1999 HOD maps out how ANA will work for nurses, society

Nearly 600 registered nurses gathered in Washington, DC, to determine how ANA can better the lives of all RNs and continue to be a force for social change as it moves into the 21st century.

The nurses -- all delegates to the 1999 House of Delegates (HOD) -- charged ANA with leading the way on major issues such as preventing needlesticks, eliminating medication waste in long-term care facilities and developing strategies to retain experienced nurses in the workforce. The HOD, made up of representatives elected from each state nurses association (SNA), meets annually to set broad-based policy for ANA.

In addition to looking at nursing, health care and social issues, this year's delegates also voted on ANA bylaws changes aimed at increasing membership.

"We have to continue to build the house that ANA built many, many years ago," ANA President Beverly L. Malone, PhD, RN, FAAN, said to HOD attendees. "We are building on a firm foundation, and we invite all nurses within our borders to be part of the American Nurses Association.

"We are here to care for nurses, so they can care for patients. We're very aware of what it takes for nurses to care for patients, and for nurses to care for the American public."

What follows are brief summaries of the major HOD actions. (See HOD preview story in May/June 1999 issue of The American Nurse.)

Several delegates spoke in favor of the bylaws changes during the House of Delegates June meeting. Above, former ANA Board member Mary Germain, EdD, RN, CS, addressed the bylaws change on the federal nurse constituency. Below, 1999 Congress of Nursing Practice chair Christina Seiloff, PhD, RN, CNA, discussed the newly created Congress on Nursing Practice and Economics.

Working toward a safer workplace

To prevent the nearly one million needlesticks that health care workers sustain each year, the HOD voted for a comprehensive measure that builds on ANA's 1991 position statement, which called for engineering controls, or safer needle devices, to be included as part of universal precautions.

In its recommendation, the HOD agreed that engineering controls are "the first and best line of defense" to prevent exposure to bloodborne pathogens and urged ANA to work with legislative, regulatory and accrediting bodies to ensure that safer needle devices are implemented wherever RNs practice. Delegates want ANA to focus on educating nurses on post-exposure follow-up, which includes testing and treatment, and ways to evaluate, select and implement safer devices. And, they want nurses involved in evaluating and selecting which devices ultimately are used.

Prior to the vote, Massachusetts Nurses Association President Karen Daley, MPH, RN, shared her story about contracting HIV and hepatitis C following a needlestick and urged her fellow delegates to support the measure.

"One source of strength for me is working to make sure that what happened to me doesn't happen to another nurse or health care worker," Daley said. "We have the power to do this."

Delegates also approved ANA's recommendation to create a safer workplace for nurses. Known as "Caring for Those Who Care," the plan includes promoting research on health and safety issues, as well as advocating for nurses' participation in evaluating hazards in the workplace and developing health promotion policies to evaluate, select and implement the use of safer procedures and devices.

Into practice

Delegates agreed with the ANA Board of Directors' (BOD) view that a collaborative approach is needed to better gauge the supply and demand of registered nurses, especially in light of an aging nursing workforce. As part of the recommendation, ANA, together with the SNAs, will collaborate with staff nurses, nurse managers and administrators, employer groups and other nursing organizations to create a practice environment that will retain and attract experienced nurses.

As it had in 1998, the HOD again tackled the complex issue of interstate/multistate practice Ð adopting a measure that supports the needs of SNAs that back a strong state-based licensure system and those that favor a mutual recognition compact model for multistate licensure. One of the approaches outlined in the recommendation involves ANA advocating for an expedited endorsement process, so RNs can begin practicing in another state quicker. For SNAs that support mutual recognition compacts, delegates directed ANA to monitor and evaluate any activities that affect RN and advanced practice registered nurse (APRN) practice as states move forward on this licensure change.

In another HOD action, delegates agreed that nurses need to speak the same language when it comes to proving their effectiveness, particularly in a health care environment that routinely slashes RN positions to meet budget demands. Therefore, they directed ANA to advocate for the timely implementation of ANA-recognized standardized nursing languages (SNLs), including the Nursing Management Minimum Data Set (NMMDS) to establish comparability of nursing data in all clinical settings across the country.

