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Adopted Resolution Titles 2003
2003 Resolution #1 Whereas, ANA/INA believe membership retention and recruitment is a top priority, and Whereas, the strength of a professional Association is dependent on an actively involved membership, and Whereas, there are 38,000 licensed registered nurses in Iowa, but only 1224 belong to INA, and Whereas, new graduate members bring perspective and strength necessary to the growth of the Association, and
Whereas, the most effective recruitment technique by far is personally asking someone to join, and
Whereas, it is critical to reach and maintain high levels of existing member Commitment, and Whereas, the Membership/Public Relations Commission has set a goal of 2000 members by 2005; therefore, be it Resolved, that the Regional and State Membership Committees and the INA Board of Directors continue to evaluate and improve present means to retain and recruit members to ensure a strong professional organization; and be it further Resolved, that each INA Region contact all Schools of Nursing in their region annually addressing the benefits of ANA/INA membership. Rationale: Recruitment must be an ongoing priority-A membership-driven, non-profit organization depends on constantly bringing in new members to be successful. Everyone-not just the president, membership chair or the Board-can help recruit nurses to join. Retention is even more important than recruitment. Given the intense competition every organization faces for members, money, volunteers and attention, treating members like customers who may "shop" elsewhere makes good sense. (Clearly an organization cannot keep every member; some leave for reasons that are out of any organization's control. And it is not possible to provide all members exactly what they want at all times-that's not what most members expect. There is much, however, that can be done to keep interested members from becoming dissatisfied and alienated. Keep up with what members are thinking and whether they are satisfied with their membership.) Proposed Implementation Steps: 1. Appointment by Region Boards of a representative to the INA Membership/Public Relations Commission to ensure communication of activities and resources. 2. Provide Membership folders with pertinent information to new members and recruitment activities throughout the state. 3. Publish the membership benefits and services in each printing of the Iowa Nurse Reporter. 4. Plan programs that focus on identified member interest yearly within each region. 5. Offer reduced rate membership to non-members attending the annual meeting (convention). 6. Utilize media promotions for recruitment. Proposed Cost: $5000 2003 Resolution # 2
Whereas, the largest single professional healthcare workforce in public health agencies is public health nursing; and Whereas, according to the 2000 National Sample Survey of Registered Nurses (Public Health Nursing Section, 2003), the number of registered nurses employed in public/community health settings with the title "public health nurse" has decreased from 39% in 1980 to just 17.6% in 2000; and Whereas, the American Nurses Association is a long-standing member of the Quad Council of Public Health Nursing Organizations (ANA Congress on Nursing Practice & Economics; Association of Community Health Nursing Educators; American Public Health Association, Public Health Nursing Section; Association of State and Territorial Directors of Nursing); and Whereas, a recent survey (2003) by the National Association of County and City Health Officials (NACCHO) examining the impact of the smallpox vaccination program on local public health services found that limited staffing and resources are forcing local public health agencies to shift workers from other programs, such as communicable disease and immunization programs, to the smallpox vaccination program; and Whereas, the Institute of Medicine (IOM) report The Future of the Public's Health in the 21st Century (2003) raises concerns about the availability of an adequate local public health infrastructure, particularly in terms of staffing and communication systems, to provide critical public health services; and Whereas, the IOM's report (2003) also found that funding for the public health infrastructure has recently increased to support the infrastructure that relates to bioterrorism and emergency preparedness but may still be insufficient; and Whereas, public health nurses are the primary providers of well child care, including immunizations, and preventive health services for pregnant women, school-aged children, and individuals at risk for or experiencing chronic disease, as well as for linking clients with other health care providers and community resources; therefore be it Resolved, that the Iowa Nurses Association will advocate for: 1. Acknowledgment of the critical nature of the public health nurse's role in promoting and protecting the health of individuals, families and communities. 