WORCESTER, Mass.—At a historic and closely watched meeting held at Mechanics Hall in Worcester today, members of the Massachusetts Nurses Association (MNA) voted by an overwhelming margin to disaffiliate from the American Nurses Association (ANA).

The vote was held at a special business meeting called to decide the issue, drawing the largest ever attendance at an MNA meeting in the organization's 98-year history. More than 2300 nurses attended the meeting, twice as many nurses as attended a previous meeting on the same issue held last November. The final tally was 1925 to 413, with more than 82% of the members attending the meeting voting in favor of a bylaw change to authorize the split with ANA, easily exceeding the two-thirds super majority required. The vote to disaffiliate will be binding and final after the MNA completes balloting for those members who couldn't attend due to scheduling conflicts or due to religious reasons.

Nurses were jubilant after the vote, as it signified not only a break with the ANA, but a significant step in the MNA's evolution as a powerful voice for progressive action on the nursing and health care front. Those calling for disaffiliation from ANA raised concerns about the ANA as being too moderate and 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.

"This is our day of independence, and it is a day when front-line nurses across this state and this nation are empowered," said Denise Garlick, RN, President of the MNA and a strong proponent of the split from ANA. "The MNA has claimed its power and, with this vote, will have the resources necessary to move an aggressive agenda in Massachusetts to fight for safe staffing legislation that will improve the safety of the patients we care for."

"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. 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 arm. "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 20,0000 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.

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, immediately after the vote, the MNA will meet with the California 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 organizational, 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."

Now that Massachusetts and California, two of the largest and most powerful state nurses associations are out of the ANA Federation, the MNA expects other, staff nurse-oriented states to consider doing the same. The state of Maine, in fact, will hold its own vote on disaffiliation in April.

"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."

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