Special Interest Groups

• WHAT IS ITS MISSION?
• HOW IS IT STRUCTURED?
• PRIMARY FUNCTIONS
• PROGRAMS
• BUDGET INFORMATION
• HISTORY
• CURRENT POLITICAL ISSUES
• FUTURE DIRECTIONS
• GROUP RESOURCES
• GROUP PUBLICATIONS
• BIBLIOGRAPHY

ESTABLISHED: 1897
EMPLOYEES: 198 (1997)
MEMBERS: 174,609 (1997)
PAC: American Nurses Association Political Action Committee (ANA-PAC)

Contact Information:
ADDRESS: 600 Maryland Ave. SW, Ste. 100 W. Washington, DC 20024-2571
PHONE: (202) 651-7000
TOLL FREE: (800) 274-4262
FAX: (202) 651-7001
URL: http://www.nursingworld.org
PRESIDENT: Beverly L. Malone

WHAT IS ITS MISSION?

According to the American Nurses Association's published statement, its mission is to "advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the general public."

HOW IS IT STRUCTURED?

The American Nurses Association (ANA), a federation of 53 state and territorial nurses associations (SNAs), is the leading professional organization for registered nurses (RNs) in the United States. RNs are nurses who hold a diploma or degree in nursing and have passed a state licensing examination set by the National Council of State Boards of Nursing. RNs automatically become members of the ANA by joining an SNA. The ANA's 53 SNAs, also known as "constituent members," are drawn from each of the 50 states, Guam, the Virgin Islands, and the District of Columbia. The SNAs, in turn, are made up of district and regional associations, of which there were well over 800 in 1998. For individual RNs, SNA membership has been a prerequisite for ANA membership since 1982.

The ANA's general policies and positions are determined by its House of Delegates, which meets annually and comprises representatives elected to two-year terms by the members of each SNA. One of its tasks is to elect the ANA's 15-member board of directors, which is responsible for implementing House of Delegates' decisions and for conducting the general business of the organization. The board of directors includes five officers—a president, two vice presidents, a secretary, and a treasurer—and ten directors. Officers are elected to two-year terms, directors to four-year terms. The day-to-day running of the ANA is in the hands of an executive director and a Washington staff including RNs, economists, attorneys, lobbyists, and communications officers.

Organizational Structure

The ANA has devised a complex organizational structure for addressing professional and organizational issues and ensuring that the concerns of SNAs and individual members are heard. Two key bodies are the Congress of Nursing Practice and the Congress on Nursing Economics, which advise the House of Delegates and the board of directors. Each congress has 15 members, 9 elected by the House of Delegates and 6 appointed by the board of directors.

The Congress of Nursing Practice is assisted by the Institute of Constituent Members on Nursing Practice, which includes one representative from each SNA. The bylaws also allow the board of directors to establish consultative councils, open to any ANA member, to work with the Congress of Nursing Practice.

The Congress on Nursing Economics receives advice from two bodies, the Institute of Constituent Member Collective Bargaining Programs, whose membership comprises one representative from each of the more than 25 SNAs that act as collective bargaining agents for their nurses, and the Commission on Economic and Professional Security, consisting of eight congressional appointees. Yet another advisory body is the Constituent Assembly, which includes two representatives from each SNA (the president and the chief administrator) and reports to the House of Delegates and board of directors on professional and organizational issues.

Affiliates

The ANA works with three affiliated organizations to advance the cause of nursing. The oldest is the American Nurses Foundation, a nonprofit organization incorporated by the ANA in 1955 to provide financial support for nursing research and education. The American Academy of Nurses, founded by the ANA in 1973, is a self-governing body of prominent nurses who seek to influence American health care policy and oversee research into various issues that affect the nursing profession. The American Nurses Credentialing Center, founded in 1991, grew out of earlier ANA efforts to offer specialist certification in areas such as pediatric and geriatric nursing.

ANA ties with other nursing and health care organizations in the United States are established and maintained through participation in numerous organizations and cooperative endeavors. Two particularly important institutions are the Nursing Organization Liaison Forum, an ANA-sponsored body whose membership encompasses representatives from more than 70 specialized nursing organizations, and the Tri-Council for Nursing, which initially included the ANA, the National League for Nursing, and the American Association of Colleges of Nursing. A fourth member, the American Organization of Nurse Executives, was added later, but the Tri-Council kept its original name.

