Monday August 20th 2018

Nurses address staffing and other professional issues at ANA’s national meeting

Nurses address issues at ANA’s House of Delegates meeting in June. Photo: Eddie Arrossi

Appropriate staffing continues to be a crucial issue for RNs working in acute care and other settings, inducing nurses participating in the American Nurses Association House of Delegates (HOD) to approve a strong, comprehensive resolution on this ongoing practice, workplace, and patient safety concern.

Originally introduced by the Ohio Nurses Association (ONA), some 450 delegates attending the Washington, DC-area meeting adopted a resolution June 16 that calls for ANA to champion an enforceable, nurse-led staffing process that includes staffing principles, minimum nurse-to-patient ratios, collection of nursing-sensitive data, and penalties associated with facilities’ non-compliance.

In bringing forward the resolution, ONA noted in an action report that adequate nurse staffing continues to be a pivotal issue for nurses in acute care settings — with decreased levels of staffing leading to nurse turnover and burnout, as well as errors related to fatigue, stress, and frequent interruptions.

ONA also pointed to some statistics that illustrate the need to boost advocacy around staffing issues. Only one third of states have adopted staffing processes that allow for nurse input or are reinforced by statutory penalties. Fourteen states and the District of Columbia have some type of staffing language on the books, with seven of those states having language based on nurse staffing principles developed by ANA. Further, very few states require hospitals to incorporate patient outcomes in a staffing plan or evaluate staffing levels as a factor when analyzing adverse events.

At the HOD, some nurse delegates spoke to the challenges that nurses in settings beyond acute care face — such as long term care, sub-acute care and school nursing.

Judy Huntington, MN, RN, executive director of the Washington State Nurses Association, and other delegates commented that staffing and care are linked.

“This is a patient care issue in every single setting where patient needs must be met,” Huntington said.

ANA recently revised its staffing principles, and the document is available for members online at

Reference Committee Chair Frank D. Moore (at podium) and committee members were vital to moving practice issues at the HOD. Photo: Eddie Arrossi

The 2012 ANA’s Principles for Nurse Staffing details the many elements needed to achieve optimal staffing, which in turn, enhances nurses’ ability to provide safe, quality care. ANA’s Board of Directors also acknowledged the validity of minimum nurse-to-patient ratios set by law when combined with strategies that encompass facility and unit-level considerations.

Taking action on other workplace concerns

Another key issue that was addressed focuses on preventing workplace violence. In this measure introduced by the Maryland Nurses Association (MNA), delegates agreed to ask ANA to petition the U.S. Occupational Safety and Health Administration (OSHA) to require health care and social services employers to develop comprehensive workplace violence prevention programs. These programs should include comprehensive factors, such as ensuring management commitment and employee involvement, risk assessment and surveillance, training and education, and post-assault programs and record-keeping.

In its action report, MNA noted that health care has a high incidence of non-fatal workplace violence — accounting for almost 60 percent of non-fatal workplace violence across all industry sectors. The report also noted research showing that state laws are effective in increasing the amount of violence prevention programs in health care facilities, and that federal OSHA standards, such as the bloodborne pathogen standard, are successful at decreasing occupational risks.

Several delegates at the HOD spoke about the importance of having legislation in place to protect health care workers from violence. They also noted ongoing violence in mental health facilities and other settings in which patients may be grappling with undiagnosed mental health issues.

Oregon Nurses Association delegate Susan Walters, RN, wholeheartedly endorsed the resolution. She also reported that data show that workplace violence prevention programs are effective, and said that training should be mandated for health care workers just as advanced cardiovascular life support training is for critical care nurses.

MNA also submitted two resolutions designed to keep nurses safe that were accepted for HOD debate.

Jennifer Tucker, president of the Minnesota Organization of Registered Nurses, adds the C/SNA’s ribbon to the flag of ANA constituent/state nurses associations. Photo: Eddie Arrossi

Delegates voted to adopt a measure involving advocacy around the right of nurses to engage in alternative duty that does not require handling hazardous drugs when they are trying to conceive, are pregnant or are breastfeeding. The measure also notes that it is essential for health care facilities to have programs to educate nurses about the risk of reproductive and developmental effects that have been associated with hazardous drugs.

For example, the MNA action report pointed to studies that have shown health care workers who have been exposed to hazardous drugs have greater incidence of fetal abnormalities, fetal loss, and fertility problems. Further, it has been recognized that environmental chemical pollutants find their way into human milk, and hazardous drugs are an environmental chemical pollutant for nurses who work with them.

