Tag Archives: ANA

The Most Trusted Professionals Need a Title!

Today I sent a letter to my Congressman, using a nifty widget that the ANA sends out from the RNAction platform. I had to select my “title” from the following list:
Lt Gen
The Hon.
The Right Reverend
The Very Reverend

THERE IS NO TITLE FOR NURSES! We are supposed to come to the table as equal partners with physicians according to the IOM’s plan to reform our health care system in a meaningful way…yet we have no title.

Nurses are the most respected professionals in this country for 17 years straight but still we have no professional title? I call BS! It was explained to me that Congress has not yet approved an official title for nurses, so we can’t use one. Well, time to create one! If we can, as a profession, choose and propose a title, we can make it happen. Please help me send this around to all the nurses you know, so that we might engage in a profession-wide discussion and finally get the respect we deserve by having a title.

We can create a hashtag such as #TitleforNurses, #NursingProfessionalTitle or #Nrs.isMyTitle

Let’s make it happen! Please complete the poll below.

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Hill Day for Nurses 6/21/18 and the Need to Act to Restore Justice

On Thursday, June 7, 2018 the United States Department of Justice indicated it will no longer defend the Affordable Care Act’s protections for patients with pre-existing conditions. Department of Justice. Yes, you read that correctly. Merriam-Webster’s dictionary lists as it’s first entry for the definition of justice;

the maintenance or administration of what is just especially by the impartial adjustment of conflicting claims or the assignment of merited rewards or punishments :meting out justice: social justice.

It is unfathomable what this administration considers to be just, just action, or justice. But it is clear that justice is not for the many, only for the few who can pay the entry fee. This runs completely contrary to the four essential ethical principles which underlie nursing and medical practice – beneficence, nonmaleficence, autonomy and JUSTICE. Justice, in a civil society, requires that all people be treated equally under the law. Justice ensures that the weak are not steamrollered by the strong, and have access to important resources such as food, clean air and water, shelter, and reasonable medical care. Are we not a civilized society?

Apparently not, if this administration continues to destroy our environment, deny people essential dignity, and reap financial gain by preying upon the most vulnerable. It makes me want to both cry and vomit. #Cromit, I guess…

What can we as nurses do? Ask yourself, what would Flo do? Get involved! The American Nurses Association Hill Day is on June 21st this year. I know it’s coming up fast, but if you can possibly make it, it promises to be a phenomenal opportunity to speak directly to those who are charged with representing us in this government. You can learn more (including discounted hotel rooms and how to register) by reading the ANA’s Capital Beat post from June 12, below:


And please, please, please, whatever you do, #Vote.


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Nursing: The Last Ethical Profession? Ethics and mHealth – Published.

It is well known that nurses are the most trusted professionals in the United States. Perhaps this is due to the immutable and fundamental nature of ethics in nursing. The complete LACK of ethics, respect, integrity and honesty in our political system presently, embodied by the person occupying the White House, is appalling. As nurses, we continue to fight the good fight in our jobs. But we must do more, we must # resist on every level.

I had the honor of having another article published in the Online Journal of Nursing Informatics. The link is below. It deals with ethical design for mobile health applications. As nurses, we work to ensure that ethics permeate every aspect of our profession. Now it is time to ensure that this commitment extends to every aspect of our lives. The American Nurses Association offers any number of ways to be involved. Let’s do this… after all – #whatwouldflodo ?


Here’s the link to my most recent publication:



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Northern Michigan Nurses and Community Organize Against Unsafe Staffing…Might they Strike?

Try to run a hospital without nurses. It can’t be done. If people didn’t need nursing care, they would go home. The hospital runs on the backs of the nurses. You can’t pull people from other departments, or cross-train employees. So… if the nurses go on strike you either have to hire a tremendous number of replacements at huge cost (who would still need orientation to the various units and policies), or close. It’s possible the folks at Duke LifePoint have underestimated the “sisu” or just plain guts of the people in the Upper Peninsula of Michigan, because the nurses have struck before and they could do it again.