PRIMARY FUNCTIONS

The ANA engages in a wide range of activities designed to further the interests of RNs and improve health care for Americans. These include developing standards for nursing education and practice; maintaining a code of ethical conduct for nurses; supporting nursing research; promoting collective bargaining by nurses at the state level; championing nursing issues through the media; seeking to shape national policy on nursing and health care by lobbying members of Congress, sponsoring a political action committee (ANA-PAC), and undertaking other Washington-based efforts; helping SNAs develop state-level political action programs; and forging links with other nursing and health care organizations in the United States and internationally.

The ANA's Legislative and Regulatory Efforts in Washington

ANA political activity at the national level is overseen by two branches of the organization, the Department of Federal Government Relations and the Department of Political and Grassroots Programs. The latter is responsible for assisting ANA-PAC and for directing a grassroots mobilization initiative known as the Nurses Strategic Action Team (N-STAT). ANA-PAC and N-STAT both place a heavy emphasis on educating RNs to play a more effective role in politics at the national and state levels.

The Department of Federal Government Relations uses in-house lobbyists to forward the ANA's legislative agenda by working with members of Congress and their staffs to shepherd legislation through Congress. This includes drafting of bills for presentation by the ANA's congressional allies, obtaining congressional cosponsors, and preparing testimony for delivery to congressional committees and subcommittees. In many cases the department forms alliances with other nursing organizations, labor unions, and consumers', women's, and minority groups. Once a bill becomes law, the department lobbies the relevant federal agencies to ensure that the desired regulations are passed.

The staff of the Department of Political and Grassroots Programs have several responsibilities, one of which is to assist ANA-PAC's board of trustees, which endorses and financially supports congressional and presidential candidates whose platforms meet with ANA approval. ANA-PAC, which was founded in 1974, increased its political presence substantially in the 1990s. During the 1993-94 election cycle, it ranked 30th among more than 4,000 PACs in terms of the size of its monetary contributions to candidates for federal office, and among health care PACs was surpassed only by the American Medical Association and the American Dental Association. ANA-PAC funds are raised for the most part through a mail and telephone campaign directed at ANA members.

N-STAT represents a sophisticated effort by the Department of Political and Grassroots Programs, in cooperation with the SNAs, to mobilize the political potential of the ANA's large membership. Each member of the House and Senate is assigned a nurse who is responsible for bringing the ANA's legislative concerns to the member's attention and for mobilizing ANA political efforts in the member's congressional district or state. These Congressional District Coordinators and Senate Coordinators, as they are called, collectively make up the N-STAT Leadership Team. They are supported by the N-STAT Rapid Response Team, more than 50,000 politically committed rank-and-file ANA members who work on ANA political campaigns and can be called on to write or telephone their legislators en masse in support of particular initiatives.

PROGRAMS

ANA programs and initiatives run the gamut from holding political policy conferences and workshops for RNs, to offering a comprehensive syllabus of continuing education courses, to financially supporting sexual health education efforts in schools through the ANA/Foundations Nurses Campaign to Reduce Adolescent High Risk Behaviors.

Many ANA activities are motivated by a belief that, as Kathleen Canavan writes in the American Journal of Nursing, "inadequate RN staffing levels result in higher rates of negative patient outcomes." In the 1990s era of hospital downsizing and restructuring, the ANA has attempted to stave off large-scale cuts in nursing staff and the replacement of RNs with minimally trained and less expensive technicians and nurses' aides. The centerpiece of this campaign is the Nursing Safety and Quality Initiative, launched in 1994 as a multifaceted effort to convince legislators, hospital administrators, and the general public that reductions in RN staffing levels make for unsound fiscal and public health policy.

On the consumer outreach front, the initiative has included a drive to persuade the public that "Every Patient Deserves a Nurse." In 1995-96, the initiative provided funding for six SNAs to develop standards for quantifying the impact of RN care on patients—a first step in obtaining the hard evidence needed to demonstrate a link between RN staffing levels and patient outcomes.

In the legislative arena, the ANA worked with Representative Maurice Hinchey (D-N.Y.) to introduce a Patient Safety Act in the 104th Congress in April 1996. The act contained three main requirements: that health care institutions collect and publish specific information about staffing and patient outcomes; that "whistleblower" provisions be added to the Medicare law to prevent employer retaliation against nurses who report or express concern about unsafe conditions for patients; and that the U.S. Department of Health and Human Services be given the task of reviewing the health and safety impact on patients of all mergers and acquisitions involving health care institutions, and the authority to halt those judged to be a threat to patients. Although the bill failed to get past the committee stage, it was reintroduced by Hinchey in the 105th Congress in March 1997. According to an ANA board member commenting on the bill's reintroduction, several years might be needed to build public and political support for the bill.

