2000 resolutions

• Resolution #1: Adequate and Appropriate Nurse Staffing
• Resolution #2: Reduction of Patient Restraint and Seclusion in Health Care
• Resolution #3: Restraint of Trade Against ARNPs
• Resolution #4: Building Safer Health Care Systems
• Resolution #5: Professional Practive Advocacy
• Resolution #6: Comprehensive Tobacco Control Program
• Resolution #7: Infant and Child Restraints on Airplanes
• Resolution #8: Chemical Dependence Treatment
• Resolution #9: Domestic Abuse Prevention, Awareness, and Intervention
• Resolution #10: Groundwater Contamination
• Resolution #11: Midwifery in Iowa
• Resolution #12: ARNP Pronouncement of Death
• Resolution #13: Feedback to Mandatory Reporters
• Resolution #14: Holistic Health Care

Resolution #1

Adequate and Appropriate Nurse Staffing

Submitted by American Nurses Association House of Delegates - Author, Lynn Boes

WHEREAS, the Institute of Medicine (IOM) Report "To Err is Human: Building a Safer Health System," released November 1999 brought attention to the questionable quality of health care delivered in the United States; and

WHEREAS, recent research suggests important linkages between nurse staffing and adverse patient care outcomes (American Nurses Association, May 2, 2000; Korner, 1998); and

WHEREAS, many nurses across the country are concerned about the inadequacies of staffing and are struggling with excessive and unsafe overtime work to meet patient care needs; and

WHEREAS, some health care entities in Iowa are facing nursing shortages, resulting in nurses working overtime; and

WHEREAS, fatigue in nurses from overtime and other factors can adversely impact decision-making; therefore be it

RESOLVED, that Iowa Nurses' Association make available upon request information on Assignment Despite Objection (ADO) forms; and be it further

RESOLVED, that Iowa Nurses' Association make available upon request the American Nurses Association Principles for Nurse Staffing; and be it further

RESOLVED, that Iowa Nurses' Association communicate to the hospital, nursing home and home care associations their concern regarding adequate and appropriate nurse staffing.

Proposed Implementation Activities:

1. Provide information upon request to individual nurses.

2. Communicate Iowa Nurses' Association position to the Iowa Hospital Association, the Nursing Home Association, and the Home Care Association their concern regarding adequate and appropriate nurse staffing.

3. Present education on this issue at the annual convention.

Proposed cost: $250. Proposed priority: 5 (highest)

Resolution #2

Reduction of Patient Restraint and Seclusion in Health Care Settings

ANA House of Delegates - Author, Judy Collins

WHEREAS, a fifty state survey conducted by the Hartford (Connecticut) Courant newspaper in 1998 revealed at least 142 deaths related to use of physical restraint or seclusion since 1988 (Weiss 1998); and

WHEREAS, nursing has a history of involvement in attempts to reduce the use of restraint going back over 100 years; and

WHEREAS, when restraint was employed in the past, it was in the belief that such action would promote patient and staff safety; and

WHEREAS, the danger of employing restraint and seclusion has been demonstrated to be problematic; and

WHEREAS, there is a strong interest in monitoring the use of restraint/seclusion in both the regulatory and legislative arenas; and therefore be it

RESOLVED, that Iowa Nurses' Association promote the dissemination of a nursing position statement on patient restraint and seclusion that provides direction for nursing practice to be developed by the American Nurses Association in collaboration with other nursing specialty organizations; and be it further

RESOLVED, that Iowa Nurses' Association advocate for:

1. legislative and regulatory remedies,

2. more research and education to explore patient safety factors and enable the use of least restrictive interventions,

3. sufficient staff with necessary competencies to perform safe restraint/ seclusion use and behavior management.

Proposed Implementation Activities:

1. Publish and disseminate the position statement on patient restraint and seclusion through the Iowa Nurse Reporter and any other communication means.

2. Work with specialty nursing organizations to educate Iowa’s nurses regarding practice guidelines related to restraint/seclusion use in varying care levels and populations.

