Michigan 2019 Annual Report

PSYCHIATRIC 

NURSE 

PR ACTITIONER 

Part-time contract position to provide psychiatric assessments and 

medication reviews for mental health and substance abuse clients 

at a non-profit family service agency. 

NP and behavioral health experience required. 

Resume and cover letter by April 3rd to: 

LCCC, 2020 E. Grand River, #104, Howell, MI 48843 

or email: mark@livingstoncatholiccharities.org 

EOE 

(517) 545-5944 Livingstoncatholiccharities.org

2019 ANNUAL BOOK OF REPORTS 

TABLE OF CONTENTS 

ANA-Michigan Board of Directors. ............................................2 

2019 Strategic Plan. .....................................................3 

Membership Assembly Agenda. ..............................................5 

Meeting, Rules and Parliamentary Procedure. ....................................6 

President’s Report ..................................................... 12 

2019 Year End Financial Statements. ......................................... 13 

2020 Budget ......................................................... 17 

Executive Director Report ................................................ 19 

Government and Legislative Report. ......................................... 21 

Listing of all 2019 Committee members ....................................... 25 

Committee Report: Nursing and Health Policy. .................................. 26 

Committee Report: Nursing Practice ......................................... 27 

ANA Membership Assembly Representatives Report. ............................... 29 

Candidate Bios. ....................................................... 32 

Bylaw Amendments .................................................... 41 

Appendix 

ANA-Michigan Position Statements. .......................................... 54 

Enhanced Nurse Licensure Compact. ....................................... 54 

Safe Staffing, Safe Care, Safe Nurse. ....................................... 56 

Title Protection ..................................................... 60 

Work Place Violence .................................................. 62 

ANA-Michigan Policy on Position Statement. .................................... 65 

ANA-Michigan Bylaws ................................................... 66 

Printed and published for ANA-Michigan by: 

Arthur L. Davis Publishing Agency 

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

(319) 277-2414 

1


2


3


AGENDA 

ANA-Michigan Membership Assembly 

March 25, 2020 

1:00 – 2:00 p.m. 

Radisson, Lansing, Michigan 

1:00 Call to Order—Carole Stacy, President 

• Roll Call of the Board of Directors 

• Roll Call of Membership 

• Declaration of Quorum 

• Review and Approval of the Agenda 

• March 1, 2019 Membership Assembly Minutes 

1:05 President’s Message—Carole Stacy, President 

1:10 ANA-Michigan Financial Road Map—Tobi Moore, Executive Director 

1:15 Greetings from the Michigan Nursing Students Association 

1:20 2020 Proposed Bylaw Amendments—Vineta Mitchell, Bylaws Chair 

1:40 Memberships Comment and Open Forum 

1:45 Recognition of Outgoing Board Members—Carole Stacy, President 

1:50 Tellers Report—Linda Taft, Nominations Chair 

• President Elect 

• Director (2 Positions) 

• Newly Licensed Director 

• Nominations Committee (2 Positions) 

1:55 Passing of the Gavel—Carole Stacy, President 

2:00 Announcements and Adjournment—Julia Stocker Schneider, President 

5


MEMBERSHIP MEETING RULES & PARLIAMENTARY PROCEDURE 

Meeting Rules 

_____________________________________ 

Rule 1: Registered members must wear their 

name badges during the business session. 

All membership in good standing may 

vote. 

Rule 2: In making a motion or speaking to a 

question, a delegate shall move to the 

floor microphone, address the Chair, 

await recognition of the Chair, and give 

the delegate’s name and region. 

Rule 3: The correct form to use in making a 

motion is “I move that...” 

Rule 4: All motions and amendments should be 

written and signed by the maker of the 

motion or amendment and then given to 

the Chair. 

Rule 5: A member may not speak against her/ 

his own motion, but may vote against it. 

Rule 6: No member shall speak more than once, 

or longer than three minutes, on the 

same question until all have spoken who 

wish to express and opinion. 

Rule 7: All reports and supplements to reports 

shall be written and shall not be read. 

Rule 8: Only currently paid members of the 

Association are entitled to vote at the 

polls upon verification of their current 

dues being in good standing according 

to the most current membership rosters 

provided to the tellers. 

Rule 9: The Association staff shall report the 

number of members registered after the 

opening ceremonies. Supplementary 

reports may be given later as the Chair 

may direct. 

Rule 10: A member should raise her/his hand to 

indicate she/he cannot hear. 

Rule 11: The member will act only on the 

resolves of a resolution. Questions of 

clarification will be handled according 

to parliamentary procedure. 

Rule 12: All sessions of the Annual Business 

Meeting shall be open to the public 

unless the Chair declares an executive 

question. 

Parliamentary Information 

_____________________________________ 

Robert’s Rules of Order, Newly Revised is the 

parliamentary authority that shall govern the 

ANA-MI Business Meeting. The chair, as the 

presiding officer, rules on all matters relative 

to parliamentary law and procedures. The 

Parliamentarian serves only in an advisory 

capacity to the presiding officer and members. 

Member participation in the business session is 

governed by the standing rules. 

The motions that follow are defined in terms of 

action a delegate may desire to propose. Rules 

governing these motions are listed in Table 1. 

A main motion introduces a subject to the 

Business Meeting for consideration and is stated: 

“I move that....” 

FILLING OUT A MOTION FORM 

Motion forms are at the registration table 

and will be available on tables during the 

Membership Assembly Meeting. Please fill 

them out completely before bringing forward 

a motion for consideration at the Business 

Meeting for discussion. 

You must sign your name and Region and 

get the signature of a person to second the 

motion before bringing it up. 

An amendment (primary) is a motion to modify 

the working of a motion. The motion to amend 

may be made in one of the following forms, 

determined by the action desired: “I move to 

amend by....” 

6

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

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

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

the end of the motion).” 

• substituting (paragraph or entire text of 

a resolution or main motion and inserting 

another that is germane). 

An amendment to an amendment is a motion to 

modify the wording of the proposed amendment 

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

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

amendment are applicable for making a secondary 

amendment. 

The motion to commit or refer is generally used to 

send a pending motion (also called “the question”) 

to a small group of selected persons - a committee, 

board, or cabinet, for example - so that the question 

may be studied and put in better condition for the 

assembly to consider. The motion is stated: “I move 

to commit the question to..........for further 

study.” 


The motion to reconsider enables a majority of the 

assembly to bring back for further consideration a 

motion that has already been voted. The purpose 

of reconsidering a vote is to permit correction 

of hasty, ill-advised, or erroneous action, or to 

consider added information or a situation that has 

changed since the vote was taken. (Note exception 

on the Table - Rules Governing Motions) 

Parliamentary inquiry is a question directed to 

the presiding officer to obtain information on 

parliamentary law or the rules of the organization 

as relevant to the business at hand. A member 

addresses the chair and states: “I rise to a (point) 

of parliamentary inquiry.” 

Point of information is a request, directed to 

the chair or through the chair to another officer 

or member for information relevant to the 

business and hand. The request is not related 

to parliamentary procedure. The member 

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

of information.” 

The motion to close a debate (previous question), 

if seconded and approved by a two-thirds vote, 

stops discussion on the pending question and is 

stated: “I move the previous question.” 

A division of the assembly may be called by any 

member if the chair’s decision on a voice vote 

is in question. The member proceeds to the 

microphone and states: “I call for a division of 

the house.” The chair then takes a standing or 

roll call vote. 

A division of the question may be called when 

a pending motion relates to a single subject but 

contains several parts, each capable of standing 

as a complete proposition. The parts can be 

separated, and each considered and voted on as 

a distinct question. The motion is stated: “I move 

to divide the question........as follows....” 

The motion to appeal the decision of the chair is 

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

is made by a member and seconded by another 

member, the question is taken from the chair 

and vested in the voting body for a ANA-Michigan 

decision. The motion is stated: “I move to appeal 

the decision of the chair.” 

Before a member can make a motion or address 

the assembly on any question, it is necessary that 

he or she obtain the floor through recognition by 

the presiding officer. The member must: 

• rise and proceed to the microphone. 

• address the chair by saying, “Madam 

Chairperson” 

• await recognition 

• give name and region 

• state immediately the reason for rising 

7


Rules Governing Motions 

___________________________________________________________________________________________________________ 

Interrupt Speaker Recognized by Chair Requires a Second Debated Vote 

Main motion NO YES YES YES Majority 

Amendment NO YES YES YES Majority 

Amendment to amendment NO YES YES YES Majority 

Limit Debate NO YES YES NO Two-thirds 

Close debate 

(previous quest.) 

NO YES YES NO Two-thirds 

Divide the Question NO YES YES NO Majority 

Reconsider NO YES YES YES Majority* 

Point of parliamentary inquiry YES NO NO NO Chair Decides 

Point of Information YES NO NO NO Chair Decides 

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

to reconsider requires a two-thirds vote. 

Considering a career in Public Health? 

The Grand Traverse County Health Department has 

regular opportunities for Public Health Professionals! 

http://www.grandtraverse.org/1574/Job-Postings 

Call Today: 231-995-6100 

8


March 1, 2019, 8:30 a.m. – 9:22 a.m. 

GVSU L.V. Everhard Center Grand Rapids, MI 

Executive Board: Carole Stacy; Stacy Slater; Julia Stocker Schneider; Bridget Leonard; 

Directors: 

Lynne Harris; Suzanne Keep; 

Executive Director: Tobi Lyon Moore 

Excused: 

_____________________________________________________________________________________ 

Peggy Ursuy; Kathy Dontje; Edith English 

8:30 Call the Meeting to Order 

President Stacy called the meeting to order at 0830. 

Roll Call 

Stacy: Present; Slater: Present; Leonard: Present; Julia Stocker Schneider: Present; Harris: 

Present; Keep: Present; Ursuy: Excused; Dontje: Excused; English: Excused; Moore: Present. 

President Stacy declared a quorum (36 members in attendance). 

Corrections or additions to the Agenda 

None Stated. 

Approval of Agenda 

Motion #1: Approval of Agenda 

Made by: Stocker Schneider. 

Agenda approved. 

MINUTES 

BOARD MEETING 

No additional correction to October annual meeting minutes noted. 

Motion #3: Approve 10.26.2018 Annual meeting minutes. 

Made by L. Harris. PASSED 

_____________________________________________________________________________________ 

8:33 President’s Message 

• 2019 Strategic Plan presented, pillars discussed 

• Policy influence- letter sent to Governor Whitmer regarding ANA-MI stance on nursing in MI 

• Task force to write ANA-MI statement, sent to membership expert to bring a grounded 

perspective, 

• Appointments to committee and state agencies discussed: Legislation, Policy, Education, 

Finance, and Practice. 

_____________________________________________________________________________________ 

8:37 ANA- MI Financials 

• Treasurer Stacy Slater presented the financial statements. 

• Membership dues budget was $15413.67, in January took in $16,844.71 

• 1 month into operating budget $9843.74 was January net gain 

Motion #2: Accept ANA-MI January financials report as corrected 

Made by Klemczak. PASSED 

9


8:45 Introduction of MNSA Board 

• Megan Piotrowski, President of MNSA discussed goals: 

o Increase membership engagement to approximately 3000 members 

o Offer creative community service activities, Social media/new technology 

o Convention planning early and more advertising 

o Strategic plan and value to local chapters for members and nursing students 

o Relying on faculty to build connections and guide the way, working with and learning 

from ANA-MI 

_____________________________________________________________________________________ 

08:48 Deborah Bach-Stante- Director of Nursing Office Policy 

• SB 111- Modifies allegation process, more requirements for the reporter and accused. 

