Empowering Nurses for the Future - nursingALD.com

An Official Publication of the Illinois Nurses Association The Voice of Illinois Nursing for more than 100 Years 

Volume 5 • No. 4 October 2009 

2009 INA Bylaws Proposed 

Pages 7, 10 

INA Convention 

October 14-17, 2009 

Yorktown Hilton 

Lombard Illinois 

Empowering Nurses for the Future 

Please join us for the Illinois Nurses’ 80th Biennial 

Convention Empowering Nurses for the Future. Held 

at the Yorktown Hilton in Lombard Illinois, INA’s 2009 

convention is a must attend event for anyone interested in 

nursing and the healthcare industry. 

With more than 27 CE course options, this year’s 

convention, Empowering Nurses for the Future, is 

designed to embrace and empower nurses in fields across 

the spectrum of nursing. 

Through its educational programs, the INA offers 

opportunities for more than 6,000 members and other 

healthcare professionals to develop expertise, form 

professional relationships and exercise leadership, while 

contributing to the future of nursing. 

This two-day convention is jam-packed with activities 

including exhibits, receptions and the INA Awards 

Banquet. Conference attendees will help chart the future 

of the organization while networking with peers and 

gaining insight into the nursing profession. Take advantage 

of this exciting opportunity to interact with hundreds of 

professional nurses! 

Please visit INA’s website to view the current sessions 

offered at the convention. Exact descriptions should 

be listed on the website by Sept. 15. Also, look for the 

unveiling of the new cover of INA’s Chart publication! 

Don’t forget that one lucky registrant will win a new HP 

Mini Netbook 

INA Convention Pull-Out 

Pages 7-10 

current resident or 

Presort Standard 

US Postage 

PAID 

Permit #14 

Princeton, MN 

55371 

Continuing Education 

Lateral Violence and Bullying in the Workplace 

Pages 11-13 

Registration Fees Member Non-Member Retiree Student 

One Day Registration 

(attendance at continuing 

education sessions only) 

$125.00 $150.00 $125.00 

Full Registration 

(includes award banquet) 

$250.00 $275.00 $175.00 

Late Registration $300.00 $350.00 $225.00 

Individual Awards 

Banquet Tickets 

(included in full registration) 

$50.00 $50.00 $50.00 

PAC Fundraising Event 

(price is separate from full Registration) 

$100.00 $100.00 $100.00 

FY 2009 Nurse Educator Fellowship Awards Ceremony (left to right, 1) MariJo Letizia, PhD, 

RN, APN/ANP-BC; 2) Mary K. Pabst, PhD, RN; 3) Victoria Folse, PhD, RN, APRN, BC, LCPC; 4) 

Mary Kakenmaster, MSN, RN; 5) Thelma Warner, MSN, RN; 6) Jodene Scheller, PhD, RN; 7) 

Teresa A. Saxton, MSN, RN; 8) Dawna Egelhoff, MSN, RN; 9) Michele Bromberg, MSN, APN, 

BC, Advisory Board Chair; 10) Mary Ann Freitag, DNP, RN; 11) Dianne M. Bazell,PhD, IBHE 

Deputy Director; 12) Sandra Hughes, PhD, RN; 13) Peggy A Gallahger, EdD, RN, CNE; 14) 

Frances R. Vlasses, PhD, RN, NEA-BC; and 15) Nancy Kipnis, MSN, RN) Unable to attend, 

Nancy Oldenburg, EdD, RN, CPNP and Patrick Robinson, PhD, RN, ACRN 

Nursing Faculty Receive Fellowship Awards 

The IBHE and the Advisory Board for the Illinois Center for Nursing recognized the 2009 Nurse Educator 

Fellows during the advisory board’s May meeting. This distinguished group of nursing faculty were nominated 

by their schools of nursing and competed against 37 applicants to become part of this select group of 15 Nurse 

Educator Fellows in fiscal year 2009. This program helps to ensure the retention of well-qualified nursing 

faculty at institutions of higher learning by providing a one-time salary supplement to the fellows. The IBHE 

application period for this program is early fall, pending the appropriation of state funds.

Page 2 October 2009 The Illinois Nurse 

President’s Message 

Pam Robbins BSN, RN 

President Illinois Nurses Association 

The acknowledgement that 

quality patient care is linked 

to the educated skilled nursing 

professional is finally reaching 

the ears of the healthcare industry 

and the public. The federal 

government’s move to identify 

preventable complications 

occurring in hospitals and 

restricting Medicare payment 

for such “preventable hospital 

acquired conditions” was 

initiated last year. The HHS. 

gov web page of Centers Pam Robbins 

for Medicare and Medicaid 

Services (CMS) has a fact sheet, 

“Medicare Takes New Steps to Help Make Your Hospital 

Stay Safer” that outlines reasonably preventable conditions. 

The federal government cited several selected conditions they 

believe are “reasonably preventable” by following evidencedbased 

guidelines. Conditions identified as costly or common 

hospital acquired conditions range from retained foreign 

objects post-surgical procedures to severe pressure ulcers. 

Documentation of conditions not present on admission will 

be on a “no pay list” for reimbursement. Finally, they are 

listening to what nurses have been saying for years. Payment 

of continued identifiable poor outcomes costs more to the 

federal government system and it is unacceptable! Reasonable 

oversight to reducing such hospital acquired conditions seen 

as avoidable was based on evidence based research. In this 

equation, qualified skilled professional nursing care begets 

better patient outcomes and leads to the reduction of mortality 

and morbidity rates, evidence any nurse already knows! So 

how does the nurse find a foothold validating quality nursing 

care in their individual work place? 

Let’s return to the backbone of nursing education, 

Evidenced-Based (E-B) research. “Nursing research 

provides a specialized base of scientific knowledge that 

helps the nursing profession to anticipate and successfully 

meet the constantly changing challenges of healthcare 

provision and gives us leverage to maintain and justify our 

importance and relevance in current and future societies” 

(Nellett, 2009, p. 1). Nursing standards of any specialty 

rely on sound nursing research when determining what 

the standards of practice should be. Nursing professionals 

whether at the bedside, supervisory or master’s prepared 

nursing researcher, are all consumers of nursing research 

and all can assist in improving patient outcomes if 

common goals are embraced. Simply said, “a consumer of 

nursing research is one who reads, reviews and critiques 

nursing research findings and who attempts to use and 

apply the findings in practice. … Nursing research links 

theory, practice and education” (Nellett, 2009, p. 2). How 

does the bedside professional nurse responsible for direct 

care accomplish such? Here are some key guides for safe 

care and activation of E-B research. 

Nurses must know the regulatory law and rules 

(policies) of their institution. You must be knowledgeable 

in your own specialty practice as to what are the 

standards of care in that particular specialty. If you are 

practicing outside of any of these, you must address 

them immediately! Document your care clearly in the 

medical record. If gaps are seen in nursing care, report 

them, investigate and discover, through E-B research, 

improvements to delivery safer care. It is paramount that 

buy-in happens from the bedside nurses to administration 

when embracing a commitment to improved healthcare 

delivery. Sound nursing research and existing specialty 

nursing standards can improve changes in delivery of care. 

Better healthcare delivery systems decrease patient injury 

and it is up to nursing to define what is best for patients 

and the profession. 

Nursing research is the road to improving care. 

The idea that work environments are driven by cost 

containment only validates the need to push for nurses to 

advocate for nursing care that is based on sound nursing 

research. E-Based Practice is gaining momentum even 

though it has been around since the day of Florence 

Nightingale, whose concepts are congruent with the 

present priorities of nursing research…promotion of health, 

prevention of disease. (Lo-Biondo-Wood & Haber, 2006). 

All nurses are consumers of nursing research. To 

modify your work environment, use evidenced based 

data! This is a great start to defining staffing requirements 

for specific patient populations. The care of the patients 

is directly related to their aggregate needs AND the 

educational background and skills of the registered nurses 

caring for them. The bedside nurse can search databases to 

find research to update their nursing practices and improve 

patient outcomes. Access is available though hospital 

libraries, and educational institutions. Every hospital 

with a healthcare curriculum most certainly has database 

access. You want nursing research articles that may be 

downloaded in full-text and include such databases as 

CINAHL Plus, Cochrane Collection, Cochrane Database of 

Systematic Reviews, and Database of Abstracts of Reviews 

of Effectiveness (DARE). Also useful are the following 

databases, but there may not be full text, articles: Medline 

(First Search) and Medline Plus. Identify improvements 

and share with administration and colleagues. Your E-B 

research is the bedrock of your presentation! 

How does an Illinois nurse then activate what he/ 

President’s Message continued on page 3 

Il l I n o I s nu r s e s As s o c I A t I o n 

President 

Pamela Robbins, BSN, RN: pamrobbins@urbancom.net 

First Vice President 

Mildred Taylor, BSN, RN: m.taylor.rn@comcast.net 

Second Vice President 

Roosevelt Gallion, M.Ed, BSN, RN: RG2194@aol.com 

Secretary 

Lori Anderson, CRNA, RN: react911@aol.com 

Treasurer 

Sharon Zandell, RN: sharon.zandel@med.va.gov 

Board of Directors: 

Rebecca O. Armea, RN: rarmearn@sbcglobal.net 

Sandra Fischer, RN: fish23w@yahoo.com 

Queen Gallien-Patterson, RN: qpatterson@aol.com 

P. Joan Larsen, RN: pjscrapbook@frontiernet.net 

Terri L. Williams RN: sewpro9370@aol.com 

Joyce Bailey RN: jabrn_51@webtv.net 

Barbara M. Gaffke, PhD, MSN, CS: gaffke5@ameritech.net 

Mary Bortolotti, RN: mandkbort@aol.com 

Karen Kelly, EdD, RN, CNE-BC: kkellys@aol.com 

Pamela J. Para RN, MPH, CPHRM, ARM, FASHRM: 

pjpara2001@yahoo.com 

Ruby P. Reese RN PhD 

Susan Draine: susan.draine@comcast.net 

District Presidents 

1 Roosevelt Gallion: RG2194@aol.com 

2 Mary Bortolotti: mandkbort@aol.com 

3 Sharon Peterson: speterson@crusaderclinic.org 

5 Royanne Shultz: royanneschultz@hotmail.com 

8 Ann O’Sullivan: aosullivan@blessinghospital.com 

9 Terri Williams: sewpro9370@aol.com 

10 Jane Bruker: jkbru@aol.com 

13 Janet Lynch: lynch.janet08@gmail.com 

14 Martha McDonald: Martha.mcdonald@sih.net 

15 Vacant 

17 Ann Smith: nevann@comcast.net 

18 Vacant 

19 Margaret Kraft: margaret.kraft@att.net 

20 Cheryl Anema: tccnurse@aol.com 

21 Sandra Webb Booker: stethes@yahoo.com 

E & GW Commission 

Sandra D. Robinson, Chair: nursemoney06@yahoo.com 

Linda Briggs: lindasbriggs@yahoo.com 

LaGretta Green: ltg1106@aol.com 

Rosemary Kelly: ranajarkelly@yahoo.com 

Virginia Rockett: momynator@yahoo.com 

Judith K. Hopkins: Sicu40@aol.com 

Thomas Magana: ndirish01@sbcglobal.net 

Christine H. Szkarlat: Christine.Szkarlat@va.gov 

Joseph Williams: Sangamojoe@aol.com 

Local Unit Chairpersons/Co-Chairs 

City of Chicago: Timothy Hudson 

RC-23 State of Illinois: Lee Goehl 

Co-Chair Bill Schubert 

St. Joseph: Marlene Murphy and Chris Daly 

Union Health Services: Sophie Heldak 

University of Chicago: Karen Keller and Tom Magana 

University of Illinois: Marcia Hymon (D20), Leo Sherman 

VA Hines: Gail Robinson 

Christine Szkarlat (D9) 

VA North Chicago: Thelma Fuentes 

VA Westside: Murrie Davis (D01)

