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2020 ANNUAL BOOK OF REPORTS

Table of Contents

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

Newly Appointed BOD Member Gerry Infante. ....................................3

2020 Strategic Plan. .....................................................5

Meeting, Rules and Parliamentary Procedure. ....................................7

Annual Meeting Agenda. ................................................. 11

2019 Minutes ........................................................ 13

President's Report. ..................................................... 16

2020 Year End Financial Statements. ......................................... 18

2021 Budget ......................................................... 23

Executive Director's Report ............................................... 25

MHSA, Advocacy and Legislative Report ....................................... 27

Committee Report: Nursing and Health Policy. .................................. 29

Committee Report: Nursing Practice. ........................................ 30

Committee Report: Education. ............................................ 31

Committee Report: COVID-19 Task Force ..................................... 33

Committee Report: Leadership Academy Task Force .............................. 34

ANA Membership Assembly Representative Report ................................ 35

Leadership Candidate Bios. ............................................... 37

Bylaw Amendments. .................................................... 57

Champions for Nursing Partnership Program . ................................... 64

ANA-Michigan Leaders serving on SOM LARA Implicit Bias Training Rules Advisory

Workgroup & Subgroups ................................................ 68

2020 COVID-19 Pandemic. ................................................ 70

COVID-19 Training Program for K-12 Schools .................................... 71

Appendix

ANA-Michigan Position Statements

Policy on Position Statements. ........................................... 74

Moral Distress. ...................................................... 76

Preventing Workplace Violence in Healthcare Settings. ........................... 78

Telehealth & Connected Health. .......................................... 81

Mitigating Implicit Biases to Reduce Disparities in Patient Outcomes . ................. 84

Safe Nurse Staffing to Improve Quality of Care. ................................ 87

Enhanced Nurse Licensure Compact. ....................................... 91

“Nurse” Title Protection. ............................................... 93

2020 Nurse Award Winners. ............................................... 95

ANA-Michigan Bylaws Current. ............................................ 109

1

Printed and published for ANA-Michigan by:

Arthur L. Davis Publishing Agency

P.O. Box 216 | Cedar Falls, Iowa 50613

(319) 277-2414


2


ANA-Michigan Board of Directors

Newly-Licensed Director Appointed

ANA-Michigan is honored to announce that Mr. Gerardo Infante, BSN, RN, has been appointed by the

ANA-Michigan Board of Directors to fill the Newly-Licensed Director position. Mr. Infante will serve

in this position until the spring of 2022.

We are so excited that he has accepted this role and look forward to his enthusiasm, ideas and

diverse cultural perspectives which will help advance our mission and to have him join us in the

evolution of our amazing profession.

Per the Bylaws, the ANA-Michigan Board of Directors appointed Mr. Infante to serve in this position

for the remaining term as the elected Newly-Licensed Director position was vacated by Megan

Piotrowski.

Gerardo O. Infante BSN, RN

Gerardo has the honor of being the current President of the National Association

of Hispanic Nurses Michigan Chapter (NAHN-MI) where he has served for the

last four years. He has been actively participating in community events and

research projects that benefit the Latino population in Michigan.

Since January 2020 Gerardo is currently the charge nurse and clinical

coordinator in a DaVita Dialysis Clinic in Monroe, Michigan. Prior to joining

DaVita Dialysis, Gerardo was a nurse for CHASS (Community Health and Social

Services) a FQHC in Detroit Michigan. He was part of a $1.5 Million grant from

the U.S. Department of Health and Human Services Health Resources and

Services Administration lead by the University of Michigan School of Nursing.

The objective was to improve chronic care coordination for underrepresented and underserved

populations utilizing bilingual-bicultural registered nurses serving as leaders to interdisciplinary

teams. Gerardo is also part of the Michigan Nursing Action Coalition working on the “Nursing

Workforce Diversity Project."

He has also been apart of the “ANA-Michigan Networks of Support Virtual Meet-Ups" as a discussion

moderator and thought leader, and participates on the Implicit Bias Training Rules Advisory Workgroup

headed by LARA.

Gerardo received his bachelor of science in nursing from American Sentinel University, Colorado,

graduating Magna cum laude.

His short nursing career has been dedicated to bringing culturally appropriate care to the Hispanic

population.

Dios te Bendiga / God Bless

3


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• MSN or Post Graduate Certificate Nurse Administrator

• MSN or Post Graduate Certificate Primary Care Family Nurse Practitioner

• Post Graduate Certificate for Psychiatric Mental Health Nurse Practitioner (APRNs only)

• BSN to DNP (which includes Primary Care Family Nurse Practitioner)

• MSN to DNP

Contact - Dr. Cynthia Hupert, Graduate Coordinator cmhupert@svsu.edu

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Membership Meeting Rules and 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

Business 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....”

7

• 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 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 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 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

8

Interrupt

Speaker


Rules Governing Motions

Recognized by

Chair

Requires a

Second

Debated

Main motion NO YES YES YES Majority

Amendment NO YES YES YES Majority

Amendment to NO YES YES YES Majority

amendment

Limit Debate NO YES YES NO Two-thirds

Close debate NO YES YES NO Two-thirds

(previous

quest.)

Divide the NO YES YES NO Majority

Question

Reconsider NO YES YES YES Majority*

Point of YES NO NO NO Chair Decides

parliamentary

inquiry

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.

Vote

9


ANA-Michigan Annual Assembly Meeting

(virtual)

March 24, 2021 | 12:30-1:30 pm est | Zoom

AGENDA

Time Agenda Item Presenter

12:30 Call to Order:

• Roll Call of the Board of Directors

• Roll Call of Membership

• Declaration of Quorum

• Review and Approval of the Agenda

• Annual Assembly Meeting Minutes from

March 1, 2019

Julia Stocker Schneider,

President

12:35 Address from President Julia Stocker Schneider,

President

12:45 ANA-Michigan Financial Road Map Nancy Martin, Treasurer

12:50 Address from Executive Director Tobi Lyon, Executive Director

12:55 Proposed 2021 Bylaw Amendments

• Amendment #1

• Amendment #2

• Amendment #3

• Amendment #4

1:05 Address from Michigan Nursing Students

Association

Vineta Mitchell, Chair Bylaws

Committee

Nicholas Cooper, MNSA

President

1:10 Membership Comment and Open Forum Julia Stocker Schneider,

President

1:15 Recognition of Outgoing Board Members

• Nikeyia Davis, Secretary

• Nancy Martin, Treasurer

• Margaret Calarco, Director

• Suzanne Keep, Director

1:20 Teller’s Report

• Secretary

• Treasurer

• Director (2)

• Nominations Committee (2)

• ANA Membership Assembly Representative

Julia Stocker Schneider,

President

Carole Stacy, Chair

Nominations Committee

1:25 Announcements and Adjournment Julia Stocker Schneider,

President

11


MINUTES

BOARD MEETING

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.

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

13


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

14


• 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.

15


President’s Report

Julia Stocker Schneider, PhD, RN, CNL

It has been one year since I began my term as ANA-Michigan President, and what a

year it has been! Our Annual Conference and Meeting was cancelled last March due

to the onset of the COVID-19 pandemic, so our 2020 leadership transition occurred

remotely. While we have missed seeing one another, ANA-Michigan shifted work

very effectively to the virtual environment without missing a beat. Our organization

has continued to support our membership and to address issues that have emerged

during this highly visible and challenging year for nurses. Below are some highlights of the work we

engaged in during 2020:

• COVID Support Strategies

ANA-Michigan:

o Initiated Networks of Support calls led by members to provide nurses with an opportunity

to connect surrounding COVID pandemic experience, needs, and practice issues

o Created a COVID-19 Task Force to examine the impact of the crisis on nursing practice

and policy. The Task Force is planning to host a “Meeting of the Minds” with other

nursing organizations in Michigan to enhance partnership and collaboration to support

nurses’ well being

o Participated in a study to examine PPE and mental health symptoms among nurses

during the COVID pandemic https://journals.lww.com/joem/Fulltext/2020/11000/

Personal_Protective_Equipment_and_Mental_Health.2.aspx

o

o

Created COVID-19 Training Program for K-12 Schools

Gathered nurses’ PPE and COVID practice stories to support advocacy efforts to address

nurses needs

• Diversity, Equality, & Inclusion Support


o Provided education & networks of support to promote health equity and cultural

humility.

o Sent representatives to participate in LARA’s Implicit Bias Training Rules Advisory Work

Group

o Initiated development of a Nurses of all Kinds recognition program

o Prepared to develop implicit bias education/training offerings with nurse contact hours

once LARA has released the program requirements

o Developed a position paper on mitigating implicit bias

• Member Engagement


o Shifted educational offerings to virtual, continued development of the ANA-MI Leadership

Academy postponed until Fall 2021

o Developed an Ad Hoc Member Engagement Steering Committee (MI-SQUAD) to increase

member networking opportunities, enhance social media presence, and other approaches

that support engagement with nurses in Michigan

16

o

o


Implemented the Champions for Nursing Partnership Program pilot to enhance our

Organizational Affiliate Program

Is finalizing the development of a Foundation for nurse funding, so that we can apply

for and accept funds that can be used to support members and initiatives.