More power to LARA and changes to Attorney General 

• New Administrative rules proposed, need a lot of education 

o 2018 033LR- Changes to nursing administrative role, clinical placement ratios put 

control at the site level, no prescribing number being made to be more flexible 

o 2019 024LR- Public Health code which changed license expiration date from 3/31 to 

date of license issue date now will be expiration. The electronic process still has 

glitches and the nurse is still responsible for renewal even if they do not receive 

notification of expiration 

• Nursing Licensure Survey- All nurses should receive, if link not received information is 

located in the last ANA publication 

• Enactment of Nurse Licensure Compacto 

LARA- panels of medical marijuana, applications being accepted for emergency rules 

r/t poisoning. Public hearing on 3/12/19 

• State Innovation Model- Blueprint for Medicaid database for Health Innovation for MDHHS 

can sign up, need provider language 

• Section 298 Merging of mental health and physical health. All nurses should be aware, info 

on the website and call for participation in community hearings. 

_____________________________________________________________________________________ 

09:01 Recognition of Outgoing Board Members 

• Stacy Slater 

• Bridget Leonard 

• Lynne Harris 

• Suzanne Keep 

• Peggy Ursuy 

• Katherine Dontje 

• Edith English 

_____________________________________________________________________________________ 

09:05 Teller’s Report 

• 2019 Election Results 

o Secretary- Nikeyia Davis 

o Treasurer- Stacy Slater 

o Director At Large (2 Year Term)- Margaret Calarco & Suzanne Keep 

o Director At Large (1 Year Term)- Bridget Leonard & Kathy Dontje 

o Newly Licensed Director- Andrea Corrie 

o Nominations Committee- 1 Year term: MaryLee Pakieser 

o Membership Assembly- Stacy Slater 

10


• Ballots will go out at the end of April to fill the (2) 2 year term positions for the Nominating 

Committee 

_____________________________________________________________________________________ 

09:10 Membership Comments 

• MOTION #4: ANA-MI to joining the MI Coalition to Prevent Gun Violence for $100.00. 

Made by Myrna Holland/2nd Kathleen Birdsall. PASSED 

• Discussion on other areas where ANA-MI pays for membership to support 

• Committee membership 

o ANA-MI member 

o Consent to Serve, Board approves 

o Bylaws defines number of positions, usually 9 

o At end of the year, fall 2019, call to membership for 1-2 year terms, there are openings 

on various committees 

• 2020 Conference in the Spring, 1 day event around Leadership/Advocacy in Lansing 

• May 2019- 1 day meeting at Northern MI University in the Upper Peninsula to work with 

Education Committee to plan 

_____________________________________________________________________________________ 

09:22 Adjournment 

Mission 

Advancing the nursing profession in Michigan. 

Vision 

ANA-Michigan is a vital community of professional nurses in Michigan. Together, we are the experts 

in nursing practice. Our strength is our solution-focused thought leadership, our long-term view of 

the nursing profession in a dynamic healthcare environment, and our impact on quality care and 

patient safety. 

11


PRESIDENT’S REPORT 

While my term has been a little shortened due to the change in timing of our 

Annual Meeting, I think we have made strides in moving ANA-Michigan forward. As 

I came into office, we were undergoing a total restructure of our organization. My 

thought at the time was to view the new structure as a work in progress, and it has 

certainly been. Looking back on 2019 I think we have found areas of change within 

the new structure that have worked well and some that we need to rethink and go 

back to the drawing board, but always moving forward. 

2019 

• ANA-Michigan’s social media presence has grown. 

12 

Carole Stacy, 

MSN, MA, RN 

• Using technology to facilitate meetings has enabled us to cut back on travel costs and 

increasing member participation. 

• ANA-Michigan has continued to see an increase in membership. 

• Our committees are working on policy, legislative and practice issues, producing policy papers 

on workplace violence and moving Enhanced Nurse Licensure Compact legislation forward. 

• ANA-Michigan supported me and Nursing and Health Policy Committee member Barbara 

Medvec to attend the ANA American Nurses Advocacy Institute (ANAI), a yearlong program 

that begins with an intensive three-day seminar in advocacy training. The ANAI is held each 

year, accepting 24 ANA members from across the ANA national network. ANA-Michigan has 

had members attend for the last several years. ANAI participants select an advocacy issue 

relevant to their state to work on during their time in the Institute. 

• ANA-Michigan has worked to forge or maintain relationships with other nursing and healthcare 

related organizations in Michigan; APRN Alliance of Michigan (AAOM), Coalition of Michigan 

Nursing Organizations (COMON), Capital Area Health Alliance (CAHA), Michigan Organization 

of Nurse Leaders (MONL). 

• ANA-Michigan has continued to support the Michigan Nursing Students Association (MNSA) by 

providing meeting space and having an ANA-Michigan Consultant position on the Board. 

• ANA-Michigan has worked with the Office of Nursing Programs to provide input into development 

of the annual nursing workforce survey for 2020 and a survey of employers to gather data on 

strategies being utilized to decrease or prevent workplace violence. ANA-Michigan has helped 

disseminate the link to the 2019 survey through our ability to communicate with not only our 

members but Michigan’s nurses with our print and online publications. 

This Annual Book of Reports will showcase how our committees and our organization have flourished 

and served our members during 2019. 

Being President of ANA-Michigan has been a tremendously positive opportunity for me. I have met 

ANA colleagues from many of the ANA Constituent State Associations. I have learned that while each 

of our organizations may look different, we share many of the same issues and problems. Having the 

opportunity to attend the ANA Membership Assembly and the ANA Leadership Summit each year has 

increased my knowledge of the advocacy process and the way ANA and its members are supporting 

nurses and shaping the nursing profession. This is big, no it is huge work that requires many nurses 

working together. I would recommend that members of ANA-Michigan consider running for an office 

or serving on one of our committees. Your time and effort will be well spent.


FINANCIAL STATEMENTS 

Operating Revenues: 

2019 Written Financial Summary 

Membership Dues: We budget a monthly average membership revenue to be $15,416.67 and instead 

we averaged $18,266.47. 

Conference Income: This year the conference was a financial success making a profit of $7,112.74. This 

is record setting, as ANA-Michigan hasn’t made over $4,000 at a conference in its history. 

Non-Dues Revenue: We fell short by $5,745.44 from what we budgeted to receive for our non-dues 

revenue as our profit sharing from the career center, CE App and ANA Personal Benefit Program didn’t 

perform. One Main terminated their contact in November as Michigan wasn’t preforming. 

Operating Expenses: 

We are currently over-budget in the following categories: 

Marketing/Promotion: we ordered additional membership promotional materials that will also carry 

us over into 2020. With our growth in membership our supply was almost out before year end, 

we have been at additional conferences promoting ANA-MI, resulting in us being over budget by 

$1,675.98. 

Technology Hosting: with the launch of the new website this year we incurred some additional fees 

which has us currently over budget by $2,947.17. 

Membership Assembly: is over budget by $2,064.99 due to the increase of additional sleeping rooms 

that ANA didn’t cover, meal expenses for representatives, and some additional transportation costs 

for parking. We had five members present at the assembly. 

Net Profit: 

We ended the year with a net gain of $34,281.73. Our Merrill Lynch account the portfolio was up 

about 15% in 2019, which is excellent for a moderate allocation. The portfolio grew over $12,000 

to almost $95,000, in 2020. 

13


14


15


16

2020 BUDGET 


Approved 2020 Budget 

17


Approved 2020 Budget 

18


EXECUTIVE DIRECTOR REPORT 

I cannot say whether things will get better if we change; what I can say is they 

must change if they are to get better. – Georg C. Lichtenburg 

2019 was a year that brought many changes to ANA-Michigan. On October 26, 

2018, ANA-Michigan members passed major structural changes to the association 

with the passing of new bylaws. 

The prior ANA-Michigan governance structure catered to less than 4% of our 

membership; the ability to reach and increase our engagement for the entire 

membership has been the goal of the board for the past two years. While change 

can be difficult and not everyone will get on board, the leadership for the association knew that if 

we didn’t change, we wouldn’t be able to sustain as an organization. 

One of the key structure changes is that now ANA-Michigan can offer organizational affiliate 

membership. ANA-Michigan is referred to as the “convener of conversations” here in Michigan. 

Allowing this option will better position ANA-Michigan to fulfill our commitment of being that go-to 

convener. 

By working together with other specialty and healthcare associations, we can collaborate in finding 

solutions to issues that face the nursing profession, regardless of specialty. We must continue to push 

ANA-Michigan’s vision of all registered nurses as a powerful, unified force in engaging consumers and 

transforming health and health care. Our ability to achieve that vision is significantly strengthened 

by the knowledge and experience our affiliates bring, from contributing to our publications to sharing 

specialized knowledge at meetings and events. While each organization maintains its autonomy, the 

nursing profession and the patients we serve benefit from a shared voice that speaks on health care 

issues from a position of unrivaled experience and expertise. 

We spent time in 2019 getting the new committee structure in place and moving forward on our 

strategic initiatives. There were changes that we wanted to accomplish, but as an organization we 

couldn’t execute until 2020. 

In 2020, members can expect to see numerous programming options, with a few of them to include 

programming to be provided in three different locations. This will enable us to provide access to 

a variety of high quality and relevant programming related to nursing practice issues to members 

across the state. 

We will also be launching the new Nursing Leadership Academy. This program consists of three twoday 

sessions that will be held over four to six months to empower participants to return to their 

workplace and implement the knowledge and skills learned in the sessions. Part 1 will be held June 

2-3, 2020; Part 2 on September 15-16, 2020; and Part 3 is set for November 17-18, 2020. 

This year, the Nursing Health Policy created a position statement on “Preventing Workplace Violence 

in Healthcare Settings.” Thank you to all the members who worked tirelessly to create these 

19 

Tobi Lyon Moore, 

MBA


positions! In 2019, ANA-Michigan was featured by ANA and highlighted both our Enhanced Nurse 

Licensure Compact and Staff Nursing Staffing to Improve Quality of Care. 

On March 1, 2017 the association became a part of a membership pilot with ANA called the “Value 

Pricing Pilot.” Membership growth since then is at 86.6%. Yes – 86.6% growth since March 1, 2017! We 

ended December 2019 with 2,633 members. ANA-Michigan is seeing a 2.8% average monthly growth 

in membership. In 2019, the association had a 11.2% growth rate. The average rate for all the states 

who are participating in the “Value Pricing Pilot” was at 9.1% growth in 2019. 

ANA-Michigan leads ANA out of all states in membership growth. Below is a list of all the top 8 states 

in terms of membership growth who are participating in the pilot. 

1. Michigan: 86.6% 

2. New Jersey: 75% 

3. Idaho: 72.8% 

4. Illinois: 70.1% 

5. California: 60.5% 

6. Missouri: 60.4% 

7. Maryland: 55.3% 

8. Iowa: 54.9% 

During our Membership Assembly in 2020, one of the proposed bylaw amendments is to support that 

the pilot be no longer a pilot, instead becoming the official membership structure for the association. 

This structure has been extremely successful, and I encourage the membership to support making 

this change. 

It’s an amazing time to be a nurse in Michigan, and even bigger and better things are on the horizon. 

