Barbara Blakeney, MS, APRN,BC, ANP
President
American Nurses Association
Constituent Assembly Address
November 8, 2002

Good morning. On behalf of the ANA Board of Directors, -- most of whom are here today -- I extend greetings to Constituent Assembly Chair Liz Dietz, the Constituent Assembly Executive Committee, members of the Constituent Assembly, Commission on Workplace Advocacy Chair Clair Jordan, United American Nurses President Cheryl Johnson and guests.

I am proud and honored to serve as your president. This is a challenging time for nursing, our country and the world. We live in a world that is indeed changed since September 11, 2001. We live with the threat of terrorist attacks, war, and random acts of violence. As soon as we breathed a sigh of relief that the snipers terrorizing the Washington metropolitan area had been apprehended, we learned about a terrorist threat to rail travel. Soon thereafter, we heard of the deadly shootings at the University of Arizona School of Nursing in Tucson. As you know, three nursing instructors, Cheryl McGaffic, Barbara Monroe, and Robin Rogers, were killed. To our friends and colleagues from Arizona, we extend our sympathy and our support. Our world has changed. There is no doubt about it.

As we cope with the new reality, we see a renewed interest in nursing's unique contributions to health care and society. As the country focuses on disaster preparedness, the implications of a growing shortage of nurses take on new meaning. Furthermore, in the past several months, we have witnessed a new sense of urgency -- from a variety of stakeholders -- in understanding and addressing the root causes of the growing shortage of nurses.

I am pleased to see that the Constituent Assembly Executive Committee has developed a full agenda reflecting many of the critical issues before the profession. Clearly, these are issues that are of universal interest to our members. In addition to these pressing issues, ANA is actively representing the interests of the profession in myriad ways. ANA CEO Linda Stierle will share a more detailed update about ANA's practice, policy and governmental affairs initiatives in her presentation. I'm sure you will be pleased to learn of the significant work underway to advance ANA's agenda.

I have been inspired as I have traveled this fall to CMA conventions and other nursing meetings. I have heard firsthand from nurses taking the lead on critical nursing issues and key public health issues such as disaster preparedness.

Perhaps the most pressing issue is the crisis in nurse staffing and the growing shortage of nurses, something the ANA has long been sounding the alarm about to policy-makers, the media and the general public. I want you to know that ANA delivers the same message in every forum. That message is: that while we laud and encourage recruitment efforts - they will ultimately fail unless we focus attention - and resources - on retention of nurses. And in order to improve retention - working conditions must improve. Nurses MUST be recognized and respected for their professional expertise. We MUST receive better compensation and benefits. Time and time again, ANA has stood up and said "no more" to barriers that prevent nurses from providing excellent care. And finally, in order for retention efforts to be successful, employers must change their thinking about nurses - they must understand that we are an asset, not an expense. They must understand that our skills and experience make the critical difference in achieving quality patient outcomes and that without nurses - their institutions are merely buildings full of empty beds!

This message was bolstered by new, dramatic research published in the Journal of the American Medical Association on October 23. JAMA published a new study by Pennsylvania State Nurses Association members Linda Aiken and Julie Sochalski and their colleagues from the School of Nursing at the University of Pennsylvania. The study of more than 10 thousand registered nurses and 230 thousand surgical patients found a 7 percent increase in mortality for every patient added to a nurse's workload. By the time that workload reached eight patients - the rate had increased to 31 percent. Each patient added to a nurse's workload - beyond four -- also substantially increased nurse burnout and job dissatisfaction.

While no one in this room is surprised by these findings, this latest study added to the body of research on this critical issue plus it captured the attention of the media and the public - as it should. I hope many of you saw the New York Times editorial that ran on October 25 titled, "Dying for Lack of Nurses." It highlighted the study, was supportive of nursing and closed with a real sense of urgency. I quote: "If the medical establishment can't find some way to make the profession more attractive, the exodus may turn into a stampede." While nursing can't do it alone, ANA is clearly focused on answering that call.

And the good news is that due to ANA's hard work and persistence, these issues are receiving wider public recognition - and action. On August 1st, I joined President Bush in the Oval Office for the signing of the Nurse Reinvestment Act - legislation that was dormant until ANA exerted pressure through N-STAT- its formidable grassroots network -- to get Congress to take action. While our work won't be completed until we get Congress to appropriate the needed funding to make this act meaningful, I have no doubt that the ANA enterprise has the political clout to make this a reality. While we are sorting out the impact of the outcome of this week's elections and what the next steps will be in the appropriations process, I am pleased to report that ANA-PAC posted an impressive 84% win rate. And we are gaining important support among influential voices outside of Congress. I hope many of you saw the recent newspaper column by Steve and Cokie Roberts urging Congress to take action and fund the Nurse Reinvestment Act. We are being heard and we are winning new allies each day.

