysis and recommendation <strong>of</strong><br />
policy positions to the Board <strong>of</strong> Directors.<br />
Platform Issues<br />
Access to Quality Care<br />
1. Promote accessibility to healthcare for all residents <strong>of</strong> <strong>Michigan</strong>.<br />
2. Support services for vulnerable populations.<br />
3. Ensure nursing care by appropriate licensed providers.<br />
4. Assure basic human needs services that impact individual health status.<br />
5. Support programs that enhance health literacy.<br />
Human Rights/Social Justice<br />
1. Provide for informed healthcare choices through evidence-based education <strong>of</strong> <strong>Michigan</strong> residents.<br />
2. Support legislative proposals that positively impact the health and welfare <strong>of</strong> <strong>Michigan</strong> residents.<br />
3. Educate legislators when proposals would negatively impact the health and well-being <strong>of</strong><br />
<strong>Michigan</strong> residents.<br />
4. Oppose discrimination in health policies/regulations and delivery <strong>of</strong> care.<br />
5. Support competent care for diverse <strong>Michigan</strong> populations.<br />
6. Protect the privacy <strong>of</strong> <strong>Michigan</strong> residents in issues <strong>of</strong> healthcare.<br />
Quality and Safety <strong>of</strong> Health Care<br />
1. Maintain state policies and regulations consistent with national nursing standards.<br />
2. Support for programs that address health promotion and maintenance and prevention <strong>of</strong> disease/<br />
disability.<br />
3. Actively collaborate with healthcare organizations within the state for purposes <strong>of</strong> quality care,<br />
patient safety and nursing input.<br />
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<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
Advances in the Practice and/or Pr<strong>of</strong>ession <strong>of</strong> Nursing<br />
1. Promote the viability <strong>of</strong> pr<strong>of</strong>essional nursing organizations.<br />
2. Promote statewide communication within the pr<strong>of</strong>ession.<br />
3. Encourage occupational health and safety <strong>of</strong> nurses.<br />
4. Support public funding for nursing research and education.<br />
Process for Position Statement Review<br />
1. Requests for development <strong>of</strong> an Association position statement on a policy, issue or legislation<br />
may be made by the Board <strong>of</strong> Directors, an individual member, or based on member survey<br />
results.<br />
2. The request is sent to the Public Policy Council for consideration.<br />
3. The Public Policy Council reviews the issue, evaluates the issue in relation to the <strong>ANA</strong>-<strong>Michigan</strong><br />
Mission, Values and Impact Statement and the Platform criteria.<br />
4. The Public Policy Council makes a recommendation to the Board using an evidence-based review<br />
<strong>of</strong> the issue and its relevance to the above Platform Criteria. Topic experts may be used to<br />
develop the position statement.<br />
5. The Board determines whether the proposed position statement is adopted by the Association<br />
and made public.<br />
6. The Association positions are reviewed by the Public Policy Council annually.<br />
7. Recommendations for policy changes are made to the Board.<br />
8. Joint positions (e.g. with other healthcare groups) may be developed.<br />
Approved by the <strong>ANA</strong>-<strong>Michigan</strong> Board <strong>of</strong> Directors on September 19, 2015<br />
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<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
POSITION STATEMENT<br />
MORAL DISTRESS IN TIMES OF CRISIS<br />
Background<br />
Moral distress is “knowing the right thing to<br />
do but being in a situation in which it is nearly<br />
impossible to do it.” 1<br />
Critical care teams wrestle daily with moral<br />
challenges in the context <strong>of</strong> their normal<br />
pr<strong>of</strong>essional activities. 2 During a crisis, such as<br />
the COVID-19 pandemic, everyday challenges<br />
are compounded. For example, patient surge<br />
results in shortages <strong>of</strong> lifesaving equipment<br />
needed to keep patients alive 3 and a lack <strong>of</strong><br />
personal protective equipment necessary to<br />
protect nurses, their patients, their families, and<br />
their communities. 4,5 Team members struggle<br />
to maintain their pr<strong>of</strong>essional, emotional,<br />
and moral equilibrium when caught in tragic<br />
situations beyond their control.<br />
Nurses, and all members <strong>of</strong> the healthcare<br />
team, must protect their personal integrity<br />
and sense <strong>of</strong> justice to be effective in their<br />
work. Too <strong>of</strong>ten, nurses are pressured to<br />
compartmentalize emotions, and to rapidly and<br />
stoically “do your duty.” Sustaining a strong<br />
sense <strong>of</strong> duty maintains order, serves patients,<br />
and preserves the respect <strong>of</strong> coworkers and<br />
loved ones. However, discerning one’s duty may<br />
not take the linear path <strong>of</strong> simply following<br />
orders and regulations. Those who apply a carebased<br />
morality prioritize relationships with<br />
others in making moral decisions. 1,6 Embracing<br />
a care-based perspective recognizes that nurses<br />
live in a web <strong>of</strong> moral duties that includes their<br />
duty to protect themselves, their patients, their<br />
families, and their communities.<br />
Recommended Actions for<br />
Healthcare Institutions<br />
Every organization must:<br />
• Provide the vital supplies and equipment<br />
that nurses need to protect themselves and<br />
others.<br />
• Establish evidence-based, consistent,<br />
procedures for equitably allocating scarce<br />
resources and use them in a way that<br />
maximizes value without endangering<br />
safety. 8,9<br />
• Consider creating an interdisciplinary<br />
triage committee composed <strong>of</strong> respected<br />
volunteers to provide unbiased opinions in<br />
difficult situations. This preserves each direct<br />
caregiver’s ethical duty for beneficence. 3<br />
• Ensure that administrators are accessible to<br />
those performing direct patient care, and<br />
that they maintain clear communication<br />
and transparency regarding institutional<br />
challenges.<br />
• Guarantee that nurses are included as<br />
decision makers on all institutional ethics<br />
committees.<br />
• Monitor the clinical and organizational<br />
climate to identify situations that could<br />
create moral distress.<br />
• Provide tools to help clinicians recognize<br />
the experience <strong>of</strong> moral distress.<br />
• Create interdisciplinary forums to discuss<br />
patient goals <strong>of</strong> care and divergent opinions<br />
regarding those goals <strong>of</strong> care in an open,<br />
respectful environment.<br />
• Ensure institutional support systems include<br />
easy access to:<br />
• Ethics committees<br />
76
• Critical stress debriefings<br />
• Protocols for end-<strong>of</strong>-life care<br />
• Readily available crisis counseling<br />
• Employee assistance programs<br />
• Grief counseling<br />
Recommended Actions for Nurses<br />
Nurses must:<br />
• Pay attention to your inner voice and<br />
recognize when it conflicts with what you<br />
are being asked to do or what circumstances<br />
demand that you do.<br />
• Create a moral compass for yourself by<br />
expanding your ethical knowledge. Seek out<br />
pr<strong>of</strong>essional and institutional resources that<br />
can provide ethical guidance, such as:<br />
• American Nurses Association Code <strong>of</strong> Ethics<br />
for Nurses 10<br />
• International Council <strong>of</strong> Nurses Code <strong>of</strong><br />
Ethics for Nurses 11<br />
• Your hospital’s ethics committee or moral<br />
distress consulting team.<br />
• Learn the signs and symptoms <strong>of</strong> moral<br />
distress. They include:<br />
• Feelings <strong>of</strong> frustration, anger, and guilt 12<br />
• Physical manifestations such as heart<br />
palpitations, insomnia, and fatigue<br />
• Psychological consequences such as<br />
withdrawal, emotional exhaustion, and<br />
depersonalization <strong>of</strong> patients. 13<br />
• Seek out a trusted mentor.<br />
• Use employee assistance resources and see a<br />
qualified pr<strong>of</strong>essional counselor or therapist<br />
when needed.<br />
• Lean on coworkers, friends, and loved ones.<br />
They are all in the mix as you balance your<br />
personal and pr<strong>of</strong>essional duties, and they<br />
need to know when you are experiencing<br />
moral distress.<br />
• Practice self-care, and keep a reflection<br />
journal.<br />
References<br />
1. Jameton A. What moral distress in nursing history<br />
could suggest about the future <strong>of</strong> health care. AMA J<br />
Ethics. 2017;19(6):617-628.<br />
2. Savel RH, Munro CL. Moral distress, moral courage.<br />
Am J Crit Care. 2015;24(4):276-278. doi: 10.4037/<br />
ajcc2015738<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
77<br />
3. Truog RD, M.D., Christine Mitchell C, Daley GQ.<br />
