Iowa Nurses Association
Resolution Titles 2004

1. Safe Staffing in Acute Care Facilities (update 1994)
2. Transforming the Work Environment (new-ANA)
3. Culture for an Effective Work Environment (Revised 1994)
4. Revision of Dependent Adult Abuse System (new)
5. Patient Safety and Prescription Drugs (new-ANA/Iowa)
6. Protecting the Rights of Individual ANA members (new-ANA)
7. INA/ANA Membership Options (new-ANA)
8. ANA Dues Escalator (new-ANA)
9. INA Dues Increase (new)
10. Funding Center for Workforce Planning (new)
11. Criminal History Use of Alcohol and Drugs (Revised 1994)
12. Care for Persons with Mental Illness
13. Violence in the Schools/Bullying (Revised 1999)
14. Liability of Nurses in a Disaster (new)

WHEREAS, there has been prominent research on RN staffing levels and safe patient care, and

WHEREAS, there has been prominent research on RN staffing levels and burnout, job satisfaction and nurse retention, and,

WHEREAS, by increasing RN staffing levels and thereby lowering the patient-to-RN ratio, hospitals decrease the risk of unsafe patient care and reduce RN turnover rates; therefore, be it

RESOLVED, that INA support legislation that requires hospitals to develop staffing plans to ensure that RN staff is allocated to provide adequate, appropriate, and quality delivery of healthcare services; and be it further

RESOLVED, that INA supports legislation that protects RNs by allowing them to have input on staffing that potentially violate minimum safe patient-to-RN ratios; and be it further

RESOLVED, that INA supports legislation that protects RNs by allowing them to object to assignments that violate minimum safe patient-to-RN ratios; and be it further

RESOLVED, that INA encourage and work with hospitals applying for Magnet Status as granted by the American Nurses Credentialing Center (ANCC).

IMPLEMENTATION STEPS:
1. Encourage staff nurses to pursue actions to document unsafe staffing situations.
2. Publish an article for the Iowa Nurse Reporter.
3. Explore the alternatives for sharing information on this issue with hospital administrations and trustees.
4. Prepare an article about Magnet Status as granted by the American Nurses Credentialing Center (ANCC) for publication in the Iowa Association of Nursing Students (IANS) newsletter.

Priority: High

WHEREAS, it is essential that work environments are designed to support the professional practice and patient safety priorities of registered nurses and the safety and health of registered nurses; and

WHEREAS, work environments should include: -- Organizational cultures that support a commitment to safety and continuous learning as well as an awareness of the safety implications resulting from fatigue, insufficient nurse staffing, deployment of inexperienced staff to unfamiliar areas, and decisions made without direct care registered nurse staff

-- Work processes and workspaces designed to reduce the incidence of errors and injuries to improve the detection and prevention of errors and injuries so that appropriate interventions can be made

-- Nursing staff of sufficient number and experience who communicate effectively and work collaboratively with all members of the healthcare team

-- A management philosophy and practices based on evidence that is capable of transforming policies and practices to create a culture of safety; and

WHEREAS, the American Nurses Association and the Iowa Nurses Association has long had as organizational priorities nurse staffing, patient outcomes, patient safety, prohibition on overtime, improper floating, professional autonomy and recruitment and retention of nurses, and the American Nurses Association and Iowa Nurses Association has also testified on the role these factors play in the delivery of safe, quality care and in the professional satisfaction of nurses;

WHEREAS, the Institute of Medicine (IOM) has recently released a report, Keeping Patients Safe; Transforming the Work Environment for Nurses, which builds on both To Err is Human (2000) and Crossing the Quality Chasm (2001) and outlines strategies to implement key recommendations from those reports to build work environments more conducive to patient safety; and

WHEREAS, registered nurses are active at the local, state, and federal level lobbying for policies required to improve the environment of care and the outcomes for patients and a safer work environment; therefore be it

RESOLVED, that the Iowa Nurses Association support the IOM recommendations outlined in Keeping Patients Safe: Transforming the Work Environment of Nurses as a guide for establishing research, safety and quality of care policy priorities, legislative initiatives and contract language; and be it further

RESOLVED, that the Iowa Nurses Association reaffirm the strategies and objectives identified by the nursing community in Nursing's Agenda for the Future as pivotal to improving working conditions and creating safe environments for patients and nurses; and be it further

RESOLVED, that the Iowa Nurses Association assist in disseminating the American and Iowa Nurses Association position on evidence-based research and practices that update and expand on the original IOM recommendations.