In addition, delegates authorized ANA to establish a proactive position of support for independent prescriptive authority for all APRNs who are providers in Veterans Affairs health care facilities and to aid in the monitoring of actions related to the implementation of rules for independent prescriptive practices.

Costs and confidentiality

Delegates threw their support behind a recommendation that addresses the costly practice of wasting -- and not recycling -- medications in long-term care facilities. ANA was directed to research the problem, including examining the impact of prescribing practices and fiscal, regulatory and reimbursement policies with an eye toward making positive changes in these procedures.

Continuing nursing's long-standing view that access to health care is a fundamental right for all Americans, the HOD directed ANA to endorse the single payer mechanism as the most desirable option for financing a reformed health care system. Delegates further asked ANA to continue to advocate for other measures to increase access to quality health care for all.

Delegates also affirmed their commitment to protecting patients' privacy. They requested that ANA develop a policy statement that outlines the nurse's role in preserving the confidentiality of patients' health records process in light of technological advances in storing and transmitting such information. They further supported a plan to educate pertinent groups about the nurse's role on this issue.

Safety nets for retirement

While a host of policy-makers continues to debate changes in Social Security, such as raising the retirement age for receiving benefits, the HOD passed a strong recommendation aimed at maintaining Social Security as a social insurance program that is universal and portable with guaranteed benefits. In addition, delegates oppose raising the retirement age and the use of individual private investment accounts as a substitute for the existing Social Security structure, but they support funding mechanisms that require those most able to pay to contribute their fair share to ensure the program's solvency.

The HOD directed ANA to work toward pension equity for nurses, the majority of whom are women, who historically have little or no pension benefits beyond Social Security after they retire. The HOD action, in part, asks ANA to advocate for equitable pension plans for all women. Delegates also want ANA to promote awareness within the nursing community about the gaps that might exist among Social Security, personal pension, life expectancy and the "cost" of retiring.

Creating life, destroying life

So nurses can better inform their patients about advances in genetics, the HOD wants ANA to promote the inclusion of genetics information in basic, advanced and continuing education programs and to disseminate information on genetic discoveries and their applications in health care through other strategies. Delegates also want ANA to study the ethical and practical implications of genetics development, and advocate for nondiscrimination toward persons that have or are at risk of developing a condition with a genetic component.

On a related topic, delegates agreed to a recommendation that supports the current moratorium on human cloning and supports research using somatic cell, nuclear transfer technique and cloning of human genes, cells and tissue for the remediation of disease.

After discussing the crucial role nurses can and do play in responding to mass casualty incidents, delegates directed ANA to develop a position statement that addresses nursing's role in all levels of disaster preparedness for mass casualty incidents; advocate for domestic and international policies for the prevention of, and sanctions against, the use of weapons of mass destruction; and collaborate with SNAs and other organizations to ensure nurses are educationally prepared to respond to events that result in mass casualties.

Workplace violence

After expressing concern about the recent school shootings and the increasing rate of workplace violence, the HOD reaffirmed its previous commitment to gun control measures and advocated for a 72-hour-waiting period before gun purchases are finalized.

Looking ahead

The HOD approved a vision statement for ANA that calls on the association to empower and unite all registered nurses to advance the profession nationally and internationally. Further, delegates adopted a set of core values for ANA that includes a commitment to providing health care consumer advocacy and advancing nursing's role in the development of health care policy at the state, local and national levels, as well as a commitment to consistently anticipating changes in health care and creating plans to preserve the integrity of nursing practice.

For more detailed information on 1999 HOD actions, check ANA's website, http://nursingworld.org/ana2000/, or call Sheila McKie at (202) 651-7042.

Federal policymakers talk health care at ANA-PAC luncheon

Two U.S. senators and a congressional chief of staff came down from Capitol Hill to pay homage to nurses and talk about workplace and health care issues at an American Nurses Association Political Action Committee (ANA-PAC) leadership luncheon that drew more than 200 nurses.

Sen. Bill Frist (R-TN) applauded nurses' advocacy efforts. Here, he poses with ANA-PAC chair Frances Edwards, MSN, RN, Vice Chair Victoria Boyce, MSN, RN, ANA President Beverly L. Malone, PhD, RN, FAAN, and ANA-PAC Luncheon Committee member Greer Glazer, PhD, RN, CNP, FAAN.

