The POWER Of ONE VOICE

Nurses Activism

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Power of One Voice

Newly elected ANA president shares her thoughts about nursing-and her hope

By Kay Bensing, MA, RN

Advance For Nurses

When you throw your hat into the ring as a candidate for president of the American Nurses Association (ANA), it's not a decision you make on a whim. Why would you aspire to lead the profession now, as it grapples with the most critical national nursing shortage ever, when uniting 2.7 million nurses toward a common goal is no easier than it's ever been, and when the organization's membership is declining steadily? To take on these challenges, you would need a strong sense of self, proven leadership skills, years of experience and an understanding of the daily struggles of your colleagues. You would have to believe that you can rally the troops to have renewed pride in their profession, thus motivating them to get involved in issues that affect their patients, their practice and the future of nursing.

Expert in Public Policy Barbara A. Blakeney, MS, APRN,BC, ANP, elected ANA president in June, believes she is well suited for the job. Recently, ADVANCE posed a number of questions to the leader who represents the largest group of health care professionals in the country. She spoke candidly about the membership issue and how to attract more nurses to join their professional organization.

A practicing nurse for 32 years, Blakeney most recently served as director of health services for the homeless at the Boston Public Health Commission. Previously, she was the principal public health nurse for homeless services and addiction services at the Division of Public Health, Department of Health and Hospitals in Boston. Additionally, she was primary care nurse practitioner with Amherst (MA) Medical Associates and at Boston City Hospital. Blakeney, an expert in public health, health care policy and leadership development, has been active in ANA for years, serving on national committees and holding the offices of first and second vice president. She has received numerous awards for her leadership abilities and public health contributions from ANA, other nursing associations and community groups that she has served.

Seeking Common Ground:

In its annual listing of the top 100 most powerful people in health care today, Modern Healthcare recently ranked Blakeney No. 34 on the list. Then, after being on the job just a few weeks, she traveled to President Bush's recent economic summit in Waco, TX. There, she shared the spotlight with other experts in discussing implementation of the recently passed Nurse Reinvestment Act and key factors ANA believes will help to mitigate the shortage-access to academic opportunities, scholarship and loan repayment programs, plus scholarships for nurses who want to earn advanced degrees that would qualify them to teach. Asked which of her many transferable skills would be most helpful in her new position, Blakeney didn't hesitate for a moment.

While she credits her experience in providing population-based programs for those in need to be a plus, she sees her ability to bring people together as her strongest suit. "I always look for a common ground," she said. "Too often, we look at what's different in people, instead of looking at what we have in common." She explained that looking for similarities doesn't negate the need for diversity in nursing. "There's a lot of common ground in nursing. There are many issues that all of us have tremendous stakes in and I would like to see us focus on these. The reality is we have a galvanizing issue in front of us-the crisis in nurse staffing and the nursing shortage. We need to focus a great deal of our time to find short-term and long-term solutions to these problems."

The ANA:

A Generational Concern Addressing the subject of ANA's declining membership, Blakeney doesn't hedge. She believes that one of the reasons for nurses not joining their professional organization is generational. "I don't know that nursing organizations or any organizations in general have begun the process of refining their message and how they do business to attract younger members of our society. This is certainly an issue with nursing. "ANA is always interested in making sure our message is current and relevant. But to be relevant, you have to demonstrate it. If no one knows what you're doing, then you're irrelevant." Blakeney believes ANA needs to strengthen its communication ability with the state affiliates, then support them to do the same with their members. "We need to give people information that they can look at in a few minutes and then give them the resources where they can explore issues more deeply," she said. "Rethinking how we get information out to nurses is critical."

Broadest-Based Organization:

Another issue related to ANA's declining membership, according to the president, is that when nurses in specialty practice consider how much time and resources they have to devote to nursing organizations, they choose to support their specialty. "We want to continue to encourage nurses to support their specialty organization, but we also want people to recognize that the work of the profession as opposed to practice issues gets done in organizational frameworks. ANA is the broadest-based organization in the country, representing the broadest-based thinking on issues," Blakeney said. "It's great to support your specialty, but we want you to support your profession as a whole-and that means ANA," she concluded. Is it puzzling to Blakeney that only 6 percent of practicing nurses have gotten the message that ANA is their voice, speaking on behalf of their interests? "It is surprising, but it's also a recognition that nurses are struggling every day to do practice well, and at the end of the day they know in their hearts that they haven't been able to do the right thing for their patients," she reflected.

