American Nurses Association 2010 House of Delegates:

Championing Nursing in Texas

by

Jeff Watson, BSN, RN-BC, NE-BC

Texas Delegate

Introduction

In mid-June, 2010, over 600 Registered Nurses (RNs), gathered in the capital of the United States as the American Nurses Association (ANA) House of Delegates (HOD) began the work of the profession.  The group of RNs, elected by peers, engaged in a dynamic exchange of ideas, ultimately sharpening the focus and direction of the organization.  Delegates were charged to consider the emerging landscape of healthcare as professional representatives making decisions to benefit ANA and nursing as a whole.  Before the HOD were a variety of concerns.  This paper briefly discusses the background of the ANA and the Texas Nurses Association (TNA).  A concise review of Nursing's Social Policy Statement is included.   The discourse concludes with a review of how selected decisions of the 2010 ANA HOD influence the TNA and provide support for all RNs practicing in the West Texas region.

Background

The ANA is a unique full-service professional organization representing the professional interests of the nation's 3.1 million RNs through state constituent member associations (CMAs) and multiple organization affiliates.  The ANA moves the nursing profession ahead through promoting superior standards of nursing practice, supporting the rights of nurses in the workplace, projecting an encouraging and pragmatic view of nursing, and lobbying the Congress on health care matters affecting nurses and the general public (ANA, 2010).

The TNA is a state constituent member association of the ANA.  The TNA was originally founded in 1907 as the Texas Graduate Nurses' Association (TNA, 2010).  Members of the TNA believe nurses are the best advocates for the profession in all practice environments.  The TNA has been at the forefront of national nursing, most recently with the development of a state program now known as Pathways to Excellence, administered through the American Nurses Credentialing Center.  Since January 2008, 36 hospitals have received the Pathway to Excellence designation, with only two of those hospitals being outside of Texas (ANCC, 2010).

Nursing's Social Policy Statement

The profession of nursing has been characterized as the crucial health care profession (ANA, 2010).  Nurses are highly esteemed for the knowledge, skill, and care delivered in the ongoing battle to improve the overall wellbeing of the American public.  Nursing, as a profession, has a single scope of practice embodied in the variety of activities of practicing RNs (ANA, 2010).

Nursing also has a social contract with American society.  The contract applies to the work of the professional nurse in the context of individual, family, group, community, or population settings (ANA, 2010).  The elements of the social contract are:

• Humans manifest an essential unity of mind, body, and spirit.
• Human experience is contextually and culturally defined.
• Health and illness are human experiences. The presence of illness does not preclude health, nor does optimal health preclude illness.
• The relationship between the nurse and patient occurs within the context of the values and belief of the patient and nurse.
• Public policy and the healthcare delivery system influence the health and wellbeing of society and professional nursing.
• Individual responsibility and inter-professional involvement are essential (ANA, 2010).

Nursing's Social Policy Statement is a foundational publication of the ANA,

helping to conceptualize the framework of nursing.  The Social Policy Statement also informs and provides direction to nursing researchers, educators, and administrators (ANA, 2010).

Bylaws Amendments

Bylaws are rules and regulations governing the operation of an organization (Merriam-Webster, 2010).  The Nurses Associated Alumnae of the United States and Canada, forerunner of the ANA, first established and approved bylaws in 1897 (ANA Bylaws, 2008).  Amendments to the bylaws occurred throughout the years, as the changes occurred in the socio-political landscape of America.  The following is a brief discussion of two ANA HOD 2010 bylaw amendments with national, state, and local implications.

Unifying language. In December 2007, the ANA notified its two Affiliate Organizational Members, the United American Nurses (UAN) and the Center for American Nurses (Center) of intent to disaffiliate.  The UAN was the official collective bargaining wing of the ANA to support nurses in unionized organizations.  The Center was the opposing wing of workforce advocacy to support those nurses from right-to-work states who are not members of collective bargaining units or unions.  Today, both entities continue to exist as advocacy options for nurses without a direct link to the ANA.  Leadership of the ANA argued each state nursing association would be better positioned to determine appropriate advocacy avenues for RN members (Patton & Sterle, 2007).  On July 1, 2008, disaffiliation was finalized.

Owing to the disaffiliation with the UAN and the Center, language revisions were necessary for accuracy of the ANA bylaws.  Previous bylaw language ensured the advocacy programs of collective bargaining and workplace advocacy.  The new language of the bylaws is as follows:  "Support of CMAs' right to engage in collective bargaining and workforce advocacy for nurses" (ANA HOD, 2010).

