ANA-Michigan - 2020 Annual Book of Reports
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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
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Printed and published for ANA-Michigan by:
Arthur L. Davis Publishing Agency
P.O. Box 216 | Cedar Falls, Iowa 50613
(319) 277-2414
2020 ANNUAL BOOK OF REPORTS
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2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
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2020 ANNUAL BOOK OF REPORTS
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2020 ANNUAL BOOK OF REPORTS
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2020 ANNUAL BOOK OF REPORTS
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....”
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• 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....”
2020 ANNUAL BOOK OF REPORTS
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
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Interrupt
Speaker
2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
• 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.
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2020 ANNUAL BOOK OF REPORTS
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
ANA-Michigan:
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
ANA-Michigan:
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
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o
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2020 ANNUAL BOOK OF REPORTS
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
ANA-Michigan:
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
ANA-Michigan:
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.
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2020 ANNUAL BOOK OF REPORTS
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.
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2020 ANNUAL BOOK OF REPORTS
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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.
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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
Committee Duties & Assignments
• 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
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:
• Margaret Calarco, PhD, RN, NEA-BC
• Katherine Dontje, PhD, FNP-BC, FAANP
• Marge Freundl, MSN
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:
• 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
Committee Duties & Assignments
• 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
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:
• April Liberty, BSN, RN
• Nancy Martin, DNP, RN
• Mihaela Reed, MSN
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:
• Ruth Duffy, BSN
• Gerardo Infante, BSN, RN
• Patrick Joswick, DNP, AGNP-C, RN
Chair: Suzanne Keep, PhD, RN
Nikeyia Davis, MBA-HCM, BSN, RN, CNN
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)
Nikeyia Davis, MBA-HCM, BSN, RN, CNN
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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2020 ANNUAL BOOK OF REPORTS
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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2020 ANNUAL BOOK OF REPORTS
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.
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2020 ANNUAL BOOK OF REPORTS
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.
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2020 ANNUAL BOOK OF REPORTS
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.
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2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
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.
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2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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.
2020 ANNUAL BOOK OF REPORTS
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
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2020 ANNUAL BOOK OF REPORTS
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.
81
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.
2020 ANNUAL BOOK OF REPORTS
• 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/
2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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.
2020 ANNUAL BOOK OF REPORTS
• 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.
2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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.
2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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
2020 ANNUAL BOOK OF REPORTS
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.
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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
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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
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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.
2020 ANNUAL BOOK OF REPORTS
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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Exceptional Promise Award
Marissa Loud, MSN, RN, RNC-NIC
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 Marissa's Spotlight
Exceptional Promise Award
Dominique Mones, 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 Dominique's Spotlight
Exceptional Promise Award
Shantiniqua Collins, BS, 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 Shantiniqua's Spotlight
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Exceptional Promise Award
Hyder Mirza, BSN, RN
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 Hyder's Spotlight
Exceptional Promise Award
Lesley Telfor, BSN, RN
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 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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