2. Investment in information systems and technology training to strengthen the public health infrastructure. 3. Federal funds to health departments to attract, retain, and continually enhance the role and compensation of public health nurses. 4. Better enumeration of the number of public health nurses. 5. Further development and implementation of quality indicators that are sensitive to public health nursing functions. Proposed Implementation Steps: 1. Publish an article in Iowa Nurse Reporter 2. Monitor legislation and funding (federal and state)
Proposed Cost: $500 2003 Resolution # 3
Whereas, despite living in an era of improved recognition, identification and prevention, diseases and infectious agents continue to emerge; and Whereas, diseases or infectious agents that were not necessarily thought to be transmissible to humans are now emerging; and Whereas, the Institute of Medicine (IOM) has stated that in the future it will be difficult to predict when and where new microbial diseases will emerge; and Whereas, regardless of practice arena, all registered nurses risk exposure to these infectious agents; and Whereas, registered nurses may inadvertently expose others including patients/clients, co-workers and family members, to an infectious agent through cross-contamination and/or an occupationally-acquired disease; and Whereas, methods to curtail transmission are known for most agents, and if not, interim recommendations are often developed and disseminated by the Centers for Disease Control and Prevention (CDC), therefore be it Resolved, that the Iowa Nurses Association will: 1. Support the dissemination to the nursing community of the CDC's Plan to Prevent Emerging Infectious Diseases, 2. Advocate for ongoing and timely education and training of registered nurses and other healthcare personnel regarding appropriate mechanisms to protect themselves and their patients/clients, including the importance of handwashing, appropriate personal protective equipment (PPE), and environmental controls that help stop the spread of the disease. Proposed Implementation Steps: 1. Publish an article in the Iowa Nurse Reporter. 2. Monitor the need for legislation (federal and state). Proposed Cost: $250-500 2003 Resolution #4 Whereas, the Iowa Board of Nursing screens licensee applicants for criminal felony history by voluntary disclosure, and Whereas, some applicants have failed to disclose criminal history, and Whereas, other states that require a criminal history felony background check statistically report that 10-15% of license applicants fail to disclose a criminal history; the Iowa Board of Nursing expects that a similar percentage of applicants fail to disclose a criminal history, and Whereas, when other states require a criminal history background check, applicants will search for states such as Iowa that do not have this requirement, and Whereas, continued membership in the Nurse Licensure Compact requires that the Iowa Board of Nursing do a criminal history background check, and Whereas, state surveyed hospitals are required to perform criminal felony history and dependent/adult abuse background checks creating an inconsistency, and Whereas, home health agencies and other health care providers are also currently required to perform criminal felony history and dependent/adult abuse background checks, and therefore be it Resolved, that the Iowa Nurses Association will: 1. Educate nurses regarding the benefits to the public. 2. Support the Iowa Board of Nursing legislation to provide the authority to do a DCI and FBI criminal history felony background check for all nurse license applicants. Proposed Implementation Steps: 1. Publish an Iowa Nurse Reporter article regarding the benefits of background checks to the public of a criminal history felony background check for all nurse license applicants. 3. Support legislation to provide the Board of Nursing with the authority to do a DCI and FBI criminal history background check. 4. Encourage necessary legislative or regulatory changes to include dependent/adult abuse background checks Proposed Cost: $1000 2003 Resolution # 5
