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1999-2000 resolutions
INA REPRESENTATION AT THE ANA LEVEL (Reaffirmation of resolution #7, 1989) WHEREAS There are no INA members elected to ANA office and there are very few INA members who hold appointed positions; and WHEREAS INA has many members who have qualities and abilities that would enhance the leadership of ANA; and WHEREAS Involvement at the national level promotes and provides an opportunity to learn about, understand and develop a commitment to INA/ANA; and WHEREAS INA has no program to develop candidates who have leadership qualities to secure candidates for ANA elected office; and WHEREAS INA has no defined structure to promote and finance INA members to become national leaders, therefore be it RESOLVED That INA develop a program to encourage and stimulate INA members to seek ANA office; and be it further RESOLVED That INA members actively seek appointments to ANA openings; and be it further RESOLVED That INA develop a funding process that will assist INA members to actively and effectively participate in the ANA election and appointment process. ILLEGAL DRUG USE BY GROUPS OF CHILDBEARING AGE (Revision of Resolution #9, 1989) WHEREAS Illegal drug use, abuse and addiction is prevalent in our society; and WHEREAS Illegal drug use, abuse and addiction is not social class specific; and WHEREAS Illegal drug use, abuse and addiction contribute to dysfunctional family processes, and WHEREAS Research studies on the effects of illegal drug use on the fetus and newborn have declined since the inception of methamphetamine use leading to inadequate information about the effects of methamphetamine; and WHEREAS Newborns continue to present with symptoms of illegal drug withdrawal in spite of ongoing Public Health Education efforts directed toward groups of childbearing age about the adverse effects on the fetus and newborns; and WHEREAS Passive fetal illegal drug use may cause long term psychological and physiological dependence in the newborn and lifelong disabilities, therefore be it RESOLVED That the Iowa Nurses' Association (INA) make nurses aware of the multifaceted responses to health problems and potential health problems related to family processes as a result of illegal drug use, abuse, dependence and addiction by persons of childbearing age and the consequent negative effects on society; and be it further RESOLVED That INA study and support research proposals and programs that will empower and direct health care, political and social forces towards effective solution of this health problem and others related to substance abuse. Resolution # 3 (Revision of Resolution # 13, 1989) WHEREAS Registered Nurses have direct involvement with reproductive issues; and WHEREAS The Iowa Nurses Association (INA) represents Registered Nurses in Iowa; and WHEREAS INA is a leader and educator in the health care community, therefore be it RESOLVED That INA support the American Nurses Association position paper on Reproductive Health (See below) American Nurses Association Reproductive Health Summary: The American Nurses Association (ANA) has historically advocated for the health care needs of all patients, including services related to reproductive health. ANA believes that health care clients have the right to privacy and the right to make decisions about personal health care based on full information and without coercion. Also, nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client's life is in jeopardy, nurses are obligated to provide for the client's safety and to avoid abandonment. (See www.nursingworld.org for full text.) BICYCLE SAFETY AMONG CHILDREN (Revision of Resolution #18, 1989) WHEREAS Bicycles are associated with more childhood injuries than any other consumer product except the automobile; and WHEREAS Head injury is the leading cause of death in bicycle crashes and is the most important determinant of bicycle-related death and permanent disability; and WHEREAS Head injuries account for more than 60 percent of bicycle-related deaths, more than two-thirds of bicycle-related hospital admissions and about one-third of hospital emergency room treated bicycle injuries; and WHEREAS The single most effective safety device available to reduce head injury and death from bicycle crashes is a bicycle helmet; and WHEREAS It is estimated that only 15 percent of children ages 14 and under wear a helmet when riding a bicycle; and WHEREAS Safety experts and children's health professionals believe that education has proven most effective when combined with mandatory bicycle helmet laws for children under 15, and are key factors in reducing injury and death among our nation's children; and WHEREAS Universal use of bicycle helmets by children under age 15 would prevent 250 deaths annually (based on 1995 information) and save estimated lifetime medical costs of $3.2 billion annually; and WHEREAS Fifteen states and more than 30 localities have enacted some form of bicycle helmet legislation, most of which cover only young riders, therefore be it RESOLVED That the Iowa Nurses