ANA's Chief Executive Officer's Status Report

[-jt]

Chief Executive Officer's Status Report

ANA Activities and Accomplishments

the month in review - February 2001

This report summarizes the highlights of ANA activities during February 2001. The report focuses on the following Core ANA Issues and functions:

Workplace Rights

Appropriate Staffing

Workplace Health and Safety

Continuing Competence

Patient Safety/Advocacy

Ethics and Human Rights

Nursing Standards and Guidelines

Acronyms Contained in This Report

Nurse Staffing:

ANA is leading the way in research, policy and practice, and workplace strategies to ensure that the number and mix of staff are appropriate, protecting both patients and nurses.

(Research is necessary to support our statements, claims, and efforts)

ANA Continued to participate in numerous meetings with other union representatives, nursing organizations, health professional organizations, and House and Senate staff to discuss legislative approaches and strategies to address shortage and staffing issues. Began regular meetings with other union representatives to develop mandatory overtime legislative proposal.

Held a press conference at the National Press Club in Washington, DC on February 6 and issued a press release announcing the results of ANA's Safe Staffing Survey. The nationwide state legislative agenda was unveiled by President Foley; she outlined legislative priorities of the nationwide state legislative agenda that are designed to address staffing problems identified by the survey.

The conference and release garnered coverage on more than 100 television stations, including segments on NBC Nightly News (Feb. 13) and ABC's Good Morning America (Feb. 14), as well as a half-hour segment on C-SPAN (Feb. 17). Print news coverage included The Chicago Tribune (Feb. 14), The Boston Globe (Feb. 25), and The Washington Post (Feb. 27) among others. The results of the survey were also quoted later in the month by Senator Hillary Rodham Clinton at a Congressional Hearing on nurse staffing and by Senator John Kerry at the National Sample Survey Press conference.

Participated in a live discussion regarding nursing shortage, First Vice President Underwood on February 17 on the "Washington Journal," a one-half hour segment on C-SPAN.

In conjunction with ANA's press conference in Washington, DC, various CMAs also held press conferences in their states and introduced staffing legislation.

The following state staffing legislation has been introduced so far this year:

Studies: Arkansas, Kentucky, New Hampshire, New Mexico, Pennsylvania, Virginia and West Virginia introduced legislation calling for the establishment of a task force, commission or committee to study and make recommendations on nursing shortages in their states.

Standards: Kansas introduced legislation requiring minimum standards to be developed for the operation of nursing pools while New York, Ohio, and Oregon have introduced legislation requiring healthcare facilities to develop staffing standards and plans. Rhode Island legislation calls for a Commission to set staffing standards.

Data Collection: Georgia, Hawaii, Mississippi, North Dakota, Tennessee, and Texas legislation would require centers to collect information regarding supply and demand of nurses.

Education: California, New Mexico, North Dakota and Texas are addressing the nursing shortage through funding to expand enrollment in nursing schools.

Appropriations: Hawaii, Mississippi and New Mexico legislation would provide appropriations to hire additional school nurses.

Nursing Quality Indicators: The collection of nursing quality indicators would be required in Massachusetts, New Jersey and New York.

Staffing Ratios: New Mexico and New York would require student to school nurse ratios while Connecticut and New Jersey would require minimum nurse-to-patient ratios in hospitals.

Mandatory Overtime: Prohibition of mandatory overtime has been introduced in California, Connecticut, Hawaii, Illinois, Iowa, Maine, Maryland, Minnesota, Nevada, New York, Ohio, Oregon, Rhode Island, Washington and West Virginia.

Whistleblower: Illinois, Missouri, New Hampshire, New York, Oregon, Rhode Island, and Wyoming have introduced legislation that protects whistleblowers in healthcare institutions. Whistleblower rotections not specific to healthcare workers have been introduced in Arizona, California, Hawaii, Indiana, Mississippi, Nevada, New Mexico, New York, North Dakota, Texas, Vermont, Virginia, Washington.

Issued a press release on February 13, on the nursing shortage following a Senate subcommittee hearing on the issue. President Foley was subsequently interviewed by CNBC's "Wall Street Journal Report" (aired Feb. 24) as well as The New York Times, The Wall Street Journal, WebMD, Long-Term Care Interface, Medical Economics Magazine, Nursing Spectrum and ABC Radio (air and print dates not yet determined).