IMPLEMENTATION STEPS:
1. Article for Iowa Nurse Reporter
2. Explore dissemination of information

Priority: Medium

WHEREAS, it is the responsibility of the Iowa Nurses' Association to promote and protect the right of each and every member, including the opportunity to contribute to and influence the professional activities of the Association; and

WHEREAS, the participation of all members is essential to fulfill the multipurpose function of the professional association; and

WHEREAS, leadership and management are key to the changes required to create a nursing work environment that enhances patient safety, including comprehensive policies and practices to transform the ways nurses work and their physical workspace, ways to enhance the capacity of the nursing workforce, and approaches to instilling the culture of safety that permeates all aspects of the organization; and

WHEREAS, participation in the professional association by nurses in management positions is necessary for the vitality of the organization; therefore be it

RESOLVED, that the Iowa Nurses' Association monitor trends which are developing relative to employment situations of nurses who function in supervisory positions and provide ongoing support in dealing with such situations; and be it further

RESOLVED, that the Iowa Nurses' Association actively support and protect nurses in management positions right to participate as members of the Association; and be it further

RESOLVED, that this 2004 meeting of the Iowa Nurses' Association membership remain a multi-purpose organization.

IMPLEMENTATION STEPS:
1. Work with the Iowa Organization of Nurse Leaders (IONL) to offer joint educational programming related to patient safety and quality outcomes for staff nursing leaders and nursing managers.
2. Work with Iowa Organization of Nurse Leaders to develop a learning collaborative that identifies evidenced-based management practices and methods for implementation.
3. Advocate for a discussion group that will include management and staff nurse leaders.

Priority: High

WHEREAS, current law allocates authority for investigation of Dependent Adult Abuse in two different agencies (Department of Human Services and Department of Inspection & Appeals), that at times are applying different standards to similar types of information, and have been known to use different legal approaches to the litigation of such allegations, resulting in inconsistencies; and

WHEREAS, Dependent Adult Abuse is an issue which has been subject to increased reporting in Fiscal Year 2003; and

WHEREAS, coalitions advocating changes in the current Dependent Adult Abuse system have been meeting to work on legislative changes, and were successful in 2004 in changing the reporting time frame, as well as the individual who is ultimately accountable to report such abuse; and

WHEREAS, some approaches for resolving Dependent Adult Abuse have suggested imposing more liability on the nurse or other caretaker who is assigned to the dependent adult and often multiple other dependent adults, for any injury sustained by the dependent adult; and

WHEREAS, there is currently a shortage of nurses and other health care providers to render services to the elderly; and

WHEREAS, imposing harsh penalties on nurses and other caretakers for incidents resulting in injury to a dependent adult will ultimately make nurses and other caretakers less willing to care for the dependent adult, which places the dependent adult in a more vulnerable position; and

WHEREAS, current legal framework does not seek to be rehabilitative for caretakers who could learn different approaches to better manage their own behavior, in dealing with some instances of Dependent Adult Abuse; therefore be it

RESOLVED, that the Iowa Nurses Association participate in coalitions to assist in providing input into improving the current dependent adult abuse system; and be it further

RESOLVED, that the Iowa Nurses Association support legislation supporting a single system for investigating and prosecuting Dependent Adult Abuse; and be it further

RESOLVED, that the Iowa Nurses Association support efforts to be rehabilitative to health care workers to learn better ways to manage their own behavior when dealing with difficult dependent adults; and be it further

RESOLVED, that the Iowa Nurses Association honor and support those nurses who daily care for dependent adults and acknowledge their dedication and professionalism to stay in a specialty of their choice even with daily threats of liability.

Implementation Steps
1. Publish an article in the Iowa Nurse Reporter.
2. Initiate legislation for a single system for investigation.