On August 13, I represented nursing at a special economic forum in Waco, Texas, on health care security called by President Bush and chaired by Health and Human Services Secretary Tommy Thompson. Since that meeting, I've met one-on-one with Secretary Thompson and we held a press conference together about the HHS-ANA partnership to create National Nurses Response Teams.

In September, I delivered testimony - along with UAN Secretary-Treasurer Jeanne Surdo and American Academy of Nursing Secretary Linda Burnes Bolton - to the Institute of Medicine's Committee on Work Environment and Patient Safety. On October 17, I spoke to congressional staffers about the nursing shortage at an event organized by the Alliance for Health Reform and webcast by the Kaiser Family Foundation.

And we are working hard at the international level, as well. Cheryl Johnson, Kathy Hall and I joined a number of nursing organizations from major industrialized nations at the International Council of Nurses Workforce Forum in Iceland in September.

I am proud to represent nursing at these forums. ANA receives countless invitations to be at the table to represent the profession and ANA's endorsement is actively sought by a variety of organizations to add credibility to their issues and programs.

What we must all understand is that the reason that ANA is invited to represent the profession is because ANA is the most diverse nursing organization. That diversity is our greatest strength -- and our greatest challenge.

It is also important to note that many of the initiatives underway and recommended in reports on the nursing shortage by a variety of organizations, affirm several recommendations that the nursing community calls for in its report, Nursing's Agenda for the Future, released in April 2002.

Nursing's Agenda for the Future was developed by more than 60 nursing organizations to address the complex, interrelated factors that have created the growing shortage of nurses. It sprang from the historic "Call to the Nursing Profession" summit in September of 2001. At the summit, participants collectively developed a plan to identify the profession's vision for the year 2010, as well as the key strategies needed to achieve that vision.

The Call to the Profession emerged from action at the 2001 House of Delegates, charging ANA to convene the profession to address this critical public health issue.

Nursing's Agenda for the Future has been widely circulated to nursing organizations and, to date, about 50 - including the Michigan, Missouri and Virginia Nurses Associations -- have submitted more than 200 action plans that will help accomplish our goals for nursing. I encourage all of you to become familiar with Nursing's Agenda, to use it as a blueprint to guide the work of your organization and to promote it at the forums you attend. Nursing's Agenda for the Future is an example of work that ANA is uniquely positioned to initiate and sustain.

As we gather together, it's important to acknowledge our accomplishments and to recognize what we have accomplished as the ANA enterprise. Working together, we experience a synergy that produces far greater accomplishments than working independently and in isolation. We are truly greater than the sum of our parts!! Through collaboration and more than a century of hard work, ANA has built a reputation as a leading international and national nursing organization. We are THE VOICE of nursing - a respected resource for legislators, regulators, health care leaders and the public. It is the partnership of ANA and the CMAs that presents nursing as a unified profession. It is ANA's diverse membership and its multi-purpose focus that makes us unique and powerful. We make a difference. There is no doubt about it.

One way in which unity in nursing works is at the state legislative level. No other nursing organization has the political influence that ANA constituent member nurses associations have in the state legislative arenas nor the structure that is provided by the presence of a nurses association at the state level.

For the past three years, ANA and the Constituent Member Association lobbyists have developed a nationwide state legislative and regulatory agenda focusing on issues related to nurse staffing. This powerful strategy is working - legislation is getting passed at the state level, and that is providing momentum for action at the federal level. In addition, other groups are emulating our strategy.

We make a difference through the Commission on Workplace Advocacy's work to address the challenges and opportunities for the mature/experienced nurse. In addition, the Commission is developing tools to empower nurses to address such universal workplace challenges as physician/nurse relationships and conflict resolution.

We make a difference through UAN's work to organize more nurses who seek collect bargaining representation and through UAN's partnership with the CMAs to negotiate innovative contracts that protect nurses, nursing practice and patient care. For example, UAN won its first new unit in July at the Denver VA, and its National VA Council is getting ready to negotiate a national contract for its members.

We make a difference through the Congress on Nursing Practice and Economics and its work on standards and position statements. For example, the Congress has just completed work on the Principles of Documentation, a companion to the Principles of Nurse Staffing and Nurses' Bill of Rights. These documents provide guidance to all nurses regardless of their role or setting.

We make a difference when the American Academy of Nursing launches initiatives to harness technology to support nurses and to improve workforce planning. The focus of their annual meeting last week was on the important issue of disparities in health care. We make a difference when the American Nurses Foundation supports nursing research through it research grants program. The Foundation is now at the center of the initiative to improve nurses' competence in geriatrics.