Provided information on the legal definition of overtime and "floating" to be put on NursingWorld and for use in other materials.

Workplace Rights

ANA protects, defends and educates nurses about their rights as employees.

Met with numerous Congressional offices to solicit support for increased funding for nurse education programs operated by the Health Resources and Services Administration (e.g., loan repayments for shortage areas, Nurse Education Act). ANA authored a letter to President Bush asking him to include the Tri-Council approved funding amounts for these programs in his budget package. The preliminary budget released by President Bush on February 28 included support for targeted nurse education funding.

Secured opportunity for Kathy Hall, Executive Director of the Maryland Nurses Association to testify at a February 13 Senate hearing on the nursing shortage. ANA used this opportunity to highlight the need for workplace reform as well as support for education/recruitment programs.

ANA's participation on this panel was especially important as we were the only organization representing staff nurses (other panelists included the American Organization for Nurse Executives, the American Hospital Association, a dean of a school of nursing, and public health official).

Visited Congressional offices of members of the House of Representatives Budget Committee to provide staff with background information on the Nurse Education Act and suggested appropriations allocations for FY 2002. The Nurse Education Act provides for the preparation of advanced practice nurses, basic nurse education and workforce diversity.

Attended the Health Professions and Nursing Education Coalition (HPNEC) meeting to share information with each other about the President's budget and Congress' priorities and deadlines. Also updated the HPNEC fact sheet and brochure's sections on nursing to ensure that ANA's position was represented.

Secured spot for President Foley to testify in front of the House of Representatives Labor, Health and Human Services, Education and Related Agencies Subcommittee on Appropriations. Also prepared her written testimony to discuss nursing funding priorities including the Nurse Education Act, loan forgiveness programs, and the National Institute of Nursing Research.

Submitted comments to Healthcare Finance Administration (HCFA) related to the proposed rules to implement the Medicare Inpatient Rehabilitation Prospective Payment System (PPS) which covers operating and capitol costs for inpatient rehabilitation hospital services. ANA's comments supported the implementation of a PPS system for inpatient rehabilitation facilities with a per discharge payment unit based on a case-mix-group classification system as a more equitable payment system than the current system.

ANA's comments raised concerns that the proposed payment system may not adequately reflect the actual costs of providing the services because the data used to project costs probably do not accurately reflect nursing staff time resource usage within the case mix groups. ANA recommended that HCFA examine this problem and seek to resolve it as the system is evaluated and adjusted.

ANA attended a briefing hosted by George Mason University and the Division of Nursing, Bureau of Health Professions, Department of Health and Human Services where preliminary data from the March 2000 National Sample Survey was released. The panel discussion focused on legislative strategies to address the pending nursing shortage.

Presented ANA's views on nursing shortage and strategies at a leadership meeting of the Association for Women's Health, Obstetric and Neonatal Nurses with 200 attendees. Other panel participants included representatives from the American Organization of Nurse Executives and the Colleagues in Caring Program.

Represented UAN/ANA at an international conference on work-family balance.

Representatives from ANA and the UAN met with the Deputy General Secretary of the New South Wales Nursing Association. The discussion centered around sharing strategies to address common nursing issues and efforts to organize nurses for purposes of collective bargaining.

Continue monitoring the U.S. Supreme Court case of NLRB v. Kentucky River and the oral argument held on February 21.

(amicus brief previously submitted)

Workplace Health and Safety

ANA fights for a safer workplace by addressing the growing number of hazards that threaten nurses, such as needle stick injuries, latex allergy, back injuries and violence.

Initiated strategic legislative/grassroots activities regarding ergonomic standards after they were nullified.

Interfaced with nurse researcher interested in collaborating with ANA to investigate the relationships between inadequate staffing, work schedules and injury/illness in nurses. Potential for National Institute for Occupational Safety & Health (NIOSH) research funded partnership between Harvard and the CMAs to help link hard-to-access hospital discharge databases with health and safety statistics for specific hospitals.

Worked for several months with the 60-minute CBS producers on a February 25 segment on needlesticks featuring past MNA President Karen Daley (who contracted HIV after needlestick at work). ANA was not mentioned but the issue received much attention.

Utilized "Health and Safety" column in the February AJN magazine to discuss how to review and strengthen an overall health and safety program for the workplace.