Sen. Jay Rockefeller (D-WV), Sen. Bill Frist (R-TN) and Jim Messina, chief of staff for Rep. Carolyn McCarthy (D-NY), attended the fund-raiser, which took place during the June 1999 House of Delegates meeting in Washington, DC. The ANA-PAC is a bipartisan organization that supports candidates who stand up for nurses and quality health care.

"I'll start off by saying 'I love you,'" said Rockefeller, who then told the nurses one of the "many, many reasons" why. When the Rockefellers' first-born child was two weeks old, he was diagnosed with pyloric stenosis, which required immediate surgery.

"Sharon and I were absolutely terrified, crying," Rockefeller said. "I'll never forget the nurse. She was so unbelievable Ð the way she was able to calm Sharon and myself down and care for Jamie."

For Rockefeller, the nurse who took care of his now-adult son epitomized what quality health care is all about. But what he addressed at the luncheon were the problems he saw plaguing health care today.

"Health care is a passion for all of us," he told the group. "It's a policy passion for me -- and one that can have the deepest repercussions in people's lives. The fact that the number of uninsured Americans is increasing by one million a year is morally repugnant to me."

Rockefeller reported that people who are insured also have difficulty getting appropriate health care, which has resulted in the need for the Patients' Bill of Rights -- federal legislation that includes certain guarantees, such as appropriate coverage for emergency care. "People tell me that HMOs are not taking care of all their health problems," he said. "We're attempting to do something about it."

Rockefeller also spoke of a need to correct mistakes that were made in the Balanced Budget Act of '97 by restoring funding to health care programs that were inappropriately slashed. He further called on nurses to remain vigilant about bad health care policy, specifically Medicare reform proposals that don't include coverage for prescription drugs, such as new medications used to treat people with Alzheimer's.

He pointed out that seniors spend about $2,100 in out-of-pocket health care costs, including purchasing supplemental insurance for prescription coverage. In his home state of West Virginia, that expenditure takes a huge bite out of the average senior's total gross income of $10,763, according to Rockefeller.

Rockefeller repeatedly urged nurses to keep up the good fight. "Never stop fighting for what you want," he said.

Frist also addressed health care issues that are part of his and nursing's agenda. Noting his career as a surgeon and his work with patients in Africa, which has a high rate of HIV and AIDS, he expressed his support for needlestick legislation aimed at protecting nurses from exposure to life-threatening diseases.

"This is a workplace safety issue that is very real to me," Frist said. He added that he continuously draws on his own experiences as a health care professional and seeks input from nurses on the front lines to help him shape health care policy.

In addition, Frist spoke of the pride he took in his collaborative work with nurses to ensure adequate funding for the Nurse Education Act.

"We looked at three issues you said were important Ð the need for increased advanced practice nurse training, increased workforce diversity and strengthening basic nurse education," Frist said.

He also described rewriting legislation that addressed nurse-midwives' concerns about mandating 48-hour maternity stays. "Nurse-midwives said women don't necessarily have to be in a hospital for 48 hours. What they need is the insurance coverage," Frist said.

And like Rockefeller, he called on nurses to continue their advocacy efforts on issues such as protecting the confidentiality of medical records and ensuring that information netted from the Human Genome Project is not ultimately used to discriminate against patients.

Representing one of the three nurses in Congress, Jim Messina spoke of Carolyn McCarthy's efforts to move along the needlestick and whistle-blower measures in the House. His main focus, however, was gun control. He explained that McCarthy was unable to attend the ANA-PAC event because of last-minute congressional wrangling over a gun control.

"One way to reduce health care costs is to reduce the violence caused by guns," Messina said. "Thirteen children die every day from gun violence." He attributed those deaths in large part to the absence of safety locks and no mandatory background checks on people buying guns at gun shows.

McCarthy's goal of closing the "gun show loophole" was dealt a setback when the House voted against tougher gun control measures. However, the House also defeated a measure that many believe would have weakened existing gun control law. The issue is expected to be revived when a House-Senate conference committee meets later this summer.

The ANA-PAC raised more than $21,500 during the ANA House of Delegates meeting. Nurses also had the opportunity to meet with congressional leaders on their turf during the HOD. More than 20 delegations from the state nurses associations met with federal legislators and senior staff to discuss nursing and other issues.

