ANA-Michigan 2021 Annual Book of Reports

2021 ANNUAL BOOK OF REPORTS 

2021 

ANNUAL 

REPORT 

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Table of Contents 

2021 Board and Committee Roster. ..................................... 3 

2021 Strategic Plan. ............................................... 6 

2022 Strategic Plan. ............................................... 7 

Meeting Rules and Parliamentary Procedure ............................... 8 

2022 Membership Assembly Meeting Agenda ...............................11 

2021 Annual Meeting Minutes. ........................................13 

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

2021 Year End Financial Statements. ....................................18 

2022 Budget ....................................................22 

Executive Director's Report ..........................................24 

Committee Report: Nursing and Health Policy. .............................30 

Committee Report: Nursing Practice. ...................................31 

Committee Report: Education. .......................................32 

2021 ANA-Michigan Award Winners. .....................................34 

2021 ANA Membership Assembly Report ..................................35 

2022 Leadership Candidate Bios .......................................39 

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

ANA-Michigan Nurses Foundation. ......................................68 

Appendix 

ANA-Michigan Position Statements 

Enhanced Nurse Licensure Compact. ..................................75 

Mitigating Implicit Bias to Reduce Disparities in Patient Outcomes. ..............77 

Moral Distress. .................................................80 

Nurse Title Protection ............................................83 

Preventing Workplace Violence in Healthcare Settings. ......................84 

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

Telehealth and Connected Health. ....................................91 

ANA-Michigan Policy on Position Statements. .............................94 

Current ANA-Michigan Bylaws. ........................................95 

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Published for ANA-Michigan by: 

Arthur L. Davis Publishing Agency 

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

(319) 277-2414


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2021 Board and Committee Roster 

Board of Directors 

President Julia Stocker Schneider, PhD, RN, CNL 

President-Elect Bridget Leonard, DNP, MBA-HCM, RN, CRRN, NEA-BC 

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

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

Director Katherine Dontje, PhD, FNP-BC, FAANP 

Director Anne Kreft, BSN, RN 

Director Joshua (Josh) Meringa, MPA, MHA, MBA, BSN, RN, NPD-BC 

Director Julie Powell, DNP, MSN, RN, AGCNS-BC, CNEcl 

Newly Licensed Director Gerardo (Gerry) Infante, BSN, RN 

Tobi Lyon, MBA, CAE, Executive Director 

Julia Stocker 

Schneider 

Bridget Leonard 

Nikeyia Davis 

Julie Bulson 

Katherine Dontje 

Anne Kreft 

Joshua Meringa 

Julie Powell 

Gerardo Infante 

Tobi Lyon 

MNSA Faculty Advisor: Nadine Wodwaski, DNP, MSN-ed, ACNS, RN 

Bylaws Committee 

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

Member - Nadia Farhat, MSN, RN-BC, AGCNS-BC 

Member - Kechi Iheduru-Anderson, DNP, RN, CNE, CWCN 

Member - Kimberly Hickey, MSN, RN, GCNS-BC 

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

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Education Committee 

Chair - Bridget Leonard, DNP, MBA, RN, CRRN, NEA-BC 

Member - Gerardo Infante, BSN, RN 

Member - Jennifer Mecomber, MSN, RN 

Member - Patrick Joswick, DNP, AGNP-C, RN 

Member - Ruth Duffy, BSN 

Member - Mary Zugcic, RN, ACNS-BC, CRNI 

Finance Committee 

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

Member - Jason Baker, MSN, AGACNP-BC, CCRN, RN 

Member - Jaime Sinutko, RN, MSN, PhD 

Member - Susan Owens, PhD, RN, FNP-BC 

Member - VACANT 

Legislative Committee 

Chair - Linda Buck, DNP, MSN/ED, RN 

Member - Remy Bruder, DNP, RN 

Member - Donna Cassidy, DHSc, MSN, RN 

Member - Nancy George, PhD, RN, FNP-BC, FAANP 

Member - Lori Glenn, DNP, CNM, RN 

Member - April Liberty, BSN, RN 

Member - Noor Khalil, Med, BSN, RN 

Member - Anna Scott, RN 

Member - Susan Wiers, DNP, RN 

MHSA Representative - Evelyn Zois Sweeney 

Nominations Committee 

Chair - Carole Stacy, MSN, MA, RN 

Member - MaryLee Pakieser, MSN, RN, BC-FNP 

Member - Joyce Reder, MSN 

Member - Suzanne Keep, PhD, RN 

Member - Beth VanDam, MSN, RN-BC, CNL 

Nursing & Health Policy Committee 

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

Member - Alexa Andersen, MA, BSN, RN 

Member - Beth Ammerman, DNP, FNP-BC 

Member - Holly Thalman, BSN, RN 

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

Member - Ramona Berry, MSA, BSN, RN 

Member - Barbara Medvec, DNP, RN, NEA-BC 

Member - Wanda Chukwu, DNP, MA, CNEcl, RN 

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

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Nursing Practice Committee 

Chair - Julie Powell, DNP, MSN, RN, AGCNS-BC 

Member - Bethann Perkins-Simmons, BSN, RN 

Member - Erin Sudheimer, MSN, RN 

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

Member - Nadia Farhat, RN, MSN, AGCNS-BC 

Member - Nichole Budnick, BSN, RN 

Member - Molly Stapish, MSN, CMSRN 

Member - Marnie VanDam, MSN, RN 

Member - Ruth Kechnie, RN, BSN, MSA, OCN, NE-BE 

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AMERICAN NURSES ASSOCIATION 

MICHIGAN 

2021 

STRATEGIC PLAN 

Mission: Advancing the nursing profession in Michigan. 

Vision: ANA-Michigan is a vital community of professional nurses in Michigan. Together, we 

are the experts in nursing practice. Our strength is our solution-focused thought leadership, 

our long-term view of the nursing profession in a dynamic healthcare environment, and our 

impact on quality care and patient safety. 

ADVANCING 

NURSES 

LEADERSHIP 

ENGAGING 

MEMBERSHIP 

EXPERIENCE 

BOLSTER 

ADVOCACY 

Goal: Elevate the level of 

professionalism in nursing. 

Goal: Transform our culture for 

optimal member engagement. 

Goal: Leverage nurse’s 

engagement in advocacy. 

• Identify hot topics that are 

most relevant to the current 

nursing environment 

• Identify a platform for 

sharing/discussing current hot 

topics/issues, best practices 

and innovation 

• Elevate the professional 

image of nursing to the public 

• Enhance the support of 

nursing students 

• Foster the advancement 

of professional development 

(education and certifications) 

• Advance workforce priorities 

and improve the work 

environment across diverse 

practice settings 

• Increase the participation of 

members in leadership roles 

• Create a new process that 

will promote an increase in the 

Nurse Recognition Award 

• Identify opportunities to 

provide social engagement/ 

networking events to 

encourage member 

engagement and 

member appreciation 

• Enhance our presence via 

Social Media platforms to 

make them stand out in 

the marketplace 

• Identify a social or 

communications platform for 

“Nurse to Nurse” forums, chats, 

problem and solution sharing, 

or a listening ear 

• Create new approaches that 

increase direct relationships 

with all registered nurses 

• Identify opportunities to 

educate members on the 

critical role of the nurse 

in advocacy 

• Empower nurses to advocate 

for the profession 

• Provide resources to build 

advocacy skills where they 

can leverage and tell their 

personal stories 

• Increase nurse participation 

in advocacy efforts 

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2022 

MICHIGAN STRATEGIC PLAN 

ADVANCING 

NURSE 

LEADERSHIP 

ENGAGING 

MEMBER 

EXPERIENCE 

BOLSTER 

ADVOCACY 

MOBILIZE 

STUDENTS AND 

NEW NURSES 

PROMOTE 

NURSING 

WELLNESS 

Goal: Elevate the level 

of professionalism in 

nursing 

• Identify hot topics that 

are most relevant to 

the current nursing 

environment 

• Identify a platform 

for sharing/discussing 

current hot topics/ 

issues, best practices, 

and innovation 

• Elevate the professional 

image of nursing to the 

public 

• Foster the 

advancement 

of professional 

development and 

identify current topics 

critical to nurses 

today (education and 

certification) 

• Advance workforce 

priorities and improve 

the work environment 

across diverse practice 

settings 

• Better reflect and 

support the voice of the 

“point of care” nurse in 

the organization and in 

products and services 

• Increase diversity in 

membership; racially, 

ethnically, by nursing 

practice area and 

geographically in the 

state 

• Clarify and amplify the 

organization’s identity 

and brand to nurses 

and other healthcare 

professionals 

• Create a gold-standard 

leadership program 

to enhance the skills 

of early to mid-level 

careerists 

• Mentor nurses in 

leadership skills 

that translate into 

effective mentorship 

and guidance in the 

workplace. 

Goal: Transform our 

culture for optimal 

member engagement 

• Increase the 

participation of 

members in leadership 

roles 

• Create a new process 

that will promote 

and increase nurse 

recognition 

• Identify opportunities 

to provide social 

engagement/ 

networking events to 

encourage member 

engagement and 

appreciation 

• Enhance our presence 

via social media 

platforms to make 

them stand out in the 

marketplace 

• Identify a social or 

communications 

platform for “nurse to 

nurse” forums, chats, 

problem and solution 

sharing or a listening 

ear 

• Create new approaches 

that increase direct 

relationships with all 

registered nurses 

• Create customized 

learning and 

communication 

pathways for nurses at 

all levels 

Goal: Leverage 

nurse’s engagement 

in advocacy 

• Identify opportunities 

to educate members 

on the critical role of 

the nurse in advocacy 

efforts 

• Empower nurses 

to advocate for 

themselves and the 

profession 

• Provide resources 

to build advocacy 

skills where they can 

leverage and tell their 

personal stories 

• Increase nurse 

participation in all 

forms of advocacy, 

including professional 

and legislative 

• Train nurses to serve 

as advocates on issues 

urgent and important 

to the profession 

• Unite all nurses under 

the ANA-Michigan 

umbrella to create 

a strong voice that 

allows for collaborative 

advocacy 

Goal: Create a 

pipeline of new to 

nursing members 

to assure nursing 

leadership going 

forward 

• Create an “Early 

Careerist” Task Force 

that will lead the 

charge on new nurse 

initiatives 

• Create a strong 

relationship between 

ANA-Michigan and 

MNSA to assure a 

seamless transition 

to the workforce and 

full ANA-Michigan 

membership 

• Create programming 

and engagement 

opportunities 

specifically for new 

nurses 

• Enhance the support of 

nursing students 

Goal: To be the 

organization that 

advocates for 

wellness in the 

nursing profession 

• Address and educate 

around nursing burnout 

and bullying 

• Educate and engage 

nurses in ways 

to advocate for 

themselves and others 

• Foster a culture of 

wellness and selfcare 

in the nursing 

profession 

• Help instill change that 

will promote healthier 

work environments for 

nurses in employment 

settings across the 

state of Michigan 


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Membership Meeting Rules and Parliamentary Procedure 

Rule 1: 

Rule 2: 

Rule 3: 

Rule 4: 

Rule 5: 

Rule 6: 

Rule 7: 

Rule 8: 

Rule 9: 

Rule 10: 

Rule 11: 

Rule 12: 

Meeting Rules 

Registered members must wear their name 

badges during the business session. All 

membership in good standing may vote. 

In making a motion or speaking to a 

question, a delegate shall move to the floor 

microphone, address the Chair, await 

recognition of the Chair, and give the 

delegate’s name and region. 

The correct form to use in making a motion 

is “I move that...” 

All motions and amendments should be 

written and signed by the maker of the 

motion or amendment and then given to 

the Chair. 

A member may not speak against her/his 

own motion, but may vote against it. 

No member shall speak more than once, or 

longer than three minutes, on the same 

question until all have spoken who wish to 

express and opinion. 

All reports and supplements to reports shall 

be written and shall not be read. 

Only currently paid members of the 

Association are entitled to vote at the polls 

upon verification of their current dues 

being in good standing according to the 

most current membership rosters provided 

to the tellers. 

The Association staff shall report the 

number of members registered after the 

opening ceremonies. Supplementary 

reports may be given later as the Chair may 

direct. 

A member should raise her/his hand to 

indicate she/he cannot hear. 

The member will act only on the resolves of 

a resolution. Questions of clarification will 

be handled according to parliamentary 

procedure. 

All sessions of the Annual Business Meeting 

shall be open to the public unless the Chair 

declares an executive question. 

Parliamentary Information 

Robert’s Rules of Order, Newly Revised is the 

parliamentary authority that shall govern the ANA-MI 

Business Meeting. The chair, as the presiding officer, 

rules on all matters relative to parliamentary law and 

procedures. The Parliamentarian serves only in an 

advisory capacity to the presiding officer and members. 

Member participation in the business session is 

governed by the standing rules. 

The motions that follow are defined in terms of action a 

delegate may desire to propose. Rules governing these 

motions are listed in Table 1. 

A main motion introduces a subject to the Business 

Meeting for consideration and is stated: “I move 

that....” 

FILLING OUT A MOTION FORM 

Motion forms are at the registration table and will be 

available on tables during the Business Meeting. Please 

fill them out completely before bringing forward a 

motion for consideration at the Business Meeting for 

discussion. 

You must sign your name and Region and get the 

signature of a person to second the motion before 

bringing it up. 

An amendment (primary) is a motion to modify the 

working of a motion. The motion to amend may be 

made in one of the following forms, determined by the 

action desired: “I move to amend by....” 

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

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

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

end of the motion).” 

• substituting (paragraph or entire text of a 

resolution or main motion and inserting 

another that is germane). 

An amendment to an amendment is a motion to 

modify the wording of the proposed amendment and 

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

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

applicable for making a secondary amendment. 

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The motion to commit or refer is generally used to send 

a pending motion (also called “the question”) to a small 

group of selected persons - a committee, board, or 

cabinet, for example - so that the question may be 

studied and put in better condition for the assembly to 

consider. The motion is stated: “I move to commit the 

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

The motion to close a debate (previous question), if 

seconded and approved by a two-thirds vote, stops 

discussion on the pending question and is stated: “I 

move the previous question.” 

A division of the assembly may be called by any 

member if the chair’s decision on a voice vote is in 

question. The member proceeds to the microphone 

and states: “I call for a division of the house.” The 

chair then takes a standing or roll call vote. 

A division of the question may be called when a 

pending motion relates to a single subject but contains 

several parts, each capable of standing as a complete 

proposition. The parts can be separated, and each 

considered and voted on as a distinct question. The 

motion is stated: “I move to divide the 

question........as follows....” 

The motion to reconsider enables a majority of the 

assembly to bring back for further consideration a 

motion that has already been voted. The purpose of 

reconsidering a vote is to permit correction of hasty, 

ill-advised, or erroneous action, or to consider added 

information or a situation that has changed since the 

vote was taken. (Note exception on the Table -Rules 

Governing Motions) 

Parliamentary inquiry is a question directed to the 

presiding officer to obtain information on parliamentary 

law or the rules of the organization as relevant to the 

business at hand. A member addresses the chair and 

states: “I rise to a (point) of parliamentary inquiry.” 

Point of information is a request, directed to the chair 

or through the chair to another officer or member for 

information relevant to the business and hand. The 

request is not related to parliamentary procedure. The 

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

point of information.” 

The motion to appeal the decision of the chair is 

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

by a member and seconded by another member, the 

question is taken from the chair and vested in the 

voting body for a ANA-Michigan decision. The motion 

is stated: “I move to appeal the decision of the chair.” 

Before a member can make a motion or address the 

assembly on any question, it is necessary that he or 

she obtain the floor through recognition by the 

presiding officer. The member must: 

• rise and proceed to the microphone. 

• address the chair by saying, “Madam 

Chairperson” 

• await recognition 

• give name and region 

• state immediately the reason for rising 

Rules Governing Motions 

Interrupt Speaker Recognized by Chair Requires a Second Debated Vote 

Main motion NO YES YES YES Majority 

Amendment NO YES YES YES Majority 

Amendment to amendment NO YES YES YES Majority 

Limit Debate NO YES YES NO Two-thirds 

Close debate (previous quest.) NO YES YES NO Two-thirds 

Divide the Question NO YES YES NO Majority 

Reconsider NO YES YES YES Majority* 

Point of parliamentary inquiry YES NO NO NO Chair Decides 

Point of Information YES NO NO NO Chair Decides 

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

motion to reconsider requires a two-thirds vote. 

9


10


ANA-Michigan Membership Assembly Agenda 

April 1, 2022 

11:45—12:30 p.m. 

11:45 Call to Order—Julia Stocker Schneider, President 

• Roll Call of the Board of Director 

• Roll Call of Membership 

• Declaration of Quorum 

• Review and Approval of the Agenda 

• March 24, 2021, Meeting Minutes 

11:50 Address from the President— Julia Stocker Schneider, President 

11:55 Treasurer’s Report—Julie Bulson, Treasurer 

12:00 ANA-Michigan Nurses Foundation—Katherine Dontje, Director 

12:05 Preliminary Results of Statewide Study of Nurses’ Experiences Using Their Electronic 

Health Record (EHR) — Julia Stocker Schneider, President 

12:15 Memberships Comment and Open Forum 

12:20 Recognition of Outgoing Board Members—Julia Stocker Schneider, President 

12:25 Tellers Report—Carole Stacy, Nominations Chair 

12:28 Passing of the Gavel— Julia Stocker Schneider, President 

12:30 Announcements and Adjournment—Bridget Leonard, President 

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4 

April 15, 2024 

October 15, 2023 

12

Membership Assembly 

March 24, 2021 

12:30 pm – 1:30 pm 

Virtual meeting held by Zoom 


2021 ANNUAL 

MEMBERSHIP MEETING 

MINUTES 

12:30 Call the Meeting to Order 

President Stocker Schneider called the meeting to order at 12:30 pm. 

Roll Call 

Stocker Schneider: Present; Leonard, Present; Davis, Present; Martin, Present; Calarco, 

Present; Dontje, Present; Keep, Present; Kreft, Present; Infante, Present 

President Stocker Schneider declared a quorum (41 members in attendance). 

Corrections or Additions to the Agenda 

None Stated. 

Motion #1: Approval of Agenda 

Made by Nancy Martin; Second by Suzanne Keep; Motion Passed. 

March 1, 2019, Annual Assembly Meeting Minutes 

No additional corrections to March annual meeting minutes noted. 

Motion #2: Approve March 1, 2019, Annual Meeting Minutes. 

Made by Nancy Martin; Second by Suzanne Keep; Motion Passed. 

12:35 President’s Message 

• COVID-19 activities were reviewed. 

• Year of the Nurse activities were presented. 

• Diversity & Inclusion initiatives were discussed. 

• The Nursing Informatics Survey was examined. 

12:45 ANA- Michigan Financials 

• Treasurer Nancy Martin presented the financial statements. 

• Membership dues budget was $18,600.00; ended the year with $19,769.41. 

• The association had a net loss of $5,484.88 due to having to cancel the March 2020 

Annual Conference. 

• A handful of operating expenses were over-budget: board insurance, marketing and 

promotion, postage, and technology hosting. 

• The association never had to move money from savings or investment account 

throughout the year and always maintained a cash flow of $15,000 to $25,000 in 

the checking account. 

• In November 2020, ANA-Michigan was able to place an additional $15,000 from 

savings to the investment account. 

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Motion #3: Accept ANA-MI 2020 Financial Report as presented. 

Made by Bridget Leonard; Second by Marge Calarco; Motion Passed. 

12:50 Address from Executive Director 

• Tobi Lyon discussed the following: 

• The office was closed on March 16, 2020, due to COVID-19; the Annual Conference 

was cancelled a week later. 

• Testimony was provided regarding the PPE shortage; 25 events were provided – 

more than ever before in ANA-Michigan’s history. 

• Staff was recognized and roles were summarized. 

• MHSA was recognized. 

• An update was provided on advocacy events. 

• Member highlights were shared. 

• The Champions for Nursing Partnership Program was announced. 

• Things to watch for in 2021 included: whistleblowing that aligns with the code of 

ethics, preventing workplace violence against nurses, creating an official foundation 

as a 501(c)3. 

• The outgoing board members were recognized and thanked. 

12:55 Proposed Bylaw Amendments 

• President Stocker Schneider invited Vineta Mitchell, Bylaws Committee Chair, to 

the microphone to present the bylaws amendments. 

• Chair Mitchell stated that the bylaws amendments were published to the membership 

on January 22nd. There was a bylaws hearing held on February 17th, and based on 

the hearing the Bylaws Committee is proposing no changes to the four amendments. 

• Amendment #1 – Change in categories of membership and dues structure. No 

discussion. MOTION CARRIES 89%. 

• Amendment #2 – Revision of unexcused absence policy regarding the Board of 

Directors. No discussion. MOTION CARRIES 98%. 

