ana advances entry position, keeps structure

ANA President Barbara Nichols greets AN A advances wellwishers after her election to a second term as head of the organization.

The American Nurses’ Association (ANA) is entry position,

struggling with serious problems. It ’is faced with declining membership, plagued with financial problems, and threatened by trade unions. At the ANA biennial meeting in Houston, June 8 to 13, the House of Delegates made decisions they hoped would shore up the association as well as advance the profession.

Opening the two-and-a-half day session of the House Tuesday morning, ANA President Barbara Nichols outlined the important issues-strengthening the economic and general welfare program, membership de- cline, a dues increase at the national level, the organizational structure of the association, and toughest of all, titling and competencies for two categories of nursing.

“Change has and will continue to occur in the profession’s educational pattern,” Nichols said. “Our task at this convention is to ensure

keeps structure Elinor s Schrader Patricia Patterson

288 AORN Journal, August 1980, Vol32, No 2

that such change is orderly, relevant, realistic, systematic, and planned for, rather than a chaotic emotional happening.”

Referring to the intense organization of nurses by trade unions and divisiveness within the nursing profession, Nichols reaffirmed that “collective bargaining is both a legitimate and essential function of this association.”

On the declining ANA membership, Nichols said the association’s chronic problem has been a failure to recruit and retain a large numberof nurses in theorganization. Although new members are recruited, many do not continue their membership. Current membership is 179,388 compared to 188,791 in 1978-a loss of 9,403.

Nichols told the delegates that ANA is “se- verely handicapped by lack of funds.” She said the delegates’ decision on dues would determine “to what extent the national purposes of our professional association will be fulfilled.”

Attendance at the convention was down considerably. As of Thursday, 5,225 were registered compared to 6,747 in Honolulu in 1978 and 9,271 in Atlantic City in 1976. The declining convention registration may reflect in- creased travel costs and staffing pressures as well as the declining membership.

Nominations rounded out the Tuesday

morning agenda, with Jean Steel of Mas- sachusetts nominated from the floor to run against Barbara Nichols, who had been running unopposed for president. The House then recessed until Thursday and Friday to deal with the major issues.

Delegates spent hours on less critical issues early in the meeting, then raced through more important decisions because time was running out. Delegates often appeared more in- terested in parliamentary maneuvers than in accomplishing the business of the House. At one point in the discussion on restructuring, President Nichols informed the delegates that more than half of the discussion had been spent on parliamentary inquiries than on the substance of the issue. Delegates waiting as long as four and five hours at microphones were angered when those seeking a point of parliamentary procedure or information used the time to speak to the issue.

Thursday morning’s session started out slowly as delegates tangled over reordering the agenda and relatively minor bylaws amendments. The bylaws debate centered on whether the Labor Management Reporting and Disclosure Act required ANA to extend full membership privileges to about 470 members living outside the US and its possessions. After

Presidents of state delegations line up at the microphone for a roll call vote.


ANA endorses nurse as circulator The news that US Department of Health and Human Services (HHS) Secretary Patricia R Harris has signed the proposed Medicare regulations that would permit technicians to circulate gave dramatic impetus to the ANA resolution endorsing the RN as circulator.

AORN President Barbara Stanewick and Headquarters staff received word at the convention that the Secretary had signed the regulations, which would be published within the week in the Federal Register. There would be a 60-day comment period.

Medical-Surgical Nursing Practice, the ANA resolution came before the House of Delegates in the closing hour of business. It was introduced by Division chairperson Cynthia C Scalzi, who said that state nurses associations would be notified after the publication of the regulations.

Speaking to the resolution, AORN Assistant Executive Director/ProfessionaI Judith Pfister was applauded as she said the proposed regulations will affect all of nursing because of the adverse effect they will have on the quality of nursing care for the patient having surgery.

Adding his support, Clifford Jordan, ANA Board member and former member of the AORN task forces on the perioperative role,

Presented by the Division on

AORN President Barbara Stanewick (top) chairs an AORN caucus during the convention. Judith Pfister, AORN staff member (top right), speaks on the circulating nurse resolution before the House of Delegates.

several delegates objected to these direct members running for office and the House of Delegates, the majority decided, after a three-hour debate, to adopt the extended privileges.

Starting Thursday afternoon, the delegates spent some ten hours debating the proposals for restructuring the association. At 10 pm, they finally approved by 405 to 352 the Board’s recommendation to retain the current tri-level membership. The Board had studied three models-the current tri-level with membership required at the national, state, and district levels; a direct membership option with membership open at any or all of the three levels; and a federation model in which state nurses associations-not individual members- would be the members.