Priority: High

WHEREAS, the unit dose medication administration system was developed more than twenty years ago for hospital settings as a means of increasing the efficiency and lowering the rate of errors during medication administration; and

WHEREAS, unit dose dispensing has steadily grown to a point that it is the established standard nationwide in long-term care; and

WHEREAS, unit dose dispensing now constitutes a standard for approval for by the Joint Commission on Accreditation of Hospitals (JCAHO) and is recommended by the Institute of Medicine, National Patient Safety Partnership, American Society of Health-System Pharmacists, National Coordinating Council for Medication Error Reporting and Prevention, The Institute for Healthcare Improvement and the National Coordinating Council for Medication Error Reporting and Prevention; and

WHEREAS, the Veteran's Administration is requiring that residents of long term care facilities have their medications in 90-day bulk supplies, and

WHEREAS, pharmacy benefit managers are granting benefits to subscribers of health insurance and long-term care insurance products that require their pharmacy be supplied in 90-day bulk supply; and

WHEREAS, the pharmaceutical industry has been successful in preventing legislation that would allow negotiations for lower prices for government insurance programs,

WHEREAS, family members are desiring to reduce resident's long-term care costs by bringing in drugs from international countries rather than using the local pharmacist which provides long-term care facility prescriptions in unit dose; and

WHEREAS, a preliminary cost-analysis to individual residents or tenants has not likely been balanced with neither the wastage costs when an individual has received their bulk stock medications, and the physician, advanced registered nurse practitioner or physician assistant may have changed the dosage or prescription type, nor the staffing costs for assistance in medication administration; and

WHEREAS, the registered nurse is the last line of defense in carrying out a prescribed medication administration regimen; therefore be it

RESOLVED, that the Iowa Nurses Association will 1. Advocate for patient safety in the use of medications, especially in the long-term care settings due to the increased financial pressure of prescription drug costs. 2. Support efforts to raise awareness of the impact of pharmaceutical cost containment efforts on potential patient safety.

IMPLEMENTATION STEPS:
1. Monitor and advocate on state legislation that addresses patient safety and pharmaceutical issues in all areas of health care delivery.
2. Publish an article in the Iowa Nurse Reporter on the issues.
3. Explore ways to educate the consumer.

Priority: High

WHEREAS, the American Nurses Association has long held the organizational norm that the members of the Constituent Member Associations (CMAs) should enjoy full participatory rights in the American Nurses Association by virtue of the payment of their dues to ANA through the CMA; and

WHEREAS, individuals choose to belong to their CMA because they want to belong to both the state association and their national professional association, the American Nurses Association; and

WHEREAS, the ANA Bylaws require CMAs to "protect individual members' right to participate in the CMA." (Article II, Section 1.c.1.c); and

WHEREAS, Article II, Section 1.c.1.a of the ANA Bylaws states that it is a CMA responsibility to include in its bylaws the obligation of the CMA to pay dues to the ANA in accordance with policies adopted by the ANA House of Delegates; and

WHEREAS, permitting a small percentage of members to take away the rights and privileges of ANA membership from the vast majority of the members of a CMA who may not support disaffiliation is fundamentally unfair to the members; therefore be it

RESOLVED, that the Iowa Nurses Association be responsible to ANA for the payment of dues in accordance with this policy until such time that 2/3 of the entire CMA membership vote to disaffiliate from ANA. "Constituent Member Association (CMA) membership," for these purposes, is defined as individual members of the CMA who have ANA rights and privileges of membership as a result of their CMA membership; and be it further

RESOLVED, that the Iowa Nurses Association inform the state membership of their need to ensure compliance with this ANA House of Delegates policy change.

IMPLEMENTATION STEPS:
1. Publish an article in the Iowa Nurse Reporter

Priority: High

WHEREAS, The American Nurses Association (ANA) has created three membership options available to the Iowa Nurses Association (INA) members, (INA/ANA, ANA-only, or INA-only), and

WHEREAS, the INA has not made a determination to exercise its option to allow ANA-only or INA-only membership, and has retained the dual INA/ANA membership option, and

WHEREAS, the Iowa Nurses Association values accessibility to the organization by potential members, and

WHEREAS, those INA members holding office in ANA are to be ANA members in good standing, and

WHEREAS, the INA President is automatically a Delegate to ANA Convention when elected, and

WHEREAS, those representing INA in the state and national levels are expected to retain local INA membership, therefore be it

RESOLVED, that INA exercise its option to allow ANA-only, INA-only, and dual INA/ANA membership options, and be it further

RESOLVED, that nurses nominated for, elected, or appointed to ANA office shall hold dual membership in INA and ANA and be in good standing with both throughout the term of office, and be it further

RESOLVED that nurses nominated for, elected or appointed to INA state and/or regional level office shall hold membership in INA as a minimal requirement to serve.