Coordinated work with Occupational Safety and Health Administration (OSHA) in Philadelphia on new ANF Grant for $297,936 over two years to produce Train-the-Trainer and health and safety programs to build nursing competency at the National, State and Local levels. Funding will be forthcoming in March for staff hiring.

Continuing Competence

Today's informed consumers are demanding that the competence of licensed professionals be validated throughout their career. ANA must lead the debate and guide the development and implementation of continued competency standards for the profession.

ANA disseminated American Medical Association's Ethics Force (EFORCE) Privacy Report regarding protection of medical information.

Wrote and submitted, in with the editor of AJN, $800,000 grant to Robert Woods Johnson Foundation for an End of Life supplement and series of articles over a two year period, as well as training at 2002 ANA Convention.

Patient Safety/Advocacy

By effecting positive change around issues that are so critical to nursing and its future, ANA will advance its ultimate goal, quality patient care. In today's environment that means ensuring that patient safety and quality are priority, not profit-making.

Participated in the Reprogenetics project conducted by the Hastings Center and funded by the Greenwall Foundation (February 23-24). This project will result in an influential report which will make recommendations to improve the settings in which infertility and genetic services are offered to patients.

Co-sponsored a summit for members of the Consumer Coalition for Health Privacy to provide information on the details of the new health privacy regulations and to consider strategies for protecting and strengthening the regulations. GOVA staff participated on a "Call to Action" panel.

Met with Midwest Research Institute (MRI) and University of Kansas School of Nursing scientists to discuss issues regarding National Database of Nursing Quality Indicators (NDNQI) and its continuing development of national databanks and more intense analysis of the increasing pool of data.

Provided nursing input into the planning process for the National Coordinating Council on Medication Error Reporting Programs (NCC-MERP) invitational meeting on practitioner accountability.

Provided nursing's perspective on the enlargement of the National Coordinating Council on Medication Error Reporting Programs (NCC-MERP) by suggesting the inclusion of a nursing representative from ANA's Nursing Organization Liaison Forum (NOLF).

Continued to provide nursing input into the development of guidance on appropriate restraint to a Food and Drug Administration (FDA)/HCFA workgroup.

Heightened awareness of the need for nursing input into the deliberations of the Institute of Medicine (IOM) Committee on Assuring the Health of the Public in the 21st Century leading to the nomination of a well-qualified public health nurse.

Featured Becky Hartman, the daughter of patient Shirley Keck, who was permanently injured as a result of her hospital's short staffing at ANA's February 6 press conference on ANA's "Safe Staffing" survey.

Published "Nursing Quality Indicators Beyond Acute Care: Measurement Instruments" to validate community-based indicators.

Ethics and Human Rights

President Foley provided testimony, which was followed by documentation on the role of the professional registered nurse in the provision of care to the under served, to the IOM Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.

Represented ANA at educational session about new genetic findings resulting from completion of genome map on February 12 and at the National Institutes of Health genome gala that evening. Used this late breaking news to: educate ANA staff and to prepare update to the Human Rights Council at NYSNA.

Disseminated Draft 10 of the Code of Ethics for Nurses to the task force and advisory board. The Draft will be submitted to ANA's BOD at its March meeting and to the HOD in June 2001.

Nursing Standards and Guidelines

Attended Health Information Systems Society (HIMSS) annual conference February 4-8 to identify information systems products that include ANA recognized languages.

Attended the Drug Enforcement Agency Technical Working Group meeting for Electronic Prescriptions for Controlled Substances. The proposed rule is to be published in March, with the final rule due in June per Congressional mandate.

Nurses with prescriptive authority will be affected if they elect to migrate from paper-based prescriptions for controlled substances to a commercial electronic ordering system that transmits the prescription to dispensing pharmacies.

Scheduled and participated in telephone conference call for gerontological nursing scope and standards workgroup to finish addressing field review comments and what edits will be incorporated into the document to be forwarded to the Congress on Nursing Practice and Economics for approval.

Conducted telephone meeting with University of Iowa professor of nursing and University of Pennsylvania endowed chair of nursing to discuss preliminary strategies for review and revision of Nursing Minimum Data Set to ensure the United States' position in collaborating on international nursing minimum data set initiative.

http://www.ana.org/about/lately/ceofeb01.htm

(the work of just one month.)