The toughest triage — Allocating ventilators in a<br />
pandemic. NEJM. Published online March 23, <strong>2020</strong>.<br />
doi: 10.1056/NEJMp2005689 https://www.nejm.org/<br />
doi/full/10.1056/NEJMp2005689<br />
4. Interim Infection Prevention and Control<br />
Recommendations for Patients with Suspected or<br />
Confirmed Coronavirus Disease 2019 (COVID-19) in<br />
Healthcare Settings. Centers for Disease Control and<br />
Prevention. https://www.cdc.gov/coronavirus/2019-<br />
ncov/infection-control/control-recommendations.<br />
html<br />
5. Interim Guidance: Rational use <strong>of</strong> personal protective<br />
equipment for coronavirus disease 2019 (COVID-19).<br />
World Health Organization. Accessed March 25,<br />
<strong>2020</strong>. https://apps.who.int/iris/bitstream/<br />
handle/10665/331215/WHO-2019-nCov-IPCPPE_use-<br />
<strong>2020</strong>.1-eng.pdf<br />
6. van Nistelrooij I, Leget C. Against dichotomies:<br />
On mature care and self-sacrifice in care<br />
ethics. Nurs Ethics. 2017;24(6):694-703. doi:<br />
10.1177/0969733015624475<br />
7. Barden C, Cassidy L, Cardin S, eds. AACN Standards<br />
for Establishing and Sustaining Healthy Work<br />
Environments: A Journey to Excellence. 2nd ed.<br />
Aliso Viejo, CA: American Association <strong>of</strong> Critical-<br />
Care Nurses; 2016. https://www.aacn.org/<br />
nursing-excellence/standards/aacn-standardsfor-establishing-and-sustaining-healthy-workenvironments.<br />
Accessed March 25, <strong>2020</strong>.<br />
8. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation<br />
<strong>of</strong> scarce medical resources in the time <strong>of</strong> covid-19.<br />
N Engl J Med. Published online March 23, <strong>2020</strong>. doi:<br />
10.1056/NEJMsb2005114<br />
9. Daugherty Biddison EL, Faden R, Gwon HS, et al.<br />
Too many patients…a framework to guide statewide<br />
allocation <strong>of</strong> scarce mechanical ventilation<br />
during disasters. Chest. 2019;155(4):848-854. doi:<br />
10.1016/j.chest.2018.09.025<br />
10. American Nurses Association. Code <strong>of</strong> Ethics for<br />
Nurses With Interpretive Statements. Silver Spring,<br />
MD: Nursesbooks.org Retrieved from https://<br />
www.nursingworld.org/practice-policy/nursingexcellence/ethics/code-<strong>of</strong>-ethics-for-nurses/coeview-only/<br />
11. The ICN Code <strong>of</strong> Ethics. Revised. Geneva Switzerland:<br />
International Council <strong>of</strong> Nurses; 2012.<br />
12. Epstein EG, Delgado S. “Understanding and<br />
Addressing Moral Distress.” Online J Issues Nurs.<br />
Published online September 30, 2010. doi: 10.3912/<br />
OJIN.Vol15No03Man01.<br />
13. Rushton CH, Caldwell M, Kurtz M. Moral Distress:<br />
A catalyst in building moral resilience. Am J<br />
Nurs. 2016;116(7):40-49. doi: 10.1097/01.<br />
NAJ.0000484933.40476.5b
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
POSITION STATEMENT<br />
PREVENTING WORKPLACE VIOLENCE IN HEALTHCARE SETTINGS<br />
Background<br />
The <strong>ANA</strong> Nurses Bill <strong>of</strong> Rights maintains that<br />
nurses have the right to a work environment<br />
that is safe for themselves and for their patients<br />
regardless <strong>of</strong> the setting <strong>of</strong> care.<br />
According to reports from National Institute<br />
for Occupational Safety and Health (NIOSH),<br />
individuals who are injured and who miss work<br />
as a result <strong>of</strong> violence in healthcare settings<br />
is increasing (U.S. Department <strong>of</strong> Labor [DOL],<br />
Bureau <strong>of</strong> Labor Statistics, 2014).<br />
Violence in healthcare facilities is complex and<br />
multiple factors may contribute to the problem.<br />
Nurses and other caregivers have a personal and<br />
pr<strong>of</strong>essional duty to “do no harm” to patients.<br />
Many will put their own safety at risk to help a<br />
patient and some consider violence “part <strong>of</strong> the<br />
job.” Many excuse attacks as being unintentional<br />
and due to an individual’s illness or impairment.<br />
In addition to physical harm, individuals who<br />
experience or witness violence in the healthcare<br />
workplace are at risk for emotional consequences<br />
that can lead to time away from work, burnout,<br />
job dissatisfaction, and decreased productivity.<br />
These and other consequences compromise both<br />
worker and patient safety.<br />
As <strong>of</strong> June, 2019, 36 states have established<br />
or increased legal penalties for the assault <strong>of</strong><br />
nurses and other healthcare providers and nine<br />
states require healthcare organizations to run<br />
workplace violence programs (<strong>ANA</strong>, 2019). As<br />
<strong>of</strong> this writing, <strong>Michigan</strong> has NEITHER specific<br />
legal penalties nor workplace violence program<br />
requirements for healthcare organizations.<br />
Definition <strong>of</strong> Workplace Violence<br />
NIOSH defines workplace violence as physically<br />
and psychologically damaging actions that occur<br />
in the workplace or while on duty. (NIOSH, 2002).<br />
This can include verbal violence – threats, verbal<br />
abuse, hostility, harassment which can cause<br />
psychological trauma and stress even though<br />
there is no physical injury (OSHA, 2015)<br />
NIOSH describes four basic types <strong>of</strong> workplace<br />
violence:<br />
Type 1 – Involves “criminal intent” In this type<br />
<strong>of</strong> violent encounter, individuals with criminal<br />
intent have no relationship to the business or<br />
employees.<br />
Type II: Involves a customer, client, or patient.<br />
In this type “individual has a relationship with<br />
the business and becomes violent when receiving<br />
services.”<br />
Type III: Involves a “worker on worker”<br />
relationship and includes employees who attack<br />
or threaten another employee.<br />
Type IV: Violence involves personal relationships<br />
and includes “individuals who have interpersonal<br />
relationships with the intended target but no<br />
relationship to the business”<br />
Types II and III are the most common types in<br />
health care settings.<br />
78
Evidence<br />
According to The Occupational Safety and<br />
Health Administration (OSHA), healthcare<br />
workers, including nurses, are at 4x higher risk<br />
<strong>of</strong> experiencing workplace violence than those<br />
who work in other industries. Registered nurses<br />
experienced 14 violent injuries resulting in days<br />
away from work per 10,000 full time employees<br />
compared with a rate <strong>of</strong> 4.2 per 10,000 in private<br />
industry as a whole. Psychiatric aides are at<br />
highest risk (590 per 10,000) followed by nursing<br />
assistants (55 per 10,000). (U.S. Department <strong>of</strong><br />
Labor [DOL], Bureau <strong>of</strong> Labor Statistics, 2014).<br />
The statistics underpinning this statement are<br />
drawn solely from reported incidents and OSHA<br />
notes that many incidents that could be included<br />
are NOT reported for a variety <strong>of</strong> reasons. Part<br />
<strong>of</strong> the problem is that because violent incidents<br />
are so common, they have become normative<br />
and among victims, only 30% <strong>of</strong> nurses and 26%<br />
<strong>of</strong> physicians actually reported the incidences<br />
(OSHA, 2015).<br />
Core Components<br />
<strong>ANA</strong>-MI concurs with <strong>ANA</strong> regarding interventions<br />
and supports the following:<br />
Primary prevention strategies that include<br />
development <strong>of</strong> workplace violence prevention<br />
programs, development <strong>of</strong> relevant policies, and<br />
education programs specifically designed for<br />
nurses and frontline caregivers. Students should<br />
also learn about the issue in nursing education<br />
programs. Employers and educational institutions<br />
must support work environments that are safe<br />
and align with OSHA’s “Guidelines for Preventing<br />
Workplace Violence for Healthcare and Social<br />
Service Workers” (OSHA, 2015; Lipscomb &<br />
London, 2015.)<br />
Secondary prevention strategies that include<br />
interventions designed to reduce and/or<br />
minimize the negative impact <strong>of</strong> workplace<br />
violence. Reporting incidences <strong>of</strong> violence is<br />
paramount so that accurate data can be gathered<br />
and analyzed.<br />
Tertiary prevention strategies that are designed<br />
to reduce the consequences <strong>of</strong> workplace<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
79<br />
violence and may include incident debriefing,<br />
counseling programs, root cause analysis and<br />
confidentiality assurances. Legislative and legal<br />
strategies that protect all healthcare providers<br />
should be considered and supported.<br />
References<br />
American Nurses Association. (2019) Workplace violence.<br />
Retrieved from https://www.nursingworld.org/practicepolicy/advocacy/state/workplace-violence2/<br />
American Nurses Association. (2016). American Nurses<br />
Association calls for a culture <strong>of</strong> safety in all health<br />
care settings [Press release]. Retrieved from https://<br />
www.nursingworld.org/news/news-releases/2016/<br />