• Legislative


o Interviewed and hired a new lobby firm, Muchmore, Harrington, Smalley, and Associates

(MHSA) that has significantly enhanced our legislative presence at the Michigan capital

o Hosted a Town Hall Meeting with Senator Gary Peters

o Took action to support passage of the enhanced Nursing Licensure Compact (eNLC)

bill in Michigan including meeting with Governor Whitmer’s policy director, appointed

members for eNLC Task Force to support passage of eNLC

• Advocacy & Coalition Building

ANA-Michigan was represented at:

• APRN Alliance of Michigan (AAOM) to work towards the removal of barriers to APRN

Practice

• Coalition of Michigan Organizations of Nursing (COMON) to network, share educational

opportunities, and work toward mutual goals with 32 other Michigan nursing organizations

• Informatics & Telehealth


o Developed a position paper on telehealth & connected health

o Entered into a partnership with the Texas Nurses Association, the Texas Organization of

Nursing Leadership, and the Michigan Organization of Nurse Leaders (MONL) to support

a statewide comparison study to understand nurses’ experience with electronic health

records. The findings will be used to implement strategies that can lessen the burden

of EHRs on nurses. Link to Complete the Survey: https://nursing.ttuhsc.edu/surveys/

ehr-michigan/

Despite this unusual and difficult year, it has been my honor to serve as your President. We have much

to be proud of, including growing our membership, remaining financially sound, expanding member

engagement strategies, and increasing our visibility and influence on nursing issues in Michigan. It

has only been through the contributions of our many dedicated members, and to the support of

our staff that these achievements have been realized. I am confident that we can build on these

accomplishments in the coming year as we emerge from the pandemic with stronger recognition of

the importance of our role, and a renewed commitment to advocate for our profession. I encourage

each of you to become involved as we grow in nursing leadership together at ANA-Michigan.

17


Financial Statements

The 2020 Year-End Written Financial Summary

Operating Revenues:

Membership Dues: 2020 monthly budget was $18,600.00 to bring in for membership revenue. We

ended the year with $19,769.41.

Conference Income: The association had a net loss of $9,221.13 due to having to cancel the March

2020 annual conference.

Non-Dues Revenue: We hit our non-dues revenue by 104.7%.

Operating Expenses:

We end the fiscal year being over budget in the following areas:

Board Insurance was over by $1,629.12 per 2019 quote. For 2021, we have found a new provider

that will bring this cost back to what it was in 2018 and 2019.

Marketing and Promotion by $2,650.89 as this is the expenses related to nurse’s month gifts,

membership promotion and year-end holiday card.

Postage is over by $2,997.95 related to the nurse’s month gifts mailing and all the outreach we have

been doing related to membership promotions, which have resulted in our increase in membership.

Technology Hosting is over by $3,585.90; as part of this is the contracts related to 2021 renews on

the website and legislative action center.

Net Loss:

We ended the year with a net loss of $5,484.88. This is due to not having the conference and the hotel

contract that we had to pay related to canceling the event and the leadership institute not occurring

in the fiscal year. We never had to move money from savings or investment account throughout the

year and always maintained a cash flow of $15,000 to $25,000 in the checking account. In November,

we moved an additional $15,000 from savings to the investment account.

18


19


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21


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24


Executive Director Report

Tobi Lyon, MBA, CAE

To Remain Silent is to be Complicit. – President Ernst Grant, ANA President

The year 2020 was an unexpected and unprecedented challenge for many, and

when it began we had no idea to the extent of how it truly it would be the, “Year

of the Nurse.” It will forever be remembered as a year that made history and

changed life as we knew it, not only as nurses but as a country. On March 10, 2020,

in accordance with Governor Whitmer’s first “Stay-at-Home” Executive Order, ANA-

Michigan strategically pivoted operations to fully support the needs of nurses during

this time of great uncertainty. ANA-Michigan’s innovative approach and ability to proactively switch

gears to respond to COVID-19 was nationally recognized for establishing new modern practices and

has expanded our outreach and engagement to include more front-line nurses and potential members.

Due to the nature of the nursing profession and the frontline position nurses took from the very

beginning of the pandemic, an obvious top priority for ANA-MI was support as a direct response to

the fight against COVID-19 and the effect it was having on nurses. Tools and educational offerings

included a COVID-19 resources webpage, multiple webinars including, “Mitigating the Effects of

Trauma in Current Crisis” and “Psychological First Aid for Nurses,” strategically positioned “Thank

You” Nurse billboards and over 5,000 KN95 masks donated to members, nurses and health facilities in

need. I remain both humbled and in awe of the sacrifice nurses made in 2020 to fight this pandemic

and throughout the year.

Throughout the year, ANA-Michigan also continued its mission to advance nursing practice in Michigan.

ANA-MI developed position statements on Mitigating Implicit Bias, Telehealth & Connected Health,

the Enhanced Nurse Licensure Compact, Nurse Title Protection and Safe Nurse Staffing. Moving

forward, ANA-MI is in-progress of finalizing position statements in regard to the COVID-19 vaccination

and whistleblowing that aligns with the nurses’ code of ethics.

Advocacy was another key initiative in 2020, as dedicated nurses were tested to their personal limits.

For the first time ever, ANA-MI contracted its first lobbying firm, Muchmore Harrington Smalley &

Associates, LLC (MHSA). MHSA has earned the reputation as one of Michigan’s leading lobbying firms

and has a sterling reputation. ANA-MI was proud to provide our Strengthening the Voice of Nursing

campaign, featuring a webinar series, social media toolkit, tips on reaching out to Legislators and

a virtual town hall event with Representative Mary Whiteford. Our goal for this campaign was to

help decision-makers recognize the essential voice of nursing in current healthcare debates and

discussions. Because the ideals and mission of ANA-MI come to life through the real nursing stories

of our members, we know it’s critical for the voice of the nurse to be heard and ANA-MI is there to

support those voices every step of the way. ANA-MI in partnership with the Michigan Council for

Nurse Practitioners, held a virtual Town Hall with U.S. Senator Gary Peters as well.

25


As important as education is to ANA-MI, this too was significantly impacted by the COVID-19 pandemic.

While the 2020 Annual Conference and Assembly Meeting was cancelled, ANA-MI was proactive and

responsive with interactive virtual programming and creative opportunities for nurses to connect

virtually. A majority of the virtual programs were offered complimentary to all nurses. ANA-MI

recognized our 2020 Nurse Recognition Award Winners virtually as well.

As it turns out, the pandemic would make it the perfect year to unveil the ANA-Michigan Champions

for Nursing Partnership Program (CNPP). With the need for educational and emotional support for

nurses at an all-time high, it was the right time to reach out to partnering organizations to join us

and help support the advancement of the nursing profession. CNPP benefits are designed to provide

a mutually beneficial and long-term partnership between ANA-MI and the supporter, designed

strategically as a one-stop-shop for both supporting nurses and providing visibility and recognition for

the partnering organization. Whether through subscriptions to ANA-MI newsletters and publications

or new sponsorship opportunities and special annual conference benefits, the program is sure to

connect organizations that care with ANA-MI nurses in need. CNPP offers multiple levels of support

to allow for different tiers of engagement, from as low as one $250 annual contribution, all the

way to our Gold Partner for a $2,000 contribution. By becoming a part of the CNPP, partnering

organizations are standing with ANA-MI as we stand beside our nurses.

Lastly, I’m pleased to report record membership growth for ANA-MI for spring and summer 2020. It

is my sincere hope that this growth is a true reflection of the quality of the many services, support

tools and educational opportunities provided by our organization.

Never have I been more proud to be part of this organization. Through the most difficult parts of this

pandemic, nurses stood strong and stood together, dedicated and focused on patient care, amidst

nearly intolerable circumstances. As we begin to see light at the end of the tunnel of COVID-19

may that same hope and determination lead us to a better tomorrow. Thank you for your continued

support of ANA-Michigan and the nursing profession.

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ANA-Michigan's First Official Registered Lobby Firm: MHSA

ANA-Michigan reaches a new milestone in our association's storied history; beginning July

1st, ANA-Michigan will have its first official registered lobby firm!

ANA-Michigan has retained Muchmore Harrington Smalley & Associates, LLC (MHSA) as our new

multi-client lobbying firm. The firm possesses substantial experience, professional approach, unique

problem-solving skills, and unmatched creative energies while focusing on providing superior client

service in the development and implementation of successful strategies.

MHSA will provide weekly special reports and ANA-Michigan will be update our Advocacy page on our

website with this information as well as including links to the special reports in our newsletters to

keep members up to date.

MHSA works aggressively to shape public policy and weave client interests into the Michigan

Legislature’s agendas and initiatives; this includes the Executive and Administrative branches,

agencies, bureaus of the State of Michigan, the Michigan Economic Development Corporation, and

local and county governments.

MHSA was founded in 1988 and has earned the reputation as one of Michigan's leading lobbying firms.

MHSA was recently named Michigan's "Number 1" multi-client lobbying firm and "Number 1" lobbying

organization (including corporations, trade associations, non-profit organizations, and multi-client

lobbying firms); this according to a comprehensive survey conducted by Inside Michigan Politics

(IMP).

With more than 4,100 registered lobbyist agents in Michigan, five MHSA lobbyists earned honors

and ranked in the category of "Individual Lobbyists: The Top 10." MHSA's five lobbyists earning a

top 10 individual power ranking include Pat Harrington and Jon Smalley, both of whom will support

ANAMichigan.

To determine the power ranking of organizations and individuals who are both "players" and "effective,"

the IMP survey was distributed to all members of the Michigan Legislature, selected legislative and

administration staff members, members of the capitol news media, and others.

To learn more about the three team members from MHSA dedicated to ANA-Michigan, visit https://

mhsa.com/lobbyists to view their profile.

To view this week's special reports from MHSA for ANA-Michigan, click here.

To learn more about MHSA visit https://mhsa.com/

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Nurse Licensure Compact Update

By Evelyn Sweeney, ANA-Michigan Legislative Consultant,

Muchmore Harrington Smalley & Associations (MHSA)

Although many policies are of great interest to nurses, perhaps one of the most significant and

impactful to the profession is legislation enacting the enhanced Nurse Licensure Compact (eNLC).

As many know, the eNLC enables registered nurses and licensed practical/vocational nurses to hold

one multi-state license, with the privilege to practice in his or her home state and other NLC states.

There are currently 34 member states in the current NLC and, as you all know, Michigan is not one

of them.

On January 15, 2019, Representative Mary Whiteford, a nurse by trade, introduced House Bill 4042

which would have enabled Michigan to join the compact. The bill enjoyed wide support from a

diverse set of interest groups which included the Michigan Health and Hospital Association, AARP,

Leading Age Michigan, the Michigan Primary Care Association and of course, ANA-Michigan, to name

just a few. Representatives from ANA-MI testified in support of the bill in February 2020 before

the House Health Policy Committee. The bill was opposed by the Michigan Nurses Association as

well as the Michigan Department of Licensing and Regulatory Affairs. Concerns expressed by the

department largely focused on their responsibility of regulating health professionals in Michigan.

