• Pro Independent MNA

• Is Affiliation with ANA Worth the Investment?

A look at the numbers says ‘no'

• Vote for Disaffiliation, Vote Pro-MNA

• Leadership Requires Disaffiliation
  
  

Pro Independent MNA

Disaffiliation is a positive step in the process of strengthening and growing the MNA. The Congress on Health and Safety and Cabinet for Labor Relations have proposed bylaw changes that call for disaffiliation because we believe an independent MNA with focused resources will represent its membership needs and goals with clarity and force.

As a result of severing our membership with the ANA, the MNA would no longer be required to pay the state's membership fee to the ANA federation. This fee/assessment is over $1 million annually.

For nurses who share the following core values and wish to vigorously pursue an agenda that addresses these values, an independent MNA is necessary in order to fight against the corporatization of the health care system, the destruction of our profession and the erosion of our role as patient advocates.

Core values:

• To protect and promote the profession of nursing.
• To enhance the knowledge and promote the education of nurses.
• To foster clinical expertise and activism on behalf of our practice and patients.
• To protect the health and safety of nurses in all work settings.
• To enhance and promote the economic, health and general welfare of nurses.

The ANA has performed some services for nurses that are valuable and this deserves to be acknowledged.. However, by virtue of the ANA's federation model, specifically the need to serve 53 masters (the state nurses associations), it's newest member, the federal government nurses and its goal to foster the structural relationships with its' organizational affiliates, the ANA "tries to be all things to all people." Consequently, its positions and actions seek the middle ground and are thus moderate by nature. The ANA has a long history of "moderate" positions that have not impacted positively on the escalating health care crisis we face in Massachusetts. With all due respect, the ANA has existed for nearly a century—it is incongruent to believe that the ANA has been an effective leader when nursing today is in such complete chaos and facing extinction.

In Massachusetts, we have the highest percentage of managed care in the country endorsing the concept of market driven health care. As a result there is a prevailing business mentality we experience as the ratcheting up of pressure on nurses and nursing, the introduction of "for-profits," and the worst nurse shortage we have seen yet. Continued "moderate" positions and actions synonymous with ANA leadership, will only exacerbate the exploitation and expendability of nurses, the destruction of our profession and ultimately result in the erosion of our role as patient advocates. Unlike ANA, in response to the pressures of managed care and market driven health care, MNA members, such as the St. Vincent nurses, have taken ever more effective and aggressive stands. The St. Vincent nurses 49-day strike was a shot heard around the country placing the health care industry and Tenet on notice, that nurses as advocates will draw the line when their patients and license are put at risk. In Massachusetts compromise is not an answer for many of the issues we face and solutions that we must secure — reallocating resources otherwise spent for continued failed leadership by ANA, to effective leadership by MNA, will assist in achieving these much needed solutions.

As elected leadership structures recommending and pursuing disaffiliation from ANA, we have considered this action carefully and explored the potential consequences. We are secure that with careful strategic planning, initiatives may be undertaken to assure that member services will be enhanced and new systems instituted that will mitigate any limited adverse effects.

By way of example, concerns have been expressed surrounding the potential loss of a "national voice." This can be addressed effectively through the re-direction of our retained resources as well as coalition building with other like-minded nursing organizations. The California Nurses Association disaffiliated from the ANA in 1995 and they have been successful on the state level as the first and only state successfully passing staffing legislation. They also have maintained a presence at the national level through the retention of a national firm to monitor and lobby those issues the California membership determines to be of priority.

We believe that directing our resources on actions with a clear, unequivocal voice on targeted issues is a far better option for Massachusetts nurses than to fund a moderate national voice that may undermine our memberships position — or worse still, subsidize positions that are in opposition to our memberships goals.

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Is affiliation with ANA worth the investment? A look at the numbers says 'no'

As an ANA delegate, I've monitored the finances of ANA for the past six years.

These are my conclusions:

1. ANA appears headed for financial ruin. This will occur whether MNA remains in ANA or not.
2. There is no credible plan available from the ANA Board of Directors to address this crisis.
3. The ANA House of Delegates, the body with ultimate authority at ANA, has chosen not to require a recovery plan to assure the viability of ANA.
4. Members of MNA are receiving too little for the $85 per member per year "assessed" upon each of us by ANA, an amount that will inevitably increase.

ANA's crisis has been years in the making. Even when ANA was operating "in the black," concerns were voiced about how resources were used.

In 1995, the 25,000 members of the California Nurses Association left ANA, a loss of $2 million a year. Still, 1996 and 1997 resulted in "surpluses," building reserves to $13 million. By 2000, three years of deficit spending drew reserves down to $9 million. Without a $30 dues increase, the board forecast reserves would drop to $7 million by the end of 2000, then to $3 million in 2001. By 2002, our reserves will be gone, left at minus $2 million!