americannurses-association-calls-for-a-culture-<strong>of</strong>-safetyin-all-health-care-settings/<br />
xxii<br />
American Nurses Association. Position Statement on<br />
Incivility, Bullying, and Workplace Violence. 2015. Web:<br />
https://www.nursingworld.org/practice-policy/workenvironment/violence-incivility-bullying/<br />
The Joint Commission. (2010). Preventing violence in the<br />
health care setting. Sentinel Event Alert, Issue 45. Web:<br />
https://www.jointcommission.org/assets/1/18/SEA_45.<br />
PDF<br />
The Joint Commission. Sentinal Event Alert: Physical and<br />
verbal violence against healthcare workers. Retrieved<br />
from: https://www.jointcommission.org/assets/1/18/<br />
SEA_59_Workplace_violence_4_13_18_FINAL.pdf<br />
National Institute <strong>of</strong> Occupational Safety and Health<br />
(NIOSH). Division <strong>of</strong> Safety Research. (2002) Violence:<br />
occupational hazards in hospitals. Cincinnati, Ohio: U.S.<br />
Department <strong>of</strong> Health and Human Services, Public Health<br />
Services, Center for Disease Control and Prevention, NIOSH<br />
Division <strong>of</strong> Safety Research.<br />
National Institute for Occupational Safety and Health.<br />
(2013). Workplace violence prevention for nurses. CDC<br />
Course No. WB1865—NIOSH Pub. No. 2013-155. Retrieved<br />
from https://www.cdc.gov/niosh/topics/ violence/<br />
training_nurses.html.<br />
Occupational Safety and Health Administration. (2015).<br />
“Guidelines for preventing workplace violence for<br />
healthcare and social service workers” (Publication No.<br />
OSHA 3148-04R 2015). Retrieved from https://www.osha.<br />
gov/Publications/osha3148.pdf.<br />
Occupational Safety and Health Administration. (2015).<br />
“Workplace violence in healthcare: understanding<br />
the challenge.” https://www.osha.gov/Publications/<br />
OSHA3826.pdf<br />
U.S. Government Accountability Office. (2016). Additional<br />
Efforts Needed to Help Protect Health Care Workers from<br />
Workplace Violence. Retrieved from tps://www.gao.gov/<br />
products/GAO-16-11 xxviii Occupational Safety and Health
Administration (OSHA). 2015. Retrieved from https://<br />
www.osha.gov/Publications/OSHA3827.pdf xxix<br />
U.S. Department <strong>of</strong> Labor, Bureau <strong>of</strong> Labor Statistics.<br />
(2014). Nonfatal occupational injuries and illnesses<br />
requiring days away from work, 2013. (No. USDL-14-2246).<br />
Retrieved from http://www.bls.gov/news.release/pdf/<br />
osh2.pdf.<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
Approved: November 8, 2019 by the <strong>ANA</strong>-<strong>Michigan</strong><br />
Board <strong>of</strong> Directors To be reviewed: November 8,<br />
2021<br />
Contact www.ana-michigan.org nurse@anamichigan.org<br />
(517) 325-5306<br />
80
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
POSITION STATEMENT<br />
TELEHEALTH AND CONNECTED HEALTH<br />
BACKGROUND<br />
The United States is in the midst <strong>of</strong> a global<br />
pandemic from Covid-19, a highly contagious<br />
disease that has caused severe social, economic<br />
and cultural disruptions to everyday life in<br />
America. Telehealth, also referred to as<br />
Connected Health, has grown exponentially<br />
during this time as more services are being<br />
delivered and are eligible for reimbursement<br />
from public and private insurers. The Center for<br />
Medicare and Medicaid Services (CMS) released<br />
new guidelines for telehealth in April, <strong>2020</strong> that<br />
encourage expansion <strong>of</strong> services to populations<br />
they cover. Examples from major <strong>Michigan</strong><br />
healthcare systems include <strong>Michigan</strong> Medicine<br />
which conducted 444 virtual visits in February,<br />
<strong>2020</strong> and increased those to more than 20,000<br />
visits by the end <strong>of</strong> April, <strong>2020</strong>. Henry Ford<br />
Health System went from conducting 150 virtual<br />
visits per week to 10,000 virtual visits and report<br />
high patient satisfaction with this option.<br />
Nearly 20% <strong>of</strong> Americans live in rural areas<br />
where there is a shortage <strong>of</strong> both providers and<br />
healthcare facilities. “The health consequences<br />
for communities that lack resources can be dire”<br />
states Joelle Fathi DNP RN ARNP CTTS, an expert<br />
on biobehavioral nursing and health informatics<br />
and a member <strong>of</strong> the 2018 <strong>ANA</strong> Steering<br />
Committee to revise its Core Principles <strong>of</strong><br />
Telehealth. Fathi further states that connected<br />
health has value for patients in urban and major<br />
metropolitan areas. The expansion <strong>of</strong> healthcare<br />
services through connected health creates the<br />
opportunity to serve populations with care that<br />
is “necessary, timely, efficient, convenient and<br />
effective.” (Moore & Trainum, 2019, p. 32).<br />
The Affordable Care Act and the 2017 Health<br />
Care Act both support the use <strong>of</strong> telehealth and<br />
technology to expand access to care delivery.<br />
Tamara Broadnaux DNP RN NEA-BC, Clinical<br />
Operations, Department <strong>of</strong> Veterans Affairs<br />
states that “As providers move toward more<br />
value-based, shared saving, and accountable<br />
care models as required in healthcare reform,<br />
connected health provides better care<br />
coordination, management and communication<br />
with patients.” (Moore & Trainum, 2019, p. 32).<br />
In 2019, <strong>ANA</strong> released Core Principles on<br />
Connected Health (Principles) as a guide for<br />
healthcare pr<strong>of</strong>essionals who use telehealth<br />
technologies to provide quality care. This<br />
document is an update to the 1998 <strong>ANA</strong> Core<br />
Principles on Telehealth and reflect the evolution<br />
<strong>of</strong> healthcare using a more interdisciplinary<br />
approach. There are 13 Principles within the<br />
guide that identify unique issues related to<br />
practice, regulatory, privacy, reimbursement,<br />
documentation and competencies. (<strong>ANA</strong>, 2019).<br />
The Centers for Disease Control and Prevention<br />
(CDC) has issued Guidelines on using Telehealth<br />
to expand access to essential healthcare services<br />
during and beyond the COVID-19 pandemic.<br />
<strong>ANA</strong> recognizes that connected health provides<br />
a method <strong>of</strong> healthcare delivery that can<br />
improve access to quality health care when<br />
implementation is conducted using accepted<br />
standards and best available evidence. Nurses<br />
play an essential role in the adoption and use <strong>of</strong><br />
connected health across care settings and roles<br />
and are well-positioned to lead in the adoption<br />
and use <strong>of</strong> care via these technologies.<br />
81
DEFINITIONS<br />
The American Nurses Association defines<br />
telehealth and Connect Health as “the use <strong>of</strong><br />
electronic information and telecommunications<br />
technologies to support and promote long<br />
distance clinical health care, patient and<br />
pr<strong>of</strong>essional health-related education, public<br />
health and health administration. Technologies<br />
include: videoconferencing, the internet, storeand-forward<br />
imaging, streaming media, and<br />
terrestrial and wireless communication” <strong>ANA</strong>,<br />
n.d. While telehealth has been in existence for<br />
many years, it has grown exponentially recently<br />
due in part to need to deliver care virtually<br />
during the coronavirus pandemic.<br />
Centers for Medicare & Medicaid Services (CMS)<br />
(<strong>2020</strong>) define telehealth as “a two-way, real- time<br />
interactive communication between a patient<br />
and a physician or practitioner at a distant<br />
site through telecommunications equipment<br />
that includes, at a minimum, audio and visual<br />
equipment.”<br />
Several telehealth modalities allow providers<br />
and patients to connect using technology to<br />
deliver health care:<br />
• Synchronous: This includes real-time<br />
telephone or live audio-video interaction<br />
typically with a patient using a smartphone,<br />
tablet, or computer.<br />
• In some cases, peripheral medical<br />
equipment (e.g., digital stethoscopes,<br />
otoscopes, ultrasounds) can be used<br />
by another HCP (e.g., nurse, medical<br />
assistant) physically with the patient,<br />
while the consulting medical provider<br />
conducts a remote evaluation.<br />
• Asynchronous: This includes “store and<br />
forward” technology where messages,<br />
images, or data are collected at one point<br />
in time and interpreted or responded to<br />
later. Patient portals can facilitate this type<br />
<strong>of</strong> communication between provider and<br />
patient through secure messaging.<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
• Remote patient monitoring: This allows<br />
direct transmission <strong>of</strong> a patient’s clinical<br />
measurements from a distance (may or<br />
may not be in real time)to their healthcare<br />
provider.<br />
• Mobile Health (mHealth): This includes the<br />
use <strong>of</strong> mobile devices to support health care<br />