Association (INA) promote dissemination of information on the safety hazards and injury statistics for bicycle riders under 15 years of age and the benefits of bicycle helmet use; and be it further RESOLVED That INA collaborate with nursing specialty organizations in supporting proposed legislation to mandate bicycle helmet use for Iowa's children under 15. CERTIFIED NURSE MIDWIFERY (Submitted by Advocacy and Representation Commission - Author, Marcia Dedic) WHEREAS Unlicensed health providers who are not registered nurses and are providing reimbursed home birth delivery services; and WHEREAS Significant information about midwifery and the utilization of certified nurse midwives (CNM) as case providers, their education, scope of practice and certification needs to be available to the public; and WHEREAS Certified Nurse Midwives are essential in the provision of available, affordable, quality obstetrical care and that the American Nurses Association (ANA) strongly supports national and state approved nurse midwifery programs; and WHEREAS ANA concurs with the American College of Nurse Midwives (ACNM) commitment to nursing as the foundation for practice of nurse-midwifery in the United States; and WHEREAS Every effort must be pursued to assure and expand access to quality care for pregnant and postpartum women and their newborns; and WHEREAS The inadequacy of maternal care for adolescents and women who are poor or live in rural communities that lack access to prenatal care contributes to a large number of infant deaths and low birth weights each year; and WHEREAS Certified Nurse Midwives receive education as evidenced by accreditation of schools of nursing, accreditation for schools of nurse midwives, state licensure as a registered nurse and a defined scope of practice and continuing education that enables them to provide high quality care, therefore be it RESOLVED That INA support certified nurse midwifery as stated in ANA's Nurse Midwifery position paper or other licensed health care practitioners and be it further RESOLVED That INA does not support direct-entry midwifery practice. AMERICAN NURSES ASSOCIATION Nurse-Midwifery Summary: The current crisis of inadequate maternity care for the American woman, and in particular for those who are poor or live in rural communities, has contributed to the need to critically evaluate the existing health care delivery system. Nurses and the general public are concerned that the lack of access to prenatal care contributes to an alarming number of infant deaths and low birth weight infants each year. Every effort therefore, must be pursued to assure access to quality care for pregnant and postpartum women, and their newborns. In response, this position statement supports the increased development and utilization of certified nurse-midwives as care providers. (See www.nursingworld.org for full text.) UTILIZATION OF EMT/PARAMEDICS IN NON-TRADITIONAL ROLES (Submitted by the Advocacy and Representation Commission - Authors Mary Moser and Vicki Hertko) WHEREAS Health care cost containment efforts encourage the utilization of all trained personnel; and WHEREAS EMT/Paramedics are certified following a curriculum which includes limited assessment and a clearly defined skill set; and WHEREAS The Iowa Nurses Association (INA) has been asked for input by the Emergency Medical Services organization as it explores the utilization of its members in non-traditional roles; and WHEREAS Unlicensed Assistive Providers (UAP) can contribute to the over-all provision of quality care; and WHEREAS Hospital based ambulance services employ EMT/Paramedics who may have "down" times when their skills could be utilized in various hospital departments; and WHEREAS A goal of nursing services is to provide appropriate, quality and safe care; and WHEREAS The utilization of UAP should ensure appropriate oversight, a means to remove incompetent or unsafe practitioners from the patient care area, and generally to protect the public, therefore be it RESOLVED That INA is concerned about the utilization of unlicensed but certified EMT's and Paramedics in the hospital acute care setting for skills for which education and certification can be documented, and be it further RESOLVED That INA is concerned that the decision regarding the use of EMT/Paramedics for the performance of non-life saving procedures on the nursing unit should rest with the RN at the point of care, and be it further RESOLVED That INA support the clear delineation of titles and credentials through the use of name badges so as not to mislead patients and family members, and be it further RESOLVED That INA support the adoption of reporting mechanisms for complaints to the certifying body regarding unsafe or inappropriate care by a certified EMT/Paramedic and be it further . RESOLVED That INA collaborate with the Iowa Board of Nursing, and others on the appropriate use of certified EMT's and Paramedics in the acute care setting and disseminate the results to RN's. PREVENTION, EDUCATION AND REGULATION OF NEEDLESTICK INJURY (Submitted by the Advocacy and