Protecting Nurses' Welfare: A Chronicle of Achievement (sound)

[Music] how long has you been no matter what role they play or what setting they work in nurses have one basic goal to provide the best nursing care possible achieving this goal is greatly affected by the conditions under which nurses practice implementation of Standards involvement in decision-making Staffing care plans inservice education salary and fringe benefits these factors have a significant impact on the quality of Nursing Care since its founding in 1896 the American Nurses Association has worked very hard to ensure working conditions which are conducive to the highest quality of Nursing Care according to past Ana president an Zimmerman one of the criteria for a profession is that it have a professional association an integral part of that professional association in addition to its education and standards Etc is the um economic Weare of its members the members have a responsibility and a right to have something to say about the environment in which they practice their profession and so it is the total environment for practice as well as for their economic and social welfare that I believe is an integral part of the American Nurses Association in 1946 Ana launched a sophisticated program for dealing with the socioeconomic concerns of nurses past Ana president Barbara Nichols the economic and general welfare program has not been understood by many its relevancy or relationship to other programs but the economics of what we do uh impact Recruitment and Retention certainly there is a relationship to uh salary over time and education and so all of these things impact and relate so you cannot really view the program in isolation you have to see it as an integral part of what the profession is about and that is providing care for people as well as attracting uh bright people into the [Music] profession when Ana delegates met in Atlantic City in September 1946 there was a pressing need to safeguard the economic and social welfare of nurses a distinct program was needed there was a critical shortage of nurses World War II had placed great demands upon the profession poor working conditions low salaries the absence of fringe benefits these were obstacles to recruiting and retaining nurses very past Ana president Elizabeth Porter salaries were lower than they should be according to all information we had as a carryover from the earlier historical periods in nursing hours were long modern Personnel practices were not discussed vacation periods uh were fair but not long enough in most cases and such practices as sick leave and of course any insurance carried by the employer these were practices well known today that were unknown in those days two factors in particular influenced Ana's decision to implement a National Economic Security program first the success of the California Nurses Association as the duly authorized bargaining agent for its members in front of the war Labor Board second a study conducted by Raymond Rich Associates on the structure of organized nursing it warned that nursing could not maintain high standards of practice attract qualified recruits or retain the best nurses unless it achieved a decent measure of Social and economic security for nurses these Consultants urged Ana to assume this responsibility rather than leaving this field to organizations outside the profession as a result the Ana House of delegates adopted a National Economic Security program it also adopted the association's first platform containing several statements on the welfare of nurses Mary Roberts editor of the American Journal of Nursing came to the board and said this organization has got to have a statement of what it stands for the board of directors then proceeded to try and adopt the platform and at that time the statement was made there had to be a plank about economic and social welfare as it was known then for nurses Shirley Titus who was the executive director in California and a member of the board tried to explain it she gave up in despair because a member of Thea board of directors didn't understand it so she just for get it Katherine densford the president said to Shirley Titus we're not going to forget it you and Pearl mver and Bill Scott will go to lunch and come back with a plank that deals with collective bargaining and that's how the first plank got into the first platform of the American Nurses Association surely Titus was a driving force behind the economic security program the program as it was brought to the Ana House of delegates grew out of the very strong aggressive leadership of the California nurses Association the credit must go to Charley Titus I had been interested and I did some graduate study in the field of personnel Administration and that created a bond between Shirley and myself I was talking about Personnel Administration and she was talking about how to achieve such policies in nursing in the early stages of the economic security program which was later renamed the economic and general welfare program the National Organization took a lot of leadership in developing criteria encouraging the states having educational programs all around the country as they did this it had a lot of national input then as uh laws changed and uh roles changed the state Nurses Association became much more active because it had to be their program and the role of the National Organization then became one of supportive of Education Financial underpinning uh National policies uh and the role of the States became the more active aggressive uh representation role Ana executive director Judith Ryan at the time that Ana moved forward toward development of its economic and general welfare program The Economic Security program as it was called at the time there were already States like California who had well-developed Collective bargain and Labor Relations programs others were in the initial throws of those pieces after the program was adopted at the national level the states then began to develop the kinds of Economic and general welfare thrusts that fit their General cultures those states that existed in areas in which there was Heavy labor activity and collective bargaining was a well-utilized tool in the Personnel Arena developed collective bargaining programs those states that were right to work states looked at different kinds of approaches the program became uniquely a state program unique to that State's particular approach to economic and general welfare in the employment setting sna collective bargaining initially focused on improvements in salaries fringe benefits and working conditions As Time passed snas began to use collective bargaining to