• Amendment #3 – Revision of unexcused absence policy regarding the committees. 

No discussion. MOTION CARRIES 95%. 

• Amendment #4 – Revision of responsibilities of the Nursing and Health Policy 

Committee and the Legislative Committee. No discussion. MOTION CARRIES 

95%. 

01:05 Address from Michigan Nursing Students Association 

• President Nicholas Cooper shared the following: 

• MNSA passed an enhanced honorary membership to open the door to undiscovered/ 

potential nurses. 

• MNSA is focused on inspiring nurses and caring for each other; caring takes places 

on both sides of the bedside. 

01:10 Membership Comment and Open Forum 

• Member Anna Scott recognized staff and expressed appreciated for the virtual app. 

• Member Deborah Bach-Stante encouraged nurses to respond to nurse licensure 

survey by March 31st. 

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• Member Linda Buck recognized Evelyn Sweeney and MHSA for the value of the 

partnership. 

01:15 Recognition of Outgoing Board Members 

• Nikeyia Davis, Secretary 

• Nancy Martin, Treasurer 

• Margaret Calarco, Director 

• Suzanne Keep, Director 

01:20 Teller’s Report 

• Carole Stacy, Chair of the Nominations Committee presented the Teller’s Report. 

• Electronic ballots were sent out via email on February 18 and voting remained open 

until 5pm on March 4 

• 3057 ballots were submitted; 221 members voted for a voter turnout rate of 7.2% 

• 2021 Election Results 

o Secretary – Nikeyia Davis 

o Treasurer – Julie Bulson 

o Director (2) – Josh Meringa and Julie Powell 

o Nominations Committee (2) – Beth Van Dam and Suzanne Keep 

o ANA Membership Assembly Representative – Anne Kreft 

01:25 Adjournment 

• Motion #5: Motion to Adjourn. 

Made by Carole Stacy; Second by Julie Bulson; Motion Passed. 

• The meeting was adjourned at 1:25 pm. 

15


President’s Report 

Julia Stocker 

Schneider 

As I reflect on 2021, my second and final year as ANA-Michigan President, I am 

proud of the work we have done as an Association. Though still operating remotely, 

we kicked off our year with a successful Annual Conference and Meeting that 

brought our members together virtually. The program was designed to support 

our self-care, healing, and emergence from the conditions that have challenged 

us as nurses during the pandemic. This set our pathway forward for the year to 

shape the way for a brighter future for nurses in Michigan. 

Our 2021 journey forward began with a strategic analysis of our association’s 

education offerings and approach that included an environmental scan and 

stakeholder survey. We were able to learn more about who our nurse learners 

are and what their needs and preferences are, including content and delivery. Armed with this data, 

we were able to develop a forward-looking plan that will help us to stay relevant and desired by 

Michigan nurses for our professional development programs and educational offerings. 

Given how much our world has changed since the onset of the COVID pandemic, we also invested 

significant time and effort in 2021 to evaluate our progress towards our current priorities and to 

identify new priorities in the current environment that are in need of our attention. Through this 

work, our Board of Directors added two new areas of priority focus. Given the challenges to our nursing 

workforce that were exacerbated by the latest COVID surges, we identified the need for a strong 

pipeline into the nursing profession in Michigan. Therefore, we have identified the mobilization of 

students and new nurses as a strategic priority. The board has also recognized the toll the pandemic 

has taken on nurses in our state and has added the promotion of nurse wellness as a top priority. 

ANA-Michigan has begun to utilize our 2022 strategic plan to drive our actions to advance the nursing 

profession in Michigan. In an effort to advance nursing leadership, we are offering an Empowered 

Leader Series to support leadership development. To address current issues that are most relevant 

to Michigan nurses, we are also hosting a virtual town hall. As nurses, we face many challenges 

out there. Through coming together on these issues, we can provide leadership on them as an 

Association. 

We continued working to engage member experience, including implementing the type and kinds 

of educational offerings that better suits the needs of Michigan nurses, improving communication 

and engagement mechanisms, as well as nurse recognition in our state. We are active in bolstering 

advocacy through our lobbying efforts, meeting with the Governor’s Office, and our coalition 

building with others through our participation in the Healthcare Workforce Sustainability Alliance. 

In addition to our involvement in the alliance, we are planning other activities designed to mobilize 

students and new nurses. We launched a foundation in 2021 that will give us additional avenues to 

16


support nursing, including providing scholarships to nursing students. We are also engaging in efforts 

to promote nurse wellness, including our partnership with the Michigan State Medical Society to 

provide SafeHaven, our adoption of a position on mitigating implicit bias, and our sharing of resources 

to support nurse wellness. 

It has been my honor to serve as your ANA-Michigan President during these past two years. While it 

has been a challenging time for nurses, I am grateful to the membership that we can come together 

through ANA-Michigan to support one another and our nursing profession in the state. I am hopeful 

about our direction and am excited to continue to serve along with you in ANA-Michigan as we lead 

with creative solutions that support the achievement of our vision for nursing in our state. 

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Financial Statements 

2021 Year-End Written Financial Summary 

Operating Revenues: 

Membership Dues: This fiscal year, we budgeted to receive a monthly average of $20,833.33 

per membership dues. We ended $10,889.46 ahead of budget and averaged a monthly income of 

$21,740.79 from dues. 

Conference Income: 2021 was the Association’s first virtual conference, and we had a net profit of 

$7,697.00. The 2020 conference was entirely canceled due to COVID, making 2019 the last in-person 

conference we held, which resulted in a profit of $7,112.74. 

Partnership Program: The newly launched partnership program has brought in additional new 

revenue totaling $5,500.00. 

RN Connect: $5,000 grant money for ANF was received to be a part of the RN Connect program. 

NSO: Revenue is ahead by $1,500 as they contributed an additional $1,500 in sponsorship. The 

Association budgeted $3,000 per their contract. Due to the facilitation of ANA selecting NSO over 

Mercer, NSO gave the states who had NSO prior a one-time extra sponsorship for $1,500 in 2021. 

Personal Benefit Program: ANA’s royalties for the personal benefit program have increased 

significantly, resulting in $1,512.07 unplanned revenue. In 2019 and 2020, ANA-Michigan received 

less than $500 each year. Thus, we removed the line item from the budget. 

Operating Expenses: 

Outside Contract Services: This line item is over budget. The $17,500 contract for education 

assessment, $3,500 for strategic planning, and $7,750 for the first installment for the contract 

regarding Ignite Sessions and Empowered Leader Series. The fee for our strategic planning facilitator 

was the only line item planned for when we did the 2021 budget. 

Net Profit 

We had anticipated a net profit of $1,900; instead, we made a net profit of $12,878.16. 

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12:31 PM ANA-Michigan 

01/12/22 Balance Sheet 

Accrual Basis As of December 31, 2021 

Dec 31, 21 

ASSETS 

Current Assets 

Checking/Savings 

Bank of America Merrill Lynch 147,347.93 

Dorothea Milbrandt Fund--Reserv 16,165.73 

MSU Business Savings Accot 17,261.93 

MSU Checking 12,576.43 

Total Checking/Savings 193,352.02 

Accounts Receivable 

Accounts Receivable 625.00 

Total Accounts Receivable 625.00 

Total Current Assets 193,977.02 

TOTAL ASSETS 193,977.02 

LIABILITIES & EQUITY 

Equity 

Opening Balance Equity 96,071.78 

Unrestricted Net Assets 70,408.76 

Net Income 27,496.48 

Total Equity 193,977.02 

TOTAL LIABILITIES & EQUITY 193,977.02 

19 

Page 1



01/12/22 Profit & Loss Budget vs. Actual 

Accrual Basis January through December 2021 

Jan - Dec 21 Budget $ Over Budget % of Budget 

Ordinary Income/Expense 

Income 

08-000 Nurse Appreciation Event 5,550.00 6,000.00 -450.00 92.5% 

10-000 Conference 

10-100 Exhibitor 2,500.00 3,000.00 -500.00 83.3% 

10-200 Registration 8,922.00 14,000.00 -5,078.00 63.7% 

10-300 Sponsorships 0.00 5,000.00 -5,000.00 0.0% 

Total 10-000 Conference 11,422.00 22,000.00 -10,578.00 51.9% 

11-000 Membership Engagement 0.00 15,000.00 -15,000.00 0.0% 

12-000 Interest Income 23.82 150.00 -126.18 15.9% 

13-000 Leadership Institute 0.00 34,000.00 -34,000.00 0.0% 

14-00 Membership Dues 260,889.46 250,000.00 10,889.46 104.4% 

15-000 Non-Dues Revenue 

15-100 Career Center 0.00 1,000.00 -1,000.00 0.0% 

15-300nDonations 6,602.48 

15-600 Miscellaneous Revenue 90.00 

15-700 Publications 6,000.00 5,000.00 1,000.00 120.0% 

15-750 RN Connect 5,000.00 

15-800 NSO 4,500.00 1,500.00 3,000.00 300.0% 

15-950 Personal Benefit Program 1,512.07 

15-955 Webinars 1,301.00 16,000.00 -14,699.00 8.1% 

15-975 Partnership Program-CNPP 5,500.00 

Total 15-000 Non-Dues Revenue 30,505.55 23,500.00 7,005.55 129.8% 

Total Income 308,390.83 350,650.00 -42,259.17 87.9% 

Expense 

21-000 ANA Logo Merchandise 0.00 0.00 0.00 0.0% 

22-000 Annual Conference 

22-100 Audio/Visual 0.00 4,000.00 -4,000.00 0.0% 

22-200 Awards 1,316.74 

22-500 Marketing--Conference 0.00 500.00 -500.00 0.0% 

22-800 Speakers 2,650.00 5,000.00 -2,350.00 53.0% 

22-900 Supplies/Materials 0.00 4,700.00 -4,700.00 0.0% 

22-950 Mobile App 1,000.00 1,000.00 0.00 100.0% 

Total 22-000 Annual Conference 4,966.74 15,200.00 -10,233.26 32.7% 

23-000 Business Expenses 

23-100 Business Reg Fees 40.00 50.00 -10.00 80.0% 

23-200 Business/Board Insurance 1,000.00 1,000.00 0.00 100.0% 

Total 23-000 Business Expenses 1,040.00 1,050.00 -10.00 99.0% 

24-000 Committees 5,073.08 10,000.00 -4,926.92 50.7% 

25-000 Contract Services 

25-100 Accounting Fees 1,138.50 1,500.00 -361.50 75.9% 

25-200 Assoc. Mgmt. Services 163,250.00 150,000.00 13,250.00 108.8% 

25-300 CEU 3,033.24 3,750.00 -716.76 80.9% 

25-500 Legal Fees 2,000.00 2,000.00 0.00 100.0% 

25-600 Lobbyist Contract 54,000.00 54,000.00 0.00 100.0% 

25-700 Outside Contract Serv 28,749.00 3,000.00 25,749.00 958.3% 

Total 25-000 Contract Services 252,170.74 214,250.00 37,920.74 117.7% 

26-000 Membership Engagemen E... 0.00 15,000.00 -15,000.00 0.0% 

27-000 Leadership Institute Exp 0.00 20,000.00 -20,000.00 0.0% 

20 

Page 1



01/12/22 Profit & Loss Budget vs. Actual 

Accrual Basis January through December 2021 

Jan - Dec 21 Budget $ Over Budget % of Budget 

28-000 Operations 

28-100 Cred. Card Proc/Security 644.00 1,500.00 -856.00 42.9% 

28-200 Dues and Subscriptions 5,615.30 3,000.00 2,615.30 187.2% 

28-300 Marketing/Promotion 10,301.58 12,000.00 -1,698.42 85.8% 

28-400 Postage, Mailing Service 1,101.94 2,500.00 -1,398.06 44.1% 

28-500 Printing and Copying 1,417.65 1,500.00 -82.35 94.5% 

28-600 Supplies 0.00 1,500.00 -1,500.00 0.0% 

28-700 Technology Hosting 11,722.92 11,000.00 722.92 106.6% 

28-800 Telephone 1,506.39 2,000.00 -493.61 75.3% 

Total 28-000 Operations 32,309.78 35,000.00 -2,690.22 92.3% 

29-000 Other Expenses 

29-100 COMON 250.00 250.00 0.00 100.0% 

29-300 Miscellaneous 365.53 

29-500 MSNA 615.56 2,500.00 -1,884.44 24.6% 

29-700 Foundation 2,500.00 3,000.00 -500.00 83.3% 

Total 29-000 Other Expenses 3,731.09 5,750.00 -2,018.91 64.9% 

30-000 Travel and Meetings 

30-100 ANAI 0.00 2,000.00 -2,000.00 0.0% 

30-200 Board of Dir. Meetings 0.00 2,500.00 -2,500.00 0.0% 

30-300 Board/Member Expenses 1,606.83 5,000.00 -3,393.17 32.1% 

30-400 Lobbyist Expense 0.00 2,500.00 -2,500.00 0.0% 

30-500 Membership Assembly 0.00 6,000.00 -6,000.00 0.0% 

30-600 Staff Travel/Other 1,108.17 5,000.00 -3,891.83 22.2% 

Total 30-000 Travel and Meetings 2,715.00 23,000.00 -20,285.00 11.8% 

31-000 Nurse App. Event Exp 4,750.74 6,000.00 -1,249.26 79.2% 

32-000 Quarterly Webinars 2,035.50 3,500.00 -1,464.50 58.2% 

Total Expense 308,792.67 348,750.00 -39,957.33 88.5% 

Net Ordinary Income -401.84 1,900.00 -2,301.84 -21.1% 

Other Income/Expense 

Other Income 

33-000 Unrealized Gain/Loss Inv 

33-100 Unrealized Gain 27,898.32 

Total 33-000 Unrealized Gain/Loss... 27,898.32 

Total Other Income 27,898.32 

Net Other Income 27,898.32 

Net Income 27,496.48 1,900.00 25,596.48 1,447.2% 

21 

Page 2


3:40 PM 

11/08/21 

Accrual Basis 

ANA-Michigan 

2022 Approved Budget 

Jan - Dec 22 

Ordinary Income/Expense 

Income 

08-000 Nurse Appreciation Event 6,000.00 

10-000 Conference 

10-100 Exhibitor 3,000.00 

10-200 Registration 14,000.00 

10-300 Sponsorships 5,000.00 

Total 10-000 Conference 22,000.00 

11-000 Membership Engagement 10,000.00 

12-000 Interest Income 150.00 

13-000 Leadership Institute 25,000.00 

14-00 Membership Dues 260,000.00 

15-000 Non-Dues Revenue 

15-100 Career Center 500.00 

15-700 Publications 5,000.00 

15-800 NSO 1,500.00 

15-950 Personal Benefit Program 1,500.00 

15-955 Webinars 5,000.00 

15-975 Partnership Program-CN... 6,000.00 

Total 15-000 Non-Dues Revenue 19,500.00 

Total Income 342,650.00 

Expense 

22-000 Annual Conference 

22-100 Audio/Visual 4,000.00 

22-500 Marketing--Conference 500.00 

22-800 Speakers 5,000.00 

22-900 Supplies/Materials 4,700.00 

22-950 Mobile App 1,000.00 

Total 22-000 Annual Conference 15,200.00 

23-000 Business Expenses 

23-100 Business Reg Fees 20.00 

23-200 Business/Board Insuran... 1,000.00 

Total 23-000 Business Expenses 1,020.00 

24-000 Committees 5,000.00 

25-000 Contract Services 

25-100 Accounting Fees 1,000.00 

25-200 Assoc. Mgmt. Services 159,000.00 

25-300 CEU 3,500.00 

25-500 Legal Fees 1,500.00 

25-600 Lobbyist Contract 54,000.00 

25-700 Outside Contract Serv 15,000.00 

Total 25-000 Contract Services 234,000.00 

26-000 Membership Engagemen ... 5,000.00 

27-000 Leadership Institute Exp 10,000.00 

28-000 Operations 

28-100 Cred. Card Proc/Security 1,000.00 

28-200 Dues and Subscriptions 6,000.00 

28-300 Marketing/Promotion 12,000.00 

28-400 Postage, Mailing Service 1,000.00 

28-500 Printing and Copying 1,000.00 

28-600 Supplies 1,000.00 

28-700 Technology Hosting 11,000.00 

28-800 Telephone 2,000.00 

Total 28-000 Operations 35,000.00 

22 

Page 1


3:40 PM 

11/08/21 

Accrual Basis 

ANA-Michigan 

2022 Approved Budget 

Jan - Dec 22 

29-000 Other Expenses 

29-100 COMON 250.00 

29-500 MSNA 2,500.00 

29-700 Foundation 1,500.00 

Total 29-000 Other Expenses 4,250.00 

30-000 Travel and Meetings 

30-100 ANAI 2,000.00 

30-200 Board of Dir. Meetings 1,500.00 

30-300 Board/Member Expenses 5,000.00 

30-400 Lobbyist Expense 2,500.00 

30-500 Membership Assembly 6,000.00 

30-600 Staff Travel/Other 5,000.00 

Total 30-000 Travel and Meetings 22,000.00 

31-000 Nurse App. Event Exp 2,500.00 

32-000 Quarterly Webinars 3,500.00 

Total Expense 337,470.00 

Net Ordinary Income 5,180.00 

Net Income 5,180.00 

23 

Page 2


Executive Director Report 

“To do what nobody else will do, in a way that nobody else can do, in spite 

of all we go through…that is what it is to be a nurse.” – Rawsi Williams, RN 

While it is indisputable that nurses faced an ongoing crisis in 2021 that was fraught 

with personal challenges and trying circumstance, ANA-Michigan continued to 

expand its outreach, grow its membership, and advance the goals of its strategic 

plan. And though the pandemic continues to present nursing professionals with 

challenges related to COVID-19 (in terms of their health and the health of those 

in which they serve), ANA-Michigan members and leadership have continued to 

Tobi Lyon, MBA, CAE 

demonstrate resiliency and care. We have doubled down on our commitment 

to ourselves and each other and continue to drive our initiatives through advocacy efforts, media 

visibility, and self-care resources and support. As I reflect on the year, I am truly inspired by the 

strides ANA-Michigan has made as we readjust and redefine our terms. How this was possible in the 

face of a global health crisis can only be attributed to the proactivity, dedication, and sacrifice of 

our nurses and leadership. 

While I am so proud of the advances we continue to make and the plans we have for the future, 

it remains a critical matter that we prioritize the need to take proper care of our nurses and 

support their wellness and well-being. Though there are many successes to celebrate, it would 

be remiss not to acknowledge and act on behalf of those who are struggling. Nurses, physicians, 

and healthcare providers are taking care of people every day. But who is taking care of them? The 

American Nurses Foundation conducted several surveys this year (all available on ANA’s website, 

nursingworld.org), and the statistics from these surveys reflect the toll that the pandemic continues 

to take on this committed profession. The study reported that of the nurses surveyed, 51% reported 

being exhausted, 43% reported being overwhelmed, 23% were depressed, 22% were angry, and a 

mere 21% were optimistic about the future. 

While these results are hard-hitting and difficult to know, even more impactful are the statistics 

on how nurses are handling the stress and strain of the pandemic. Only 24% reported having sought 

professional mental health support, 36% believe they should be able to manage it themselves, and 

30% cite a lack of time. Some are concerned that if they did seek professional mental health support, 

they could potentially face license issues, retribution by the employer, and stigma from co-workers. 

These roadblocks to mental healthcare for nurses must be removed, and a shift to prioritization 

of nurse well-being must occur before a severe problem becomes worse. Additionally, one of my 

biggest takeaways from these results was that some nurses reported not knowing where to access 

support or indicating that they felt Employee Assistance Programs were not readily available to them. 

Because nursing support programs do exist, ANA-Michigan is working on new ways to communicate 

this information immediately and effectively. 

24


Given these ongoing hardships and stressors on healthcare providers, ANA-Michigan has partnered 

with the Michigan State Medical Society (MSMS) to promote a new comprehensive and confidential 

well-being program, SafeHaven, that comes not a moment too soon. Many are suffering from 

stress and burnout, and it's affecting some providers at crisis levels. I feel that with ANA and ANA- 

MI programming, faith in each other, prioritization of self-care, and our advocacy efforts rooted 

in communication and clarity we will be able to realign the healthcare industry with nurses needs 

and insight at the forefront. This program offers nurses and physicians a host of resources designed 

to aid in addressing career fatigue and behavioral health concerns. The types of care provided by 

SafeHaven include: 

• In-the-moment telephonic support, available 24/7 

• Face-to-face counseling sessions 

• Peer Coaching 

• WorkLife Concierge 

• VITAL WorkLife App—connect with your resources, take assessments to evaluate well-being, 

access Insights, videos and more 

• Telephonic legal and financial consultations and resources 

• Member website with extensive work and life resources 

Nurses, physicians, and health care providers are a precious resource — and that's why SafeHaven 

is committed to helping them stay well, avoid burnout, connect to their purpose, and manage the 

demands of their personal and professional lives. ANA-Michigan is proud to stand alongside MSMS to 

offer this leading resource as a value-added member benefit. For more information on SafeHaven 

as it pertains to members of ANA-Michigan visit us online. 