Despite these predictions, the dues increase was pulled from the agenda of the House of Delegates when defeat seemed likely. However, there's been no change in this year's budgeted deficit of $3 million. At the ANA Finance Forum in June, delegates pleaded with the treasurer to share the board's plan to address the shortfall. She replied that the responsibility for ANA finances lies with the board alone. But ANA bylaws are clear: "The Board of Directors shall report and be accountable to the ANA House of Delegates." Delegates subsequently brought the same request for accountability to the full House of Delegates, which instead chose to "trust those whom we've elected." The record of the recent past is not promising, especially to Massachusetts.

To restore balance, ANA must decrease spending and/or increase revenues. ANA has cut staff by 32, a 15 percent reduction, affecting all departments except:

• United American Nurses: the "union," the structure of which MNA opposed because of inadequate "insulation" from management domination.
• Workplace Advocacy: a new department providing alternatives to collective bargaining.

With no dues increase, rapid growth in membership is necessary. But ANA has been steadily losing members.

"Non-dues revenue" cannot make up the difference. Income from investments will go to zero as reserves are depleted. Only a fraction of certification fees ever reaches ANA. In "products and services," $400,000 income from the ANA credit card, expected to offset the deficit this year, turned out to be a "miscalculation".

In 1998, the ANA Board commissioned a study of ANA's finances by the Lang Group. The findings were alarming:

• "One thing is for certain—ANA is in a financial crisis...because of many years of poor financial leadership and inadequate long-range planning."
• "We uncovered...a plethora of uncertainties that...make it impossible to determine the accuracy of the 1999 budget."
• "ANA has only one significant source of profitable non-dues revenue—certification. However, all of the certification products were spun-off into a separate entity (ANCC) that is not directly under ANA's control."

There are other "entities." The 1997 audit listed $30 million in assets of the five wholly-owned "subsidiaries" of ANA. These are run by boards composed of, or appointed by, the ANA board itself. The House of Delegates does not demand fiscal accountability from ANA about this interlocking corporate network. When ANA sold the American Journal of Nursing for $24 million, there was no report to the House on the details of the secret sale and none demanded.

The makeup of the House will not change anytime soon. Adoption of term limits and proportional representation, to make the ANA more democratic and more accountable to the staff nurses whose dues pay most of the bills, are opposed by those currently in control of the House. And the House elects the ANA Board.

MNA has a choice this November. Do we keep sending our dues to ANA, getting less in return? Is it wiser to invest in MNA and pursue better national and international alliances of nurses? It's your money.

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Vote for disaffiliation, vote pro-MNA

In January of 1999, after receiving thousands of angry letters written by registered nurses who were fed up regarding the current condition of the nursing profession, Ann Landers posed a question to America's staff nurses. She acknowledged our history of exploitation and abuse in the work place and the exodus of nurses from our profession. She wrote that she received not one single positive letter from anywhere in the country. She closed that column by asking nurses; "So what are you going to do about it?"

Currently all members of the Massachusetts Nurses Association are being asked to consider disaffiliation from the American Nurses Association. By doing so, the MNA will save $1.2 million in membership dues which are currently paid to ANA every year for national leadership, and to represent nursing's national voice.

One of the strongest arguments being put forth for not disaffiliating from the ANA is couched in concern that nursing will lose our "national voice." Consider the following commentaries on US nursing's national voice.

In November 1999, influential media powerhouse Madge Kaplan, senior health desk editor and bureau chief of National Public Radio's International "Marketplace" at WGBH, addressed national nurse leaders in Arlington, Va. Invited to speak to fellows of the American Academy of Nursing (FAAN), Kaplan delivered a speech entitled, Why isn't Nursing More Newsworthy?

In her comments Kaplan noted that even though nurses are the backbone of the health care industry by virtue of our numbers alone, "the invisibility, the taking for granted of nurses, is pervasive..."

Many of Kaplan's observations highlighting the absence of nursing's national visibility and lack of influence in national health care, were based on responses from an informal survey of health care journalists from around the nation. For example, Ms. Kaplan informed nursing leaders that "Reporters don't seem to know which nursing groups to pay attention to, who the important nursing leaders are- as spokespersons for the profession." She added, "Nurses don't seem to be playing an important role in larger healthcare debates and policy developments, especially at the national level."

Kaplan questions editorial bias, then goes on to say, "the underlying message here is that something isn't quite working when the largest healthcare profession in the U.S. isn't reported on more." She suggests, "The nursing profession needs to announce it's involvement in patient care and consumer health issues" and "they [nursing] should be contributing to the discussion of what the issues are in outpatient care, home care, the nursing home, and assisted living. For example, is the nursing profession concerned about the aging of the population?" These comments are alarming.