Short-Term Solutions:

In a recently published study, researcher Julie Sochalski, PhD, RN, documented that new nurses are leaving the profession much faster than their predecessors and men are leaving twice as fast as women. ANA's Nursing's Agenda for the Future is a comprehensive plan to develop long-term strategies that deal with the many facets of the problem. However, as the exodus of new nurses continues, does ANA have short-term solutions? "One of the short-term solutions that we need to continue to support and push is Magnet recognition," the highest recognition for nursing excellence awarded by the American Nurses Credentialing Center (ANCC). "The number of hospitals applying for this recognition is skyrocketing these days. "We believe that hospitals that not only meet the ANCC guidelines but implement them as well are good places for nurses to work.

These facilities empower nurses and they have a significant say in how practice occurs. We know that turnover rates are lower in Magnet hospitals, and that the environment in general is better." Better Mentoring Programs Critical to retaining new graduate nurses is how young people are mentored, according to Blakeney. "This mentoring should not only be directed to new grads but to young people who are looking for second careers. We have an opportunity to build a new cadre of nurses who come from different disciplines. They have career skills and life experiences that make them valuable to the profession. "We have a variety of folks who might value a career in nursing. There are traditional and non-traditional students, and we need to focus on both groups simultaneously," she acknowledged.

Grading the Media:

Grading the media on its efforts to educate the public about nursing and the shortage, Blakeney candidly noted that to some extent media coverage of the shortage has been uneven. "In some cases, the experts that the media identifies are not the real experts-nurses," she said, adding that the so-called experts sometimes featured in coverage tend to speak only on the economic issues related to the shortage. "The bottom line is that when nurses look at what they need to practice well, you will hear the vast majority of them talking about their practice environment and the difficulties in it. "Sure, they'll be talking about money, but they're going to be talking about physicians who can sometimes be outrageous; how they have to deal with violence in the workplace; the reality of mandatory overtime; and being floated to clinical areas where their expertise is not where it should be to provide safe care."

The Invisible Nurse:

"Money has to do with attracting and retaining competent nurses. But the bottom line is if the nurse isn't there, it's almost like Jimmy Stewart in It's a Wonderful Life. His character had the opportunity to see what his life would have been like if he hadn't been there. If a nurse isn't at the bedside, then she doesn't see the ventilator patient getting into trouble and she can't fix it before it becomes an incident. "Much of what a nurse does is invisible, in that she prevents something from happening. Because she's at the bedside, incidents don't happen. We take this for granted. Take the nurse out of the equation, and things do happen," said Blakeney, who believes nurses need to educate the media about these reality-based issues.

The new ANA president praised the recent Johnson & Johnson marketing campaign that highlighted diversity in nursing. However, she believes that more community outreach programs that introduce junior and senior high school students to nursing and provide academic counseling are needed to fulfill this goal. High on Blakeney's wish list for ANA-sponsored programs is that district associations, within the state organizations, will take on projects that encourage young people to become nurses.

Power of One Voice:

"I would like to leave as my legacy what I call the power of one voice," she summarized. "This means one strong voice for nursing. It doesn't mean that we all agree and that we are all in lockstep. It means that our common ground is so powerful and so clearly recognized that we speak with one common voice. It means that we have a common frame of reference to address the problems nursing faces."........... http://www.advancefornurses.com/NWoe_1.html

Specializes in CV-ICU.
Originally posted by lee1

Interesting. $275 is the NATIONAL ANA dues including my state dues. How is yours higher?? I do not pay extra dues for the state chapter I belong to.

$78 is the NATIONAL AACN dues, $20 is for the local chaper???

How are yours so much higher???

Lee1, I was referring to the $571 I pay yearly to be a member of ANA/MNA/and my district association. This amount breaks down to $55/year for my district dues; $376 for MNA dues; and $120 for ANA dues. We also have a $20 dues option which we can designate for any of the following funds: a strike fund (for those of us that are part of the union), a scholarship fund; the general fund; and the last choice is MNAF (our foundation fund). I pay extra because I belong to a state that does collective bargaining for us(we are part of a union FOR nurses BY nurses). Because of this UNION, I AM eligible to retire in 3 more years with a pension, I have health insurance, and I can use my unions' strength to make my workplace safe.

My District Nurses Association has over 5000 members, and I am on the Board of Directors of it; my state has 13 Disticts, which are geographical areas across the state. 3 of these Districts are in metropolitan areas and my district is one of those 3. My district association has had its' own lobbyist for our state legislature, we have our own Exec. Director, we offer many CEU classes (even independant study), we have our own professional practice group, awards committee, a group for night nurses, an advanced practice group, and many other groups and committes, according to the different interests of our members.