Nurses gather in London for centennial celebration

Nearly 4,000 nurses from across the world gathered June 27-July 1 to celebrate the centennial of the International Council of Nurses (ICN) in London. The event featured international speakers, sessions and debates, and an opportunity for nurses, including representatives from the ANA, to go beyond their countries' borders and discover commonalities and shared strengths.

ICN President Kirsten Stallknecht, RN, opened the main session with her thoughts about nursing's evolution during ICN's 100-year existence.

"This bold ambition was born at a time when even the thought of a minimum wage, of universal health insurance and the right to health were considered fantasies," she stated. "From its modest start and great hopes of 100 years ago, ICN has had a history of drama, developments, separations by war and of unity achieved through the will of its leadership."

Honorary ICN patron Christopher Reeve sent words of strong support to the nursing community. "Nurses have been pivotal to my own recovery and health," said the actor, who was paralyzed after being thrown from a horse in 1995. "I know that this is also true for the millions around the world who are restored to health and comforted in illness by the caring, compassion and expertise of nurses."

Honoring its own

An Indiana State Nurses Association member was among the nurses honored during the ICN conference. Madrean Schober, RN, received the inaugural Virginia Henderson Fellowship. With a long record of community-focused professional service in both the United States and El Salvador, Schober has been a nurse practitioner for 20 years in both obstetrics/gynecology and adult primary health care. She will focus on family health for the fellowship.

ICN also paid tribute to its founder, Ethel Bedford Fenwick, during the unveiling of a "Blue Plaque" at the pioneering nurse's former home. The Blue Plaque celebration for Fenwick was held only a few steps from a Blue Plaque marking Florence Nightingale's departure for the Crimean war in 1854.

Children's rights, nurse protections

Conference attendees were treated to presentations by several well-known speakers, including UNICEF Executive Director Carol Bellamy and Pierre Perrin, MD, chief medical officer, International Committee of the Red Cross.

Bellamy called for more attention to be paid to children's human rights. "Nurses are fierce opponents of the inequalities that threaten the rights of children globally, who are denied education, suffer gender-based violence and abuse and live under the myriad dangers of war and poverty and who are exploited and disabled," she stated.

She reported, however, that the goals set at 1990 World Summit for Children have evoked positive change: rates of infant mortality and child illness have decreased worldwide and that public discourse about child labor and sexual exploitation has increased.

"What detractors once characterized as hopeless is now transforming the lives of children," Bellamy said. For nurses in war zones, the picture is much bleaker. Perrin reported that thousands of nurses working for the Red Cross and Red Crescent are in greater danger than ever before as respect for humanitarian workers falls.

"They are being faced with being caught in attacks or taken hostage," he said in particular of the 200 nurses who work for the International Committee of the Red Cross and are specially employed to go into war zones. Since 1992, seven nurses have been killed in Afghanistan, Liberia and Chechnya.

ANA in action

The ANA sponsored several events and presentations during the five-day ICN conference. Together with the American Nurses Foundation (ANF), it cosponsored with the Nightingale Institute for Health and the Environment, the University of Maryland Environmental Health Education Center, and Health Care Without Harm, an all-day preconference: "Nursing, Health and the Environment, Global Pollutants -- Nursing Actions." ANA Occupational Safety and Health Specialist Susan Wilburn, MPH, RN, discussed the 1986 ICN resolution "Nurses and the Environment"; the 1997 ANA position statement "Reduction of Health Care Production of Toxic Pollution"; and the recent 1999 ICN position statement regarding medical waste.

Maryland Nurses Association members Barbara Sattler, DrPH, RN, and Jane Lipscomb, PhD, RN, FAAN, from the University of Maryland, discussed toxicology and health effects, followed by Vermont Nurses Association member Hollie Shaner, MSA, RN, president of the Nightingale Institute for Health and the Environment, and Ted Schettler, MD, MPH, author of "Generations at Risk," who presented information regarding the health care industry's impact on the environment.