and public health information exchange.<br />
Information exchange using mHealth may<br />
include general educational information,<br />
targeted texts, and disease outbreak<br />
notifications.<br />
Nurses have the background, skills and creative<br />
ingenuity to help patients effectively<br />
navigate and engage in telehealth modalities<br />
across the continuum <strong>of</strong> care.<br />
Nurses have the background, skills and creative<br />
ingenuity to help patients effectively navigate<br />
and engage in telehealth modalities across the<br />
continuum <strong>of</strong> care.<br />
RECOMMENDATIONS:<br />
1. Endorse the term telehealth and Connected<br />
Health, as this is the most widely used and<br />
accepted term used in national guidelines,<br />
by third party payors and most pr<strong>of</strong>essional<br />
organizations<br />
2. Adopt the 2019 <strong>ANA</strong> Core Principles on<br />
Connected Health.<br />
3. Advocate to make permanent recent policy<br />
changes that reduce barriers to telehealth<br />
services and reimbursement at the state and<br />
national level.<br />
4. Advocate for registered nurses (RN) and<br />
advance practice registered nurses (APRN)<br />
to be included in any legislation and to<br />
have access to telehealth platforms used by<br />
organizations<br />
5. Advocate for the inclusion <strong>of</strong> telehealth<br />
content and experiences at all levels <strong>of</strong><br />
registered nursing education.<br />
82
REFERENCES:<br />
American Nurses Association (2019, June 6). <strong>ANA</strong><br />
core principles on connected health. Retrieved<br />
from https://www.nursingworld.org/~4a9307/<br />
globalassets/docs/ana/practice/ana-coreprinciples-<br />
on-connected-health.pdf<br />
American Nurses Association. (n.d.). Telehealth.<br />
https://www.nursingworld.org/practice-policy/<br />
advocacy/telehealth/<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
Moore, E., & Trainum, B. (2019). Connected<br />
health: <strong>ANA</strong>’s updated principles put nursing at<br />
the forefront. American Nurse Today, 14(12), 32-<br />
33.<br />
U.S. Centers for Medicare & Medicaid Services<br />
(<strong>2020</strong>, April 24). Telehealth. Retrieved from<br />
https://www. cms.gov/Medicare/Medicare-<br />
General-Information/ Telehealth<br />
83
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
POSITION STATEMENT<br />
MITIGATING IMPLICIT BIAS TO REDUCE DISPARITIES IN PATIENT OUTCOME<br />
The purpose <strong>of</strong> this statement is to explore<br />
implicit bias and the role it plays in healthcare<br />
disparities and to identify what nurses can do to<br />
encourage equality <strong>of</strong> care for all patients.<br />
BACKGROUND<br />
Our United States Declaration <strong>of</strong> Independence<br />
assures equality, life, liberty and the pursuit<br />
<strong>of</strong> happiness as fundamental rights for all<br />
(Jefferson, 1776), yet there is nothing in the<br />
document that promises healthcare as a right for<br />
all citizens. For this and other reasons, healthcare<br />
imbalances and disadvantages are present in our<br />
country. Citizens with steady incomes, better<br />
health insurance, healthy food, clean water and<br />
greater access to care <strong>of</strong>ten experience better<br />
healthcare opportunities than citizens with less<br />
money, lesser or no health insurance coverage,<br />
inadequate food and water resources and less<br />
access to care (Probst, et. al, <strong>2020</strong>; Oppel, et<br />
al, <strong>2020</strong>) . Healthcare disparities have been<br />
defined by Healthy People <strong>2020</strong> as “a particular<br />
type <strong>of</strong> health difference that is closely linked<br />
with social, economic, and/or environmental<br />
disadvantage” (ODPHP). With the onset <strong>of</strong> the<br />
COVID-19 pandemic, healthcare disparities have<br />
become more obvious.<br />
Citizens <strong>of</strong> color are even at a greater risk for<br />
healthcare disparities. While African American<br />
citizens made up 14% <strong>of</strong> <strong>Michigan</strong>’s population,<br />
they accounted for 35% <strong>of</strong> the COVID-19 cases<br />
by July <strong>2020</strong> and were noted to be four times<br />
more likely to die a COVID-19 related death than<br />
their Caucasian counterparts (<strong>Michigan</strong>.gov).<br />
Several studies have shown that implicit bias by<br />
healthcare providers is associated with lower<br />
quality <strong>of</strong> care (FitzGerald & Hurst, <strong>2020</strong>).<br />
Healthcare disparities such as these sparked<br />
<strong>Michigan</strong>’s governor, Gretchen Whitmer, to form a<br />
task force to advise her on strategies to eliminate<br />
these racial disparities. One recommendation is<br />
to mandate healthcare providers to participate in<br />
implicit bias training as a condition <strong>of</strong> relicensure<br />
in an effort to eliminate discrimination against<br />
all citizens, especially those from disadvantaged<br />
backgrounds (executive order <strong>2020</strong>). <strong>ANA</strong>-MI<br />
strongly supports Governor Whitmer’s stance on<br />
eradication <strong>of</strong> racism and healthcare disparities.<br />
The mission statement which drives the American<br />
Nurses Association is to “Lead the pr<strong>of</strong>ession to<br />
shape the future <strong>of</strong> nursing and health care.”<br />
As nurses, it is up to us to facilitate increased<br />
opportunities for those experiencing disparities<br />
in healthcare due to bias. It is up to us to help<br />
even the playing field and to progress toward full<br />
equality in healthcare.<br />
IMPLICIT BIAS<br />
Implicit bias, also known as unconscious bias,<br />
as been defined as “thoughts and feelings that,<br />
by definition, <strong>of</strong>ten exist outside <strong>of</strong> conscious<br />
awareness, and therefore are difficult to control,”<br />
(Hall, Implicit Racial/Ethnic Bias Among Health<br />
Care Pr<strong>of</strong>essionals and Its Influence on Health<br />
Care Outcomes: A Systematic Review, 105 AM. J.<br />
PUBLIC HEALTH 2588 (Dec. 2015). Furthermore,<br />
implicit bias includes any preconceived thoughts<br />
that can result in disparities and it is the duty <strong>of</strong><br />
the healthcare provider to become aware <strong>of</strong> our<br />
own biases to help embrace the changes needed<br />
to eliminate healthcare disparities (<strong>ANA</strong>, 2018;<br />
Fitzgerald & Hurst, 2016). It has been noted<br />
when people experience discrimination based<br />
on personal characteristics, it can impact their<br />
84
physical and psychological health (Sutin, Stephan<br />
& Terracciano, 2016). Racism has been described<br />
as a public health crisis which affects the mental<br />
as well as physical health <strong>of</strong> all people (<strong>ANA</strong>,<br />
2018). In the past, the <strong>ANA</strong> has also taken the<br />
position there should be no discrimination in<br />
nursing practice nor in health care and that all<br />
patients should be viewed as equal and nurses<br />
should be treat them with impartiality, respect,<br />
and civility (2018).<br />
RECOMMENDATIONS:<br />
Strategies to mitigate implicit bias include<br />
building upon previous work <strong>of</strong> the <strong>ANA</strong>-<br />
<strong>Michigan</strong> (2018) based on opposing all racism<br />
and discrimination and being an advocate for<br />
all patients, regardless <strong>of</strong> their gender, race,<br />
ethnicity, etc.<br />
• Acknowledge that implicit biases do exist<br />
and becoming aware these biases can result in<br />
disparities in health outcomes associated with<br />
many demographic factors. (As nurses it is<br />
imperative to be aware <strong>of</strong> demographic factors<br />
which can undermine our patient’s success for<br />
health. Some <strong>of</strong> these factors might include<br />
questioning if there are safe living situations,<br />
availability for safe places to walk, feasibility <strong>of</strong><br />
obtaining fresh produce and other healthy food<br />
choices, and obtaining fresh clean water for<br />
drinking.)<br />
• Follow the Nursing Code <strong>of</strong> Ethics,<br />
which advises nurses to band together<br />
as patient advocates against racism,<br />
discrimination and injustice.<br />
• Participate in the required implicit bias<br />
training. While this will be a part <strong>of</strong> the<br />
next license renewal, it will also expand<br />
knowledge on this subject.<br />
• Assume the responsibility for recognizing<br />
your own implicit biases.<br />
• Commit to treat all patients equally<br />
regardless <strong>of</strong> their race, ethnicity,<br />
economic status, sexual identity, or<br />
gender.<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
• Become an advocate for all patients, for<br />
issues <strong>of</strong> diversity, equity and inclusion.<br />
As nurses it is our duty to uphold the values<br />
and mission <strong>of</strong> the <strong>ANA</strong>-<strong>Michigan</strong> by<br />
treating all patients equally and fairly.<br />
REFERENCES:<br />
<strong>Michigan</strong>.gov. <strong>Michigan</strong> Data, Cases by<br />