Nurses at Duke LifePoint’s Marquette General Hospital took to the streets yesterday, to protest the administration’s refusal to address their concerns about unsafe staffing. Supported by community members, hundreds of people gathered in this small, somewhat isolated community in Michigan’s Upper Peninsula, to march with staff RN’s. The nurses had collected and delivered over 3700 signatures on a petition calling for the hospital to bargain in good faith regarding staffing. The petition reads: “I am signing this petition to urge Duke LifePoint/UPHS Marquette to bargain with nurses for an agreement that ensures guaranteed minimum RN staffing levels that are safe for patients, in every department and on every shift.”

The nurses, in contract negotiations since April, are requesting that language be inserted that establishes minimum nurse staffing levels. Although they had agreed to a two-month extension of the previous contract, that contract lapsed in late July due to the administration’s refusal to address staffing levels. Scott Balko, RN – President of the Marquette RN Staff Council/Michigan Nurses Association – described the situation saying, “Duke LifePoint understaffs and overworks nurses to the point that quality of care is compromised. Patients at UPHS Marquette deserve better. Nurses are fighting for safe staffing, and the success of our petition shows that members of this community are with us.”

What may be unique about the Marquette RN Staff Council (RNSC) is it’s history and longevity. Visionary nurses in the 1960’s saw the need for Marquette’s nurses to be represented by a professional labor union. In 1968, the National Labor Relations Board certified the election that established the Michigan Nurses Association (MNA) as the entity representing the RNSC in contract negotiations. The RNSC is now the professional labor organization of the Registered Nurse staff at Marquette General Hospital, which is represented by MNA and affiliated with the AFL-CIO. In the last 45 years, although more than a dozen contracts have been successfully negotiated, the nurses have gone out on strike twice. They could do it again.

Previously the hospital responded by merely stating that there is a national nursing shortage. This is not true in Marquette, where Northern Michigan University graduates BSN’s twice a year (December and May), and any number of other Upper Peninsula universities and community colleges offer LPN, ADN, and BSN, and RN-to-BSN programs. In fact, the hospital has been laying off nursing staff. Marquette is in the unusual position of having an RN surplus!

The hospital updated their response after the petitions were delivered, now claiming that, “UP Health System – Marquette takes very seriously our commitment to deliver high-quality, safe and compassionate care close to home, and we strive daily to create excellent workplaces for our employees. In regard to today’s events, we respect every person’s right to assemble and speak freely, and we value the input of everyone in our community. We are unable to comment further because we are currently negotiating with the Michigan Nurses Association union to develop a contract that meets the needs of our nursing staff and hospital.”

If they want to develop a contract that meets the needs of the nursing staff and patients, they are going to need to put their money where their mouths are. Otherwise, they may be faced with no nurses…and no patients. It is unwise to test the mettle of a Yooper (people who live in the Upper Peninsula). Especially when they are advocating for patient safety.


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Medicaid Expansion Fiscally Sound: Trump Policy – Not So Much…

The powerful image above is Dr. Pamela Cipriano, President of the American Nurses Association (ANA) addressing Congressional staffers. The ANA is the voice of nurses in this country, and advocates for better health and health care for all. The link below will take you to an article explaining the title of this post. Simply put, offering people primary care through Medicaid keeps them out of the Emergency Department, ultimately saving money all the way around. Trump has decided to undo his predecessor’s freeze on funding uncompensated care for states who refused to expand their Medicaid programs as offered by the Affordable Care Act. Not a good move.

States who refused federal funding to expand Medicaid did so out of political spite and fear of criticism by the extreme right wing of the Republican party. They did so not thinking or caring one bit about the people who live in their state. They did so knowing their actions were fiscally irresponsible and detrimental to the health of their constituents. Really? How much longer can we keep this farce going?

Thanks to the ANA for its continued advocacy on the part of those who are vulnerable, uninsured and clearly unrepresented. Inform yourself. Call your Congressional representatives. Be a part of the solution. #Resist !


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The Future of Nursing is…Now!