On the legislative front, the long-awaited passage of HB 4359, a bill to expand the scope of practice 

for certified registered nurse anesthetists, was signed into law by Governor Gretchen Whitmer, 

officially making the legislation Public Act 53 of 2021. The bill will allow CRNAs greater autonomy 

in their practice while ensuring that only CRNAs with appropriate experience and credentials can 

operate without physician oversight. HB 4359 passed the House and Senate with broad bipartisan 

support and took effect on October 11, 2021, and we are excited about what this will mean for our 

nurses’ career autonomy going forward. 

Lastly, while not a new program, but certainly new from ANA, is the compelling report recently 

completed by the National Commission to Address Racism in Nursing. The Commission officially 

released the results from the survey of over 5,600 nurses with findings showing racism is a substantial 

problem within the profession. Among other statistics, the survey reported that 63% of nurses surveyed 

say that they have personally experienced an act of racism in the workplace with the transgressors 

being either a peer (66%), patients (63%), or a manager or supervisor (60%). Additionally, 57% of 

nurses said they have challenged racism in the workplace, but more than half said their efforts 

resulted in no change. 

These findings validate the Commission’s new definition of racism : “assaults on the human spirit in 

the form of actions, biases, prejudices, and an ideology of superiority based on race that persistently 

cause moral suffering and physical harm of individuals and perpetuate systemic injustices and 

inequities.” It is imperative that we not only continue to address this problem but bring about 

intentional change and spread meaningful awareness. 

25


While I intend to emulate and encourage the hope that nurses everywhere have exhibited, I am 

unsure exactly what the future and coming years will hold in terms of the aftereffects of this 

pandemic. What I can assure you is that in addition to keeping our association relevant and providing 

resources and information: we are here to help. As outlined, we are taking significant action to not 

only bring awareness to the issues nurses are facing but to provide tangible, accessible solutions. 

Whether through advocacy, mental health tools, or information, you will always have this community 

to lean on and utilize as an advocate. As we close another calendar year and set new goals around 

engagement, transformation, and communication efforts, I am proud to continue to fulfill ANA- 

Michigan’s mission but more notably to continue to stand beside and serve each of you. Thank you. 

26


A New Administration 

ANA-Michigan Lobbyist, Muchmore Harrington Smalley & Associations (MHSA) 

On Wednesday, January 20, our country observed the inauguration of the 46th 

President of the United States. The moment was historic and unprecedented (a word 

we have used often the last 12 months!) for so many reasons, including the swearing 

in of the country’s first woman of African American and South Asian descent as 

Vice President. Although this year’s inauguration certainly looked and felt different 

in light of the ongoing COVID-19 pandemic and a deep political polarization, it 

remains a day of profound consequence and hope. 

Evelyn Sweeney 

President Biden, like his predecessors, has crafted a challenging and ambitious 100-day agenda, 

dominated by a $1.9 trillion COVID-19 relief plan he needs Congress to approve. Although the 

President can look to allies in Congress, as both chambers are now controlled by democrats, the 

margins are very slim. Couple tight numbers with a campaign theme of unity and “restoring the 

soul of America,” the President will need to make a habit of reaching across the aisle and securing 

bi-partisan support if he hopes to cultivate a spirit of inclusivity and productivity during his tenure. 

We saw quick action from President Biden (his first day in office) on issuing executive actions not 

requiring congressional approval including, rejoining The Paris Climate Accord, extending restrictions 

on evictions and foreclosures and requiring masks to be worn on all federal property and during 

interstate travel on airlines or trains. 

Arguably President Biden’s most immediate and pressing priority is overseeing a more intentional and 

hands-on federal response to the COVID-19 pandemic, including vaccine deployment and economic 

stimulus/business relief efforts. President Biden has proposed a $1.9 trillion COVID-19 relief plan 

which would include $1400 per person direct payments to most households, expanded paid leave 

and increases in the child tax credit. The proposal also includes $416 billion to create a national 

vaccination program with the goal of inoculating 50 million Americans and opening schools for faceto-face 

learning within his first 100 days in office. 

Governor Whitmer who was seriously vetted as a Vice Presidential contender was invited to attend 

the Biden-Harris inauguration by the President-elect. Governor Whitmer was also tapped by the 

President to serve as one of the co-chairs of the inaugural committee, as well as one of four National 

Democratic Committee Vice Chairs. 

Governor Whitmer has repeatedly articulated her hope and confidence in what the Biden 

administration will mean for Michigan, anticipating a strong relationship with the President and 

the federal government. On the day of the inauguration Governor Whitmer issued the following 

statement, “On his first day in office, President Biden has made it clear that he is committed to 

ending the COVID-19 pandemic once and for all and building a stronger, more sustainable nation for 

future generations. President Biden’s action to urge Americans everywhere to do their part and mask 

up and launch a coordinated national response to the pandemic will undoubtedly save lives and put 

us on track to defeat our common enemy: COVID-19.” 

27


President Biden has stated he sees himself as a, “transitional” President. The reality is his administration 

will face some of the nation’s most complicated and significant challenges in a lifetime. I believe 

former President George W. Bush stated it best when he directly expressed a message of support to 

President Biden by stating, “Your success is our country’s success”. 

Certified Nurse Anesthetists See Legislative Win with Passage of HB 4359 

By Evie Zois Sweeney 

Muchmore Harrington Smalley Associates 

After decades of legislative debate and negotiating, legislation was recently enacted in Michigan that 

expands the scope of practice for Certified Registered Nurse Anesthetists (CRNAs). House Bill 4359, 

now Public Act 53 of 2021, was sponsored and championed by Representative Mary Whiteford (R-Casco 

Twp.), a registered nurse by trade. The bill passed both the House and Senate with overwhelming 

bipartisan support, despite expressed concerns from the Michigan State Medical Society. 

The bill amends the Michigan Public Health Code and allows a registered professional nurse who 

holds a specialty certificate as a nurse anesthetist to perform the following duties: 

• Develop a plan of care 

• Perform all patient assessments, procedures, and monitoring to implement a plan of care or 

to address patient emergencies that arise during implementation of the plan of care 

• Selection, ordering, or prescribing and the administration of anesthesia or analgesic agents, 

including pharmacological agents that are prescription drugs (as defined) or controlled 

substances 

The bill would also allow a CRNA to practice without supervision if the individual met one of the 

following criteria: 

• He or she has practiced in the specialty health field of nurse anesthetist for three years or 

more, and has practiced in that heath profession specialty field in a healthcare facility for 

a minimum of 4,000 hours, OR 

• He or she has a doctor of nurse anesthesia practice degree or doctor of nursing practice 

degree 

House Bill 4359 emphasizes collaboratively participating in a patient-centered care team and 

includes language that does not require new or third party reimbursement or mandated worker’s 

compensation benefits. 

Representative Whiteford has been a passionate force, advocating for “scope reform” over multiple 

legislative sessions. She believes the bill will enable Michigan hospitals and health care facilities to 

choose the anesthesia model that works best for their community, while increasing patient access to 

anesthesia services in underserved parts of the state and helping to control health care costs. 

House Bill 4359 was signed by Governor Whitmer on July 13, 2021 and is now Public Act 53 of 2021. 

The Public Act can be viewed here. It will take effect on October 11, 2021. 

28


In highly anticipated news, State Senator Rick Outman (R-Six Lakes) introduced Senate Bill 680 on 

October 5, 2021, legislation that would allow full practice authority for nurse practitioners in the 

State of Michigan. The bill was introduced with bi-partisan cosponsors, representing broad regional 

support from Detroit to Traverse City. 

The legislation amends the public health code and outlines the requirements an individual needs to 

successfully complete to achieve nurse practitioner status in the State of Michigan. In addition, the 

bill outlines an expanded scope of practice for nurse practitioners that includes, but is not limited 

to the following allowable functions: 

➢ Performing comprehensive assessments, providing physical examinations and other health 

assessments, and providing screening activities 

➢ Diagnosing, treating, and managing patients with acute and chronic illnesses and diseases 

➢ Ordering, performing, supervising, and interpreting laboratory and imaging studies 

➢ Prescribing pharmacological and nonpharmacological interventions and treatment that are 

within the registered professional nurse’s specialty role 

➢ Engaging in health promotion and disease prevention 

➢ Providing health education 

The bill also includes language that would allow a nurse practitioner to consult with and refer 

patients to other health professionals, as well as supervise registered professional nurses, licensed 

practical nurses, and other health professionals, as appropriate. Finally, the bill includes important 

language that would allow an advanced practice registered nurse who holds a specialty certification 

in the specialty field of nurse practitioner to prescribe a controlled substance included in schedules 

2 to 5 of part 72 of the public health code without delegation from a physician. 

Senate Bill 680 would allow a nurse practitioner to practice at the top of his or her scope of practice 

and reflects the highly skilled education and training necessary to earn the specialty certification. 

Senator Outman has characterized the legislation as an opportunity to improve healthcare quality, 

expand access to care, and invest in public health. Senate Bill 680 has been referred to the Senate 

Health Policy and Human Services Committee. A committee hearing is expected in 2022. 

29


ANA-Michigan Committee Reports 

ANA-Michigan Nursing and Health Policy Committee 

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

Alexa Andersen, MA, BSN, RN 

Beth Ammerman, DNP, FNP-BC 

Holly Thalman, BSN, RN 

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

Ramona Berry, MSA, BSN, RN 

Barbara Medvec, DNP, RN, NEA-BC 

Wanda Chukwu, DNP, MA, CNEcl, RN 

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

Committee Duties & Assignments 

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

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

nursing organizations in relevant nursing and health policy. 

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

policy makers. 

• Monitor and address nursing and healthcare regulatory policy issues. 

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

Committee. 

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

and procedures as established by the Board of Directors. 

2021 Report 

• Completed Telehealth and Mobile Health Position Statement for board approval and 

dissemination to the membership. 

• Completed Mitigating Implicit Bias to Reduce Disparities in Patient Outcomes for board 

approval and dissemination to the membership. 

• Spearheaded the initial development of implicit bias training opportunities to be considered 

for the ANA-Michigan membership. 

• Completed Implicit Bias Training Article for the quarterly newsletter publication. 

• Completed A Guide To Surviving A Crisis: Empowering Your Voice Article for the quarterly 

newsletter publication. 

Acknowledgements 

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

members for their dedication and service to the membership: 

• Beth Ammerman, DNP, FNP-BC 

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

• Barbara Medvec, DNP, RN, NEA-BC 

• Linda Sarantis, MSN, RN, S.A.N.E. 

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

30


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

were appointed to serve the membership for a two-year term: 

• Beth Ammerman, DNP, FNP-BC 

• Marina Andriyakhova, BSN, RN, CWCN 

• Deborah Bach-Stante, BSN, MPH, MSW 

• Sarah Jennings, DNP, MPA, RN, NEA-BC 

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

Chair: Julie Powell, DNP, MSN, RN, AGCNS-BC 

Nichole Budnick, BSN, RN 

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

Nadia Farhat, RN, MSN, AGCNS-BC 

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

Molly Stapish, MSN, CMSRN 

Erin Sudheimer, MSN, RN 

Bethann Perkins-Simmons, BSN, RN 

Marnie VanDam, MSN, RN 

ANA-Michigan Nursing Practice Committee 


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

organizations with specific clinical expertise in developing initiatives. 

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

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

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

affecting nursing practice. 

• Address ethical issues in practice. 

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

policies and procedures as established by the Board of Directors. 


• Drafted an information sheet on the history of vaccines to share with the membership and 

the community. 

• Drafted a position statement on COVID-19 vaccines. 

• Developed an article for the quarterly newsletter publication on the role of the professional 

nurse in community health care and other alternate roles in nursing. 

• Drafted an article on travel nurses, staffing challenges and retention for the quarterly 

newsletter publication. 

• Reviewed The Virtual Nurses’ Lounge, The Emotional PPE Project, and SafeHaven as potential 

platforms for ANA-Michigan to consider for mental health resources. 

• Brainstormed ideas for a potential statement regarding COVID-19 vaccine boosters. 

• Pushed a social media campaign to raise awareness for flu shots and COVID-19 vaccines. 

31





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

• Nadia Farhat, RN, MSN, AGCNS-BC 

• Julie Powell, DNP, MSN, RN, AGCNS-BC 

• Molly Stapish, MSN, CMSRN 

• Marnie VanDam, MSN, RN 



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

• Denise Ervin, BSN, NC-BC 

• Ruth Kitzmiller, MSA, BSN, RN, NE-BC 

• Gina Schrader, MSN, RN, CEN 

• Wendy Szafranski, MSN, RN, CNE 

ANA-Michigan Education Committee 

Chair: Bridget Leonard, DNP, MBA, RN, CRRN, NEA-BC 

Ruth Duffy, BSN 

Gerardo Infante, BSN, RN 

Patrick Joswick, DNP, AGNP-C, RN 

Jennifer Mecomber 

Mary Zugcic, RN, ACNS-BC, CRNI 


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

• Plan the annual educational conference. 

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

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

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

and procedures as established by the Board of Directors. 


• Oversaw the final planning stages for the 2021 ANA-Michigan Annual Conference and 

Membership Assembly. 

• Finalized the planning of nurse contact hours in conjunction with the 2021 Virtual Annual 

Conference and Membership Assembly. 

• Developed quarterly educational virtual programming. 

• Worked on developing a potential 2021 Leadership Academy. 

• Finalized and released for use the Reality of Becoming a Nurse webinar series for members. 

• Partnered with Oakland University to host a Virtual Abstracts and Poster Webinar for members 

ahead of the 2022 Annual Conference and Membership Assembly. 

• Initiated and developed all details related to the 2022 Annual Conference and Membership 

Assembly. 

• Worked to host Ignite Sessions at the Annual Conference for the first time as a new opportunity. 

32





• Dr. Bridget Leonard, DNP, MBA, RN, CRRN, NEA-BC 

• Jennifer Mecomber, MSN, RN 

• Mary Zugcic, RN, ACNS-BC, CRNI 



• Maria Bobo, DNP, RN, WHNP-BC, CENP 

• Kristen Dessouki, DNP, RN, FNP (c) 

• Linda Keilman, DNP, MSN, GNP-BC, FAANP 

33


2021 ANA-Michigan Award Winners 

ANA-Michigan hosted the Awards and Recognition Fundraiser on Tuesday, November 16, 2021, to 

launch the newly formed ANA-Michigan Nurses Foundation and to formally recognize excellence in 

nursing this year. To make the event extra meaningful, ANA President Dr. Ernest Grant flew in from 

the east coast to join ANA-Michigan for the evening as a VIP guest and keynote speaker. 

Seven awards were presented, and five recipients were in attendance to accept in person, a sight we 

would not have been able to witness just one year ago. Adding to the night’s joy was the attendance 

of four 2020 award recipients, who had never had the chance to celebrate their awards in person 

with their peers. 

Congratulations to the 2021 Award Recipients: 

• Exceptional Promise Award – Zoe Retell 

• Future Nurse Leader Award – Meklit Shonga, RN 

• Public Policy Advocate Award – Sue Anne Bell, PhD, FNP-BC, FAAN 

• Innovation Award – The Dr. Gary Burnstein Community Health Clinic 

• Collaborative Practice Award – Kent County Health Department 

• Lifetime Achievement Award – Phyllis S. Brenner, PhD, RN 

• Dorothea Milbrandt Nurse Leader Award – Linda Taft, RN 

Photo 

Unavailable 

Zoe Retell Meklit Shonga Sue Anne Bell Phyllis S. Brenner Linda Taft 

Kent County Health Department 

34 

The Dr. Gary Burnstein Community Health Clinic


Summary of the 2021 Virtual Annual Meeting 

of the ANA Membership Assembly 

The American Nurses Association (ANA) Membership Assembly held its annual meeting virtually 

on Friday, June 18, 2021. ANA President, Ernest Grant, PhD, RN, FAAN, presided. 

CALL TO ORDER 

ANA President Grant called the Virtual Annual Meeting of the ANA Membership Assembly to 

order at 4:35pm ET on Friday, June 18, 2021. 

ORDER OF BUSINESS 

A quorum 1 for the transaction of business was established. 

The proposed Standing Rules for the Conduct of the Business of the Virtual Annual Meeting of the 

ANA Membership Assembly (Standing Rules) were disseminated for review on May 18, 2021. 

Per Section 5.b of the proposed Standing Rules: No motions shall be permitted except for a 

motion to adopt the agenda, a motion to adopt the rules for the meeting, and a motion to 

approve the recommendations of the ANA Professional Policy Committee. Therefore, no motions 

to amend the Standing Rules were permitted. 

ANA President Grant presented the proposed Standing Rules. Without objection, the Standing 

Rules were approved. 

The Agenda for Virtual Annual Meeting of the ANA Membership Assembly meeting was 

disseminated on May 18, 2021. Per Section 5.b of the Standing Rules: No motions shall be 

permitted except for a motion to adopt the agenda, a motion to adopt the rules for the meeting, 

and a motion to approve the recommendations of the ANA Professional Policy Committee. 

Therefore, no motions to amend the agenda were permitted. 

ANA President Grant presented the agenda for the Virtual Annual Meeting of the ANA 

Membership Assembly. Without objection, the agenda was approved. 

REPORT OF THE NOMINATIONS AND ELECTIONS COMMITTEE 

Gayle Peterson, RN-BC, Chair of the Nominations and Elections Committee (NEC) reported that a 

Call for Nominations was issued in December 2020 for ANA elective offices for the following 

positions on the ANA Board of Directors (board) Vice-President, Treasurer, Director-at-Large, and 

1 

A quorum for transaction of business by the Membership Assembly shall consist of 50 percent of the total C/SNA and IMD 

representatives and three members of ANA's Board of Directors, one of whom is the ANA President or Vice President (ANA 

Bylaws Article III, Section 8.b). 

35 

1


Director-at-Large Recent Graduate as well as four positions on the Nominations and Elections 

Committee. A second Call for Nominations was disseminated in February 2021 due to insufficient 

nominations for the following ANA Elective Offices: Vice-President, Director-at-Large, Directorat-Large 

Recent Graduate and four positions on the ANA Nominations and Elections Committee. 

On March 19, 2021, the final slate of candidates was announced. Membership Assembly voting 

representatives were reminded that officer positions on the board are elected by majority vote 

and all other positions are elected by plurality. 

ANA PRESIDENT’S ADDRESS 

ANA President Grant presented his Address. 

VIDEO GREETINGS FROM THE NATIONAL STUDENT NURSES ASSOCIATION 

Participants viewed a pre-recorded address from Kyle Loose, President of the National Student 

Nurses Association. 

REPORT OF THE ANA CHIEF NURSING OFFICER 

ANA Chief Nursing Officer, Debbie Hatmaker, PhD, RN, FAAN, presented her report. 

REPORT OF THE ANA CHIEF EXECUTIVE OFFICER 

ANA Chief Executive Officer, Loressa Cole, DNP, MBA, RN, NEA-BC, FACHE, FAAN, presented her 

report. 

VIDEO GREETINGS FROM THE AMERICAN ACADEMY OF NURSING 

Participants viewed a pre-recorded address from Eileen Sullivan-Marx, PhD, RN, FAAN, President 

of the American Academy of Nursing. 

NIGHTINGALE TRIBUTE 

ANA President Grant read the poem, She Was There, written by ANA member Duane Jaeger, 

MSN, RN, APRN, to pay tribute to the nurses who passed away since the 2020 ANA Membership 

Assembly. 

VIDEO GREETINGS FROM THE AMERICAN NURSES CREDENTIALING CENTER 

Participants viewed a pre-recorded address from Rhonda Anderson, DNSc(h), MPA, BS, RN, 

LFACHE, FAAN, President of the American Nurses Credentialing Center. 

REPORT OF THE ANA TREASURER 

ANA Treasurer Jennifer Mensik Kennedy, PhD, RN, NEA-BC, FAAN, presented the Report of the 

ANA Treasurer. 

VIDEO GREETINGS FROM THE AMERICAN NURSES FOUNDATION 

Participants viewed a pre-recorded address from Wilhelmina M. Manzano, MA, RN, NEA-BC, 

President of the American Nurses Foundation. 

REPORT OF THE ANA PROFESSIONAL POLICY COMMITTEE 

36 

2


Susan King, MS, RN, CEN, FAAN, member of the ANA Professional Policy Committee (Committee) 

reported that the Call for Proposals for the 2021 Membership Assembly opened on November 

19, 2020, and closed on February 1, 2021, with 21 new proposals submitted by the deadline. 

