"There is a strong and growing movement of nurses in this country who are looking for more proactive and aggressive approaches to the health care and nursing crisis in this country," said Denise Garlick, President of the MNA. "The landslide nature of these two votes demonstrates that front-line nurses no longer support the plodding, far too moderate approaches taken by the ANA. This vote will allow the MNA to utilize our resources to address our key concern, which first and foremost is to pass legislation to mandate safe staffing levels in Massachusetts Health Care facilities. It also frees us to pursue alliances with more progressive, like-minded organizations on the national level."

The final vote tally includes the results of a vote taken on March 24 in Worcester, where more than 2,400 nurses attended a special meeting to decide the issue. At that meeting, the largest gathering of nurses in Massachusetts's history, MNA members voted 1,925 to 413 in favor of disaffiliation. By court order, that vote could not be binding until the MNA completed supplemental mail balloting for nurses who couldn't attend the March 24th meeting because of work schedule conflicts or for religious reasons. The mail balloting was conducted in April, with the final tally of mail ballots completed on April 30. Per the judge's order, the tally from the March 24th meeting was added to today's supplemental mail ballots to arrive at the final vote. The counting of the mail ballot was monitored and certified by the American Arbitration Association. The MNA will meet with the judge on May 10 for a status hearing to inform him of the result, which the organization views as a formality.

Those calling for disaffiliation from ANA raised concerns about the ANA as being to slow to respond to a growing crisis in nursing, including the impact of managed care, health care corporatization, short staffing, mandatory overtime and other issues causing turmoil for nurses at the bedside. For example, while the MNA is pushing for legislation to regulate nurse-to-patient ratios, the ANA has proposed weak regulations that call upon the industry to develop a patient classification system, with no requirement that the industry adhere to that system. They have also promoted legislation granting the industry the ability to experiment with staffing models that replace nurses with unlicensed personnel, something the nursing community has opposed for years.

"It is clear from this vote that the MNA membership does not feel ANA advocates for the interest of nurses on the frontlines of health care. Rather its leadership is weighted toward the industry and as a result the profession and our patients have suffered," Garlick said. "The ANA's silence of action on the issues of importance has been deafening—MNA nurses as strong advocates for their patients and their profession are unwilling to be co-opted by the industry through the ANA. And so they will move in a direction consistent with their values and with the public trust bestowed on them, they will advocate for the patients aggressively at the bedside and external venues be it political, legislative or public relations—and they will join with other progressive nurses to fill the void that exists."

Supporters of disaffiliation also raised concerns about the structure of the ANA's recently established national union for nurses, the United American Nurses (UAN).

The MNA union membership had voted unanimously in 1999 not to join the UAN, because they believed its governing structure was inadequate to protect the integrity of the MNA labor program. The concern relates to the concept of insulation, a labor term that refers to the amount of separation needed between management influence in the conduct of union business. Under the current UAN structure, the ANA Board of Directors, which is comprised of nurse managers, as well as the ANA executive director, have decision making power related to the UAN. The lack of proper insulation makes those who belong to the national union subject to legal changes by anti-union management attorneys.

The issue was intensified in December when the ANA/UAN voted to make membership by ANA state nurses associations with labor programs mandatory in June. The ANA also proposed and will seek passage of a "discipline" bylaw, that would give them the power to sanction state nurses associations that fail to follow their bylaws and their positions. The MNA believed if they didn't vote to disaffiliate now, under the new discipline bylaw, they may never have that opportunity again.

"Our membership was not willing to take the risk of being forced into a union structure that in any way jeopardized the integrity of our own union," said Karen Higgins, elected leader of the MNA's union. "Our members clearly understood the inherent conflict of belonging to a union that was ultimately run by representatives of the industry we sit across the table from every day in negotiations. One of the hottest issues in nursing right now is mandatory overtime. In fact, the current ANA President, Mary Foley, the person with the ultimate control of the UAN is a vice president of nursing who has used mandatory overtime to staff her hospital."

The MNA, which represents more than 20,000 nurses throughout the state, was one of 54 constituent members of the American Nurses Association's federation of state nurses associations. The MNA, which has been affiliated with the ANA since 1903, was the second largest state nurses association after New York in the ANA federation. In 1995, the California Nurses Association, which was the largest member of the federation, also voted to disaffiliate, and has experienced tremendous growth and unprecedented success since and has now grown to become the largest state nurses association in the country. In 1998, unionized members of the Pennsylvania Nurses Association voted to disaffiliate and formed the Pennsylvania Association of Staff Nurses and Allied Professionals.

MNA's Future is Looking Bright

Along with California, the MNA has been long perceived as an innovative and progressive champion of nursing and health care reform, including taking a leadership role on the state and national level on such issues as nurse staffing, whistle blower protection, mandatory overtime, workplace safety, and single payer health care reform of the health care system. A key benefit of disaffiliation for the MNA is financial. The organization will now be able to allocate the $1.2 million per year that once went to ANA for its own use in support of the MNA's agenda at the state and national level for the benefit of nurses in Massachusetts. This year, that means supporting the organization's efforts to win safe staffing legislation to improve nurses' practice conditions by mandating safe nurse-to-patient staffing ratios in all health care settings.

With MNA's new freedom, the organization plans to evaluate its current working relationship with other like-minded independent nursing organizations to create a more progressive, staff nurse-oriented national organization that will give front-line caregivers an undiluted, uncompromised voice on issues of particular concern to staff nurses. Work in this regard would involve MNA's members and ultimately would be ratified by the membership.

In fact, in June, the MNA will meet with the California Nurses Association, the Maine State Nurses Association and the Pennsylvania Association of Staff Nurses and Allied Professionals to begin discussions about the building of a new nurse association that will include staff nurses and nurses who support them; providing a forum for these organizations to push their agenda on the national stage.

"There has been a lack of cohesion and a lack of a unified voice for frontline caregivers in this nation that we are anxious to fill," said Higgins. "While informal discussions and a working relationship have been evolving between our organizations for more than two years, we are now in a position to undertake the real work necessary to build something totally new and powerful to change nursing and health care in this nation. Our plan is to begin meeting to develop the core principles of a new national organization, as well as to outline a possible structure that we can all take back to our membership for further development and discussion. Unlike the ANA, no decisions on a national organization will become a reality without our members having the opportunity to discuss, define and vote to ratify such a structure."

"We are ready and willing to join forces with other states who are committed to fighting for frontline caregivers and for taking strong stands on patient care issues and the protection of our profession," said Garlick. "This is truly the beginning of a bright and powerful future for nurses, not only here in Massachusetts, but anywhere else in this nation where there are nurses who want to be part of a movement for real reform and dramatic change."