The department contends they would be ceding their authority and oversight to an out-of-state

compact body. Concerns regarding an inequitable “level of care” were also expressed pointing to

education requirement differences between states.

None the less, the bill was successfully reported from the House Health Policy Committee and out

of the full House by a vote of 55-50 with four members not voting in February 2020. With COVID-19

ravaging the state during the spring and late fall, plus an increased emphasis on the need and use of

telehealth services throughout the state, the Senate discharged the bill from committee and passed

it on December 10, 2020 despite the same concerns from the administration.

The bill was presented to the Governor on December 22, but was ultimately vetoed on December

30. In her veto letter the Governor specifically stated, “The Constitution of 1963 provides that “[t]

he public health and general welfare of the people of the state are hereby declared to be matters

of primary public concern. The legislature shall pass suitable laws for the protection and promotion

of the public health.” Art. 4, sec. 51. While I value interstate cooperation, especially around issues

that are peculiarly interstate in nature, these compacts require Michigan to cede its sovereign

interest in regulating health professions to an outside body. Forfeiting our prerogative as a state to

set the standard of care required of nurses practicing in our state would violate the command of

section 51 of article 4. I am therefore vetoing this bill.”

The administration’s opposition to all compact legislation remains an on-going concern. However,

with the start of the new legislative session on January 13, 2021 there is renewed hope that through

education, member engagement and persistence, we can address the Governor’s concerns. We

anticipate the reintroduction of an eNLC bill soon. We also believe Representative Whiteford will

sponsor the bill. She is coordinating a work group where interested stakeholders along with the

administration will work closely, share ideas and attempt to forge a compromise.

ANA-MI leadership will be part of these workgroups and looks forward to soliciting members for

feedback as well as engaging members in discussions with their local elected officials.

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ANA-Michigan Committee Reports

ANA-Michigan Nursing and Health Policy Committee

Chair: Katherine Kessler, MSN, MSA, RN

Beth Ammerman, DNP, FNP-BC

Kristin Castine, MSN, RN, ANP-BC

Nikeyia Davis, MBA-HCM, BSN, RN, CNN

Cheryl LaPlaunt, RN, MPA, BSN

Barbara Medvec, DNP, RN, NEA-BC

Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC

Linda Sarantis, MSN, RN, S.A.N.E.

Nadine Wodwaski, DNP, MSN-ed, CNS, RN

Committee Duties & Assignments

• Develop nursing and health policy initiatives related to ANA-Michigan’s Policy Platform.

• Monitor and analyze nursing and health policy issues; collaborate with other health and

nursing organizations in relevant nursing and health policy.

• Educate and collaborate with public policy makers, relevant private and organizational

policy makers.

• Monitor and address nursing and healthcare regulatory policy issues.

• Recommend and refer policy issues requiring legislative action or initiative to the Legislative

Committee.

• Assume other responsibilities for health policy as provided for in these bylaws and in policies

and procedures as established by the Board of Directors.

2020 Report

• Monitored the COVID-19 pandemic.

• Developed ANA-Michigan position statement on Moral Distress developed by the AACN

(American Association of Critical Care Nurses) and adopted by ANA-Michigan.

• Developed ANA-Michigan position statement on Reducing Violence in Healthcare Settings.

• Developed ANA-Michigan position statement on Telehealth and Connected Health.

• Developed ANA-Michigan position statement on Implicit Bias.

• Member participation is consistent and engaged with members representing a range of

geographic, rural, urban and practice areas.

• Shared articles with members on nursing and health policy related topics via the ANA-

Michigan newsletter.

Acknowledgements

On behalf of ANA-Michigan, we would like to recognize and thank the following out-going committee

members for their dedication and service to members:

• Kristin Castine, MSN, RN, ANP-BC

• Katherine Kessler, MSN, MSA, RN

• Cheryl LaPlaunt, MPA, BSN, RN

• Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC

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ANA-Michigan would also like to recognize and welcome new, in-going committee members who

were appointed to serve members on this committee for a two-year term:

• Alexa Andersen, MA, BSN, RN

• Ramona Berry, MSA, BSN, RN

• Wanda Chukwu, DNP, MA, CNEcl, RN

• Holly Thalman, BSN, RN

Chair: Katherine Dontje, PhD, FNP-BC, FAANP

Margaret Calarco, PhD, RN, NEA-BC

Linda Dunmore, MSN, RN, NE-BC, CPHQ, CPHS

Nadia Farhat, RN, MSN, AGCNS-BC

Marge Freundl, MSN

Julie Powell, MSN, RN, AGCNS-BC

Molly Stapish, MSN, CMSRN

Marnie VanDam, MSN, RN

ANA-Michigan Nursing Practice Committee


• Identify and address nursing practice issues in Michigan. Collaborate with related nursing

organizations with specific clinical expertise in developing initiatives.

• Bring focus to the health and safety of nurses in all practice settings.

• Develop programs that broadly address the personal health and well-being of nurses.

• Collaborate with the Nursing and Health Policy Committee in addressing regulatory issues

affecting nursing practice.

• Address ethical issues in practice.

• Assume other responsibilities for nursing practice as provided for in these bylaws and in

policies and procedures as established by the Board of Directors.

2020 Report

• Solicited nursing practice needs/feedback from membership.

• Monitored COVID-19 pandemic.

• Supported efforts to bring information to nurses related to COVID-19 and the potential

for the adverse emotional/psychological impact on nurses by recommending the offering

of education on PTSD and psychological first aid in response to the COVID-19 pandemic

response.

o Complimentary webinar provided in May for members and all nurses.

• Discussed opportunities to prepare for next steps and/or a second “wave” of the pandemic.

• Provided information on relevant nursing practice related topics, issues and innovations via

the weekly newsletter to enhance and expand nurses knowledge.

• Recommended to Board of Directors to convene an Adhoc COVID-19 Task Force; this

recommendation was approved by the Board of Directors in May.

• Responsible for convening nurse experts to develop a training program to educate K-12

school teachers and faculty on COVID-19.

o Reviewed and selected member nurse applicants to develop the curriculum and serve

trainers.

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o Provided oversight on the development of the COVID-19 school teacher/faculty virtual

training videos.

o Reviewed and approved the developed training materials that were provided as a

complimentary resource to K-12 Michigan school teachers and faculty.

o Training program videos and materials are available at no charge on ANA-Michigan

website.

• Discussed the current nursing practice environment and opportunities to provide resources to

members on vaccinations, health care worker resilience and ensuring graduation of nursing

students.

• Recommended assembling a potential adhock work group/task force to address vaccinations

and to develop materials related to vaccinations.

Acknowledgements



• Margaret Calarco, PhD, RN, NEA-BC

• Katherine Dontje, PhD, FNP-BC, FAANP

• Marge Freundl, MSN



• Nichole Budnick, BSN, RN

• Ruth Kechnie, RN, BSN, MSA, OCN NE-BC

• BethAnn Perkins-Simmons, BSN, RN

• Erin Sudheimer, MSN, RN

Chair: Bridget Leonard, DNP, MBA, RN

April Liberty, BSN, RN

Nancy Martin, DNP, RN

Jennifer Mecomber, MSN, RN

Mihaela Reed, MSN

Mary Zugcic, RN, ACNS-BC, CRNI

ANA-Michigan Education Committee


• Seek input from Members on educational topics and speakers to plan educational offerings.

• Plan the annual educational conference.

• Develop an annual Membership Assembly and conference budget to be submitted to the Board

of Directors for prior approval for the following year’s Assembly program and conference.

• Assume other responsibilities for conference as provided for in these bylaws and in policies

and procedures as established by the Board of Directors.

2020 Report

• Planned the 2020 ANA-Michigan Annual Conference

o Event was cancelled due to state’s executive order to quarantine due to the COVID-19

pandemic.

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o Full refunds provided to all registrants.

• Developed and offered the Networks of Support Virtual Meet-Up Series for all nurses, not

just ANA-Michigan members, to connect routinely and have a safe-place among nursing

peers for support during the COVID-19 pandemic and to discuss other timely and relevant

issues affecting or impacting nurses.

o Series received national recognition.

o Open discussions and specific topic discussions were both offered.

o Each Networks of Support’s discussion was lead by a thought leader (ANA-Michigan

leadership including board and committee members).

• Developed and offered the “Strengthening the Voice of Nursing Virtual Event” based on

topics recommendations from the Nursing Practice Committee and discussions from the

Nursing Health & Policy and Legislative Committees that promoted nurses using their voices

to speak-up on issues that matter to them most. Interactive education included:

o Leveraging the Power of Nurses: Promoting Health Equity through a Framework of

Cultural Humility.

o Event included a town hall with Representative Mary White.

o Storytelling and how to articulate your nursing story.

o Recommendations for meeting with legislators & legislative update.

o Do 1 thing activity and reporting.

• Offered town hall with US Senator Gary Peters in partnership with MICNP.

• Provided multiple complimentary and/or low cost webinars for all nurse on self-care during

the early on-set of the COVID-19 pandemic to help support nurses’ well being and resiliency.

o Stress Management and Self-Care for Nurses (multiple).

o Stress First Aid.

• Planned the first time ever, virtual, 2021 Annual Conference & Membership Assembly

scheduled for March 24-25, 2021.

• Monitors planning for the Leadership Academy by way of Leadership Academy Task Force

updates.

• Monitors the SOM Implicit Bias Training Advisory Workgroup to stay apprised of implicit bias

training requirements for nurses and other health care licensures.

o Executive Directive 2020.07 is an order requires LARA, in consultation with relevant

boards and task forces, to promulgate rules to establish implicit bias training standards

as part of the knowledge and skills necessary for licensure, registration, and renewal of

licenses and registrations to 26 health professions, this workgroup will work together to

o

establish this training.