The Illinois Nurse October 2009 Page 3 

Il l I n o I s nu r s e s As s o c I A t I o n 

Illinois Nurses Association/ 

Illinois Nurses Foundation 

105 W. Adams, Suite 2101 911 S. Second Street 

Chicago, IL 60603 Springfield, IL 62704 

312/419-2900 217/523-0783 

Fax: 312/419-2920 Fax: 217/523-0838 

www.illinoisnurses.com 

Executive Director: 

Susan Swart, MS, RN: Ext. 229, sswart@illinoisnurses.com 

Chief Financial Officer: 

Rick Roche: Ext. 230, rroche@illinoisnurses.com 

Program Director, EGW: 

Elwood R. Thompson: Ext. 228, ethompson@illinoisnurses.com 

Deputy Executive Director: 

Sharon Canariato, MSN, MBA, RN, Ext. 235 

scanariato@illinoisnurses.com 

Director of Marketing and Member Services: 

Joseland Nixon, MS: Ext. 232 jnixon@illinoisnurses.com 

Associate Director, Continuing Education: 

Kemi Ani, Ext. 240 kani@illinoisnurses.com 

E&GW Staff Attorney: 

Alice Johnson, Ext. 239, ajohnson@illinoisnurses.com 

E&GW Staff Specialists: 

Rick Lezu, 217-523-0783 rlezu@illinoisnurses.com 

Remzi Jaos, Ext. 245 rjaos@illinoisnurses.com 

Pam Brunton, Ext. 224 pbrunton@illinoisnurses.com 

Abass Wane, Ext. 249 awane@illinoisnurses.com 

E&GW Coordinator: 

Rhonda Perkins, Ext. 223 rperkins@illinoisnurses.com 

Coordinator, Springfield 

Staci Moore, 217-523-0783 staci@illinoisnurses.com 

Staff Accountant: 

Toni Fox, Ext. 243 tfox@illinoisnurses.com 

Administrative Assistant: 

Brenda Richardson, Ext. 248 brichardson@illinoisnurses.com 

Melinda Sweeney, Ext. 222 msweeney@illinoisnurses.com 

Editorial Committee 

Theresa Adelman, RN 

Alma Labunski, EdD, MS, RN, Chair 

Margaret Kraft, RN, PhD 

Linda Olson, PhD, RN 

Lisa Anderson Shaw DPH, MA, MSN 

Mary Shoemaker, PhD, BS, MS, RN 

The Illinois Nurse is published quarterly (4 issues yearly) by the 

Illinois Nurses Association, 105 W. Adams, Suite 2101, Chicago, 

IL 60603. 

Advertising Rates Contact—Arthur L. Davis Publishing Agency, 

Inc., 517 Washington St., P.O. Box 216, Cedar Falls, Iowa 50613, 

(800) 626-4081, sales@aldpub.com. INA and the Arthur L. 

Davis Publishing Agency, Inc. reserve the right to reject any 

advertisement. Responsibility for errors in advertising is limited to 

corrections in the next issue or refund of price of advertisement. 

Acceptance of advertising does not imply endorsement or approval 

by the Illinois Nurses Association of products advertised, the 

advertisers, or the claims made. Rejection of an advertisement 

does not imply a product offered for advertising is without merit, 

or that the manufacturer lacks integrity, or that this association 

disapproves of the product or its use. INA and the Arthur L. Davis 

Publishing Agency shall not be held liable for any consequences 

resulting from purchase or use of an advertiser’s product. Articles 

appearing in this publication express the opinions of the authors; 

they do not necessarily reflect views of the staff, board, or 

membership of INA or those of the national or local associations. 

President’s Message continued from page 2 professional nursing services are delivered. Building safer 

she needs to do in the work environment? Using nursing 

research is simple. After you have found the research that 

helps you validate your concerns, working with a Clinical 

Nurse Specialists whose expertise is educating nursing 

staff will be key to implementing any hospital’s quality 

improvement plan. Institutions should have qualified 

Masters and Doctorate prepared nurses to assist in the 

needs of improving healthcare delivery systems to produce 

better patient outcomes, and education for bedside nurses 

to engage in improving nursing care for their patient 

populations. All nurses are consumers of nursing 

research. Nurses, who are organized in nursing unions, 

have Nursing Care committees for improving practice/ 

working conditions. Yes, work conditions for nurses are 

inseparable from nursing practice issues! Share the gaps of 

your current work situation and develop a plan to improve. 

Use E-B data as a resource when working with the Nursing 

Committee to determine staffing plans. The formation of 

this type of committee is mandated at every hospital by 

the Illinois law Nurse Staffing by Patient Acuity (PA 95- 

0401). 

INA has educational CE’s to assist professional 

nurses in learning how to become a consumer of nursing 

research and building your nursing advocacy skills. 

Join your professional nursing association, the Illinois 

Nurses Association, to advance your advocacy skills and 

advance your nursing practice. Safe care emanates from 

adequate nurse staffing based on patient aggregate needs 

and the skills and abilities of the registered nurse, when 

healthcare delivery systems is the recommendation of the 

Institute of Medicine’s federal study. All levels of nursing 

are to be engaged using Nursing Research as road map to 

improve patient care. I truly believe it is time to activate 

the process and have nursing define the improvements 

needed in today’s healthcare system. Nursing research has 

communicated for decades that the value of quality nursing 

care is priceless. 

www.cms.hhs.gov/apps/media/fact_sheets.asp August 

4, 2008 “Medicare Takes New Steps to Help Make Your 

Hospital Stay Safer” 

Lo-Biondo-Wood & Haber. (2006). Nursing Research 

Methods and Critical Appraisal for Evidence-Based 

Practice. St. Louis: Mosby Elsevier. 

Nellett, G. H. (2009). Lecture 1 Notes from Nursing 

Research, Summer 2009, 

Staffing by Patient Acuity—Public Act (PA) 95-0401 

www.ilgov The Illinois General Assembly Homepage


INA Convention Benefits Anyone involved in the Nursing Industry 

Participation at the INA Convention gives you more 

one-on-one exposure to more healthcare professionals you 

could ever hope to meet in the nursing industry during 

one event. You also get the chance to learn the latest in 

healthcare technology, well before it hits the market. By 

exhibiting at the INA Convention, you’ll get a chance to 

meet the top leaders in the nursing industry. INA supports 

your exhibit investment in a variety of ways: 

• Innovative programming will draw more than 500 

INA attendees. 

• More than 80% exclusive exhibit hours are scheduled 

to give you maximum visibility and exposure to this 

target market. 

• A grand opening reception, sponsored by INA, will 

showcase your products and services during kick off 

of the convention in the exhibit hall. 

• Each exhibitor will receive a list of all attendees 

for follow-up and future sale and promotional 

opportunities 

To request an Exhibitor Prospectus and take advantage 

of this opportunity to reach your target market effectively 

and efficiently, contact Joseland Nixon at 312-419-2900, 

x232. 

Exhibitor Information 

Exhibit Fees 

Premium Exhibit space . . . . . . . . . . . . . . . . . . . . $1,000 

Includes premium location in exhibit hall and ½ page 

ad in both program booklets 

Standard Exhibit space . . . . . . . . . . . . . . . . . . . . . . $750 

Includes standard 8x10 exhibit space and ¼ page ad in 

both program booklets 

Budget Exhibit space . . . . . . . . . . . . . . . . . . . . . . . . $500 

Includes standard 8x10 exhibit space 

Set-Up 

Thursday, October 15th after 1 p.m. 

Exhibit Schedule 

Thursday, October 15th 

4:45 p.m. – 6:15 p.m. Reception in Exhibit Hall 

Friday, October 16th 

Continuing Education scheduled throughout the day. 

Friday’s Exhibitor events include: Breakfast at 7:30 a.m. 

(Exhibitors only); Exhibit Hall Open at 8 a.m. - Breakfast 

for attendees in exhibit area; Lunch in exhibit hall at 11:30 

a.m. (Exhibitors only); Exhibit Hall Open for Lunch at 

noon. 

Breakfast and lunch for two exhibitors per booth is 

included in your exhibit cost. Additional meals can be 

purchased in advance of the event for a nominal charge. 

Tear Down 

Friday, October 16th 

4:00 p.m. – Exhibit Hall will close at 4:30 p.m. 

How Well Is Your Workplace Staffed? 

by: Sharon V. Canariato, MSN, MBA, RN 

Insufficient nurse staffing 

is among the top concerns for 

nurses today. Recent studies 

have demonstrated what most 

nurses already know: nursing 

care and patient safety are 

absolutely linked. Research 

has shown that improved 

RN staffing has a beneficial 

effect on patient outcomes and 

mortality. Nurses, therefore, 

play a critical role in patient 

safety and quality of care. Safe 

nurse staffing is at the top of 

the Illinois Nurses Association 

agenda. 

Sharon Canariato 

An American Nurses Association poll of registered 

nurses nationwide reveals their significant concerns 

over how nurse staffing affects the quality of care, and 

contributes to the growing nursing shortage. The results 

highlight the need for adequate nurse staffing critical to 

the delivery of quality patient care. 

The ANA poll of 14,933 nurses was completed on the 

website safestaffingsaveslives.org from March 31, 2008 to 

June 5, 2009. These were the findings: 

• What is your role? 

Staff Nurses = 74% 

Other = 18% 

Nurse Managers 8% 

• How often do you engage in non-nursing roles? 

Examples: Delivering meal trays, transfer 

patients, draw labs, go to pharmacy 

Always (Every Day) = 65.7% 

Frequently (Once a Week) = 18.2% 

Sometimes (Once a Month) = 5.8% 

No Response = 4.1% 

Rarely (Less than Monthly) = 4.0% 

Never = 2.2% 

• How often are you able to take your full meal 

break? 

Sometimes (Once a Month) = 24.7% 

Rarely (Less than Monthly) = 24.1% 

Frequently (Once a Week) = 23.1% 

Always (Every Day) = 12.4% 

Never = 11.7% 


• Would You Feel Confident Having Someone close 

to you Receive Care in the Facility in Which You 

Work? 

No = 49.5% 

Yes = 45.9% 


• Do You Believe the Staffing on Your Unit and 

Shift is Sufficient? 

No = 71.9% 

Yes = 23.5% 


• Are You Currently Considering Leaving Your 

Position? 

Yes = 52.7% 

No = 45.0% 


• If You Are Considering Leaving Your Current 

Position, Is the Reason Associated with 

Inadequate Staffing? 

Yes = 42.2% 

Not Applicable = 30.6% 


No = 11.3% 

INA believes that providing nurses with the authority 

to establish nurse staffing plans, as evidenced by Illinois’ 

new Nurse Staffing by Acuity law, ensures that patients’ 

needs would be met and the working environment of that 

nurse would be improved. Some factors to be considered 

in developing a safe staffing plan includes the acuity level 

of the patients, staff experience and skill mix, the need for 

nurses to have adequate opportunity and time to exercise 

professional judgment with respect to patient care and 

an acknowledgement that patient needs can change from 

moment to moment. 

If you would be interested in attending a working 

seminar to develop a staffing plan for your hospital and/ 

or unit, please contact Illinois Nurses Association at 312- 

419-2900.


APN Journey to Remove Barriers to Practice 

by Bridget A. Cahill, APN/CNP 

Chairperson, ISAPN Government Relations 

Committee 

The Illinois Society of Advanced Practice Nursing 

(ISAPN), Illinois Nurses Association (INA) and the 

Illinois Association for Nurse Anesthetists (IANA) are 

working together to advance legislation that will remove 

the restrictive language regarding the mandated written 

collaborative agreement with a physician. It will likely be 

a long journey, but as nurses and advanced practice nurses, 

we are used to challenges. 

A recap of 2009 events surrounding our journey: SB 

1600 was introduced to remove all references to the written 

collaborative agreement (WCA) in all statutes. As a united 

front ISAPN, INA, and IANA co-hosted a legislative 

reception to educate legislators on our issue. The bill was 

released from the Senate Committee on Assignments and 

a hearing was held. All APN specialties were represented 

and presented compelling testimony. The bill did not pass, 

but we made great strides in our first curve of our journey. 