The TNA holds affiliation with the Center, as Texas is a right to work state.  Right to work laws allow employees the right of determination of joining and/or supporting unions (National Right to Work, 2010).  Union activity has been occurring in Texas, with the organization of hospitals in Houston, El Paso, Corpus Christi, Brownsville, and McAllen (NNOC, 2010).  Texas has the third highest number of RNs in the country behind California and New York, states where RNs are largely organized and represented by a nursing union (NNOC, 2010).  Nurses are not required to join a union to work in Texas.  The Center offers a website replete with resources for clinical nurses, nurse leaders and nurse educators to assist in gaining necessary skills for self-advocacy (Center for American Nurses, 2010).

Pilot programs.  The unstable economic environment has influenced declining membership in ANA, making financial viability a permanent concern of both the ANA and TNA.  With the intent of increasing membership, the ANA Bylaws Committee requested a bylaws change allowing ANA leadership to explore and trial new membership options.  Specialty nursing organizations compete for organizational membership dollars of the rank and file.  Many nurses, unfortunately, do not fully comprehend the single nursing organization protecting the practice of the RN is the ANA, not specialty organizations.  Seeking non-traditional membership options, with the agreement of CMAs, is necessary to ensure ANA is the one true representative voice of nurses everywhere, particularly in West Texas.  The HOD approved the following bylaw language:

For the purpose of retaining and/or increasing membership and on a pilot basis, the Board of Directors may establish membership categories, dues rates and payment options that may differ with HOD policies and bylaws.  Such pilot programs with the written agreements of involved CMAs shall not exceed the longer of two years or until the conclusion of the next scheduled House of Delegates after the completion of a pilot (ANA HOD, 2010).

Reference Hearings

Resolutions are acts of determination (Merriam-Webster, 2010).  Changes in the world and nation prevail upon the ANA to adapt, requiring membership to determine a path for the profession.  Four significant resolutions, all affirmed by the delegates at the 2010 HOD are discussed, including implications for the nurses of West Texas.

Health literacy. Health literacy is defined as the capacity to obtain and functionally utilize health information (Mancuso, 2008).  Poor health literacy is responsible for an annual financial burden of $73 billion in America (Committee on Health Literacy, 2004).  To realize the best health outcomes, significant comprehension of health and wellness teaching is imperative.  Nurses must be able to structure education to maximize understanding (Boswell, Cannon, Aung, & Eldrige, 2004).

Patient education is now viewed in a broader model of health awareness and promotion, leaving behind the days of illness-related instructions (Roter, Satashefsky-Margalit, & Rudd, 2001).  In any environment or practice setting, patient teaching yields positive outcomes if the patient grasps the healthcare information offered (Sorrell, 2006).  As an example, Rudd (2007) reports the process of taking medication involves the expected adult tasks of reading, time differentiation, planning, and scheduling.  Therefore, health literacy relates not only to health information but to a variety of assumed mundane tasks necessary for the implementation of health-related activities.

In patient teaching, West Texas nurses face the major obstacles of education, language, transient worker lifestyle, economics, and time.  Nurses understand healthcare knowledge is necessary for life.  The frustration in practice lies in knowing the information needing to be shared and failing in efforts to accomplish the goal.  There is no blame to place.  The ANA HOD affirmed the healthcare literacy resolution to promote and support nursing initiatives and research aimed at improving health literacy in the United States and across the world.

Healthcare for undocumented immigrants. Since 1970, there has been a steady influx of documented and undocumented immigrants into the United States (Derose, Escarce, & Lurie, 2007).  Undocumented immigrants have greater challenges in accessing healthcare than documented immigrants secondary to language and cultural barriers (Urrutia-Rojas, Marshall, Trevino, Lurie, & Minguia-Bayona, 2006).

Most immigrants arrive in the United States looking for work.  The health status of this population is good upon arrival, particularly since the immigrants are younger.  As undocumented immigrants age and face constant cultural barriers, access to healthcare is difficult, thus the vulnerability of this population increases.  A 2006 study in North Texas demonstrated access to care as a fundamental requirement to improvement of healthcare outcomes (Urrutia-Rojas, et.al., 2006).