Prior to the convention, the ANA Board had endorsed the direct membership model. But after the hearings, where there was little interest in direct membership, the Board changed its course and proposed retaining the tri-level membership with a streamlined organizational structure. In support of its resolution, the Board stated there were inadequate data to support the need for a major structural change. Also, the transition would be expensive. One dele- gate suggested that it would decrease the unity of nursing as well as decrease the ef- fectiveness of ANA in Washington. Margaret A Quan, ANA secretary, argued that afederation model was a financial risk since it would make ANA dependent on the state nurses associations. Harold MacKinnon, ANA treasurer, estimated the transition would cost $3 million.


urged the delegates, “to write to Patricia Harris denying operating room technicians the right to circulate in the operating room.”

overwhelmingly endorsed by the delegates. The resolution, which follows, was

The Registered Nurse as Circulator in the Operating Room

Whereas, the management of continuous safe health care in the operating room requires a collaborative relationship between physicians and those individuals functioning as circulators,

Whereas, the individual functioning as

circulator must provide care that is based upon knowledge of such biological sciences as anatomy, physiology, microbiology and pharmacology,

educated to plan care based upon the above knowledge and provide that care through a scientific problem-solving approach-the nursing process,

Whereas, the registered nurse circulator can effectively take responsibility to utilize the sophisticated techniques required in emergency situations,

Whereas, the registered nurse circulator has the expertise to collaborate in the establishment of a cost effective operating room environment that ensures quality to the consumer, and

Accreditation of Hospitals and the Association of Operating Room Nurses have gone on record supporting the registered nurse as the individual who should assume the responsibility and accountability for assuring the delivery of quality nursing care in the operating room by functioning as the circulating nurse; therefore be it

Association affirms that the registered nurse is the only individual qualified to function as the circulator in the operating room.

Whereas, the registered nurse is

Whereas, the Joint Commission on

Resolved, that the American Nurses’

Moreover, the Board believed that individual nurses should have the right to hold membership at the national level.

There was considerable interest in the federation model, proposed in a resolution by the State of Washington delegation. Although the proposers believed that a federation model would strengthen the national level and its major programs, many delegates had doubts about such a structure.

Opposition to the continued tri-level membership came from the many states currently not complying with the tri-level membership requirement. There have been a number of direct membership projects, six approved by ANA, but an estimated 26 projects not approved. This means that an estimated two- thirds of the state nurses associations do not

comply with the current bylaws requiring tri- level membership. During the past biennium, the delegates had directed the Board not to enforce the bylaws. But this time, the delegates declined to pass a recommendation that the Board defer enforcing the bylaws during the next biennium. Thus, the Board may now invoke the bylaws against those state nurses associations not in compliance.

The resolution on restructuring asked the Committee on Bylaws to prepare amendments on streamlining the organization. The suggested model includes a House of Delegates with no more than 300 members and annual rather than biennial meetings. The delegates will have another go at these provisions when the bylaws amendments are presented at the next meeting in 1982. It was 11 pm Thursday

AORN Journal, August 1980, Vol32, No 2

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Never better, Dumas says of nursing Rhetaugh G Dumas, FAAN, set an upbeat tone as keynote speaker at the opening session by calling attention to what “is right about nursing.”

“It is my firm belief that the nursing profession has never been better,” she affirmed, citing appointments to policy-making groups and accomplishments in nursing education, standards, and research.

Access to health care, cost of nursing services, and health promotion are the major issues she saw facing the profession. Taking stock, the new deputy director of the National Institute of Mental Health found nursing well prepared to meet these challenges through its tradition of patient education and “caring for those whom society casts out.”

“We have a wealth of knowledge among ourselves. Indeed, nursing is a social necessity!” she said. But there are liabilities, too.

“Because we have ignored our own social and professional interactions for so long, concentrating only on our patients, people outside nursing have made it their business to make our decisions for us,” she said. She applauded nurses for confronting the education issueand encouraged them to build the power they need to improve their economic status and professional image.

Avariety of nursing leaders were recognized at the simple and dignified opening ceremony.

when the House completed its work on struc- turing.

Reconvening at 8 am Friday, the House faced an almost impossible agenda that in- cluded credentialing, the dues increase, the economic and general welfare program, and the resolutions on entry into practice. Elections would be announced at 11 :30 am. It was not clearthat there would be time to consider other resolutions. But by almost eliminating discussion on resolutions, the House, in the late afternoon hours, made decisions on the 30-odd resolutions before it.

A resolution on the Credentialing Study ran into strong opposition, primarily from the New

Wisconsin delegates got in the spirit of Texas with their red cowboy hats.

York State delegation. The Credentialing Study, originally sponsored by ANA, has proposed major changes in credentialing in nursing. The study recommends the creation of a credentialing center with other organizations involved in its governance. The resolution called on structural units of ANA and consti- tuent associations to promote implementation of the study recommendations. In presenting the resolution, Board member Lucie Kelly, made it clear that implementation meant educating nursing and the public, not putting the recommendations into effect. Anticipating some of the opposition, she also emphasized that the Board intended to preserve the rights of ANA in credentialing. Opposition to the resolution came from those who wanted ANA to retain control over credentialing.