During another preconference event, the fellows of the American Academy of Nursing (AAN) and the Royal College of Nursing (RCN) gathered to begin developing nursing knowledge for the 21st century. During her keynote address, Norma Lang, PhD, RN, FRCN, FAAN, also discussed the need for science development and the relationship among science, practice and policy for nursing and health care. RCN convener June Clark, FRCN and AAN President Joyce Fitzpatrick, PhD, RN, FAAN, provided overviews of each academy.

On June 29, the ANA and the ANF hosted a reception for 250 people at the American Embassy in London. ANA President Beverly L. Malone, PhD, RN, FAAN, and ANF President Cecilia Mulvey, PhD, RN, and Philip Lader, Ambassador to the Court of St. James, welcomed the group to the Embassy.

Malone presented a crystal bridge to Stallknecht as a metaphor for the long and supportive partnership between ANA and ICN. Mulvey presented a donation to the ICN Foundation to ICN Executive Director Judith Oulton. The donation included contributions from ANA, ANF and some of the NOLF organizations to assist in advancing the profession of nursing internationally.

State nurses association members Douglas Olsen, RN, Anne Davis, RN, and Gwen Anderson, RN, participated in a preconference session that looked at international perspectives on ethical partnerships between nurses, patients and families, as well as interprofessional partnerships. During the session, the launch of the International Center for Nursing Ethics, which will be housed at the University of Surrey in London, was announced.

For more information on the International Council of Nurses, call (41 22) 908 01 00 or go to www.icn.ch/

ANP honored

American Nurses Publishing (ANP) recently won an award in the 14th annual book design and effectiveness competition sponsored by the Washington Book Publishers. The award-winning entry, the Writer's Guide to Nursing and Allied Health Journals, placed second in the category of one- and two-color jackets and covers published by trade and professional associations. The competition recognizes excellence in bookmaking in Washington, D.C., Maryland, Virginia, and West Virginia, and features government, nonprofit, commercial, and association publishers. Other honorees in this year's competition include Smithsonian Institution Press, World Bank, Time-Life Books and National Geographic Society. The Writer's Guide to Nursing and Allied Health Journals costs $38.95 for SNA members and $48.95 for nonmembers. To order, call (800) 637-0323 and ask for publication 9812WG or order online at http://www.nursesbooks.org. American Nurses Publishing is the publishing program of the American Nurses Foundation, an affiliate of the ANA.

ANA president appointed to World Health Assembly

At the request of the Clinton administration, ANA President Beverly L. Malone, PhD, RN, FAAN, attended the World Health Organization's (WHO) policy-setting assembly in May. The WHO's 191-member states meet in Geneva, Switzerland, for the assembly each year.

Prior to the meeting, the WHO released the World Health Report 1999: Making a Difference. The report finds that in high-income regions, non-communicable diseases such as depression and heart disease, and injuries are the leading causes of disability and premature death. Infectious diseases -- including malaria, diarrhea, tuberculosis and AIDS -- continue to plague the poor. WHO singles out malaria control and the prevention of tobacco-related diseases as areas needing "concerted global action."

"If current trends continue, by the year 2030, tobacco will kill 10 million people a year -- over 70 percent of them in developing countries, where information on tobacco-related disease is often weakest," the authors conclude.

In addition, the report says the two major challenges confronting health systems in all countries are how to ensure efficiency and how to achieve -- and maintain -- universal coverage. It points out that many countries need to increase overall spending on health if they are to make even the most inexpensive and effective health measures available to the whole population.

ANA unveils needlestick prevention campaign

ANA unveiled its national campaign to prevent needlesticks called "Safe Needles Save Lives" at the June 1999 House of Delegates in Washington, DC.

The campaign, which includes a national media outreach component, was created to build on ANA's longstanding efforts to protect nurses from occupational injuries and illnesses. "Safe Needles Save Lives" specifically is designed to build awareness among nurses, policy-makers and the public about the prevalence of potentially life-threatening needlestick injuries and the need for state and federal legislation mandating the use of safer needle devices in all practice settings. The campaign also will include educational and other workplace efforts.

For more information, contact your state nurses association, Michelle Nawar at ANA, (202) 651-7122 or mnawar@ana.org, or Michelle Slattery, (202) 651-7027 or mslatter@ana.org. To order a free single copy of the "Safe Needles Save Lives" brochure, call (800) 274-4ANA.