Whereas, the Iowa Nurses Association has previously been directed by its membership to work collaboratively with advanced registered nurse practitioners (ARNPs) across Iowa to identify and address attempts to limit the scope of ARNP practice, and Whereas, the Iowa Nurses Association supports the American Nurses Association (ANA) position on Nurse-Midwifery, and Whereas, Iowa had a licensure law for Birth Centers, which previously had been enforced in such a restrictive manner (requiring two physician visits) that it was in conflict with clientele wishes) such that only two birth centers were licensed over the duration of the licensure law effective dates, and Whereas, in 2002, the Iowa Legislature repealed the Birth Center licensure law and some Iowa legislators have acknowledged standards required by the Commission on the Accreditation of Birth Centers (CABC) for accredited birth centers are sufficient to protect the public, and Whereas, various ARNPs who are INA members have requested that the INA collaborate with advanced practice nurses, physicians and legislators to re-establish a birth center licensure law, while there are ARNPs who are INA members that have requested that INA resist the establishment of a birth center licensing law; and therefore be it Resolved, that the Iowa Nurses Association will: 1. Advocate for the position adopted by the Iowa Nurses Association membership after discussion on the matter at its annual meeting. 2. Facilitate the healthy exchange of dialogue between members with differing points of view. Proposed Implementation Steps: 1. Publish an article in the Iowa Nurse Reporter 2. Monitor legislation and funding Proposed Cost: $500 2003 Resolution # 6
Whereas, ARNPs are licensed independent providers under Iowa Code Chapter 152 and Iowa Administrative Code 655, Chapter 7, and Whereas, ARNPs do NOT require physician supervision or oversight to practice within their specialty scope of practice, and Whereas, ARNPs providing care to their clients within their scope of practice does NOT constitute a 'medically delegated function', and Whereas, all hospitals in Iowa are required to be licensed under Iowa Code Chapter 135B, and Whereas, 135B.7 prohibits denial of clinical privileges to licensed ARNPs, solely by reason of licensure or education, and Whereas, 135B.7 allows hospitals to establish procedures for interaction between patients and practitioners, and Whereas, 135B.7 does NOT provide for hospitals to establish rules or policies for privileges that are discriminatory, and Whereas, Iowa hospital medical staff bylaws, rules and regulations have consistently developed privilege criteria that require a physician supervision and/or sponsorship, and Whereas, Iowa hospitals have consistently classified ARNPs under categories such as "allied Health Professional" or "ancillary Personnel"; of which such category also includes Physician Assistants, Certified Surgical Technicians, dental assistants, and licensed practical nurses, and Whereas, Iowa hospital medical staff bylaws, rules and regulations have changed privilege criteria for dentists and doctors of podiatric medicine without a requirement of 'supervision' or 'sponsorship', and have classified these providers as "associate professionals" or consider them as part of the medical staff, and Whereas, under 135B.7, clinical privilege rules that apply only to ARNPs are, by definition, discriminatory, particularly if they establish policy or rules that are contrary to, or in addition to, state ARNP scope of practice and collaboration/consultation statutes and rules, and Whereas, requiring sponsorship or supervision for privileges for ARNPs allows physicians to limit ARNPs access to acute care services for their clients and this limitation constitutes discrimination against ARNPs and creates a barrier to practice of ARNPs and, as such, constitutes restraint of trade, and Whereas, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) defines a Licensed Independent Practitioner as a health professional who is permitted by law and also permitted by the hospital to provide patient care services without supervision or direction, and Whereas, the Iowa Nurse Practice Act makes it clear that ARNPs in Iowa are permitted by law to practice without supervision or direction, and Whereas, despite the fact that Iowa ARNPs would otherwise be considered Licensed Independent Practitioners, the restrictive and anticompetitive medical staff bylaws, rules and regulations of Iowa hospitals deny ARNPs the right to practice without supervision or direction, and therefore be it Resolved that: 1. Iowa Nurses Association will seek to assist ARNPs with access to full, non-restricted clinical and admitting hospital privileges to practice within their full scope of practice, and 2. ARNPs will seek legislative and legal support to resolve the restraint of trade imposed on ARNPs by the discriminatory rules/privilege criteria promulgated by hospitals and physician/medical staffs. Proposed Implementation Steps: 1. Publish an article in the Iowa Nurse Reporter to educate members about the issue. 