In the months since the survey's release, the ANA has intensified its advocacy, through the news media and on Capitol Hill, for improvements in nurses' working conditions. Advocacy on behalf of nurses and the profession also has resulted in a tangible tool-the Bill of Rights for Registered Nurses-to aid nurses in improving their workplaces and ensuring their ability to provide safe, quality patient care. The impetus for the Bill of Rights originated at the ANA's May 2000 Summit on Nurse Staffing in Washington, DC, at which more than 200 nurses identified the need for a document that would detail what nurses need and deserve in order to do the best for their patients.

"The ANA Bill of Rights is a powerful statement of the rights that every registered nurse must have to provide high-quality patient care in a safe work environment," stated ANA President Mary E. Foley, MS, RN.

The Bill of Rights for Registered Nurses clearly states that nurses have the right to a safe work environment, to practice in a manner that ensures the provision of safe care through adherence to professional standards and ethical practice, and to advocate freely on behalf of themselves and their patients. (See page 57 for the full text of the Bill of Rights for Registered Nurses.)

Judith Thompson, executive director of the South Carolina Nurses Association, sees this last right-advocacy of nurses themselves-as a primary right. "Nurses have not been taught to be their own advocates," she pointed out. "As a profession, we have done a miserable job in letting nurses know what their workplace rights are."

The code discusses conflicts of interest and personal boundaries and notes that there may be situations in which public health considerations override individual rights. According to the code, ethical principles such as justice, beneficence, and patient autonomy should dictate nursing practice, along with virtues such as honesty, compassion, courage, wisdom, confidentiality, and respect for privacy.

Thompson envisions the Bill of Rights as a teaching tool. "Not only will this help students to understand what they should expect in the workplace, but it will educate nurses already in practice about the bare-bones rights they should be experiencing in their workplaces," Thompson said.

Nurses should post the Bill of Rights on workplace bulletin boards and in communal areas. "On a practical level, this is a tangible reminder to employers of what nurses should be able to expect in their workplaces," Foley said. "But this also should serve as a morale boost when energies and enthusiasm are low, because these rights reinforce the professionalism of us all."

The Bill of Rights has already proven to be a morale boost to nurses in one very public forum: the 81-day nurses' strike at the Western Reserve System's Forum Health in Youngstown, Ohio, that ended in late July. According to Linda Warino, RN, who was on the Youngstown bargaining unit's negotiating team, after several weeks on the strike line, the nurses were worn down by attacks on their professionalism. "For many," Warino said, "the Bill of Rights supported them by personally reinforcing the professionalism they were demonstrating by advocating for their patients and themselves.

"The nurses were thrilled to see that the American Nurses Association-the professional association of nurses-publicly stated that nurses have the right to do whatever is necessary to advocate for their patients and to ensure a safe work environment," continued Warino, a director-at-large of United American Nurses (UAN), the ANA's labor arm. She noted that, in addition to issues of short staffing and mandatory overtime, the striking nurses were seeking fair compensation and protection of their benefits. "The Bill of Rights speaks directly to the issue of fair compensation, and the nurses at Youngstown were gratified to see that."

Warino said that nurses in collective bargaining settings should use the Bill of Rights to improve their workplaces by negotiating its provisions as part of the work agreement. She believes that having the Bill of Rights in the work contract makes it easier to ensure that issues such as inadequate staffing and mandatory overtime are addressed.

In settings where collective bargaining is not a strategy, nurses should work with their facility's recruitment and retention committee and policy-and-procedure-setting committee to ensure that the provisions of the Bill of Rights are incorporated into working documents of the facility. Thompson points out that the Bill of Rights and the newly revised Code of Ethics for Nurses are two of the biggest workplace advocacy tools available to nurses. "The Code of Ethics for Nurses outlines the commitment that the nurse is making to society, while the Bill of Rights lists the things that the nurse should be able to expect from society."

To ensure that the Bill of Rights would meet the needs of nurses in various practice settings, it was reviewed by the ANA's Commission on Workplace Advocacy, the UAN, and the ANA's Congress on Nursing Practice and Economics. It was subsequently reviewed and approved by the ANA Board of Directors and unveiled to tumultuous applause at the ANA's House of Delegates in June.

"This Bill of Rights is intended to empower nurses by making it clear what is absolutely non-negotiable in the workplace," Foley said. "The ANA and its constituent member associations will continue their longstanding work, through political and legislative activism, collective bargaining, workplace advocacy, and public education, to ensure that the basic tenets of this Bill of Rights are a reality for nurses across the country."

The ANA is developing a User's Guide and a poster for the Bill of Rights for Registered Nurses, slated to be available for purchase late this year from American Nurses Publishing at www.NursesBooks.org.

The American Nurses Association's

Bill of Rights for Registered Nurses

Registered nurses promote and restore health, prevent illness, and protect the people entrusted to their care. They work to alleviate the suffering experienced by individuals, families, groups, and communities. In so doing, nurses provide services that maintain respect for human dignity and embrace the uniqueness of each patient and the nature of his or her health problems, without restriction in regard to social or economic status. To maximize the contributions nurses make to society, it is necessary to protect the dignity and autonomy of nurses in the workplace. To that end, the following rights must be afforded:

1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice.
3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses and its interpretive statements.
4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.
5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities.
6. Nurses have the right to a work environment that is safe for themselves and their patients
7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.

Disclaimer:The American Nurses Association (ANA) is a national professional association. ANA policies reflect the thinking of the nursing profession on various issues and should be reviewed in conjunction with state association policies and state board of nursing policies and practices. State law, rules, and regulations govern the practice of nursing. The ANA's "Bill of Rights for Registered Nurses" contains policy statements and does not necessarily reflect rights embodied in state and federal law. ANA policies may be used by the state to interpret or provide guidance on the profession's position on nursing.

Adopted by the ANA Board of Directors: June 26, 2001

Rebecca Wiseman is a senior specialist, workplace advocacy, at the American Nurses Association.

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