Proposed cost: $250. Proposed priority: 4 (mid-high)

Resolution #3

Restraint of Trade Against ARNPs

ANA House of Delegates - Authors, LaVone Sopher and Lynn Boes

WHEREAS, over the past three decades, research has continued to demonstrate that advanced registered nurse practitioners (ARNPs) have established and built upon a record of delivering quality health care (Mundinger, 2000); and

WHEREAS, great strides have been made in recent years to establish ARNPs as independent providers of health care services; and

WHEREAS, the Balanced Budget Act of 1997, section 4511 (Public Law 105-33) provided for the direct reimbursement to nurse practitioners (NPs) and clinical nurse specialists (CNSs) in all geographic locations and practice settings while these nurses function within their scope of practice and in collaboration with physicians (as state law defines these terms); and

WHEREAS, despite these achievements there are continuing indications that ARNPs face significant barriers in the health care marketplace that, in part, could be considered restraint of trade; and

WHEREAS, anesthesiologists have placed large advertisements in Iowa newspapers disparaging certified registered nurse anesthetists (CRNAs); and

WHEREAS, the American Medical Association (AMA) has drafted a Citizen’s Petition seeking to have the Health Care Financing Administration (HCFA) impose detailed prescriptive and restrictive requirements on ARNP practice that were never envisioned under federal law; and

WHEREAS, these attempts to place barriers to access ARNP services will adversely effect health care delivery in Iowa; therefore be it

RESOLVED, that Iowa Nurses' Association work collaboratively with ARNPs across Iowa to identify and address attempts to limit the scope of ARNP practice and reimbursement; and be it further

RESOLVED, that Iowa Nurses' Association make materials available to parties addressing the restraint of trade issue.

Proposed Implementation Activities:

1. Contact other Iowa ARNP organizations/groups to effectively educate and involve ARNPs on this issue.

2. Identify positions of the Iowa Medical Society, Iowa Osteopathic Medical Association, the Iowa Academy of Family Physicians and other groups that may seek to restrain the practice of ARNPs.

3. Identify and monitor other barriers to ARNP practice, i.e., insurance companies, HCFA and state rules for Medicare and Medicaid.

4. Develop strategies to counteract positions in opposition to ARNPs.

Proposed cost: $500-$1,000. Proposed priority: 5 (high)

Resolution #4

Building Safer Health Care Systems

Submitted by American Nurses Association House of Delegates - Authors, Carol Fetters Anderson and Mary Malone

WHEREAS, medical errors end the life of 44,000 people in US hospitals each year (Cook, Woods and Miller, 1998 and Brennan, Leape, Laird, et.al., 1991); and

WHEREAS, the American Medical Association in 1999 estimated that more than 98,000 persons were killed by medical errors; and

WHEREAS, medical errors and adverse patient incidents include: transfusion and medication errors, equipment or device failure, wrong site surgery, preventable suicides, falls, burns and mistaken identity; and

WHEREAS, errors may be more easily detected in hospitals, they occur in every health care setting: day surgery and outpatient clinics, retail pharmacies, nursing homes, and home care; and

WHEREAS, a systems approach, which includes adequate and appropriate staffing is absolutely integral to the reduction of patient errors and adverse incidents; therefore be it

RESOLVED, that Iowa Nurses' Association promote awareness among the public and policymakers about the effects of health care system downsizing, restructuring and reorganization which undermines the quality and safety of patient care; and be it further

RESOLVED, that Iowa Nurses' Association support the Institute of Medicine (IOM) recommendations regarding patient safety; mandatory state-based error reporting system; implementation of non-punitive systems that do not blame individuals for reporting and analyzing errors with Iowa healthcare organizations; and implementation of proven medication safety systems and practice by healthcare organizations; and be it further

RESOLVED, that Iowa Nurses' Association evaluate the need for passage of whistleblower legislation in Iowa that protects the essential role of nurses in efforts to correct system errors; and be it further

RESOLVED, that Iowa Nurses' Association work the with Iowa Hospital Association and regulatory bodies to reduce the culture of blame related to health care errors and encourages system safety that minimizes risk of errors.

Proposed Implementation Strategies:

1. Participate in coalition meetings to evaluate whether Iowa should have mandatory or voluntary reporting system on medical errors.

