March 2020 American Nurse Journal 33 ANA ON THE FRONTLINE NEWS FROM THE AMERICAN NURSES ASSOCIATION nn Nurses make their voices heard34 American Nurse Journal Volume 15, Number 3 By Gregory Craig, MPA, MS, and Samuel Hewitt P romoting the critical role nurses play in the health of patients and the nation, as well as guaranteeing a strong nursing workforce into the future, are core components of the American Nurses Association’s (ANA’s) federal legislative agenda. In 2020, as the second session of the 116th Congress gets underway, ANA is focusing its legisla- tive efforts in key areas: passage of Title VIII reau- thorization for nursing workforce programs, pre- venting workplace violence, defending the scope of practice of registered nurses (RNs) and advanced practice RNs (APRNs), helping to curb the opioid epidemic, and preventing gun violence. These legis- lative priorities are based on ANA’s strategic goals, positions, emerging issues, and the current political environment. Factors influencing policy Election years are always tough for legislative and policy victories, especial- ly during a presidential election year. Members of Congress will spend more time at home cam- paigning for reelection, while hearings and com- mittee work will essen- tially shut down from July until the election. The House impeachment of the President and Senate trial will have an impact on what gets accom- plished by Congress for the remainder of the year. Although no one can predict what will happen after the elections in November, ANA will remain nimble in its efforts to promote nursing. ANA’s 2020 legislative priorities include the following. Passage of Title VIII Nursing Workforce Reauthorization Act Title VIII of the Public Health Service Act authorizes Nursing Workforce Development Programs, which support RN and APRN education and training pro- grams across the country. The House passed the Title VIII Nursing Workforce Reauthorization Act of 2019 (H.R. 728/S. 1399) on October 28, 2019, by voice vote. The Senate Health, Education, Labor, and Pen- sions (HELP) Committee passed the legislation out of committee in November, meaning the next hurdle is a vote on the Senate floor. But because an amend- ment was made during the legislative markup in HELP, the House will once again have to pass the bill or amend it and send it back to the Senate. At press time, ANA was expecting action on this measure. Funding of Title VIII Nursing Workforce Development Programs and the National Institute of Nursing Research (NINR) 2019 was a banner year for nurses in the annual Con- gressional appropriations process. Through ANA’s grassroots and legislative efforts, along with others from the nursing community, Congress appropriated an increase of $10.5 million in Title VIII Nursing Work- force Development Programs funding for FY2020 for a total of almost $260 million. In addition, Congress appropriated an increase of more than $6 million in funding for the NINR at the National Institutes of Health (NIH), bringing the total funding to $169 mil- lion. These are signifi- cant increases com- pared with 2019, when Congress appropriated flat funding for both programs. Workplace violence prevention One in four nurses are assaulted on the job, which is why prevent- ing workplace violence continues to be a top priority for ANA. In 2019, ANA members helped the House pass the Workplace Vio- lence Prevention for Health Care and Social Service Workers Act (H.R. 1309/S. 851). This bill requires the Department of Labor (DOL) to promulgate an occu- pational safety and health standard that requires em- ployers in healthcare and social services settings to implement comprehensive plans to protect their em- ployees from workplace violence. DOL has had vol- untary guidelines on the record for years, but no en- forcement mechanisms to make employers in these settings comply. ANA will continue to push for pas- sage of this legislation in the Senate in 2020. Opioid crisis The SUPPORT for Patients and Communities Act of 2018 included a provision that granted nurse practi- tioners and physician assistants permanent prescrip- Federal legislative agenda ANA focuses on key workplace and workforce issues ADVOCACY Nurses attending ANA Hill Day in Washington, DC, visit Rep. Joe Courtney (D-CT) to advocate for key nursing issues. Courtney, at left, sponsored workplace violence prevention legislation in the House. March 2020 American Nurse Journal 35 tive authority for buprenor- phine; clinical nurse specialists (CNSs), certified nurse-mid- wives (CNMs), and certified registered nurse anesthetists (CRNAs) were given 5-year authority. As of January, more than 18,000 APRNs have com- pleted the continuing