I’m at #HIMSS17, seeing all of the people who are shaping the future of health care in our country. How many nurses? Not a whole ton. HIMSS stands for the Health Information Management Systems Society. Health care is increasingly being defined by technology and data. This is not a bad thing, as we want to move into a system in which evidence-based practice is the norm rather than the exception. In this case, the transition cannot be gradual.  Value-based reimbursement is a reality. This impacts providers, systems, and clinicians in the immediate future. Sometimes it’s hard to adapt.

Change management and collaboration are two themes that are continuously emerging at HIMSS17. Clinicians have to see and believe in the benefits that technology has to offer. Disparate software systems/vendors need to step up to the plate in terms of interoperability and establish a means to facilitate the flow of information. It’s just that simple.

Kudos to those who are actively involved in the quest to make this happen. One thing I have learned as a result of this experience is that we need to keep the patient, a human being, squarely in the focus as the most important player in this scenario. Nurses are uniquely positioned to do so.

By empowering nurses to bring their training and skills into the provision of primary care services, everyone wins. Legislation to allow APRNs to practice unrestricted in the VA system was the first step. We must continue to insert ourselves into all conversations, and take our rightful place within the industry as the largest group of care providers in the country!

Recent progress in this regard was reported by the ANA here:


Let’s keep it going!

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Reimbursement for Nursing Services: A Pipe Dream or Potential Reality

I have the privilege of studying for my MSN in Informatics in an entirely online format with Capella University. An interesting line of analysis arose, during a discussion of universal nursing terminology. There are a number of universal terminologies, perhaps the best known being NANDA, NIC and NOC. The Omaha System is integrated within SNOMED, perhaps making it the most likely candidate for eventual universal utilization.

Be that as it may, the question arose: would the use of standardized nursing terminology ultimately lead to billing separately for nursing services. Why or why not? Would nursing be perceived differently if their departments were revenue-earning? My reply is below:

I think the key lies in re-framing both the public and the industry’s perception of nursing as ‘revenue draining’, and instead creating a ‘value added’ perception.

Increasingly numerous studies are indicating that better nursing environments lead to nurses’ ability to perform their job better and subsequently better patient outcomes. Because of my passionate belief in advocacy and the use of social media to change perception, I would like to refer you to my blog post in in this regard which can be found here:


This post refers to a study authored by Jeffrey H. Silber, MD, PhD, from the Perelman School of Medicine at the University of Pennsylvania. Dr. Silber found that the higher the acuity of the patient, the more difference the nursing environment made. Perhaps most germane to this discussion was Dr. Silber’s conclusion:

Hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients.

Simply put, more nurses working in a better environment result in better patient care and lower mortality with similar costs. On a systemic level, more nurses and better working conditions for nurses actually results in decreased cost relative to outcomes, and increased value. The abstract is accessible from the reference citation below. I was made aware of it through the ANA’s news outlet for members, ANA SmartBrief. Members can subscribe at the ANA member website to read the most current news about nursing.

Whether or not the government – driver of reimbursement reform and change – will pick up on this and ultimately require nursing services to be unbundled and tracked for outcomes will probably be the determining factor as to whether floor nursing services will be separately reimbursable. Hospitals, however, could conceivably offer a ‘tiered’ service. OK, that sounds terrible but it is the way this county works. We are definitely a health care industry, not a socialistic system where everyone gets the same. As such, market forces prevail. Hospitals could offer patients Cadillac services at a higher price, which the patient/family would pay out of pocket. Sort of like staying at the Hilton as opposed to the Red Roof Inn…

It is a fascinating discussion (here comes the soap box), but unless we as individuals and as a profession advocate for such a change, it is highly unlikely. Unless, perhaps, President Sanders is elected. (Where is my unicorn?).


Silber J., Rosenbaum P., McHugh MD, et al. (2016). Comparison of the value of nursing work environments in hospitals across different levels of patient risk. JAMASurg.  Advance online publication. doi:10.1001/jamasurg.2015.4908.

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