We make a difference when the American Nurses Credentialing Center's Magnet Recognition program gains increased recognition as a proven strategy to positively impact nurse recruitment and retention as well as patient outcomes. For example, if funded, the Nurse Reinvestment Act provides grants to encourage facilities to implement Magnet criteria. Reports on the nursing shortage issued by the American Hospital Association and the Joint Commission highlighted the value of the magnet program.

Why do we do all of this? Why do we care?

We care because it makes a difference. We do it to assure patient safety through quality nursing and other patient advocacy initiatives. ANA is on the cutting edge of patient outcomes research and demonstrating from a scientific perspective the value of registered nurses in patient care. This data, being collected through the ANA-funded National Database of Nursing Quality Indicators, is absolutely essential as nurses advocate for more appropriate staffing, against mandatory overtime, and it is data that will better articulate the economic value of nurses.

Furthermore, ANA is leading the way in preparing society to care for the growing number of elderly. We are working with the American Nurses Foundation and the American Nurses Credentialing Center to improve nurses' competence in geriatrics and we are partnering with the Administration on Aging to improve lay caregivers' skills in caring for family members. And, ANA continues to advocate for universal health care coverage. Nurses' Agenda for Health Care Reform continues to be relevant and we are working with the Robert Wood Johnson-funded Campaign to Cover the Uninsured at the state and national level to keep that vision alive.

While the profession is facing pressure points and seizing new opportunities, ANA is in the midst of long overdue and necessary organizational change. Two and half years ago, ANA's constituent members gave a mandate to the board of directors to change the association.

The message from the April 2000 Constituent Assembly was clear - the status quo was unacceptable. ANA needed to clarify its role, demonstrate relevance in the new millennium and grow in membership and financial strength.

Since that time, work related to the future vision of the association has absorbed an extraordinary amount of time, energy and resources of ANA's elected leaders, staff and members.

I think it's important to remind ourselves about ANA's overarching goal in moving bylaws changes forward. ANA's goal is: "To be the unifying force to advance quality health for all." As you can see, the goal is global and overarching. It is not confined to nursing or to health care. It is about ANA leading the quest for a healthy nation, a healthy world. It is big and audacious. It is nursing at its finest.

ANA works to define, refine and strengthen the infrastructure of nursing so that we all might some day practice nursing the way we know it is meant to be practiced. No profession survives without those who pay attention to the infrastructure issues.

Let me go further and say that ANA is the only Nursing Organization that addresses the whole of our profession. Our membership is diverse and we are all better for it. The debate and discussion in our Association is broad based because we are broad based. The credential that is needed to be a member of ANA is Registered Nurse, nothing more and nothing less. We are all equal in the house of ANA. We have different perspectives, different experiences and different cultures from region to region across the country. What we share in common is a deep and abiding love of and respect for nursing as it is meant to be practiced; a sincere determination to accomplish those changes that make a difference for our profession and our patients and a shared respect for our knowledge, skills and abilities. This is more than enough common ground upon which to build an agenda for the future.

Isn't it time we focused on our outcomes on behalf of the profession and not our differences within the ANA house?

I've just shared with you some important examples of how the ANA enterprise is working to ensure adequate health care for consumers and stronger protections for nurses. But we can't achieve our goals with fewer and fewer nurses choosing to join ANA and the CMAs. We need a strong, dedicated and robust membership to achieve the goals of the profession. That is why it is so important that we create an innovative, flexible organizational structure that allows us to connect with more nurses and reach our potential power as the largest of the health care professions.

For almost a year now, we've been focused on bylaws revisions - on the structure of the organization. It has consumed a large amount of time and energy of many people in this room.

I know that all of you have a strong interest in the future direction of the ANA and how it is structured under new bylaws. As constituent members of ANA, that is your right and your responsibility.

The ANA Board understands and shares the sense of urgency in completing this work. It is critical that we find a way to get to a place where we all can value and cherish the history -- but, more importantly -- the future of ANA, THE national nursing professional association. Only then will we be positioned to gain the consensus needed to achieve the two-thirds vote of the House of Delegates required to approve bylaws revisions. We are at a critical juncture in our process. We will address this in greater detail this afternoon.

However, it's important to remember that the initial charge from the April 2000 Constituent Assembly as well as the recommendations from the Futures Task Force were more global than "changing the structure." In striving to "reinvent" ourselves for the 21st century and beyond, the Futures Task Force identified the following keys to success:

A reputation for value
An enjoyable culture
A nimble infrastructure

So that is our challenge, and it is a challenge that I know in my heart we can meet - WE MUST MEET -- through leadership and unity of purpose. Together, we can and we will achieve our goal to "be the unifying force to advance quality health for all." There is no doubt about it.

Thank you

Related Links:

• CEO Stierle's Slide Presentation:
  PDF version

2002 press releases

Other past press releases:2001 | 2000 | 1999 | 1998 | 1997 | 1996

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