Demographic Characteristics, Mich.<br />
Coronavirus, https://www.michigan.gov/<br />
coronavirus/0,9753,7-406-98163_98173---,00.<br />
html, (last visited July 5, <strong>2020</strong>).<br />
Sutin, A., Stephan, Y. & Terracciano, A. (2016).<br />
Perceived discrimination and personality<br />
development in adulthood. Developmental<br />
Psychology, 52(1), 155-163. doi: 10.1037/<br />
dev000069 American Nurses Association (<strong>ANA</strong>)<br />
(2018). Position statement on The Nurse’s<br />
Role in Addressing Discrimination: Protecting<br />
and Promoting Inclusive Strategies in Practice<br />
Settings, Policy, and Advocacy. Found at: https://<br />
www.nursingworld.org/~4ab207/globalassets/<br />
practiceandpolicy/nursing-excellence/<br />
ana-position-statements/social-causes-andhealth-care/the-nurses-role-in-addressingdiscrimination.pdf<br />
Center for Disease Control & Prevention.<br />
COVIDView, A Weekly Surveillance Summary <strong>of</strong><br />
U.S. COVID-19 Activity, (July 5, <strong>2020</strong>). https://<br />
www.cdc.gov/ coronavirus/2019-ncov/coviddata/covidview/index.<br />
html, (last visited July 5,<br />
<strong>2020</strong>).<br />
Oppel, R.A., et al., The Fullest Look Yet at the<br />
Racial Inequity <strong>of</strong> the Coronavirus, N.Y. TIMES<br />
(Jul. 5, <strong>2020</strong>), https://www.nytimes.com/<br />
interactive/<strong>2020</strong>/07/05/us/coronavirus-latinosafrican-americans-cdc-data.html.<br />
William J. Hall , et al., Implicit Racial/Ethnic<br />
Bias Among Health Care Pr<strong>of</strong>essionals and Its<br />
Influence on Health Care Outcomes: A Systematic<br />
Review, 105 AM. J. PUBLIC HEALTH 2588 (Dec.<br />
2015), https://www. ncbi.nlm.nih.gov/pmc/<br />
articles/PMC4638275/#bib1.<br />
85
Id. (observing that “Non-Hispanic American<br />
Indian or Alaska Native persons have an ageadjusted<br />
hospitalization rate approximately 5.7<br />
times that <strong>of</strong> non-Hispanic White persons.”)<br />
CDC Health Disparities and Inequalities Report<br />
– United States, 2013, 62 MNWR (Supp. 3) 1,<br />
1-187 (2013), https://www.cdc.gov/mmwr/<br />
pdf/other/ su6203.pdf. Id. at 157-160.<br />
The Heart Attack Gender Gap, U. EDINBURGH:<br />
EDINBURGH FRIENDS (Oct. 29, 2019),<br />
https://www.ed.ac.uk/edinburgh-friends/<br />
supplements/the-heart-attack-gender-gap.<br />
Deadly Delivery: The Maternal Health Crisis in<br />
the USA, AMNESTY INT’L. (May 7, 2011),https://<br />
www.amnestyusa.org/reports/deadly- deliverythe-maternal-health-care-crisis-in-the-usa/.<br />
Agency For Healthcare Res. And Quality, U.S.<br />
Dep’t Of Health And Human Serv., Pub No. 14-<br />
0006, National Healthcare Disparities Rep.<br />
(2013).<br />
FitzGerald C, Hurst S. (2017). Implicit bias in<br />
healthcare pr<strong>of</strong>essionals: a systematic review.<br />
BMC Med Ethics. 2017 Mar 1;18(1):19. doi:<br />
10.1186/s12910- 017-0179-8. PMID: 28249596;<br />
PMCID: PMC5333436.<br />
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Jefferson, T. (1776). The Declaration <strong>of</strong><br />
Independence, preamble. Retrieved from<br />
https://etc.usf.edu/ lit2go/133/historicamerican-documents/4957/the-<br />
declaration-<strong>of</strong>independence/<br />
American Nurses Association. Mission Statement.<br />
https://www.nursingworld.org/ana/about-ana/<br />
Probst, J. C., Zahnd, W. E., Hung, P., Eberth, J.<br />
M., Crouch, E. L., & Merrell, M. A. (<strong>2020</strong>). Rural-<br />
Urban Mortality Disparities: Variations Across<br />
Causes <strong>of</strong> Death and Race/Ethnicity, 2013–2017.<br />
American Journal <strong>of</strong> Public Health, 110(9),<br />
1325– 1327. https://doi-org.proxy.lib.umich.<br />
edu/10.2105/ AJPH.<strong>2020</strong>.305703<br />
Office <strong>of</strong> Disease Prevention and Health<br />
Promotion (ODPHP). (internet accessed<br />
11/02/<strong>2020</strong>). Disparities. Healthy People <strong>2020</strong>.<br />
U.S. Department <strong>of</strong> Health and Human Services:<br />
Washington, DC. https://www.healthypeople.<br />
gov/<strong>2020</strong>/about/foundation-health- measures/<br />
Disparities#6<br />
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<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
POSITION STATEMENT<br />
SAFE NURSE STAFFING TO IMPROVE QUALITY OF CARE<br />
It is the position <strong>of</strong> the <strong>ANA</strong>-<strong>Michigan</strong> that:<br />
1. Optimal nurse staffing is essential for quality and safe patient care in all health care<br />
settings.<br />
2. Determination <strong>of</strong> optimal nurse staffing requires a framework and policies that inform<br />
organizational decision making through analysis <strong>of</strong> the many factors that impact the<br />
delivery <strong>of</strong> safe patient care.<br />
3. Optimal nurse staffing is a complex determination and cannot be achieved through<br />
application <strong>of</strong> simple patient to nurse ratios.<br />
4. Safe nurse staffing models should be selected that most closely match the characteristics<br />
<strong>of</strong> the institution and include active and substantive input from the nurses who are closest<br />
to patient care.<br />
Background<br />
Medical errors are now the third leading cause <strong>of</strong><br />
death in the United States (US). The persistent<br />
nature <strong>of</strong> medical errors is documented in<br />
the Institute <strong>of</strong> Medicine (IOM) report, To Err<br />
Is Human, which pointed to nearly 100,000<br />
preventable deaths in US hospitals annually<br />
(IOM, 1999). This work shaped decades <strong>of</strong><br />
research with focus on patient safety. Nurses<br />
are the largest clinical group <strong>of</strong> providers in<br />
hospitals and other health care settings; thus,<br />
nurses’ impact on patient safety is significant.<br />
A large body <strong>of</strong> evidence exists documenting<br />
the relationship between nursing care, nurse<br />
staffing, and patient safety. Risks associated<br />
with suboptimal pr<strong>of</strong>essional nurse staffing in<br />
the patient care setting include medication<br />
errors, compromised ability to “rescue” patients<br />
at risk for death, increased incidence <strong>of</strong> patient<br />
falls, hospital-acquired pressure ulcers, physical<br />
restraint use, and missed care.<br />
87<br />
Optimal nurse staffing is a complex process<br />
not being amenable to simple division or nurse<br />
patient ratios; straightforward ratios do not<br />
result in safe care. Moving toward a pr<strong>of</strong>essional<br />
model that empowers registered nurse (RN)<br />
decision-making regarding their practice requires<br />
a framework focused on the analysis <strong>of</strong> multiple<br />
factors affecting patient care delivery. To create<br />
a work environment that allows pr<strong>of</strong>essional RNs<br />
to meet the demands and complexity <strong>of</strong> patient<br />
care, sufficient pr<strong>of</strong>essional nursing staffing care<br />
models are crucial to the delivery <strong>of</strong> high quality<br />
safe patient care. Shifting the nursing culture<br />
towards a pr<strong>of</strong>essional model that empowers<br />
RNs with decision-making involvement and<br />
includes a framework for organizations’ decision<br />
making about staffing based on the analysis <strong>of</strong><br />
multiple factors affecting patient care versus<br />
a one-dimensional standardized nurse-patient<br />
ratios approach is vital to “ensuring the right<br />
staff are in the right place at the right time”<br />
(Bolvin, 2017, p. 31). Harmonious with the<br />
American Nurses Association (<strong>ANA</strong>) position, <strong>ANA</strong>-<br />
MI is committed to creating dynamic solutions
that support context dependent, optimal<br />
nurse staffing necessary to meet the needs <strong>of</strong><br />
healthcare recipients.<br />
This paper presents the outcomes evidence about<br />
recent approaches to nurse staffing and identifies<br />
the principles, concepts, and framework for<br />
determining optimal nurse staffing for safe<br />
patient care. While the referenced studies<br />
on safe nurse staffing are hospital-based, the<br />
principles and methods may also be applied to<br />
nurse staffing in other health care settings.<br />
Evidence<br />
The impasse between nurses and administrators<br />
about the solution to the complex issue <strong>of</strong><br />
ensuring the delivery <strong>of</strong> safe care within the<br />
context <strong>of</strong> increasing patient acuity and fiscal<br />
constraints <strong>of</strong> hospitals has moved the issue <strong>of</strong><br />
adequate staffing to the political arena (Hertel,<br />
2012). In 2004, nurse staffing took center<br />
stage when California became the first state to<br />
mandate nurse-to-patient ratios in acute care<br />
settings. By 2009, 14 states had enacted nurse<br />
staffing legislation and, as <strong>of</strong> September 2010,<br />
24 states have enacted or proposed legislation to<br />
mandate staffing ratios, staffing acuity systems,<br />
or staffing plans and committees (Douglas, 2010).<br />
Subsequent studies examining the relationship<br />
between mandatory staffing ratios and nurse<br />