address pressing professional concerns today local unit nurses address a wide variety of issues collective bargaining can actually be um a tool for use by this Association for getting across our standards of practice our positions and for promoting that one strong voice in nursing a career ladder with a 100% clinical Focus seemed like a genuinely good idea with Association went for it and introduced the issue of a clinical ladder as one of its major objectives to be included in the collective bargaining agreement this system would address staff nurse job satisfaction and in fact would permit and encourage nurses who excelled in clinical competence to remain by their patients bedsides and was bound to improve patient care and Advance the concept of Independence in nursing practice we created a career counselor position to help nurses stay within the hospital Center and have movement within that Center based on some kind of decision making that has been thought out we proposed contract language called the role of the registered nurse in which case we addressed Staffing and having Staffing ratios patient Acuity classification systems we address the issue of in services and education um and it also identified a large issue with at our particular institution which involved the time that it took a registered nurse to perform non- nursing functions functions that could have and should have been performed by other departments other than nursing most sna negotiated contracts establish one or more professional practice committees these these committees provide the mechanisms for ongoing communication between nurses and management this committee is an elected Committee of the registered nurses covered under a collective bargaining agreement the scope and responsibility of that committee is to deal with everything other than Collective barging it's to deal with things such as nursing care plans uh it's to deal with Staffing levels it's to deal with evaluations it's to make recommendations about how you can improve nursing care and so forth it has an enormous potential I sit on the professional performance committee what we've done with that was the most exciting thing was dealing with nurse satisfaction when we had the nurse shortage and we went out and we looked at sat dissatisfaction within the workplace did a poll went back and we stopped our turnover at that point by almost 10% which was very exciting for us we have a professional performance committee at our particular institution there are many issues that come to our committee for instance lack of uniformity in implementing the policies and procedures of the hospital right we are able to discuss this and allow management to make changes prior to following Grievances and that has been very effective also this is similar to uh possibly a nursing care committee yes yeah okay that's what we have in our Hospital a nursing care committee and and we sort of did the same thing I also sit on the clinical promotions committee which takes nurses and reviews them a peer review and promotes them upward right makes recommendations to promotion to their directors it's been an interesting process what's come out of that committee not only have nurses been promoted but we've developed an interviewing process that they utilize when hiring new nurses into the hospital Center your contract allowing nurses to sit on Hospital committees or insisting that nurses sit on Hospital committees to form old care plan studies a level of care Staffing patterns based on those levels of care it upgrades the nursing profession and it gives in the long run the patient much better safer nursing practice also the hospital benefits because if there's an unsafe area in the hospital this is communicated on this committee and um the committee serves as a voice by organizing we get hurt since 1946 Ana has never wavered in its belief in nurses involvement in collective bargaining in the final analysis unless you recognize that you have the right and it isn't a privilege it's a right that you have to negotiate uh to be represented to be covered by a collective bargaining agreement and that if you take that right and go beyond just the the traditional scope of collective bargaining that takes place at the table and get into the policymaking Arenas uh then we can bring about some changes when we go to the bargaining table we just don't talk about more money or better working conditions but we also take consideration that their educational potentials that need to be developed we also look into better quality patient care better Staffing to ensure that the quality of care is given these are the things that we talk about participating in your local bargaining unit your state nursing association we can meet some of the basic needs of nursing so that nurses can turn their major energies to better patient care upgrading their nursing profession getting higher degrees of Education or sitting for certification we say that nurses want to make a difference well yes we can make a difference if we are in the right place so being a part of something like this has really given me the opportunity to be verbal to bring about changes and to touch other people's lives in a way that they want and uh I found that most gratifying we're seeing nurses at the grassroot level involved in professional issues that were never involved before and I think we need to keep that going so that nationally we can advance our profession to where it needs to be in my opinion I said it when I was president and I would repeat it again that the best representation of nurses is the American Nurses Association through its state nurses associations the constituents of the association this is important because what we are talking about is who can articulate practice issues if nurses cannot speak in their own behalf then the autonomy of what we are about will be articulated by others and we will not control our own destiny it is imperative then that the state nurses associations be the board for nursing in this Arena at that historic convention in 1946 nursing leaders did view collective bargaining as important but as by no means the only strategy needed we were interested in the total work situation collective bargaining was simply the technique of trying to achieve these goals but nurses needed to have protection in other ways a second component of the economic and general welfare program is based on lobbying litigation and advocacy three factors uh that the association at every level must look at and work towards one relates to the changing Dynamic of legislation and it's an impact on wage and labor ideology the second Factor relates to different interpretations of