One proposal, Recognizing Mary Eliza Mahoney during National Nurses Week/Month, was 

received for consideration as an emergent proposal. The Committee determined that the 

proposal did not meet the criteria, per Section 4 of the Membership Assembly Policy 

Development Guide, to be considered by the 2021 Membership Assembly and elected to forward 

the proposal to the board for consideration prior to the board’s May 2022 meeting. 

Four Dialogue Forums were held virtually. Dialogue Forums #1, Health Care Delivery Systems that 

Fully Incorporate Nursing Services, and #2, Precision Health and Genomics were held on Tuesday, 

June 1, 2021, and Dialogue Forums #3, APRN Full Practice in Nursing Homes, and #4, Lessons 

Learned: COVID-19 Pandemic Crisis Standards of Care, on Thursday, June 3, 2021. 

New this year participants had an opportunity to provide input on the preliminary 

recommendations for each Dialogue Forums via an online comment period which was open 

from Wednesday, June 9, 2021, to Monday, June 14, 2021. A total of nine individuals submitted 

comments during the online comment period. 

Along with the final recommendations for each Dialogue Forum, the Committee’s report 

included a summary of comments from the Dialogue Forum and submissions received during 

the comment period. 

ANA President Grant reminded participants that per Section 5.b of the Standing Rules no motions 

to amend the final recommendations of the Committee would be permitted and that voting will 

occur remotely immediately following the Membership Assembly through 11:59pm ET Thursday, 

June 24, 2021. 

ANA RECOGNITIONS 

ANA President Grant recognized the following: 

Constituent/State Nurses Associations 

• ANA-Hawaii (new member as of 2020) 

• Nevada Nurses Association (centennial in 2020) 

• New Mexico Nurses Association (centennial in 2021) 

• New Jersey State Nurses Association (member for 120 years) 

Outgoing C/SNA Executive Directors 

• Tina Gerardi, Executive Director of the Tennessee Nurses Association 

• Colleen Casper, Executive Director of the Colorado Nurses Association 

• Sally Watkins of the Washington State Nurses Association 

ANA Board of Directors with terms ending December 31, 2021 

37 3


ANA Board of Directors with terms ending December 31, 2021 

• Vice-President, Susan Y. Swart 

• Treasurer, Jennifer Mensik-Kennedy 

• Director-at-Large, Jeff Watson 

• Director-at-Large (Recent Graduate), Marcus Henderson 

ANA President Grant introduced Katheren Koehn, MA, RN, FAAN, Executive Director of the 

Minnesota Organization of Registered Nurses, who presented the final recognition to retiring 

ANA staff member, Janet Haebler, Associate Director II, Policy and Government Affairs. 

VOTING INSTRUCTIONS 

NEC Chair Peterson shared that the Proviso adopted by the Membership Assembly on March 23, 

2021, held that “voting operations must be administered by an independent vendor, under the 

supervision of the Nominations and Elections Committee and the ANA Office of General Counsel, 

using an appropriate Internet-based voting application capable of ensuring full protection of the 

integrity and secrecy of the vote.” Based on the mandate, the ANA Office of General Counsel 

reviewed and selected Elections America, the independent vendor that has administered ANA’s 

national elections since 2014. 

An overview of the remote voting process was shared by NEC Chair Peterson for the election of 

ANA Board Members, ANA NEC members, as well as the motions to approve the 

recommendations of the ANA Professional Policy Committee was presented. 

CLOSING REMARKS FROM THE ANA PRESIDENT 

ANA President Grant thanked ANA staff for their work in successfully incorporating meetings and 

related events associated with Membership Assembly virtually this year. In closing, ANA 

President Grant acknowledged that ANA has had the privilege of working to advance, advocate 

for and elevate the profession, improve nurses’ work environments, and strive for the public 

good all while in the face of a global pandemic. Highlighted efforts included the work of the 

National Commission to Address Racism in Nursing, celebration of the Year of the Nurse, ANA’s 

125 th anniversary, and other milestones across the ANA Enterprise. 

In closing, ANA President Grant presented a video clip of the American Nurse Heroes 

documentary, developed as part of the Year of the Nurse celebrations, in collaboration between 

ANA, HealthCom Media, and Al Roker Entertainment. 

ADJOURN 

ANA President Grant adjourned the Virtual Annual Meeting of the ANA Membership Assembly at 

7:11pm ET on Friday, June 18, 2021. 

### 

38


2022 ANA-MI LEADERSHIP CANDIDATE 

PRESIDENT-ELECT 

Barbara Medvec, DNP, MSN, MSA, NEA-BC 

University of Michigan - School of Nursing | Clinical Assistant Professor 

Saline, MI 

What activities are you currently involved with or have been 

in the past related to ANA-Michigan or ANA? 

- ANA-Michigan Leadership Academy Taskforce (2019-2021) 

- ANA-Michigan Nursing and Health Policy Committee 

(2018-2021) 

- ANA Advocacy Institute Fellow - ANA-Michigan 

Representative (2019-2020) 

What other professional organizations are you involved with? 

Michigan Organization of Nurse Leaders (MONL) 

American Organization of Nursing Leaders (AONL) 

Coalition of Michigan Organizations of Nursing (COMON) 

Sigma Theta Tau - International Rho Chapter 

American Hospital Association 

American Academy of Ambulatory Care Nurses (AAACN) 

International Nursing Association for Clinical Simulation and Learning (INASCL) 

Online Learning Consortium (OLC) 

Doctors of Nursing Practice, INC 

Council on Graduate Education for Administration in Nursing (CGEAN now ASLN) 

National Arab American Nurses Association (NAANA) 

American College of Healthcare Executives (ACHE) & Michigan (MACHE) 

What other elected, appointed offices or community activities relevant to this position 

have you been involved with? 

Past President of Ann Arbor Chapter of the Oncology Nursing Society (ONS) 

Past Secretary of the national Oncology Nursing Society (ONS) 

National Chapter Chairperson Oncology Nursing Society (ONS) 

Chair - Standards of Practice Committee (AAACN) 

Chair - Bylaws Committee (CGEAN/ASLN) 

ANA-Michigan Leadership Academy Taskforce 

ANA-Michigan Nursing and Health Policy Committee 

ANA Advocacy Institute Fellow - ANA-Michigan Representative 

39


Please write a statement that indicates your view on issues facing ANA-Michigan? Indicate 

why you want to serve in this role and why you are best qualified to carry out the duties of 

this office? This statement will be shared publicly with the membership. 

The reality of the continued pandemic offers both opportunity and challenges for ANA 

Michigan and our Michigan nurses. Facing the reality of nursing fatigue, burnout, loss of 

leaders and nursing expertise is a challenge as we now face workforce shortages and 

continued demand changes in care delivery. Three key areas for our continued consideration 

in nursing include: 

1. Cultivating all means to build professional resilience and support for nursing mental/ 

physical health to retain our nursing workforce. 

2. Engaging everyone in our nursing community to build their voice, share experiences 

and stories to gain access to environments and individuals to shape and contribute to the 

priorities facing healthcare and nursing. 

3. Building the understanding of the value of nursing to the residents in the State of Michigan 

recognizing that nurses are the safety surveillance in healthcare. 

I want to serve in this role and leverage my skills and experience to promote the greatness of 

nursing and Michigan nursing. Using our ANA Michigan Strategic plan to build our path along 

with using the The Future of Nursing 2020-2030 Charting a Path to Achieve Health Equity 

will be essential on this journey as we begin to rebuild amidst the pandemic. 

I am best qualified to carry out these duties based on an extensive career in nursing 

from bedside to executive leadership and professional organization leadership. Beyond 

my professional experiences I am passionate for nurses and nursing. I want to assure 

that Michigan nurses will continue have provide their expertise, empathy, patience and 

compassion in addition to their expert voices as we move forward into the post pandemic era 

of nursing practice and health care. 

(National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; 

Committee on the Future of Nursing 2020-2030. The Future of Nursing 2020-2030: Charting 

a Path to Action.) 

Please include any other additional comments you would like to add. 

Thank you for this opportunity to serve. 

40



PRESIDENT-ELECT 

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

Spectrum Health | Nurse Educator & Academic Liaison 

Grandville, MI 



ANA – Mentorship program: currently working as a mentor 

with 1 mentee, previously worked with 2 mentees last year 

• Serve as the Student Nurse Online Community Manager 

since 2021 

ANA-MI – Served on the Board of Directors as a Director at Large 

since 2021 

Served on the Nursing & Health Policy Committee for 2 years 

• Served on workgroup that developed the ANA-MI COVID-19 Training Program for K-12 

Schools 

• Served on the Steering Committee for the ANA-MI Nursing Leadership Academy 

• Selected to serve on the ANA-MI Bylaws Committee for 2021-2023 

WNA (ANA affiliate): I serve as a CEAP Committee Member/Peer Reviewer for the Wisconsin 

Nurses Association Continuing Education Approval Program 


I have been an active member of the National Council of State Boards of Nursing during my 

time serving on the Michigan Board of Nursing. 

I serve on the program advisory boards for several nursing programs including Michigan 

State University, Ferris State University, Grand Rapids Community College, Baker College, 

Cornerstone University and Hope College. 

I am an adjunct nursing faculty member for Calvin University, Hope College, and Davenport 

University. 

I am a practice agency representative for Spectrum Health on the West Michigan Clinical 

Placement Consortium. 

I have worked with DHHS Office of Nursing Programs for the past several years, providing 

input into the annual licensing survey of MI nurses. 

41




I was appointed by Gov Snyder in 2012 and 2016 to represent nurses in practice or 

administration with a BSN on the Michigan Board of Nursing (2012-2020) 

Elected as Chair of the Michigan Board of Nursing 2013-2020. 

Served as a Board of Nursing member on the Administrative Rules Committee and Chaired 

the Allegations Committee. 

I serve as an elected City Council Member in my home community of Grandville, MI. 

I have been involved with the Michigan Municipal League, serving on several legislative 

committees and the Elected Officials Academy Board. 

I was elected to serve on the Michigan Municipal League Board of Trustees in 2021. 

I serve on the Grandville Business Relations Committee and Grandville Parks & Recreation 

Board. 




The strategic focus of the 2022 ANA-MI Strategic Plan aligns closely with my vision for 

ANA-MI to be the premier nursing professional organization in Michigan. I am proud to be 

a member of this organization, and I am seeking opportunities to become involved in a 

leadership capacity, to serve the members, and to further advance the mission and vision of 

the organization. I believe my background, knowledge, experience, and previous and current 

service to the nursing professional make me an ideal candidate to serve ANA-MI Board in a 

leadership role. 

This past couple of years, having gone through several waves of the COVID-19 pandemic, 

during the proclaimed “Year of the Nurse” no less, has not only highlighted the importance 

and value of nursing to our communities, but has also made evident the need for nurses to be 

engaged in activities that advance and support the profession and patient care in a variety of 

ways. Long the ‘most trusted profession’, nursing has been at the forefront in confronting the 

COVID-19 pandemic and raising public awareness and appreciation for the contributions of 

the profession. 

There are several key issues facing ANA-MI in the coming years: 

Advancing nursing leadership and professional development remains a great need within 

the profession. In a dynamic field like nursing, we must continue to support and encourage 

professional development, advance educational and certification achievement, and continue 

to promote both formal and informal continuing professional development opportunities for 

all nurses to learn and grow. The COVID-19 pandemic has highlighted the need for nurses to 

be innovative, resilient, and adaptable to ever-changing conditions related to patient care 

needs and the healthcare environment. We must continue to seek ways to both encourage 

interest and entry into the profession, while seeking to promote greater diversity with the 

goal of the profession more closely resembling the makeup of the communities we serve. Our 

newest nurses, both in school, and entering the workforce are entering the profession at one 

42


of the most challenging times any of us can remember. We need to lift them up and support 

them as they develop their practice and build healthy professional behaviors. I believe my 

professional experience in nursing education and professional development, both supporting 

and providing professional development opportunities for experienced as well as new nurses 

and students entering the profession, would serve the organization well to advance these 

efforts. Mobilizing new nurses and student nurses about to enter the profession provides an 

opportunity to engage the next generation of nurses to advance the organization, as well as 

move the profession forward in new ways. 

Going virtual for many meetings and other social activities has allowed us to think outside 

the box and reimagine what communication, networking, and engagement look like. Virtual 

has forced us to develop a level of comfort engaging in new platforms and provides a new 

level of convenience to reach members across distances, as well as eliminate travel time and 

expense to participate in meetings and other professional development activities. This new 

way of conducting business, networking, and connecting people provides opportunities 

for improving member engagement, accessibility, and communication. ANA-MI has an 

opportunity to capitalize on these technologies to bolster membership engagement, improve 

member experience, and deliver value to members in new ways not previously available. 

The COVID-19 pandemic has also highlighted the need for nurses to take care of themselves 

both physically and mentally so that they can have the capacity to care for others. Nurses 

can set an example for health and wellness for the community. The mental health needs of 

nurses, perhaps some of the hardest hit from the COVID-19 experience, are likely to be at an 

all-time high in the months and years to come. We have an opportunity, and obligation to 

support the wellness and well-being of nurses, especially their mental health. During my time 

on the Board of Nursing, I reviewed and consulted on many cases of nurses involving mental 

health or substance abuse. We need to take care of our own, and support those that are 

struggling with these issues, for the safety of patients, as well as to promote the resilience of 

the profession. 

Bolstering advocacy efforts at the state and national levels remains an important priority for 

nurses and ANA. ANA-MI has excellent opportunities to advocate on behalf of the profession 

and nurses practicing in all areas and practice settings across the State. We are stronger with 

one voice, which can be challenging at times in nursing with so many different specialties 

and practice environments represented within the profession. We need to focus on the 

issues and concerns that impact all of us, instead of getting caught up on those issues that 

we differ on. ANA-MI is poised to be a leader in Michigan representing the voice of nursing 

to our legislators and state government officials through sharing our positions on important 

healthcare and professional issues of concern. We have opportunities to engage and inform 

members like never on important policy matters, as well as educate nurses on the important 

role of advocacy within the profession. My background in local government, as well as my 8 

years on the Michigan Board of Nursing have providing me insight, and unique experiences 

with public policy, nursing regulation, advocacy, and government. 

In summary, there are many issues facing nurses in the coming years, and I believe ANA-MI 

is well positioned to be at the forefront leading the way to advance the nursing profession. 

As an experienced clinician, nurse educator, public servant, and community leader, I believe 

my skill set and experience would serve the organization well. I am driven, collaborative, 

detail-oriented, conscientious, enthusiastic, engaged, and professional. I am proud to be a 

nurse, and I look forward to and am excited for the opportunity to serve the profession and 

be a part of these efforts to advance the nursing profession through ANA! Thank you for the 

opportunity to be considered for President-Elect of ANA-MI. 

43



DIRECTOR 

Gerardo Infante, BSN, RN 

Davita Dialysis | Clinical Coordinator 

Ypsilanti, MI 

What activities are you currently involved with or have 

been in the past related to ANA-Michigan or ANA? 

I have been participating actively in the board as the current 

Newly Licensed Director, which I filled for a partial term. 


NAHN (president) & ANNA (Co-secretary) 



MHC (Michigan Health Council - Diversity Workgroup) 




As a recent licensed RN and part of a “double” minority (Hispanic & a male nurse), I can bring 

a different perspective to the board to help our nursing colleagues in Michigan. 


I would love to continue serving in any capacity on the ANA-MI board. 

44



DIRECTOR 

Bethany Skillen, BSN, RN 

Mercy Health Physician Partners | Manager for Ambulatory 

Geriatrics Programs 

Grand Rapids, MI 



I am a member and keep up with ANA-Michigan news and 

related information. 


- HCCI: Home Centered Care Institute 

- AAHCM: American Academy of Home Care Medicine 



- National Home Care Collaborative: a program through Johns Hopkins University and the 

John A. Hartford Foundation 

- Calvin University School of Health Steering Committee 

- Currently being considered for GR City Affordable Housing Fund Board 




We are in unprecedented times as a state, as a nation and as a planet. We need a strong 

and collaborative group of leaders to continue listening, supporting and directing Michigan 

Nurses. There is a reason each one of us became a part of the most trusted profession, but 

we’re tired, and we need kindness, advocacy and action in order to continue our work. I’d be 

honored to represent you as a Director for the ANA-Michigan. 


I am scheduled to complete my MPA, Master’s in Public Administration, from Kent State University 

in May 2022. This degree has challenged me to think across silos and to collaborate 

with other disciplines within our communities. True health can only be achieved when we 

think of education, access to healthy food, housing, and a fair justice system as components 

of health care. 

45



NEWLY LICENSED DIRECTOR 

Alexa Andersen, MA, BSN, RN 

Cherry Health | RN Care Manager 

Belmont, MI 



I’m a current member of ANA-MI’s Nursing & Health Policy 

Committee. 


Michigan Nurses Association (general member), Michigan Nursing 

Students Association (Graduate Consultant & Presidential 

Advisor), National Student Nurses’ Association (general member) 



ANA-MI’s Nursing & Health Policy Committee (member), New Directions for Nurses (Board of 

Directors President) 




When I think about the issues facing ANA-MI at this time, there are two things that come to 

my mind: continuing to build & increase participation & engagement, and also the current 

health & well-being of our members considering the challenging times we’ve been facing due 

to COVID-19. Although building connections with our members is always a consideration, I 

believe that the COVID-19 pandemic has made it even more imperative that we engage with 

our members & truly understand their needs. I believe that ANA-MI stands at a unique place 

to be that resource for nurses too, and that our organization can make a positive impact in 

the lives of our members. 

I am extremely interested in serving in the Newly Licensed Director role as well & believe 

I would be best qualified to carry out the duties of this office for a variety of reasons too. 

While in my one-year accelerated second-degree BSN program, I became involved in the 

Michigan Nursing Students Association (MNSA) & served as President during 2020 (and 

currently as a Graduate Consultant & Presidential Advisor). It was through this involvement 

46


that I came to further understand the needs of nursing students & then new nurses. I learned 

about ANA & ANA-MI through my involvement with MNSA & in addition to becoming a 

general member of ANA following graduation, I became a committee member with ANA- 

MI’s Nursing & Health Policy Committee. I’ve thoroughly enjoyed my experience so far on this 

committee & genuinely seek to become more involved with ANA-MI - and especially help 

bring to light & move forward the unique concerns of new nurses in the field. I am a very 

relational, positive, & communicative individual, and I believe that it is these qualities & my 

past experiences that will greatly aid me in this role as the Newly Licensed Director. 


I genuinely look forward to getting further involved in ANA-MI through serving as the Newly 

Licensed Director. I believe that this would be a tremendous opportunity to connect with new 

nurses & help connect them to our wonderful, professional organization - especially during 

this extremely challenging time in nursing & healthcare. Thank you for your consideration! 

47



NEWLY LICENSED DIRECTOR 

Cheri Wollack, RN 

Michigan Medicine | Acute Medicine/Telemetry RN Level C 

Saline, MI 



As a student at Washtenaw Community College I was a 

member of the National Student Nurses’ Association and 

collaborated to recruit a speaker for our Human Trafficking 

Awareness Event that served the students at WCC as well as 

healthcare professionals in the community and provided CEU 

credit. 

Additionally, I worked with Dr. Joanne Yastik, Director of Nursing at WCC, 

to write a proposal for the League for Innovation in the Community College Public Health 

2019 grant application. We felt our project entitled “Accessing Oral Health Care and Oral 

Health Education Across the Lifespan,” a collaborative effort between our nursing and dental 

assisting students, would respond to a need inour community. 


In addition to ANA and ANA-MI, I am an active member of MNA-UMPNC at Michigan 

Medicine. I have also been approved to attend the American Holistic Nurses Association 

Conference in June of 2022. 



Michigan Medicine 

I serve on our unit’s UBC committee in the role of Secretary and Vaccine Lead. 

- Minute Keeping 

- Seeking to improve our quality and safety metrics 

- Promoting timely, safe delivery of influenza, pneumonia, and Covid vaccinations to our 

patients 

I serve on our unit’s Celebrations and Wellness Committee helping to improve the morale and 

health of our staff members and reduce burnout. 

- Implemented regular Diversity, Equity and Inclusion events 

- Promoted opportunities to serve in the community through 

- Sleep in Heavenly Peace - building beds for children in need 

- HOPE Clinic’s Christmas Program - providing gifts, medical, dental, and mental health care 

along with nutritious food, hygiene items, and baby supplies for the underprivileged in our 

community 

48


I also serve as our M-Healthy Champion and lead our Healthy U program promoting an active 

lifestyle among our staff. 