satisfaction and patient safety and outcomes<br />
have demonstrated mixed results (Aiken et al.,<br />
2010; Bolton, et al., 2007; Hertel, 2012)<br />
Research on nurse staffing ratios’ impact on<br />
patient safety has demonstrated higher nurse<br />
to patient ratios are associated with decreased<br />
mortality rates, fewer failure to rescue events,<br />
and lower hospital–acquired pneumonia rates<br />
(Douglas, 2010). Mandated ratios in California<br />
were associated with lower mortality and better<br />
nurse retention; 74% <strong>of</strong> nurses reported they felt<br />
the quality <strong>of</strong> care had improved since mandated<br />
ratios (Aiken et al., 2010).<br />
Conversely, individual studies and systematic<br />
reviews have reported difficulty in consistently<br />
detecting statistically significant associated<br />
improvements in a variety <strong>of</strong> nurse-sensitive<br />
patient outcomes with increased nurse staffing<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
88<br />
(Hickam et al., 2003; Kane, Shamliyan, Mueller,<br />
Duval, & Wilt, 2007; Lake & Chung, 2006; Lang<br />
et al., 2004; Seago,2001: all as cited in Bolton<br />
et al., 2007). In a large-scale study, Bolton and<br />
colleagues (2007) examined patient outcomes<br />
from 2004 to 2006 in 185 hospitals in California<br />
compared to 2002 (pre-mandated staffing ratios)<br />
and found no statistical significance in the<br />
association between increased nurse staffing and<br />
key indicators <strong>of</strong> falls, hospital-acquired pressure<br />
ulcers, and restraint use rates (Bolton et al.,<br />
2007). The inconsistency in outcomes associated<br />
with increased nurse staffing underscores the<br />
complexity <strong>of</strong> determining optimal staffing.<br />
A survey <strong>of</strong> administrators about strategies<br />
to accommodate mandated ratios lends to<br />
potential insight about why mandated ratios<br />
do not consistently result in improved patient<br />
safety and outcome measures. Respondents<br />
reported ancillary support staff lay<strong>of</strong>fs (thus<br />
shifting non-RN work to the pr<strong>of</strong>essional nurse)<br />
and use <strong>of</strong> contingent nurses to provide break<br />
coverage; both strategies could have a negative<br />
impact on patient safety and continuity <strong>of</strong> care<br />
(Douglas, 2010). Similarly, Bolton and colleagues<br />
(2007) found that with mandated staffing ratios<br />
came a change in staff mix with a reduction in<br />
care provided by LPN and other non-licensed<br />
staff, suggesting that administration leaders<br />
used RN hours to meet the regulatory staffing<br />
requirements. These approaches raise concerns<br />
about the unintended consequence <strong>of</strong> negating<br />
the potential positive impact <strong>of</strong> mandated higher<br />
RN to patient ratios by 1) effectively reducing RN<br />
time to attend to RN activities and 2) increasing<br />
the risk for mistakes related to the potential<br />
for communication errors during hand<strong>of</strong>fs to<br />
contingent nurses along with variability <strong>of</strong> the<br />
skills and competencies <strong>of</strong> contingent nurses in<br />
unfamiliar settings.<br />
Definition <strong>of</strong> Safe Staffing,<br />
Core Components and Staffing Models<br />
Definitions<br />
The <strong>ANA</strong> defines staffing as … “a match <strong>of</strong><br />
registered nurse expertise with the needs <strong>of</strong> the<br />
recipient <strong>of</strong> nursing care services in the context
<strong>of</strong> the practice setting and situation“(<strong>ANA</strong>, 2012,<br />
p. 6). Staffing is done in the present – day to day<br />
and sometimes shift to shift. Staffing work can<br />
be centralized (one department is responsible<br />
for staffing all the units) or decentralized<br />
(units manage their own staffing needs) or a<br />
combination <strong>of</strong> both.<br />
Core Components<br />
<strong>ANA</strong> Core Components <strong>of</strong> Nurse Staffing:<br />
1. All settings should have well-developed<br />
staffing guidelines with measurable nursesensitive<br />
outcomes specific to that setting<br />
and healthcare consumer population, which<br />
are used as evidence to guide daily staffing.<br />
2. RNs are full partners working with other<br />
healthcare pr<strong>of</strong>essionals in collaborative,<br />
interdisciplinary partnerships.<br />
3. RNs, including direct care nurses, must have<br />
a substantive and active role in staffing<br />
decisions to ensure the necessary time with<br />
patients to meet care needs and overall<br />
nursing responsibilities.<br />
4. Staffing needs must be determined based on<br />
an analysis <strong>of</strong> healthcare consumer status<br />
(e.g., degree <strong>of</strong> stability, intensity, and<br />
acuity) and the environment in which the<br />
care is provided. Additional considerations<br />
include pr<strong>of</strong>essional characteristics, skill<br />
set, and mix <strong>of</strong> the staff and previous staffing<br />
patterns that have been shown to improve<br />
outcomes.<br />
5. Appropriate nurse staffing should be based<br />
on allocating the appropriate number <strong>of</strong><br />
competent practitioners to a care situation,<br />
pursuing quality <strong>of</strong> care indices, meeting<br />
consumer-centered and organizational<br />
outcomes, meeting federal and state laws<br />
and regulations, and attending to a safe,<br />
quality work environment.<br />
6. Cost-effectiveness is an important<br />
consideration in delivery <strong>of</strong> safe, quality<br />
care.<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
89<br />
7. Reimbursement structure should not<br />
influence nurse staffing patterns or the level<br />
<strong>of</strong> care provided.<br />
Staffing Models<br />
Shortcomings in current RN staffing models<br />
present opportunities for improvements that<br />
benefit patients, nurses, and healthcare<br />
organizations. No single staffing model is ideal<br />
in all care settings or situations. Staffing must<br />
be adjusted according to patient care needs<br />
within a specific unit or department. Fixed or<br />
rigid models do not provide flexibility essential<br />
to adapt to rapid and fluid changes in acute care<br />
environments.<br />
There is a difference between staffing and<br />
scheduling. Schedules are planning documents<br />
that are future focused. Factors that affect a<br />
schedule include: historical census for a time<br />
period, the surgical schedule, and seasonal<br />
or predictable issues such as the flu season.<br />
Schedules must also accommodate vacations,<br />
maternity leaves, staff illness and institutional<br />
policies.<br />
Various staffing models are used in healthcare<br />
settings. Three models follow; each has<br />
advantages and disadvantages.<br />
1. Budget Based Staffing: the number <strong>of</strong> nurses<br />
is determined according to nursing hours<br />
per patient days. Total patient days are the<br />
average number <strong>of</strong> patients on a particular<br />
unit for a 24-hour period. Nursing hours refers<br />
to the total number <strong>of</strong> hours nurses work on<br />
that unit for a specific amount <strong>of</strong> time. This<br />
model does not take into consideration the<br />
actual number <strong>of</strong> patients, the “churn” in<br />
patients – admissions, discharges, transfers<br />
in 24 hours, or patient acuity.<br />
2. Staffing by Nurse to Patient Ratios: This<br />
model dictates the number <strong>of</strong> patients one<br />
nurse can care for during a designated period<br />
<strong>of</strong> time. It does not take into consideration<br />
other unit staff such as CNA’s, housekeeping,<br />
unit clerks, etc. Also, it doesn’t take into<br />
account patient acuity or nurse driven<br />
care decisions. This model may also affect
patient throughput from areas such as the<br />
Emergency Department, Labor and Delivery,<br />
and the ICUs.<br />
3. Staffing by Patient Acuity: This model<br />
considers the acuity or complexity <strong>of</strong> each<br />
patient, which is <strong>of</strong>ten determined by the<br />
number <strong>of</strong> tasks and amount <strong>of</strong> time to<br />
complete them. Rather, this model should<br />
consider the full scope <strong>of</strong> nursing practice<br />
and time needed to maintain standards <strong>of</strong><br />
care. This complex model also needs to<br />
consider individual patient characteristics<br />
such as age, diagnosis, comorbidities,<br />
socioeconomic status, cultural and family<br />
issues, and severity <strong>of</strong> illness.<br />
References<br />
Aiken, L. H., Sloane, D. M., Cimiotti, J. P.,<br />
Clarke, S. P., Flynn, L., Seago, J. A., . . . &<br />
Smith, H. L. (2010). Implications <strong>of</strong> the California<br />
nurse staffing mandate for other states. Health<br />
services research, 45(4), 904-921.<br />
American Nurses Association. (2012). Principles<br />
for nurse staffing (2nd ed.). Silver Spring,<br />
MD: Nursesbooks.org. Retrieved from http://<br />
www.nursesbooks.org/ebooks/download/<strong>ANA</strong>_<br />
Principles_Staffing.pdf<br />
