2002 AJN Table of Contents
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Issues Update
American Journal of Nursing -
September, 2002 - Volume 102, Issue 9
Empowering Nurses
The ANA and its constituent member associations (CMAs) want registered nurses nationwide to feel professionally satisfied instead of frustrated, and empowered instead of powerless. They have been developing, strengthening, and promoting workplace advocacy (WPA) strategies they hope will make a difference in nurses' professional lives. Although the ANA and its CMAs have always had strong (WPA) programs in place, national and state nursing leaders believed there was a real need to step up efforts to address a health care system in which staffing is short, mandatory overtime is common, and budgets are tight.
THE NATIONAL SCENE
A driving force behind new national efforts is the nine-member Commission on Workplace Advocacy (CWPA) created by the ANA House of Delegates in June 2000. Strategies that fall under the WPA umbrella include legislative activities, member educational campaigns, conflict resolution, leadership development, and health and safety initiatives. Betsey Snow, MPH, RN, director of the ANA’s WPA department, also describes workplace advocacy as a philosophy. “Our goal is to empower nurses so they can go to the table with administrators and be skilled at negotiating their positions, knowledgeable about the issues, and competent at implementing changes,” Snow said. “We believe nurses have the power to work with hospital leadership to make their work environment better. And we believe the relationship between nurses and administrators should be based on collaboration and cooperation.”
One major CWPA project involves the production and dissemination of a series of materials to CMAs to help them strengthen their WPA programs. The first volume in the series is a User’s Guide, released earlier this year, that includes the history of the CWPA and its functions. The second volume released, Empowerment Through Knowledge, is a compilation of materials covering federal law and regulations, state law, the ANA’s Code of Ethics for Nurses, and nurses’ rights and responsibilities.
Two other volumes, slated to be released by the end of the year, will focus on conflict resolution and protections such as health care standards.
Another major CWPA project, still in its initial phase, addresses the needs of the “mature, experienced nurse” in the workplace. The CWPA recently surveyed this RN population at the ANA’s June convention.
A SAMPLING OF STATE INITIATIVES
The Texas Nurses Association (TNA) is in the midst of conducting its biennial nurse satisfaction survey. In the last survey, nurses reported that their primary concern was staffing. Nurses believed that not only were there not enough nurses to staff units, but also that health care facilities had no systems in place to ensure adequate staffing levels, according to Clair Jordan, MSN, RN, executive director of the TNA and the CWPA chairperson.
Texas nurses’ other chief concerns included their lack of ability to resolve conflicts with managers over patient care issues, difficult relationships with physicians, and frustration with the amount of time spent on paperwork.
To tackle any professional issue, WPA leaders use a two-pronged approach, Jordan said. First, they identify which changes are needed to address RNs’ concerns adequately. Then they must determine which strategies will most effectively bring about those changes.
For example, when the TNA survey revealed nurses’ concerns about staffing, its leadership immediately convened a work group that included staff nurses, nurse managers, and hospital administrators to look at the issues from all sides.
“The group started with an exploration of how nurses and managers could arrive at a win-win solution,” Jordan said. The TNA ultimately pursued and won changes in hospital licensing regulations that incorporate key aspects of the ANA’s Principles for Nurse Staffing.
As of this month, Texas hospitals are required to have a committee in place to address staffing issues. (A third of its members must be staff nurses.) Hospitals also must collect data on at least one of the ANA’s quality indicators, which link increased RN staffing levels with decreased patient complications, and on workplace injuries and patient satisfaction as they relate to staffing levels. And nurses cannot be required to work overtime except in clearly defined emergencies.
The Arkansas Nurses Association (ArNA) leaders held 12 town hall meetings throughout the state over the past 18 months to hear what RNs had to say about their profession.
“What we heard is that nurses are frustrated not only about their work environment, but also about the image of nursing,” said David Eubanks, MSN, RN, chief executive officer of the ArNA. It also became clear that many nurses are unfamiliar with protections offered in their states’ nurse practice acts and other workplace rights resources, he said.
To help nurses become better informed, the ArNA and the Arkansas State Board of Nursing (ASBN) offer joint educational programs on the nurse practice act, particularly the strong protections it offers regarding patient abandonment and delegation. The ArNA also printed the ASBN’s decision-making tree on delegation in Nurses’ Quick Reference to Workplace Issues, distributed to nurse members.
One of the nurses presenting on delegation at the joint ArNA–state board meetings was Deborah Jones, MNSc, RN, assistant director of nursing practice at the ASBN. In her role as chairperson of the ArNA’s WPA Task Force, she talks with staff nurses about what WPA is and how it can help them protect their licenses and improve their workplaces.
“Traditionally, staff nurses in Arkansas did whatever their nurse managers told them to do,” Jones said. “Workplace advocacy programs give staff nurses the information and the skills they need to talk with their employers. They can sit down with their managers and explain why a certain practice is a patient safety issue and what implications it can have for their license.”
Additionally, the ArNA has been instrumental in securing nurses appointments to legislative and other policymaking work groups so that RNs can be heard on issues that affect patient care and the profession. And the ArNA is scheduled to introduce a new prepaid plan that will give members access to legal services for a low monthly fee.
MORE EFFORTS
While the Georgia Nurses Association (GNA) has been using WPA strategies for 95 years, it wasn’t until this past year that the GNA formally launched its own Commission on Workplace Advocacy.
“We felt we needed to change the structure to become more focused and organized in our approach to responding to the increasingly urgent calls we were getting from nurses about their work environment,” said GNA president Debbie Hatmaker, PhD, RN.
Many of the questions that the GNA has been receiving concern staffing issues, such as employers implementing inflexible work hours and mandatory overtime—a practice previously unheard of in Georgia and one that the GNA wants to curtail.
One way the GNA is trying to respond quickly to nurses’ requests for information about their workplace rights is through a frequently asked questions (FAQs) section on its Web site. (Nurse leaders take calls from nurses about a variety of issues.)
The GNA also held a charge nurse workshop to discuss staffing solutions that don’t overtax bedside nurses.
Extending the GNA’s reach, Hatmaker represents the association on a state Health Care Workforce Policy Advisory Committee, which recently held four forums on work environment, employee retention, and satisfaction in the workplace. Participants shared “best practices,” or practical solutions, that promote good working environments.
Much of the Colorado Nurses Association’s (CNA’s) efforts focus on nurse empowerment and conflict resolution.
For the past few years, the CNA has been offering a workplace consultation service that allows nurses to call for information that helps them address their problems. For example, trained advocates offer advice on communicating effectively with administrators, discuss existing regulations and standards that can help RNs improve their workplaces, and answer questions about navigating board and hospital discipline processes, said CNA executive director Paula Stearns, MSN, RN.
The CNA also held a series of workshops on nurses’ legal rights and conflict resolution, a WPA strategy gaining popularity.
Nurses know what works when resolving conflicts with their patients; yet they often lack assertiveness in settling disputes with their peers or managers, said Vicki Carroll, MSN, RN, a member of the CNA and the CWPA. The process of conflict resolution affords nurses a way to address workplace issues that is better than complaining to each other. CNA advocates help RNs develop the skills needed to state a case clearly, without undue emotion, and to feel confident in their right to express concerns and issues, Stearns said.
The TNA also recently entered into partnership with the Texas Hospital Association and Chorda Conflict Management, Inc. for the purpose of developing a strong conflict resolution program that empowers nurses at all levels in addressing workplace issues.
For more information on WPA activities, go to www.NursingWorld.org and click on “Workplace Advocacy.”
Susan Trossman is the senior reporter for the American Nurse at the ANA.
The ANA promotes workplace advocacy strategies that work.
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