Education Committee Chair Bridget Leonard, Nikeyia Davis and Gerry Infante appointed

to sub workgroups on behalf of ANA-Michigan.

• Planned two-part virtual workshop for January 2021 on “Advancing Your Idea & Creating a

Successful Side Hustle” as a joint provided event with ONA, INA & WNA.

• Planning a “Nurse Appreciation/Pride Celebration” as an in-person networking event at end

of year and will include the 2021 nurse recognition awards.

• Planning quarterly 2021 virtual education calendar for quarters 2-4 with nurse contact hours.

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Acknowledgements



• April Liberty, BSN, RN

• Nancy Martin, DNP, RN

• Mihaela Reed, MSN



• Ruth Duffy, BSN

• Gerardo Infante, BSN, RN

• Patrick Joswick, DNP, AGNP-C, RN

Chair: Suzanne Keep, PhD, RN


Katherine Dontje, PhD, FNP-BC, FAANP

Bridget Leonard, DNP, MBA, RN

Imana Minard, RN

Mary White, RN

ANA-Michigan Adhoc COVID-19 Task Force

2020 Report

• Convened by the Nursing Practice Committee to discuss how can ANA members address

health disparities/ social determinants of health related to the COVID-19 pandemic.

• Focus efforts on nurses and the pandemic, and direct efforts to promote self-care among

nurses. It is known that nurses are experiencing burn-out, PTSD and other stressors in which

young and older nurses are deciding to leave the profession.

• Facilitating a Meeting of the Minds with other nursing organizations to collaborate on

discussing what effect COVID-19 has had on nurses, and what measures can be taken to

support nurses.

• The objective is to understand what stressors nurses are experiencing related to the

pandemic, and how can ANA nurses help in addressing this issue. The goal is to have this

collaborative meeting in April of 2021.

• Discussed the current COVID-19 environment nationally and for Michigan.

• Reviewed COVID-19 related issues identified by the Nursing Practice and Education

Committees.

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ANA-Michigan Adhoc Leadership Academy Task Force

Chair: Jeanette Klemczak, RN

Shari Carson, BSN, RN, CDP, CDONA, FACDONA, IP-BC

Katherine Kessler, MSN, MSA, RN

Nancy Martin, DNP, RN

Barbara Medvec, DNP, RN, NEA-BC

Joshua Meringa, MPA, MHA, MBA, BSN, RN-BC

Carole Stacy, MSN, MA, RN

2020 Report

• Series rescheduled from 2020 to 2021 due to COVID-19 pandemic.

• Task Force continued to research potential funding sources for Leadership Academy

scholarships.

• Determined the methods of delivery (in-person only and/or combination with virtual

components).

• Seeking consultation on energized approaches to online learning.

• Adjusted curriculum to reflect emerging issues (leading in crisis, implicit bias, etc.).

• Nurse leaders across the state participated in focus groups to identify key concepts and

desired skills for the succession of nursing leadership in their organizations including

hospitals, home health, and long term care settings.

• Tentative content experts (faculty/speakers) have been identified.

• Identifying additional sources of funding.

• Considered the impact of the pandemic and economic situation of healthcare systems.

• Assessed the environment for evidence to support moving forward with event.

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2020 MEMBERSHIP ASSEMBLY REPORT

SUBMITTED BY: JULIA STOCKER SCHNEIDER,

STACY SLATER, BRIDGET LEONARD

On Monday, June 1st ANA Virtual Special Meeting of the Membership Assembly voted on a proviso to

the ANA Bylaws to allow the Annual Membership Assembly to be held virtually and national elections

to be conducted remotely. The three-hour Membership Assembly meeting was scheduled for June

19, 2020 from 5:00-8:00pm.

President Julia Stocker Schneider, Membership Assembly Representative Stacy Slater, Presidentelect

Bridget Leonard, and NEC candidate Marylee Pakieser attended the 2020 virtual membership

assembly meeting. It was a great opportunity to see the ANA Board seamlessly and successfully

execute the meeting in a virtual format. It was valuable to observe the Board at work, to hear some

of the discussions of the Board and contributions of members.

Friday, June 19, 2020

The Virtual Session of the Membership Assembly was held. 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 the virtual format.

Much discussion centered around the effects of COVID-19 on nursing advocacy, nursing education,

and racial disparities made glaringly visible by the pandemic.

Debbie Hatmaker reported on ANA Enterprise and the strategic goals to Elevate the profession of

nursing globally, to Engage all nurses to ensure professional success, to Evolve the practice of nursing

to transform health and healthcare, and to Enable transformational capabilities through operational

excellence.

• Passage of the Home Health Care Act and Title VIII as part of the CARES Act.

• Call to Action for Congress to rebuild public health nursing workforce.

• Direct aid to nurses using short-term grants (Hilton 236,000 room nights used).

• Media opportunities to position nurses as the Voice of Nursing.

• Social Media presence.

• Credentialing Center has been very customer focused in responding to challenges presented

by the closing of testing centers.

• COVID work is focused on ANA’s relevance and driving membership. Original goal was a net

gain of 10,000+ members but the relevance of ANA’s work was so well demonstrated that by

the end of May the net gain was 14,000 new members.

• Dialogue forum updates – specifically Visibility of Nurses in the Media from the 2019

Membership Assembly – a Nurse Expert Data Base is being created.

• New Business Item – To create an ad hoc committee to exam nurse suicide research. More to

report later on this important committee.

• It takes an Enterprise to battle a pandemic – speed over elegance.

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Professional Policy Committee – All dialogue forums were canceled for 2020 but will all be considered

for the 2021 assembly. Proposed revisions to the execution of the dues escalation of membership

dues and change from labor organization to non-labor organization.

• Dues escalation policy revision – voting to be conducted remotely after the meeting.

• President Grant opened the chat for comments/clarification regarding the Dues Escalation

Policy.

o No comments.

Statement on Racial Justice for Communities of Color – Emergent Proposal

• This was approved as it met the requirements for an emergent proposal.

• The emergent proposal was disseminated on 6/16/2020.

• The statement and pledge were approved.

o No additional comments.

Nominations and Elections Committee – Voting instructions

• The proviso adopted 6/1/20 will be administered by an independent vendor under the

supervision of the NEC and the ANA Office of General Counsel.

• Voting opened immediately after the meeting through 11:59 p.m. EST 6/25/20.

• President Grant opened for questions.

o No additional comments.

Closing comments by President Grant regarding the impact of COVID-19 on nursing and to use our

influence to educate others. Imagine a world where all voices are heard and respected. Change is

needed and to take action at the ballot box!

Virtual Day of Advocacy - #RNAction – 6/25/20

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Candidates of Integrity:

Meet Your ANA-Michigan Future Leaders

This year, ANA-MI Members will elect:

• Secretary

• Treasurer

• Director (2)

• Nominations Committee (2)

• ANA Membership Assembly Representative

On Tuesday, February 9, ANA-Michigan members had the opportunity to “Meet the Candidates”

via an interactive virtual forum to connect with the 2021 leadership election candidates and ask

questions before voting.

The “Meet the Candidate” Forum was recorded and can be viewed on our website at www.anamichigan.org.

Ballots were mailed out on Thursday, February 18, 2021 and voting remained open until 5:00 p.m.

Thursday.

This year’s leadership candidates of integrity by position

included on the 2021 ANA-Michigan election ballot:

Secretary – (Elect 1)


Henry Ford Health System

Home Dialysis Therapies Registered Nurse

Ypsilanti, MI

Vanessa Riley, BSN, RN

Advantis

Occupational Health Nurse

Clio, MI

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Treasurer – (Elect 1)

Julie Bulson, DNP, MPA, RN, NE-BC

Spectrum Health

Director, Business Assurance

Grand Rapids, MI

Director – (Elect 2)

Barbara R. Medvec, DNP, RN, MSA, MSN NE-BC

University of Michigan School of Nursing

Clinical Assistant Professor and MSN Program Lead

Saline, MI

Joshua Meringa, MPA, MHA, MBA, BSN, RN, NPD-BC

Spectrum Health System

Nurse Educator & Academic Liaison

Grandville, MI

Julie Powell, MSN, RN, AGCNS-BC, CNEcl, EBP(CH)

Michigan State University

Nursing Faculty

Temperance, MI

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Christine W. Saltzberg, PhD, MSHCE, MS, PHCNS-BC, RN

Self

Consultant

Highland Township, MI

Nominations Committee – (Elect 2)

Linda John, MSN, RN, PhD (c)

Oakland University

Clinical Nursing Instructor

Troy, MI

Suzanne Keep, PhD, RN

University of Detroit Mercy

Site Director of Pre-Licensure Program: Associate Professor

Grand Rapids, MI

Beth VanDam, MSN, GERO-BC, CNL

Mercy Health Saint Mary's

Clinical Nurse Leader

Grand Rapids, MI

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ANA Membership Assembly Representative – (Elect 1)

Anne R. Kreft, BSN, RN

Munson Medical Center

Behavioral Health - Clinical Practice RN

Traverse City, MI

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ANA-Michigan Announces NEW Champions for Nursing Partnership Program

Creating a One Stop Shop for Supporting Nurses of All Kinds

During these unpresented times, uniting nurses and organizations of all kinds for collaboration is

more important than ever. ANA-Michigan has designed a new Champions for Nursing Partnership

Program (CNPP) to promote alignment of collaborative efforts to advance the nursing profession and

to provide a network of diverse resources for nurses.

Schools of nursing, nursing and health care organizations, professional networks, health care systems,

health care vendors, nursing consultants and all other champions for nursing are encouraged to

partner with us!

By becoming a part of the CNPP, ANA-Michigan members will receive enhanced, diverse and more

inclusive resources that support our mission, vision and strategic plan.

To discuss how ANA-Michigan and your organization could partner together, please visit the anamichigan.org.