The ANA Code of Ethics guides nurses in practice.  The question of equal access is addressed clearly in the Code of Ethics, supporting the rights and well being of all human beings regardless of socio-economic status or personal attributes (ANA, 2005).  In West Texas, undocumented immigrants have become a part of the routine practice in the delivery of nursing care in all organizations.  Managing the increasing population has placed an additional burden on the already taxed local healthcare system.  The HOD affirmed the ANA position of equal access to care and education of nursing regarding the long-term and wide-ranging impact of essential healthcare services.

Mentoring programs for novice nurses. A resolution was presented to support mentoring programs aimed at new nursing graduates who are leaving the nursing profession within the first one or two years of employment.  Reasons cited in literature for turnover include:  staffing, workload, patient acuity, poor leadership support, and environments promoting unsafe care (American Association of Colleges of Nursing, 2009).  In 2000, a 28% increase in the number of RNs not employed in nursing was reported by the United States Department of Health and Human Services (Granger, 2006).

A 2005 study of novice nurses in Nevada indicated a 30 percent attrition rate in the first year and 57 percent the second year due to transition realities (Bowles & Candela, 2005).  Erickson and Grove (2007) found younger nurses experienced much higher stress levels, agitation, and burnout in practice.  Evidence in both studies linked mentorship with experienced nurses as a best practice for meeting the emotional weight of the transition into professional nursing practice.

While preceptor programs focus mainly on socialization to an organization, mentoring programs have been identified through research as a strong method for reducing costly turnover through relationship-building with experienced nurses within the organization (Wagner & Seymour, 2007).  Mentoring programs have also been identified with improving role transition, reducing stress, increasing nurse satisfaction, and overall improvement of the work environment (Bally, 2007).  Mills and Mullins (2008) reported increased retention and positive effects for mentors and protégés in a 3-year study of a structured mentoring project in California.

West Texas is fortunate to have a wide variety of RN educational opportunities with baccalaureate nursing programs found in Canyon, Lubbock, and San Angelo.  Associate degree nursing schools are located in Amarillo, Levelland, Midland and Odessa.  A single diploma program remains in Lubbock.  The rich educational opportunities in West Texas set the stage for a robust nursing workforce.  However, many novice nurses have left the area and profession secondary to similar challenges faced by new nurses across the country.  In response, many West Texas healthcare organizations have begun to establish mentoring programs in an effort to support the novice nurse in the transition to professional practice.

Social networking and the nurse. There is very little research regarding the new phenomena of social networking and its role in nursing practice.  The ANA HOD, in an effort to begin the dialogue, brought forth an informational resolution.  An informational resolution does not require the ANA HOD to take action, however, it does indicate action will be considered in the future as nursing research evolves and demands attention.

The nature of social networking is new to most everyone.  Nurses need to understand the potential reach of social networking sites such as Facebook®, MySpace®, and Twitter®.  Although social networking sites have positive benefits in the realm of mutual support and knowledge sharing, there are negative effects as well.  Some negative aspects include:  loss of privacy, legal liability, and loss of professionalism (Frohna, McGregor, & Spector, 2009).

The ANA Code of Ethics outlines ethical responsibilities of nurses in practice relating to social networking (ANA 2005).   Crossing over through personal and professional boundaries can represent a conflict of interest for the nurse.  Nurses have accountability for individual actions, professionally and personally.  Nurses have the responsibility to behave consistent with personal and professional values to protect the integrity of self and profession.

The HOD supported this informational resolution.  Social networking remains unfamiliar territory for the ANA.  Research is needed to guide and inform policies and practices in the utilization of social networking on the national stage as well as at the local level.

Conclusion

It is clear the ANA is tackling the very issues nurses in West Texas deem important.  With the strengthening of national union activity, nurses in Texas want options to best advocate for colleagues and patients within individual organizations.  Nurses wish to be armed with accurate information on advocacy programs.  The ANA has also taken on other local concerns of health literacy and care of undocumented immigrants.  Experienced nurses, novice nurses, nurse administrators, and healthcare organizations will be the recipients of the ANA resolve to develop mentoring programs, fostering and growing a stable and compassionate workforce.  The ANA is looking ahead to the potential threat social networking poses to nursing professionalism.

The ANA is an organization of professional nurses for professional nurses.  The ANA is a unique collective of voices echoing concerns from a variety of perspectives from all across the country, yet with a unified theme.  The ANA is and always has been the collective voice of nursing in the America.  Standing strong, the ANA continues to fight for and champion the practice of RNs in Texas and across the country.  The ultimate benefactors of the work of the ANA are the patients for who nurses care.

References

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