Thank you for continuing to support ANA-Michigan and the nursing profession. 

“It is one thing to have been educated and licensed as an RN, another to be employed as an 

RN, but the mark of a real professional is a love for – and interest in – what is happening to the 

profession, and a commitment to help it. Without taking this third step, without identification 

as a member of the professional nursing organization, many nurses are merely draining the 

good from the profession without adding their share to keep it strong and dynamic.” 

– Mary Munger, Montana Nurses Association Past President 

20


GOVERNMENT & LEGISLATIVE REPORT 

Enhanced Nurse Licensure Compact (eNLC): 

Rep. Whiteford, RN, re-introduced the eNLC legislation. HB 4042 would join Michigan 

with other states participating in the eNLC to allow an RN to obtain a multi-state 

license and have privileges to practice in any other eNLC state. The bill was reported 

favorably from the House Health Policy committee and awaits action in the House 

Ways and Means committee. 

ER Personnel Protection: 

SB 80 amends the Michigan Penal Code to extend to emergency room personnel a 

prohibition against assaulting, battering, wounding, resisting, or endangering law 

enforcement or other emergency personnel. The bill also would require an employer 

of any of the people included in that provision to post a sign at any property used by 

the employer stating that it is a felony to assault such a person knowing that the person is performing 

his or her duties. The bill includes nursing in the definition of emergency room personnel. 

HBs 4327 and 4328 would extend the prohibition against assault from just the ER, like SB 80, to health 

professionals and medical volunteers in any health care setting. The House versions of the legislation 

received a hearing only in House Judiciary Committee in April. 

SB 303 would require hospitals, public health departments and certain other healthcare settings to 

create a workplace violence prevention plan with input from employees; train employees on policies, 

reporting violence, and de-escalation and other prevention techniques; and track workplace violence 

and report injuries from violence to law enforcement. Workers who report violence against them 

would be protected from retaliation. 

Nurse to Patient Ratios: 

HB 4279/SB 159: Three years after the effective date or four years if it’s a rural hospital, the hospital 

must establish a committee for each unit (half of members must be direct care RNs) to determine 

staffing levels. The minimum direct care Nurse to Patient ratio is in effect at all times. Assigned RNs 

must be qualified and competent per each unit assigned. The hospital cannot impose overtime (unless 

of an emergency) and a hospital may decrease the number of patients per what is required. The 

committee must re-evaluate the staffing plan at five years, and annually thereafter. 

The hospital must post a notice describing the requirements of the law, the rights of RNs and patients, 

and how to file a complaint. The dept. must establish a toll-free number for complaints and a person 

that files a complaint is protected under the whistleblower act. The hospital must file a plan with 

the dept. annually or be subject to fines. The dept. can post the names of the hospitals that are in 

violation of the law. The bill defines acuity tool, mandatory overtime, and staffing plan, etc. and 

includes the ratios. 

HB 4280/SB 161: Fines hospitals that force overtime. If an RN works 12 hours, they must have eight 

consecutive hours off. This does not apply to emergencies, or if they were required to work longer than 

12 hours due to the patients need and leaving would have an adverse effect on the patient. An RN can 

21 

Monika Miner 

Government 

& Legislative 

Advisor


voluntarily accept working overtime, however, the hospital cannot force, threaten, etc. a nurse that 

refused to work overtime. A hospital must post how someone can file a complaint. 

HB 4281/SB 160: Requires a hospital to maintain records of nurse to patient ratios, and make it readily 

available to the dept., RNs and the public. 

Sexual Assault Prevention: 

The House and Senate have re-introduced several bills that aim to prevent sexual assault that didn’t 

make it through the legislature last session. 

SB 216: Would develop educational material for students grades six through 12 on sexual harassment 

and assault, an explanation that such acts are not the victim’s fault and provide contact information 

for victims. 

SB 217: Health professionals would be required to obtain consent for medical examinations of minors 

involving vaginal or anal penetration, have another individual present during the examination and 

retain records of that examination for at least 15 years. 

SB 218: Sentencing guidelines for SB 217 and for intentionally failing to document such medical 

examinations would carry a maximum sentence of two years imprisonment. 

SB 219: Prohibit sexual contact and sexual penetration under the pretext of medical. 

SB 220: Sentencing guidelines for SB 219 would make it a felony with a maximum sentence of 20 years 

imprisonment and sexual penetration under pretext of medical treatment would carry a maximum 

sentence of 25 years imprisonment. 

The House versions that mirror the senate versions are: HBs 4370-4384 and also include automatic license 

revocation for certain crimes; bans on using a position of authority to prevent reporting of complaints 

or from discouraging Title IX reporting; expansion of the list of mandatory reporters of instances of 

sexual assault, with required training; and development of sexual assault response improvement plans 

and grants. HB 4384 is a new bill that would require physicians to disclose to patients if they have been 

given probation by a state licensing board. 

Medication Aide: 

Representative Ben Fredrick has re-introduced the medication aide legislation with some changes from 

last year’s bill. HB 4098 defines a medication aide as someone who administers regularly scheduled 

medications to residents of a nursing home or a skilled nursing facility while under the supervision of a 

RN. A medication aide cannot administer controlled substances or injectable forms of medication, the 

initial administration of medications or the administration of as needed medications. A medication aide 

must first be a nurse aide and have practiced as a nurse aide, and must take a competency test upon 

completion of a state approved medication aide program. The bill was reported favorably from the 

House Health Policy committee and awaits committee action in the House Ways and Means committee. 

Pilot Program for Medics: 

Rep. Farrington has reintroduced HB 4023 and HB 5052, which would amend the Public Health Code to 

permit the Department of Licensing and Regulatory Affairs (LARA) to establish a pilot program in which 

military medical personnel could practice and perform certain delegated acts, tasks, or functions, 

under the supervision of a licensed physician or podiatrist. The bills were reported favorably out of the 

House Military, Veterans and Homeland Security committee and had a hearing only so far in the House 

Ways and Means committee. 

22


Extended Eligibility for CISM Services: 

House Bill 4862 (substitute H-1), introduced by Rep. Wozniak amends the Critical Incident Stress 

Management Services of the Public Health Code to expand the definition of emergency service providers 

eligible for the critical incident stress management (CISM) services to all licensed health professionals 

as well as anyone who is employed or under contract with a health facility or agency. 

Currently, the CISM services are available to individuals who provide emergency response services, 

including law enforcement officers, corrections officers, firefighters, emergency medical services 

providers, dispatchers, emergency response communication employees, or rescue service providers. 

The bill has passed the House and is awaiting action in the Senate floor. 

Prohibition of Nonconsensual Pelvic Examinations: 

House Bill 4958, introduced by Rep. Hornberger, would amend Part 161 (General Provisions) of the 

Public Health Code to prohibit a licensee or registrant from performing a pelvic examination or 

allowing a student in the course of studies for a health profession training program to perform a pelvic 

examination on an anesthetized or unconscious patient. A pelvic examination on an anesthetized or 

unconscious patient could be conducted in any of the following circumstances: 

- The patient or patient’s authorized representative provided written, informed consent to the 

pelvic examination and it was necessary for preventative, diagnostic, or treatment purposes. 

- The patient or patient’s authorized representative provided written, informed consent to a 

surgical procedure or diagnostic examination to be performed on the patient and the pelvic 

examination was within the scope of care for that procedure or examination. 

- The patient was unconscious and incapable of providing informed consent and the pelvic 

examination was necessary for diagnostic or treatment purposes. 

- A court ordered the pelvic examination in order to collect evidence. 

The bill has passed the House and is awaiting action in the Senate Health Policy and Human Services 

committee. 

Michigan CARES Hotline: 

Rep. Whiteford introduced House Bill 4051 that would add section 165 to the Mental Health Code, 

establishing a Michigan CARES (Community, Access, Resources, Education, and Safety) hotline for 

individuals experiencing a mental health crisis. The hotline would be a telephone referral system 

available 24 hours a day, 7 days a week. The bill passed and was signed into law by the Governor. It is 

now Public Act 12 of 2020. 

Require Electronic Transmission of Prescriptions: 

House Bill 4217 would change the provision that currently allows a prescription to be transmitted 

electronically, as long as it complies with certain requirements, to require a prescriber or his or 

her agent to transmit the prescription electronically under those circumstances, beginning January 

1, 2021. The prescription, including one for a controlled substance, would have to be transmitted 

directly to the patient’s chosen pharmacy. There are, however, exceptions written into the legislation. 

The bill has passed the House and is awaiting action in the Senate Health Policy and Human Services 

committee. 

23


Hospice Exemptions: 

Senate Bills 127 and 128 would amend the Public Health Code and exempt patients under the care of 

a hospice from certain requirements related to a bona fide prescriber-patient relationship and MAPS 

reporting. SB 128 is now law. 

Michigan Essential Health Provider Repayment Program: 

SB 343 increases the maximum amount of debt or expense that the Department of Health and Human 

Services could pay on behalf of a designated health professional through a health provider repayment 

program to $250,000 over ten or more years. The bill has passed the Senate and is awaiting action in 

the House Health Policy committee. 

Updates the Mental Health Code: 

Senator Vanderwall, Chair of the Senate Health Policy and Human Services committee, and Rep. Ben 

Fredrick, Vice Chair of the House Health Policy committee, are drafting legislation to update the 

mental health code. The intent of the legislation will be to address access issues and update the MHC 

by including PAs, NPs, and CNSs in the definition of “mental health professional,” among other updates. 

Title Protection for “Nurse:” 

Representative Julie Calley is drafting legislation to protect the title “nurse.” 

LARA Update: 

The Pharmacy Controlled Substance Administrative Rules were changed last year to require that 

individuals with a controlled substance license complete a one-time training in opioids and other 

controlled substances awareness that meets the standards under Rule 338.3135. 

Now, those applying for a Controlled Substance license are required to certify that they have completed 

the one-time training in opioids and controlled substances awareness as part of the application process. 

Current controlled substance licensees will have to certify that they have met the training requirement 

when they renew at their first full renewal cycle. Meaning if the licensee was part way through their 

current license cycle when Rule 338.3135 went into effect (January 4, 2019) the licensee would have 

another full licensure cycle to meet the requirement. 

The rules also state that a prescriber or dispenser shall not delegate or order the prescribing, dispensing, 

or administering of a controlled substance as authorized by this act to an advanced practice registered 

nurse, registered professional nurse or licensed practical nurse unless the nurse complies with the rule. 

24


COMMITTEE REPORTS 

Thank you to all our members who volunteered and served on ANA-Michigan committees in 2019. By 

you sharing your talents the association is better because of you paying it forward. 