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ANA-Michigan Members Serving on State of

Michigan’s Workgroups to Develop New Implicit

Bias Licensure Requirements and Training

The COVID-19 pandemic has illustrated, with brutal proof, the persistence of racial disparities in

our society. As of July 5, 2020, Black Michiganders represented 14% of the state population, but over

35% of confirmed COVID-19 cases where the race of the patient was known. COVID-19 is over four

times more prevalent among Black Michiganders than among white Michiganders. And Michigan is

no outlier. According to the Centers for Disease Control and Prevention (CDC), “non-Hispanic Black

persons have a [COVID-19 associated hospitalization] rate approximately 4.7 times that of non-

Hispanic White persons.” Moreover, Black and Latino people have been nearly twice as likely to die

from the virus as white people, according to CDC data. Indigenous populations have experienced a

hospitalization rate even higher than that of Black Americans.

This disparity is not limited to COVID-19. People of color face disparities in terms of morbidity,

mortality, and health status. Black, Hispanic, and Indigenous Americans have higher infant mortality

rates than white and Asian Americans. The premature death rate from heart disease and stroke is

highest among Black Americans.

Race and ethnicity are not the only demographic factors associated with disparity in health outcomes.

For example, women are more likely to experience delayed diagnosis of heart disease compared to

men, as well as inferior heart attack treatment. Sometimes, these disparities intersect, as in the

case of childbirth, where the United States is one of the few countries experiencing a rise in the

maternal mortality rate, and Black women are nearly four times as likely to die during childbirth as

are white women.

Faced with these disparities during the COVID-19 pandemic, Michigan has led the way in identifying

and addressing the problem. Michigan was one of the first states to report COVID-19 data by race and

ethnicity. When it became clear the virus had devastated communities of color with particular force,

Governor Gretchen Whitment issued Executive Order 2020-55, creating the Michigan Coronavirus

Task Force on Racial Disparities—a group dedicated to studying, reporting on, and finding solutions

to the disparate effects of COVID-19 on people of color.

But much work remains. To be sure, the causes of these disparities are multiple and complex. Social

determinants of health such as education, employment, and environmental factors—all of which

correlate with race and ethnicity—are part of the explanation. Research also shows that disparities

result in part because of differences in the delivery of medical services to people of different races.

The National Healthcare Disparities Report concluded that white patients received care of a higher

quality than did Black, Hispanic, Indigenous, and Asian Americans. People of color face more barriers

to accessing health care than do white people, and are generally less satisfied with their interactions

with health care providers.

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These disparities can arise even when not intended because of the prevalence of what is sometimes

called implicit bias: thoughts and feelings that, by definition, often exist outside of conscious

awareness, and therefore are difficult to control. But they can shape behavior, including the behavior

of health care professionals. One way to reduce disparities in health outcomes, therefore, is to seek

to eliminate the unconscious biases, misconceptions, and stereotypes that can lead to disparities in

how health care is provided.

Michigan’s front-line health-care workers have been its greatest heroes in the fight against COVID-19.

Without their selfless and courageous service, many more lives would be lost and disrupted due to

this pandemic. Nevertheless, we—all of us—need to do better, and training health-care workers

how to recognize and mitigate implicit bias will only help these workers carry out their mission

of providing the best health care to all they serve.

For this reason, and on the recommendation of the Michigan Coronavirus Task Force on Racial

Disparities, the Department of Licensing and Regulatory Affairs (LARA) has convened an Implicit Bias

Stakeholders Workgroup and Subgroups to establish new rules requiring all health care professionals,

including nurses, to receive training on implicit bias and the way it affects delivery of health care

services. This type of training has value for all Michiganders in all professions and walks of life and

ANA-Michigan is fully committed to supporting this.

We are honored and grateful to have the following dedicated and passionate ANA-Michigan leaders

serving on the LARA Implicit Bias Stakeholders Workgroup and Subgroups:

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Supporting Nurses During the

2020 COVID-19 Pandemic

Upon Governor Whitmer’s first Executive Order 2020-04 to “stay at home” on March 10, 2020 in

response to the COVID-19 pandemic, ANA-Michigan strategically pivoted operations to fully respond

to and support the needs of nurses during this time of uncertainty, setting aside routine, daily

operations and the status quo. ANA-Michigan’s aggressive pivot and innovative, proactive approach

has been nationally recognized, at the forefront for establishing new modern practices and has

expanded our outreach and engagement to include more front-line nurses and potential members.

Here are some ways that ANA-Michigan supported nurses during the on-set of the pandemic:

• Donated more than 5,000 KN95 masks to nurses and health facilities in need during the onset

of the pandemic and early PPE shortages.

• Donated Billboards of Gratitude for Nurses displayed across the state.

• COVID-19 Webpage: ANA-Michigan created the COVID-19 Resources webpage for members

and all nurses to have a “one stop shop” for up to date, evidence-based data and information

on COVID-19.

• ANA-Michigan and our members shared stories from the front-line with Senators, key

government officials and the community to help advocate for PPE and participated in both

state and national interviews with various media outlets. ANA-Michigan members also

participated in multiple Town Halls with key state and US representatives.

• Throughout these unprecedented times, ANA-Michigan provided multiple opportunities

for members and all nurses to connect for opportunities that support their well-being.

Opportunities include but were not limited to:

o Networks of Support Virtual Meet-Ups for Nurses (multiple)

o Webinars on Stress Management and Self-Care for Nurses

o Webinar on Stress First Aid for Nurses

• Recognizing Year of the Nurse: No one could have predicted that how 2020 would truly be

the Year of the Nurse. Despite the pandemic, ANA-Michigan and members still found ways

to recognize and celebrate being a nurse.

70


COMPLIMENTARY RESOURCE AVAILABLE

ANA-Michigan COVID-19 Training Program for K-12 School Teachers, Faculty and Staff

Developed as a proactive response to the growing needs of K-12 Schools amid the COVID-19 pandemic

the American Nurses Association of Michigan (ANA-Michigan) is proud to offer a FREE online

comprehensive four-part training program for teachers, faculty and staff. With so much information

circulating that is constantly changing or completely inaccurate, ANA-Michigan is determined to

secure the facts and share appropriate safety measures to help schools support their worried staff

and concerned parents.

The comprehensive virtual training course includes the following sections:

• Part 1: Introduction to Coronavirus

• Part 2: Maintaining Safety Practices During COVID-19

• Part 3: Managing Stress During COVID-19

• Part 4: Tool kit for School Faculty and Personnel Resources

Schools that would like to work with one of our nurse trainers for specific questions, or for an

online Q&A chat can schedule now through ANA-Michigan. Please direct specific questions about the

COVID-19 Training Program to Nurse@ana-michigan.org or (517) 325-5306 or online on our website

at ana-michigan.org.

About ANA-Michigan

American Nurses Association-Michigan (ANA-Michigan) is the premier organization representing the

interests of registered nurses (RNs) across the state. ANA-Michigan brings nurses together to advance

their careers and the profession through standard-setting, advocacy, and professional development.

71


ANA-Michigan COVID-19 Training Program for K-12 School Teachers, Faculty & Staff:

AUTHORS & TRAINERS

The ANA-Michigan COVID-19 Training Program was developed by the following ANA-Michigan

members on behalf of ANA-Michigan in response to the 2020 COVID-19 Pandemic. This Training

Program, and all its included materials, are the property of ANA-Michigan. Authors and Trainers

are listed below in alphabetical order by last name.

Dayna Bennett, MSN, APRN, FNP-C

Dayna Bennett is a Family Nurse Practitioner who works with

Opdyke Medical, a family medical practice where she treats individuals through

the lifespan. She has a special interest in women’s health, child health, diabetes,

hypertension and weight management. She graduated with her Bachelor of Science

in Nursing from the University of Windsor and Master of Science in Nursing from

Ursuline College. She is a member of the ANA-Michigan and Michigan Council of

Nurse Practitioners. She enjoys living in Michigan with her three children and

husband.

Dr. Donna Cassidy, DHSc, MSN, RN

Donna Cassidy has been an RN for 26 years. During her career

Donna has worked in a variety of roles with increasing responsibilities. Donna

spent 11 years working in education before moving into a nurse leadership role.

Donna currently serves as the Hospital Administrator for a small community

hospital in Southwest Michigan. Donna earned her Associates Degree in Nursing

in 1994 and her BSN in 2002. Donna has a MSN from Walden University with a

focus on Nursing Education and a Doctorate of Health Sciences with a focus on

Organizational Leadership and Behavior earned from AT Still University.

Dr. Wanda Chukwu, DNP, MA, CNEcl, RN

Wanda Chukwu, DNP, MA, CNEcl, RN, is a proud member of ANA-Michigan. Dr.

Chukwu is currently taking time out of her daily routine to incorporate new

strategies to manage stress and build resilience during the COVID-19 pandemic.

She is currently employed as a fulltime nursing faculty member; and also works as

an independent consultant helping individuals create policies and procedures for

their health-related ventures. In her spare time she enjoys watching old movies

and listening to good music.

Linda Dunmore, MSN, RN, NE-BC, CPHQ, CHSP

Linda Dunmore serves as the Senior Director of Clinical Services for Mercy Health

in Muskegon. She has been with the organization for over 30 years and is currently

responsible for the leadership in Quality, Accreditation, Patient Safety, Infection

Prevention and Control (IPC), Clinical Education and Employee Health. Linda is

an adjunct faculty for Indiana Wesleyan University. Linda is a member of ANA-

Michigan and sits on the Nursing Practice Committee.

72


Noor Khalil M.Ed., BSN, RN

Noor Khalil is a family nurse practitioner student interested in community

nursing, holistic health care, transcultural health and reducing health disparities

among vulnerable populations. During the pandemic, she has cared for COVID-19

patients providing patient-family centered care. Her clinical background is in

medical surgical nursing. She earned a Master of Education in health education

concentrating on community health education from Wayne State University and

a Bachelor of Science in Nursing from Oakland University with summa cum laude

distinction.

Kristin Mahler, MPH, RN, NCSN

Kristin Mahler, RN,BSN, MPH, NCSN, is a proud member of ANA-Michigan. Kristin

works as a school nurse in Ann Arbor Public Schools since 2007. Prior to school

nursing worked in a variety of inpatient and out patient settings. Active member

of the Michigan Association of School Nurses Board of Directors. Nationally

Certified School Nurse.