Representation Commission and Iowa ANA Delegates) WHEREAS The Federal Government reports between six hundred thousand and one million accidental needle stick injuries from hollow bore needles among health care providers in the United States of which nearly 80% are hospital employed registered nurses; and WHEREAS There is a concern of under reporting of injuries because of the perceived negative consequences from employers and peers; and WHEREAS Needle stick injuries with hollow bore needles can occur at all stages of patient care and account for 80-90% of the transmission of nearly 20 blood borne pathogens among health care providers including Hepatitis B and C, and HIV; and WHEREAS Injuries from blood borne pathogens are not only potentially fatal but constitute a substantial cost burden for the United States health care systems including $300 - $1500 per injury for the necessary testing and follow-up care and OSHA mandated compliance with the Blood Borne Pathogen Standard of 1991 in costs of $460 million per year for personal protective equipment and training and $98 million per year for engineering and work practice controls; and WHEREAS The Centers for Disease Control (CDC) reports that 1.) 1800 health care providers contract Hepatitis B or C annually; 2.) 100-200 workers die each year from Hepatitis infection; 3.) infection with Hepatitis B may be as high as 30% following a single needle stick exposure; 4.) a worker's chance of sero-conversion to HIV is one in every 300 to HBV is one in six and to HCV is one in twenty accidental sticks; and 5.) contaminated disposable hollow bore needles and syringes in the hands of injection drug users has resulted in at least 36% of the current HIV infections and 50% of the current Hepatitis B infections in the United States, therefore be it RESOLVED That INA educate nurses regarding: dangers of hollow bore needles, protective behaviors individual nurses can use to prevent injuries, how to evaluate, select and implement safer devices and provide post-exposure follow-up including testing and treatment; and be it further RESOLVED That INA collaborate with other interested parties and support initiatives to: 1) decrease or eliminate accidental injuries from hollow bore needles, 2) increase reporting of hollow bore needle stick injuries, and 3) track disease transmissions from patient to worker; and be it further RESOLVED That INA encourage registered nurse participation on employer purchasing and product evaluation committees and that all available engineering controls, not just those available through Group Purchasing Organizations (GPOs), be considered when decisions are made regarding personal protective equipment and workplace controls that may enhance worker safety; and be it further RESOLVED That INA support legislation and regulation which addresses the cost of hollow bore needle injuries and methods to decrease the mortality and morbidity of health care workers who are occupationally exposed through the implementation of engineering controls (also known as safer needle devices) as the first and best line of defense to prevent exposure to bloodborne diseases; and be it further RESOLVED That INA urge institutions and agencies to develop post-exposure follow-up protocols with provisions including: testing, medication, counseling and support as needed and/or as indicated by established CDC recommendations. TELEHEALTH SERVICES PROVIDED BY REGISTERED NURSES (Submitted by the Advocacy and Representation Commission - Author, Judy Collins) WHEREAS Technological advancements have led to innovations in the delivery of health care; and WHEREAS These technologies include but are not limited to the use of computer, fax, television/video systems, monitors, and telephone; and WHEREAS The use of technology has allowed for access to a variety of health care services by increasing numbers of consumers within home and community setting, and WHEREAS The access to necessary health care is of great concern to persons who are homebound or live in rural settings; and WHEREAS The opportunities for nurses through the use of advanced technologies are growing; and WHEREAS The cost effectiveness and efficiency when using these methods have been established; and WHEREAS The provision of Telehealth services does not respect state borders, therefore be it RESOLVED That INA promote the education of nurses related to opportunities available through the use of technology; and be it further RESOLVED That INA advocate for protection of patients through the regulation of providers who provide services beyond state borders; and be it further RESOLVED That INA provide information to legislators and other policy makers regarding regulatory issues related to nursing practice and Telehealth. LONG-TERM CARE FOR PERSONS WITH SEVERE MENTAL ILLNESS (Submitted by the Advocacy and Representation Commission - Author, Rose Marie Friedrich) WHEREAS Long-term 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 long-term 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 Lack of long-term 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 