Bylaws Committee 

Vineta Mitchell, Southfield, Chair 

Jamie Platt, Byron Center 

Linda Taft, Clinton Township 

Education Committee 

Julia Stocker Schneider, Pinckney, Chair 

Julie Bulson, Grand Rapids 

Nancy Martin, Harbor Springs 

Rachel Peltier, Mount Pleasant 

Mihaela Reed, Brighton 

Finance Committee 

Nancy Martin, Harbor Springs, Chair 


Vineta Mitchell, Southfield 

Karen Paulosky, Williamsburg 

Nominations Committee 

Linda Taft, Clinton Twp, Chair 

MaryLee Pakieser, Traverse City 


Leslie Simons, Lansing 

Beth VanDam, Grand Rapids 

Nursing and Health Policy Committee 

Katie Kessler, Northville, Chair 

Kristin Castine, Royal Oak 

Nikeyia Davis, Romulus 

Mindi Johnson, Lincoln Park 

Cheryl LaPlaunt, Sault Ste. Marie 

Nadine Wodwaski, Detroit 

Amber Irrer, DeWitt 

Barbara Medvec, Saline 

Joshua Meringa, Grandville 

Legislative Committee 

Nancy George, Brownstown Township, Chair 

Peggy Kearney, Ferndale 

Linda Buck, Kalamazoo 

Tracey Connolly, Macomb 

Jeanine Easterday, Traverse City 

James Lee, Sterling Heights 

Susan Wiers, Bruce Township 

Cynthia McNerlin, Spring Lake 

Nursing Practice Committee 

Katherine Dontje, Bath, Chair 

Margaret Calarco, Plymouth 

Linda Dunmore, Twin Lake 

Nadia Farhat, Dearborn 

Marge Freundl, Grosse Pointe Woods 


Julie Powell, Temperance 

Tamara Putney, Interlochen 

25



NURSING AND HEALTH POLICY 

Katie Kessler MSN MSA RN – Chair 

Members: Kristin Castine, Royal Oak 

Nikeyia Davis, Romulus 

Mindi Johnson, Lincoln Park 

Cheryl LaPlaunt, Sault Ste. Marie 

Nadine Wodwaski, Detroit 

Amber Irrer, DeWitt 

Barbara Medvec, Saline 

Joshua Meringa, Grandville 

The Nursing and Health Policy Committee is tasked with developing nursing and health policy 

initiatives related to ANA-Michigan’s public policy agenda. The committee is comprised of nurses 

from education and practice who are located across Michigan. The committee meets on the third 

Monday of the month by phone from 7-8 pm. We have had excellent participation at our meetings 

which is a testament to the members who often participate from their offices after working hours. 

In 2019-20, the committee developed a process for identifying priorities for nursing and health policy. 

We then developed a list of important topics and did a rank order process by email to identify the 

major priorities. We follow the format of ANA position statements using an evidence base approach. 

We identified violence in healthcare settings as a major priority and worked to develop a position 

statement entitled Reducing Workplace Violence in Healthcare Settings. The statement was 

submitted to the ANA MI Board and approved in October, 2019. This position statement can be found 

on page 62. Building on this work, the Chair and members are also on the planning committee for a 

conference on the Issue of Violence in Healthcare that is scheduled for August 6, 2020 in Livonia MI. 

The committee is currently working on a position statement regarding Reducing Gun Violence from 

a Public Health perspective using the same process. 

One feature of this collaborative committee that has proven very valuable is the opportunity members 

have to share and discuss issues from the perspective of their practice population and their location 

around the state. We have representation from urban, suburban and rural areas and a variety of 

practice specialties. This diversity has enabled the group to better understand specific issues and 

how they impact nurses and patients in different ways. A portion of every meeting is used getting 

updates and input on issues at the forefront of each member’s practice which has both informed our 

work and enriched the committee experience. 

26



Chair: Katherine Dontje, Bath 

Committee: 

Margaret Calarco, Plymouth 

Linda Dunmore, Twin Lake 

Nadia Farhat, Dearborn 

Marge Freundl, Grosse Pointe Woods 


Julie Powell, Temperance 

Tamara Putney, Interlochen 

NURSING PRACTICE 

Developed and Held a Two-Part Webinar Series: Creating Calm During the Chaos: 

• Part 1: Creating Understanding of Agitation in the Workplace 

o Monday October 7th 7:00 p.m. 

o Free to ANA-Michigan membership, recorded as well for membership to access 

o 63 members registered 

o These sessions focused on creating a common philosophy and understanding of agitation. 

Viewing agitation through a trauma informed lens the presenters will provide evidence-based 

education around the underpinnings of agitation and provide opportunities for reflective 

questions and answers around common struggles that people have in supporting agitated 

patients and families. This webinar was presented by Nichole Figueroa and Kris Hamick. 

• Part 2: Best Practices & Learning from Others 

o Monday, November 4th 7:00 p.m. 

o Free to ANA-Michigan membership, recorded as well for membership to access. 

o 57 members registered 

o This session focused on evidence-based approaches for supporting staff and health systems 

in providing care to patients and families who are displaying agitation/dangerous behaviors. 

Presenter’s will provide best practices within their respective health systems as well as 

provide evidence-based approaches for supporting individual skill development and health 

system development around workplace violence. The presenters will provide opportunities 

for reflective questions and answers during session. This webinar was presented by Nichole 

Figueroa and Kris Hamick. 

27


In addition, the committee held a Member Wellness and Engagement Activity. 

Step Up Challenge 

• Challenge to promote wellness of nurses (counting steps) 

• The challenge will take place October 1 to October 31, 2019 

• The registration fee is $25 and proceeds will go to the Michigan Association for Suicide 

Prevention 

• After participants registered, they received an email with access to an online step tracking 

system where they could keep track of their steps and see where they are ranked! This 

tracking system was compatible to connect to many fitness devices to automatically log 

activities 

• This was an individual challenge, participants competed against other participants 

Participation 

• 10 members participated; all proceeds of $250.00 donated to the Michigan Association for 

Suicide Prevention 

• 1st prize: Apple Air Pods (Winner – Josh Meringa, Grandville) 

• 2nd prize: Fitbit Inspire (Winner – MaryLee Pakieser, Traverse City) 

• 3rd prize: Free ANA-Michigan Membership (Winner – Mary Frazier, Milan) 

28


ANA MEMBERSHIP ASSEMBLY 

REPRESENTATIVES REPORT 

Submitted by: Carole Stacy, Julie Stocker Schneider, and Stacy Slater 

ANA Membership Representatives 

Wednesday, 6/19 

Tobi Moore, Carole Stacy and Julia Stocker Schneider attended the Open Session of the ANA Board 

of Directors Meeting. It was a great opportunity to see the ANA Board in action, including ANA- 

Michigan’s very own MaryLee Pakieser. It was valuable to observe the Board at work, and to hear 

some of the discussions of the board and members of the ANA Enterprise first hand. 

Thursday, 6/20 

Hill Day events began with a briefing breakfast and update on issues for discussion with our senators 

and representatives. Keynote speaker, Rep. Lauren Underwood, MSN, MPH, RN (D-IL) motivated and 

inspired the membership to reach higher. President Grant signaled the Nurses call-to-action. Federal 

legislative overview was provided by Samuel Hewitt and Kristina Wegner. Topics for discussion included 

Title VIII Nursing Workforce Reauthorization Act (S. 1109/HR. 959), the Home Health Care Planning 

Improvement Act of 2019 (S 296/H.R. 2150), and the Workplace Violence Prevention for Health Care 

and Social Services Workers Act (S. 851/H.R. 1309). Hill Day participants were also encouraged to 

speak and elicit support from their representatives about safe staffing levels for nurses and patients. 

Our group included ANA-MI members Carole Stacy, Julia Stocker Schneider, Stacy Slater, Marylee 

Pakieser, Linda Taft, and Adebosela Bakare. Our delegation met with staff for Senators Stabenow and 

Peters, Representatives, Bergman, Huizenga, Lawrence, Levin, Kildee, Moolenaar, Slotkin, Stevens, 

Upton, and Walberg. More than 400 nurses from 48 states participated in Hill Day activities. 

Friday, 6/21 

The Opening Session of the Membership Assembly began at 8A. The Membership Assembly is comprised 

of representatives from ANA’s constituent and state nurses’ associations, the Individual Member 

Division, and specialty nursing organizational affiliates as well as the ANA Board of Directors. Annual 

updates and reports were presented and attendees participated in Dialogue Forums including: 

Removal of Outdated ANA Language to Increasing Access to Vaccination Compliance; Deferred Action 

for Childhood Arrivals (DACA) Recipients Eligibility to take the NCLEX; Visibility of Nurses in the 

Media; and Human Trafficking: A Nursing Perspective on Solving a Public Health Crisis. The Dialogue 

Forum Topic of Visibility of Nurses in the Media was submitted by ANA-MI and was one of four out of 

60 submissions selected by the Professional Policy Committee to be included in the recommended 

dialogue forum. 

One of the most energizing events was the Hackathon. The purpose of the exercise was to identify 

strategic activities to raise the Visibility of Nurses in the Media (as part of the dialogue forum 

submitted by ANA-MI) by harnessing the brainstorming power of the entire membership assembly of 

400 nurses. Through three rounds of consideration a best strategy was identified with a pitch for the 

#1 idea. The Hackathon created a vibrant buzz and much discussion among the assembly, 

29


Report from the Committee on Bylaws was received. Voting on Bylaws was held on Saturday. 

Evening events included the Candidate Forum that included Marylee Pakieser as a candidate for reelection 

for Director at Large and the Midwest Region meeting. The ANA PAC Reception was also held 

and was attended by MaryLee Pakieser and Tobi Lyon Moore. 

Saturday, 6/22 

Voting for various ANA positions took place Saturday morning. Ernest Grant, PhD, RN, FAAN, of the 

North Carolina Nurses Association was elected as the association’s next president and is the first 

male to lead ANA. His term, as well as the other newly elected Board of Directors At Large members, 

will begin January 1, 2019. ANA’s Membership Assembly elected the following members to serve on 

the 9-member board of directors: Vice President Susan Swart, EdD, MS, RN, CAE, of ANA- Illinois; 

Treasurer Jennifer Mensik, PhD, RN, NEA-BC, FAAN, of the Oregon Nurses Association; Director-at- 

Large James Watson, DNP, RN, NEA-BC, of the Texas Nurses Association; Director-at-Large, Recent 

Graduate Marcus Henderson, BSN, RN, of the Pennsylvania State Nurses Association. 

Those continuing their terms on the ANA board in 2020 are: President Ernest Grant, PhD, RN, FAAN, 

of the North Carolina Nurses Association; Secretary Stephanie Pierce, PhD, MN, RN, CNE, of the 

Louisiana State Nurses Association; Director-at-Large Tonisha J. Melvin, DNP, CRRN, NP-C, of the 

Georgia Nurses Association; Director-at-Large Varsha Singh, DNP, APN, RN, of the New Jersey State 

Nurses Association; Director-at-Large, Staff Nurse Jennifer Gil, BSN, RN, of ANA Massachusetts. 

Participants in the Member Assembly broke into smaller groups to discuss pertinent topics including: 

revision of Nursing Scope and Standards of Practice, Healthy Nurse Healthy Nation, Occupational 

Licensure Reform and Potential Implications for Nursing, ANCC Credentialing Program, and War 

Stories and Worldly Wisdom. 

Thank you for the opportunity to represent ANA-Michigan! 

MaryLee Pakieser (ANA Director at Large), Carole Stacy (ANA-Michigan President), Julia Stocker Schneider (ANA- 

Michigan President-Elect), Stacy Slater (ANA-Michigan Membership Assembly Representative), Linda Taft (ANA- 

Michigan Immediate Past President), Adebusola Bakare (ANA-Michigan Member), Amy Brown (Office of Debbie 

Stabenow), Staff Member from the Office of Senator Gary Peters, Representative Jack Bergman, 

Representative John Moolenaar, and Tobi Moore (ANA-Michigan Executive Director) 

30


31

CANDIDATE BIOS 


CANDIDATE — PRESIDENT ELECT 

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

DMC-Rehabilitation Institute of Michigan | Chief Nursing Officer 

Farmington Hills, MI 

1. What activities are you currently involved with or have been in the past 

related to ANA-Michigan or ANA? 