Speaking for the New York State delegation, Elaine Beletz criticized the study’s recommendations and stated that credentialing should remain with the professional


Nichols elected to second term Barbara Nichols won her second term as ANA president, defeating Jean E Steel, who was nominated from the floor. Nichols is director of inservice education at St Mary’s Hospital Medical Center, Madison, Wis. Steel is an adult nurse practitioner and an assistant professor at Boston University School of Nursing.

Other officers elected were Carol Spengler, first vice-president; Cappe Eudy, second vice-president: Margaret Ann Quan, secretary; and Louise Shores, treasurer. New board members are Mary Finnin, Kathleen Montgomery, Harold MacKinnon, Patricia Devine, and Ethelrine Shaw. Clifford Jordan, a strong supporter of AORN projects, was narrowly defeated in his bid for secretary.

Elected to the executive committee for the Division on Medical-Surgical Nursing Practice were Margaret Fuhs, Carol Roe, Jeanette Chambers, Margaret Stafford, and Cynthia Scalzi.

society-ANA. Also speaking from New York State, Laura Simms spoke against relinquish- ing implementation of ANA standards to other organizations. “Don’t consider that we will have control at all after the honeymoon is over,” she warned. “Can’t we learn that ANA has responsibility for control of this profession?”

The vote revealed divided opinion among the delegates, and New York State quickly introduced a motion that the Board of Directors establish mechanisms for protecting and facilitating ANA’s role in credentialing and report with a plan in 1982. The motion received strong support.

The rest of Friday morning was spent grap- pling with the dues question. Although the Board faced strong opposition to its request to double the national dues from $35 to $70, the delegates compromised on raising the dues Sept 1 by $20, to $55. During the discussion, various sums were considered, as well as a sliding scale. Several delegates contended that an increase would be “hard to sell at home,” but most conceded the need was real.

Delegates reaff irmed ANA’s belief in collective bargaining by calling on the Board of Direc- tors to “assign a substantial increase in fund- ing” for the program. Ada Jacox, a Board member, pointed out that 5.4% of the 1980 ANA budget went to the collective bargaining program although the number of those cov- ered by contracts is estimated to “exceed one-third of the membership.”

The resolution was revised from an earlier one that specified 20% of the budget for the Economic and General Welfare (E and GW) Program. Explaining the need for more funds at a hearing, Leota Acord, acting chair of the Commission on E and GW said, “We’re all aware of the problems at this time with some other unions raiding our units. It is very important, even though money is very tight at this time, that ANA make a strong commitment to the E and GW program.” She reported to the House that state associations had just won

Margaret Applegate, Indiana, introduces substitute motion to postpone titling two categories of nurses until competency statement is finished.


ANA recognizes outstanding nurses Seven nurses were honored during the ANA convention for their outstanding contributions to their profession and the health care field.

Mary Elizabeth Carnegie, FAAN, former editor of Nursing Research, received the Mary Mahoney Award. The award honors the contributions of a registered nurse whose efforts have promoted the integration of minority group nurses in the nursing profession.

ANA’s Honorary Recognition Award was presented to Marilyn Goldwater, a member of the Maryland House of Delegates. She was honored as an individual who has rendered distinguished service to the nursing profession and whose accomplishments and contributions are of national or international significance to nursing.

Goldwater was praised by ANA President Barbara Nichols for her role in sponsoring and enacting legislation that reflects an “acute awareness of the role of nurses in providing for the health needs of people.”

lngeborg G Mauksch, FAAN, received ANA’s Honorary Membership Award for outstanding leadership, participation, and contributions to the purposes of the association. Mauksch is the Valere Porter Distinguished Service Professor of Nursing and Family Nurse Clinician, Vanderbilt University School of Nursing, Nashville, Tenn. She has served as chairman of the ANA

Congress for Nursing Practice, as a member of the National Joint Practice Commission, and as nurse advisorto the International Council of Nurses.

The Pearl Mclver Public Health Nurse Award was presented to Doris R Schwartz, FAAN, an instructor in the Geriatric Nurse Practitioner Program of Cornell University-New York Hospital. The award recognizes outstanding professional contributions to public health.

Anne Zimmerman received the Shirley Titus Award for her contributions to ANA’s Economic and General Welfare Program. Executive administrator of the Illinois Nurses’ Association, Zimmerman was ANA president from 1976 to 1978.

The 1980 recipient of the ANA Honorary Nursing Practice Award was Betty Ann McArdle, head nurse of the Family Centered Maternity and Gynecology Unit, University of Illinois Hospital, Chicago. The Honorary Nursing Practice Award recognizes a nurse who assists patients in maintaining optimum levelsof health and, as a role model, creatively inspires her peers to improve their quality of nursing practice.