In a related resolution, delegates voted to adopt a measure that, in part, asks ANA to reaffirm efforts that support the right of nurses to practice in health care facilities where hazardous drug safe handling practices modeled on National Institute for Occupational Safety and Health (NIOSH) guidelines are in place and are promoted. And it asks that ANA advocate for legislation that requires health care employers to take precautions to prevent health care workers’ exposure to hazardous drugs.

To protect workers from hazardous exposures NIOSH recommends the “Hierarchy of Controls,” which addresses practices involving elimination, substitution, engineering controls, administrative controls, and personal protective equipment, MNA noted in its report. The MNA report also referenced research showing that occupational exposure to hazardous drugs has been associated with acute symptoms, such as hair loss, contact dermatitis, and eye injury, as well as adverse reproductive and developmental outcomes.

Protecting the environment

Delegates voted for a measure designed to help nurses, and ultimately their patients and the public, better understand health concerns associated with fossil fuel energy and the benefits of energy conservation and renewable energy sources.

Originally submitted by the Pennsylvania State Nurses Association (PSNA) it also asks ANA, in part, to support activities that monitor, reduce, and remediate environmental health risks for individuals and communities where coal, oil and natural gas extraction and use are occurring. Additionally it asks that ANA support legislative initiatives that require monitoring, reporting, and regulatory reform to protect public health and the environment.

In the report that accompanied the resolution, PSNA noted that energy policies at the federal and state levels have a direct impact on human and ecological health. It quoted studies linking increased rates of asthma attacks, cardiovascular disease, and lung cancer to the country’s reliance on fossil fuels.

Nurse delegates reported health concerns in their states where these processes are being used, and said that it was important for ANA and nurses nationwide to address this issue because it is a public health concern.

Alabama State Nurses Association delegate Helen Wilson, MSN, RN, noted that protecting the environment is key to the health of patients and nurses.

Recognizing accomplishments, participating in events

Both ANA President Karen A. Daley, PhD, MPH, RN, FAAN, and ANA Chief Executive Officer Marla Weston, PhD, RN, thanked nurse delegates for their hard work throughout the HOD, and noted their courage to meet challenges head on.

In her report to the HOD, Weston presented an overview of ANA’s work in many areas. She noted, for example, ANA’s ongoing activities with the 35-member Coalition for Patients Rights to help ensure all nurses can practice to the full extent of their education and license. She noted the development of the ANA Leadership Institute that is geared toward cultivating leadership abilities in every nurse in every setting. And she pointed out the work of ANA’s Center for Health, Wellness and Safety to educate nurses, such as through the Healthy Nurse Conference (held just before the HOD) and the ongoing Safe Patient Handling program.

While at the HOD, nurses had the opportunity to participate in a variety of events and recognize colleagues for their support of nurses, the profession, and the public’s health and well-being.

During a HOD session June 16 and at a special luncheon afterward, nurses, friends and family attended a ceremony in which six nurses were inducted into ANA’s Hall of Fame and 12 others received ANA national awards for their exceptional contributions to nursing practice and other important arenas.

Some 40 donors from the HOD and greater Washington area who generously supported the ongoing work of the American Nurses Foundation also were recognized at the luncheon for their commitment to their RN colleagues and the profession. Additionally, nurses took the opportunity to make donations onsite at the HOD to celebrate their colleagues through ANF’s Honor a Nurse program ( In total, 76 nurses were honored through this program, raising $3,450.

Through a traditional ceremony known as The Nightingale Tribute, HOD participants and observers honored Past President Jo Eleanor Elliott, MA, BSN, RN, FAAN, and other nurse colleagues who have died.

Elections also took place at the HOD, with Daley being reelected ANA president.

On the political advocacy side, more than 100 nurses from around the country headed to Capitol Hill following a June 13 breakfast briefing as part of ANA’s Lobby Day. Another 1,500 participated in the event virtually by sending their members of Congress e-mails or making phone calls. RNs focused on three key issues while meeting Congressional policymakers: supporting legislation to ensure safe RN staffing, solid funding for Title VIII Nursing Workforce Development programs, and a measure that permits advanced practice registered nurses to certify home health plans of care.

The ANA-PAC raised more than $37,000 in donations, and held “thank you events” that included a high donor champagne toast reception, sunset dinner cruise, and political breakfast briefing.

HOD-approved resolutions in their entirety are expected to be online soon at

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