long-term 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 long-term care for persons with severe mental illness. IN SUPPORT OF IMPLEMENTING THE NATIONAL STUDENT NURSES ASSOCIATION "TOTAL SCHOOL MEMBERSHIP" PLAN IN SCHOOLS OF NURSING (Submitted by: District 7, INA - Author Jean Logan) WHEREAS The National Student Nurses Association (NSNA) is the voice of all nursing students on issues related to nursing students and nursing (Kelly & Joel, 1999); and WHEREAS The current membership of NSNA has declined in recent years and currently represents only 12% of potential student membership; and WHEREAS The "total school membership plan" is designed to increase the number of members through inclusion of membership dues as part of student activity or tuition fees (Total School Membership Plan, 1998); and WHEREAS Students learn about the values and culture of the nursing profession through active involvement in the NSNA (Logan, 1994; Logan & Degen-Stout, 1998); and WHEREAS The resolutions of NSNA usually support the goals of ANA (Kelly and Joel, 1999); and WHEREAS One of the roles of The Iowa Nurses Association is to mentor the 13 Iowa Association of Nursing Students (INA bylaws); therefore be it RESOLVED That the Iowa Nurses Association advocate for the "total school membership plan" in nursing school in Iowa; and be it further RESOLVED That the INA support other states in advocating for the "total school membership plan"; and be it further RESOLVED That the INA send copies of this resolution to the American Nurses Association, the American Association of Colleges of Nursing, the National Student Nurses Association and any other organization deemed appropriate. VIOLENCE IN THE SCHOOLS (Submitted by R. Holland, Reference Committee) WHEREAS The incidents of school violence continue to increase; and WHEREAS The Surgeon General has declared school violence to be a public health issue; and WHEREAS A limited amount of research has been done to identify the reasons and prevention of the commission of violence by children (under age of 18); and WHEREAS Adolescent and child school health is a frontier yet to be developed by the profession of nursing; and WHEREAS Guns, the media, a sense of powerlessness and limited parenting skills have been identified as factors contributing to the commission of violent acts by children; and WHEREAS Society has not come to consensus on a plan of action to address this issue, therefore be it RESOLVED That INA promote, support, and participate in research that explores the cause, prevention and treatment of school violence; and be it further RESOLVED That nurses support parents, school personnel, related organizations and school nurses in their efforts to reduce school violence; and be it further RESOLVED That INA evaluate and support appropriate, effective legislative and administrative initiatives at the community, state, and federal level directed toward the elimination of school violence. EXAMINING THE NURSING WORKFORCE (Submitted by Iowa ANA Delegates - Author, Judy Collins) WHEREAS Throughout the history of modern United States nursing there have been swings of shortage and supply of registered nurses; and WHEREAS The 1990's have seen rapid changes in the financing and organization of health care delivery; and WHEREAS These trends have had an impact on employment settings, nurse staffing, wages and recruitment and retention rates for nurses; and WHEREAS The future demand for nurses is increasing related partly to the aging of the U.S. population, especially in Iowa and the increase in the incidence of chronic illness; and WHEREAS There is an aging of the nursing workforce with the average age of the practicing nurse being 42.3 years in 1996 (Moses, 1998); and WHEREAS There is a shortage of nursing personnel, especially experienced competent nurses in a time of projected demand for increase in nursing services, therefore be it RESOLVED That INA collaborate with members of the Iowa Council of Nurses (ICON) to develop a model to forecast the future needs of nurses in Iowa and appropriate utilization of the nurse workforce, and be it further RESOLVED That INA collaborate with the American Nurses Association (ANA) in their efforts to develop an integrated forecasting model, and be it further RESOLVED That INA collaborate with ANA and local nursing education programs to encourage and support funding to increase basic education of licensed nurses and facilitate recruitment of qualified candidates, and be it further RESOLVED That INA collaborate with ANA and nurse employers regarding strategies to improve the retention of competent nurses in the workforce, and be it further RESOLVED That INA report findings, program and policy recommendations and implementation strategies to the Iowa House of Delegates at the 2000 INA Convention, American Nurses Association, Iowa Congressional Delegation and Iowa policymakers. USE OF IOWA TOBACCO SETTLEMENT MONEY (Submitted by Mary Hansen and Ellen Strachota, District 7) WHEREAS The money from the tobacco settlement is being distributed to each state