2. Collaborate with other advanced practice nurse organizations in Iowa for the development of such legislation. Proposed Cost: $1,000 2003 Resolution #7 Whereas, Iowa citizens pay the same amount of Medicare tax as the citizens of the other 49 states, and Whereas, the Medicare reimbursement for an Iowa citizen is $3 per person and $7 per person for a resident of Mississippi making this an unequal distribution of Medicare funds, and Whereas, Iowa has the highest population of persons over 85 who have the greatest health care needs and many of these needs are not met due to the disparity from state to state in covered services, and Whereas, there is an inequity between rural and urban reimbursement within the state of Iowa itself, and Whereas, all Iowa nurses' salaries and benefits are negatively impacted by the low Medicare reimbursement in all health care settings and for all health care providers, therefore be it Resolved, that the Iowa Nurses Association encourage all nurses, their friends and families contact their state and national elected officials asking them to pass legislation that will bring about fair and equal distribution of Medicare funds. Proposed Implementation Steps: 1. Publish an article in the Iowa Nurse Reporter. 2. Utilize the Voter Voice service purchased by the Iowa Nurses Association to contact elected officials with the message. Proposed Cost: $500-750 2003 Resolution # 8
Whereas, the Balanced Budget Act of 1997 has had a dramatic impact on home health services; and Whereas, the Centers for Medicare and Medicaid (CMS) mandate provides for an interim payment system (IPS) that will limit home health agency reimbursement to the lower of: 1) actual fiscal year 1998 costs, 2) the per beneficiary cost limit applied in the aggregate, or 3) the agency cost caps in the aggregate, and Whereas, the interim payment system has the potential to limit access to care for chronically ill or elderly needing home health services, and Whereas, cost savings should not be pursued at the expense of quality; therefore be it Resolved, that the Iowa Nurses Association advocate for the protection of patient access to quality home health services; and be it further Resolved, that the Iowa Nurses Association endorse a payment system that: a) is based on nurse sensitive outcomes, b) reflects case-mix intensity and appropriate levels of care and c) is commensurate with the intensity of services provided. Proposed Implementation Steps: 1. Provide information to Iowa's congressional delegation on the impact of the interim payment system (IPS) throughout Iowa. 2. Monitor payment systems established by the Centers for Medicare and Medicaid (CMS). 3. Disseminate information to members through the Iowa Nurse Reporter on how the system works and current reimbursement. 4. Work to increase public awareness related to inequities within the system. Proposed Cost: $750-$1000 2003 Resolution #9
Whereas, the aging population in Iowa is increasing and the decisions about end of life care need to be addressed on a more frequent basis, and Whereas, patient/family or other decision makers may not be informed about end of life issues, how to manage them, and where to get information about these issues, and Whereas, many people do not have access to information about advance directives and or living wills, until a time when imminent need interferes with thedeliberative decision making processwhich mayresult in unwanted end of life care procedures, and Whereas,advance directives and living wills may be signed without consideration for different situations e.g. if a person does not want to be put on a ventilator, during an episode of pneumonia , when all other systems are functioning adequately, and Whereas, it is difficult for family members to have conversationsabout their wishes for end of life care, due to social and/or cultural constraints, that will bring all members to consensus so that the wishes of the dying person are honored, and therefore be it Resolved, that the Iowa Nurses Association encourage members to become informed about end of life care issues by publishing in the Iowa Nurse Reporter available resources, and be it further Resolved, that members encourage all nurses to become educated about end of life issues, and converse with their patient's families/decision makers about end of life care wishes, and be it further Resolved, that all nurses based on their education and personal experience about end of life issues take every opportunity to educate patients and the public.