Joshua Meringa, MPA, MHA, MBA, BSN, RN, NPD-BC

Joshua Meringa is a Nurse Educator and Academic Liaison at Spectrum Health

in Grand Rapids, Michigan. His responsibilities include facilitating orientation

training for new RNs and Nurse Technicians, managing academic affiliations with

nursing programs at colleges and universities throughout West Michigan and

providing leadership and oversight for the Spectrum Health nursing continuing

education program. Mr. Meringa has been a Registered Nurse since 2002 and

is certified in nursing professional development through the American Nurses

Credentialing Center and as a certified Basic Life Support Instructor through the

American Heart Association. He is a member of ANA-Michigan and the Wisconsin Nurses Association

Continuing Education Approval Committee. Mr. Meringa is the immediate past Chair of the Michigan

Board of Nursing. He holds a Bachelor of Science in Nursing from Calvin College, and Master’s degrees

in Public Administration, Healthcare Administration and Business Administration from Grand Valley

State University. Meringa lives in Grandville, Michigan with his wife and three school-aged children.

Marnie VanDam, RN, BSN, MSN

Marnie VanDam, RN, BSN, MSN earned her Bachelor of Science degree from

Oakland University and her Master of Science in nursing education from Capella

University. She has 27 years of nursing experience with the last 10 years in

emergency medicine. Mrs. VanDam is also employed by her local school district

as a nurse consultant. Marnie is an active member of the ANA-Michigan Nursing

Practice Committee.

To request a meeting with one of the ANA-Michigan Authors/Trainers so that they may address any

specific questions or concerns that your teachers, faculty or staff may have, please contact ANA-

Michigan directly at: Nurse@ana-michigan.org Office: (517) 325-5306

73


ANA-MICHIGAN POLICY ON PUBLIC POSITION STATEMENTS

POLICY

ANA-Michigan shall take public positions on legislation and health policy proposals, and recommend

actions based on the following Platform and process.

PURPOSE

ANA-Michigan’s position statements articulate the Association’s stand on health care policy

proposals of importance to its membership and the public it serves. Positions are generated in

response to trends and best practices in health care and health policy related to current and

emerging issues that impact the health of the citizens of Michigan, their access to care, standards

and excellence in nursing practice; and the profession of nursing.

All proposed policy positions are first benchmarked to the ANA-Michigan Mission, Vision and

Strategic Values. The Criteria below are also applied to the analysis and recommendation of

policy positions to the Board of Directors.

Platform Issues

Access to Quality Care

1. Promote accessibility to healthcare for all residents of Michigan.

2. Support services for vulnerable populations.

3. Ensure nursing care by appropriate licensed providers.

4. Assure basic human needs services that impact individual health status.

5. Support programs that enhance health literacy.

Human Rights/Social Justice

1. Provide for informed healthcare choices through evidence-based education of Michigan residents.

2. Support legislative proposals that positively impact the health and welfare of Michigan residents.

3. Educate legislators when proposals would negatively impact the health and well-being of

Michigan residents.

4. Oppose discrimination in health policies/regulations and delivery of care.

5. Support competent care for diverse Michigan populations.

6. Protect the privacy of Michigan residents in issues of healthcare.

Quality and Safety of Health Care

1. Maintain state policies and regulations consistent with national nursing standards.

2. Support for programs that address health promotion and maintenance and prevention of disease/

disability.

3. Actively collaborate with healthcare organizations within the state for purposes of quality care,

patient safety and nursing input.

74


Advances in the Practice and/or Profession of Nursing

1. Promote the viability of professional nursing organizations.

2. Promote statewide communication within the profession.

3. Encourage occupational health and safety of nurses.

4. Support public funding for nursing research and education.

Process for Position Statement Review

1. Requests for development of an Association position statement on a policy, issue or legislation

may be made by the Board of Directors, an individual member, or based on member survey

results.

2. The request is sent to the Public Policy Council for consideration.

3. The Public Policy Council reviews the issue, evaluates the issue in relation to the ANA-Michigan

Mission, Values and Impact Statement and the Platform criteria.

4. The Public Policy Council makes a recommendation to the Board using an evidence-based review

of the issue and its relevance to the above Platform Criteria. Topic experts may be used to

develop the position statement.

5. The Board determines whether the proposed position statement is adopted by the Association

and made public.

6. The Association positions are reviewed by the Public Policy Council annually.

7. Recommendations for policy changes are made to the Board.

8. Joint positions (e.g. with other healthcare groups) may be developed.

Approved by the ANA-Michigan Board of Directors on September 19, 2015

75


POSITION STATEMENT

MORAL DISTRESS IN TIMES OF CRISIS

Background

Moral distress is “knowing the right thing to

do but being in a situation in which it is nearly

impossible to do it.” 1

Critical care teams wrestle daily with moral

challenges in the context of their normal

professional activities. 2 During a crisis, such as

the COVID-19 pandemic, everyday challenges

are compounded. For example, patient surge

results in shortages of lifesaving equipment

needed to keep patients alive 3 and a lack of

personal protective equipment necessary to

protect nurses, their patients, their families, and

their communities. 4,5 Team members struggle

to maintain their professional, emotional,

and moral equilibrium when caught in tragic

situations beyond their control.

Nurses, and all members of the healthcare

team, must protect their personal integrity

and sense of justice to be effective in their

work. Too often, nurses are pressured to

compartmentalize emotions, and to rapidly and

stoically “do your duty.” Sustaining a strong

sense of duty maintains order, serves patients,

and preserves the respect of coworkers and

loved ones. However, discerning one’s duty may

not take the linear path of simply following

orders and regulations. Those who apply a carebased

morality prioritize relationships with

others in making moral decisions. 1,6 Embracing

a care-based perspective recognizes that nurses

live in a web of moral duties that includes their

duty to protect themselves, their patients, their

families, and their communities.

Recommended Actions for

Healthcare Institutions

Every organization must:

• Provide the vital supplies and equipment

that nurses need to protect themselves and

others.

• Establish evidence-based, consistent,

procedures for equitably allocating scarce

resources and use them in a way that

maximizes value without endangering

safety. 8,9

• Consider creating an interdisciplinary

triage committee composed of respected

volunteers to provide unbiased opinions in

difficult situations. This preserves each direct

caregiver’s ethical duty for beneficence. 3

• Ensure that administrators are accessible to

those performing direct patient care, and

that they maintain clear communication

and transparency regarding institutional

challenges.

• Guarantee that nurses are included as

decision makers on all institutional ethics

committees.

• Monitor the clinical and organizational

climate to identify situations that could

create moral distress.

• Provide tools to help clinicians recognize

the experience of moral distress.

• Create interdisciplinary forums to discuss

patient goals of care and divergent opinions

regarding those goals of care in an open,

respectful environment.

• Ensure institutional support systems include

easy access to:

• Ethics committees

76

• Critical stress debriefings

• Protocols for end-of-life care

• Readily available crisis counseling

• Employee assistance programs

• Grief counseling

Recommended Actions for Nurses

Nurses must:

• Pay attention to your inner voice and

recognize when it conflicts with what you

are being asked to do or what circumstances

demand that you do.

• Create a moral compass for yourself by

expanding your ethical knowledge. Seek out

professional and institutional resources that

can provide ethical guidance, such as:

• American Nurses Association Code of Ethics

for Nurses 10

• International Council of Nurses Code of

Ethics for Nurses 11

• Your hospital’s ethics committee or moral

distress consulting team.

• Learn the signs and symptoms of moral

distress. They include:

• Feelings of frustration, anger, and guilt 12

• Physical manifestations such as heart

palpitations, insomnia, and fatigue

• Psychological consequences such as

withdrawal, emotional exhaustion, and

depersonalization of patients. 13

• Seek out a trusted mentor.

• Use employee assistance resources and see a

qualified professional counselor or therapist

when needed.

• Lean on coworkers, friends, and loved ones.

They are all in the mix as you balance your

personal and professional duties, and they

need to know when you are experiencing

moral distress.

• Practice self-care, and keep a reflection

journal.

References

1. Jameton A. What moral distress in nursing history

could suggest about the future of health care. AMA J

Ethics. 2017;19(6):617-628.

2. Savel RH, Munro CL. Moral distress, moral courage.

Am J Crit Care. 2015;24(4):276-278. doi: 10.4037/

ajcc2015738


77

3. Truog RD, M.D., Christine Mitchell C, Daley GQ.

The toughest triage — Allocating ventilators in a

pandemic. NEJM. Published online March 23, 2020.

doi: 10.1056/NEJMp2005689 https://www.nejm.org/

doi/full/10.1056/NEJMp2005689

4. Interim Infection Prevention and Control

Recommendations for Patients with Suspected or

Confirmed Coronavirus Disease 2019 (COVID-19) in

Healthcare Settings. Centers for Disease Control and

Prevention. https://www.cdc.gov/coronavirus/2019-

ncov/infection-control/control-recommendations.

html

5. Interim Guidance: Rational use of personal protective

equipment for coronavirus disease 2019 (COVID-19).

World Health Organization. Accessed March 25,

2020. https://apps.who.int/iris/bitstream/

handle/10665/331215/WHO-2019-nCov-IPCPPE_use-

2020.1-eng.pdf

6. van Nistelrooij I, Leget C. Against dichotomies:

On mature care and self-sacrifice in care

ethics. Nurs Ethics. 2017;24(6):694-703. doi:

10.1177/0969733015624475

7. Barden C, Cassidy L, Cardin S, eds. AACN Standards

for Establishing and Sustaining Healthy Work

Environments: A Journey to Excellence. 2nd ed.

Aliso Viejo, CA: American Association of Critical-

Care Nurses; 2016. https://www.aacn.org/

nursing-excellence/standards/aacn-standardsfor-establishing-and-sustaining-healthy-workenvironments.

Accessed March 25, 2020.

8. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation

of scarce medical resources in the time of covid-19.