BUDGET INFORMATION

The ANA is a nonprofit organization with federal 501(c)6 filing status. In 1996, the ANA reported total revenues of $24,394,319. These revenues consisted of $13,018,059 in member dues, $5,108689 in program service revenues, $2,618,239 of income from investments, $1,464,456 in government contributions, $358,113 from the sale of assets, $173,000 in direct public support, and $1,653,763 of revenue from other sources, including conference fees, affiliate fees, and advertising.

ANA expenses in 1996 totaled $23,286,549. These expenses included $7,381,014 in employee salaries, $3,735,874 in administrative expenses, $2,076,882 in rent and other occupancy expenses, $1,796,553 in employee benefits and payroll taxes, $1,303,098 is spent on conferences and meetings, $1,199,933 goes towards travel expenses, $1,199,243 goes to professional fees, $1,037,766 is allocated in grants, $950,516 is spent on printing and publications, $797,097 in compensation for officers, and $1,808,663 in other expenses.

HISTORY

The first steps toward establishing the organization later known as the ANA were taken by members of 10 nurses alumnae associations at a meeting held outside New York City in 1896. The following year they founded the Nurses Associated Alumnae of the United States and Canada, which became the ANA in 1911. The ANA's current federated structure came into being in 1982.

During its early years the ANA concentrated on promoting state licensing for nurses, which began in North Carolina in 1903 and was adopted by the last of the then 48 states in 1923. This campaign provided the impetus for the establishment of SNAs. In the 1940s the ANA turned its attention to collective bargaining, which it endorsed in 1946 (although it maintained a no-strike policy until 1968). The right of nurses in the nonprofit hospital sector to organize and strike, however, was not granted by the National Labor Relations Act until 1974. Today, collective bargaining is the province of the SNAs, although the parent organization retains a keen interest in labor relations issues.

Although the ANA established a Committee on Legislation in 1923 and placed a lobbyist in Washington in 1951, the organization did not embark on an energetic program of political advocacy at the national level until the 1980s. During the first half of the 1990s, two important developments accelerated the ANA's involvement in national politics. One was its 1991 move from Kansas City, Missouri, to Washington, D.C. Lucille Joel, the ANA's president at the time, told Mohammed Hanif of the Washington Post that the decision to relocate was made to "give us the visibility and clout we need to increase our effectiveness with the lawmakers, funding agencies and other health-related associations." It was also intended to strengthen the ANA's working relationship with its Washington-based affiliates and with women's organizations, labor unions, and similar groups.

The second development was the ANA's participation in national health care reform efforts from 1991 to 1994. The genesis of this activity was the ANA's 1989 creation of a task force to propose changes to the American health care system. After extensive consultations with the SNAs and other nursing organizations, the ANA produced a document entitled Nursing's Agenda for Health Care Reform in 1991, which endorsed universal health care and a revamping of the manner in which medical services were delivered. In time it received the support of 76 nursing and health care organizations in the United States.

From 1992 to 1994 the ANA produced several position papers elaborating on the proposals in Nursing's Agenda for Health Care Reform. In conjunction with its political action committee, ANA-PAC, the ANA worked strenuously to promote its ideas on health care reform in Congress and to offer financial and other support to sympathetic legislators. The November 1992 presidential and congressional elections marked a turning point in this process. Presidential candidate Bill Clinton's pledge of sweeping health care reform won over the ANA, which in August became the first group of health professionals to endorse his campaign (he received the ANA's endorsement again in 1996). Eventually the ANA lent its public support to 260 congressional candidates, 76 percent of whom were elected.

Shortly after his inauguration, Clinton put together a health care transition team in Washington, whose work eventually led to the creation of the Health Security Act (HSA). During the months leading up to the introduction of the HSA in September 1993, ANA representatives met with Clinton officials to discuss health care reform on more than 50 occasions. When the HSA finally appeared, it incorporated the fundamental principles that had been proposed in Nursing's Agenda for Health Care Reform and further developed at an August 1993 summit of 63 American nursing organizations: "universal benefits; removal of barriers to nursing care; a nursing work force transition plan (monies and opportunities) to the restructured delivery system; a dedicated graduate nursing education (GNE) fund; and nursing inclusion on federal, state, and local health policy boards."