--------------------------------------------------------------------------------

[-jt]

Chief Executive Officer's Status Report

ANA Activities and Accomplishments

the month in review - February 2001

This report summarizes the highlights of ANA activities during February 2001. The report focuses on the following Core ANA Issues and functions:

Workplace Rights

Appropriate Staffing

Workplace Health and Safety

Continuing Competence

Patient Safety/Advocacy

Ethics and Human Rights

Nursing Standards and Guidelines

Acronyms Contained in This Report

Nurse Staffing:

ANA is leading the way in research, policy and practice, and workplace strategies to ensure that the number and mix of staff are appropriate, protecting both patients and nurses.

(Research is necessary to support our statements, claims, and efforts)

ANA Continued to participate in numerous meetings with other union representatives, nursing organizations, health professional organizations, and House and Senate staff to discuss legislative approaches and strategies to address shortage and staffing issues. Began regular meetings with other union representatives to develop mandatory overtime legislative proposal.

Held a press conference at the National Press Club in Washington, DC on February 6 and issued a press release announcing the results of ANA's Safe Staffing Survey. The nationwide state legislative agenda was unveiled by President Foley; she outlined legislative priorities of the nationwide state legislative agenda that are designed to address staffing problems identified by the survey.

The conference and release garnered coverage on more than 100 television stations, including segments on NBC Nightly News (Feb. 13) and ABC's Good Morning America (Feb. 14), as well as a half-hour segment on C-SPAN (Feb. 17). Print news coverage included The Chicago Tribune (Feb. 14), The Boston Globe (Feb. 25), and The Washington Post (Feb. 27) among others. The results of the survey were also quoted later in the month by Senator Hillary Rodham Clinton at a Congressional Hearing on nurse staffing and by Senator John Kerry at the National Sample Survey Press conference.

Participated in a live discussion regarding nursing shortage, First Vice President Underwood on February 17 on the "Washington Journal," a one-half hour segment on C-SPAN.

In conjunction with ANA's press conference in Washington, DC, various CMAs also held press conferences in their states and introduced staffing legislation.

The following state staffing legislation has been introduced so far this year:

Studies: Arkansas, Kentucky, New Hampshire, New Mexico, Pennsylvania, Virginia and West Virginia introduced legislation calling for the establishment of a task force, commission or committee to study and make recommendations on nursing shortages in their states.

Standards: Kansas introduced legislation requiring minimum standards to be developed for the operation of nursing pools while New York, Ohio, and Oregon have introduced legislation requiring healthcare facilities to develop staffing standards and plans. Rhode Island legislation calls for a Commission to set staffing standards.

Data Collection: Georgia, Hawaii, Mississippi, North Dakota, Tennessee, and Texas legislation would require centers to collect information regarding supply and demand of nurses.

Education: California, New Mexico, North Dakota and Texas are addressing the nursing shortage through funding to expand enrollment in nursing schools.

Appropriations: Hawaii, Mississippi and New Mexico legislation would provide appropriations to hire additional school nurses.

Nursing Quality Indicators: The collection of nursing quality indicators would be required in Massachusetts, New Jersey and New York.

Staffing Ratios: New Mexico and New York would require student to school nurse ratios while Connecticut and New Jersey would require minimum nurse-to-patient ratios in hospitals.

Mandatory Overtime: Prohibition of mandatory overtime has been introduced in California, Connecticut, Hawaii, Illinois, Iowa, Maine, Maryland, Minnesota, Nevada, New York, Ohio, Oregon, Rhode Island, Washington and West Virginia.

Whistleblower: Illinois, Missouri, New Hampshire, New York, Oregon, Rhode Island, and Wyoming have introduced legislation that protects whistleblowers in healthcare institutions. Whistleblower rotections not specific to healthcare workers have been introduced in Arizona, California, Hawaii, Indiana, Mississippi, Nevada, New Mexico, New York, North Dakota, Texas, Vermont, Virginia, Washington.

Issued a press release on February 13, on the nursing shortage following a Senate subcommittee hearing on the issue. President Foley was subsequently interviewed by CNBC's "Wall Street Journal Report" (aired Feb. 24) as well as The New York Times, The Wall Street Journal, WebMD, Long-Term Care Interface, Medical Economics Magazine, Nursing Spectrum and ABC Radio (air and print dates not yet determined).