– Current ANA-MI Director 

– ANA-MI Conference Committee 2018-2019 

– Past ANA-MI Recording Secretary 2013-2019 

2. What elected, appointed offices or community activities relevant to this position have you 

been involved with? 

– Current Advisory Board Member for Siena Heights University MBA Program 

– Past MONE Region 1 Recording Secretary 

– Past-President/CEO Black Nurses Rock, Inc.- Detroit, MI 

– Past National Marketing Director for Black Nurses Rock, Inc. 

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

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

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

A continued issue facing ANA-Michigan is how to attract, engage, and retain members. As we all 

know, nurses are aging and baby boomers want to retire. So we have to find creative ways to show 

our millennials that they are our future. As Florence Nightingale quoted, “The most important 

practical lesson that can be given to nurses is to teach them what to observe.” Thus we have to 

provide the skills they need not only at the bedside, but also in the community and boardroom 

to be a voice for nursing. We have to show nurses how to fight for their practice at the unit, 

hospital, local, and legislative levels to ensure our patients get the care they deserve. We have 

to look at staffing ratios and ensure that nurses are able to provide safe, quality care. We must 

be mentors and resources for our future so they feel comfortable being advocates not only for 

the patients, but themselves. We have to support our nursing educators and nursing leadership so 

our nurses become even more prepared than in the past to deal with complex issues that extend 

beyond the bedside. All of the aforementioned is in alignment with 2020 being the Year of the 

Nurse; we owe this to Florence Nightingale and all practicing nurses. 

As an ANA-Michigan Board member since 2013, I have had the advantage of working with a 

great group of Nurse Leaders committed to making a difference. I have worked alongside four 

dedicated, hard-working Presidents that have paved the way to where we are today. I have seen 

our growth and I want to carry the torch as we strive to place nursing at its highest peak in the 

realm of healthcare. I am an experienced nursing leader and board member that is dedicated, 

knowledgeable, resourceful, and ready to serve! 

32


CANDIDATES — DIRECTOR 

Linda K Buck DNP, MSN/ED, RN 

GVSU | Senior Academic Advisor, Adjunct Graduate Faculty 

Kalamazoo, MI 



I have been an active member of the Legislative Committee (and its former 

iteration) for approximately three years. I was also active in Region 3 before the 

reorganization of ANA-Michigan. On a national level, I attended the American 

Nurses Advocacy Institute (ANAI) in 2017 in Washington, DC. This gathering afforded me the 

opportunity to connect with like-minded nurses from across the country as well as ANA professional 

staff. I have reviewed the Roles and Responsibilities of the Director position and am ready to 

commit myself in service to nurses in Michigan. 



I am an active member of the nursing program advisory board for both Muskegon Community 

College and Kalamazoo Valley Community College. In these positions, I work to advance the 

interests of nursing education and the nursing profession in general. 




Nursing workforce and staffing; health care workplace violence; the opioid epidemic; nurse title 

protection; enhanced nurse licensure compact (eNLC); access to healthcare for rural and underserved 

populations; APRN scope of practice – these are just a few of the issues facing nurses in 

Michigan. My view is that, as the Michigan affiliate of the ANA, we are called upon to respond 

and work with all stakeholders to find common ground, bringing the nursing perspective to the 

discussion. I support ANA-Michigans’s opportunity to investigate these issues and to engage with 

others while advocating for evidence-based solutions. The people of Michigan deserve nothing 

less than our best effort. In support of this stand, I wish to add my 40-plus years of health 

care experience and education to moving ANA-Michigan – and therefore all nurses in our state – 

forward. I have the passion to devote to a Director position and am ready to serve ANA-Michigan 

members in this capacity. 

Julie Bulson DNP, MPA, RN, NE-BC 

Spectrum Health | Director, Emergency Preparedness 

Grand Rapids, MI 



I am currently on the Education, Nominations, and Finance Committees and 

have been involved in the Research Committee and was part of the Nurse 

Abuse Panel at in the past. I have been involved at a local level leader for 

33


Region 3 (before the regions were dissolved) and at a state level for the past 

five years. 



– AONL Foundation Grant Committee and the Bylaws Committee as well as participation as a 

delegate to Israel in 2016 

– HSIN-HPH Federal Planning Committee 

– Healthcare Representative appointed to the State Fire Safety Board 

– Member of the State Ethics Advisory Committee (aka State Disaster Medical Advisory Committee) 




Healthcare is at a critical juncture with significant changes in how we deliver healthcare. This 

will occur whether the ACA stays or is repealed. These changes will dramatically change how we 

as nurses provide our care and to whom. As nursing leaders I believe it is our responsibility to 

provide support to our nursing forces, be the voice of the nurses and advocate for what is right 

for nursing practice and our patients. We can achieve this through our professional organization 

– ANA and ANA-Michigan. 

Katherine Dontje PhD, FNP-BC, FAANP 

Michigan State University|Associate Professor Bath, MI 



I am seeking to be a candidate for the director position on the Board of ANA- 

Michigan. I have been actively engaged in ANA-Michigan activities, in the last 

year I have served a one year term as Director on the Board of Directors. I 

am also the chair of the Practice Committee where we have initiated several 

projects to engage ANA-Michigan members. Prior to the changes in the 

bylaws, I served as Treasurer of Region Six for three years and President of Region Six for two 

years. In the role of president of Region Six I also had the opportunity to serve as Region Six liaison 

on the Board of Directors of ANA-Michigan. These opportunities have allowed me to understand 

the structure and purpose of ANA-Michigan. My experience with various committees and the 

board has expanded my knowledge of nursing issues and the needs of nurses within the State of 

Michigan. I am very committed to ANA-Michigan and highly support its purpose and goals to serve 

all nurses within Michigan. I have a good understanding of the different roles and responsibilities 

and would be interested in the opportunity to reach out to individuals to grow the cohort of 

potential leaders within ANA-Michigan. 



Positions and activities include: Director for ANA-Michigan Board, Chair of the Practice Committee 

for ANA-Michigan, Past President of Sigma Theta Tau Alpha Psi Chapter, Member of National Nurse 

Practitioner Faculty Organization Directors Special Interest Group, Board Member of Michigan 

34


Primary Care Consortium, and serving on several committees representing the College of Nursing 

within Michigan State University. 




Michigan nurses have a number of significant issues facing the profession. A priority issue that ANA- 

Michigan is working on is advocating for nurse title protection. One of the issues that has brought 

this forward is the push nationally by veterinary technicians to change their title to veterinary 

nurse. Many states have in their nurse practice act that the title of nurse is protected and can 

only be used for those who have meet the licensure requirements of a registered nurse. Michigan 

does not have this and it is essential that ANA-Michigan as well as other nursing organizations 

in the state band together to obtain nurse title protection. Another issue is the need to define, 

protect and advance the scope of practice for all nurses. Our state has a very restrictive practice 

environment and we need to be vigilant to avoid any further restrictions while pressing for an 

expansion of independent practice at all levels of nursing in accordance with the Future of 

Nursing Recommendations. In order to do this, we need a strong legislative and policy agenda. 

A final example is the issue ANA-Michigan faces to maintain, engage and grow the membership 

of the organization. There has been tremendous growth in membership over the last few years 

due to a change in dues structure and excellent marketing campaigns. The organization will now 

need to focus on continuing this growth as well as engaging the membership in the work of the 

organization. The recent bylaws changes provide opportunities for more members to be involved 

in the new committee structure. These are just a few of the issues that ANA-Michigan will need 

to focus on in the next years. 

I feel I am qualified to serve on the Board of Directors in the position of director for a number 

of reasons. The first is that I have had the privilege of serving on the ANA-Michigan Board of 

Directors over the last two years. This has provided me with an understanding of the workings 

of the board as well as an opportunity to work collaboratively with other members of the board 

and the ANA-Michigan staff. Through my work on the board, I have been able to increase my 

knowledge of the issues facing nurses across the state of Michigan and the importance of the 

work ANA-Michigan does to advocate for nurses in the state. I am also passionate about nursing 

and have been in a number of different types of nursing roles throughout my professional career 

including staff nurse, manager, faculty, and nurse practitioner. My experience in leadership roles 

in several state and national organizations has prepared me to work within the organizational 

structure of ANA-Michigan. In closing, I would be honored to serve you as a board member. 

Ruth Kechnie RN, BSN, MSA, NE-BC 

Beaumont Health | Director of Nursing, Richmond, MI 



I have recently became a ANA member in the last year and I am interested 

in becoming more involved with the organization. I will be attending the 

upcoming ANA-Michigan Conference and Annual Meeting in March. 

35




Current role of Director of Nursing for Medical Surgical Nursing 




ANA-Michigan aligns with my viewpoint on the the importance of providing appropriate nurse 

staffing ratios to positively impact patient outcomes and patient satisfaction; the establishment 

of working conditions for nurses to work safely; and supporting nurses in the current health care 

environment with increased complex ethical issues. I fully support and believe in the importance 

of certification in nursing specialties along with hospitals achieving Magnet recognition to improve 

nursing outcomes and support the model of shared governance. I would be honored to serve in the 

role to be an ANA-Michigan advocate for nursing and feel I am best qualified due to my current 

role of Director of Nursing over 11 Medical Surgical inpatient units. A role in which I advocate on 

a daily basis for nursing related issues such as staffing problems, working conditions, and ethical 

dilemmas they are facing; all while encompassing a focus on patient and family focused care to 

improve the patient experience. 

I have been a RN for over 25 years and took on a leadership role in the profession of nursing in 

the last 10 years. The ability to provide insight and experience into the profession of nursing and 

how the profession has evolved and changed over time would be a role I would embrace. My years 

of experience including the roles of a bedside nurse, preceptor, charge nurse, serving on nursing 

committees, serving as an assistant nurse manager and clinical nurse manager to Director of 

Nursing would be an asset to this role and enhances my ability to empathize with the challenges 

and issues facing nurses. 

Anne Kreft BSN, RN 

Munson Medical Center | Psych/Mental Health Clinical Practice RN 

Traverse City, MI 



– ANA-Michigan Conference Planning Committee, 2018-19 

– ANA-Michigan Region 2 Board Member, 2016-19 

– ANA-Michigan Research and Evidence Based Practice Council, 2016-18 

– ANA-Michigan Board of Nursing Rules Task Force, June 2016-18 

– ANA-Michigan Membership Task Force, Jan-May 2016 

– ANA Membership Assembly Representative - Alternate Delegate 2016-17 

– ANA Catch-5 Rising Star Award, October 2017 



– UAC Co-Chair Munson Medical Center D6, 2019-20 

– Skin Committee Co-Chair Munson Medical Center 2018-19 

– Skin Committee member Munson Medical Center 2016-19 

36


– Beacon Committee member, Munson Medical Center A2, 2017-18 

– UAC Shared Governance Council Designated Seat 2015 




The ANA, as an organization, is the tie that binds all nurses from every discipline together as 

one profession with one voice. At my first MSN class, our professor asked us to memorize the 

ANA definition of nursing. That definition, she said, would serve as a touchstone throughout the 

semester and throughout our nursing career. It sets nursing apart and defines our uniqueness from 

any other health care discipline. 