My State Association has over 16,000 members. We have 4 very active areas: the E&GW (economic and general welfare --usually refers to the UNION part of the association- deals with our contracts and negotiates with the hospitals, etc.; deals with unsafe staffing); the Commission on Nursing Practice (this group deals with general workplace issues which are found in ALL practice areas; there are excellent documents on Supervision and Delegation, Nursing Quality Indicators, Concerns for Practice Forms (which are different from Unsafe staffing forms),etc. Then there is our governmental affairs branch and also our Education branch. I'm losing steam here; maybe the easiest thing I can tell you to do is to go to MNA's website and browse through the site a while. It's at http://www.mnnurses.org. You won't be able to read the individual contracts (sorry, I did try); but maybe compare our state association with yours and see if I am right: it IS a bargain at this price.

I'm going to go to bed (I worked my 12 hr night shift last night) now and will address more questions when I get up.

Specializes in CV-ICU.

BTW, when you look at MNA's Board of Directors, please note that 10 out of the 12 board members are STAFF NURSES. Our President is a CNP who once lost her job for her union activites when she was a staff nurse. She still fully supports staff nurses; and she went on in nursing to earn her CNP thanks to a scholarship (or maybe more than 1) from MNA. The other board member is an educator. Because of MNA's collective bargaining arm, we do not have managers on our BOD.

The ANA also has it's union arm, the UAN. I have always been a member of the ANA, and thereby a member of the state constituiency. I think all nurses should support the ANA and be a member. When nurses' view points about a nursing matter in this nation is asked for, the ANA is called on.

Specializes in CV-ICU.
Originally posted by lee1

Then what is the APN, NP or whatever you call them locally?

Advanced Nurse Practicioner. I have belonged to the ANA for many years and this is the focus of what I saw them concentrating on over the last decade. The staff nurse's problems seemed to be just that-----their own-----

Middle managers did nothing to help them, made them worse

ANA allowed the problems to escalate. Only now, do they seem to be making them a priority. BUT, a little to late, I am afraid.

Okay, I'm awake again so will continue this discussion. I have been a delegate or alternate for the past 10 to 12 years to the ANA conventions (and a delegate to my state convention for 22 of the past 23 years-- I missed the convention right after my dtr's. birth) and have gone to each of these conventions as a staff nurse. So I'm going to tell you just the stuff that I remember being involved in at the national level of the association, not the just the media information. Unfortunately, I can't remember all of the dates of these different activities because I'm not quite that organized.

I do remember going to a convention back in 1990 or '91 and learning about the Nursing Practice Act. ANA was giving information about suggested state legislation for the nursing practice act, the nursing disciplinary diversion act, and the prescriptive authority act (okay, so this last topic is dealing with advanced practice, sorry). I was bowled over by the workshop and realized the importance of working within the legal limits of my Nurse Practice Act and what my rights and limits were. I have been very interested in my Nurse Practice Act ever since and have served on my state associations' Nursing Practice Commission (and even chaired it). I was involved in a Nursing Practice Summit at Washington DC in which staff nurses from across the country came together and discussed the deplorable state of staff nursing (back in 1994 or'95-- I was on crutches with a knee injury at the time). I was astounded to hear nurses being only 1 of 2 or 3 RNs on a 35 to 40 bed unit, with ventilated patients, even back then! We were dealing with UAP's back then and problems with delegation and supervision, remember? And ANA came out with powerful statements in opposition of UAP's-- (I can't remember the correct abbreviations for this bunch; RCTs or PCAs or something weird); these were supposed to be unlicensed assistive personnel under the direction of physicians; remember? They never came into being, thanks to ANA.

ANA pushed for and implemented their Principles for Nursing Staffing in 1996. Unfortunately, that wasn't a success because the principles were shot down by other changes in the health care arena-- managed care and higher acuity sidelined ANA's ideas of staffing units according to HPPD (hours per patient day)--in other words, ANA was pushing for staffing according to patient ACUITY, not just the nurse patient RATIOS that CNA and PSNAP want. What good is 1 nurse to 4 patients when the four patients might all be extremely high acuity and should maybe staffed at 1:2 instead of 1:4? I work CV-ICU, I am now often caring for patients that would have been dead 3 or 4 years ago, they are that ill. No matter what type of unit most of you are currently working on, I know your patients are also much sicker than they were back then. Maybe if ANA had more staff nurses as members back then, this might have occurred, who knows?

Okay, more recently, we can talk about the needlestick and blood exposure lobbying that ANA did at the Capital that led to the changes in OSHA's policies on needlestick injuries and the vast changes that have occurred in our workplaces. Or the development of the UAN. Or the Workplace Advocacy Program for non-unionized nurses (and those in right to work states). Check these things out. ANA HAS been there, and is working on a daily basis for the staff nurse; the nurse at the bedside; and for nurses who are not at the bedside also.