under the $206 billion "Master Settlement Agreement" to be used as designated by each state's legislature; and WHEREAS The initial payment to Iowa is estimated to be at $76 million and future payments will range between $55-69 million annually; and WHEREAS The tobacco settlement monies could be used for the Center for Disease Control recommendations for community and school based efforts supported by the Tobacco Free Coalition and for state funded programs such as, core public health functions, anti-smoking campaigns and educational programs, increased Medicaid reimbursement and state assisted child care; and WHEREAS The main reason for the settlement was based on the resources that the states have spent on health care related and smoking related illnesses, therefore be it RESOLVED That the Iowa Nurses Association (INA) lobby the Iowa General Assembly and the Governor to allocate money from the tobacco settlement for health care purposes as follows so that one third goes to local community comprehensive health initiatives including funds for school health programs managed by registered nurses in the schools, enforcement, countermarketing and evaluation of the prevention and cessation program effectiveness, one third goes to core public health functions and one third to Medicaid reimbursement; and be it further RESOLVED That a tobacco-use prevention advisory board be appointed by the Governor and report to the Governor integrating the perspectives of various state agencies and with representation from both traditional and non-traditional tobacco-use prevention organizations with state and local tobacco-use prevention experts. ASSESSMENT SKILS OF LICENSED PRACTICAL NURSES (LPN) IN LONG TERM CARE SETTINGS (Submitted by the Advocacy and Representation Commission - Author, Larry Hertel) WHEREAS The number of elderly persons in the State of Iowa continues to grow; and WHEREAS The State of Iowa has the highest number of elderly persons as compared to other states; and WHEREAS The health and well-being of elderly Iowans is a concern of Registered Nurses; and WHEREAS Elderly persons may live in Iowa's long term care settings; and WHEREAS A higher level of care has been needed for residents of Iowa's long term care settings because of an increased level of acute and chronic health conditions in the elderly population; and WHEREAS Registered Nurses (RN) are responsible for the supervision of the nursing care provided to residents of Iowa's long term care settings; and WHEREAS Registered Nurses are also responsible for the supervision of Licensed Practical Nurses and Certified Nurse Aides who provide care to the elderly in Iowa's long term care settings; and WHEREAS Federal regulations which govern the operation of long term care settings do not require 24-hour daily coverage or presence of Registered Nurses; and WHEREAS Licensed Practical Nurses (LPN) may be asked to assist Registered Nurses with assessments of residents in Iowa's long term care settings; and WHEREAS The data collected using the standardized assessment tool, the Minimum Data Set (MDS), for long term care residents must be verified as accurate by Registered Nurses; and WHEREAS An appropriate level of training and competence is necessary to complete the MDS and other nursing assessments in the care of residents in long term care settings, therefore be it RESOLVED That the Iowa Nurses' Association support a thorough evaluation of nursing assessment tasks to determine which can safely be delegated Licensed Practical Nurses and which cannot in the long term care setting. STANDARDIZED EDUCATION FOR NURSE AIDES (Nurse Aide, Home Health Aide, etc.) (Submitted by Larry Hertel, District 5) WHEREAS The Iowa Department of Education recently revised its rules establishing accreditation standards for schools in the State of Iowa; and WHEREAS The former accreditation standard required the (school) board to adopt a policy for the implementation of a school health services program designed to help each student protect, improve, and maintain physical, emotional and social well-being; and WHEREAS All accredited Iowa schools have had such a school health services program; and WHEREAS The new accreditation standards removes this requirement as the Iowa Department of Education has determined that there was no legislative Authority for the former requirement; and WHEREAS Prevention of illness and disability with school nurses in every school building is highly cost effective as compared to later medical intervention and social problem adjustment, therefore be it RESOLVED That INA supports legislation that authorizes the requirement that each accredited school in Iowa, as a component of school improvement, adopt a policy for the implementation of school health service program under the direction of an RN for each student; and be it further RESOLVED That INA supports its member talking to their representatives about this matter so that action will be taken this (2000) legislative session before schools dismantle their current policy. 
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