Entering the nursing profession as a career changer, I believed that joining a professional 

organization goes hand in hand with the chosen career. It is not what the organization can do 

for you, but what you can contribute as a member. Over the last five years, as I was finding 

my ultimate nursing path, I became involved in as much as I could at the ANA regional and 

state level. My service to ANA-Michigan has included ANA Region 2 Membership Task Force, ANA- 

Michigan Board of Nursing Rules Task Force, ANA-Michigan Research and Evidence Based Practice 

Council, ANA-Michigan Conference Planning Committee, and Region 2 Board Member. In 2017, 

I was deeply humbled and honored to have been awarded the ANA Catch-5 Rising Star Award. 

These experiences have given me a basis for understanding how ANA, at the state level, can 

impact every nurse in their daily practice and help the profession move forward in this extremely 

fast paced environment. 

Working as a clinical practice RN in Northern Lower Michigan, I can see firsthand the issues 

that serve to form the current position statements for ANA Michigan; preventing workplace 

violence against nurses, safe staffing ratios, enhanced nurse licensure compact, and “nurse” 

title protection. I feel strongly that these statements form the basis for change that can help to 

transform everyday practice for working nurses. If elected to the Board, I will work hard on your 

behalf to help those statements become reality in practice. 

CANDIDATES — NOMINATIONS COMMITTEE 

Joyce Reder 

Heart to Heart Healthcare Training and Saginaw Valley State University 

Adjunct Nursing Instructor 

Bay City, MI 



I keep up to date by reading the news briefs sent to me by the ANA. I have also 

met with local politicians to advocate for minimum practice requirements – 

an agenda item of the ANA. 

37




I attend meetings for Sigma Theta Tau. I have not held an office before. 




I believe that minimum practice requirements should be strongly advocated for. The benefits 

are inarguable. This is not to say that RNs with associated degrees have not contributed to our 

profession. I had been an RN for 18 years before I went back to get a BSN. I remember thinking at 

that time, “Well I’ve worked in the ICU and literally saved lives, now you’re telling me I’m not good 

enough?” I really had to get past my personal feelings, and think about what is good for patients 

and for the profession. The biggest thing that I have learned by continuing my education, is that I 

have so much more to learn. Technologies, medications, standards, methodologies are constantly 

changing for nurses. The necessity of a commitment to lifelong education is imperative. 

I would like to serve the ANA and be a part of advocating for minimum practice requirements in 

our state. I currently have an MSN and am working on a DNP degree. I teach nursing students at 

a local university. I love teaching and getting to know my students. I truly believe they have so 

much more to learn now than I had to when I graduated nursing school in 1993. There is more than 

just the science to learn, but also leadership and advocating for legislation to help all nurses. 

I would be proud to serve in any capacity. I would enjoy learning more about governance and the 

ANA. 

Marylee Pakieser MSN,RN,BC-FNP 

Palliative/Chronic Care Management | Nurse Practitioner 

Traverse City, MI 



I have been an active member of ANA since 1974. I have served in a variety 

of leadership roles at the local and state levels from 1980 to present (ANA- 

Michigan President-Elect 2012-2014; President 2014-2016). I recently 

completed a term on the ANA Board of Directors as Director at Large. During 

that time I was appointed to the ANA PAC and was elected as the Vice Chair. 

Currently I am on the ANA-Michigan Nominations Committee. 



– Founding member of RN-AIM 

– Northern Lakes Community Mental Health Board 2003-2011 

– Michigan Center for Rural Health 2004-2010 

– Safe Harbor Homeless Shelter - volunteer 2013 to present 

38





I owe the development of my leadership skills to my involvement in my professional nursing 

association. My entry was welcomed at the district level by an incredible group of nurturing RNs 

across the health care spectrum. At times when I felt my current position was not where I wanted 

to be in nursing – those meetings helped me stay grounded in the true essence of nursing. That 

early encouragement and guidance helped me advance to different leadership roles within the 

association and in other non-nursing groups. That is the main reason for my decision to seek 

re-election to the nominations committee. I no longer want to be in the limelight, I am more 

interested with igniting the energy of the next generation. I think it is important to encourage 

our younger nursing colleagues to seek leadership roles. I want to open doors for them and 

provide them encouragement and resources as they develop their leadership skills. I believe that 

is how we keep our association vibrant, relevant, and strong – by always moving forward. 

CANDIDATE — NEWLY LICENSED DIRECTOR 

Megan Piotrowski 

Ascension St. John | Acute Care Pediatrics GN/RN 

Grosse Point Farms, MI 



This past year I was elected as President of the Michigan Nursing Student 

Association. As President, I collaborated with members, school-level student 

nurse associations, faculty, and other organizational stakeholders to cultivate 

the skills and professional development of more than 3000 nursing students around the state of 

Michigan. My role included presiding over all meetings; ensuring that board decisions aligned with 

the directions given by the House of Delegates; representing the organization at local, regional 

and national events; and collaborating with professional organizations such as ANA-Michigan. 

Personally, I joined ANA as a student member and attended the annual conference. 

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

have you been involved with? 

– Oakland University School of Nursing Dean’s Circle, Rochester Hills MI 

– Michigan Nursing Student Association, Lansing MI 

a. President 

b. Secretary & Bylaws, Policies, Resolution & Legislation Committee Member 

– National Student Nurse Association Health Policy Education Task Force Member 

39





Currently, the most pressing issues facing ANA-Michigan are as follows: 

1. Promoting access to affordable, quality care with safe staffing 

2. Addressing the opioid epidemic 

3. Illuminating the nurses role in addressing health disparities and social determinants of health 

4. Preventing workplace violence 

5. Preventing gun violence 

6. Protecting against the health-related impacts of climate change 

I feel uniquely qualified to serve as the Newly Licensed Director because I have demonstrated 

leadership in a number of diverse organizations. Most recently, I was elected the president of the 

Michigan Nursing Student Association for 2019-2020. I also currently serve as a lead analyst for 

the Evidence Analysis Library, a subunit of the Academy of Nutrition and Dietetics responsible for 

synthesizing nutrition research and evaluating the methodology to support the development of 

evidence-based nutrition practice guidelines to optimize patient care. Prior to pursuing a career 

in nursing, I served as the committee chair and president of the New Mexico State University 

Human Nutrition and Food Science Association. 

In these roles, I have demonstrated an ability to lead by clearly articulating project goals, 

verbalizing expectations and evaluating our team progress. I enjoy mobilizing people and am 

passionate about advocating for the implementation of evidence-based, quality improvements. 

I truly believe in that nurses are meant to be transformational community leaders and we should 

be committed to using evidence based practice, public education and research to optimize the 

health of diverse communities. As a soon-to-be newly licensed nurse, and current nutrition and 

health researcher working with diverse and vulnerable populations, I have become keenly aware 

of the many gaps that exist in healthcare. I also see first hand how racial and ethnic minorities 

are disproportionately affected by chronic illness, climate related health issues and have higher 

morbidity and mortality from chronic diseases; this is unacceptable. Nurses cannot optimize 

patient care until they address issues that arise from antiquated healthcare policies, a lack of 

diversity in the health profession and, subsequent, healthcare gaps. I want to be at the forefront 

of advocating for the necessary changes so I serve my patients with compassion and provide the 

highest quality care that they deserve. 

40


41


42


43


44


45


46


47


48


49


50


51


52


APPENDIX 

53


On April 13, 2018, the ANA-MI Board of Directors voted to support the Enhanced Nurse Licensure 

Compact, that would permit Michigan to join the current 30 states who are part of the “enhanced 

nurse licensure compact.” The Public Policy Council studied and discussed in-depth strengths and 

weaknesses. The Council and Board members held a “learning session” on the eNLC with a presentation 

by a representative from the National Council of State Boards of Nursing. The Council recommended 

SUPPORT with the provision that the MI Department of Licensing and Regulatory Affairs (MI-DLARA) 

does not pass on the costs of implementation of the eNLC through another increase in the nurse 

licensure fees. The legislature doubled Michigan nurse licensure renewal fees in 2017. 

WHAT IS THE NURSE LICENSURE COMPACT? 

The NLC allows a registered nurse (RN) or licensed practical nurse (LPN) to possess a multistate 

license, which permits practice in both their home state and other compact states, while maintaining 

the primary state of residence. Unless the nurse is under discipline or restriction, a multistate license 

permits practice (physically or telephonically/electronically) across state lines in all NLC states. 

WHAT IS THE RATIONALE FOR ANA-MI’s SUPPORT OF eNLC? 

The Council first considered: 

Is this bill consistent with the tenets of ANA-MI’s Policy Platform? 

FACTORS INFLUENCING SUPPORT FOR THE BILL 

• There is an increase in nursing practice and patient care access across state lines (care 

coordination, occupational health, etc.) 

• Regional or national health crises require rapid deployment of nurses to areas of need. 

• There is need to move nurses with highly specialized skills to states with medical crises for patient 

populations. A recent example is the number of Michigan residents who required specialized care 

available only through nurses employed in multiple states across a national healthcare system 

who were experienced in this specialized care. This care was related to contaminated injections 

prepared at a compounding pharmacy in Massachusetts. 

• There are increasing national and international infectious disease outbreaks that require 

movement of nurses to meet patient and community needs (Ebola, flu, etc.). 

• New nurse graduates will have more flexibility with a Michigan “home state” license if there are 

not sufficient available nursing positions in Michigan. 

• Nursing faculty and students are sometimes engaged in clinical placements across state lines. 

• Nurses move across states to support family care needs. These nurses may desire to continue 

nursing employment. They may be delayed in their ability to obtain a new state license. 

54


FACTORS INFLUENCING CHALLENGES OF THE BILL 

• Nurses are responsible to know multiple state requirements for ongoing licensure. For example, 

Florida requires continuing education for infection control. 

• Nurses must be knowledgeable about and abide by varying state laws and regulations. 

• In cases of nurses providing care through technology (telephonic, web site, etc.), it is not clear 

in which state the nursing practice is located (the state of the nurse or the state of the patient 

receiving care). There does not appear to be ongoing monitoring, data collection, or an evaluation 

plan to inform policies related to eNLC. 

• eNLC membership does not provide assurance that nurses will in fact be knowledgeable of laws 

that pertain to nursing practice within those jurisdictions prior to engaging in practice in member 

states. 

OTHER INFORMATION 

• The Michigan Organization of Nurse Leaders (MONL) who are predominately hospital chief nursing 

officers are in support of HB4938. 

• Rep. Whiteford is awaiting ANA-MI’s position and a discussion prior to scheduling a House Health 

Policy Committee hearing. 

• If the bill is passed, Michigan nursing education programs will need to include information about 

nurse licensure compacts and, as importantly, prepare faculty with this information for teaching. 

• Legislators and organizations such as the AARP are interested in knowing ANA-MI’s position on this 

bill. 

NEED MORE INFORMATION? 

• For more information on the enhanced NLC, visit nursecompact@ncsbn.org 

• For a current map of eNLC states, visit www.nursecompact.com 

55


It is the position of the ANA-Michigan that: 

1. Optimal nurse staffing is essential for quality and safe patient care in all health care settings. 

2. Determination of optimal nurse staffing requires a framework and policies that inform 

organizational decision making through analysis of the many factors that impact the delivery 

of safe patient care. 

3. Optimal nurse staffing is a complex determination and cannot be achieved through application 

of simple patient to nurse ratios. 

4. Safe nurse staffing models should be selected that most closely match the characteristics 

of the institution and include active and substantive input from the nurses who are closest to 

patient care. 