These are some of the things that I consider important for the staff nurses, and that I have seen and been involved in at the national level of ANA. I think I've rambled long enough now. I could go on if you want more information, just ask, okay? :)

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Your second quote (not being up to date) might have something to do with why you havent seen much about staff RNs. As you say, you do not have much recent info about the association so I can understand how you might not know about the changes we've made in it. But is it fair to be blasting a group of nurses for not doing something & then later admit you dont have current info on what they are doing at all? Maybe its time to read up. :)

A lot of what the ANA does is in the legislature. The organizations job is primarily in DC to get the laws passed that will change the conditions at your bedside. If you look at the Governmental Affairs page at the ANA website, you can read about all of the ANA-supported & ANA-written bills that have been submitted to Congress for Safe Patient Care (national ban on forced ot, improved workplace conditions), Quality Care (safe staffing numbers), Nurse Safety, Nurse Retention, hospital work enviornments, LTC staffing ratios, workplace safety, and the condemnation of foreign recruitment as a way to avoid improving working conditions that are driving US RNs from the job, just to name a few that affect the staff RN.

All of these bills & the lobbying we are doing (and paying for) to get them passed into law are designed specifically for the staff RN at the bedside - which is what the majority of our membership is.

There is MUCH more happening than just the Nurse Reinvestment Act (which, btw, ALSO has provisions for improved working conditions & nurse RETENTION initiatives -- & is not just about nursing education, loan forgiveness, & recruitment of new students). At the website, you can also read the texts of ANA research that proved a relationship between better RN staffing and better pt outcomes - which has been confirmed by other independent research studies this year. You can read testimonies ANA leaders and staff RN members have given before Congress on these issues - every single one of them stresses the importance of RETENTION & WORKING CONDITIONS & the fact that to reverse the "shortage" at the bedside "we MUST start FIRST with the work environment". And that is the focus of the bills we've gotten into Congress.

If you need a quick update on what the organization is doing, there are ANA press releases, articles written by ANA leaders & members, texts of newspaper, press conferences, & TV interviews, and hearing testimonies that you can read there which ANA leaders & staff RN members have given - again stressing to all the unsatisfactory work environment as being THE MAIN CAUSE of the exodus of nurses & the reasons why we must have national laws to improve it because if left up to the hospital administrators, nothing will ever change. Ive posted so many of these items on this website that I dont know how anybody can read all that & still say we arent doing anything about the nurse at the bedside. The nurse at the bedside is THE main focus. Every issue comes right back to that.

Im working so hard in that organization for the issues of the staff RN at the bedside (I am one) & I see so many other ANA leaders & ANA members doing the same that it can be kind of disheartening to hear another nurse say she doesnt see us doing anything --- and then hear that she hasnt even looked to find out before putting us down.

The Nurse Reinvestment Act with its provisions for new nurse recruitment, incentives and initiatives to retain experienced nurses & to improve working conditions didnt come from outerspace. It came from the work the ANA & its members did & paid for. As did most of the current legislation & media attention.

When the bills for a national ban on forced ot for ALL nurses, & national laws for safe staffing & the rest -- for ALL nurses -- are passed, we'll know where that came from too. :)

Dues vary depending on state assoc & what ITS MEMBERS VOTED FOR. At the ANA convention last year, the members of all the state assocs got together & voted to increase their dues to the ANA to about $185/yr. That means that out of the total dues we pay our state assoc, $185/yr goes to the ANA. Anything over that amount stays with the state assoc. The total amount is decided by a vote of the members of the state assoc. Your state assoc members decided on a total of $275 - which includes the ANA dues in that. Non-union members of my state assoc pay about $300/yr total but our collective bargaining members voted at convention to increase our own dues from 1.2% of the lowest regional base salary to 1.6% because we wanted to expand our union services. In my region of the state, the lowest base salary is about $52,000. 1.6% of that is my state assoc dues because I am in the union branch too. The same $185/yr goes to the ANA - the rest stays with our state assoc & comes back to us in service.

"THEY" dont put anybody in power. The MEMBERS VOTE for who the members themselves want to put in power. The problem in the past was that while the majority of the membership of the ANA is staff RNs, staff RNs didnt run for leadership positions. We can point the finger at the leaders all we want, but it still comes back to the fact that staff RNs have LET the power slip by them. Im guilty of it too. Ive been an RN for 20 yrs, a member of my state assoc & ANA for 18 of them but only active & involved in either for the last 8 yrs or so. The first 10, I didnt even think about it & knew nothing of what was happening in my profession. I went to work & went home to take care of my family. I didnt give a thought to the ANA - never saw them at my bedside so out of sight out of mind. I did see my state assoc there so I thought more of them but it was a fleeting thought in my busy life......