Lulu Wolf Hassenplug, dean emeritus, School of Nursing, University of California, Los Angeles, was the first recipient of the Jessie M Scott Award. Established in 1979, the award recognizes Hassenplug as a nurse who has significantly demonstrated the interdependent relationships among nursing practice, education, and research.

important elections in New York and Califor- nia.

Delegates took further action toward making the baccalaureate in nursing the entry level for professional nursing but stopped short of sug- gesting titles for two categories of nurses. Fol- lowing up on 1978 mandates to identify and title two categories of nursing practice, develop a mechanism for defining comprehensive competency statements for the two categories, and promote educational mobility, the delegates

approved guidelines for educational mobility, intended to increase flexibility of

academic programs 0 adopted a mechanism for developing

roles, functions, and competency statements rejected “preliminary concepts” that the future titles be nurse for the professional category and associate nurse for the as- sisting category approved accompanying resolutions to promote minority representation in nursing education and to advocate that baccalaureate students enroll in schools that consider the ANA Standards of Nursing Education and permit pursuit of advanced


academic degrees. The titling proposal was in trouble from the beginning of the week. The ANA Commission on Nursing Education, which directs work on the entry issue, anticipated controversy in its careful wording of the titling resolution. Called “preliminary concepts,” the titles were not in- cluded in the part of the resolution that could be debated and amended by delegates.

In a forum the Commission sponsored Monday, some delegates called the proposal “fragmenting,“ “premature,” and “speaking to the emotional component” of the issue. Other titles were suggested. Then the audience started asking how a substitute motion could be introduced to bypass the subject.

When the resolution came before the delegates Friday afternoon, they adopted a substitute, introduced by Margaret Applegate of In- diana, that postpones titling until after the Commission finishes its comprehensive statement on competencies.

Russell Tranbarger, a North Carolina dele- gate, seemed to sum up the mood. “I believe the titles are the least significant and most divisive at this time,” he said. “I believe it is important that we commit ourselves solidly and totally to the baccalaureate for entry into practice so we can go on about the business of developing competencies and designing cur- ricula to develop those competencies.’’

No deadline was set for completing the competency statement or titling. The Commis- sion is now developing general competencies for the two categories, which is the first phase of the competency mechanism approved by the delegates. “Due to the complexity and financial implications,” no date has been set for completing the second phase, developing practice models for testing and evaluating the competencies. The Commission will present a progress report at the 1982 convention. Meanwhile, the only immediate action will be to publish and disseminate the educational mobility guidelines.

With its most controversial issues settled, the House spent the last few hours of Friday hearing reports of the five divisions and the resolutions they were presenting. With little discussion, they approved most of them, in- cluding the resolution endorsing the OR nurse as circulator, presented by the Division on Medical-Surgical Nursing Practice.

NSNA plans seminars on nursing careers Helping students and graduating seniors plan for their careers in nursing is the focus of the National Student Nurses’ Association’s (NSNA) sixth annual Project Tomorrow series. Programs will be held in three cities: New Orleans, Oct 31 to Nov 1; Chicago, Nov 14 to 15; and Cherry Hill, NJ, Dec 5 to 6.

Faculty for the two-day program are Sally Karioth, RN, an assistant professor at Florida State University and a private pqactitioner in thanatology; Eileen Jacobi, RN, dean, University of Texas, El Paso, and former executive director of the American Nurses’ Association; and Phoebe Helm, executive director, developmental education, Triton College, Rivergrove, 111.

“Fitting in without Selling Out” will be a discussion of biculturalism and the integration of two sets of values.

In “Search for Tomorrow,” Jacobi will discuss self-assessment for job choice and examination of feelings to determine the type of nursing practice best suited to personal needs.

Jacobi will also explore opportunities in nursing for RNs in nonclinical settings, such as program planning or nursing journalism, during the session “This Is Your Life in Nonclinical Settings.” In a concurrent session, “This Is Your Life in Clinical Settings,” Karioth will discuss nursing alternatives in a variety of clinical settings.

How the student can learn to allocate time to study for the state board examination by learning how to tell what’s important to study is the subject of “Avoiding the Senior Syndrome,” a session by Helm. In a following session, “Multiple Choices,” techniques for taking the state board examination will be presented.

need for personal financial planning for the new graduate preparing for the first job.

Project Tomorrow will conclude with ”Where in Health Are We Going?” a panel discussion of professional issues in nursing by Karioth and Jacobi.

For more information, write or call the NSNA, Ten Columbus Cir, Room 2330, New York, NY 1001 9.

In “Money Matters,” Jacobi will look at the


ana advances entry position, keeps structure

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