N Engl J Med. Published online March 23, 2020. doi:

10.1056/NEJMsb2005114

9. Daugherty Biddison EL, Faden R, Gwon HS, et al.

Too many patients…a framework to guide statewide

allocation of scarce mechanical ventilation

during disasters. Chest. 2019;155(4):848-854. doi:

10.1016/j.chest.2018.09.025

10. American Nurses Association. Code of Ethics for

Nurses With Interpretive Statements. Silver Spring,

MD: Nursesbooks.org Retrieved from https://

www.nursingworld.org/practice-policy/nursingexcellence/ethics/code-of-ethics-for-nurses/coeview-only/

11. The ICN Code of Ethics. Revised. Geneva Switzerland:

International Council of Nurses; 2012.

12. Epstein EG, Delgado S. “Understanding and

Addressing Moral Distress.” Online J Issues Nurs.

Published online September 30, 2010. doi: 10.3912/

OJIN.Vol15No03Man01.

13. Rushton CH, Caldwell M, Kurtz M. Moral Distress:

A catalyst in building moral resilience. Am J

Nurs. 2016;116(7):40-49. doi: 10.1097/01.

NAJ.0000484933.40476.5b


POSITION STATEMENT

PREVENTING WORKPLACE VIOLENCE IN HEALTHCARE SETTINGS

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.

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.

78

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 underpinning 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


79

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/practicepolicy/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-safetyin-all-health-care-settings/

xxii

American Nurses Association. Position Statement on

Incivility, Bullying, and Workplace Violence. 2015. Web:

https://www.nursingworld.org/practice-policy/workenvironment/violence-incivility-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

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 tps://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 www.ana-michigan.org nurse@anamichigan.org

(517) 325-5306

80


POSITION STATEMENT

TELEHEALTH AND CONNECTED HEALTH

BACKGROUND

The United States is in the midst of a global

pandemic from Covid-19, a highly contagious

disease that has caused severe social, economic

and cultural disruptions to everyday life in

America. Telehealth, also referred to as

Connected Health, has grown exponentially

during this time as more services are being

delivered and are eligible for reimbursement

from public and private insurers. The Center for

Medicare and Medicaid Services (CMS) released

new guidelines for telehealth in April, 2020 that

encourage expansion of services to populations

they cover. Examples from major Michigan

healthcare systems include Michigan Medicine

which conducted 444 virtual visits in February,

2020 and increased those to more than 20,000

visits by the end of April, 2020. Henry Ford

Health System went from conducting 150 virtual

visits per week to 10,000 virtual visits and report

high patient satisfaction with this option.

Nearly 20% of Americans live in rural areas

where there is a shortage of both providers and

healthcare facilities. “The health consequences

for communities that lack resources can be dire”

states Joelle Fathi DNP RN ARNP CTTS, an expert

on biobehavioral nursing and health informatics

and a member of the 2018 ANA Steering

Committee to revise its Core Principles of

Telehealth. Fathi further states that connected

health has value for patients in urban and major

metropolitan areas. The expansion of healthcare

services through connected health creates the

opportunity to serve populations with care that

is “necessary, timely, efficient, convenient and

effective.” (Moore & Trainum, 2019, p. 32).

The Affordable Care Act and the 2017 Health

Care Act both support the use of telehealth and

technology to expand access to care delivery.

Tamara Broadnaux DNP RN NEA-BC, Clinical

Operations, Department of Veterans Affairs

states that “As providers move toward more

value-based, shared saving, and accountable

care models as required in healthcare reform,

connected health provides better care

coordination, management and communication

with patients.” (Moore & Trainum, 2019, p. 32).

In 2019, ANA released Core Principles on

Connected Health (Principles) as a guide for

healthcare professionals who use telehealth

technologies to provide quality care. This

document is an update to the 1998 ANA Core

Principles on Telehealth and reflect the evolution

of healthcare using a more interdisciplinary

approach. There are 13 Principles within the

guide that identify unique issues related to

practice, regulatory, privacy, reimbursement,

documentation and competencies. (ANA, 2019).

The Centers for Disease Control and Prevention

(CDC) has issued Guidelines on using Telehealth

to expand access to essential healthcare services

during and beyond the COVID-19 pandemic.

ANA recognizes that connected health provides

a method of healthcare delivery that can

improve access to quality health care when

implementation is conducted using accepted

standards and best available evidence. Nurses

play an essential role in the adoption and use of

connected health across care settings and roles

and are well-positioned to lead in the adoption

and use of care via these technologies.

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DEFINITIONS

The American Nurses Association defines

telehealth and Connect Health as “the use of

electronic information and telecommunications

technologies to support and promote long

distance clinical health care, patient and

professional health-related education, public

health and health administration. Technologies

include: videoconferencing, the internet, storeand-forward

imaging, streaming media, and

terrestrial and wireless communication” ANA,

n.d. While telehealth has been in existence for

many years, it has grown exponentially recently

due in part to need to deliver care virtually

during the coronavirus pandemic.

Centers for Medicare & Medicaid Services (CMS)

(2020) define telehealth as “a two-way, real- time

interactive communication between a patient

and a physician or practitioner at a distant

site through telecommunications equipment

that includes, at a minimum, audio and visual

equipment.”

Several telehealth modalities allow providers

and patients to connect using technology to

deliver health care:

• Synchronous: This includes real-time

telephone or live audio-video interaction

typically with a patient using a smartphone,

tablet, or computer.

• In some cases, peripheral medical

equipment (e.g., digital stethoscopes,

otoscopes, ultrasounds) can be used

by another HCP (e.g., nurse, medical

assistant) physically with the patient,

while the consulting medical provider

conducts a remote evaluation.

• Asynchronous: This includes “store and

forward” technology where messages,

images, or data are collected at one point

in time and interpreted or responded to

later. Patient portals can facilitate this type

of communication between provider and

patient through secure messaging.


• Remote patient monitoring: This allows

direct transmission of a patient’s clinical

measurements from a distance (may or

may not be in real time)to their healthcare

provider.

• Mobile Health (mHealth): This includes the

use of mobile devices to support health care

and public health information exchange.

Information exchange using mHealth may

include general educational information,

targeted texts, and disease outbreak

notifications.

Nurses have the background, skills and creative

ingenuity to help patients effectively

navigate and engage in telehealth modalities

across the continuum of care.

Nurses have the background, skills and creative

ingenuity to help patients effectively navigate

and engage in telehealth modalities across the

continuum of care.

RECOMMENDATIONS:

1. Endorse the term telehealth and Connected

Health, as this is the most widely used and

accepted term used in national guidelines,

by third party payors and most professional

organizations

2. Adopt the 2019 ANA Core Principles on

Connected Health.

3. Advocate to make permanent recent policy

changes that reduce barriers to telehealth

services and reimbursement at the state and

national level.

4. Advocate for registered nurses (RN) and

advance practice registered nurses (APRN)

to be included in any legislation and to

have access to telehealth platforms used by

organizations

5. Advocate for the inclusion of telehealth

content and experiences at all levels of

registered nursing education.

82

REFERENCES:

American Nurses Association (2019, June 6). ANA

core principles on connected health. Retrieved

from https://www.nursingworld.org/~4a9307/

globalassets/docs/ana/practice/ana-coreprinciples-

on-connected-health.pdf

American Nurses Association. (n.d.). Telehealth.

https://www.nursingworld.org/practice-policy/

advocacy/telehealth/


Moore, E., & Trainum, B. (2019). Connected

health: ANA’s updated principles put nursing at

the forefront. American Nurse Today, 14(12), 32-

33.

U.S. Centers for Medicare & Medicaid Services

(2020, April 24). Telehealth. Retrieved from

https://www. cms.gov/Medicare/Medicare-

General-Information/ Telehealth

83


POSITION STATEMENT

MITIGATING IMPLICIT BIAS TO REDUCE DISPARITIES IN PATIENT OUTCOME

The purpose of this statement is to explore

implicit bias and the role it plays in healthcare

disparities and to identify what nurses can do to

encourage equality of care for all patients.

BACKGROUND

Our United States Declaration of Independence

assures equality, life, liberty and the pursuit

of happiness as fundamental rights for all

(Jefferson, 1776), yet there is nothing in the

document that promises healthcare as a right for

all citizens. For this and other reasons, healthcare

imbalances and disadvantages are present in our

country. Citizens with steady incomes, better

health insurance, healthy food, clean water and

greater access to care often experience better

healthcare opportunities than citizens with less

money, lesser or no health insurance coverage,

inadequate food and water resources and less

access to care (Probst, et. al, 2020; Oppel, et

al, 2020) . Healthcare disparities have been

defined by Healthy People 2020 as “a particular

type of health difference that is closely linked

with social, economic, and/or environmental

disadvantage” (ODPHP). With the onset of the

COVID-19 pandemic, healthcare disparities have

become more obvious.

Citizens of color are even at a greater risk for

healthcare disparities. While African American

citizens made up 14% of Michigan’s population,

they accounted for 35% of the COVID-19 cases

by July 2020 and were noted to be four times

more likely to die a COVID-19 related death than

their Caucasian counterparts (Michigan.gov).

Several studies have shown that implicit bias by

healthcare providers is associated with lower

quality of care (FitzGerald & Hurst, 2020).

Healthcare disparities such as these sparked

Michigan’s governor, Gretchen Whitmer, to form a

task force to advise her on strategies to eliminate

these racial disparities. One recommendation is

to mandate healthcare providers to participate in

implicit bias training as a condition of relicensure

in an effort to eliminate discrimination against

all citizens, especially those from disadvantaged

backgrounds (executive order 2020). ANA-MI

strongly supports Governor Whitmer’s stance on

eradication of racism and healthcare disparities.

The mission statement which drives the American

Nurses Association is to “Lead the profession to

shape the future of nursing and health care.”

As nurses, it is up to us to facilitate increased

opportunities for those experiencing disparities

in healthcare due to bias. It is up to us to help

even the playing field and to progress toward full

equality in healthcare.