educa- tion requirements to be grant- ed the waiver to prescribe buprenorphine for addiction treatment. While this is great progress, it’s not a silver bullet to solving the opioid crisis. All prescribers with a controlled substance license can already prescribe buprenorphine for pain, but not for addic- tion treatment. ANA has endorsed the Mainstreaming Addiction Treatment Act (H.R. 2482/S. 2074), which will remove the requirement for additional continuing education to be able to provide medication-assisted treatment to patients with opioid use disorder. It also will eliminate the sunsetting of CNS, CNM, and CRNA authority to prescribe buprenorphine. Gun violence prevention ANA achieved another long-term goal in 2019 in the appropriations process: For the first time since 1996, Congress appropriated money to the Centers for Dis- ease Control and Prevention (CDC) and the NIH to study gun violence. Congress has been unwilling or unable to provide such funding since 1996, when a policy rider, known as the Dickey Amendment, was attached to the annual federal spending bill. This rid- er stated that none of the funds made available for injury prevention and control at the CDC may be used to advocate or promote gun control. The actual law didn’t specifically ban CDC and NIH from re- searching gun violence. However, career employees feared if they continued to direct money to research the issue, Congress might cut their overall funding, so they discontinued the programs. In 2018, Congress amended the law to clarify that such research is allowed, and this year added funding for it in the latest appropriations package. Another achievement on be- half of nurses was the pas- sage of H.R. 8, the Bipartisan Background Checks Act of 2019. Endorsed by ANA, this legislation prevents firearm sales between pri- vate parties unless a licensed gun dealer conducts a background check. We’re proud of the progress made, but it’s unlikely to get a vote in the Senate, and President Trump has said he would veto the bill if it passed Congress. ANA will continue to advocate for funding for the CDC and NIH for research into gun violence prevention and for other common- sense legislation to protect all Americans, including universal background checks. Giving nurses a voice ANA strives to ensure that nurses, the most honest and ethical profession for the past 18 years, are rep- resented on critical issues facing the profession and healthcare. Through legislative efforts in 2020, ANA will continue to advocate on behalf of nurses and the patients they serve, and to elevate the role of nursing in America’s healthcare system. — Gregory Craig is a senior health policy advisor and Samuel Hewitt is a senior associate director in the Policy & Government Affairs Department at ANA. ANA resources RNAction—Get involved, take action, and learn more about critical nursing issues. Visit ana.aris- totle.com/SitePages/HomePage.aspx Capitol Beat Blog —Stay up to date on the latest healthcare policy and advocacy. Visit anacapitol- beat.org #NursesVote—ANA empowers nurses across the country to become engaged advocates. #Nurses- Vote is your go-to resource for information on candidates, ANA’s nursing priorities, and how best to engage with and support the candidate of your choice. ANA encourages all nurse advo- cates to become well-informed voters and help ensure every presidential candidate considers advancing the nursing profession to be one of their core priorities. Visit nursesvote.org North Carolina Nurses Association leaders met with Sen. Richard Burr (R-NC) (center), along with ANA President Ernest Grant and Enterprise CEO Loressa Cole. Burr is Senate sponsor for Title VIII nursing workforce legislation. Nurses from Arizona prepare for their Capitol Hill visits in Washington, DC. 36 American Nurse Journal Volume 15, Number 3 A lthough the relationship between nursing care and safe, high-quality patient care is widely understood today, healthcare leaders have difficulty agreeing on a systematic method for allo- cating nursing resources, accord- ing to a new report published by the Healthcare Financial Manage- ment Association (HFMA). The American Nurses Association (ANA) and the American Organi- zation for Nursing Leadership co- authored the report with HFMA. The report also was endorsed by the American Association of Criti- cal-Care Nurses. “Nurses have a direct impact on quality of care and patient and family satisfaction. It is time to shift the nurse staffing paradigm so that the contributions of nurs- es to positive patient outcomes are understood, valued, and viewed as a priority investment rather than a discretionary ex- pense,” said ANA President Ernest J. Grant, PhD, RN, FAAN. With 