IMPLEMENTATION STEPS:

1. Assign revision of the Bylaws to the INA Bylaws Committee to reflect the changes in membership options.
2. Publish an article in the Iowa Nurse Reporter.

Priority: High

WHEREAS, the 2001 ANA House of Delegates has charged the ANA Board of Directors to establish a process of on-going financial needs analysis and advise the House of Delegates every three (3) years or more frequently, if necessary, regarding the need for a dues increase; and

WHEREAS, the increase to the dues conversion factor passed in 2001 to offset the erosion of the purchasing power of ANA's dues dollars by inflation since the last increase in 1989, but it did not build in any cushion to offset the future impact of inflation; and

WHEREAS, inflation has continued to rise since the implementation of the increase of the dues conversation factor passed in 2001 and is expected to continue; and

WHEREAS, membership dues are ANA's primary revenue source, accounting for approximately 70% of its income; and

WHEREAS, without an escalator to offset the impact of inflation, programmatic reductions that will impact basic core issue work will be necessary to balance the budget, therefore be it

RESOLVED, that the Iowa Nurses Association comply with the Assessment of ANA Dues from Constituent Member Associations so that the ANA Assessment Factor will be increased automatically, based on the Consumer Price Index for Urban Consumers (CPI-U), (but not to go below 0% or to exceed 2% per annum) without requiring additional authorization of the ANA House of Delegates; and that this dues escalator will be calculated on an annual basis, implemented every three years and rounded to the nearest dollar; and be it further

RESOLVED, that the initial increase based on this escalator clause will be effective January 1, 2005 and will be computed using the 12 months percentage change from June to June for the period June 2001 through June 2004 with notification of the exact amount of the increase to the state in August 2004 and will sunset in 2010.

IMPLEMENTATION STEPS:
1. Article in Iowa Nurse Reporter
2. Take steps to comply with ANA dues

Priority: High

WHEREAS, the American Nurses Association is proposing a dues increase of fifty cents a month ($6/year); and

WHEREAS, it is administratively easier to make one change in the unified dues structure, particularly for those members on payroll deduct; and

WHEREAS, in preparation of the Iowa Nurses Association annual budget the Finance Committee is continually faced with the increased cost of doing business and assuring that the organization maintains financial viability; and

WHEREAS, for the last two fiscal years the Regions have voluntarily agreed that the state office maintain one dollar and twenty-five cents per member per quarter in the state accounts that would otherwise be transmitted to the Region accounts; and

WHEREAS, membership dues are the Iowa Nurses' Association primary revenue source, accounting for approximately 60% of its income; therefore be it

RESOLVED, that the Iowa Nurses Association increase the state dues to the membership by fifty cents a month ($6/year); and be it further

RESOLVED, that the Iowa Nurses Association state office retain permanently the one dollar and twenty-five cents per member per quarter ($5/year) in the state treasury; resulting in the Region receiving two dollars and fifty cents per member per quarter ($10/year).

IMPLEMENTATION STEPS:
1. Article in Iowa Nurse Reporter
2. Take steps to comply with dues increase

Priority: High

WHEREAS, accessing and forecasting health workforce supply and demand; addressing barriers to recruitment and retention; supporting strategies developed at the local level; engaging in activities that promote and assure a viable, diverse health workforce in Iowa are supported by the creation in 2002 of the Center for Health Workforce Planning in the Iowa Department of Public Health's Bureau of Health Care Access; and

WHEREAS, the Center is important to health of Iowans because it assists a broad spectrum of health workers and consumer access to unbiased information about current and projected workforce needed to meet the health needs of all Iowans; creates data-based position papers, issue briefs and calls to action that build upon Iowa surveys and forecasting groups and can be used to effect public policy and legislative changes; and builds new collaboratives to transform Iowa into one healthy community served by a sustainable, diverse and competent workforce; and