IMPLICIT BIAS

Implicit bias, also known as unconscious bias,

as been defined as “thoughts and feelings that,

by definition, often exist outside of conscious

awareness, and therefore are difficult to control,”

(Hall, Implicit Racial/Ethnic Bias Among Health

Care Professionals and Its Influence on Health

Care Outcomes: A Systematic Review, 105 AM. J.

PUBLIC HEALTH 2588 (Dec. 2015). Furthermore,

implicit bias includes any preconceived thoughts

that can result in disparities and it is the duty of

the healthcare provider to become aware of our

own biases to help embrace the changes needed

to eliminate healthcare disparities (ANA, 2018;

Fitzgerald & Hurst, 2016). It has been noted

when people experience discrimination based

on personal characteristics, it can impact their

84

physical and psychological health (Sutin, Stephan

& Terracciano, 2016). Racism has been described

as a public health crisis which affects the mental

as well as physical health of all people (ANA,

2018). In the past, the ANA has also taken the

position there should be no discrimination in

nursing practice nor in health care and that all

patients should be viewed as equal and nurses

should be treat them with impartiality, respect,

and civility (2018).

RECOMMENDATIONS:

Strategies to mitigate implicit bias include

building upon previous work of the ANA-

Michigan (2018) based on opposing all racism

and discrimination and being an advocate for

all patients, regardless of their gender, race,

ethnicity, etc.

• Acknowledge that implicit biases do exist

and becoming aware these biases can result in

disparities in health outcomes associated with

many demographic factors. (As nurses it is

imperative to be aware of demographic factors

which can undermine our patient’s success for

health. Some of these factors might include

questioning if there are safe living situations,

availability for safe places to walk, feasibility of

obtaining fresh produce and other healthy food

choices, and obtaining fresh clean water for

drinking.)

• Follow the Nursing Code of Ethics,

which advises nurses to band together

as patient advocates against racism,

discrimination and injustice.

• Participate in the required implicit bias

training. While this will be a part of the

next license renewal, it will also expand

knowledge on this subject.

• Assume the responsibility for recognizing

your own implicit biases.

• Commit to treat all patients equally

regardless of their race, ethnicity,

economic status, sexual identity, or

gender.


• Become an advocate for all patients, for

issues of diversity, equity and inclusion.

As nurses it is our duty to uphold the values

and mission of the ANA-Michigan by

treating all patients equally and fairly.

REFERENCES:

Michigan.gov. Michigan Data, Cases by

Demographic Characteristics, Mich.

Coronavirus, https://www.michigan.gov/

coronavirus/0,9753,7-406-98163_98173---,00.

html, (last visited July 5, 2020).

Sutin, A., Stephan, Y. & Terracciano, A. (2016).

Perceived discrimination and personality

development in adulthood. Developmental

Psychology, 52(1), 155-163. doi: 10.1037/

dev000069 American Nurses Association (ANA)

(2018). Position statement on The Nurse’s

Role in Addressing Discrimination: Protecting

and Promoting Inclusive Strategies in Practice

Settings, Policy, and Advocacy. Found at: https://

www.nursingworld.org/~4ab207/globalassets/

practiceandpolicy/nursing-excellence/

ana-position-statements/social-causes-andhealth-care/the-nurses-role-in-addressingdiscrimination.pdf

Center for Disease Control & Prevention.

COVIDView, A Weekly Surveillance Summary of

U.S. COVID-19 Activity, (July 5, 2020). https://

www.cdc.gov/ coronavirus/2019-ncov/coviddata/covidview/index.

html, (last visited July 5,

2020).

Oppel, R.A., et al., The Fullest Look Yet at the

Racial Inequity of the Coronavirus, N.Y. TIMES

(Jul. 5, 2020), https://www.nytimes.com/

interactive/2020/07/05/us/coronavirus-latinosafrican-americans-cdc-data.html.

William J. Hall , et al., Implicit Racial/Ethnic

Bias Among Health Care Professionals and Its

Influence on Health Care Outcomes: A Systematic

Review, 105 AM. J. PUBLIC HEALTH 2588 (Dec.

2015), https://www. ncbi.nlm.nih.gov/pmc/

articles/PMC4638275/#bib1.

85

Id. (observing that “Non-Hispanic American

Indian or Alaska Native persons have an ageadjusted

hospitalization rate approximately 5.7

times that of non-Hispanic White persons.”)

CDC Health Disparities and Inequalities Report

– United States, 2013, 62 MNWR (Supp. 3) 1,

1-187 (2013), https://www.cdc.gov/mmwr/

pdf/other/ su6203.pdf. Id. at 157-160.

The Heart Attack Gender Gap, U. EDINBURGH:

EDINBURGH FRIENDS (Oct. 29, 2019),

https://www.ed.ac.uk/edinburgh-friends/

supplements/the-heart-attack-gender-gap.

Deadly Delivery: The Maternal Health Crisis in

the USA, AMNESTY INT’L. (May 7, 2011),https://

www.amnestyusa.org/reports/deadly- deliverythe-maternal-health-care-crisis-in-the-usa/.

Agency For Healthcare Res. And Quality, U.S.

Dep’t Of Health And Human Serv., Pub No. 14-

0006, National Healthcare Disparities Rep.

(2013).

FitzGerald C, Hurst S. (2017). Implicit bias in

healthcare professionals: a systematic review.

BMC Med Ethics. 2017 Mar 1;18(1):19. doi:

10.1186/s12910- 017-0179-8. PMID: 28249596;

PMCID: PMC5333436.


Jefferson, T. (1776). The Declaration of

Independence, preamble. Retrieved from

https://etc.usf.edu/ lit2go/133/historicamerican-documents/4957/the-

declaration-ofindependence/

American Nurses Association. Mission Statement.

https://www.nursingworld.org/ana/about-ana/

Probst, J. C., Zahnd, W. E., Hung, P., Eberth, J.

M., Crouch, E. L., & Merrell, M. A. (2020). Rural-

Urban Mortality Disparities: Variations Across

Causes of Death and Race/Ethnicity, 2013–2017.

American Journal of Public Health, 110(9),

1325– 1327. https://doi-org.proxy.lib.umich.

edu/10.2105/ AJPH.2020.305703

Office of Disease Prevention and Health

Promotion (ODPHP). (internet accessed

11/02/2020). Disparities. Healthy People 2020.

U.S. Department of Health and Human Services:

Washington, DC. https://www.healthypeople.

gov/2020/about/foundation-health- measures/

Disparities#6

86


POSITION STATEMENT

SAFE NURSE STAFFING TO IMPROVE QUALITY OF CARE

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.

87

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.

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


88

(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, hospital-acquired 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.

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 nursesensitive

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.


89

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 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 nursing-sensitive outcomes pre-and postregulation.

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

90


POSITION STATEMENT

ENHANCED NURSE LICENSURE COMPACT

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.)

91

• 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.

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

92


POSITION STATEMENT

“NURSE” TITLE PROTECTION

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

93

References

1. Michigan Public Health Institute. Michigan

Annual Nurse Survey Project. Okemos,

Michigan June 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-keephealthy-lead-honestethicalprofession.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

www.ana-michigan.org

nurse@ana-michigan.org

(517) 325-5306

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Since this year, ANA-Michigan couldn't celebrate the 2020 award winners in person, we wanted to

take the opportunity to recognize them during Nurses Month, and even more fitting, Recognition

Week.

Please be sure to click on each award winner’s link to learn more about them or see included award

winner spotlights.

Dorthea Milbrandt Nurse Leader Award

Kathy Stutzman, MSN, RN-BC, CCRN-K

The Dorothea Milbrandt Nurse Leader Award has been created to honor nurses

who have demonstrated excellence in building successful mentoring relationships

with other nurses and/or nursing students. This award is presented on behalf of

the late Dorothea Milbrandt, RN, MPS, MSN, who had an important and lasting

impact on nursing in Michigan for nearly 40 years.

View Kathy's Spotlight

Lifetime Achievement Award

Sally Decker, PhD, RN, CNE, CHSE

The Lifetime Achievement Award recognizes an individual’s profound impact and

longstanding commitment to nursing.

View Sally's Spotlight

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Public Policy Advocate Award

Lynne Harris, MSN, RN

The Public Policy Advocate Award accords a nurse who has demonstrated success

in using public policy and advocacy as strategies in advancing nursing in Michigan.

View Lynne's Spotlight

Friend of Nursing Award

Representative Mary Whiteford

The Friend of Nursing Award is conferred on a non-nurse who has rendered

valuable assistance to the nursing profession. Their contributions and assistance

are of statewide significance to nursing.

Future Nurse Leader Award

Cierra Scott, BSN, RN

The Future Nurse Leader Award is given yearly to a recent (within two years of

graduation) nursing school (AD, BSN, Diploma) graduate who demonstrates great

potential for leadership in the profession. The candidate for this award must

be nominated by a dean and/or faculty member and must indicate his or her

intention to reside in Michigan for the next year.

View Cierra's Spotlight

Exceptional Promise Award

Myesha Hollins, CCHT, SN

Exceptional Promise Award aims to spotlight aspiring nursing students for their

skills today and promise for tomorrow.

ANA-Michigan will recognize distinguished nursing students who exemplify

leadership and achievement in their community and their scholarly efforts. The

purpose is intended to celebrate and encourage exemplar dedication to the

nursing profession.

View Myesha's Spotlight

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Marissa Loud, MSN, RN, RNC-NIC






nursing profession.

View Marissa's Spotlight


Dominique Mones, SN






nursing profession.

View Dominique's Spotlight


Shantiniqua Collins, BS, SN






nursing profession.

View Shantiniqua's Spotlight

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Hyder Mirza, BSN, RN






nursing profession.

View Hyder's Spotlight


Lesley Telfor, BSN, RN






nursing profession.

View Lesley's Spotlight

Innovation Award

Henry Ford Health System

Innovation: Human Trafficking Screen Tool

Created by: Danielle Bastien

Innovation Award will identify a health system or individual hospital for an

innovative practice/ approach which improves nursing and patient outcomes.

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ANA-Michigan - 2020 Annual Book of Reports

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