2. Educate nurses regarding reporting of medical errors in a "blame-free" environment.

3. Gather information on and evaluate the need for passage of whistleblower legislation.

Proposed cost: $500. Proposed priority: 5 (highest)

Resolution # 5

Professional Practice Advocacy

Revision of Resolution #1 from 1990 and #16 from 1975 MAINTAIN THE VISIBILITY OF THE ECONOMIC AND GENERAL WELFARE PROGRAM - Author, Mary Malone

WHEREAS, the American Nurses Association has modified the bylaws of the association to create a United American Nurses (UAN) and a Workplace Advocacy Commission (WPAC); and

WHEREAS, the Iowa Nurses’ Association is a member of the United American Nurses (UAN) of the American Nurses Association and the Workplace Advocacy Commission of the American Nurses Association; and

WHEREAS, it is the responsibility of Iowa Nurses' Association Economic and General Welfare program to provide economic and general welfare service to members of the Iowa Nurses’ Association; and

WHEREAS, it is the right for each person to exercise their rights under

1. The National Labor Relations Act,

2. The Iowa Public Employee Relations Act, and

3. The Federal Executive Orders; and

WHEREAS, the Iowa Nurses’ Association educates members regarding workplace advocacy and advise them on their rights and effective strategies; therefore be it

RESOLVED, that the Economic and General Welfare program continue to inform nurses of the economic and general welfare benefits of membership in Iowa Nurses’ Association, and be it further

RESOLVED, that the Economic and General Welfare program representatives continue to assist the nurses in local health care settings to organize local units for bargaining and be it further

RESOLVED, that Iowa Nurses' Association continue to conduct workplace advocacy programs responsive to individuals or groups.

Proposed Implementation Activities:

1. Maintain the current Economic and General Welfare program.

2. Disseminate information from the American Nurses Association on workplace advocacy programs as it becomes available.

Proposed cost: E&GW program amount, plus $250. Proposed priority: 5 (highest)

Resolution # 6

Comprehensive Tobacco Control Program

Revision of Resolution #13 from 1990 - Author, Karen Fread

WHEREAS, Iowa Nurses’ Association is committed to health and prevention of illness; and

WHEREAS, a significant number of teenagers begin to smoke each day, and have related health and social problems; and

WHEREAS, Iowa Nurses' Association is a member of the Tobacco Free Coalition; and

WHEREAS, Iowa’s tobacco settlement funds were appropriated for health care including a $9.3 million for a comprehensive tobacco control program; therefore be it

RESOLVED, that Iowa Nurses' Association participate in activities that assure implementation of a comprehensive tobacco control program that addresses the needs of all Iowans; and be it further

RESOLVED, that Iowa Nurses' Association continue to support appropriation of all tobacco settlement moneys for health care.

Proposed Implementation Activities:

1. Monitor the implementation of comprehensive program.

2. Submit names to serve on advisory committee.

3. Lobby in support of the issue.

Proposed cost: Budgeted staff time. Proposed priority: 5 (highest)

Resolution # 7

Infant and Child Restraints on Airplanes

Revision of Resolution #5 from 1990 - Authors, Deb Tarara and Karen Fread

WHEREAS, It has been demonstrated that restraint devices save lives in accidents; and

WHEREAS, Car and airplane accidents have demonstrated that restrained infants and children are protected from the full effects of accident and injury; and

WHEREAS, Recent efforts by child protection groups are targeting child and infant restraints in airplanes; and therefore be it

RESOLVED, That the Iowa Nurses’ Association supports efforts to encourage infant and child restraint regulations on airplanes, and be it further

RESOLVED, That the Iowa Nurses’ Association communicates this resolve to major airlines and their regulatory bodies, and Iowa’s Congressional Delegation.

Proposed Implementation Activities:

1. Communicate to major airlines encouraging child restraints on airplanes.

2. Support federal legislation or regulation for child restraints on airplanes

3. Educate parents to use restraint devices in accordance with manufacturer’s recommendations.

Proposed cost: $100. Proposed priority: 1 (lowest)

Resolution # 8

Chemical Dependence Treatment

Revision of Resolution #10 from 1990

RESOURCES FOR THE TREATMENT OF DRUG ADDICTION - Authors, Julie Terrell and Judy Collins

WHEREAS, it is widely held that chemical dependence is a disease process, often responsive to treatment; and