2020 declared the Year of the Nurse and the Midwife, this 19-page report is especially timely and critical in advancing an important nursing priority. It explores the different sources of stress that nursing and finance leaders routinely encounter in the course of their work. Enhancing mutual understanding of their respective professional roles and challenges can help the two groups work together toward shared goals, according to the authors. ANA Past President Pamela Cipriano, PhD, RN, FAAN, is the lead ANA author. The report, The Business of Car- ing: Promoting Optimal Alloca- tion of Nursing Resources , also calls on healthcare leaders to pi- oneer creative nurse staffing ap- proaches, assess the impact of new technology on all phases of care, strive for fierce collabora- tion, and agree on principles for allocating appropriate nursing resources for patient care. These principles include the following: nurse staffing makes a critical difference for patients and for the care experience; safe nurse staffing leads to better patient outcomes; and optimal staffing reduces nurse turn- over, which in turn reduces the cost of care. The report is available at bit.ly/nursingreport. L illee Smith Gelinas, MSN, RN, CPPS, FAAN, editor-in-chief of the Ameri- can Nurse Journal and an American Nurses Association (ANA) and Texas Nurses Association member, was recent- ly selected to serve on the Patient Safety Measures of Hospital Harm Technical Ex- pert Panel (TEP) through the Centers for Medicare & Medicaid Services (CMS). The purpose of the TEP is to develop and maintain patient safety measures of hos- pital harm related to falls, postoperative bleeding, and diagnostic errors for CMS quality and payment programs, such as the Hospital Inpatient Quality Reporting Program and the Hospital-Acquired Con- ditions Reduction Program. “ANA congratulates Ms. Gelinas on her appointment to this CMS patient safety panel,” said ANA President Ernest Grant, PhD, RN, FAAN. “Her leadership and expertise on patient safety issues will no doubt help move this important work forward.” The TEP’s objectives are to improve pa- tient safety and reduce or eliminate hos- pital-acquired conditions, to evaluate and address performance gaps, identify and incentivize opportunities for im- provement, and to develop, maintain, reevaluate, and implement patient safe- ty measures, including electronic clini- cal quality measures (eCQMs) for falls, post-operative bleeding, and diagnostic errors for CMS’ hospital-level quality re- porting programs. A strong nursing presence in decision- making related to patient safety measures is critical, particularly when it comes to avoidable hospital harm. Nursing care is the frontline of preventing these types of harm, and ANA continues to be a leader in ensuring that nursing is represented in these discussions. Payers and health systems are transitioning to measuring patient safety through eCQMs, which presents the profession with the opportunity to demonstrate the central role of nursing in patient safety. ANA representative named to CMS patient safety panel Guidance for improving allocation of nursing resources ANA NEWS Lillee Smith Gelinas March 2020 American Nurse Journal 37 RECOGNITION C ertified Nurses Day™, celebrated annually on March 19, is a day of recognition that honors nurses worldwide who contribute to better patient outcomes through board certification in their specialty. Employers, certification boards, education facilities, and healthcare providers take this day to publicly acknowledge nurses who care enough to earn and maintain the highest credentials in their specialty, demonstrating their commitment to nurs- ing professionalism and excellence. Certified Nurses Day is celebrated on the birthday of Margretta “Gretta” Madden Styles, EdD, RN, FAAN, a renowned pioneer and expert in nurse cre- dentialing. Styles, who was an accomplished advo- cate for nursing standards and certification, ad- vanced nursing practice and regulation worldwide for more than two decades. Certified Nurses Day is the perfect opportunity to in- vite all nurses to advance their career by choosing certification. The American Nurses Credentialing Center (ANCC) provides free downloadable tools and celebra- tion ideas at certi- fiednursesday.org. Winners of the ANCC Certified Nurse Awards are announced in con- junction with Cer- tified Nurses Day. The awards showcase certified nurses in various specialties who have made impact- ful and valuable contributions to the nursing profes- sion and the field of healthcare. To view the outstanding nurses who exemplify the value of continuing professional development through certification as the 2020 Nurse Award