One thing we learned is that not all nurses understand 

the WCA, its implications, and how it can be a method to 

‘control’ the scope of practice of APNs. 

The specific language regarding the WCA can be 

found in Section 65-35 of the Nurse Practice Act. (Log 

onto www.idfpr.com, click Department of Professional 

Regulation, and select ‘nursing.’ That will take you directly 

to the Nurse Practice Act and the language in question. 

What is a written collaborative agreement? Does it 

protect or hinder APN practice? 

A Written Collaborative Agreement: 

• Is an agreement, that must be signed by both the 

APN and physician describing the APN scope of 

practice and articulating specifics to the working 

relationship. It is NOT a work contract! Nor does it 

provide such security. 

• It is not liability protection. The APN is accountable 

for his/her own judgment and decisions. 

• Guidelines must be developed between the APN and 

physician, and followed by the APN and physician. 

• The APN and physician MUST meet in person once 

a month. (CRNA readers, check the specific Act 

language for your requirements.) 

• If an APN wishes to collaborate with more than one 

physician, that is permissive as long as the APN 

provides a copy of all agreements to a physician, 

should he/she request the written collaborative 

agreement. 

Eliminating the written collaborative agreement does 

not and will not remove the requirement to collaborate 

with our physician colleagues and any other member of 

the healthcare team. APNs know and respect the work 

of our colleagues and recognize physician specialists are 

needed to provide the best care possible to our patients. 

And APNs know the limits of their scope of practice based 

on their individual education and experience. We know 

when to ask for collaboration and consultation. A WCA, as 

currently required, is simply not needed for collaboration 

and cooperation to exist. Recall that prior to the statutory 

licensure, APNs did practice, and practiced safely, without 

a WCA! The challenge is in front of us. We know it will 

be a tough, multi-year process. And, we know we need the 

understanding and support of every nurse in the state. 

Educate ourselves first and then the legislators will 

enable us to take the next step! We need your help!! 

Please volunteer to become grassroots activist. Contact me 

(bacgovrel@comcast.net) if you desire to get involved and I 

will connect you with the GR Chairs of each organization 

working together to make this a reality. Nursing has a 

long and powerful history of affecting change in Illinois 

healthcare when we stand together and make our voices 

heard. I invite you to join us.


Illinois Nurses Foundation 

Foundation Seeks to Aid 

Nurses in Need 

The Illinois Nurses Foundation understands times are hard, but they are even harder 

for those less fortunate. In this tough economic environment, we have seen many people 

suffering without food, clothing or shelter. Among those in need are nurses. The Illinois 

Nurses Foundation has created a Caring Garden to grow a special fund to provide this 

much needed assistance. Through your efforts to grow this fund, you will be tending to 

the future hopes of these nurses. 

Nurses who are facing financial hardship due to illness, natural disaster, personal or 

family crisis often have no place to turn. INF wants to give them hope, one more way to 

further our mission to support the nurses of Illinois. The donation form located here is 

also on our website at www.illinoisnurses.com. Please support these nurses today. This 

special fund is the only one of its kind in Illinois; help us give the nurses in crisis a ray of 

hope. Donate today! 

Name: 

Address: 

City, State Zip: 

Donation amount: 

Check Check Number: 

Credit Card 

Visa MasterCard 

Card Number : 

Expiration Date: 

Name on Card: 

Verification Code (On back of card): 

Mail donations to: 

Illinois Nurses Foundation- Nurses in Need 

105 W. Adams St., 

Suite 2101 

Chicago, IL 60603


2009 INA Bylaws Proposed 

CURRENT BYLAW 

Article V Members 

Section 5.02 Membership Privileges 

In addition, each member, who is eligible to be organized for purposes of 

collective bargaining, shall have the right to: 

(8)exercise freedoms of speech and assembly, as protected by the United States 

Constitution and federal and state statutes; and to, form, join, and assist any 

labor organization which is not in direct competition with the INA, other 

constituent member associations (CMAs) and ANA. The exercise of these 

rights, in and of themselves does not constitute grounds for disciplinary action 

by ANA. 

PROPOSED BYLAW AMENDMENT 


Add new (7) and (8) to Article V Members Section 5.02 (a) Membership 

Privileges and renumber current (7) to (9). 

(7) INA only members do not receive benefits from ANA at the national 

level; and, 

(8) RNs working or living in Illinois may join at the state level only, at 

any time and for such periods of time that INA state only membership is 

sanctioned by a written agreement with the ANA; 

In addition, each member, who is eligible to be organized for purposes of 

collective bargaining, shall have the right to: 

(9) exercise freedoms of speech and assembly, as protected by the United 

States Constitution and federal and state statutes; and to, form, join, and assist 

any labor organization which is not in direct competition with the INA, other 

constituent member associations (CMAs) and ANA. The exercise of these 

rights, in and of themselves does not constitute grounds for disciplinary action 

by ANA. 

Conformity with ANA Bylaws. 

RATIONALE 

CURRENT BYLAW 

Section 5.04 Transfer - State 

Transfer of membership from INA to another Constituent Member Association 

and from another ANA Constituent Member Association to INA shall be in 

accordance with ANA bylaws. 


Add new language to Section 5.04 Transfer - State 

Transfer of membership from INA to another Constituent Member Association 

and from another ANA Constituent Member Association to INA shall be in 

accordance with ANA bylaws, without payment of additional dues. The 

transferring constituent is not required to refund to the individual 

member nor to the receiving constituent dues already paid. 

Conformity with ANA Bylaws. 

Article VII Dues 

Section 7.04 Dues to ANA 

RATIONALE 

CURRENT BYLAW 

The INA shall be bound by the obligation to pay dues to the ANA pursuant to 

the ANA bylaws and the House of Delegates policy and until such time that 

INA members vote to disaffiliate from ANA by 2/3 of the vote cast by a ballot 

distributed to the entire INA membership. This vote may occur by mail or 

electronic ballot, with appropriate notice and procedures to protect the integrity 

and validity of the vote. 

Article VII Dues 

Section 7.04 Dues to ANA 


INA shall remit a portion of dues to the ANA that is equal to that which 

INA remits to ANA for direct members in accordance with the ANA 

dues policy and the written agreement between the INA and ANA. The 

INA shall be bound by the obligation to pay dues to the ANA pursuant to the 

ANA bylaws and the House of Delegates policy and until such time that INA/ 

ANA members vote to disaffiliate from ANA by 2/3 vote of the entire INA/ 

ANA membership. This vote may occur by mail or electronic ballot, with 

appropriate notice and procedures to protect the integrity and validity of the 

vote. 

Conformity to ANA Bylaws. 

RATIONALE 

It is noted that INA and ANA have no written agreement. 

CURRENT BYLAW 

Article XI Officers and Directors 

Section 11.02 Directors 

There shall be 14 directors, 4 of whom shall be staff nurses. Directors are 

elected each biennium in the manner provided in Article XXI. 


Article XI Officers and Directors 

Section 11.02 Directors 

There shall be 10 directors. Directors are elected each biennium in the manner 

provided in Article XXI. 

RATIONALE 

This director number change is prudent, from a fiscal standpoint, and because 

INA has significantly fewer members than when this number of directors 

was chosen. Designating staff nurse seats on the INA BOD was done at a 

time when there were very few staff nurses serving on the INA Board. The 

intent was to designate, for a temporary period of time, seats for staff nurses 

to aspire to. For the last many elections, a significant portion of the INA BOD 

are nurses in direct care. The term staff nurse, becoming less used, no longer 

strictly defines the direct care nurse. With the broad range of titles and job 

descriptions, clinical designation is almost impossible to gauge. 

CURRENT BYLAW 

Article XII Board of Directors 

Section 12.01 Composition 

The Board of Directors shall consist of the following: 

a) five officers of INA; 

b) fourteen directors, four of whom shall be staff nurses 


Article XII Board of Directors 


The Board of Directors shall consist of the following: 

a) five officers of INA; 

b) ten directors 

RATIONALE 

This director number change is prudent, from a fiscal standpoint, and because 

INA has significantly fewer members than when this number of directors 

was chosen. Designating staff nurse seats on the INA BOD was done at a 

time when there were very few staff nurses serving on the INA Board. The 

intent was to designate, for a temporary period of time, seats for staff nurses 

to aspire to. For the last many elections, a significant portion of the INA BOD 

are nurses in direct care. The term staff nurse, becoming less used, no longer 

strictly defines the direct care nurse. With the broad range of titles and job 

descriptions, clinical designation is almost impossible to gauge. 

CURRENT BYLAW 

Article XVIII Commissions 


The Commissions on Continuing Education and Economic and General 

Welfare shall consist of nine members. The Commission on Workforce 

Advocacy shall consist of five members. 




The Commissions on Continuing Education, Workforce Advocacy and 

Economic and General Welfare shall consist of nine members. 

RATIONALE 

Consistency of membership across all commissions. The Commission on 

Workforce Advocacy needs additional members due to the current projects. 

Section 18.06 Terms 

(See Proviso) 

Section 18.06 Terms 

(See Proviso) 

CURRENT BYLAW 


RATIONALE 

Note Proviso: As approved at 2008 HOD. 

Three (3) Commission on Workforce Advocacy (CWFA) Commissioners shall 

be elected for the 2011-2015 term. Two (2) CWFA Commissioners will remain 

in their positions from 2007-2013. This will ensure future staggered terms. 

The CWFA will decide the slots by lot or by attrition. 

Bylaws Proposed Amendments continued on page 10 

2009 INA Convention


INA Convention Schedule 

Thursday, October 15, 2009 Schedule 

4:00pm-7pm Registration 

4:45pm-6:15pm 

6:15pm-8pm 

Exhibitor Welcome Reception 

PAC Reception 

Thursday, October 15, 2009 

Registration: 4:00 pm – 7:00 pm 

Exhibitor Welcome Reception: 4:45 pm – 6:15 pm 

PAC Event: 6:15 pm – 8:00 pm 

2009 INA Convention 

Friday, October 16, 2009 

7:00am-3pm Registration 

7:00am-4pm Exhibit Hall 

7:00am-9am Breakfast with Exhibitors 

Concurrent Sessions 

9:00am-10 am Psycho-Neuro Immunology and Allostasis: 

Translating Research into Practice—Rebecca 

West, APN/CNP 

Interventional Options for the Treatment of 

Emphysema—Theresa Boley, APN/CNP 

Demystifying Grassroots Lobbying (repeated 

session) 

Changes to the ANCC Continuing Education 

Criteria— Jean Roberson, MS, RN 

Lateral Violence and Bullying in the 

Workplace—Ann O’Sullivan, MSN, RN, CAN 

Newborn Hearing Screening: Why We Do It 

and Why It Matters—Gail Tanner, AuD 

9:00am-2pm Onsite voting/INA office 


10:15am-11:15am Reimbursement Issues— 

Marie Lindsey, APN/CNP, PhD 

A Case-Based Approach to Improving 

Outcomes in HIV/AIDS— 

Ann Williams, EdD, ANP 

Patient Evaluation after Bariatric Surgery — 

Ed Schafer, RN, DNP 

Presenting Educational Opportunities for 

Nursing— 

Alexia Hieber Johnson, APN/CNS, CCRN 

Retaining Nurses: What Will It Take? —Patti 

Ludwig-Beymer, PhD, RN, CTN 

Telemedicine: The Future is Now — Pamela 

J. Para, RN, MPH 

Write is Might: Running from Risk— Linda J. 