WHEREAS, society’s current response to chemical dependence is criminal punishment of the individual, without addressing the underlying public health problems of addiction; and

WHEREAS, a great number of chemically dependent individuals have also been diagnosed with a mental illness (dual diagnosis); and

WHEREAS, an inadequate number of treatment options exist including residential treatment and long-term follow-up care for all chemically dependent persons, particularly those treatments which are sensitive to the needs of dual diagnosis clients; therefore, be it,

RESOLVED, that Iowa Nurses' Association educate membership to the nature of this crisis in care; and be it further

RESOLVED, that Iowa Nurses’ Association will lobby for and support legislation for parity in mental health including increased services for chemical dependence; and be it further

RESOLVED, that Iowa Nurses’ Association will work with organizations and individuals committed to establish a comprehensive treatment response to the multifaceted problem of chemical dependence.

Implementation Activities

1. Educate the membership to the crisis of criminalization of chemically dependent dually diagnosed individuals.

2. Support legislation that supports parity in mental health including increased services for chemical dependency.

3. Participate in coalitions and task forces that seek a comprehensive treatment response

Proposed cost: $1,500. Proposed priority: 5 (highest)

Resolution # 9

Domestic Abuse Prevention, Awareness, and Intervention

Revision of Resolution #11 from 1990 - Author, Julie Terrell

WHEREAS, Iowans continue to die as a result of domestic abuse; and

WHEREAS, many abuse victims, with or without children, continue to be unable to access to emergency shelters; and

WHEREAS, registered nurses are often the first health care contact to the battered person; and

WHEREAS, domestic abuse is a serious and socially complicated problem; and

WHEREAS, Iowa law does not require mandatory reporting of domestic abuse at this time, therefore, be it

RESOLVED, that the Iowa Nurses’ Association monitor the effectiveness of national and state programs that address all forms of domestic abuse; and therefore be it further

RESOLVED, that Iowa Nurses' Association support initiatives addressing domestic abuse including careful dialogue about the risks and benefits of mandatory reporting.

Implementation Activities:

1. Educate members on domestic abuse initiatives through the Iowa Nurse Reporter and other communication means.

2. Advocate for a domestic abuse shelter in every county whether privately or publicly funded.

3. Dialogue with appropriate stakeholders about feasibility of initiating legislation requiring mandatory reporting of domestic abuse.

Proposed cost: $100. Proposed priority: 5 (highest) 

Resolution # 10

Groundwater Contamination

(Revision of Resolution #3 from 1990)

Authors, Daoka Baccum-Hartman, Stephanie Weddell, and Karen Fread

WHEREAS, during the last decade federal funding for public health and other federal programs have declined and it had been difficult and almost impossible for states and local government to make up the difference; and

WHEREAS, the current health care crisis is in part due to an undervalued and underfunded public health infrastructure; and

WHEREAS, groundwater contamination contributes to widespread illness and death. Increasing episodes of contaminated water supplies to cities is currently jeopardizing our nation’s health. The effects of long term exposure to chemical contaminates of water is not fully known; therefore, be it

RESOLVED, that Iowa Nurses’ Association supports research efforts designed to identify the effect on health of groundwater contamination; and be it further,

RESOLVED, that Iowa Nurses' Association assert a position that the health of the community is secured through the prevention of disease and the promotion of health using the core public health functions of data collection, environmental health, investigation and control of adverse health condition and policy development; and be it further

RESOLVED, that Iowa Nurses' Association recommend nominees for appointment to membership on committees, task forces, and advisory committees dealing with environmental health concerns that will ensure public health benefits to all US residents.

Proposed Implementation Activities:

1. Communicate to the new Environmental Health Director of the Department of Public Health the Iowa Nurses’ Association position on environmental issues and willingness to serve on committees.

2. Support state legislation that addresses improved environmental health.

3. Advise the Iowa Nurses’ Association membership of relevant research in the Iowa Nurse Reporter and other communication means.

Proposed cost: $100. Proposed priority: 1 (low)

Resolution # 11

Midwifery in Iowa

This resolution was not adopted by the INA House of Delegates. The position taken in 1999 stands.