Background 

Medical errors are now the third leading cause of death in the United States (US). The persistent 

nature of medical errors is documented in the Institute of Medicine (IOM) report, To Err Is Human, 

which pointed to nearly 100,000 preventable deaths in US hospitals annually (IOM, 1999). This 

work shaped decades of research with focus on patient safety. Nurses are the largest clinical group 

of providers in hospitals and other health care settings; thus, nurses’ impact on patient safety is 

significant. A large body of evidence exists documenting the relationship between nursing care, 

nurse staffing, and patient safety. Risks associated with suboptimal professional nurse staffing in the 

patient care setting include medication errors, compromised ability to “rescue” patients at risk for 

death, increased incidence of patient falls, hospital-acquired pressure ulcers, physical restraint use, 

and missed care. 

Optimal nurse staffing is a complex process not being amenable to simple division or nurse patient 

ratios; straightforward ratios do not result in safe care. Moving toward a professional model that 

empowers registered nurse (RN) decision-making regarding their practice requires a framework focused 

on the analysis of multiple factors affecting patient care delivery. To create a work environment that 

allows professional RNs to meet the demands and complexity of patient care, sufficient professional 

nursing staffing care models are crucial to the delivery of high quality safe patient care. Shifting the 

nursing culture towards a professional model that empowers RNs with decision-making involvement 

and includes a framework for organizations’ decision making about staffing based on the analysis of 

multiple factors affecting patient care versus a one-dimensional standardized nurse-patient ratios 

approach is vital to “ensuring the right staff are in the right place at the right time” (Bolvin, 2017, 

p. 31). Harmonious with the American Nurses Association (ANA) position, ANA-MI is committed to 

creating dynamic solutions that support context dependent, optimal nurse staffing necessary to 

meet the needs of healthcare recipients. 

56


This paper presents the outcomes evidence about recent approaches to nurse staffing and identifies 

the principles, concepts, and framework for determining optimal nurse staffing for safe patient 

care. While the referenced studies on safe nurse staffing are hospital-based, the principles and 

methods may also be applied to nurse staffing in other health care settings. 

Evidence 

The impasse between nurses and administrators about the solution to the complex issue of ensuring 

the delivery of safe care within the context of increasing patient acuity and fiscal constraints of 

hospitals has moved the issue of adequate staffing to the political arena (Hertel, 2012). In 2004, 

nurse staffing took center stage when California became the first state to mandate nurse-to-patient 

ratios in acute care settings. By 2009, 14 states had enacted nurse staffing legislation and, as of 

September 2010, 24 states have enacted or proposed legislation to mandate staffing ratios, staffing 

acuity systems, or staffing plans and committees (Douglas, 2010). Subsequent studies examining 

the relationship between mandatory staffing ratios and nurse satisfaction and patient safety and 

outcomes have demonstrated mixed results (Aiken et al., 2010; Bolton, et al., 2007; Hertel, 2012) 

Research on nurse staffing ratios’ impact on patient safety has demonstrated higher nurse to patient 

ratios are associated with decreased mortality rates, fewer failure to rescue events, and lower 

hospital–acquired pneumonia rates (Douglas, 2010). Mandated ratios in California were associated 

with lower mortality and better nurse retention; 74% of nurses reported they felt the quality of care 

had improved since mandated ratios (Aiken et al., 2010). 

Conversely, individual studies and systematic reviews have reported difficulty in consistently 

detecting statistically significant associated improvements in a variety of nurse-sensitive patient 

outcomes with increased nurse staffing (Hickam et al., 2003; Kane, Shamliyan, Mueller, Duval, & 

Wilt, 2007; Lake & Chung, 2006; Lang et al., 2004; Seago,2001: all as cited in Bolton et al., 2007). In 

a large-scale study, Bolton and colleagues (2007) examined patient outcomes from 2004 to 2006 in 

185 hospitals in California compared to 2002 (pre-mandated staffing ratios) and found no statistical 

significance in the association between increased nurse staffing and key indicators of falls, hospitalacquired 

pressure ulcers, and restraint use rates (Bolton et al., 2007). The inconsistency in outcomes 

associated with increased nurse staffing underscores the complexity of determining optimal staffing. 

A survey of administrators about strategies to accommodate mandated ratios lends to potential 

insight about why mandated ratios do not consistently result in improved patient safety and outcome 

measures. Respondents reported ancillary support staff layoffs (thus shifting non-RN work to the 

professional nurse) and use of contingent nurses to provide break coverage; both strategies could 

have a negative impact on patient safety and continuity of care (Douglas, 2010). Similarly, Bolton 

and colleagues (2007) found that with mandated staffing ratios came a change in staff mix with a 

reduction in care provided by LPN and other non-licensed staff, suggesting that administration leaders 

used RN hours to meet the regulatory staffing requirements. These approaches raise concerns about 

the unintended consequence of negating the potential positive impact of mandated higher RN to 

patient ratios by 1) effectively reducing RN time to attend to RN activities and 2) increasing the risk 

for mistakes related to the potential for communication errors during handoffs to contingent nurses 

along with variability of the skills and competencies of contingent nurses in unfamiliar settings. 

57


Definition of Safe Staffing, 

Core Components and Staffing Models 

Definitions 

The ANA defines staffing as ... “a match of registered nurse expertise with the needs of the recipient 

of nursing care services in the context of the practice setting and situation” (ANA, 2012, p. 6). 

Staffing is done in the present – day to day and sometimes shift to shift. Staffing work can be 

centralized (one department is responsible for staffing all the units) or decentralized (units manage 

their own staffing needs) or a combination of both. 

Core Components 

ANA Core Components of Nurse Staffing: 

1. All settings should have well-developed staffing guidelines with measurable nurse-sensitive 

outcomes specific to that setting and healthcare consumer population, which are used as evidence 

to guide daily staffing. 

2. RNs are full partners working with other healthcare professionals in collaborative, interdisciplinary 

partnerships. 

3. RNs, including direct care nurses, must have a substantive and active role in staffing decisions to 

ensure the necessary time with patients to meet care needs and overall nursing responsibilities. 

4. Staffing needs must be determined based on an analysis of healthcare consumer status (e.g., 

degree of stability, intensity, and acuity) and the environment in which the care is provided. 

Additional considerations include professional characteristics, skill set, and mix of the staff and 

previous staffing patterns that have been shown to improve outcomes. 

5. Appropriate nurse staffing should be based on allocating the appropriate number of competent 

practitioners to a care situation, pursuing quality of care indices, meeting consumer-centered 

and organizational outcomes, meeting federal and state laws and regulations, and attending to 

a safe, quality work environment. 

6. Cost-effectiveness is an important consideration in delivery of safe, quality care. 

7. Reimbursement structure should not influence nurse staffing patterns or the level of care provided. 

Staffing Models 

Shortcomings in current RN staffing models present opportunities for improvements that benefit 

patients, nurses, and healthcare organizations. No single staffing model is ideal in all care settings 

or situations. Staffing must be adjusted according to patient care needs within a specific unit or 

department. Fixed or rigid models do not provide flexibility essential to adapt to rapid and fluid 

changes in acute care environments. 

There is a difference between staffing and scheduling. Schedules are planning documents that are 

future focused. Factors that affect a schedule include: historical census for a time period, the 

surgical schedule, and seasonal or predictable issues such as the flu season. Schedules must also 

accommodate vacations, maternity leaves, staff illness and institutional policies. 

Various staffing models are used in healthcare settings. Three models follow; each has advantages 

and disadvantages. 

1. Budget Based Staffing: the number of nurses is determined according to nursing hours per patient 

days. Total patient days are the average number of patients on a particular unit for a 24-hour 

period. Nursing hours refers to the total number of hours nurses work on that unit for a specific 

58


amount of time. This model does not take into consideration the actual number of patients, the 

“churn” in patients – admissions, discharges, transfers in 24 hours, or patient acuity. 

2. Staffing by Nurse to Patient Ratios: This model dictates the number of patients one nurse can 

care for during a designated period of time. It does not take into consideration other unit staff 

such as CNA’s, housekeeping, unit clerks, etc. Also, it doesn’t take into account patient acuity 

or nurse driven care decisions. This model may also affect patient throughput from areas such as 

the Emergency Department, Labor and Delivery, and the ICUs. 

3. Staffing by Patient Acuity:This model considers the acuity or complexity of each patient, which 

is often determined by the number of tasks and amount of time to complete them. Rather, this 

model should consider the full scope of nursing practice and time needed to maintain standards 

of care. This complex model also needs to consider individual patient characteristics such as 

age, diagnosis, comorbidities, socioeconomic status, cultural and family issues, and severity of 

illness. 

References 

Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., . . . & Smith, H. L. 

(2010). Implications of the California nurse staffing mandate for other states. Health services 

research, 45(4), 904-921. 

American Nurses Association. (2012). Principles for nurse staffing (2nd ed.). Silver Spring, MD: 

Nursesbooks.org. Retrieved from http://www.nursesbooks.org/ebooks/download/ANA_ 

Principles_Staffing.pdf 

American Nurses Association. (2015). Optimal nurse staffing to improve quality of care and patient 

outcomes. Retrieved from http://www.nursingworld.org/DocumentVault/NursingPractice/ 

Executive-Summary.pdf 

Bolvin, J. 2017) CNOs and CFOs partner to reap benefits of acuity-based staffing. American Nurse 

Today 12(9), 30-32. 

Buerhaus, P. I. (2009). Avoiding mandatory hospital nurse staffing ratios: An economic commentary. 

Nursing Outlook, 57(2), 107-112. 

Bolton, L. B., Aydin, C. E., Donaldson, N., Storer Brown, D., Sandhu, M., Fridman, M., & Udin Aronow, 

H. (2007). Mandated nurse staffing ratios in California: A comparison of staffing and nursingsensitive 

outcomes pre-and post-regulation. Policy, Politics, & Nursing Practice, 8(4), 238-250. 

Douglas, K. (2010). Ratios-If it were only that easy. Nursing Economics, 28(2), 119-125. 

Hertel, R. (2012). Regulating patient staffing: A complex issue. Academy of Medical-Surgical Nursing, 

21(1), 3-7. 

Institute of Medicine (IOM). (1999). To err is human. Washington, DC: National Academies Press. 

Mensik, J. (2014). What every nurse should know about staffing. American Nurse Today, 9(2), 1-11. 

Approved: December 15, 2017 

by the ANA-Michigan Board of Directors 

To be reviewed: December 14, 2018 

Contact 

www.ana-michigan.org 

nurse@ana-michigan.org 

(517) 325-5306 

59


Written by Susan Wiers, DNP and Public Policy Council 

The 173,000 plus Registered Nurses in Michigan are essential to the health and safety of the state’s 

residents. 1 The title “Nurse” is not included in the list of protected titles in the Michigan Public Health 

Code (MPHC). Thus, the residents of Michigan cannot be assured that individuals calling themselves 

nurses possess the education and competencies required for licensure and safe practice. 2 At least 

39 states have adopted language in their nurse practice acts restricting use of the title “Nurse” or 

language implying an individual is a nurse who is educated and licensed as authorized by the state. 3 

Despite Recommendation 2a of the Michigan Department of Community Health Task Force on Nursing 

Practice that “Nurse” be included as a protected title in the MPHC and the Administrative Rules of 

the Michigan Board of Nursing, Michigan remains in the minority of states without title protection 

for ‘Nurse.” 2,3 

Nursing has been ranked as the most respected, ethical profession in Gallup polls for 16 consecutive 

years since 2002. 4 This trust in nursing must be safeguarded from individuals and groups who 

misrepresent themselves as nurses thus threatening safety and health of the public. 5 Tolerating overt 

use of the title “Nurse” or misleading titles implying individuals other than those who have met the 

requirements for licensure from state boards of nursing lends itself to exploitation of vulnerable 

individuals and erosion of nursing’s well-earned public reputation and confidence. 