In the Community 

I volunteered with Hope Clinic’s Healthy You Program (2 sessions) 

- Implemented and facilitated a weekly walking group to promote activity among identified 

at-risk clients 

- Performed regular health checks including vital signs, HgB A-1c monitoring, weight loss 

accountability, and spiritual care 

- Promoted healthy dietary choices by providing nutrition information and cost-effective 

recipes for our clients 

- Mobilized nurse volunteers on 8B to provide health education and supplies for the 

community New Life Church | City Staff and Volunteer 

- Mentored high school students, single professionals and hosted youth events 

- Coached adult volunteers 

- Donor recruitment and communication 

- Lead and engaged youth on various personal growth, leadership retreats and service trips- 

- Counseled youth and adults in a variety of areas including personal growth, mental health, 

spiritual well-being, marriage relationships, etc. 

Certifications 

Youth Mental Health First Aid USA Certified (Exp. Nov. 2022) 

RN to BSN Degree from EMU (Projected Graduation Summer 2022) 




As a new nurse beginning my career during the Coronavirus pandemic I have experienced 

firsthand the challenges our colleagues are facing on a daily basis with no definite end 

in sight: emotional and physical burnout fueled by inadequate staffing and unsafe nursetopatient 

ratios, mental-health concerns and childcare issues related to educational 

fluctuations and isolation, fear and anxiety related to what the future will hold, not to mention 

the financial pressures many of us face. 

We wear many hats. We are spouses, parents, family members, caregivers, students, mentors, 

coaches, and volunteers. We are nursing professionals who give our very best to our patients, 

yet we struggle with exhaustion and moral conflict as we feel like it is never enough to meet 

the magnitude of needs surrounding us. Our resources are stretched thin. With patient 

safety and adequate staffing absorbing much time and energy, mentoring and professional 

development have suffered, leaving new nurses feeling disenfranchised and inadequately 

prepared. And then there is the allure of travel nursing’s inflated salaries enticing nurses 

away from their “home-base” leaving a shortage of RNs to “hold down the fort”. We cannot 

minimize the emotional impact of witnessing coworkers leave the profession or move on to 

greener pastures on those who stay behind. 

Meanwhile, violence and verbal aggression towards nurses continues to be an issue, further 

depleting our emotional bank-accounts. We are so busy working and caring and giving 

out, but feeling isolated from relationships with no time to process our grief. As individual 

49


nurses we can feel powerless to effect change. This is why I feel so passionate about serving 

on ANA-Michigan’s Board as a Newly Licensed Director. I want to provide a voice for my 

amazing colleagues in the trenches who work with such patience, skill and determination 

to provide excellent patient care, but are burning out and feeling unsupported in their 

profession. As an individual I can care for a handful of patients in a day, but in a leadership 

position I can advocate for and promote change that will benefit Michigan’s nurses and all of 

our patients collectively. 


I would like to express my strong interest in the Newly Licensed Director position with 

ANA-Michigan. As you are aware, I am a practicing Acute Medicine & Telemetry nurse at 

the University of Michigan Hospital pursuing an RN to BSN completion program at EMU 

with projected graduation of summer 2022. I believe my educational training and work 

experiences have prepared me well for serving on the board. 

As a student at WCC I had the privilege of advocating for and setting up an educational 

Human Trafficking event for our Student Nurses Association, representing my class by 

demonstrating nursing skills at our National League for Nursing Center of Excellence 

celebration attended by former Governor Snyder, writing a public health grant proposal for 

the League for Innovation in the Community with my Director of Nursing, and giving the 

Pinning Speech at my nursing cohort’s convocation. These varied experiences challenged me 

to grow intellectually and as a leader. 

During my time as a Fundraiser/Donor Liaison with RUN Global I was responsible for 

recruiting and mobilizing a richly diverse team of individuals to invest their time and 

resources in a worthwhile cause. This - in addition to my work mentoring youth and young 

adults at New Life Church, first as a volunteer for 6 years, then as an employee, greatly 

reinforced my interpersonal communication skills that will undoubtedly contribute to my 

success in this role. 

Finally, my varied experiences serving clients in their homes and working as a patient care 

tech and now as a registered nurse at the University of Michigan have solidified my passion 

to serve individuals at their most vulnerable, and my commitment to provide excellent and 

compassionate care. Over the past three years I have had the unique advantage of building 

mutual trust and rapport with the outstanding staff at Michigan Medicine, serving on our UBC 

committee and implementing evidence based interventions to improve our quality and safety 

metrics, developing a comfort level with the specific patient population we serve daily, and to 

see first hand the important role we play in quality of life outcomes for the patient and family. 

My desire is to make a significant impact right away if I am selected for the Newly Licensed 

Director Position. My colleagues and supervisors can attest to my work ethic, professionalism, 

and resourcefulness in accomplishing goals. Recognizing that this is a challenging time for 

everyone in the nursing profession and in our community, I want to sincerely thank you for 

your time and consideration. 

Warm Regards, 

Cheri Wollack, RN 

50



NOMINATIONS COMMITTEE 

Joyce Reder, MSN, RN 

Education and Training Connection | Instructor 

Bay City, MI 



I have served on the Nominations Committee for the last two 

years and would like to serve again. This is the only position I 

have served on in the past. 


I am not a member of any other professional nursing organization 



I have not served on any other committee. 




I received my ADN in 1993 from Delta College, University Center, Michigan. I received my 

BSN and then an MSN in nursing education from Regis University in Denver, Colorado. I am 

currently in the DNP program at Saginaw Valley State University, University Center, Michigan. 

I have 27 years of nursing experience in direct patient care including working in the acutecare 

setting and in the intensive care unit. I also have experience as a contracted provider in 

private-duty nursing. For the past six years I have been focusing on teaching and have taught 

clinical and classroom courses for several universities and colleges in my area. I particularly 

enjoy clinical instruction because I get to know my students very well. 

An issue that I strongly believe in in minimum education requirements for new nurses. There 

is so much more new graduates need to know to practice safely than when I graduated in 

1993. This is not to say that the profession doesn’t appreciate all that the ADN nurses have 

contributed, but new technologies, medications, treatment protocols, and evidence-based 

methods require a working knowledge of nursing research and theory. These subjects may 

not even be introduced in Associate degree programs. I practiced with an Associate degree 

for 15 years before going back to school. To those on the fence about returning for a higher 

degree, it is difficult, but we need to support each other and encourage nurses to pursue 

higher degrees for the benefit of the profession and our patients. 

51



I have enjoyed serving on the nominations committee for the last two years. I have made 

some connections with other nurse leaders and I better understand the responsibilities of 

serving for a professional organization. I hope you will consider me for another two-year term 

on the nominations committee. 

52



NOMINATIONS COMMITTEE 

Sherry Thompson, MSN, RN 

Hope Network | Nursing Coordinator 

Grand Blanc, MI 



While I have not been able to participate previously due to 

my pursuit of higher education. I am now looking forward to 

participating actively in the American Nurses Association. 


Black Nurses Rock; Actively involved in my church 



Suicide prevention programs. 




Nursing shortages and the recruitment of more minority nurses and future minority nursing 

students. As a nurse I have experienced exhaustion, mandates, and a lack of general 

appreciation that hospital administrators have for the nursing profession. As a minority 

nurse and nursing educator, I have experienced first, hand a lack of diversity, lack of support, 

lack of promotional opportunities and support of minority nurses. On the educational level 

minority nurses are unfortunately questioned disproportionately in their knowledge and 

competency unfairly. Because of the experience I know that I can be a positive voice for 

change and innovation in reversing these trends. 


I look forward to having the opportunity to work with the American Nurses Association in 

sharing ideas and promoting the nursing profession to its highest level. 

53



ANA-MICHIGAN NURSES FOUNDATION DIRECTOR 

2 YEAR TERM 

Linda Bond, MSN, PhD 

Retired, Kirkhof College of Nursing, Grand Valley State 

University | Professor Emerita, Nursing 

Kentwood, MI 



Current: ANA-Michigan Nurses Foundation Advisory Board 

Past: Past President Region 3; Past Region 3 Representative 

to the Board; Nominations Committee 


Currently, none. Past: NLN; Sigma Theta Tau, Kappa Epsilon Chapter; 

AWHONN 



I represented the Dean’s Office, Kirkhof College of Nursing Alumni Board - major project, 

establish GVSU Nursing Alumni Scholarship. Board of Directors, (Founding Member); The 

Bonnie Wesorick Center for Health Care Transformation, endowed center located within 

the Kirkhof College of Nursing, Grand Valley State University. 




Of the many issues, these two are central: supporting nurses in practice; and increasing the 

number of nurses entering the profession. As a retired nurse, these are areas where I can 

help. The newly established ANA-MI Nurses Foundation’s mission speaks to these two issues. 

Having had the opportunity to be a part of the team that is working to actualize the work of 

the Foundation, I would like continue that work. 


I have had the priviledge this past year to work with a tremendous group of nurse leaders 

and ANA-MI staff to create the structure for the recently established ANA-MI Nurses 

Foundation. I would like to continue to be a part of Board of Directors as that work continues 

and fund raising continues to be able to actualize the goals identified for our first year of 

operation. 

54




2 YEAR TERM 

Jonnie Hamilton 

DNP, MSHSA, PNP-BC, NE-BC, RN 

Ascension MI Community Health School-Based Health 

Centers | Manager 

Detroit, MI 



I have been a member of ANA since 1973 currently life 

Member of Michigan Nurses Association Member of ANA- 

Michigan since its founding Served on many committees in 

both Michigan Nurses Association and ANA Michigan Currently a 

member of the founding ANA-Michigan Foundation. 


National Black Nurses Association 

Detroit Black Nurses Association 

National Association of Pediatric Nurse Practitioners and Michigan Chapter 

Chi Eta Phi Sorority, Incorporated Professional Nurses Association 

Delta Sigma Theta Sorority. Incorporated 

Sigma Theta Tau Nurses Honor Society 



Currently Vice President of Detroit Black Nurses Assoc. 

National First Vice President Chi Eta Phi Sorority, Inc. 

Board Member of Delta Manor 

Chair Advocacy Social Health Policy Committee and Protocol Committees for Lambda Chi 

Chapter. Chi Eta Phi Sorority, Inc. 

Serve on Membership, Community Outreach and Social Action Committees for Detroit 

Alumnae Chapter of Delta Sigma Theta Sorority, Inc. 

55





As a long time member of ANA and ANA-Michigan I keep current on issues that affect 

the practice of nursing and the well-being of nurses. Currently issues that are facing 

the organization are the Nursing Shortage, and practice issues as well as organizational 

membership. As I have been a part of the implementation of the Foundation I think I would 

make a excellent director due the work that I have already put in over the past ten months 

to bring this organization to fruition. I am qualified due to my long and continued work with 

non-profits and community organizations. I helped write the duties and can carry them out. 


As a long time member of the organization having served in numerous capacities on the 

national level as a delegate for 15 years on the State level and committee chairs and members 

and on the chapter level (prior to the reorganization) as treasurer and committee member. 

56




2 YEAR TERM 

Myrna Holland, MSN, BSN, RN 

Retired (Providence - Ascension) 

Elk Rapids, MI 

None 



Advisory Board for the ANA-Michigan Nurses Foundation; 

Past President, Board Member of Region 2 (Northern) of 

ANA-MI; Founding member of RN-AIM 




Volunteer, Munson Medical Center (MMC), Traverse City 

Volunteer, Elk Rapids Community Cupboard, 501(c)(3) 

Past Board of Directors, Northern Health Plan, 501(c)(3) 

Past President & Board member of MMC Volunteers 

Past Volunteer Representative on Munson Healthcare 

Advocacy Committee 




The nursing shortage is a critical issue facing the profession and ANA-MI. For its initial year 

the ANA-Michigan Nurses Foundation (Foundation) has set goals to address the shortage 

through providing scholarships to pre-licensure nursing students and to provide non-tuition 

personal need grants to allow students to focus completing their nursing education. The 

mission and values of the Foundation were established by the Foundation’s advisory board 

to be in sync with the ANA-MI’s current strategic plan and is organized to operate through 

philanthropic work to support the ANA-MI mission of advancing the nursing profession. 

A prime goal of the Foundation is to raise funds to support their work. I strongly believe 

that as nurses we need to contribute to the growth and well-being of our nurse colleagues. 

By serving as a volunteer and by being both a legacy and annual donor to several charities, 

I have an appreciation of what prompts one to give and I have no problem in asking others 

to donate. I want to see the Foundation grow to meet the 4-Star criteria of groups such as 

Charity Navigator and to be seen as a source help, hope and pride by Michigan nurses. As a 

57




2 YEAR TERM 

Linda Taft, RN 

Retired/Community Vaccinator 

Clinton Township, MI 



Currently serving as an Advisory Board Member for the ANA- 

Michigan Nurses Foundation for it’s development and launch. 

Past President, President Elect and Secretary for ANA-MI and 

service on multiple committees and workgroups (Nominations, 

Bylaws, Governance). 

Member, ANA Nominations and Elections Committee (NEC) (2022- 

2023). Past Member, ANA Leadership Council Executive Committee 

(LCEC). Membership Assembly representative, multiple years. 


None at present. 



Served on Michigan Board of Nursing, Health Professionals Recovery Committee, COMON 

in leadership positions. Also represented Michigan at NCSBN during tenure on the Board of 

Nursing. 




ANA-Michigan is taking a multi-faceted approach to address the many challenges facing the 

nursing profession through education, support, advocacy and policy making. We are not only 

facing (and working through) the largest pandemic ever seen, but must also be positioned to 

improve conditions and compensation for nurses. 

I am seeking this position as I believe our newly formed Foundation will be well positioned to 

inform, educate and support nurses as they navigate through their personal and professional 

paths as nurses. I support our Foundation’s Mission and Values, and am excited for the 

opportunity to serve in this capacity if elected. 


No further comments. 

58




Katherine Dontje, PhD, RN 

Michigan State University | Associate Professor 

Bath, MI 



My experience with ANA-Michigan includes serving as 

treasurer and then president of reginal Six. Over the last six 

years I have been on the Board of Directors. In addition, I have 

served on the Practice Committee as a member than as chair 

of that group for 4 years. I am completing my tenure on the 

ANA-MI Board of Directors this Spring. I am presently serving as 

an Advisory Board Member of the ANA-MI Foundation and 

would like to continue that role as a director 


I am a member of several professional organizations these include Michigan Council of Nurse 

Practitioners, American Academy of Nurse Practitioners, National Organization of Nurse 

Practitioner Faculty and Sigma Theta Tau. In addition, I serve as an evaluator for Commission 

on Collegiate Nursing Education. I also serve as a grant reviewer for the Health Resources 

and Services Administration. 



I have served as President of Sigma Theta Tau Alpha Psi Chapter, Present of the local chapter 

of Michigan Council of Nurse Practitioners. I was a member of the Primary Care Consortium 

which focused on bring multidisciplinary groups together on Primary care issues and 

concerns. I also feel that my role as project lead on two large HRSA grants is relevant to this 

position. As Project Director I am responsible for organizing the activities and monitoring 

finances. 




During the last few years nurses have faced a number of challenges, the most significant of 

these is the COVID-19 Pandemic. Due to this healthcare crisis, nurse especially those in front- 

59


line positions in hospitals and extended care facility have been under an extreme amount 

of stress. These nurses are facing many diverse challenges that have not been experience 

in the past. This has resulted in nurses leaving the profession due to stressful working 

conditions. The biggest issue facing ANA-MI and all major professional nursing organizations 

is how to best support nurses that are feeling overwhelmed emotionally and financially due 

to the changing health care environment. One way ANA- MI is addressing this issue is the 

establishment of the ANA-MI Nurses Foundation which has been established to provide 

financial support to nursing students and nurses across the state through scholarships and 

grants to those in need. I feel my position as an ANA-MI Board member and my participation 

in establishing the framework for the Foundation makes me highly qualified to continue to 

participate in the leadership of this group 


I feel the ANA-MI Nurses Foundation is an important addition to ANA-MI and will provide 

opportunity to support nurses across the state and would like to be part of the process of 

getting this organization established. 

60




3 YEAR TERM 

MaryLee Pakieser, MSN, RN, FNP-BC 

Advanced Correctional Healthcare, Inc. | NP 

Traverse City, MI 



ANA-MICHIGAN - Current 

- Advisory board member for the ANA-Michigan Nurses 

Foundation 

- Nominations Committee (2021 -2022) 

ANA - Current 

- ANA-PAC Leadership Society 2020 to present , Chair 1/2021 

- Nominations Committee 2020 -2022 

- APRN Task Force 2021 to present 

- RNAction Influncers Task Force 9/2021 to present 

ANA-MICHIGAN - Past 

- Nomination Committee Chair 2016-2018 

- President 2014-2016 

- President -Elect 2012-2014 

- Public Policy Council 2012-2014 ,2016-2018 

- Michigan Delegate to ANA Member Assembly 2012,2014-2016 

ANA - Past 

- Board of Director Member at Large 1/2018-12/2019 

- Committee on Appointments 2018 -2019 

- Committee on Honorary Awards 2019 

- ANA-PAC 1/2018 -12/2019 , Vice - chair 2019 

- Task Force on Value Pricing 2015-2019 


- Michigan Council of Nurse Practitioners (MICNP) 2002 to present 

- MICNP PAC 2013 to present 

- Membership committee 2020 to present 

- President 2011-2012 

- President-elect 2010-2011 

- Past President 2012-2013 

- Board member 2006-2010 

61




- Traverse Area District Library Board of Trustees appointed 2019 and reappointed for a four 

year term 2020 , elected as Secretary 2020 

- Northwest Michigan College / Dennos Art Museum Docent 2015 to present 

- 2011-2013 Michigan Department of Community Health Task Force on Nursing Practice, chair 

of the subgroup on advanced practice issues 

- Safe Harbor Homeless Shelter volunteer 2012 to present 

- Michigan Center Rural Health Board 2004 -2010 




I would like to address three issues facing ANA-MI. The first is the sustainability of the 

nursing workforce. This is an issue with national and global perspectives, but it is of particular 

concern for me here close to home. Prior to 2020 we were already working to alleviate 

a shortage of RNs. Now, two-years into the Covid-19 pandemic we are experiencing an 

acceleration of the staffing shortage. The pandemic has been unrelenting and has hit nurses 

particularly hard with physical and emotional stressors. Without licensed nurses, patients 

will suffer. We need the type of nursing leadership that ANA-MI cultivates to recruit the 

next generation of clinical leaders, while supporting current frontline staff in these difficult 

environments. 

The second issue is the visibility of nursing. This has been a long-standing priority for me 

and one I will continue to highlight. ANA-MI is in the position to continue advocating that 

nursing leadership is at the table as healthcare continues to evolve and change. We have 

a unique voice that champions our patient populations, and we need to make sure that we 

represent them in being part of the solution. By collaborating with other nursing and clinical 

organizations, we can drive innovative solutions to this complex challenge. 

The final issue I would like to discuss is continuation of a culture at ANA-MI that is vibrant, 

energetic and creative – that welcomes all RNs to participate and makes sure they feel like 

they belong. Advocating for diversity in our membership base, committee structures and 

Board of Directors so that we reflect the communities we serve. However, the true gift of 

diversity is inclusion – encouraging diverse perspectives and listening to different ideas; 

inviting everyone to be involved at their level of comfort – and asking for a little more. 


Serving on the Advisory Board of the ANA-MI Nurses Foundation has given me a perspective 

of hope for the future, that I would like to continue as a Director on the Foundation Board. 

The work of the foundation is to foster nurses helping nurses which resonates with me at 

a deep level. What I bring to the foundation is a long history of involvement in nonprofit 

organizations, curiosity, creativity, and the ability to work in a group. Having served on the 

Advisory Board has provided me insight into the legal and financial structure needed for a 

foundation to succeed. It will take focused efforts to raise the capital needed to advance 

the philanthropic mission. By creating an organization that builds nurses up and encourages 

them to engage at the workplace, in the community, at a government level we all win. At this 

point in my career, I believe we can overcome the challenges the nursing community faces by 

developing effective leaders. I want to be involved in this effort and I can provide guidance, 

passion and energy that will move the mission forward. 

62




3 YEAR TERM 

Carole Stacy, MSN, MA, RN 

McLaren | Carenow Clinic Nurse 

Dimondale, MI 



ANA Executive Leadership Council, ANA-Michigan 

Nominations Committee, ANA-Michigan Past President. 


ANA, National Holistic Nurse Association, Michigan 

Organization of Nurse Leaders 



Volunteer with Ingham County Health Department for Covid clinics 




I want to serve on the ANA Foundation for a variety of reasons. As an ANA-Michigan 

member since it’s inception it has been a primary goal of mine to see ANA-Michigan have a 

foundation. As a Foundation board member you are entrusted to care for the foundation’s 

philanthropic resources and to take a long-term view of how things may be different 5 or 10 

years ahead and not just our nursing world as it is today today. A Foundation Board member 

has three overarching duties: Duty of Care, Duty of Loyalty and Duty of Obedience. I would 

commit to following all of these to the best of my ability. 