IMPLEMENTATION: 1.Publish article in the Iowa Nurse Reporter. 2. Encourage member responsibility and commitment
RESOURCES, Colby, Bill; THE LONG GOODBYE Dubler, Nancy and Nemmons, David; ETHICS ON CALL Rothman, David J.; STRANGERS AT THE BEDSIDE
Proposed Cost: $250 2003 Resolution #10
Whereas, there is an established link between healthy students and improved academic achievement; and Whereas, there is a federal mandate that all children have an equal and significant opportunity to obtain an education and reach proficiency (No Child Left Behind Act of 2001), and Whereas, there are many intervening variables such as child abuse and neglect, domestic violence, child and adolescent obesity, suicide, substance abuse, adolescent pregnancy and parenting, environmental health, mental health and lack of health insurance coverage that can impede academic growth; and Whereas, advanced medical technology has made it possible for students with serious health problems to attend school and federal legislation has required school districts to provide the least restrictive environment to students with serious health problems; and Whereas, a healthy school environment is essential to student achievement and to the development of attitudes and behaviors which value a healthy lifestyle; and Whereas, the Iowa Legislature requires that school boards adopt a policy which addresses school health services; and Whereas, a registered school nurse's primary role is to support student learning by acting as an advocate and liaison between the home, school and medical community regarding health concerns that are likely to affect a student's ability to learn; and Whereas, registered school nurses have the appropriate academic preparation and professional ability to develop and manage the health care and services that are necessary to ensure students have full access to academic opportunities; therefore be it Resolved, that the Iowa Nurses Association and the Iowa School Nurse Organization support legislation that ensures that registered nurses are employed by school districts for the purpose of coordination, planning, provision and assessment of school health services. The Iowa Nurses Association and the Iowa School Nurse Organization recommend that the ratio of students per registered nurse be based on the needs of the students and the needs of the individual school community with recognition of additional weighting for students with serious health problems. Rationale: All students have a right to learn in an environment which supports the development of healthy attitudes and behaviors and academic success. School nurses, as active members of interdisciplinary student services teams, facilitate positive responses to normal development, promote health and safety, intervene with actual and potential health problems, provide case management services and actively collaborate with others to build student and family capacity for adaptation, self management, self advocacy and learning. Proposed Implementation Steps: 1. Publish an article in the Iowa Nurse Reporter from a representative of the Iowa School Nurses Organization. 2. Monitor supportive legislation regarding school nurses' issues and healthy students. 3. Support education of all nurses to learn more about "No Child Left Behind Act of 2001". Proposed Cost: $1000
Epidemic of Obesity Proposed by Rosemary Holland Whereas, the Centers for Disease Control and Prevention (CDC) has declared that obesity needs to be a major priority for the health care system, and Whereas, obesity is closing in on smoking as the leading cause of preventable deaths, and Whereas, it is projected by the Centers for Disease Control and Prevention that one in three children born in the United States in 2000 will become diabetics due to obesity and lack of physical activity, and Whereas, 64.5% of adult Americans are overweight according to the American Obesity Association, and Whereas, treatment for obesity and overweight conditions accounted for $79 billion of the national medical bill in 1998, and Whereas, in a U.S. Department of Health and Human Services (DHHS) study one in five adults engage in high level physical activity and one in four adults engage in little or no activity; therefore be it Resolved, that the Iowa Nurses Association support legislation at the state and national level that will promote prevention of obesity, and be it further Resolved, that the nurses in their practice settings advise their patients/clients about diseases that are caused by obesity and the importance of good nutrition and physical activity, and be it further Resolved, that the Iowa Nurses Association support efforts to maintain healthy nutrition and physical activities in our children's schools.
Implementation Steps: Resources: "The Nation's Health", June/July 2003 and August 2003.
Cost: $250
Change of State Dementia-Specific Assisted Living Rules and Regulations By Toni Tripp-Reimer and Janet Enslein Whereas, the number of older adults in Iowa with dementia is projected to rise in proportion to the rapidly increasing populations of persons over 65 years of age, and Whereas, the current options for long-term care of older persons in Iowa, especially with dementia are too few and unavailable in some areas of the state, and Whereas support services for families are often limited for addressing the needs of persons with dementia prior to the necessity of nursing home placement, and Whereas many current assisted living facilities often have insufficient staff members with the skills required to manage the needs of persons with dementia, and Whereas, increased staff hours of care per residents improves residents outcomes, and Whereas, the current rules require relocation to a nursing home when more than minimal assistance with functional abilities is needed, rather than promoting function for a greater length of time prior to institutionalization, and Whereas, recent research evidence provides direction for practices that promote higher quality of life and more cost effective alternatives to typical long-term care options, such that:
Resolved, that the Iowa Nurses Association support and advocate for the following changes in the state Dementia-Specific Assisted Living administrative rules and regulations:
Implementation Steps:
Cost: $1500
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