Hay, JD and 

Susan A. Wagener, RN, JD 

11:15am-12:30pm General Session-How to Stay Energized in a 

Changing World—Greg Risberg, MSA, CSP 

12:30pm-2:00pm Lunch with Exhibitors 


2:00pm-3:00pm CXR Basics for APNs— 

Maria Connolly, APN/CNS, PhD 

What Do We Tell the Kids? Practical Tips for 

Discussing Death and Dying with Children— 

Megan Styx, APN/CNP 

NP Malpractice and Remedies— 

Ellen Wodika and Nancy Lagorio 

Preceptor Model Proposal— 

Susan Draine, MSN, RN 

Employee Free Choice Act—Al Martin 

Leading Change in Creating a Blueprint for 

Cultural Competency, Part I— 

Growing the Nursing Workforce in Illinois 

—Linda B. Roberts, MSN, RN 


3:15pm-4:15pm Suturing Workshop—Ed Schaefer, RN, DNP 

Nursing Research: How to Get Started— 

Donna Plonczynski, APN/CNP 

Enhancing Ethics with Movies— 

Laura McAnally, BNS, RN, MA, MJ 

Staffing by Acuity Law— 

Debra L. Weiderman, BSN, RN 

Leading Change in Creating a Blueprint for 

Cultural Competency Part II— 

The History of Collective Bargaining at 

INA—Linda B. Roberts, MSN, RN 

5:00pm-6:00pm Illinois Nurses Foundation (INF) Reception 

6:30pm-9:30pm Awards Banquet 

Saturday, October 17, 2009 

7:00am-8:00am Breakfast 

7:30am-8:30am Registration/Credentialing 

8:30am-12:00pm House of Delegates 

12:00pm-1:30pm Lunch on your own 

12:00pm-1:30pm New Board Meeting/Lunch 

1:30pm-4:00pm House of Delegates 

Friday, October 16, 2009 

Registration: 7:00 am – 3:00 pm 

Breakfast with Exhibitors: 7:00 am – 9:00 am 

Onsite Voting 9:00 am – 2:00 pm 

CONCURRENT SESSIONS: 9:00 AM – 10:00 AM 

• Psycho-Neuro Immunology and Allostasis: Translating Research into 

Practice, Rebecca West, APN/CNP 

○ Explains the conceptual framework of psycho-neuro immunology and 

how it relates to allostasis, allostatic load, nursing research and practice. 

Discusses key findings from current related research 

• Interventional Options for the Treatment of Emphysema, Theresa Boley, 

APN/CNP 

○ Discusses types of emphysema, causes and therapies. Defines process 

for patient selection in common emphysema treatments 

• Demystifying Grassroots Lobbying 

○ Identifies components of grassroots lobbying in order to facilitate change 

in the workplace and legislature. Discusses strategies to implement a 

successful grassroots program 

• Changes to the ANCC Continuing Education Criteria, Jean Roberson, MS, RN 

○ This program will explain current guidelines for creating a nursing 

CE program, and how these guidelines will be affected by upcoming 

changes to the ANCC criteria 

• Lateral Violence and Bullying in the Workplace, Ann O’Sullivan, MSN, RN, CAN 

○ Don’t be bullied in the workplace! This program highlights the signs and 

characteristics of nurse workplace abuse and harassment. See how you can 

protect yourself and improve the workplace to protect other nurses. 

• Newborn Hearing Screening: Why We Do It and Why It Matters, Gail 

Tanner, AuD 

○ Newborn hearing screening in Illinois became mandatory in 2002. 

While screenings are performed in all nurseries in Illinois birthing 

hospitals, nurses performing the screenings rarely understand the 

electro-physiological methodology they employ. The goal is to develop 

an understanding of the “bigger picture” of newborn hearing screening 

CONCURRENT SESSIONS: 10:15 AM – 11:15 AM 

• Reimbursement Issues, Marie Lindsey, APN/CNP, PhD 

○ Reimbursement concepts are critical to APN practice. Underlying issues 

related to Medicaid, Medicare and private insurance will be discussed. 

• A Case-Based Approach to Improving Outcomes in HIV/AIDS, Ann 

Williams, EdD, ANP 

○ Be able to identify patients at risk for HIV and utilizing routine 

testing. Initiating HAART through a case-based approach. Implement 

strategies for the management of side effects, overall management and 

unique diagnostic challenges 

• Patient Evaluation after Bariatric Surgery, Ed Schaefer, RN, DNP 

○ Discusses anatomical changes that occur from different bariatric 

surgical procedures. Reviews typical and atypical presentation of 

abdominal complaints associated with bariatric surgery. Discusses 

workup and disposition of pathology 

• Presenting Educational Opportunities for Nursing, Alexia Hieber Johnson, 

APN/CNS, CCRN 

○ This program describes the process of developing CNE for the 

beginning educator, staff nurses and advanced practice nurses. This 

program will empower nurses to share knowledge through CNE 

programs at the unit level and beyond. The program starts with 

concepts of adult learning theory. 

• Retaining Nurses: What Will it Take? Patti Ludwig-Beymer, PhD, RN, CTN 

○ This course will look at the self perceptions of knowledge and expertise 

in older and younger nurses. Factors that influence willingness to 

remain in the workforce will be addressed. Discussion will also center 

on modifications to support older nurse retention. 

• Telemedicine: The Future is Now, Pamela J. Para, RN, MPH 

○ This presentation will illustrate what nurses should know about 

telemedicine from historical, legislative and patient safety perspectives. 

The presentation will explore nurses’ involvement in this emerging 

field, as well as broader concepts related to telemedicine as a strategy/ 

tool for health care reform. 

• Write is Might: Running From Risk, Linda J. Hay, JD and Susan A. Wagener, 

RN, JD 

○ The goal of this presentation is to provide nurses with a brief overview 

of the legal process, to better understand what is required by the law to 

prove and defend a nursing malpractice case. This seminar will provide 

some basic risk management concepts that apply to nurses, including 

the need for good documentation, the critical importance of the medical 

record, and what the complete medical record entails. The seminar 

will discuss the use of electronic medical records in this context 

including emails, laptop computers and related technologies in the risk 

management context. Finally, the seminar will address some common 

bases for nursing liability such as communication with other health 

care providers, admission and discharge issues, chain of command, and 

policies and procedures 

KEYNOTE SESSION: 11:15 AM – 12:30 PM 

• How to Stay Energized in a Changing World, Greg Risberg, MSA, CSP 

○ Discusses elements of genuine communication and obstacles in its 

achievement. Demonstrates ways of communicating which are more honest, 

yet appropriate, to the situation. Assists you in recognizing stress indicators 

and applying methods of stress reduction in your own life


of Events Join Us for these Special Events 

Thursday, October 15 

4:45pm-6:15pm Exhibitor Reception 

Lunch with Exhibitors: 12:30 pm – 2:00 pm 

Kick off INA’s 80th Biennial Convention with this 

annual welcoming event. Join us in thanking this year’s 

CONCURRENT SESSIONS: 2:00 PM – 3:00 PM 

exhibitors for their support of INA and the nursing 

profession during the past year as you network with old 

friends and establish new contacts. 

• CXR Basics for APNs, Maria Connolly, APN/CNS, PhD 

○ Reviews basic radiographic lung densities. Describes an approach to 

ensure thorough interpretation and characteristics found in the primary 

and acute care settings 

• What Do We Tell the Kids? Practical Tips for Discussing Death and Dying 

with Children, Megan Styx, APN/CNP 

○ Describes the central elements in a child’s concept of death and the normal 

grief responses. Identifies age-appropriate strategies to explain death to a 

child with compassion and to support a child through grief and bereavement. 

Identifies warning signs of ineffective coping in a grieving child 

• NP Malpractice and Remedies, Ellen Wodika and Nancy Lagorio 

○ Increases awareness of professional liability risks to APNs in their 

practice. Utilizes data that APNs can use to benchmark their own 

outcomes. Provides recommendations to support APNs in managing 

their own professional liability risks 

• Preceptor Model Proposal, Susan Draine, MSN, RN 

○ This proposal addresses the current nursing shortage on all levels, by 

discussing a new preceptor proposal. In this model, students enrolled in 

traditional BS RN clinical courses would be assigned to a unit to work 

with an RN who is a preceptor and be supervised by an agency based 

MSN faculty member. In exchange for acting as preceptor, the RN would 

receive credit hours of free tuition towards his/her BSN or MSN 

• Employee Free Choice Act, Al Martin 

○ Learn about the Employee Free Choice Act (EFCA). This act, which is 

pending in Congress, can greatly expand a group’s ability to organize and 

unionize. It would amend the NLRA to establish an easier system during 

organizing efforts, and for other purposes 

• Leading Change in Creating a Blueprint for Cultural Competency, Part I 

○ Become a symbol of change in the corporate environment, while 

integrating cultural competence in practice and education. You will 

review principles for cultural competence which are based on outcomes 

from developing a blueprint 

• Growing the Nursing Workforce in Illinois, Linda B. Roberts, MSN, RN 

○ Learn the history of the Illinois Center for Nursing as well as their 

successful projects in solving the states nursing shortage 

CONCURRENT SESSIONS: 3:15 PM – 4:15 PM 

• Suturing Workshop, Ed Schaefer, RN, DNP 

○ Learn principles of wound cleansing, examination, proper tissue handling 

and post care instructions. Discusses equipment needed along with 

techniques for wound closure and dressing. Various wound closure 

techniques discussed. 

• Nursing Research: How to Get Started, Donna Plonczynski, APN/CNP 

○ Discusses the value of nursing research. The process for developing a 

research question into a study is demonstrated. The procedure in ethical 

and responsible manners will be identified 

• APN Media Training, Julie Adkins, APN/CNP 

○ Discusses the type of information journalist use for television, newspaper 

and radio. You will learn how to talk to journalists of all media types as 

well as how to interpret body language cues during an interview 

• Enhancing Ethics with Movies, Laura, McAnally, BNS, RN, MA, MJ 

○ Observing ethical situations in films can give members a better 

understanding of how complex patient care is and of the ethical issues 

that often arise 

• Staffing by Acuity Law, Debra L. Weiderman, BSN, RN 

○ The Nurse Staffing by Patient Acuity law provides for nurses to become 

actively involved in their practice and have a voice in the staffing decisions 

made at their hospital. One of the many requirements includes that every 

hospital implement a staffing plan recommended by a committee of nurses, 

comprised of 50% direct-care staff 

• Leading Change in Creating a Blueprint for Cultural Competency, Part II, 

○ Continued from above description 

• The History of Collective Bargaining at INA, Linda B. Roberts, MSN, RN 

○ Learn about the development of the national and state Economic Security and 

General Welfare Program. Hear about Illinois initiatives and the strengths of 

INA’s program 

INF Reception: 5:00 pm – 6:00 pm 

INF Silent Auction: 5:30 pm – 6:00 pm 

Awards Banquet: 6:30 pm – 9:30 pm 

Saturday, October 17, 2009 

Registration/Credentialing: 7:30 am – 8:30 am 

Breakfast: 7:00 am – 8:00 am 

House of Delegates: 8:30 am – 12:00 pm 

Lunch: 12:00 – 1:30 (on your own) 

New Board Meeting with lunch: 12:00 – 1:30 

House of Delegates, continued: 1:30 – 4:00 

6:15pm-8:00pm INA PAC Reception 

Want to have fun while you help the INA Political 

Action Committee? Join us for night of fun and festivities! 

We have a night of networking and fun, including a new wild and wacky 

game show hosted by Comedy Capers. This event will pull four members 

from the audience, place them at podiums equipped with microphones and 

have them participate in a real live game show! The PAC Reception will 

last from 6:15 pm to 8:00 pm. Tickets are $100*. You can get tickets from 

the INA staff at the registration desk and at the door. You can also call 

(217) 523-0783 for information or tickets. 

* Any INA member who purchases a ticket will automatically be entered 

into a drawing for a bed and breakfast trip at the Heartland Lodge in 

Nebo, Illinois. 

Friday, October 16 

5:00pm-6:00pm Illinois Nurses 

Foundation Gala Reception 

Join us as we recognize past and present donors of the 

Illinois Nurses Foundation. The gala will also announce the 2009 Anne 

Zimmerman Fellowship to one deserving member 

who has demonstrated outstanding leadership within INA. 

Also, don’t forget to stop by the silent auction. 