American Nurses Association. (2015). Optimal<br />
nurse staffing to improve quality <strong>of</strong> care and<br />
patient outcomes. Retrieved from http://<br />
www.nursingworld.org/DocumentVault/<br />
NursingPractice/Executive-Summary.pdf<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
Bolvin, J. 2017) CNOs and CFOs partner to reap<br />
benefits <strong>of</strong> acuity-based staffing. American Nurse<br />
Today 12(9), 30-32.<br />
Buerhaus, P. I. (2009). Avoiding mandatory<br />
hospital nurse staffing ratios: An economic<br />
commentary. Nursing Outlook, 57(2), 107-112.<br />
Bolton, L. B., Aydin, C. E., Donaldson, N., Storer<br />
Brown, D., Sandhu, M., Fridman, M., & Udin<br />
Aronow, H. (2007). Mandated nurse staffing<br />
ratios in California: A comparison <strong>of</strong> staffing<br />
and nursing-sensitive outcomes pre-and postregulation.<br />
Policy, Politics, & Nursing Practice,<br />
8(4), 238-250.<br />
Douglas, K. (2010). Ratios-If it were only that<br />
easy. Nursing Economics, 28(2), 119-125.<br />
Hertel, R. (2012). Regulating patient staffing:<br />
A complex issue. Academy <strong>of</strong> Medical-Surgical<br />
Nursing, 21(1), 3-7.<br />
Institute <strong>of</strong> Medicine (IOM). (1999). To err is<br />
human. Washington, DC: National Academies<br />
Press.<br />
Mensik, J. (2014). What every nurse should know<br />
about staffing. American Nurse Today, 9(2), 1-11.<br />
Approved: December 15, 2017<br />
by the <strong>ANA</strong>-<strong>Michigan</strong> Board <strong>of</strong> Directors<br />
To be reviewed: December 14, 2018<br />
Contact<br />
www.ana-michigan.org<br />
nurse@ana-michigan.org<br />
(517) 325-5306<br />
90
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
POSITION STATEMENT<br />
ENHANCED NURSE LICENSURE COMPACT<br />
On April 13, 2018, the <strong>ANA</strong>-MI Board <strong>of</strong> Directors<br />
voted to support the Enhanced Nurse Licensure<br />
Compact, that would permit <strong>Michigan</strong> to join the<br />
current 30 states who are part <strong>of</strong> the “enhanced<br />
nurse licensure compact”. The Public Policy<br />
Council studied and discussed in-depth strengths<br />
and weaknesses. The Council and Board<br />
members held a “learning session” on the eNLC<br />
with a presentation by a representative from<br />
the National Council <strong>of</strong> State Boards <strong>of</strong> Nursing.<br />
The Council recommended SUPPORT with the<br />
provision that the MI Department <strong>of</strong> Licensing<br />
and Regulatory Affairs (MI-DLARA) does not pass<br />
on the costs <strong>of</strong> implementation <strong>of</strong> the eNLC<br />
through another increase in the nurse licensure<br />
fees. The legislature doubled <strong>Michigan</strong> nurse<br />
licensure renewal fees in 2017.<br />
WHAT IS THE NURSE LICENSURE COMPACT?<br />
The NLC allows a registered nurse (RN) or<br />
licensed practical nurse (LPN) to possess a<br />
multistate license, which permits practice<br />
in both their home state and other compact<br />
states, while maintaining the primary state <strong>of</strong><br />
residence. Unless the nurse is under discipline or<br />
restriction, a multistate license permits practice<br />
(physically or telephonically/electronically)<br />
across state lines in all NLC states.<br />
WHAT IS THE RATIONALE FOR <strong>ANA</strong>-MI’s SUPPORT<br />
OF eNLC?<br />
The Council first considered:<br />
Is this bill consistent with the tenets <strong>of</strong> <strong>ANA</strong>-MI’s<br />
Policy Platform?<br />
FACTORS INFLUENCING SUPPORT FOR THE BILL<br />
• There is an increase in nursing practice and<br />
patient care access across state lines (care<br />
coordination, occupational health, etc.)<br />
91<br />
• Regional or national health crises require<br />
rapid deployment <strong>of</strong> nurses to areas <strong>of</strong> need.<br />
• There is need to move nurses with highly<br />
specialized skills to states with medical<br />
crises for patient populations. A recent<br />
example is the number <strong>of</strong> <strong>Michigan</strong> residents<br />
who required specialized care available<br />
only through nurses employed in multiple<br />
states across a national healthcare system<br />
who were experienced in this specialized<br />
care. This care was related to contaminated<br />
injections prepared at a compounding<br />
pharmacy in Massachusetts<br />
• There are increasing national and<br />
international infectious disease outbreaks<br />
that require movement <strong>of</strong> nurses to meet<br />
patient and community needs (Ebola, flu,<br />
etc.).<br />
• New nurse graduates will have more<br />
flexibility with a <strong>Michigan</strong> “home state”<br />
license if there are not sufficient available<br />
nursing positions in <strong>Michigan</strong>.<br />
• Nursing faculty and students are sometimes<br />
engaged in clinical placements across state<br />
lines.<br />
• Nurses move across states to support family<br />
care needs. These nurses may desire to<br />
continue nursing employment. They may be<br />
delayed in their ability to obtain a new state<br />
license.<br />
FACTORS INFLUENCING CHALLENGES OF THE<br />
BILL<br />
• Nurses are responsible to know multiple<br />
state requirements for ongoing licensure.<br />
For example, Florida requires continuing<br />
education for infection control.
• Nurses must be knowledgeable about and<br />
abide by varying state laws and regulations.<br />
• In cases <strong>of</strong> nurses providing care through<br />
technology (telephonic, web site, etc.), it is<br />
not clear in which state the nursing practice<br />
is located (the state <strong>of</strong> the nurse or the state<br />
<strong>of</strong> the patient receiving care). There does<br />
not appear to be ongoing monitoring, data<br />
collection, or an evaluation plan to inform<br />
policies related to eNLC.<br />
• eNLC membership does not provide assurance<br />
that nurses will in fact be knowledgeable <strong>of</strong><br />
laws that pertain to nursing practice within<br />
those jurisdictions prior to engaging in<br />
practice in member states.<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
OTHER INFORMATION<br />
• The <strong>Michigan</strong> Organization <strong>of</strong> Nurse Leaders<br />
(MONL) who are predominately hospital chief<br />
nursing <strong>of</strong>ficers are in support <strong>of</strong> HB4938.<br />
• Rep. Whiteford is awaiting <strong>ANA</strong>-MI’s position<br />
and a discussion prior to scheduling a House<br />
Health Policy Committee hearing.<br />
• If the bill is passed, <strong>Michigan</strong> nursing<br />
education programs will need to include<br />
information about nurse licensure compacts<br />
and, as importantly, prepare faculty with<br />
this information for teaching.<br />
• Legislators and organizations such as the<br />
AARP are interested in knowing <strong>ANA</strong>-MI’s<br />
position on this bill.<br />
NEED MORE INFORMATION?<br />
• For more information on the enhanced NLC,<br />
visit nursecompact@ncsbn.org<br />
• For a current map <strong>of</strong> eNLC states, visit www.<br />
nursecompact.com<br />
92
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
POSITION STATEMENT<br />
“NURSE” TITLE PROTECTION<br />
Written by Susan Wiers, DNP and Public Policy Council<br />
The 173,000 plus Registered Nurses in <strong>Michigan</strong><br />
are essential to the health and safety <strong>of</strong> the state’s<br />
residents. 1 The title “Nurse” is not included<br />
in the list <strong>of</strong> protected titles in the <strong>Michigan</strong><br />
Public Health Code (MPHC). Thus, the residents<br />
<strong>of</strong> <strong>Michigan</strong> cannot be assured that individuals<br />
calling themselves nurses possess the education<br />
and competencies required for licensure and<br />
safe practice. 2 At least 39 states have adopted<br />
language in their nurse practice acts restricting<br />
use <strong>of</strong> the title “Nurse” or language implying<br />
an individual is a nurse who is educated and<br />
licensed as authorized by the state. 3 Despite<br />
Recommendation 2a <strong>of</strong> the <strong>Michigan</strong> Department<br />
<strong>of</strong> Community Health Task Force on Nursing<br />
Practice that “Nurse” be included as a protected<br />
title in the MPHC and the Administrative Rules <strong>of</strong><br />
the <strong>Michigan</strong> Board <strong>of</strong> Nursing, <strong>Michigan</strong> remains<br />
in the minority <strong>of</strong> states without title protection<br />
for ‘Nurse.” 2,3<br />
Nursing has been ranked as the most respected,<br />
ethical pr<strong>of</strong>ession in Gallup polls for 16<br />
consecutive years since 2002. 4 This trust in<br />
nursing must be safeguarded from individuals<br />
and groups who misrepresent themselves as<br />
nurses thus threatening safety and health <strong>of</strong> the<br />
public. 5 Tolerating overt use <strong>of</strong> the title “Nurse”<br />
or misleading titles implying individuals other<br />
than those who have met the requirements for<br />
licensure from state boards <strong>of</strong> nursing lends<br />
itself to exploitation <strong>of</strong> vulnerable individuals<br />