recipients, visit bit.ly/ANCC_CNA_Winners. A s part of the ANA Enterprise’s efforts to cele- brate and elevate nurses’ essential contribu- tions to health and healthcare during the Year of the Nurse and Midwife, it will expand National Nurses Week—traditionally celebrated May 6 to 12— to a month-long celebration in May. The theme for Nurses Month is “You Make a Differ- ence,” and each week will focus on activities to sup- port nurses, advance their practice, and encourage future generations of nurses: • Self-care Week—May 1-9 • Recognition Week—May 10-16 • Professional Development Week—May 17-23 • Community Engagement Week—May 24-31 In addition, the American Nurses Association (ANA) is hosting a webinar, “Magnify your voice—Use storytelling to advance nursing,” at 1 PM ET on May 20. Carolyn Jones, award-winning filmmaker, teaches participants how to better tell the story of their nurs- ing journey. Free to everyone, registration for the webinar is available at nursingworld.org/continuing- education/magnify-your-voice-use-storytelling-to- advance-nursing. To promote Nurses Month in local communities and media, download the Nurses Month toolkit, which in- cludes a Nurses Month logo to use on promotional materials, in social media, and at celebrations and ac- tivities, at anayearofthenurse.org. In partnership with The Washington Post , ANA is pre- senting Star Nurses, a nurse-recognition event on May 12 to honor outstanding nurses in the Washing- ton, D.C., area. The Post is accepting nominations from patients or their families, colleagues, or anyone else who is familiar with exemplary care from a nurse in D.C., Maryland, or Virginia. To learn more, visit pages.nursingworld.org/ starnurses. All nurses, hospitals, and other stakeholders are encouraged to participate in and pro- mote Nurses Month to help recognize nurs- es and educate the public about the profes- sion’s invaluable work. Be sure to share your Nurses Month activities on social me- dia channels such as Facebook and Twitter at #ANANursesMonth. With your help, this landmark year can raise the visibility of the nursing profession—enhancing nurses’ influence in policy dia- logue, as well as spurring expanded investment in ed- ucation, practice, and research. Recognizing certi昀ed nurses March 19 Celebrating Nurses Month in 202038 American Nurse Journal Volume 15, Number 3 IN BRIEF T he Centers for Disease Control and Prevention (CDC) is closely monitoring an ongoing out- break of 2019 Novel Coronavirus (2019-nCoV) in Wuhan, China. Cases have been identified in multi- ple countries, including the United States. The American Nurses Association (ANA) affirms the current CDC guidelines on the interim recommenda- tions for healthcare professionals to protect the pub- lic and themselves. For guidance, visit cdc.gov/ coronavirus/2019-nCoV/index.html. In addition, ANA also developed resources available at nursingworld. org/coronavirus. Coronaviruses are not a new family of viruses and are common in different species of animals; howev- er, it’s rare for animal coro- naviruses to evolve and spread to people. There are multiple strains that can cause mild respiratory symptoms or even the common cold. In previous years, other strains have been associated with se- vere acute respiratory syn- drome (SARS) and Middle East respiratory syndrome (MERS). Transmission of 2019-nCoV can occur person to per- son, but it’s unclear how and how easily the virus is transmitted. Symptoms associated with 2019-nCoV include mild to severe respiratory illness with symp- toms of fever, cough, and shortness of breath. The CDC believes the incubation period lasts 2 to 14 days after exposure based on what has been seen previ- ously as the incubation period of MERS viruses. Cur- rently, no vaccine is available to consumers. Older adults and people with underlying medical conditions are at increased risk. Nurses should develop and educate staff on a pre- paredness plan that provides infection prevention procedures and proto- cols used within their healthcare facility for the early identification and care of patients with symptoms associated with 2019-nCoV. Facilities should provide updated training and guidelines on the use of personal pro- tective equipment, such as gloves, gowns, masks, eye protection, and a face shield. Consistent use of proper hand hy- giene, standard precau- tions, contact precautions, and airborne precautions, along with the proper use of a National Institute for Occupational Safety and Health-approved N-95 respi- rator or higher, is recommended. Coronavirus: What you need to know T he ANA Center for Ethics and Human Rights has been a leader in healthcare ethics, nursing ethics, bioethics and human rights