6:30pm-9:30pm INA Awards Dinner 

Come celebrate another great Biennium of 

achievement. We will honor and acknowledge those 

individuals who have made significant contributions to 

INA and/or the nursing profession during the past 

Biennium. Full registrants will receive one ticket with the 

cost of registration fees. Attendees who register only for 

Friday will need to purchase a ticket if they wish to 

attend this event. Tickets must be purchased in advance 

and will not be sold onsite. 

Virtual Forums Schedule 

CONVENTION FORUMS TO BE DONE VIA GoToMeeting and 

CONFERENCE CALL 

Members can choose to participate via their computer and phone and 

view information as it is discussed or download the information from the 

INA website and participate via conference call only. The choice is yours. 

To participate via GoToMeeting an email address is necessary so as to 

send the member the appropriate link. 

Call in to 866-951-1151 conference room #1340574 

Please RSVP to Susan Swart 312-419-2900 x229 or sswart@ 

illinoisnurses.com for the forum and session you will be attending. 

DON’T FORGET TO INCLUDE YOUR EMAIL ADDRESS. 

Bylaws forum Finance forum 

Sept 22 5:30 pm Oct 1 5:30 pm 

Oct 1 10:00 am Oct 5 10:00 am 

Oct 5 6:30 pm Oct 7 6:30 pm 

Candidate forum 

Candidates and members are invited to participate in a question and 

answer session. Candidate information will be located on Votenet 

accessible from the INA convention page. All candidates should/will be 

advised to submit a bio for the website. This will provide information to 

members on who the candidates are and what their goals will be. 

Voting begins Oct 1st and ends Oct 16th at 2pm 

Sept 21 5:00 pm 

Sept 23 6:00 pm 

Legislative Platform Strategic Plan Forum 

Sept 28 10:00 am Sept 30 6:00 pm 

Oct 6 5:30 pm 

2009 INA Convention


2009 INA Convention 

CURRENT BYLAW 

18.04 Vacancies 

Vacancies on the Commission on the Continuing Education shall by filled by 

the Board. Vacancies on the Commission on Economic and General Welfare 

shall be filled by that commission. Except for unforeseen circumstances, 

failure to attend two consecutive meetings of a commission shall constitute a 

resignation, and the vacancy shall be filled as provided above. 


18.04 Vacancies 

Vacancies on the Commission on Continuing Education shall by filled by 

the Board. Vacancies on the Commission on Economic and General Welfare 

and Commission on Workforce Advocacy shall be filled by that commission. 

Except for unforeseen circumstances, failure to attend two consecutive 

meetings of a commission shall constitute a resignation, and the vacancy shall 

be filled as provided above. 

RATIONALE 

Clarification of the CWFA’s authority to fill vacancies on that commission. 

CURRENT BYLAW 

Article XXI Elections 

Section 21.01 Election by Secret Ballot 

(a) Each biennium, 5 INA officers, 14 directors, 4 members of the Congress on 

Health Policy and Practice, 2 or 3 members of the Commission on Continuing 

Education, 4 members of the Commission on Economic and General Welfare 

and 2 or 3 members of the Commission on Workforce Advocacy shall be 

elected by the membership by secret ballot. Each member shall vote for 5 

INA officers, 14 directors, 4 members of the Congress on Health Policy and 

Practice, 2 or 3 members of the Commission on Continuing Education, and 

4 members of the Commission on Economic and General Welfare. Only 

non-collective bargaining members, who are also members of the Center for 

American Nursing, may vote for members of the Commission on Workforce 

Advocacy. Only INA members who are in collective bargaining may vote for 

members of the Commission on Economic and General Welfare. 

(b) Delegates and alternate delegates to the ANA House of Delegates shall be 

elected each biennium by the Membership by secret ballot. 


Article XXI Elections 

Section 21.01 Election by Secret Ballot 

(a) Each biennium, 5 INA officers, 10 directors, 4 members of the Congress 

on Health Policy and Practice, 4 members of the Commission on Continuing 

Education, 4 members of the Commission on Economic and General Welfare 

and 4 members of the Commission on Workforce Advocacy shall be elected by 

the membership by secret ballot. Each member shall vote for 5 INA officers, 

10 directors, 4 members of the Congress on Health Policy and Practice, and 4 

members of the Commission on Continuing Education. Only non-collective 

bargaining members, who are also members of the Center for American 

Nursing, may vote for members of the Commission on Workforce Advocacy. 

Only INA members who are in collective bargaining may vote for members of 

the Commission on Economic and General Welfare. 

(b) Delegates and alternate delegates to the ANA House of Delegates shall be 

elected each biennium by the INA/ANA Membership by a separate secret 

ballot. 

RATIONALE 

Consistency of commissioner elections across all commissions. Clarification 

of member voting eligibility for the Commission on Workforce Advocacy. 

Conformity with the ANA Bylaws. 



CURRENT BYLAW 


Add new language to Article V Members 


2009 INA Bylaws Proposed . . . 

(c) Individual Affiliate members in good standing shall have membership 

privileges as follows: An Individual Affiliate is a health care worker, 

who is not a registered nurse, but is represented by the Illinois Nurses 

Association for the purpose of collective bargaining and pays dues per 

INA/EGW policy. 

1) Individual Affiliate privileges are limited to the Economic & General 

Welfare Commission. Privileges include the ability to be appointed to the 

Commission per INA bylaws and the ability to vote only for the members 

of the Commission on Economic and General Welfare. 

2) Individual Affiliate members do not receive benefits from ANA at the 

national level. 

continued from page 7 

RATIONALE 

Currently INA represents health care workers, who are not registered nurses, 

in our bargaining units. They are allowed only fair share representation. This 

change would allow for proper adherence to labor law and ANA bylaws. 

Article II Purposes and Functions 

Article II Purposes and Functions 

Add new Section 2.03 Insulation 

CURRENT BYLAW 


Section 2.03 Insulation 

It is the policy of INA that collective bargaining and subjects related to 

collective bargaining shall completely exclude participation by a supervisor 

or managerial employee (within the meaning of relevant labor law). 

E&GW Commission members must be members of an INA bargaining 

unit. 

Conformity with labor law. 

RATIONALE 

CURRENT BYLAW 


Section 18.10 Commission on 

Economic and General Welfare 

(a) Composition 

(1) All members shall be persons (a) whose functions in nursing are not 

primarily managerial in nature and (b) who are eligible for collective bargaining 

representation under federal and state labor relations laws, decisions, rulings, 

and orders including but not limited to the Labor Management Relations Act, 

Civil Service Reform Act and State Public Employee Relations Act. 


Add new language to Article XVIII Commissions 

Section 18.10 Commission on 

Economic and General Welfare 

This Commission is insulated in accordance with Article II Purposes and 

Functions, Section 2.03 Insulation, and relevant federal and state labor 

law. Reports to the Board of Directors and/or House of Delegates on 

confidential subjects related to collective bargaining shall only be given in 

insulated session. 

(a) Composition 

(1) Membership in the Commission shall consist of two (2) categories: 

1) INA members (a) whose functions in nursing are not primarily 

managerial in nature; and, (b) who are eligible for collective bargaining 

representation under federal and state labor relations laws, decisions, rulings, 

and orders, including but not limited to the Labor Management Relations Act, 

Civil Service Reform Act and State Public Employee Relations Act and are 

represented by the Illinois Nurses Association in a collective bargaining 

agreement; and, 

2) Individual Affiliates (a) whose functions are not primarily 

managerial in nature; and, (b) who are eligible for collective bargaining 

representation under federal and state labor relations laws, decisions, 

rulings, and orders, including but not limited to the Labor Management 

Relations Act, Civil Service Reform Act and State Public Employee 

Relations Act and who pay dues per INA/EGW policy. These Individual 

Affiliates will be allowed to participate in discussions that relate to 

collective bargaining only. 

Conformity with labor law. 

RATIONALE


Continuing Education Offering 

Lateral Violence And Bullying In The Workplace 

by: Ann O’Sullivan, RN, MSN, CNE, NE-BC 

Assistant Dean, Associate Professor 

Blessing-Rieman College of Nursing 

Chair, Commission on Workforce Advocacy 

Illinois Nurses Association 

Janet Lynch, RN, MSN 

Dean of Health Professions 

Sauk Valley Community College 

Vice-Chair, Commission on Workforce Advocacy 

Illinois Nurses Association 

CE OFFERING 

1.5 CONTACT HOURS 

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

This offering expires in 2 years: 

March, 2011 

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

The goal of this continuing education offering is to 

provide information on violence and bullying in the 

workplace and its implications 

The objectives of this article are: 

1. Describe Joint Commission concerns and 

requirements 

2. Define workplace abuse and disruptive behavior 

3. List strategies to reduce workplace violence and 

bullying 

4. Identify what nurses can do 

The Illinois Nurses Association created the Commission 

on Workforce Advocacy in 2007. All nurses who are 

INA members who are not members through collective 

bargaining are represented by this Commission. The core 

purpose of the WFA program is to articulate, advocate, 

and provide workforce advocacy solutions to equip nurses 

in shaping their work environment. Workforce advocacy 

is an enabling process whereby nurses are supported by 

a variety of programs, services, tools, and resources with 

which to influence their work at the Center for American 

Nurses. The mission of the Center is to create healthy work 

environments through advocacy, education, and research. 

If you are interested in having the topic “Lateral 

Violence and Bullying in the Workplace” presented at 

your facility, please call the INA office. 

Since its formation, one of the priorities of the 

Commission has been to educate nurses on the issues 

surrounding workplace violence and bullying. To this end, 

we have developed a position paper which is available on 

the INA website, offered a continuing education program 

in March 2009, and now we offer this continuing education 

article for all nurses in the state. 

Lateral violence and bullying has been extensively 

reported and documented among healthcare professionals, 

with serious negative outcomes for registered nurses, their 

patients and health care employers. There may be many 

different titles (conflict, horizontal or lateral violence, 

incivility, disruptive behavior)—but the result is the 

same—behaviors that are toxic to the nursing profession 

and have a negative impact on retention of quality staff. 

It is the position of the Illinois Nurses Association 

(INA) that there is no place in a professional practice 

environment for lateral violence and bullying among 

nurses or between healthcare professionals. All healthcare 

organizations should implement a zero tolerance policy 

related to disruptive behavior, including a professional code 

of conduct and educational and behavioral interventions to 

assist nurses in addressing disruptive behavior. (Position 

paper adapted from the Center for American Nurses 

position paper, 2008) 

Background 

The culture of the healthcare setting has been 

historically populated by images of the nurse as a 

“handmaiden” in a patriarchal environment (Kelly, 2006, 

p.23). The balance of power has not been in the nurse’s 

favor. Organizations fashioned to be hierarchical have not 

fostered a culture of professional collegiality, nor have 

they advanced the role of nursing. Too often, nurses have 

acquiesced to a victim mentality that only facilitates a 

sense of powerlessness. Nurses have reported concern 

about the lack of action taken by supervisors in addressing 

horizontal violence in the workplace (Farrell, 1997; Stanley 

et al., 2007). 

While not directly addressing bullying or horizontal 

violence, Kramer (1974) described the “reality shock” 

occurring for new graduates when they encountered 

differences in their perception of what nursing could be 

and the actual reality of the workplace. Kramer suggested 

that “reality shock” can manifest as hopelessness and 

dissatisfaction, which is a prelude to conflict in the 

workplace (p. 9). Today, bullying is an international 

phenomenon not limited to the healthcare arena, and abuse 

can also occur between professions. The phrase “nurses 

eat their young,” has been used to describe the negative 

behaviors directed toward new nurses (Rowe & Sherlock, 

2005). Griffin (2004) described the vulnerability of newly 

licensed nurses as they are socialized into the nursing 

workforce; lateral violence affected their perception of 

whether to remain in their current position. 

Sofield and Salmond (2003) found that primarily 

physicians, then patients, and patients’ families were 

responsible for most of the verbal abuse towards nurses. 

One-third of respondents expressed they would consider 

resignation in response to verbal abuse; it was concluded 

that nurses lacked the skills to deal with the verbal 

abuse and perceived themselves as powerless to change 

organizational response (Sofield & Salmond, 2003). 