and erosion <strong>of</strong> nursing’s well-earned public<br />
reputation and confidence.<br />
Nursing licensure and title protection are<br />
regulated with the primary purpose <strong>of</strong> protecting<br />
the public. 6 Nursing licensure requires specialized<br />
knowledge and independent decision-making<br />
and mandates a minimum level <strong>of</strong> demonstrated<br />
and documented competency for a specific<br />
scope <strong>of</strong> practice. 2,6 Title protection assures that<br />
individuals without the minimum education and<br />
competency for licensure cannot misrepresent<br />
themselves to the public as nurses.<br />
The title “Nurse” should be protected in the<br />
MPHC consistent with the titles “Physician”,<br />
“Dentist”, “Chiropractor”, and “Social Worker”. 2<br />
Individuals not licensed and registered by the<br />
state can and do use the title “Nurse.” 2 Legally<br />
tolerated arbitrary use <strong>of</strong> the title “Nurse”<br />
by those who do not possess the minimum<br />
education and competencies for licensure in the<br />
State <strong>of</strong> <strong>Michigan</strong> confuses public and places it<br />
at risk. 2 Just as has been done in the majority <strong>of</strong><br />
other states, the title “Nurse” must be defined<br />
and protected in the MPHC so that patients and<br />
families can be assured that their nurse possesses<br />
legitimate education and competencies to safely<br />
care for them. 2<br />
93
References<br />
1. <strong>Michigan</strong> Public Health Institute. <strong>Michigan</strong><br />
<strong>Annual</strong> Nurse Survey Project. Okemos,<br />
<strong>Michigan</strong> June 2018.<br />
2. <strong>Michigan</strong> Department <strong>of</strong> Community Health<br />
Task Force on Nursing Pratice. Final Report<br />
and Recommendations. 2012.<br />
3. American Nurses Association. Title “Nurse”<br />
Protection. December 10, 2013; https://<br />
www.nursingworld.org/practice-policy/<br />
advocacy/state/title-nurse-protection/.<br />
4. Brenan M. Nurses keep healthy lead as most<br />
honest, ethical pr<strong>of</strong>ession. 2017; https://<br />
news.gallup.com/poll/224639/nurses-keephealthy-lead-honestethicalpr<strong>of</strong>ession.aspx.<br />
5. McElroy S. Nurse Title Protection Bill passed<br />
in the 2008 West Virginia Legislative Session.<br />
Maryland Nurse. 2008;10(1):14-14.<br />
<strong>2020</strong> ANNUAL BOOK OF REPORTS<br />
6. Flook DM. The pr<strong>of</strong>essional nurse and<br />
regulation. Journal <strong>of</strong> perianesthesia<br />
nursing. 2003;18(3):160-167.<br />
7. Missouri State Board <strong>of</strong> Nursing. Nursing<br />
Practice Act and Rules. In. Jefferson City,<br />
MO2017.<br />
8. Services NDoHaH. Statues Relating to Nurse<br />
Practice Act. In: Unit DoPHL, ed. Lincoln,<br />
NE2017.<br />
9. New York State Education Law. Article 139,<br />
Nursing. 2010; http://www.op.nysed.gov/<br />
pr<strong>of</strong>/nurse/article139.htm.<br />
Approved: December 14, 2018 by the<br />
<strong>ANA</strong>-<strong>Michigan</strong> Board <strong>of</strong> Directors<br />
Contact<br />
www.ana-michigan.org<br />
nurse@ana-michigan.org<br />
(517) 325-5306<br />
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Since this year, <strong>ANA</strong>-<strong>Michigan</strong> couldn't celebrate the <strong>2020</strong> award winners in person, we wanted to<br />
take the opportunity to recognize them during Nurses Month, and even more fitting, Recognition<br />
Week.<br />
Please be sure to click on each award winner’s link to learn more about them or see included award<br />
winner spotlights.<br />
Dorthea Milbrandt Nurse Leader Award<br />
Kathy Stutzman, MSN, RN-BC, CCRN-K<br />
The Dorothea Milbrandt Nurse Leader Award has been created to honor nurses<br />
who have demonstrated excellence in building successful mentoring relationships<br />
with other nurses and/or nursing students. This award is presented on behalf <strong>of</strong><br />
the late Dorothea Milbrandt, RN, MPS, MSN, who had an important and lasting<br />
impact on nursing in <strong>Michigan</strong> for nearly 40 years.<br />
View Kathy's Spotlight<br />
Lifetime Achievement Award<br />
Sally Decker, PhD, RN, CNE, CHSE<br />
The Lifetime Achievement Award recognizes an individual’s pr<strong>of</strong>ound impact and<br />
longstanding commitment to nursing.<br />
View Sally's Spotlight<br />
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Public Policy Advocate Award<br />
Lynne Harris, MSN, RN<br />
The Public Policy Advocate Award accords a nurse who has demonstrated success<br />
in using public policy and advocacy as strategies in advancing nursing in <strong>Michigan</strong>.<br />
View Lynne's Spotlight<br />
Friend <strong>of</strong> Nursing Award<br />
Representative Mary Whiteford<br />
The Friend <strong>of</strong> Nursing Award is conferred on a non-nurse who has rendered<br />
valuable assistance to the nursing pr<strong>of</strong>ession. Their contributions and assistance<br />
are <strong>of</strong> statewide significance to nursing.<br />
Future Nurse Leader Award<br />
Cierra Scott, BSN, RN<br />
The Future Nurse Leader Award is given yearly to a recent (within two years <strong>of</strong><br />
graduation) nursing school (AD, BSN, Diploma) graduate who demonstrates great<br />
potential for leadership in the pr<strong>of</strong>ession. The candidate for this award must<br />
be nominated by a dean and/or faculty member and must indicate his or her<br />
intention to reside in <strong>Michigan</strong> for the next year.<br />
View Cierra's Spotlight<br />
Exceptional Promise Award<br />
Myesha Hollins, CCHT, SN<br />
Exceptional Promise Award aims to spotlight aspiring nursing students for their<br />
skills today and promise for tomorrow.<br />
<strong>ANA</strong>-<strong>Michigan</strong> will recognize distinguished nursing students who exemplify<br />
leadership and achievement in their community and their scholarly efforts. The<br />
purpose is intended to celebrate and encourage exemplar dedication to the<br />
nursing pr<strong>of</strong>ession.<br />
View Myesha's Spotlight<br />
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Exceptional Promise Award<br />
Marissa Loud, MSN, RN, RNC-NIC<br />
Exceptional Promise Award aims to spotlight aspiring nursing students for their<br />
skills today and promise for tomorrow.<br />
<strong>ANA</strong>-<strong>Michigan</strong> will recognize distinguished nursing students who exemplify<br />
leadership and achievement in their community and their scholarly efforts. The<br />
purpose is intended to celebrate and encourage exemplar dedication to the<br />
nursing pr<strong>of</strong>ession.<br />
View Marissa's Spotlight<br />
Exceptional Promise Award<br />
Dominique Mones, SN<br />
Exceptional Promise Award aims to spotlight aspiring nursing students for their<br />
skills today and promise for tomorrow.<br />
<strong>ANA</strong>-<strong>Michigan</strong> will recognize distinguished nursing students who exemplify<br />
leadership and achievement in their community and their scholarly efforts. The<br />
purpose is intended to celebrate and encourage exemplar dedication to the<br />
nursing pr<strong>of</strong>ession.<br />
View Dominique's Spotlight<br />
Exceptional Promise Award<br />
Shantiniqua Collins, BS, SN<br />
Exceptional Promise Award aims to spotlight aspiring nursing students for their<br />
skills today and promise for tomorrow.<br />
<strong>ANA</strong>-<strong>Michigan</strong> will recognize distinguished nursing students who exemplify<br />
leadership and achievement in their community and their scholarly efforts. The<br />
purpose is intended to celebrate and encourage exemplar dedication to the<br />
nursing pr<strong>of</strong>ession.<br />
View Shantiniqua's Spotlight<br />
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Exceptional Promise Award<br />
Hyder Mirza, BSN, RN<br />
Exceptional Promise Award aims to spotlight aspiring nursing students for their<br />
skills today and promise for tomorrow.<br />
<strong>ANA</strong>-<strong>Michigan</strong> will recognize distinguished nursing students who exemplify<br />
leadership and achievement in their community and their scholarly efforts. The<br />
purpose is intended to celebrate and encourage exemplar dedication to the<br />
nursing pr<strong>of</strong>ession.<br />
View Hyder's Spotlight<br />
Exceptional Promise Award<br />
Lesley Telfor, BSN, RN<br />
Exceptional Promise Award aims to spotlight aspiring nursing students for their<br />
skills today and promise for tomorrow.<br />
<strong>ANA</strong>-<strong>Michigan</strong> will recognize distinguished nursing students who exemplify<br />
leadership and achievement in their community and their scholarly efforts. The<br />
purpose is intended to celebrate and encourage exemplar dedication to the<br />
nursing pr<strong>of</strong>ession.<br />
View Lesley's Spotlight<br />
Innovation Award<br />
Henry Ford Health System<br />
Innovation: Human Trafficking Screen Tool<br />
Created by: Danielle Bastien<br />
Innovation Award will identify a health system or individual hospital for an<br />
innovative practice/ approach which improves nursing and patient outcomes.<br />
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