Resolution # 12

ARNP Pronouncement of Death

Authors, Janelle Nielsen and Janice Brown

WHEREAS, advanced nursing education includes the assessment of a patient’s irreversible cessation of spontaneous respiratory and circulatory functions; and

WHEREAS, that irreversible cessation of spontaneous respiratory and circulatory function is a sign and symptom of death; and

WHEREAS, the Iowa Code Chapter 702.8 and the Iowa Administrative Code for the Department of Inspections and Appeals, Chapter 51 "Hospitals" lists physicians as authorized to pronounce death; and

WHEREAS, current practice in Iowa recognizes nurse practitioners as independent practitioners, Iowa Nurses' Association seeks a change in the Iowa Administrative Code, Chapter 51 "Hospitals", Chapter 59 "Skilled Nursing Facilities, and Chapter 58 "Nursing Facilities" to allow advanced registered nurse practitioners to make pronouncement of death in those licensed facilities; therefore, be it

RESOLVED, that Iowa Nurses' Association seek a change in the Iowa Code and Iowa Administrative Code to allow nurse practitioners to provide a pronouncement of death.

Proposed Implementation:

1. Seek a change in the Iowa Code and Iowa Administrative Code for ARNP pronouncement of death.

2. Petition the Iowa Department of Inspections and Appeals for rulemaking to include nurse practitioners in addition to physicians of making a pronouncement of death.

3. Educate the membership about the issue in the Iowa Nurse Reporter and other communication means.

Proposed cost: $250. Proposed priority: 3 (mid)

Resolution # 13

Feedback to Mandatory Reporters

Revision of Resolution #16 from 1990 - Author, Lynn Boes

WHEREAS, Iowa law identifies who shall be mandatory reporters of child abuse and dependent adult abuse; and

WHEREAS, mandatory reports are to be reported to the Iowa Department of Human Services for investigation within twenty-four hours; and

WHEREAS, mandatory reporters are subject to punishment if they fail to report incidences of child abuse and dependent adult abuse; and

WHEREAS, failure to apprise mandatory reporters of the results of the investigation places the victim at risk; therefore be it

RESOLVED, that Iowa Nurses’ Association support initiatives that requires follow-up of these mandated reports; and be it further

RESOLVED, that Iowa Nurses’ Association encourage registered nurses acting as mandatory reporters to seek feedback regarding action taken by the Iowa Department of Human Services. (There is an Iowa requirement for investigations to be completed within twenty business days.)

Proposed Implementation Activities:

1. Educate registered nurses in the Iowa Nurse Reporter and other communication means about the responsibilities of mandatory reporting.

Proposed cost: $150. Proposed priority: 2 (mid-low)

Resolution #14

Holistic Health Care

Revision of Resolution #6 from 1990 - Authors, Mary Clarke and Kelly Goshen

WHEREAS, the person has a body, mind, and spirit; and

WHEREAS, the health of the person depends on nurturance of body, mind, and spirit; and

WHEREAS, complementary therapies such as herbal remedies, aromatherapy, massage and reflexology enhance holistic care; and

WHEREAS, sixty-three percent (63%) of Americans are utilizing complementary therapies; and

WHEREAS, the nurse has opportunity to emphasize the value of the whole person; therefore, be it

RESOLVED, that Iowa Nurses' Association acclaim and reaffirm nursing practice which includes the integration of the physical, psychological, emotional, and spiritual aspects of the individual; and be it further

RESOLVED, that Iowa Nurses' Association encourage nurses to utilize the nursing process in delivery of nursing care to the whole person; and be it further

RESOLVED, that Iowa Nurses' Association encourage nurses to acknowledge the strengths of a team approach to holistic care of the individual, and encourage, the nurse’s cooperation with the interdisciplinary team; and be it further

RESOLVED, that Iowa Nurses' Association recognize complementary therapies to include but not limited to herbal remedies, aromatherapy, massage, energy work and reflexology; and be it further

RESOLVED, that Iowa Nurses' Association advocate for the safe use of complementary therapies such as herbal remedies, aromatherapy, massage, energy work and reflexology.

Proposed Implementation Activities:

1. Educate the membership on the activities in the state of Iowa, including actions of the Board of Public Health, on complementary therapies.

2. Advocate for the safe use of complementary therapies.

Proposed cost: $100. Proposed priority: 3 (mid)

1999 Resolutions