Cox found the most frequent source of verbal abuse was 

physicians, and in descending order patients, families and 

peers, supervisors and subordinates (1991). The turnover 

attributed to verbal abuse was 24 percent for staff nurses 

and 25 percent for nurse managers (Cox, 1991b). Cook, 

Green and Topp (2001) found that perioperative nurses 

encountered verbal abuse by physicians. However, Rowe 

and Sherlock (2005) reported that nurses in particular were 

the most frequent source of verbal abuse towards other 

nurses. Patients’ families were the second most frequent 

source, followed by physicians and then patients (Rowe & 

Sherlock, 2005). 

In a hostile environment, communication is hindered 

and this can affect quality of care and patient safety 

(Joint Commission on Accreditation of Health care 

Organizations, 2002). Healthcare providers report 

intimidation does alter communication and negatively 

impacts patient care and safety (Institute for Safe 

Medication Practices, 2004). Healthcare professionals 

facing intimidation may sometimes choose to abdicate 

their advocacy role to avoid intimidating behaviors, 

impacting patient safety. The Institute for Safe Medication 

Practices survey (2004) revealed that more experienced 

nurses were more likely to encounter intimidating 

behaviors; differences in intimidating encounters were 

not appreciably different in terms of gender, but females 

were more likely to ask another colleague to talk with the 

intimidator for them. The organization’s effectiveness in 

handling intimidation was viewed less favorably by those 

nurses and pharmacists with more years of practice in that 

facility (Institute for Safe Medication Practices, 2004a). 

Conflict in the workplace results in serious negative 

outcomes for registered nurses and other healthcare 

professionals, organizations, and patients. The Joint 

Commission (2007) acknowledges that unresolved conflict 

and disruptive behavior can adversely affect safety and 

quality of care. Additionally, healthcare organizations are 

grappling with a continuing nursing shortage today and 

it is projected to grow worse as nurses retire (American 

Association of Colleges of Nurses, 2007). Bullying and 

lateral violence have a negative impact on the ability of 

the nursing profession to retain both new and long-term 

colleagues. 

Intimidation and disruptive behaviors can foster 

medical errors, contribute to poor patient satisfaction and 

to preventable adverse outcomes, increase the cost of care, 

and cause qualified clinicians, administrators and managers 

to seek new positions in more professional environments. 

Safety and quality of patient care is dependent on 

teamwork, communication and a collaborative work 

environment. To ensure quality and promote a culture of 

safety, healthcare organizations must address the problem 

of behaviors that threaten the performance of the health 

care team. (Joint Commission, 2008). 

Effective January 1, 2009, the Joint Commission has 

a new Leadership standard that addresses disruptive and 

inappropriate behaviors: “EP 4: The hospital/organization 

has a code of conduct that defines acceptable and 

disruptive and inappropriate behaviors; and EP 5: Leaders 

create and implement a process for managing disruptive 

and inappropriate behaviors” (Joint Commission, 2008, 

p.2). In addition, standards to the medical staff this 

chapter has been revised to include interpersonal skills 

and professionalism in the credentialing process. Joint 

Commission also presents several other suggested actions, 

including: educating all team members on appropriate 

professional behavior, holding all team members 

accountable for modeling desirable behaviors, “zero 

tolerance” for intimidating or disruptive behaviors, develop 

policies and processes for addressing disruptive behaviors. 

(Joint Commission, 2008) 

Strategies to Reduce Workplace Violence and Bullying 

First, nursing must recognize the need for cultural 

change to eliminate the effects of disruptive behavior, 

including lateral violence and bullying at the personal, 

organizational, national and international levels. Suggested 

improvements include interdisciplinary collaboration, 

communication and opportunities for education and 

training to address disruptive behavior by physicians 

(Rosenstein, 2002). In a cognitive rehearsal strategy 

proposed by Griffin (2004), nurses were taught to delay 

automatic thoughts, and respond differently through 

empowerment strategies to address lateral violence. 

Gerardi (2004) described the use of mediation techniques 

to identify conflict early and develop a plan to resolve it 

by listening, reframing the concerns raised, identifying 

commonalities and clearly defining decisions. Developing 

a critical mass of diverse professionals trained in conflict 

management can not only reduce lateral violence and 

bullying, but it can also assist with other potential conflict 

situations, such as, error disclosure issues and process 

reviews. 

The Institute of Safe Medication Practices (2004b) 

suggested organizational strategies: development of 

a multidisciplinary group that will survey staff about 

behaviors, develop educational opportunities, establish a 

standard method for collaborative communication and zero 

tolerance for intimidation, in addition to being models for 

and rewarding positive behaviors. 

Scott (2009) recommends 10 actions to deal with 

disruptive (bullying behaviors): 

1. Know what behaviors can be disruptive—both 

overt and passive behaviors can be violent, such 

as name-calling, frequent put downs, withholding 

information, rolling eyes, heavy sighing, verbal 

abuse, constant criticism, physical intimidation, 

etc. 

2. Know when to engage—When the conflict is 

ongoing or recurring; when it’s creating a potential 

threat to others; when the conflict keeps you awake 

at night. 

3. Avoid Avoidance—even though you may not know 

how to do it well, or you have a fear of retaliation, 

or time constraints. 

4. Be mindful of you own feelings—BREATHE 

and focus on what’s happening inside and out; be 

empathetic; think before saying something. 

5. Take immediate interventions when witnessing 

disruptive behavior—acknowledge that they are 

Lateral Violence & Bullying continued on page 12


upset, set limits. Arrange to talk when everyone is 

less stressed. 

6. Learn to listen—this is the most important part of 

dealing with conflict; hearing with intent; listen 

with your heart and your gut; takes practice. 

7. Collaborate with your boss—ask for assistance in 

role playing. 

8. Behave differently—choose constructive behavior 

over avoidance; understand your role in disruptive 

behaviors; do not resort to old, ineffective 

behaviors. 

9. Reflect on the experience—reflect on a recent 

experience with disruptive behavior—why did it 

matter to you? How did you feel? What could you 

have done differently? 

10. Remember—it’s all about you—not about them! 

The INA recommends the following strategies to 

eliminate disruptive behavior (lateral violence and 

bullying): 

Nurses 

1. Nurses and nurse leaders, managers and 

supervisors adopt and model professional ethical 

behavior. 

2. Recognize and appropriately address bullying 

and disruptive behavior in the workplace through 

enhanced conflict management and conflict 

resolution. 

3. Reflect on your own behavior and communicate 

respectfully with each other. Participate in 

collaborative interdisciplinary initiatives to prevent 

abuse. 

4. Work to ensure the mission, vision and values of 

their workplaces that are reflective of the Code of 

Ethics for Nurses (American Nurses Association, 

2001) and standards set by the profession, in order 


Lateral Violence & Bullying continued from page 11 to eliminate disruptive behavior (lateral violence behaviors. 

and bullying). 

2. Build on previous and current studies while 

seeking to explore innovative interventions on how 

to eliminate manifestations of disruptive behaviors. 

3. Evaluate the efficacy of promising strategies in 

eliminating disruptive behaviors (lateral violence 

and bullying) from the workplace. 

Employers/Healthcare Organizations 

1. Implement zero tolerance policies that address 

disruptive behaviors (lateral violence and bullying) 

and indicate such behaviors will not be tolerated. 

The organizations should adopt zero tolerance 

policies that include appropriate investigation 

and due process necessary to provide adequate 

safeguards to nurses and others who are accused of 

lateral violence or bullying. 

2. Promote a Culture of Safety that encourages open 

and respectful communication among all healthcare 

providers and staff (The Joint Commission, 2007). 

3. Provide support to any individual impacted by 

lateral violence and/or bullying. 

4. Provide education and counseling to victims 

and the perpetrators of horizontal violence and 

bullying. 

Nursing Continuing Education and Academic Programs 

1. Disseminate information to nurses and students 

that address conflict and provide information 

about how to change disruptive behavior in the 

workplace. 

2. Implement continuing education programs related 

to bullying and lateral violence and interventions 

to address such behaviors. 

3. Develop educational programs regarding bullying 

and strategies on how to recognize and address 

such disruptive behavior. 

4. Develop and implement curricula that educate 

nursing students on the incidence of disruptive 

behaviors including lateral violence and bullying, 

along with steps to take to eradicate this behavior. 

Nursing Research 

1. Continue to research the contributing factors 

and the process of lateral violence and bullying 

INA as a Nursing Policy Maker 

1. Support policy, development of legislation, 

regulations and standards that promote a culture of 

safety for patient care and discourage all forms of 

disruptive behavior, including lateral violence and 

bullying. 

2. Continue its work to assure that nurses influence 

legislative initiatives, accreditation standards and 

policies through active participation in the policy 

process (International Council of Nurses, 2000). 

Conclusion 

INA recognizes that lateral violence and bullying 

in the workplace is a serious problem. It is imperative 

that the profession of nursing addresses this problem to 

improve the recruitment and retention of nurses. The 

efforts to improve patient care are inextricably linked to 

the work environment of nurses (Institute of Medicine, 

2004). Disruptive behaviors of health care providers 

are not conducive to a culture of safety. The evidence is 

clear that disruptive behaviors such as lateral violence 

and bullying are serious problems that negatively impact 

the work environment of nurses. This problem is broad 

reaching and has clear implications in the current and 

future projected shortage of nurses, as well as the safety 

and quality of patient care. It has an impact on the ability 

of the profession to recruit new members and the ability 

of health care organizations and other employers to retain 

nurses. 

Lateral Violence & Bullying continued on page 13


Lateral Violence & Bullying continued from page 12 

HOW TO EARN 

CONTINUING EDUCATION CREDIT 

This course is 1.5 Contact Hours 

1. Read the Continuing Education Article 

2. Take the test on the next page. 

Complete the entire form 

DEADLINE 

Answer forms must be postmarked by 

March 1, 2011 

3. Mail or fax the completed answer form. 

Include processing fee as follows: 

INA members- $7.50 

Non members- $15.00 

Check or money order payable to INA or credit card 

information only 

MAIL: Illinois Nurses Association 

Attn: Sharon Canariato 

105 W. Adams, Suite 2101 

Chicago, IL 60603 

FAX: Credit Card Payments Only 

312-419-2920 

ACHIEVEMENT 

• To earn 1.5 contact hours of continuing education, 

you must achieve a score of 75% 

• If you do not pass the test, you may 

take it again at no additional charge. 

• Certificates indicating successful completion 

of this offering will be emailed to you 

ACCREDITATION 

Illinois Nurses Association is an approved provider of 

continuing nursing education 

by the Georgia Nurses Association, an accredited 

approver by the 

American Nurses Credentialing Center’s 

Commission on Accreditation. 


TEST QUESTIONS: 

1. Conflict in the workplace results in serious negative outcomes for registered nurses and other healthcare professionals, organizations, and 

patients. 