Provided information on the legal definition of overtime and "floating" to be put on NursingWorld and for use in other materials.

Workplace Rights

ANA protects, defends and educates nurses about their rights as employees.

Met with numerous Congressional offices to solicit support for increased funding for nurse education programs operated by the Health Resources and Services Administration (e.g., loan repayments for shortage areas, Nurse Education Act). ANA authored a letter to President Bush asking him to include the Tri-Council approved funding amounts for these programs in his budget package. The preliminary budget released by President Bush on February 28 included support for targeted nurse education funding.

Secured opportunity for Kathy Hall, Executive Director of the Maryland Nurses Association to testify at a February 13 Senate hearing on the nursing shortage. ANA used this opportunity to highlight the need for workplace reform as well as support for education/recruitment programs.

ANA's participation on this panel was especially important as we were the only organization representing staff nurses (other panelists included the American Organization for Nurse Executives, the American Hospital Association, a dean of a school of nursing, and public health official).

Visited Congressional offices of members of the House of Representatives Budget Committee to provide staff with background information on the Nurse Education Act and suggested appropriations allocations for FY 2002. The Nurse Education Act provides for the preparation of advanced practice nurses, basic nurse education and workforce diversity.

Attended the Health Professions and Nursing Education Coalition (HPNEC) meeting to share information with each other about the President's budget and Congress' priorities and deadlines. Also updated the HPNEC fact sheet and brochure's sections on nursing to ensure that ANA's position was represented.

Secured spot for President Foley to testify in front of the House of Representatives Labor, Health and Human Services, Education and Related Agencies Subcommittee on Appropriations. Also prepared her written testimony to discuss nursing funding priorities including the Nurse Education Act, loan forgiveness programs, and the National Institute of Nursing Research.

Submitted comments to Healthcare Finance Administration (HCFA) related to the proposed rules to implement the Medicare Inpatient Rehabilitation Prospective Payment System (PPS) which covers operating and capitol costs for inpatient rehabilitation hospital services. ANA's comments supported the implementation of a PPS system for inpatient rehabilitation facilities with a per discharge payment unit based on a case-mix-group classification system as a more equitable payment system than the current system.

ANA's comments raised concerns that the proposed payment system may not adequately reflect the actual costs of providing the services because the data used to project costs probably do not accurately reflect nursing staff time resource usage within the case mix groups. ANA recommended that HCFA examine this problem and seek to resolve it as the system is evaluated and adjusted.

ANA attended a briefing hosted by George Mason University and the Division of Nursing, Bureau of Health Professions, Department of Health and Human Services where preliminary data from the March 2000 National Sample Survey was released. The panel discussion focused on legislative strategies to address the pending nursing shortage.

Presented ANA's views on nursing shortage and strategies at a leadership meeting of the Association for Women's Health, Obstetric and Neonatal Nurses with 200 attendees. Other panel participants included representatives from the American Organization of Nurse Executives and the Colleagues in Caring Program.

Represented UAN/ANA at an international conference on work-family balance.

Representatives from ANA and the UAN met with the Deputy General Secretary of the New South Wales Nursing Association. The discussion centered around sharing strategies to address common nursing issues and efforts to organize nurses for purposes of collective bargaining.

Continue monitoring the U.S. Supreme Court case of NLRB v. Kentucky River and the oral argument held on February 21.

(amicus brief previously submitted)

Workplace Health and Safety

ANA fights for a safer workplace by addressing the growing number of hazards that threaten nurses, such as needle stick injuries, latex allergy, back injuries and violence.

Initiated strategic legislative/grassroots activities regarding ergonomic standards after they were nullified.

Interfaced with nurse researcher interested in collaborating with ANA to investigate the relationships between inadequate staffing, work schedules and injury/illness in nurses. Potential for National Institute for Occupational Safety & Health (NIOSH) research funded partnership between Harvard and the CMAs to help link hard-to-access hospital discharge databases with health and safety statistics for specific hospitals.

Worked for several months with the 60-minute CBS producers on a February 25 segment on needlesticks featuring past MNA President Karen Daley (who contracted HIV after needlestick at work). ANA was not mentioned but the issue received much attention.

Utilized "Health and Safety" column in the February AJN magazine to discuss how to review and strengthen an overall health and safety program for the workplace.