Nurse executive Gail Wolf, DNS, RN, FAAN, conceded in a recent column, "For the most part we have become redesigned, reinvented, cross-trained, and reengineered witless wonders." Why? Has this occurred with our permission? As we witness the deteriorating quality of care in our nation's hospitals, nursing homes and in the community, we need to question where our national nursing voice has been? At great risk in all of this, is nursing's most cherished and powerful asset—the trust of the American public. Will professional nursing not be called into question in the future?

Observations such as Madge Kaplan's and Gail Wolf's demand that all MNA members seriously consider whether we can afford the 1.2 million dollars of MNA member's money we currently send out each year for our national voice?

MNA has an outstanding record of professional nursing leadership and has earned a respected voice for nursing nationally. Recently, in one of many articles, the Boston Globe described us as "the powerful MNA." We are recognized in the national nursing community as true leaders for our work in creating legislation and policy which supports staff nurses who provide direct patient care. Our work on single payer health care, BORN reform, our Congress on Health and Safety, and whistle blower protections (to name a few) protect not only patients and our member nurses, but all nurses in Massachusetts.

California Nurses Association has also, since disaffiliating from ANA in 1995, become a strong visionary leader of nursing while growing its membership by thousands and winning unprecedented protections and accomplishments for nurses and patients. Powerful professional leadership recognizes and changes that which is not working for its members.

However, efforts to protect our work, promote our profession and end "the invisibility and pervasive taking for granted of nurses" are up to each of us. Witless wonders? The question remains: "What are we going to do about it?" Vote Pro-MNA Nov. 9.

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Leadership Requires Disaffiliation

Continued affiliation with the ANA poses both a threat to MNA and diminishes MNA's ability to effect its mission.

Consistent with the mission of the MNA, "to preserve the identity, integrity, and continuity of nursing in the Commonwealth of Massachusetts," to assure effective advocacy for the nurses and patients of Massachusetts, the Pro-MNA committee believes disaffiliation from the ANA must occur for the following reasons:

1. Failed financial stewardship by ANA

• Financial irregularities and abuses were documented in the independent audit entitled the Lang Report. Without significant dues increases ($30 per nurse) or dramatic reduction in expenses, the ANA will go bankrupt within two years. With this knowledge, the ANA HOD failed to vote to hold the ANA Board of Directors accountable or to reveal their plan for financial stability

• In 1998 the ANA Board of Directors voted to de-fund the elected structural units thereby silencing the voice of the elected leadership. Massachusetts brought an action plan to the House of Delegates to prevent this for the future. Under the current ANA HOD composition, the Massachusetts plan was decisively rejected.
• In 1996, the ANA bylaws committee rejected MNA's bylaw proposal to insulate the Institute for Collective Bargaining Program( ICBP), the predecessor structure of the UAN.
• A lack of proportional representation fostered by ANA bylaws insures that the staff nurse voice and votes are, and will remain, disproportionately under-represented in decision making. Specifically, collective bargaining nurses supply over 67 percent of ANA revenue yet represent only 18 percent of the voting body.

• The ANA House of Delegates (HOD) is comprised of delegates apportioned by bylaw from the Constituent Member Assemblies (CMAs). As a result of the manner in which delegates have been apportioned, the HOD is not reflective of the membership supplying dues—staff nurses covered by contracts. Instead, non-labor and non-staff nurse delegates are the majority of the HOD that sets the agenda for ANA resulting in moderate positions and actions on issues of importance to nurses working at the bedside —compromising our ability to deliver safe patient care.
• ANA's competing constituencies and disproportionate representation result in positions and actions far weaker than those advocated by the MNA membership; single payor, UAP's and safe staffing are glaring examples.

• In 1999, the MNA Labor Program members voted unanimously rejecting UAN membership. The primary reason was the UAN under ANA bylaws provides for the executive director to have final authority for selection and oversight of the UAN program director. Review by MNA's legal counsel resulted in the following assessment: "As a legal matter, this section leaves the UAN subject to attack on grounds that a supervisory laden Board of ANA could influence its Executive Director's oversight of UAN activities through supervision of staff, or allocation of financial resources. On a practical level, this section raises that possibility that the programmatic priorities established by the UAN or its Executive Council would not be funded or undertaken, and leaves the UAN without effective recourse…. It is the potential for such mischief rather than the fact of its occurrence which leaves the amendments subject to legal attack."

• Under a proposed bylaw passed by the UAN assembly, UAN membership would become mandatory for any CMA with collective bargaining. At present, the MNA labor program does not belong to the UAN and thus avoids any potential legal threat. This change would mandate MNA membership belong to the UAN against its wishes and legal counsel's advice.
• The UAN is seeking mandatory membership to facilitate its goal of a charter membership with the AFL-CIO, which made this one condition for providing a charter. If a charter is awarded, AFL-CIO per cap fees are required.

ANA wants us to stay, in part because of revenue and in larger part because we are leaders. Conversely the MNA must disaffiliate for those very same reasons.