WHEREAS, the Center has accomplished its mission by funding local initiatives to recruit and retain nurses and nursing personnel; assisting local experts to share best strategies to build health workforce in Iowa; incorporating registered nurses into an existing state inventory of health professions that include physicians, dentists, pharmacists, physician assistants and advanced registered nurse practitioners; and expanding activities to new categories of health workers at-risk for shortage; and

WHEREAS, the work of the Center can be sustained in the Iowa Department of Public Health after July 31, 2005 by appropriating general fund monies; therefore be it

RESOLVED, that the Iowa Nurses Association request that the Iowa General Assembly fund the Iowa Center for Health Workforce Planning; and be it further

RESOLVED, that the Iowa General Assembly assure funding to complete and sustain the Center's activities related to the Office of Statewide Clinical Education Program (OSCEP) work on the RN Tracking Inventory beyond July 31, 2005.

IMPLEMENTATION STEPS:
1. Educate nurses regarding the reports of the Center in various modes of communication.
2. Publish an Iowa Nurse Reporter article on the issue.
3. Request legislative appropriation to maintain 100% of licensing fees for the Iowa Board of Nursing and Center for Health Workforce Planning activities.

Priority: Medium to High

WHEREAS, the majority of nurses or nurse applicants with a criminal history have committed a crime involving the misuse of alcohol or drugs; and

WHEREAS, there are registered nurses in the State of Iowa whose functioning is impaired because of misuse of alcohol and drugs; and

WHEREAS, the membership of the Iowa Nurses' Association recognizes its professional responsibility to colleagues and to those they serve; and

WHEREAS, misuse of alcohol and other drugs does impair the individual's ability to meet the requirements of the Code for Nurses; and

WHEREAS, timely and effective intervention can contribute to the restoration to health of the nurse, the maintenance of standards for nursing practice, adherence to the Code for Nurses and the safety of the public; therefore, be it

RESOLVED, that the Iowa Nurses' Association support legislative and rule making activity which would provide for obtaining and review of criminal history felony background check of nurse applicants by the Iowa Board of Nursing; and

RESOLVED, that the Iowa Nurses' Association support monitoring or practice restriction of nurses deemed able to safely enter the practice of nursing by the Board of Nursing, and be it further

RESOLVED, that the Iowa Nurses' Association explore with the Board of Nursing the idea of providing educational workshops for RNs on the disease of alcoholism; and be it further

RESOLVED, that the Iowa Nurses' Association encourage schools of nursing to have the family disease of alcoholism as part of their curriculum to prepare the professional nurse to recognize the signs and symptoms of the disease in co-workers and patients.

IMPLEMENTATION STEPS:
1. Participate in the Board of Nursing's committee to implement the regulation.
2. Publish an article in the Iowa Nurse Reporter.
3. Explore the possibility for mechanisms for rehabilitation of impaired nurses in the Iowa Code.

Priority: Medium

WHEREAS, housing services for persons with severe mental illness are becoming increasingly scarce due to recent trends in mental health care within Iowa; and

WHEREAS, state mental hospital beds have been severely cut and length of stay in acute care hospitals has been reduced to 3-5 days; and

WHEREAS, a significant number of residential care facilities, Iowa's primary care settings for those with mental illness have been downsized and closed; and

WHEREAS, deinstitutionalization has resulted in homelessness and imprisonment for those with severe mental illness because there is nowhere else to go; and

WHEREAS, untreated medical illnesses, substance abuse, and suicide are commonplace among the mentally ill; and

WHEREAS, there is an increase in the use of expensive emergency services and an increased number of acute hospitalizations; and

WHEREAS, two-thirds of persons with severe mental illness are cared for by aging parents; and

WHEREAS, the federal and state requirements for mandated trial reduction of antipsychotic medications in facilities can cause unstable behavior putting clients in care facilities at risk; and

WHEREAS, lack of housing and services cause unnecessary suffering and stress on clients, families and an increase in direct and indirect costs for society, therefore be it

RESOLVED, that INA promote dissemination of information on the housing and service needs of persons with severe mental illness who require care; and be it further

RESOLVED, that INA promote the importance of community-based congregate housing with on-site professionals services for those who are severely ill; and be it further RESOLVED, that INA advocate for examination of this issue on the state level through the establishment of a statewide task force on care for persons with severe mental illness.