Coordinated work with Occupational Safety and Health Administration (OSHA) in Philadelphia on new ANF Grant for $297,936 over two years to produce Train-the-Trainer and health and safety programs to build nursing competency at the National, State and Local levels. Funding will be forthcoming in March for staff hiring.

Continuing Competence

Today's informed consumers are demanding that the competence of licensed professionals be validated throughout their career. ANA must lead the debate and guide the development and implementation of continued competency standards for the profession.

ANA disseminated American Medical Association's Ethics Force (EFORCE) Privacy Report regarding protection of medical information.

Wrote and submitted, in with the editor of AJN, $800,000 grant to Robert Woods Johnson Foundation for an End of Life supplement and series of articles over a two year period, as well as training at 2002 ANA Convention.

Patient Safety/Advocacy

By effecting positive change around issues that are so critical to nursing and its future, ANA will advance its ultimate goal, quality patient care. In today's environment that means ensuring that patient safety and quality are priority, not profit-making.

Participated in the Reprogenetics project conducted by the Hastings Center and funded by the Greenwall Foundation (February 23-24). This project will result in an influential report which will make recommendations to improve the settings in which infertility and genetic services are offered to patients.

Co-sponsored a summit for members of the Consumer Coalition for Health Privacy to provide information on the details of the new health privacy regulations and to consider strategies for protecting and strengthening the regulations. GOVA staff participated on a "Call to Action" panel.

Met with Midwest Research Institute (MRI) and University of Kansas School of Nursing scientists to discuss issues regarding National Database of Nursing Quality Indicators (NDNQI) and its continuing development of national databanks and more intense analysis of the increasing pool of data.

Provided nursing input into the planning process for the National Coordinating Council on Medication Error Reporting Programs (NCC-MERP) invitational meeting on practitioner accountability.

Provided nursing's perspective on the enlargement of the National Coordinating Council on Medication Error Reporting Programs (NCC-MERP) by suggesting the inclusion of a nursing representative from ANA's Nursing Organization Liaison Forum (NOLF).

Continued to provide nursing input into the development of guidance on appropriate restraint to a Food and Drug Administration (FDA)/HCFA workgroup.

Heightened awareness of the need for nursing input into the deliberations of the Institute of Medicine (IOM) Committee on Assuring the Health of the Public in the 21st Century leading to the nomination of a well-qualified public health nurse.

Featured Becky Hartman, the daughter of patient Shirley Keck, who was permanently injured as a result of her hospital's short staffing at ANA's February 6 press conference on ANA's "Safe Staffing" survey.

Published "Nursing Quality Indicators Beyond Acute Care: Measurement Instruments" to validate community-based indicators.

Ethics and Human Rights

President Foley provided testimony, which was followed by documentation on the role of the professional registered nurse in the provision of care to the under served, to the IOM Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.

Represented ANA at educational session about new genetic findings resulting from completion of genome map on February 12 and at the National Institutes of Health genome gala that evening. Used this late breaking news to: educate ANA staff and to prepare update to the Human Rights Council at NYSNA.

Disseminated Draft 10 of the Code of Ethics for Nurses to the task force and advisory board. The Draft will be submitted to ANA's BOD at its March meeting and to the HOD in June 2001.

Nursing Standards and Guidelines

Attended Health Information Systems Society (HIMSS) annual conference February 4-8 to identify information systems products that include ANA recognized languages.

Attended the Drug Enforcement Agency Technical Working Group meeting for Electronic Prescriptions for Controlled Substances. The proposed rule is to be published in March, with the final rule due in June per Congressional mandate.

Nurses with prescriptive authority will be affected if they elect to migrate from paper-based prescriptions for controlled substances to a commercial electronic ordering system that transmits the prescription to dispensing pharmacies.

Scheduled and participated in telephone conference call for gerontological nursing scope and standards workgroup to finish addressing field review comments and what edits will be incorporated into the document to be forwarded to the Congress on Nursing Practice and Economics for approval.

Conducted telephone meeting with University of Iowa professor of nursing and University of Pennsylvania endowed chair of nursing to discuss preliminary strategies for review and revision of Nursing Minimum Data Set to ensure the United States' position in collaborating on international nursing minimum data set initiative.

http://www.ana.org/about/lately/ceofeb01.htm

(the work of just one month.)

--------------------------------------------------------------------------------