for 30 years. In collaboration with constituents, the center has tire- lessly provided ethical guidance, both theoretical and practical, at the state, national, and international level. The center responds to and also creates policy on is- sues including the protection of human rights, end of life care, medical marijuana, social justice, assisted suicide, use of patient restraints, genetics, torture, capital punishment, racism, discrimination, social me- dia, and ethical work environments. At the core of its mission, the Code of Ethics for Nurses with Interpretive Statements drives the cen- ter’s responsiveness to the nursing profession and addresses the fundamental duty to improve the qual- ity of care for all persons, patients, families, commu- nities, and populations. ANA established the center in 1990 to help nurses obtain a better understanding of ethical issues in practice in a rapidly changing landscape. Some key highlights through the years include the following: • Published an ANA position for nurses regarding ethics and assisted suicide in 1994. • Revised the Code of Ethics to include nurses’ mor- al duty to self-respect and ethical decision-making in 2001. • Elevated nurses’ ethical obligations during disas- ters, pandemics, and extreme emergencies follow- ing September 11, 2001, and Hurricane Katrina (2005) and the Ebola crisis (2014). • Advocated at the national level for a Navy nurse who refused to force-feed Guantanamo Bay de- tainees in 2013. • Celebrated the Year of Ethics in 2015 and revised the Code to extend nurses’ obligations to popula- tions and activism in social justice. • Received American Society for Bioethics and Hu- manities Cornerstone Award in 2017. Learn more about the center and download an info- graphic recognizing the 30th anniversary at nursing- world.org/practice-policy/nursing-excellence/ethics. ANA Center for Ethics and Human Rights celebrates 30 years March 2020 American Nurse Journal 39 To: Ethics Advisory Board From: Overworked RN Subject: Freelance nursing I ’m exhausted. My unit is always short staffed. I’m asked to work longer hours and come in on my day off. I need more control over my life and schedule. I wish there was an Uber-like employment option for nurses. How does the Code of Ethics for Nurses with Interpretive Statements (the Code ) apply to freelance work? From: ANA Center for Ethics and Human Rights Free agent or freelance work is a part of the gig economy (job-to-job employment). Several technolo- gy sites enable nurses to browse open shifts, sign up, work, and get paid the same day. The more common model is for nurses to serve as full-time, semi-perma- nent employees in a single organization. Layoffs, downsizing, mergers, acquisitions, and nurs- ing shortages have resulted in nurses exploring dif- ferent employment and career options. The days of benevolent organizations providing career advance- ment and educational opportunities are dwindling. Individual nurses are relying on themselves to devel- op their skills and expertise to grow their careers. Free agency is incredibly empowering because nurses build their reputations based on their own knowledge, skills, contributions, and outcomes. Nurses have long enjoyed the flexibility of transfer- rable skills, providing the ability to move among or- ganizations, cities, and states with confidence that they’ll secure a good job. Freelance work enables nurses to have full control over their schedules, work in care areas they enjoy, and optimize their work-life balance. Skill variety offers a competitive edge. A nurse who’s competent across multiple care continuums is highly sought. The free agent model is mutually beneficial. Organi- zations benefit from having a more flexible staffing model with the ability to staff up when census and acuity rise, and staff down as it falls. The freelance nurse takes responsibility for his or her own profes- sional and career development and can be more in- dependent and resilient. Free agency isn’t limited to frontline, direct care po- sitions. Consider the needs of an organization adopting a new electronic health record or com- pleting annual training and competency educa- tion. Freelance nurse educators can support or- ganizational transformation. The opportunities are endless. The freelance mindset might be uncomfortable for some. The skills associated with marketing yourself, networking, collaboratively working in a team where relationships are shorter term, and building your career portfolio are new skills for some nurses. And the security of full-time employment and benefits remains an attractive option for many. Others embrace flexibility and are less risk-averse. Advance preparation for