IMPLEMENTATION STEPS:
1. Heighten public awareness through education in the media
2. Promote legislation and other community initiatives for appropriate housing for persons with severe mental illness as an integral part of their health care
3. Collaborate with groups of involved professionals on long-term care for persons with severe mental illness.
4. Publish an article in the Iowa Nurse Reporter.

Priority: Medium to High

WHEREAS, the nature of violence in our society goes beyond the walls of our schools in that children have always suffered the effects of some forms of violence, ranging from bullying to physical or sexual abuse, assault or murder; and

WHEREAS, there has been an increase in the last decade of the amount of research done to identify and prevent commission of violence against children (Hawker and Boulton, 2000); Smith and Brain, 2000); and

WHEREAS, the dramatic escalation in incidents of violence has created a sense of urgency in our society and there is common agreement that schools should be "safe zones" and adopt positions of no tolerance for weapons, crime and violence, but rather schools and communities must thoughtfully plan to proactively change behaviors in their quest to create a positive, healthy and safe environment; and

WHEREAS, peer bullying, the dynamic and repetitive persistent patterns of verbal and/or non-verbal behaviors directed by one or more children on another child that are intended to deliberately inflict physical, verbal or emotional abuse in the presence of a real or perceived power differential, is significant problem for approximately 8-14% of youth and is deleterious to their mental health and well-being (Bernstein & Watson, 1997; Nansel et al, 2001); and

WHEREAS, school nurses must be able to readily identify those who bully and those who are at-risk for or have experienced bullying; early identification by school nurses will effectively assist children in breaking potential cycles of violence, lessen vulnerability, help overcome adversity, become more resilient and rebound from bullying attempts without psychological harm; and

WHEREAS, the school health office is viewed as a "safe harbor" by students, school nurses can be among the first to identify at-risk or bullied students and distinguish such experience from minor health complaints by assisting students in developing problem solving and conflict resolution techniques, coping and anger management skills and a positive self-image; therefore be it

WHEREAS, that Iowa schools and communities must work together to foster safe school environments through the reduction of violence by zero tolerance for weapons, focus on anger management, introduction of counseling and peer mediation programs and development of programs to address the need for problem-solving and conflict resolution skills; and be it further

WHEREAS, that all school personnel play an important role in creating a safe school environment by being provided training in bullying prevention strategies.

RESOLVED, that the Iowa Nurses Association advocate for and support school nurses as active members of crisis intervention teams and curriculum committees and be involved in the development and planning of intervention and prevention programs; and be it further

IMPLEMENTATION STEPS:
1. Educate nurses regarding the issue in various modes.
2. Publish an article in the Iowa Nurse Reporter.
3. Request legislative action.
4. Advocate for a school nurse in all school buildings.

Priority: Medium

WHEREAS, catastrophic response plans are being developed for Iowa and throughout the nation; and

WHEREAS, volunteers are being solicited from among health professionals; and

WHEREAS, nurses are being recruited to volunteer in the event of a disaster, be it terrorism, bioterrorism, or other wide spread damages; and

WHEREAS, nurses may be asked to administer and/or dispense medications and vaccines, and to provide direct care to victims; and

WHEREAS, Iowa Code Chapter 613.17 (often referred to as the "Good Samaritan Act") covers individuals who in good faith render emergency care or assistance without compensation, but is not applicable to disasters; and

WHEREAS, some Iowa counties do protect health professionals when they are being compensated for services and some Iowa counties do not; and

WHEREAS, the nurse may be at risk when practicing in a disaster setting; therefore

RESOLVED, that the Iowa Nurses Association communicate to the Iowa Department of Health their concern regarding the liability of the RN when volunteering their services in the event of a disaster; and

RESOLVED, that the Iowa Nurses Association seeks legislation, regulation or a public policy statement to protect the RN who volunteers his/her services in a declared disaster from individual liability in the performance of these services when requested to do so by city, county, state or the federal government.

IMPLEMENTATION STEPS:
1. Educate the membership about the issue in the Iowa Nurse Reporter.
2. Seek legislative or regulatory resolution of the issue in discussions with the Department of Public Health.

Priority: Medium

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