True 

False 

2. Examples of disruptive/bullying behaviors include: 

a. name-calling 

b. rolling eyes 

c. constant criticism 

d. blaming 

e. all of the above 

3. The most important part of dealing with conflict is: 

a. Know when to engage 

b. Avoid avoidance 

c. Learn to listen 

d. Collaborate with your boss 

4. The Joint Commission requires organizations to: 

a. Create and implement a process for managing disruptive and inappropriate behaviors 

b. Education for all team members on appropriate professional behaviors 

c. Implementing a zero tolerance policy for intimidating behaviors 

d. Hold all team members accountable for modeling desirable behaviors 

5. The Illinois Nurses Association recommends that health care organizations: 

a. Implement zero tolerance policies that address disruptive behaviors (lateral violence and bullying) and indicate such behaviors will 

not be tolerated. 

b. Promote a Culture of Safety that encourages open and respectful communication among all healthcare providers and staff 

c. Provide support to any individual impacted by lateral violence and/or bullying. 

d. Provide education and counseling to victims and the perpetrators of horizontal violence and bullying. 

e. All of the above 

(Submit entire form below for contact hours) 

ANSWER FORM 

CE #15: Lateral Violence & Bullying in the Workplace 

Please circle the appropriate letter 

1. A B 

2. A B C 

3. A B C 

4. A B C D 

5. A B 

6. A B C D 

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

(Please PRINT clearly) 

Name: _______________________________________________________________________________________________________________ 

Address: _____________________________________________________________________________________________________________ 

City: ________________________________________________________________ State: _____________ Zip: ____________________ 

Phone: _________________________________________________ Email Address: _____________________________________________ 

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

Evaluation- CE 0309-15 

Strongly Agree (5) Strongly Disagree (1) 

Learner achievement of objectives: 

1. Describe Joint Commission concerns and requirements 5 4 3 2 1 

2. Define workplace abuse and disruptive behavior 5 4 3 2 1 

3. List strategies to reduce workplace violence and bullying 5 4 3 2 1 

4. Identify what nurses can do 5 4 3 2 1 

How many minutes did it take you to read and complete this program? ___________________________________________________________ 

Suggestions for improvement? Future topics? _______________________________________________________________________________ 

METHOD OF PAYMENT 

❑ INA Member ($7.50) INA ID# ________________________________________________ 

❑ Non Member ($15.00) 

❑ Money Order ❑ Check ❑ VISA ❑ Master Card ❑ American Express 

(note: a fee of $25 will be assessed for any returned checks) 

Card account number: ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 

Credit card expiration date: ____ ____ / ____ ____ 

Signature __________________________________________________________ Date _______________________ 

Mail all tests to: INA, Attn: Sharon Canariato, 105 W. Adams, Sute 2101, Chicago, IL 60603References 

American Association of Colleges of Nurses. (2007). Nursing Shortage. Retrieved December 4, 2007, from http://www.aacn.nche.edu/Media/FactSheets/Nursing/ 

Shortage.htm 

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD.: American Nurses Association. 

Center for American Nurses. (2007). Bullying in the workplace: Reversing a culture. Silver Spring, MD: Center for American Nurses. 

Center for American Nurses. (2008). Lateral violence and bullying in the workplace. Retrieved July 30, 2008, from http://www.centerforamericannurses.org. 

Cook, J. K., Green, M., & Topp, R. V. (2001). Exploring the impact of physician verbal abuse on perioperative nurses. AORN Journal, 74(3),317-318,320,322-327,329- 

330. 

Cox, H. (1991a). Verbal abuse nationwide: oppressed group behavior. Part 1. Nursing Management, 22(2), 32-35. 

Cox, H. (1991b). Verbal abuse nationwide: impact and modifications. Part 2. Nursing Management, 22(3), 66-69. 

Farrell, G. A. (1997). Aggression in clinical settings: nurses’ views. Journal of Advanced Nursing, 25(3); 501-508. 

Gerardi, D. (2004). Using mediation techniques to manage conflict and create healthy work environments. AACN Clinical Issues: Advanced Practice in Acute & 

Critical Care, 5(2), 182-195. 

Griffin, D. (2004). Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. The Journal of Continuing Education in 

Nursing, 35(6), 257-263. 

Institute for Safe Medication Practices. (2004a). Intimidation: Practitioners speak up about this unresolved problem (part I). March 11. Retrieved January 9, 2006, 

from 

http://www.ismp.org.newsletterslacutecare/articles/2004031l_2.asp 

Institute for Safe Medication Practices. (2004b). Intimidation: Mapping a Plan for Cultural Change in Healthcare (part ll). March 25. Retrieved January 9, 2006, from 

http://www.ismp.org newsletters/acutecare/articlesl20040325.asp 

Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: The National Academies Press. 

International Council of Nurses (2000). Participation of nurses in health services decision making and policy development. ICN Position Statement. Retrieved from 

July 26, 2007 http://www.icn.ch/pspolicvdevOO.htm 

Joint Commission. (2002). Health care at the crossroads: Strategies for addressing the evolving nursing crisis. Retrieved December 4, 2007, from http://www. 

jointcommission.org/NR/rdonlyres/5C138711-ED76-4D6F-909F- B06E0309F36D/0/health care at the crossroads.pdf 

Joint Commission. (2007). Leadership Chapter. Retrieved January 7, 2007 from http:/ /www.jointcommission.org/Accreditation Programs/Hospitals/Standards/hap_ 

prepub_stds.htm 

Joint Commission. (2008). Sentinel Event Alert. Retrieved October 3, 2008 from http:/ /www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm 

Kelly, J. (2006). An overview of conflict. Dimensions of Critical Care Nursing, 25(1), 22-28. 

Kramer, M.. (1974). Reality Shock: Why nurses leave nursing (1st Ed.). St. Louis, MO: The CV Mosby Company. 

Rosenstein, A. H. (2002). Nurse-physician relationships: impact on nurse satisfaction and retention. American Journal of Nursing, 102(6), 26-34. 

Rowe, M. M., & Sherlock, H. (2005). Stress and verbal abuse in nursing: do burned out nurses eat their young? Journal of Nursing Management, 13(3), 242-248. 

Sofield, L., & Salmond, S. W. (2003). Work Place violence: a focus on verbal abuse and intent to leave the organization. Orthopaedic Nursing, 22(4), 274-283. 

Scott, D. (2009). Ten tips for addressing disruptive behavior. Retrieved May 10, 2008 from www.centerforamericannurses.com. 

Stanley, K. M., Martin, M. M., Michel, Y., Welton, J. M., & Nemeth, L. S. (2007). Examining lateral violence in the nursing workforce. Issues in Mental Health 

Nursing, 28, 1247-1265. 

The Joint Commission. (2007). Pre-publication standards for critical access hospitals. Oakbrook Terrace, IL: Author. Retrieved February 15, 2008, from 

www.jointcommission.org/AccreditationPrograms/ CriticalAccessHospitals/Standards/cah_prepub _stds.htm


ILLINOIS HIV CARE 

CONNECT 

Nurses, Other Care Providers Can Refer HIV-Positive 

Individuals to Statewide Care Network 

Nurses and other health care providers are encouraged to 

refer HIV-positive individuals to one of eight regional offices 

of Illinois HIV Care Connect—www.hivcareconnect.com. 

“Illinois HIV Care Connect extends the ability of health 

care providers and others to help people living with HIV find 

the services they need to achieve optimal health and selfsufficiency,” 

said Jim Nelson, executive director of the Illinois 

Public Health Association. 

Once enrolled in Illinois HIV Care Connect, people living 

with HIV receive confidential medical case management 

services at no charge, regardless of income. Also, they may 

quality for a range of other health care and support services. 

In an effort to curb a still-serious HIV infection epidemic 

in Illinois, the Illinois Public Health Association recently 

introduced Illinois HIV Care Connect to increase awareness 

about the statewide network of services for HIV-positive 

individuals. 

Funded by the Illinois Department of Public Health through 

federal Ryan White Part B grants, Illinois HIV Care Connect’s 

regional offices are located in Belleville, Champaign, Chicago 

(two regional offices), Murphysboro, Peoria, Rockford, and 

Springfield. For more information on local offices, go to http:// 

www.hivcareconnect.com/connect.html 

Increasing awareness of HIV-related services among nurses 

and other health providers is a primary goal of the initiative, 

Nelson said. “Our new Web site has detailed information about 

the enormous resources provided by the statewide network,” 

he adds. 

People living with HIV who enroll in Illinois HIV Care 

Connect may qualify for outpatient medical care, mental 

health care, oral health care, medical nutritional therapy, 

substance abuse prevention and counseling, and other support 

services. “Illinois HIV Care Connect serves as a one-stop shop 

for all these services,” said Valerie Webb, IPHA president. 

Getting HIV-positive individuals to take advantage of these 

services helps to curb the spread and progression of HIV, Webb 

said. “It’s important that HIV-positive individuals receive the 

medical treatments they need to slow the progression of HIV. 

They also need to know the precautions they should take to 

prevent the spread of the infection to others.” 

In addition to reaching out to health care providers, Illinois 

HIV Care Connect also will encourage corrections officials to 

refer HIV-positive individuals because HIV infection within 

the prison population is five times higher than among the 

general public, Nelson said. 

HIV infection still a serious problem in Illinois 

HIV infection can progress to AIDS and other diseases. 

Illinois has the nation’s seventh highest cumulative number of 

AIDS cases, according to the Illinois Department of Public 

Health, with more than 36,000 reported cases and 18,500 

deaths since 1981. 

About one-quarter—or 10,000—of the 40,000 HIVpositive 

Illinois residents do not know they are HIV-positive, 

the department estimates. Unaware of their HIV infection, 

undiagnosed individuals spread HIV to others through 

unprotected sex, intravenous drug use, or other ways. 

Undiagnosed individuals also do not receive the benefit of 

medical treatments that can slow the progression of HIV 

infection into AIDS or other illnesses. 

To stop the progression and transmission of HIV-related 

disease, the U.S. Centers for Disease Control and Prevention 

(CDC) has recommended that all individuals age 13-64 be 

tested for HIV infection. Those wishing not to be tested 

can choose to decline or “opt-out.” As a result, the Illinois 

Department of Public Health expects that increased numbers 

of individuals will be diagnosed as HIV-positive, making 

referrals to HIV Care Connect an important way to contain 

the progression and spread of HIV infection. 

Teaching Evidence-Based Cultural Competence in 

Nursing Education: A Case Study 

Ann O’Sullivan, MSN, RN, CNE, NE-BC 

Assistant Dean, Associate Professor 

Blessing-Rieman College of Nursing 

Quincy IL 

In 2007, during major curriculum revision discussions, 

Blessing-Rieman College of Nursing decided to add a 

course on Cultural Competency to the senior level for 

all nursing students. This was based on an assessment of 

our students and their level of knowledge about cultural 

issues and their patients. The Institute of Medicine (IOM) 

(2001) reported on the evidence of unequal treatment 

of racial and ethnic minorities in health care. The IOM 

(2005) and the Sullivan Commission (2004) reported that 

health disparities were attributed to patient characteristics, 

practitioner bias and systematic factors which all point 

to the need for education for all health care practitioners. 

Faculty who were preparing to teach this new course, 

did an extensive literature review, studied and attended 

conferences on this topic to be prepared to start teaching a 

one hour online course in the fall of 2008. 

What is Cultural Competence? 

The American Nurses Association defines cultural 

diversity as “Difference between people based on a shared 

ideology and valued set of beliefs, norms, customs, and 

meanings experienced in a way of life” (ANA, 1991). 

The definitions of Cultural Competence that were chosen 

for the course are: 1.) “A process in which the health 

care provider continuously strives to achieve the ability 

to effectively work within the cultural context of a client/ 

individual, or family, or community (Campinha-Bacote, 

2002); and 2.) “The ongoing capacity of healthcare 

systems, organizations, and professionals to provide for 

diverse populations high quality care that is family- and 

patient-centered and equitable” (National Quality Forum, 

2008). Leininger (2002) defines culturally competent 

care as “Those cognitively based assistive, supportive, 

facilitative, or enabling acts or decisions that are tailor 

made to fit with the individual, group, or institutional 

cultural values, beliefs, and lifeways in order to provide or 

support meaningful, beneficial, and satisfying health care 

or well-being services.” These definitions served as the 

foundation for the course learning objectives. 

National Standards for Culturally Competent Care 

The U.S. Office of Minority Health (2001) issued 

The National Standards for Culturally Competent and 

Linguistically Appropriate Services (CLAS) in Health 

Care, which established standards in 3 specific areas: 

Culturally competent care, Language access services, and 

organizational supports. 