Nursing licensure and title protection are regulated with the primary purpose of protecting the 

public. 6 Nursing licensure requires specialized knowledge and independent decision-making and 

mandates a minimum level of demonstrated and documented competency for a specific scope of 

practice. 2,6 Title protection assures that individuals without the minimum education and competency 

for licensure cannot misrepresent themselves to the public as nurses. 

The title “Nurse” should be protected in the MPHC consistent with the titles “Physician,” “Dentist,” 

“Chiropractor,”and “Social Worker.” 2 Individuals not licensed and registered by the state can and 

do use the title “Nurse.” 2 Legally tolerated arbitrary use of the title “Nurse” by those who do not 

possess the minimum education and competencies for licensure in the State of Michigan confuses 

public and places it at risk. 2 Just as has been done in the majority of other states, the title “Nurse” 

must be defined and protected in the MPHC so that patients and families can be assured that their 

nurse possesses legitimate education and competencies to safely care for them. 2 

60


References 

1. Michigan Public Health Institute. Michigan Annual Nurse Survey Project. Okemos, MichiganJune 

2018. 

2. Michigan Department of Community Health Task Force on Nursing Pratice. Final Report and 

Recommendations. 2012. 

3. American Nurses Association. Title “Nurse” Protection. December 10, 2013; https://www. 

nursingworld.org/practice-policy/ advocacy/state/title-nurse-protection/. 

4. Brenan M. Nurses keep healthy lead as most honest, ethical profession. 2017; https://news. 

gallup. com/poll/224639/nurses-keep-healthy-lead-honest-ethical-profession.aspx. 

5. McElroy S. Nurse Title Protection Bill passed in the 2008 West Virginia Legislative Session. Maryland 

Nurse. 2008;10(1):14-14. 

6. Flook DM. The professional nurse and regulation. Journal of perianesthesia nursing. 2003;18(3):160- 

167. 

7. Missouri State Board of Nursing. Nursing Practice Act and Rules. In. Jefferson City, MO2017. 

8. Services NDoHaH. Statues Relating to Nurse Practice Act. In: Unit DoPHL, ed. Lincoln, NE2017. 

9. New York State Education Law. Article 139, Nursing. 2010; http://www.op.nysed.gov/prof/nurse/ 

article139.htm. 

Approved: December 14, 2018 by the ANA-Michigan Board of Directors 

Contact 



(517) 325-5306 

61


Background 

The ANA Nurses Bill of Rights maintains that nurses have the right to a work environment that is safe 

for themselves and for their patients regardless of the setting of care. 

According to reports from National Institute for Occupational Safety and Health (NIOSH), individuals 

who are injured and who miss work as a result of violence in healthcare settings is increasing 

(U.S. Department of Labor [DOL], Bureau of Labor Statistics, 2014). 

Violence in healthcare facilities is complex and multiple factors may contribute to the problem. 

Nurses and other caregivers have a personal and professional duty to “do no harm” to patients. Many 

will put their own safety at risk to help a patient and some consider violence “part of the job.” Many 

excuse attacks as being unintentional and due to an individual’s illness or impairment. 

In addition to physical harm, individuals who experience or witness violence in the healthcare 

workplace are at risk for emotional consequences that can lead to time away from work, burnout, 

job dissatisfaction, and decreased productivity. These and other consequences compromise both 

worker and patient safety. 

As of June, 2019, 36 states have established or increased legal penalties for the assault of nurses 

and other healthcare providers and nine states require healthcare organizations to run workplace 

violence programs (ANA, 2019). As of this writing, Michigan has NEITHER specific legal penalties nor 

workplace violence program requirements for healthcare organizations. 

Definition of Workplace Violence 

NIOSH defines workplace violence as physically and psychologically damaging actions that occur in 

the workplace or while on duty. (NIOSH, 2002). This can include verbal violence – threats, verbal 

abuse, hostility, harassment which can cause psychological trauma and stress even though there is 

no physical injury. (OSHA, 2015) 

NIOSH describes four basic types of workplace violence: 

• Type 1 – Involves “criminal intent” In this type of violent encounter, individuals with criminal 

intent have no relationship to the business or employees. 

• Type II: Involves a customer, client, or patient. In this type “individual has a relationship with the 

business and becomes violent when receiving services.” 

• Type III: Involves a “worker on worker” relationship and includes employees who attack or 

threaten another employee. 

62


• Type IV: Violence involves personal relationships and includes “individuals who have interpersonal 

relationships with the intended target but no relationship to the business” 

• Types II and III are the most common types in health care settings. 

Evidence 

According to The Occupational Safety and Health Administration (OSHA), healthcare workers, 

including nurses, are at 4x higher risk of experiencing workplace violence than those who work in 

other industries. Registered nurses experienced 14 violent injuries resulting in days away from work 

per 10,000 full time employees compared with a rate of 4.2 per 10,000 in private industry as a whole. 

Psychiatric aides are at highest risk (590 per 10,000) followed by nursing assistants (55 per 10,000). 

(U.S. Department of Labor [DOL], Bureau of Labor Statistics, 2014). The statistics underpin- ning this 

statement are drawn solely from reported incidents and OSHA notes that many incidents that could 

be included are NOT reported for a variety of reasons. Part of the problem is that because violent 

incidents are so common, they have become normative and among victims, only 30% of nurses and 

26% of physicians actually reported the incidences (OSHA, 2015). 

Core Components 

ANA-MI concurs with ANA regarding interventions and supports the following: 

Primary prevention strategies that include development of workplace violence prevention programs, 

development of relevant policies, and education programs specifically designed for nurses and 

frontline caregivers. Students should also learn about the issue in nursing education programs. 

Employers and educational institutions must support work environments that are safe and align with 

OSHA’s “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers” 

(OSHA, 2015; Lipscomb & London, 2015.) 

Secondary prevention strategies that include interventions designed to reduce and/or minimize 

the negative impact of workplace violence. Reporting incidences of violence is paramount so that 

accurate data can be gathered and analyzed. 

Tertiary prevention strategies that are designed to reduce the consequences of workplace violence 

and may include incident debriefing, counseling programs, root cause analysis and confidentiality 

assurances. Legislative and legal strategies that protect all healthcare providers should be considered 

and supported. 

References 

American Nurses Association. (2019) Workplace violence. Retrieved from https://www.nursingworld. 

org/practice-policy/advocacy/state/workplace-violence2/ 

American Nurses Association. (2016). American Nurses Association calls for a culture of safety in 

all health care settings [Press release]. Retrieved from https://www.nursingworld.org/news/ 

news-releases/2016/americannurses-association-calls-for-a-culture-of-safety-in-all-health-caresettings/xxii 

American Nurses Association. Position Statement on Incivility, Bullying, and Workplace Violence. 

2015. Web: https://www.nursingworld.org/practice-policy/work-environment/violenceincivility-bullying/ 

The Joint Commission. (2010). Preventing violence in the health care setting. Sentinel Event Alert, 

Issue 45. Web: https://www.jointcommission.org/assets/1/18/SEA_45.pdf 

63


The Joint Commission. Sentinal Event Alert: Physical and verbal violence against healthcare 

workers. Retrieved from: https://www.jointcommission.org/assets/1/18/SEA_59_Workplace_ 

violence_4_13_18_FINAL.pdf 

National Institute of Occupational Safety and Health (NIOSH). Division of Safety Research. (2002) 

Violence: occupational hazards in hospitals. Cincinnati, Ohio: U.S. Department of Health and 

Human Services, Public Health Services, Center for Disease Control and Prevention, NIOSH 

Division of Safety Research. 

National Institute for Occupational Safety and Health. (2013). Workplace violence prevention for 

nurses. CDC Course No. WB1865—NIOSH Pub. No. 2013-155. Retrieved from https://www.cdc. 

gov/niosh/topics/ violence/training_nurses.html. 

Occupational Safety and Health Administration. (2015). “Guidelines for preventing workplace 

violence for healthcare and social service workers” (Publication No. OSHA 3148-04R 2015). 

Retrieved from https://www.osha.gov/Publications/osha3148.pdf. 

Occupational Safety and Health Administration. (2015). “Workplace violence in healthcare: 

understanding the challenge.” https://www.osha.gov/Publications/OSHA3826.pdf 

U.S. Government Accountability Office. (2016). Additional Efforts Needed to Help Protect Health 

Care Workers from Workplace Violence. Retrieved from https://www.gao.gov/ products/GAO-16- 

11 xxviii Occupational Safety and Health Administration (OSHA). 2015. Retrieved from https:// 

www. osha.gov/Publications/OSHA3827.pdf xxix 

U.S. Department of Labor, Bureau of Labor Statistics. (2014). Nonfatal occupational injuries and 

illnesses requiring days away from work, 2013. (No. USDL-14-2246). Retrieved from http://www. 

bls.gov/news.release/pdf/osh2.pdf. 

Approved: November 8, 2019 

by the ANA-Michigan Board of Directors 

To be reviewed: November 8, 2021 

Contact 



(517) 325-5306 

64


65


66


67


68


69


70


71


72


73


74


75


76


77


78


79


80


81


82


83


84


85


86


87


88

COLLEGE OF HEALTH & HUMAN SERVICES 

100% 

Online courses for SVSU’s RN 

to BSN program 

TIP 

At SVSU, you receive 

individualized attention 

to assist with scheduling, 

registering for classes and ongoing 

program support. 

100% 

Placement rate of SVSU 

nursing graduates. 

FACT 

SVSU is the most affordable 

public university in Michigan 

and deferred payment is 

available. 

TIP 

RNs receive 32 validated 

articulation credits for basic 

nursing preparation and 

additional transfer credits for 

completed general education 

courses. These apply toward 

the 124 total credits required 

for a bachelor’s degree. 

Benefit 

Get a head start in your 

graduate program by taking 

up to nine graduate nursing 

credits that may be applied 

to both the RN to BSN and a 

graduate nursing degree. 

RN to BSN 

When it comes to differentiating 

yourself in the nursing field, 

standing out starts with a 

bachelor’s degree. Whether 

you’re looking for a new 

position, hoping to advance 

or seeking job security for the 

future, a BSN elevates your 

credentials, deepens your 

learning and helps you establish 

connections for growth. With 

some of the state’s most 

engaging nursing professionals 

teaching our courses, we equip 

you to care, lead, specialize 

and transfer your nursing skills 

wherever your dreams lead. With 

SVSU, the only one who gets to 

set limits on your career is you. 

ADMISSION 

REQUIREMENTS 

• A State of Michigan 

RN License 

• Cumulative GPA of 2.5 or 

higher from ADN program 

• Complete your SVSU 

application. Apply today! 

Go.svsu.edu 

• Schedule a meeting with 

RN to BSN Coordinator 

Debbie Gibson, MSN, RN to 

evaluate your transcripts. 

E: dkgibson@svsu.edu 

P: 989-964-4184 

We lead.

Michigan 2019 Annual Report

Create successful ePaper yourself

Delete template?

Save as template?