If elected to the Foundation I bring knowledge of how a board needs to work, boundless 

energy, and expertise on the culture of nursing. Having been involved in nursing at the state 

and national levels I bring connections and relationships from a wide range of contacts and 

experiences and the ability to forge strong partnerships. 


I have no other comments other than I knew Doretha Milbrandt and saw her as a nursing icon. 

I think a foundation would be exactly what she would want to see for ANA-Michigan. 

63


CHAMPIONS FOR NURSING 

PARTNERSHIP PROGRAM 

The 2021 ANA-Michigan Champions for Nursing Partnership Program is an 

enhancement of the current Organizational Affiliate Program. 

64


ANA-Michigan invites individuals and organizations to 


take part in the Champions for Nursing Partnership Program 


(CNPP), an enhancement to the pre-existing Organizational 

Affiliate Program. The CNPP benefits are designed to provide a 

mutually valuable and long-term partnership between ANA-MI and the 

supporter. CNPP offers multiple levels to allow for different tiers 

of engagement. 

BENEFITS OF CNPP 

• Complimentary subscription to ANA-Michigan’s weekly e-newsletter 

• Complimentary subscription to ANA-Michigan’s quarterly publication, The Future of Nursing 

• Discounted ANA-Michigan member rates 

• Priority consideration for other ANA-Michigan sponsorship opportunities 

By becoming a part of the CNPP, members of the ANA-Michigan will receive 

enhanced,diverse and more inclusive resources that support our mission, vision and 

strategic plan. 


Vision: ANA-Michigan is a vital community of professional nurses in Michigan. Together, 

we are the experts in nursing practice. Our strength is our solution-focused thought 

leadership, our long-term view of the nursing profession in a dynamic healthcare 

environment, and our impact on quality care and patient safety. 

2020-21 Goals: Advancing Nurses Leadership, Engaging Membership Experience and 

Bolster Advocacy. 

CNPP LEVELS 

Marketing and promotion of partners with CNPP would begin immediately in 

2021. The payment and agreement are based on a calendar year. 

• Individual Ally - $250 Minimum annual contribution 

• Bronze - $500 

• Silver - $1,000 

• Gold - $2,000 

65


BENEFITS BY LEVEL 



INDIVIDUAL ALLY BRONZE SILVER GOLD 

$250+ $500 $1,000 $2,000 

ADVERTISING 

Recognition on ANA-Michigan’s 

champions webpage including 

company logo (or name if individual 

ally) and a link to website or webpage 

of choice 

Introduction of new champion 

notification email blast to 

ANA-Michigan membership 

Submit an article or banner ad for 

weekly e-newsletter 

Recognition as a champion in 

ANA-Michigan publication 

1 PER YEAR 

1 PER YEAR 2 PER YEAR 4 PER YEAR 

Opportunity to submit an educational 

article for ANA-Michigan publication 1 ISSUE 2 ISSUES 4 ISSUES 

List events on ANA-Michigan’s online 

calendar of events & in weekly 

e-newsletter 

Email blast to members with 

information/links from champion to all 

ANA-Michigan members 

Sliding banner ad on ANA-Michigan 

website home page 


6 MONTHS 12 MONTHS 

Post on all ANA-Michigan social media 

channels 

Provide informational webinar/meeting 

of choice to ANA-Michigan membership 


1 PER YEAR 1 PER YEAR 

ANA-Michigan list of active members 

EXCLUSIVE FACE TIME WITH ANA-MICHIGAN EXECUTIVE LEADERSHIP 

Opportunity to present for up to 10 

minutes on the topic of your choice & 

provide materials to the Board of 

Directors and/or ANA-Michigan 

leadership 

ANNUAL CONFERENCE 

ANNUALLY 

1 PER YEAR 

Exhibitor’s Video (virtual exhibit) 

1 PER YEAR 1 PER YEAR 

Champion recognition -verbal, signage, 

website, and break slides 

Champion recognition on companion 

app NAME ONLY LOGO LOGO 

Advertisement in attendee program 

materials with live links LOGO ONLY 1/2 PAGE FULL PAGE 

Recognition as a general event sponsor 

Priority selection of Annual Virtual 

Conference sponsorship opportunities 

Complimentary registration to virtual 

social event at Annual Conference 

Complimentary full package registration 

to virtual Annual Conference 

1 FULL 

PACKAGE 

2 FULL 

PACKAGES 

66


2021 CNPP Partner List 

First Last Company Sponsorship Level 

Robert Upton Indiana Wesleyan University Bronze 

Gerardo Infante National Association of Hispanic Nurses Michigan Silver 

Chapter (NAHN-MI) 

Brenna Youngs NSO Silver 

Amy Johnson Oakland University School of Nursing Silver 

Mike Lazusky Olivet College RN+BSN Program Gold 

Natasha Bischoff The Morel Company Bronze 

Lauren Paton University of Detroit Mercy Bronze 

67


ANA-MICHIGAN NURSES FOUNDATION 

Since the beginning of ANA-Michigan’s establishment as an organization, a long-term goal was to 

eventually establish a 501(c)3 foundation. This was needed for the association to have additional 

avenues to impact the well-being of nurses. There was a strong need to enlarge and use the donation 

that was received by the estate of Dorothea Milbrandt into something that would attract tax-exempt 

charitable donations and grants to fund educational and research activities, as well as provide a 

dedicated foundation for members of the public to contribute their support of nursing. 

At the end of 2020, the realization of this goal started to become a reality. The ANA-Michigan Board 

of Directors appointed seven long-term association members to serve as an advisory board. They 

were tasked with the following: 

• Set the mission and vision 

• Establish strategic goals 

• Determine the official name of the foundation 

• Establish bylaws 

• Establish size and composition of the board 

• Establish an MOU between the foundation and the ANA-Michigan Board of Directors 

The advisory board first met on March 26, 2021. Along with ANA-Michigan staff, those initial tasks and 

goals were completed in under a year. The ANA-Michigan Nurses Foundation was officially approved 

as a 501(c)3 by the State of Michigan, and the following additional milestones have been reached: 

• The foundation website was set up: www.ana-michigan.foundation 

• The advisory board participated in a webinar on fundraising best practices 

• A system to receive online donations, both one-time and recurring, was put in place 

• A $10,000 fundraising goal was set for 2021 and it was met and surpassed. 

• The foundation was officially launched in the fall of 2021. 

The American Nurses Association – Michigan Nurses Foundation, was officially launched at an evening 

Awards and Recognition Fundraiser that was held at the Ann Arbor Marriott Ypsilanti at Eagle Crest on 

Tuesday, November 16, 2021. Honored guest speaker for the event was Dr. Ernest Grant, the current 

President of the American Nurses Association. 

“We were thrilled to launch the foundation, after many months of hard work and dedication on 

behalf of the Foundation Advisory Board,” said Tobi Lyon, Executive Director of ANA-Michigan. “The 

Foundation is poised to do great work as they focus on raising funds for the many needs of nursing 

across the state of Michigan.” 

Through the power of philanthropy, the ANA-Michigan Nurses Foundation promotes and advances 

Michigan nurses and the profession through the support of professional development, education, 

scholarly work, research opportunities, and personal needs. They envision being the premier nursing 

foundation that shapes the profession by energizing and mobilizing their resources. 

68


“The creation of this foundation is the culmination of great ideas and the dedication needed to turn 

them into actions,” said Myrna Holland, RN, MSN, a member of the Foundation Advisory Board. “With 

the foundation officially up and running, we can shift our focus to raising funds and allocating them 

to the areas of nursing that need it the most. Our work is just beginning.” 

A campaign to raise $10,000.00 by soliciting donations of “$1.00 Per Year for Each Year You’ve Been 

a Nurse” was successful in reaching its fundraising goal. This allowed for development of plans for 

two (2) $2,500.00 scholarships to be awarded in 2022; Scholarship for Academic Excellence and 

the Dorothea Milbrandt Leadership Scholarship. In support of personal needs, a $500.00 Personal 

Assistance Grant is in development, as well. 

Donations can be made through our foundation website: www.ana-michigan.foundation via credit 

card, PayPal or by downloading a form and mailing a check to the address on the form. Donations 

are tax-deductible, as ANA-Michigan Nurses Foundation is a 501(c)3 organization. 

The ANA-Michigan Nurses Foundation Advisory Board 

Linda Bond, MSN, PhD 

Susan Meeker, MSN, RN 

Kathy Dontje, PhD, FNP-BC, FAANP 

MaryLee Pakieser, MSN, RN, FNP-BC 

Jonnie Hamilton, DNP, PNP-BC, NE-BC 

Linda Taft, RN 

Myrna Holland, MSN, RN 

69


ANA-Michigan Nurses Foundation Mission, Vision and Values 

Introduction: 

Established in 2021, the ANA-Michigan Nurses Foundation is a tax-exempt, charitable 501(c)(3) 

organization. ANA-Michigan Nurses Foundation seeks to provide access to education and research 

opportunities to advance the future of the nursing profession. The Foundation relies on the generosity 

of its donors to fund scholarships and grants year after year. 

Mission: 

Through the power of philanthropy, we promote and advance Michigan nurses and the profession 

through the support of professional development, education, scholarly work, research opportunities, 

and personal needs. 

Vision: 

The premier nursing foundation that shapes the profession by energizing and mobilizing our resources. 

Values: 

• Education – foster professional and personal development 

• Equity – embrace fairness and justice 

• Excellence –promote the highest level of nursing practice 

• Compassion – serve and support Michigan nurses and the community 

• Integrity – act with ethical intent and transparency 

70


American Nurses Association-Michigan Nurses Foundation 

BYLAWS 

ARTICLE I—NAME, OFFICES, PURPOSE 

Section 1. Name 

The name of the organization, a Michigan not-for-profit corporation, is American Nurses Association- 

Michigan Nurses Foundation (the “Foundation”). 

Section 2. Offices 

The Foundation shall maintain a registered office in the State of Michigan and a registered agent at 

such office. The Foundation may have other offices within or without the state. 

Section 3. Purposes 

The purpose of the Foundation as set forth in its Articles of Incorporation is to establish and support 

programs initiated by the Foundation to do the following: 

a. Improve the professional and educational advancement of nurses. 

b. Facilitate leadership development. 

c. Encourage nursing research. 

d. Support professional health and wellness. 

e. Promote the professional image of nursing. 

Section 4. Charitable Organization 

A related purpose of the Foundation, as also set forth in it Articles of Incorporation, is to be and 

remain a tax-exempt charitable organization under Section 501 (c) (3) of the Internal Revenue Code 

of 1986, as amended (or any corresponding provision of any future United States Internal Revenue 

law). Therefore, the Foundation and all persons acting for or on behalf of it in pursuing its purposes 

shall: 

a. Adhere and abide by all provisions of Section 501 (c) (3) of the Internal Revenue Code 

of 1986, as amended (or any corresponding provision of any future United States Internal 

Revenue law) such that the Foundation remains a non-profit entity. 

ARTICLE II— MEMBERS 

Section 1. Classes of Members 

The Foundation shall have no members. 

ARTICLE III —BOARD OF DIRECTORS 

Section 1. General Powers 

The affairs of the Foundation shall be managed by its Board of Directors. 

71


Section 2. Number 

The Foundation Board of Directors shall be a minimum of nine (9) and a maximum of fifteen (15) 

members. Nine members from the ANA-Michigan membership will be elected by the ANA-Michigan 

membership in conjunction with the annual election. An additional one to six community members 

can be appointed by the Foundation Board of Directors. 

Section 3. Elections 

Directors shall be elected each year by the membership of ANA-Michigan at the appointed time 

either prior to or during its annual meeting. The elections shall be separate and by secret ballot and 

by the same tellers as are provided for the ANA-Michigan elections. 

Section 4. Term of Office 

Each director shall hold office for a term of two (2) years. No director shall serve more than three 

(3) consecutive terms. The terms of the directors shall be staggered. 

Section 5. Elections 

The officers of the Foundation shall be elected annually by the Board of Directors at the first regular 

meeting of the Foundation following the ANA-Michigan Annual Assembly. Vacancies may be filled, or 

new offices created and filled at any meeting of the Board of Directors. 

Section 6. Vacancies 

Any vacancy or vacancies on the Board of Directors will be filled for the balance of the unexpired 

term by a majority vote of the Foundation Board of Directors. 

Section 7. Qualifications 

Directors shall hold an active membership in ANA-Michigan. Appointed community members must be 

a Michigan resident to serve on the Foundation, but not hold an Officer position. No more than two 

(2) members of the ANA-Michigan Board of Directors may serve as members of the Foundation Board 

of Directors. 

Section 8. Annual Meeting and Reporting 

The Foundation President, or their designee, shall report to the membership of ANA-Michigan on 

financials, activities, programs, and other pertinent activities of the Foundation at the ANA-Michigan 

Annual Assembly. 

Section 9. Regular Meetings 

Directors shall meet a minimum of at least twice (2) annually. Notice of all regular meetings shall be 

given at least one (1) month in advance. 

Section 10. Special Meetings 

Special meetings of the Board of Directors may be called by the President or any three (3) directors, 

and the person(s) calling a special meeting of the Board shall set the time and manner (in person, 

electronically or by conference call) of meeting. 

72


Section 11. Notice 

The notice or waiver of notice of meeting of the Board need not specify the business to be transacted 

at, nor the purpose of, such meeting unless specifically required by law or these Bylaws. Notice 

of any special meeting of the Board of Directors shall be given at least five (5) days in advance by 

written notice to each director. 

Section 12. Quorum 

At all meetings of the Board of Directors a majority of the total number of directors then in office 

and at least one officer shall constitute a quorum for the transaction of business. If less than a 

majority of the directors is present at any meeting, a majority of the directors’ present may adjourn 

the meeting to another time without further notice. Withdrawal of directors from any meeting shall 

not cause failure of a duly constituted quorum at that meeting. 

Section 13. Removal 

Any officer elected by the Board of Directors may be removed by the Board whenever in its judgment 

the best interests of the Foundation would be served thereby. 

ARTICLE IV—OFFICERS 

Section 1. Composition 

The officers of the Foundation shall be President, Vice President, Secretary, and Treasurer. 

Section 2. Responsibilities 

a. The President shall: 

i. Serve as the principal elective officer of the Foundation. 

ii. Preside over the meetings of the Board of Directors and Executive Committee. 

iii. Supervise all administrative matters, business, and affairs of the Foundation as 

directed by the Board of Directors and in conjunction with the Executive Director of the 

Foundation. 

iv. Serve as an ex-officio member of any committees, task forces or ad-hoc committees of 

the Foundation. 

v. Serve as an ex-officio member, without vote, on the ANA-Michigan Board of Directors. 

b. The Vice President shall: 

i. Assume the duties of the Foundation President in his/her absence. 

ii. Serve as a member of the Board of Directors and the Executive Committee. 

iii. Assist the President in the performance of the duties of the office whenever requested 

to do so. 

c. The Secretary shall be accountable for the record keeping and reporting of meetings of the 

Foundation. 

d. The Treasurer shall be accountable for the fiscal affairs of the Foundation and shall provide 

reports and interpretation on the financial conditions of the Foundation, as may be requested, 

to the Board of Directors. 

e. The Executive Director of ANA-Michigan shall also be the Executive Director of the Foundation 

and shall: 

i. Function as the chief operating officer of the Foundation and have the responsibility to 

manage the day-to-day business of the Foundation according to policies established by 

the Board of Directors. 

73


ii. Be accountable to the Board of Directors and report to the President on a regular basis. 

iii. Be an ex-officio member of the Board of Directors, without voting rights. 

iv. May act as Secretary of the Foundation, as directed by either the President or the 

Secretary. 

ARTICLE V—COMMITTEES 

Section 1. Creation of Committees 

The Board of Directors can designate standing or special committees, as it deems appropriate. Each 

committee shall consist of such persons as the Board shall appoint. 

ARTICLE VI—AMENDMENTS 

Section 1. Amendments with Notice 

These Bylaws may be amended at any regular meeting of the Foundation by a majority vote, provided 

that the amendment(s) has been submitted in writing to all directors at least 30 days prior to such 

meeting. 

Section 2. Amendments without Notice 

These Bylaws may be amended without notice at any regular meeting by a two-thirds vote of those 

present and voting. 

ARTICLE V—DISSOLUTION 

Section 1. Dissolution 

Upon the termination, dissolution or winding up of the Foundation, the Board of Directors shall, 

after paying or making provisions for the payment of all liabilities, distribute all assets of the 

Foundation to an organization or organizations as are organized and operated exclusively for one or 

more exempt purposes within the meaning of Section 501(c) (3) or 501(c)(6) of the Internal Revenue 

Code. Any such assets not so disposed of shall be disposed of as designated by the Board of Directors 

or as directed by the Ingham County Circuit Court, exclusively for such purposes. 

74


POSITION STATEMENT 

ENHANCED NURSE LICENSURE COMPACT 

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

to support the Enhanced Nurse Licensure Compact, that 

would permit Michigan to join the current 30 states who 

are part of the “enhanced nurse licensure compact”. The 

Public Policy Council studied and discussed in-depth 

strengths and weaknesses. The Council and Board 

members held a “learning session” on the eNLC with 

a presentation by a representative from the National 

Council of State Boards of Nursing. The Council 

recommended SUPPORT with the provision that the MI 

Department of Licensing and Regulatory Affairs (MI- 

DLARA) does not pass on the costs of implementation of 

the eNLC through another increase in the nurse licensure 

fees. The legislature doubled Michigan nurse licensure 

renewal fees in 2017. 

WHAT IS THE NURSE LICENSURE COMPACT? 

The NLC allows a registered nurse (RN) or licensed 

practical nurse (LPN) to possess a multistate license, 

which permits practice in both their home state and 

other compact states, while maintaining the primary state 

of residence. Unless the nurse is under discipline or 

restriction, a multistate license permits practice (physically 

or telephonically/electronically) across state lines in all 

NLC states. 

WHAT IS THE RATIONALE FOR ANA-MI’s SUPPORT 

OF eNLC? 

The Council first considered: 

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

Platform? 

FACTORS INFLUENCING SUPPORT FOR THE BILL 

• There is an increase in nursing practice and patient 

care access across state lines (care coordination, 

occupational health, etc.) 

• Regional or national health crises require rapid 

deployment of nurses to areas of need. 

• There is need to move nurses with highly specialized 

skills to states with medical crises for patient 

populations. A recent example is the number of 

Michigan residents who required specialized care 

available only through nurses employed in multiple 

states across a national healthcare system who were 

experienced in this specialized care. This care was 

related to contaminated injections prepared at a 

compounding pharmacy in Massachusetts 

• There are increasing national and international 

infectious disease outbreaks that require movement 

of nurses to meet patient and community needs 

(Ebola, flu, etc.). 

• New nurse graduates will have more flexibility with a 

Michigan “home state” license if there are not 

sufficient available nursing positions in Michigan. 

• Nursing faculty and students are sometimes engaged 

in clinical placements across state lines. 

• Nurses move across states to support family care 

needs. These nurses may desire to continue nursing 

employment. They may be delayed in their ability to 

obtain a new state license. 

FACTORS INFLUENCING CHALLENGES OF THE BILL 

• Nurses are responsible to know multiple state 

requirements for ongoing licensure. For example, 

Florida requires continuing education for infection 

control. 

• Nurses must be knowledgeable about and abide by 

varying state laws and regulations. 

• In cases of nurses providing care through technology 

(telephonic, web site, etc.), it is not clear in which 

state the nursing practice is located (the state of the 

nurse or the state of the patient receiving care). There 

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Position Statement - Page 1 of 1 

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ENHANCED NURSE LICENSURE COMPACT 

does not appear to be ongoing monitoring, data 

collection, or an evaluation plan to inform policies 

related to eNLC. 

• eNLC membership does not provide assurance that 

nurses will in fact be knowledgeable of laws that 

pertain to nursing practice within those jurisdictions 

prior to engaging in practice in member states. 

OTHER INFORMATION 

• The Michigan Organization of Nurse Leaders (MONL) 

who are predominately hospital chief nursing officers 

are in support of HB4938. 

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

discussion prior to scheduling a House Health Policy 

Committee hearing. 

• If the bill is passed, Michigan nursing education 

programs will need to include information about 

nurse licensure compacts and, as importantly, prepare 

faculty with this information for teaching. 

• Legislators and organizations such as the AARP are 

interested in knowing ANA-MI’s position on this bill. 

NEED MORE INFORMATION? 