Until we were getting downsized & restructured out of jobs everyday & the AMA started a big push in Congress to fill our empty places with less expensive "REGISTERED care technicians" -- basically LICENSED uaps that would provide the nursing care but report to & be under the control of the MD. What they were trying to do was re-create the nursing profession of 100 yrs ago - and knock RNs out of it altogether.

I realized then that if nurses didnt take a stand for themselves, others would take control & put us out of existence. That was my wake up call - the very real possibility of the American Medical Assoc getting Congress to pass national laws that would allow 1 charge RN on the floor for supervision & medications with pt care provided by UAPS with a license. The hospital would have no need for nurses anymore & God forbid if I had to ever be a pt. The major fight that the ANA & its members waged against the powerful AMA (and funded with RN membership dues) prevented the creation of this new national RN replacement & preserved the nursing profession. Unable to get away with creating RCTs, hospitals had to stop the mass lay offs & start bringing back RNs. And thats the first time I saw how the ANA affects me at the bedside while it works in DC.

Before then most staff RNs were like me -- oblivious. Thats been changing & there are at least 4 staff RNs on the ANA Board of Directors & more in other leadership positions now. Instead of just complaining about what isnt being done for them, more staff RNs are waking up, getting involved & grabbing the reigns. Thats why there has been a shift of focus in the ANA these last few years. Staff RNs arent sitting back so much anymore.

Brings me to the ANA presidents thoughts:

".....the power of one voice," ...... "This means one strong voice for nursing. It doesn't mean that we all agree and that we are all in lockstep. It means that our common ground is so powerful and so clearly recognized that we speak with one common voice. It means that we have a common frame of reference to address the problems nursing faces.".........

Whatever problems the ANA has had in the past (real or perceived), isn't going to help the NOW and the FUTURE if that is always used as an excuse to not join NOW. That is so self-defeating! Hey, I won't join ANA because they didn't do what I thought they ought to do 5 - 10 years ago. Well, DUH. The past is past. Get over it. Move on. Help to make the changes NOW.

As for the high dues, I'm pretty sure that if one million new members joined, the ANA wouldn't need as much from every member to represent all nurses (members or not) in Washington.

Specializes in CV-ICU.

Last year was the first time the ANA national dues were increased in 10 years. The dues were increased also at my state association level last year for the first time in 10 years too, (and I ended up voting FOR both of those dues increases after I studied the budgets of both levels. Nothing else I've been involved in has held their costs at the same level for that long.

Couldnt have said it better. And for those who dont get involved in anying & use the excuse that the ANA "isnt paying attention to the staff RN", when they havent even looked at the ANA in years & have no idea what it & its members are actually doing, I suggest they get themselves updated.

Borrowed from another post:

Nurses MUST be recognized and respected for their professional expertise. We MUST receive better compensation and benefits......And finally, in order for retention efforts to be successful, employers must change their thinking about nurses - they must understand that we are an asset, not an expense[/b]. They must understand that our skills and experience make the critical difference in achieving quality patient outcomes and that without nurses - their institutions are merely buildings full of empty beds!.............."

Barbara Blakeney, RN

President of ANA>>>>>

Its not just words. There are many things going on in the ANA to see that it all happens. Staff Nurses can sit on the sidelines complaining about the mistakes of the past & refusing to believe that the organization & its members have learned from them & changed, or they can get involved in the new organization & steer their profession to the future. Their choice. But if they choose to sit silently on the sidelines - whether in the organization or outside of it - and do nothing wherever they are, then they have no business complaining about how the rest of us are actively trying to make a difference.

ANA update:

President Blakeney's presentation:

http://www.nursingworld.org/pressrel/2002/ca1102rm.htm

CEO Stierle's slide presentation:

http://www.nursingworld.org/about/l...home.htm#slides

Annual Stakeholder's report 2001:

http://www.nursingworld.org/about/lately/stkhld01.pdf

ANA Legislative Activity:

http://nursingworld.org/gova/federal/gfederal.htm#legis

RN Congressional Testimonies - The Nurse Staffing Crisis:

http://nursingworld.org/gova/federal/legis/testimon/index.htm

GET INVOLVED! A grass roots effort:

http://nursingworld.org/gova/federal/politic/nstat/gnstat.htm

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