The American Nurses Association (1991) states “nurses 

need to understand: 

• How cultural groups understand life processes; 

• How cultural groups define health and illness; 

• What cultural groups do to maintain wellness; 

• What cultural groups believe to be the causes of 

illness; 

• How healers cure and care for members of cultural 

groups; and 

• How the cultural background of the nurse influences 

the way in which care is delivered;” 

The American Association of Colleges of Nursing 

(AACN) identifies five key competencies considered to be 

essential for baccalaureate nursing graduates to provide 

culturally competent care (2008) which formed the basics 

for the course: 

• Apply knowledge of social and cultural factors 

that affect nursing and health care across multiple 

contexts 

• Use relevant data sources and best evidence in 

providing culturally competent care 

• Promote achievement of safe and quality outcomes 

for diverse populations 

• Advocate for social justice, including commitment 

to the health of vulnerable populations and the 

elimination of health disparities 

• Participate in continuous cultural competence 

development 

Curriculum Development 

The Health Resources and Service Administration 

(HRSA) provides an invaluable resource in the document 

“Transforming the Face of Health Professions Through 

Cultural and Linguistic Competence Education: The 

Role of the HRSA Centers of Excellence. Key factors for 

curriculum development include: 1.) Developing faculty 

commitment to implementing cultural and linguistic 

competency education was essential for learning to occur. 

While we do not have ethnic and racial diversity on our 

faculty, the course faculty spent much time learning about 

cultural competence issues. 2.) The rationale for increasing 

cultural competence through our curriculum was very 

evident to the entire faculty, and it was an essential 

component of the first modules of the course. 3.) As this 

course was taught in the senior year, it became increasingly 

evident to the faculty that a more developmental learning 

path was required for the students to fully engage and 

attain the required competencies. The HRSA document 

supports this: “…multicultural content cannot and should 

not be taught in just one course or workshop, but needs to 

be reinforced in many different ways over the course of the 

students’ education.” After one year of requiring the course 

for seniors, this separate course was dropped, and specific 

content was incorporated into each nursing course. This 

content includes: a.) attitudes about racism, homophobia, 

prejudices and biases of all kinds are openly discussed; 

b.) skills in cross-cultural communication. 4.) The faculty 

continues to work on integrating cultural and linguistic 

topics into existing courses. The toolkit developed by 

HRSA has proven invaluable. 

A sample curriculum developed by the American 

Medical Student Association (2006) has also been very 

helpful in developing essential content to integrate across 

the curriculum: 

• Definition of Culture and Cultural Competency 

• Definition of Diversity and Diverse Population 

• Issues in Health Care: The Impact of Diversity 

• Cultural Models of Health, Disease and Illness 

• Cultural/Traditional Health Care Practices 

• Negotiating Cultural Conflicts in the Doctor-Patient 

Relationship 

Teaching strategies that are suggested in this curriculum 

include: interviewing and communication, using 

interpreters, taking a cultural profile/history, case studies 

and videos. 

The AACN position paper Cultural Competency in 

Baccalaureate Nursing Education (2008) provided the 

most guidance in the course development. The essential 

competencies as outlined above, serve as the framework 

for the course and for integrating content and learning 

experiences into existing courses. The Toolkit of Resources 

for Cultural Competent Education for Baccalaureate 

Nurses (2008) provides nursing models; classroom and 

clinical teaching strategies; curricular resources such as 

case studies, websites, sample curricula; evidence-based 

practice resources; research of culturally competent 

interventions; and extensive reference and website lists. 

Models of Cultural Competence in Nursing Curricula 

There are a variety of nursing models for teaching 

Cultural Competence. We chose Purnell’s Model of 

Transcultural Health Care as the primary model. Purnell 

conceptualizes the development of cultural competence 

along an upward curve of learning and practice from 

a stage of unconscious incompetence to conscious 

incompetence, to conscious competence to unconscious 

competence. The majority of our students rated themselves 

in between the stages of conscious incompetence to 

conscious competence. The Purnell Model focuses on 

the 12 Domains of Culture: heritage, communication, 

family roles, workforce issues, bio-cultural ecology, highrisk 

behaviors, nutrition, pregnancy/childbearing, death 

rituals, spirituality, health care practices and role of health 

practitioners. Students did a self-assessment, an interview 

of a culturally diverse person, and analyzed two other 

cultures of their choice based on these 12 domains. This 

model was an effective framework for assessment and 

intervention. (Purnell & Paulanka, 2008) 

Leininger’s Cultural Care Diversity and Universality 

Theory is the primary theory we used to integrate 

cultural care diversity and holistic care into practice. 

The conceptual framework at BRCN is Whole Person 

Nursing, which includes the client’s beliefs, values, 

family, and community into their care and is congruent 

with Leininger’s Theory. Parts of Campinha-Bacote’s 

Model: Process of Cultural Competence in the Delivery 

of Healthcare Services were also included. Cultural 

awareness, knowledge, skill, encounter and desire are 

essential to developing cultural competence (2002). 

Immersion experiences in another cultural, 

socioeconomic, urban, rural or other type of group are 

identified as good learning experiences for students 

in developing cultural competence. These experiences 

are often developed as a senior elective or as part of a 

community health course. Students must have significant 

cultural awareness and knowledge in order to benefit most 

Cultural Competence continued on page 15


Cultural Competence continued from page 14 if we are to end existing health disparities and create a 

from these experiences. 

more socially just healthcare environment and society for 

all.” 

Issues in Teaching Cultural Competence 

One of the biggest issues in teaching cultural 

competence is whether to integrate the content or teach 

a separate course. At BRCN, we developed a separate 

course, because we believed there was not enough attention 

being given to students learning cultural competence due 

to lack of knowledge among the faculty. After teaching it 

this way for one year and exploring many other options, 

we will integrate the content into all courses, and provide 

more education and resources for the faculty. It will be 

essential to maintain the content and faculty development 

and support over time. 

Another key issue, is what to teach—content or 

process or both. We will focus on teaching both. Content 

on different cultural beliefs, values, and lifestyles is 

important but is not adequate on its own. This tends to 

lead to stereotyping clients and lack of an individualized 

approach. The assessment process is essential to learn 

the client’s story and goals and what’s important to them 

in order to intervene appropriately. Canales and Bowers 

(2001) suggest removing the artificial separation between 

competent and culturally competent nursing practice. 

Culturally competent care is integral to competent 

care. Their research proposed that competent nurses 

“conceptualize the provision of competent care to all 

persons who are perceived as different, rather than 

focusing only on those who are perceived as ‘culturally’ 

different.” This fits perfectly with the BRCN Whole Person 

Nursing framework. 

Evaluation is a key issue in determining graduates’ 

competence in providing culturally competent care. 

How do we know that graduates have achieved cultural 

competence? What is the best method of evaluation? Is 

cultural competence an endpoint or an ever-evolving 

process? There are many self-assessment tools available— 

but do these truly evaluate cultural competence? The 

American Academy of Nursing’s (AAN) Expert Panel on 

Culturally Competent Care developed 10 recommendations 

to stimulate the development and implementation of 

knowledge related to culturally competent care in 1992 

(AAN, 1992). The AAN expert panel reiterated these 

same recommendations in 2007: “the conceptualization, 

implementation, and evaluation of cultural competence 

remains unclear” (Giger etal., 2007). 

Lipson and Desantis (2007) identify facilitators to 

successful implementation of teaching cultural competence 

as administrative support, faculty commitment and 

adequate funding. Inhibitors are described as decrease 

in core courses focused on culture, a recipe or laundry 

list approach which focuses on cultural characteristics, a 

microlevel approach which focuses on individual nursepatient 

encounters and neglect of the macrolevel factors 

which affect health disparities and client health, and the 

geographical context and setting of the clinical education. 

And finally, Drevdahl, Canales, & Dorcy (2008) suggest 

that a focus on cultural competence does not address the 

larger health issues and risks in society. “The causes of 

health disparity exist at a much broader social, political 

and economic level, and therefore require much broader 

approaches if they are to be eliminated. We need to engage 

in critical thinking, reflective practice, and political action 

BRCN Experience 

In the major curriculum revision of 2007, the faculty 

questioned whether cultural competence was really 

integrated into the BRCN curriculum. Two faculty, the 

author and Carol Ann Moseley, RN, PhD, had studied 

education in cultural competence extensively in writing 

a HRSA grant application, agreed to develop and teach a 

one-hour, online required course for seniors. The Purnell 

Model and Leininger’s Theory were the major threads of 

the course. 

The course outline is: Transcultural Diversity and 

Healthcare, Self-Assessment. Course assignments 

included: discussion questions each week, pre- and postself-assessments, 

interview and comparison of two cultures 

based on the 12 domains. Based on student and faculty 

evaluation after the first semester, assignments were 

simplified, the Cultural Competency Nursing Care Webbased 

Course (www.omhrc.gov) and case study internet 

materials were added to the course. Finally, after teaching 

this course for 2 semesters, based on the literature, faculty 

decided to drop the course and integrate the content into 

all of the nursing courses. The course faculty will serve as 

mentors and resources to other faculty. 

References 

American Academy of Nursing Expert Panel on Cultural 

Competent Nursing Care. (1992). AAN expert panel report: 

Culturally competent nursing care. Nursing Outlook, 40(6), 

277-283. 

American Association of Colleges of Nursing. (2008). Cultural 

competency in baccalaureate education. Retrieved August 

10, 2008 from http://www.aacn.nche.edu/Education/pdf/ 

competency.pdf 

American Association of Colleges of Nursing. (2008). Toolkit 

of resources for cultural competency in baccalaureate 

education. Retrieved August 10, 2008 from http://www.aacn. 

nche.edu/Education/pdf/toolkit.pdf 

American Nurses Association. (1991). Position Paper: Cultural 

Diversity. Washington, DC: NursesBooks. 

Campinha-Bacote, J. (2002). The process of cultural competence 

in the delivery of Healthcare services: A culturally competent 

model of care. Retrieved October 15, 2008 from http://www. 

transculturalcare.net/ 

Canales, M., & Bowers, B. (2001). Expanding the 

conceptualizations of culturally competent care. Journal of 

Advanced Nursing, 36 (1), 102-111. 

Drevdahl, D., Canales, M., & Dorcy, K. (2008). Of goldfish tanks 

and moonlight tricks: Can cultural competency ameliorate 

health disparities? Advances in Nursing Science, 31(1), 13- 

27. 

Giger, J., Davidhizar, R., Purnell, L. Harden, J., Philips, J., & 

Strickland, O. (2007). American Academy of Nursing 

Expert Panel Report: developing cultural competence 

to eliminate health disparities in ethnic minorities and 

other vulnerable populations. Journal of Transcultural 

Competence, 18, 95-102. 

Institute of Medicine (IOM). (2001). Crossing the quality chasm: 

A new health system for the 21st century. Washington, DC: 

National Academy Press. 

Institute of Medicine (IOM). (2005). Quality Through 

Collaboration: The Future of Rural Health Care. Washington 

(DC): National Academy Press. 

Leininger, M. (2002). Culture care theory: A major contribution 

to advance transculture nursing knowledge and practice. 

Journal of Transcultural Nursing, 13(3), 189-192. 

Lipson, J., & Desantis, L. (2007). Current approaches to 

integrating elements of cultural competence in nursing 

education. Journal of Transcultural Competence, 18 (1) 

10S-20S. 

The National Quality Forum. (2008). Endorsing a framework 

and preferred practices for measuring and reporting 

culturally competent care. Washington, DC: NQF. 

Purnell, L., & Paulanka, B. (2008). Transcultural health care 

(3rd Ed). Philadelphia: F. A. Davis. 

Sullivan Commission. (2004). Missing persons: Minorities in the 

health professions. Washington, DC. 

US Dept of Health and Human Services—Health resources 

and services Administration. (2001). Transforming the 

face of health professions through cultural and linguistic 

competence education: The role of HRSA centers of 

excellence. Retrieved August 10, 2008 from http://www.hrsa. 

gov/culturalcompetence/ 

U.S. Office of Minority Health. (2001). National standards for 

culturally and linguistically appropriate services in health 

care. Retrieved December 16, 2006 from http://www.omhrc. 

gov/clas/index.htm 

Visit our website 

www.illinoisnurses.com 

for a complete listing of 

INA Approved Educational Activities

Empowering Nurses for the Future - nursingALD.com

Create successful ePaper yourself

Delete template?

Save as template?