• For more information on the enhanced NLC, visit 

nursecompact@ncsbn.org 

• For a current map of eNLC states, 

visit www.nursecompact.com 

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Position Statement - Page 2 of 2



MITIGATING IMPLICIT BIAS TO REDUCE DISPARITIES IN PATIENT OUTCOME 

The purpose of this statement is to explore implicit 

bias and the role it plays in healthcare disparities and 

to identify what nurses can do to encourage equality 

of care for all patients. 

BACKGROUND 

Our United States Declaration of Independence 

assures equality, life, liberty and the pursuit of 

happiness as fundamental rights for all (Jefferson, 

1776), yet there is nothing in the document that 

promises healthcare as a right for all citizens. For 

this and other reasons, healthcare imbalances and 

disadvantages are present in our country. Citizens 

with steady incomes, better health insurance, healthy 

food, clean water and greater access to care often 

experience better healthcare opportunities than 

citizens with less money, lesser or no health insurance 

coverage, inadequate food and water resources and 

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

2020) . Healthcare disparities have been defined by 

Healthy People 2020 as “a particular type of health 

difference that is closely linked with social, economic, 

and/or environmental disadvantage” (ODPHP). With 

the onset of the COVID-19 pandemic, healthcare 

disparities have become more obvious. 

Citizens of color are even at a greater risk for 

healthcare disparities. While African American 

citizens made up 14% of Michigan’s population, they 

accounted for 35% of the COVID-19 cases by July 

2020 and were noted to be four times more likely to 

die a COVID-19 related death than their Caucasian 

counterparts (Michigan.gov). Several studies have 

shown that implicit bias by healthcare providers is 

associated with lower quality of care (FitzGerald & 

Hurst, 2020). 

Healthcare disparities such as these sparked 

Michigan’s governor, Gretchen Whitmer, to form a 

task force to advise her on strategies to eliminate 

these racial disparities. One recommendation is 

to mandate healthcare providers to participate in 

implicit bias training as a condition of relicensure 

in an effort to eliminate discrimination against 

all citizens, especially those from disadvantaged 

backgrounds (executive order 2020). ANA-MI 

strongly supports Governor Whitmer’s stance on 

eradication of racism and healthcare disparities. 

The mission statement which drives the American 

Nurses Association is to “Lead the profession 

to shape the future of nursing and health care.” 

As nurses, it is up to us to facilitate increased 

opportunities for those experiencing disparities in 

healthcare due to bias. It is up to us to help even the 

playing field and to progress toward full equality in 

healthcare. 

IMPLICIT BIAS 

Implicit bias, also known as unconscious bias, has 

been defined as “the tendency to process information 

based on unconscious associations and feelings, 

even when these are contrary to one’s conscious 

or declared beliefs,” (Dictionary.com (2020). 

Furthermore, implicit bias includes any preconceived 

thoughts that can result in disparities and it is the 

duty of the healthcare provider to become aware of 

our own biases to help embrace the changes needed 

to eliminate healthcare disparities (ANA, 2018; 

Fitzgerald & Hurst, 2016). It has been noted when 

people experience discrimination based on personal 

characteristics, it can impact their physical and 

psychological health (Sutin, Stephan & Terracciano, 

2016). Racism has been described as a public health 

crisis which affects the mental as well as physical 

health of all people (ANA, 2018). In the past, the 

ANA has also taken the position there should be 

no discrimination in nursing practice nor in health 

care and that all patients should be viewed as equal 

Position Statement - Page 1 

77




and nurses should be treat them with impartiality, 

respect, and civility (2018). 

RECOMMENDATIONS: 

Strategies to mitigate implicit bias include building 

upon previous work of the ANA- Michigan (2018) 

based on opposing all racism and discrimination and 

being an advocate for all patients, regardless of their 

gender, race, ethnicity, etc. 

• Acknowledge that implicit biases do exist and 

becoming aware these biases can result in 

disparities in health outcomes associated with 

many demographic factors. (As nurses it is 

imperative to be aware of demographic factors 

which can undermine our patient’s success for 

health. Some of these factors might include 

questioning if there are safe living situations, 

availability for safe places to walk, feasibility of 

obtaining fresh produce and other healthy food 

choices, and obtaining fresh clean water for 

drinking.) 

• Follow the Nursing Code of Ethics, which advises 

nurses to band together as patient advocates 

against racism, discrimination and injustice. 

• Participate in the required implicit bias training. 

While this will be a part of the next license 

renewal, it will also expand knowledge on this 

subject. 

• Assume the responsibility for recognizing your 

own implicit biases. 

• Commit to treat all patients equally regardless 

of their race, ethnicity, economic status, sexual 

identity, or gender. 

• Become an advocate for all patients, for issues of 

diversity, equity and inclusion. 

As nurses it is our duty to uphold the values and 

mission of the ANA-Michigan by treating all patients 

equally and fairly. 

REFERENCES: 

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

Perceived discrimination and personality 

development in adulthood. Developmental 

Psychology, 52(1), 155-163. doi: 10.1037/dev000069 

American Nurses Association (ANA) (2018). Position 

statement on The Nurse’s Role in Addressing 

Discrimination: Protecting and Promoting Inclusive 

Strategies in Practice Settings, Policy, and Advocacy. 

Found at: 

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

practiceandpolicy/nursing-excellence/ana-positionstatements/social-causes-and-health-care/thenurses-role-in-addressing-discrimination.pdf 

Dictionary.com (2020). Implicit Bias. https://www. 

dictionary.com/browse/implicit-bias 

Michigan.gov. Michigan Data, Cases by Demographic 

Characteristics, Mich. Coronavirus, 

https://www.michigan.gov/ 

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

(last visited July 5, 2020). 

Center for Disease Control & Prevention. COVIDView, 

A Weekly Surveillance Summary of U.S. COVID-19 

Activity, (July 5, 2020). https://www.cdc.gov/ 

coronavirus/2019-ncov/covid-data/covidview/index. 

html, (last visited July 5, 2020). 

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

Inequity of the Coronavirus, N.Y. TIMES (Jul. 5, 

2020), https://www.nytimes.com/ 

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

Id. (observing that “Non-Hispanic American Indian 

or Alaska Native persons have an age-adjusted 

hospitalization rate approximately 5.7 times that of 

non-Hispanic White persons.”) 


78




CDC Health Disparities and Inequalities Report – 

United States, 2013, 62 MNWR (Supp. 3) 1, 1-187 

(2013), https://www.cdc.gov/mmwr/pdf/other/ 

su6203.pdf. Id. at 157-160. 

The Heart Attack Gender Gap, U. EDINBURGH: 

EDINBURGH FRIENDS (Oct. 29, 2019), 

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

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

Deadly Delivery: The Maternal Health Crisis in the 

USA, AMNESTY INT’L. (May 7, 

2011),https://www.amnestyusa.org/reports/deadlydelivery-the-maternal-health-care-crisis-in-the-usa/. 

Agency For Healthcare Res. And Quality, U.S. Dep’t 

Of Health And Human Serv., Pub No. 14-0006, 

National Healthcare Disparities Rep. (2013). 

Healthy People 2020. U.S. Department of Health 

and Human Services: Washington, DC. https://www. 

healthypeople.gov/2020/about/foundation-healthmeasures/Disparities#6 

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

healthcare professionals: a systematic review. BMC 

Med Ethics. 2017 Mar 1;18(1):19. doi: 10.1186/s12910- 

017-0179-8. PMID: 28249596; PMCID: PMC5333436. 

Jefferson, T. (1776). The Declaration of Independence, 

preamble. Retrieved from https://etc.usf.edu/ 

lit2go/133/historic-american-documents/4957/thedeclaration-of-independence/ 

American Nurses Association. Mission Statement. 

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

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

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

Urban Mortality Disparities: Variations Across 

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

American Journal of Public Health, 110(9), 1325– 

1327. https://doi-org.proxy.lib.umich.edu/10.2105/ 

AJPH.2020.305703 

Office of Disease Prevention and Health Promotion 

(ODPHP). (internet accessed 11/02/2020). Disparities. 


79



MORAL DISTRESS IN TIMES OF CRISIS 

Background 

Moral distress is “knowing the right thing to do 

but being in a situation in which it is nearly impossible 

to do it.” 1 

Critical care teams wrestle daily with moral challenges 

in the context of their normal professional 

activities. 2 During a crisis, such as the COVID-19 

pandemic, everyday challenges are compounded. 

For example, patient surge results in shortages of 

lifesaving equipment needed to keep patients 

alive 3 and a lack of personal protective equipment 

necessary to protect nurses, their patients, their 

families, and their communities. 4,5 Team members 

struggle to maintain their professional, emotional, 

and moral equilibrium when caught in tragic situations 

beyond their control. 

Nurses, and all members of the healthcare team, 

must protect their personal integrity and sense 

of justice to be effective in their work. Too often, 

nurses are pressured to compartmentalize emotions, 

and to rapidly and stoically “do your duty.” 

Sustaining a strong sense of duty maintains order, 

serves patients, and preserves the respect of 

coworkers and loved ones. However, discerning 

one’s duty may not take the linear path of simply 

following orders and regulations. Those who apply 

a care-based morality prioritize relationships with 

others in making moral decisions. 1,6 Embracing 

a care-based perspective recognizes that nurses 

live in a web of moral duties that includes their 

duty to protect themselves, their patients, their 

families, and their communities. 

Recommended Actions for 

Healthcare Institutions 

Every organization must: 

• Provide the vital supplies and equipment that 

nurses need to protect themselves and others. 

• Establish evidence-based, consistent, procedures 

for equitably allocating scarce resources 

and use them in a way that maximizes value without 

endangering safety. 8,9 

• Consider creating an interdisciplinary triage 

committee composed of respected volunteers to 

provide unbiased opinions in difficult situations. 

This preserves each direct caregiver’s ethical duty 

for beneficence. 3 

• Ensure that administrators are accessible to 

those performing direct patient care, and that 

they maintain clear communication and transparency 

regarding institutional challenges. 

• Guarantee that nurses are included as decision 

makers on all institutional ethics committees. 

• Monitor the clinical and organizational climate to 

identify situations that could create moral distress. 

• Provide tools to help clinicians recognize the 

experience of moral distress. 

• Create interdisciplinary forums to discuss patient 

goals of care and divergent opinions regarding 

those goals of care in an open, respectful environment. 

• Ensure institutional support systems include 

easy access to: 

• Ethics committees 

• Critical stress debriefings 

• Protocols for end-of-life care 

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• Readily available crisis counseling 

• Employee assistance programs 

• Grief counseling 

Recommended Actions for Nurses 

Nurses must: 

• Pay attention to your inner voice and recognize 

when it conflicts with what you are being asked to 

do or what circumstances demand that you do. 

• Create a moral compass for yourself by expanding 

your ethical knowledge. Seek out professional 

and institutional resources that can provide ethical 

guidance, such as: 

• American Nurses Association Code of Ethics for 

Nurses 10 

• International Council of Nurses Code of Ethics 

for Nurses 11 

• Your hospital’s ethics committee or moral distress 

consulting team. 

• Learn the signs and symptoms of moral distress. 

They include: 

• Feelings of frustration, anger, and guilt 12 

• Physical manifestations such as heart palpitations, 

insomnia, and fatigue 

• Psychological consequences such as withdrawal, 

emotional exhaustion, and depersonalization of 

patients. 13 

• Seek out a trusted mentor. 

• Use employee assistance resources and see a 

qualified professional counselor or therapist when 

needed. 

• Lean on coworkers, friends, and loved ones. They 

are all in the mix as you balance your personal and 

professional duties, and they need to know when 

you are experiencing moral distress. 

• Practice self- care, and keep a reflection journal. 

References 

1. Jameton A. What moral distress in nursing history could 

suggest about the future of health care. AMA J Ethics. 

2017;19(6):617-628. 

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

Crit Care. 2015;24(4):276-278. doi: 10.4037/ajcc2015738 

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

toughest triage — Allocating ventilators in a pandemic. 

NEJM. Published online March 23, 2020. doi: 10.1056/ 

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

NEJMp2005689 

4. Interim Infection Prevention and Control Recommendations 

for Patients with Suspected or Confirmed Coronavirus 

Disease 2019 (COVID-19) in Healthcare Settings. Centers 

for Disease Control and Prevention. https://www.cdc.gov/ 

coronavirus/2019-ncov/infection-control/control-recommendations.html 

5. Interim Guidance: Rational use of personal protective 

equipment for coronavirus disease 2019 (COVID-19). World 

Health Organization. Accessed March 25, 2020. https:// 

apps.who.int/iris/bitstream/handle/10665/331215/WHO- 

2019-nCov-IPCPPE_use-2020.1-eng.pdf 

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

mature care and self-sacrifice in care ethics. Nurs Ethics. 

2017;24(6):694-703. doi: 10.1177/0969733015624475 

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

Establishing and Sustaining Healthy Work Environments: 

A Journey to Excellence. 2nd ed. Aliso Viejo, CA: American 

Association of Critical-Care Nurses; 2016. https:// 

www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments. 

Accessed March 25, 2020. 

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

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

J Med. Published online March 23, 2020. doi: 10.1056/ 

NEJMsb2005114 

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

many patients…a framework to guide statewide allocation 

of scarce mechanical ventilation during disasters. Chest. 

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2019;155(4):848-854. doi: 10.1016/j.chest.2018.09.025 

10. American Nurses Association. Code of Ethics for Nurses 

With Interpretive Statements. Silver Spring, MD: Nursesbooks.org 

Retrieved from https://www.nursingworld.org/ 

practice-policy/nursing-excellence/ethics/code-of-ethicsfor-nurses/coe-view-only/ 

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

International Council of Nurses; 2012. 

12. Epstein EG, Delgado S. “Understanding and Addressing 

Moral Distress.” Online J Issues Nurs. Published online 

September 30, 2010. doi: 10.3912/OJIN.Vol15No03Man01. 

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

A catalyst in building moral resilience. Am 

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

NAJ.0000484933.40476.5b 

Contact 

www.ana-michigan.org 

nurse@ana-michigan.org 

(517) 325-5306 

This position statement was adopted by ANA MI from the 

work by AACN. 

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“NURSE” TITLE PROTECTION 

Written by Susan Wiers, DNP and Public Policy Council 

The 173,000 plus Registered Nurses in Michigan are 

essential to the health and safety of the state’s residents. 1 

The title “Nurse” is not included in the list of protected 

titles in the Michigan Public Health Code (MPHC). Thus, 

the residents of Michigan cannot be assured that individuals 

calling themselves nurses possess the education and 

competencies required for licensure and safe practice. 2 

At least 39 states have adopted language in their nurse 

practice acts restricting use of the title “Nurse” or language 

implying an individual is a nurse who is educated 

and licensed as authorized by the state.3 Despite Recommendation 

2a of the Michigan Department of Community 

Health Task Force on Nursing Practice that “Nurse” 

be included as a protected title in the MPHC and the 

Administrative Rules of the Michigan Board of Nursing, 

Michigan remains in the minority of states without title 

protection for ‘Nurse.” 2,3 

Nursing has been ranked as the most respected, ethical 

profession in Gallup polls for 16 consecutive years since 

2002. 4 This trust in nursing must be safeguarded from 

individuals and groups who misrepresent themselves as 

nurses thus threatening safety and health of the public. 5 

Tolerating overt use of the title “Nurse” or misleading 

titles implying individuals other than those who have met 

the requirements for licensure from state boards of nursing 

lends itself to exploitation of vulnerable individuals 

and erosion of nursing’s well-earned public reputation 

and confidence. 

Nursing licensure and title protection are regulated with 

the primary purpose of protecting the public. 6 Nursing 

licensure requires specialized knowledge and independent 

decision-making and mandates a minimum level of 

demonstrated and documented competency for a specific 

scope of practice. 2,6 Title protection assures that individuals 

without the minimum education and competency 

for licensure cannot misrepresent themselves to the public 

as nurses. 

The title “Nurse” should be protected in the MPHC consistent 

with the titles “Physician”, “Dentist”, “Chiropractor”, 

and “Social Worker”. 2 Individuals not licensed and registered 

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

tolerated arbitrary use of the title “Nurse” by those who 

do not possess the minimum education and competencies 

for licensure in the State of Michigan confuses public 

and places it at risk. 2 Just as has been done in the majority 

of other states, the title “Nurse” must be defined and 

protected in the MPHC so that patients and families can 

be assured that their nurse possesses legitimate education 

and competencies to safely care for them. 2 

References 

1. Michigan Public Health Institute. Michigan Annual 

Nurse Survey Project. Okemos, MichiganJune 2018. 

2. Michigan Department of Community Health 

Task Force on Nursing Pratice. Final Report and 

Recommendations. 2012. 

3. American Nurses Association. Title 

“Nurse” Protection. December 10, 2013; 

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

advocacy/state/title-nurse-protection/. 

4. Brenan M. Nurses keep healthy lead as most honest, 

ethical profession. 2017; https://news.gallup. 

com/poll/224639/nurses-keep-healthy-lead-honestethical-profession.aspx. 

5. McElroy S. Nurse Title Protection Bill passed in the 

2008 West Virginia Legislative Session. Maryland 

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

6. Flook DM. The professional nurse and regulation. Journal 

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

7. Missouri State Board of Nursing. Nursing Practice Act 

and Rules. In. Jefferson City, MO2017. 

8. Services NDoHaH. Statues Relating to Nurse Practice 

Act. In: Unit DoPHL, ed. Lincoln, NE2017. 

9. New York State Education Law. Article 139, Nursing. 

2010; http://www.op.nysed.gov/prof/nurse/ 

article139.htm. 

Approved: December 14, 2018 by the 

ANA-Michigan Board of Directors 

Contact 



(517) 325-5306 

MICHIGAN 


Position Statement - Page 1 of 1 

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PREVENTING WORKPLACE VIOLENCE IN HEALTHCARE SETTINGS 

Background 

The ANA Nurses Bill of Rights maintains that nurses 

have the right to a work environment that is safe 

for themselves and for their patients regardless of 

the setting of care. 

According to reports from National Institute for 

Occupational Safety and Health (NIOSH), individuals 

who are injured and who miss work as a result 

of violence in healthcare settings is increasing 

(U.S. Department of Labor [DOL], Bureau of Labor 

Statistics, 2014). 

Violence in healthcare facilities is complex and 

multiple factors may contribute to the problem. 

Nurses and other caregivers have a personal and 

professional duty to “do no harm” to patients. 

Many will put their own safety at risk to help a 

patient and some consider violence “part of the 

job.” Many excuse attacks as being unintentional 

and due to an individual’s illness or impairment. 

In addition to physical harm, individuals who 

experience or witness violence in the healthcare 

workplace are at risk for emotional consequences 

that can lead to time away from work, burnout, 

job dissatisfaction, and decreased productivity. 

These and other consequences compromise both 

worker and patient safety. 

As of June, 2019, 36 states have established or 

increased legal penalties for the assault of nurses 

and other healthcare providers and nine states 

require healthcare organizations to run workplace 

violence programs (ANA, 2019). As of this writing, 

Michigan has NEITHER specific legal penalties 

nor workplace violence program requirements for 

healthcare organizations. 

Definition of Workplace Violence 

NIOSH defines workplace violence as physically 

and psychologically damaging actions that occur 

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

This can include verbal violence – threats, verbal 

abuse, hostility, harassment which can cause psychological 

trauma and stress even though there is 

no physical injury (OSHA, 2015) 

NIOSH describes four basic types of workplace 

violence: 

Type 1 – Involves “criminal intent” In this type of 

violent encounter, individuals with criminal intent 

have no relationship to the business or employees. 

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

this type “individual has a relationship with the 

business and becomes violent when receiving 

services.” 

Type III: Involves a “worker on worker” relationship 

and includes employees who attack or threaten 

another employee. 

Type IV: Violence involves personal relationships 

and includes “individuals who have interpersonal 

relationships with the intended target but no relationship 

to the business” 

Types II and III are the most common types in 

health care settings. 


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Evidence 

According to The Occupational Safety and Health 

Administration (OSHA), healthcare workers, 

including nurses, are at 4x higher risk of experiencing 

workplace violence than those who work 

in other industries. Registered nurses experienced 

14 violent injuries resulting in days away from 

work per 10,000 full time employees compared 

with a rate of 4.2 per 10,000 in private industry as 

a whole. Psychiatric aides are at highest risk (590 

per 10,000) followed by nursing assistants (55 per 

10,000). (U.S. Department of Labor [DOL], Bureau 

of Labor Statistics, 2014). The statistics underpinning 

this statement are drawn solely from reported 

incidents and OSHA notes that many incidents that 

could be included are NOT reported for a variety 

of reasons. Part of the problem is that because violent 

incidents are so common, they have become 

normative and among victims, only 30% of nurses 

and 26% of physicians actually reported the incidences 

(OSHA, 2015). 