The HSA was one of the most controversial initiatives of the first Clinton administration, and after heated public and legislative debate was rejected by Congress in September 1994. Although this was a great disappointment for the ANA, Virgina Trotter Betts, president of ANA from 1992 to 1996, believes that the ANA's health care reform activities brought the organization to "a new position of strength," including a greatly enhanced public and media presence, vastly improved access to public policymakers, and stronger links with other nursing organizations. Nor has the ANA abandoned the health care reforms that it endorsed in the early 1990s. In 1998 the ANA continues to promote specific changes in nursing and health care policy originally set forth in Nursing's Agenda for Health Care Reform in 1991 and refined in 1992-94.

CURRENT POLITICAL ISSUES

Throughout its history the ANA has spearheaded or actively participated in issues involving all aspects of U.S. healthcare. To ensure "patient safety" and "nursing quality" it has advocated for state and federal regulations that affect both patients and caregivers. A specific example is the Health Worker Protection Act of 1997, which the ANA sponsored along with Congressman Pete Stark (D-Calif.). This legislation required health care facilities to use FDA-approved needle devices to prevent workers from being stuck by needles. The ANA became particularly vocal when education for nurses was threatened.

Case Study: The Nurse Education Act

The ANA's cordial relationship with the Democratic Party goes back at least to 1984, when the organization lent its support to the presidential campaign of Walter Mondale. In 1992 and 1996, Bill and Hillary Clinton's backing of health care reform and other ANA-approved causes cemented the relationship. Bill Clinton addressed the ANA's June 1996 annual convention, and in June 1997 Hillary Clinton was the keynote speaker at a luncheon honoring ANA-PAC donors.

As the ANA learned during the health care reform fight of 1993-94, however, the Clintons' good intentions were not always a sufficient guarantee that the RN agenda would easily prevail in Washington. This point was brought home with even greater force in early 1997, when the president slashed funding for the Nurse Education Act (NEA), which provides the bulk of federal monies for nurse education. The NEA is primarily used to support specialized training for nurses beyond the two to four years required before taking the RN examination.

In 1996, Clinton had been applauded by the ANA for adding $7 million to NEA funding, bringing the total to over $63 million for the fiscal year 1997. But in February 1997, as part of his attempt to balance the national budget, Clinton announced that NEA funding would be reduced to a mere $7.7 million for the fiscal year 1998. The ANA pronounced itself "stunned" and "appalled." ANA president Beverly L. Malone, quoted in a press release, repeated the familiar ANA refrain that what is good for RNs is also good for the public: "Without stable funding to support graduate-level education for nurses, we'll enter the 21st century ill-prepared to provide adequate health care to aging baby boomers and their grandchildren."

The ANA responded to Clinton's move with an intense White House and congressional lobbying campaign by its Washington staff and N-STAT. After several months of N-STAT activity, meetings with White House and congressional politicians and staff members, and congressional testimony on the need for graduate-level education for nurses, the president received from Congress and signed into law in November an appropriations bill that, among other things, restored NEA funding to its previous level. In a press release, an ecstatic ANA proclaimed the bill "a huge victory for nursing and a testament to grassroots lobbying efforts."

FUTURE DIRECTIONS

A 1997 ANA publication, Legislative and Regulatory Initiatives for the 105th Congress, identifies three major goals for the organization: nurse advocacy, ensuring that the RN "is an essential provider in all practice settings through education, research, collective bargaining, work-place advocacy, legislation and regulation"; access to quality health care for everyone living in the United States, "with particular attention given to proposals that will move towards the goal of 100 percent universal health care coverage for all U.S. citizens and residents"; and ANA/SNA viability, ensuring that the "ANA and the SNAs as multipurpose organizations will continue to be strong and effective at the national and state levels."

GROUP RESOURCES

The ANA's Web site (http://www.nursingworld.org) includes press releases, position statements, and fact sheets on various issues and activities. Information on the ANA can also be obtained by contacting the organization's communications department at 1-800-274-4262. A good way to learn about current ANA political and professional concerns is to consult issues of the monthly American Journal of Nursing. Federal government financial data on ANA-PAC and other PACs is provided by the Web site of the Center for Responsive Politics (http://www.crp.org).

GROUP PUBLICATIONS

The ANA's flagship periodical, the American Journal of Nursing, is sent monthly to every ANA member and can be found in public as well as medical libraries. It covers clinical, professional, and political topics. The American Nurse, also distributed to the entire ANA membership, is a bimonthly newspaper that focuses on political and organizational matters. Capitol Update and Nursing Trends & Issues are specialized newsletters available by subscription. There is also an Online Journal of Issues in Nursing. American Nurses Publishing, the publications arm of the American Nurses Foundation (an ANA affiliate), sells brochures, fact sheets, and books on many aspects of nursing. A catalog is available by telephoning 1-800-637-0323.