un- certainties can mitigate concerns and raise con- fidence. The Code (nursingworld.org/coe-view-only) es- tablishes the ethical standard for the profession and guides nurses in decision making. The nurs- ing profession “encompasses the protection, pro- motion and restoration of health and well-being; the prevention of illness and injury; and the alleviation of suffering in the care of individuals, families, groups, communities, and populations.” The Code explicitly states the primary obligations, values, and ideals of the profession. In every work environment, adherence to the nine provisions of the Code en- sures the nurse is practicing ethically. There’s no conflict between the freelance model and the Code . The gig economy offers exciting possibilities for nursing to advance independent practice, individual accountability, and self-care. — Response by Donna Casey, member of the ANA Center for Ethics and Human Rights Advisory Board. Nursing ethics for a gig economy Reference Caulfield C. Forbes The gig economy has arrived in the world of nursing. Forbes. September 27, 2019. forbes.com/sites/for- bestechcouncil/2019/09/27/the-gig-economy-has-arrived-in- the-world-of-nursing/#407841b16274 Do you have a question for the Ethics Inbox? Submit at ethics@ana.org. FROM THE ETHICS INBOX40 American Nurse Journal Volume 15, Number 3 A merican Nurses Associa- tion (ANA) membership includes a variety of pro- grams and products created spe- cifically for RNs, including many that are free or offer member savings. The 2020 Navigate Nursing webinar bundle features expert speakers on topics de- signed to enhance your career and work-life balance. The bun- dle is free for ANA members ($75 for non-members). Upcoming webinars include: March 25 Innovations by nurses for nurses: Self-care every nurse needs Presented by Kathleen C. Attonito, MSN, RN-BC, an ANA-New York member, and Nicole D. Benincasa, MS, LMHC, this webinar focuses on how one organi- zation gathered input from frontline nurses and ex- perts to design innovative programs and structures to meet the complex self-care needs of individuals and nursing teams. May 20 Nurses Month webinar: Magnify your voice— Use storytelling to advance nursing This webinar offers techniques on how to share your nursing story, presented by Carolyn Jones, producer and director of the documentaries The American Nurse and Defining Hope . You’ll learn how to con- struct a narrative that communi- cates your motivations, the value of your work, and the challenges you face every day. August 19 Mental health of nurses: Supporting your nursing colleagues when they need it most Presented by LaKeetra Josey, PhD, APRN, PMHNP-BC, a Dela- ware Nurses Association mem- ber, this webinar examines the impact nursing has on mental health and shows you how to im- prove your skills in identifying and offering support for mental health challenges in your colleagues and your yourself. November 11 Real solutions for workplace bullying and incivility If you’re a nurse, a significant chance exists that you’ve experienced or witnessed bullying in the workplace. ANA has developed a position statement and the #EndNurseAbuse campaign to address issues like bullying and incivility on the job. You’ll learn how organizations can take this issue from concept to action. Learn more about the series and register for all four webinars at nursingworld.org/continuing-education/ 2020-navigate-nursing. T he Individual Membership Division (IMD) of the American Nurses Association (ANA) was es- tablished by an amendment to the ANA Bylaws on June 26, 2003. The purpose of the IMD is to pro- vide the organizational structure to permit ANA-Only Members (those who elect to join ANA directly at the national level only) to participate in ANA governance, as well as the programmatic work of ANA as expressed in the ANA Bylaws. The IMD is soliciting nominations for chairperson and secretary. To review the roles and responsibilities of each posi- tion, please access the IMD Operating Policies and Procedures, under the resources tab at nursingworld. org/membership/individual-member-division. The terms of office for each position are 2 years, from July 1, 2020 through June 30, 2022. This is the official notice of the 2020 election. To qualify as a candidate for office, the nominee must be a member of the ANA IMD (ANA-Only member- ship category). Emails with information for the nomi- nation process and criteria will be sent starting April 15. If you don’t have an email on file with ANA, you’ll receive print notifications. The due date for nomina- tions is May 15. 2020 Navigate Nursing webinar series IMD call for nominations for 2020 ANA elections ANA MEMBERSHIP ELECTIONSNext >