Core Components 

ANA-MI concurs with ANA regarding interventions 

and supports the following: 

Primary prevention strategies that include development 

of workplace violence prevention programs, 

development of relevant policies, and 

education programs specifically designed for 

nurses and frontline caregivers. Students should 

also learn about the issue in nursing education 

programs. Employers and educational institutions 

must support work environments that are safe 

and align with OSHA’s “Guidelines for Preventing 

Workplace Violence for Healthcare and Social Service 

Workers” (OSHA, 2015; Lipscomb & London, 

2015.) 

Secondary prevention strategies that include 

interventions designed to reduce and/or minimize 

the negative impact of workplace violence. 

Reporting incidences of violence is paramount so 

that accurate data can be gathered and analyzed. 

Tertiary prevention strategies that are designed to 

reduce the consequences of workplace violence 

and may include incident debriefing, counseling 

programs, root cause analysis and confidentiality 

assurances. Legislative and legal strategies that 

protect all healthcare providers should be considered 

and supported. 

References 

American Nurses Association. (2019) Workplace violence. 

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

American Nurses Association. (2016). American Nurses Association 

calls for a culture of safety in all health care settings 

[Press release]. Retrieved from https://www.nursingworld. 

org/news/news-releases/2016/americannurses-associationcalls-for-a-culture-of-safety-in-all-health-care-settings/ 

xxii 

American Nurses Association. Position Statement on Incivility, 

Bullying, and Workplace Violence. 2015. Web: https:// 

www.nursingworld.org/practice-policy/work-environment/ 

violence-incivility-bullying/ 

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

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

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

The Joint Commission. Sentinal Event Alert: Physical and 

verbal violence against healthcare workers. Retrieved from: 

https://www.jointcommission.org/assets/1/18/SEA_59_ 

Workplace_violence_4_13_18_FINAL.pdf 

National Institute of Occupational Safety and Health (NIOSH). 

Division of Safety Research. (2002) Violence: occupational 

hazards in hospitals. Cincinnati, Ohio: U.S. Department of 

Health and Human Services, Public Health Services, Center 

for Disease Control and Prevention, NIOSH Division of Safety 

Research. 

National Institute for Occupational Safety and Health. (2013). 

Workplace violence prevention for nurses. CDC Course No. 

WB1865—NIOSH Pub. No. 2013-155. Retrieved from https:// 

www.cdc.gov/niosh/topics/ violence/training_nurses.html. 

Occupational Safety and Health Administration. (2015). 


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“Guidelines for preventing workplace violence for healthcare 

and social service workers” (Publication No. OSHA 

3148-04R 2015). Retrieved from https://www.osha.gov/Publications/osha3148.pdf. 

Occupational Safety and Health Administration. (2015). 

“Workplace violence in healthcare: understanding the challenge.” 

https://www.osha.gov/Publications/OSHA3826.pdf 

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

Efforts Needed to Help Protect Health Care Workers from 

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

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

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

osha.gov/Publications/OSHA3827.pdf xxix 

U.S. Department of Labor, Bureau of Labor Statistics. (2014). 

Nonfatal occupational injuries and illnesses requiring days 

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

http://www.bls.gov/news.release/pdf/osh2.pdf. 

Approved: November 8, 2019 

by the ANA-Michigan Board of Directors 

To be reviewed: November 8, 2021 

Contact 



(517) 325-5306 

Position Statement 86 - Page 3



SAFE NURSE STAFFING TO IMPROVE QUALITY OF CARE 

It is the position of the ANA-Michigan that: 

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

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

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

safe patient care. 

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

of simple patient to nurse ratios. 

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

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

patient care. 

Background 

Medical errors are now the third leading cause 

of death in the United States (US). The persistent 

nature of medical errors is documented 

in the Institute of Medicine (IOM) report, To Err Is 

Human, which pointed to nearly 100,000 preventable 

deaths in US hospitals annually (IOM, 1999). 

This work shaped decades of research with focus 

on patient safety. Nurses are the largest clinical 

group of providers in hospitals and other health 

care settings; thus, nurses’ impact on patient safety 

is significant. A large body of evidence exists documenting 

the relationship between nursing care, 

nurse staffing, and patient safety. Risks associated 

with suboptimal professional nurse staffing in the 

patient care setting include medication errors, 

compromised ability to “rescue” patients at risk 

for death, increased incidence of patient falls, hospital-acquired 

pressure ulcers, physical restraint 

use, and missed care. 

Optimal nurse staffing is a complex process 

not being amenable to simple division or nurse 

patient ratios; straightforward ratios do not 

result in safe care. Moving toward a professional 

model that empowers registered nurse (RN) 

decision-making regarding their practice requires 

a framework focused on the analysis of multiple 

factors affecting patient care delivery. To create 

a work environment that allows professional RNs 

to meet the demands and complexity of patient 

care, sufficient professional nursing staffing care 

models are crucial to the delivery of high quality 

safe patient care. Shifting the nursing culture 

towards a professional model that empowers RNs 

with decision-making involvement and includes 

a framework for organizations’ decision making 

about staffing based on the analysis of multiple 

factors affecting patient care versus a one-dimensional 

standardized nurse-patient ratios approach 

is vital to “ensuring the right staff are in the right 

place at the right time” (Bolvin, 2017, p. 31). Harmonious 

with the American Nurses Association 

(ANA) position, ANA-MI is committed to creating 

dynamic solutions that support context dependent, 

optimal nurse staffing necessary to meet the 

needs of healthcare recipients. 

This paper presents the outcomes evidence about 

recent approaches to nurse staffing and identifies 

the principles, concepts, and framework for 

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determining optimal nurse staffing for safe patient 

care. While the referenced studies on safe nurse 

staffing are hospital-based, the principles and 

methods may also be applied to nurse staffing in 

other health care settings. 

Evidence 

The impasse between nurses and administrators 

about the solution to the complex issue of ensuring 

the delivery of safe care within the context of 

increasing patient acuity and fiscal constraints of 

hospitals has moved the issue of adequate staffing 

to the political arena (Hertel, 2012). In 2004, 

nurse staffing took center stage when California 

became the first state to mandate nurse-to-patient 

ratios in acute care settings. By 2009, 14 

states had enacted nurse staffing legislation and, 

as of September 2010, 24 states have enacted or 

proposed legislation to mandate staffing ratios, 

staffing acuity systems, or staffing plans and committees 

(Douglas, 2010). Subsequent studies 

examining the relationship between mandatory 

staffing ratios and nurse satisfaction and patient 

safety and outcomes have demonstrated mixed 

results (Aiken et al., 2010; Bolton, et al., 2007; Hertel, 

2012) 

Research on nurse staffing ratios’ impact on 

patient safety has demonstrated higher nurse 

to patient ratios are associated with decreased 

mortality rates, fewer failure to rescue events, 

and lower hospital–acquired pneumonia rates 

(Douglas, 2010). Mandated ratios in California 

were associated with lower mortality and better 

nurse retention; 74% of nurses reported they felt 

the quality of care had improved since mandated 

ratios (Aiken et al., 2010). 

Conversely, individual studies and systematic 

reviews have reported difficulty in consistently 

detecting statistically significant associated 

improvements in a variety of nurse-sensitive 

patient outcomes with increased nurse staffing 

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

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

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

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

(2007) examined patient outcomes from 

2004 to 2006 in 185 hospitals in California compared 

to 2002 (pre-mandated staffing ratios) and 

found no statistical significance in the association 

between increased nurse staffing and key indicators 

of falls, hospital-acquired pressure ulcers, and 

restraint use rates (Bolton et al., 2007). The inconsistency 

in outcomes associated with increased 

nurse staffing underscores the complexity of 

determining optimal staffing. 

A survey of administrators about strategies to 

accommodate mandated ratios lends to potential 

insight about why mandated ratios do not consistently 

result in improved patient safety and outcome 

measures. Respondents reported ancillary 

support staff layoffs (thus shifting non-RN work 

to the professional nurse) and use of contingent 

nurses to provide break coverage; both strategies 

could have a negative impact on patient safety 

and continuity of care (Douglas, 2010). Similarly, 

Bolton and colleagues (2007) found that with 

mandated staffing ratios came a change in staff 

mix with a reduction in care provided by LPN and 

other non-licensed staff, suggesting that administration 

leaders used RN hours to meet the regulatory 

staffing requirements. These approaches 

raise concerns about the unintended consequence 

of negating the potential positive impact 

of mandated higher RN to patient ratios by 1) 

effectively reducing RN time to attend to RN activities 

and 2) increasing the risk for mistakes related 

to the potential for communication errors during 

handoffs to contingent nurses along with variability 

of the skills and competencies of contingent 

nurses in unfamiliar settings. 

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Definition of Safe Staffing, 

Core Components and Staffing Models 

Definitions 

The ANA defines staffing as … “a match of registered 

nurse expertise with the needs of the recipient 

of nursing care services in the context of the 

practice setting and situation“(ANA, 2012, p. 6). 

Staffing is done in the present – day to day and 

sometimes shift to shift. Staffing work can be centralized 

(one department is responsible for staffing 

all the units) or decentralized (units manage their 

own staffing needs) or a combination of both. 

Core Components 

ANA Core Components of Nurse Staffing: 

1. All settings should have well-developed staffing 

guidelines with measurable nurse-sensitive 

outcomes specific to that setting and healthcare 

consumer population, which are used as 

evidence to guide daily staffing. 

2. RNs are full partners working with other healthcare 

professionals in collaborative, interdisciplinary 

partnerships. 

3. RNs, including direct care nurses, must have 

a substantive and active role in staffing 

decisions to ensure the necessary time 

with patients to meet care needs and overall 

nursing responsibilities. 

4. Staffing needs must be determined based on 

an analysis of healthcare consumer status (e.g., 

degree of stability, intensity, and acuity) and 

the environment in which the care is provided. 

Additional considerations include professional 

characteristics, skill set, and mix of the staff 

and previous staffing patterns that have been 

shown to improve outcomes. 

5. Appropriate nurse staffing should be based on 

allocating the appropriate number of competent 

practitioners to a care situation, pursuing 

quality of care indices, meeting consumer-centered 

and organizational outcomes, meeting 

federal and state laws and regulations, and 

attending to a safe, quality work environment. 

6. Cost-effectiveness is an important consideration 

in delivery of safe, quality care. 

7. Reimbursement structure should not influence 

nurse staffing patterns or the level of care 

provided. 

Staffing Models 

Shortcomings in current RN staffing models present 

opportunities for improvements that benefit 

patients, nurses, and healthcare organizations. No 

single staffing model is ideal in all care settings or 

situations. Staffing must be adjusted according to 

patient care needs within a specific unit or department. 

Fixed or rigid models do not provide flexibility 

essential to adapt to rapid and fluid changes 

in acute care environments. 

There is a difference between staffing and scheduling. 

Schedules are planning documents that 

are future focused. Factors that affect a schedule 

include: historical census for a time period, the 

surgical schedule, and seasonal or predictable 

issues such as the flu season. Schedules must also 

accommodate vacations, maternity leaves, staff illness 

and institutional policies. 

Various staffing models are used in healthcare 

settings. Three models follow; each has advantages 

and disadvantages. 

1. Budget Based Staffing: the number of nurses 

is determined according to nursing hours per 

patient days. Total patient days are the average 

number of patients on a particular unit for a 

24-hour period. Nursing hours refers to the 

total number of hours nurses work on that unit 

for a specific amount of time. This model does 

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not take into consideration the actual number 

of patients, the “churn” in patients – admissions, 

discharges, transfers in 24 hours, or 

patient acuity. 

2. Staffing by Nurse to Patient Ratios: This model 

dictates the number of patients one nurse can 

care for during a designated period of time. It 

does not take into consideration other unit staff 

such as CNA’s, housekeeping, unit clerks, etc. 

Also, it doesn’t take into account patient acuity 

or nurse driven care decisions. This model may 

also affect patient throughput from areas such 

as the Emergency Department, Labor and 

Delivery, and the ICUs. 

3. Staffing by Patient Acuity: This model considers 

the acuity or complexity of each patient, which 

is often determined by the number of tasks 

and amount of time to complete them. Rather, 

this model should consider the full scope of 

nursing practice and time needed to maintain 

standards of care. This complex model also 

needs to consider individual patient characteristics 

such as age, diagnosis, comorbidities, 

socioeconomic status, cultural and family 

issues, and severity of illness. 

References 

Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, 

L., Seago, J. A., . . . & Smith, H. L. (2010). Implications of the 

California nurse staffing mandate for other states. Health 

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

American Nurses Association. (2012). Principles for nurse 

staffing (2nd ed.). Silver Spring, MD: Nursesbooks.org. 

Retrieved from http://www.nursesbooks.org/ebooks/download/ANA_Principles_Staffing.pdf 

American Nurses Association. (2015). Optimal nurse staffing 

to improve quality of care and patient outcomes. Retrieved 

from http://www.nursingworld.org/DocumentVault/NursingPractice/Executive-Summary.pdf 

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

of acuity-based staffing. American Nurse Today 12(9), 30-32. 

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

staffing ratios: An economic commentary. Nursing Outlook, 

57(2), 107-112. 

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

Sandhu, M., Fridman, M., & Udin Aronow, H. (2007). Mandated 

nurse staffing ratios in California: A comparison of 

staffing and nursing-sensitive outcomes pre-and post-regulation. 

Policy, Politics, & Nursing Practice, 8(4), 238-250. 

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

Economics, 28(2), 119-125. 

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

issue. Academy of Medical-Surgical Nursing, 21(1), 3-7. 

Institute of Medicine (IOM). (1999). To err is human. Washington, 

DC: National Academies Press. 

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

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

Approved: December 15, 2017 

by the ANA-Michigan Board of Directors 

To be reviewed: December 14, 2018 

Contact 



(517) 325-5306 

MICHIGAN 



90



TELEHEALTH AND CONNECTED HEALTH 

BACKGROUND 

The United States is in the midst of a global 

pandemic from Covid-19, a highly contagious disease 

that has caused severe social, economic and cultural 

disruptions to everyday life in America. Telehealth, 

also referred to as Connected Health, has grown 

exponentially during this time as more services are 

being delivered and are eligible for reimbursement 

from public and private insurers. The Center for 

Medicare and Medicaid Services (CMS) released 

new guidelines for telehealth in April, 2020 that 

encourage expansion of services to populations they 

cover. Examples from major Michigan healthcare 

systems include Michigan Medicine which conducted 

444 virtual visits in February, 2020 and increased 

those to more than 20,000 visits by the end of 

April, 2020. Henry Ford Health System went from 

conducting 150 virtual visits per week to 10,000 

virtual visits and report high patient satisfaction with 

this option. 

Nearly 20% of Americans live in rural areas where 

there is a shortage of both providers and healthcare 

facilities. “The health consequences for communities 

that lack resources can be dire” states Joelle Fathi 

DNP RN ARNP CTTS, an expert on biobehavioral 

nursing and health informatics and a member of the 

2018 ANA Steering Committee to revise its Core 

Principles of Telehealth. Fathi further states that 

connected health has value for patients in urban 

and major metropolitan areas. The expansion of 

healthcare services through connected health creates 

the opportunity to serve populations with care 

that is “necessary, timely, efficient, convenient and 

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

The Affordable Care Act and the 2017 Health 

Care Act both support the use of telehealth and 

technology to expand access to care delivery. Tamara 

Broadnaux DNP RN NEA-BC, Clinical Operations, 

Department of Veterans Affairs states that “As 

providers move toward more value-based, shared 

saving, and accountable care models as required in 

healthcare reform, connected health provides better 

care coordination, management and communication 

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

In 2019, ANA released Core Principles on Connected 

Health (Principles) as a guide for healthcare 

professionals who use telehealth technologies to 

provide quality care. This document is an update 

to the 1998 ANA Core Principles on Telehealth and 

reflect the evolution of healthcare using a more 

interdisciplinary approach. There are 13 Principles 

within the guide that identify unique issues related 

to practice, regulatory, privacy, reimbursement, 

documentation and competencies. (ANA, 2019). 

The Centers for Disease Control and Prevention 

(CDC) has issued Guidelines on using Telehealth 

to expand access to essential healthcare services 

during and beyond the COVID-19 pandemic. ANA 

recognizes that connected health provides a 

method of healthcare delivery that can improve 

access to quality health care when implementation 

is conducted using accepted standards and best 

available evidence. Nurses play an essential role in 

the adoption and use of connected health across care 

settings and roles and are well-positioned to lead in 

the adoption and use of care via these technologies. 

DEFINITIONS 

The American Nurses Association defines telehealth 

and Connect Health as “the use of electronic 

information and telecommunications technologies 

to support and promote long distance clinical 

health care, patient and professional health-related 

education, public health and health administration. 

Technologies include: videoconferencing, the 


91




internet, store-and-forward imaging, streaming 

media, and terrestrial and wireless communication” 

ANA, n.d. While telehealth has been in existence for 

many years, it has grown exponentially recently due 

in part to need to deliver care virtually during the 

coronavirus pandemic. 

Centers for Medicare & Medicaid Services (CMS) 

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

interactive communication between a patient and 

a physician or practitioner at a distant site through 

telecommunications equipment that includes, at a 

minimum, audio and visual equipment.” 

Several telehealth modalities allow providers and 

patients to connect using technology to deliver 

health care: 

• Synchronous: This includes real-time telephone 

or live audio-video interaction typically with a 

patient using a smartphone, tablet, or computer. 

• In some cases, peripheral medical equipment 

(e.g., digital stethoscopes, otoscopes, 

ultrasounds) can be used by another HCP (e.g., 

nurse, medical assistant) physically with the 

patient, while the consulting medical provider 

conducts a remote evaluation. 

• Asynchronous: This includes “store and forward” 

technology where messages, images, or data are 

collected at one point in time and interpreted or 

responded to later. Patient portals can facilitate 

this type of communication between provider and 

patient through secure messaging. 

• Remote patient monitoring: This allows direct 

transmission of a patient’s clinical measurements 

from a distance (may or may not be in real time) 

to their healthcare provider. 

• Mobile Health (mHealth): This includes the use 

of mobile devices to support health care and 

public health information exchange. Information 

exchange using mHealth may include general 

educational information, targeted texts, and 

disease outbreak notifications. 

Nurses have the background, skills and creative 

ingenuity to help patients effectively navigate and 

engage in telehealth modalities across the continuum 

of care. 

RECOMMENDATIONS: 

1. Endorse the term telehealth and Connected 

Health, as this is the most widely used and 

accepted term used in national guidelines, 

by third party payors and most professional 

organizations 

2. Adopt the 2019 ANA Core Principles on 

Connected Health. 

3. Advocate to make permanent recent policy 

changes that reduce barriers to telehealth 

services and reimbursement at the state and 

national level. 

4. Advocate for registered nurses (RN) and advance 

practice registered nurses (APRN) to be included 

in any legislation and to have access to telehealth 

platforms used by organizations 

5. Advocate for the inclusion of telehealth content 

and experiences at all levels of registered nursing 

education. 

REFERENCES: 

American Nurses Association (2019, June 6). ANA 

core principles on connected health. Retrieved 

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

globalassets/docs/ana/practice/ana-core-principleson-connected-health.pdf 

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

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

advocacy/telehealth/ 


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

ANA’s updated principles put nursing at the forefront. 

American Nurse Today, 14(12), 32-33. 

U.S. Centers for Medicare & Medicaid Services (2020, 

April 24). Telehealth. Retrieved from https://www. 

cms.gov/Medicare/Medicare-General-Information/ 

Telehealth 

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Position Statement - Page 3


ANA-MICHIGAN POLICY ON PUBLIC POSITION STATEMENTS 

POLICY 

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

recommend actions based on the following Platform and process. 

PURPOSE 

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

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

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

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

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

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

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

positions to the Board of Directors. 

Platform Issues 

Access to Quality Care 

1. Promote accessibility to healthcare for all residents of Michigan 

2. Support services for vulnerable populations 

3. Ensure nursing care by appropriate licensed providers 

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

5. Support programs that enhance health literacy 

Human Rights/Social Justice 

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

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

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

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

5. Support competent care for diverse Michigan populations 

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

Quality and Safety of Health Care 

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

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

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

nursing input 

Advances in the Practice and/or Profession of Nursing 

1. Promote the viability of professional nursing organizations 

2. Promote statewide communication within the profession 

3. Encourage occupational health and safety of nurses 

4. Support public funding for nursing research and education 

Process for Position Statement Review 

1. Requests for development of an Association position statement on a policy, issue or legislation may be made by the 

Board of Directors, an individual member, or based on member survey results. 

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

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

Impact Statement and the Platform criteria. 

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

relevance to the above Platform Criteria. Topic experts may be used to develop the position statement. 

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

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

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

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

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

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