the Judiciary the profession at each level must be sensitive to injecting a contemporary definition as the Judiciary makes interpretation and the third factor is the interplay of social economic and political ideological factors and the need uh for each level of the association as well to be sensitive to the changes occurring in those Arenas in 1960 an Ana convention speaker noted that even the key social and labor legislation which had brought about the most significant changes in the American Social System since the 1930s had nevertheless excluded Exempted rejected and otherwise discriminately treated nurses alert to this fact Ana through its economic and general welfare program set out to win for nurses and other Healthcare employees the same rights and protections accorded other workers under the law these efforts have resulted in improvements in and extension of coverage to employees in public and private profit and nonprofit help care facilities now nurses and other healthcare workers are entitled to Social Security coverage unemployment compensation protection against unfair wage and employment standards and rights to bargain collectively on wages and other employment related concerns Ana sought and was granted National consultation rights at the agency level of the Veterans Administration the association has exercised these rights in response to significant proposal changes in employment conditions in VA facilities Ana has offered its views and recommendations on subjects ranging from the handling of toxic compounds to the proliferation of new categories of health personnel another major thrust of activity has been aimed at eliminating employment discrimination in 1946 Ana made a public commitment to remove barriers that prevented the Full Employment and professional development of nurses belonging to minority racial groups in the 1950s Ana endorsed the principle of equal pay for equal work as a means of improving women's wages Ana support helped to enact the federal Equal Pay Act in 1963 although Limited in scope it was the first federal statute Banning employment discrimination against women Ana was in the Forefront in challenging pension benefits based on sex segregated mortality tables in 1973 AA filed discrimination charges with the equal employment opportunity commission on behalf of several nurse Educators against the nation's largest university pension underwriter this action Drew public attention to the inequities in the pension system Ana filed a friend of the court brief in the case of Norris versus Arizona governing Committee in that historic case the Supreme Court struck down the practice of paying lower monthly benefits to women based on sex segregated mortality tables Ana provided financial support to nurse Incorporated of Denver a group of Public Health nurses they charge the city of Denver with violating title seven of the Civil Rights Act by discriminating against women in Pay practices legal authorities believe this action paved the way for the Supreme Court's decision in the county of Washington versus Gunther in that Landmark case the Supreme Court ruled that that sex discrimination and salaries is a violation of title 7 even when the jobs held by women are not equal to those held by men in the early 1980s Ana working with the Illinois Nurses Association charged the state of Illinois with discriminating against its women employees in female dominated job classifications special counsel Edith Barnett I am representing the American Nurses Association the Illinois Nurses Association and 21 individuals in a class action sex discrimination lawsuit filed yesterday here in federal district court in Chicago our lawsuit charges the state of Illinois with violation with violating federal civil rights law and its pay practices to its female employees our Workforce is very sex segregated that is women work in a certain number of jobs and men work in other jobs study after study shows that if you apply job evaluation procedures to these different sex segregated jobs that is if you measure the jobs in terms of the common requirements of skill effort responsibility and working conditions the points come out very much the same this means that the job requirements are not very different and yet the salaries are very different in the Illinois case the state of Illinois made a job evaluation study of 12 female dominated classifications in comparison with 12 male dominated classifications this study when compared with the wages actually being paid to the males and to the females showed that males were receiving approximately $66,000 more annually than females Ana president Unis Cole the findings brought out in our lawsuit against the state of Illinois are blatant examples of problems that nurses continue to have it is time that employers acknowledge that these practices are much more than unfair they are violations of the law the nursing profession represents one of the most flagrant examples of pay discrimination against a traditionally female occupation our Research indicates that approximately 97% of all nurses are women no other profession is so closely identified with working women nurse in is one of the most sex segregated uh job classifications in this country and study after study has shown that nurses are one of the most underpaid categories in relation to the demands of the job they perform nursing is a tough job and the women who do the job don't get paid enough I've been in several situations where at one point I was a single parent raising three teenage children and I would sit on the negotiation table and and I would hear over and over again that's not a bad salary for a woman and I would turn around and ask can you see a man accepting that salary and raising three teenage children on it um can you see anybody running a household on that salary and there would be dead silence uh I would be compared to teachers or other underpaid professions that are predominantly women and no one would really address the issue that I'm not a secondary income I'm a primary wage earner since the passage of the civil rights laws employers have become more sophisticated about trying to hide such problems and perhaps consciously try to change their attitudes but the past attitudes uh are still uh Incorporated in the present discriminatory wage differentials and it's this that we have to get at we are committed to and will continue to work for the elimination of sex discrimination in employ employment of all women ever since the economic security program was adopted at the 1946 convention AA has developed an Ever widening campaign to heighten awareness of the value of nursing services to draw attention to factors that affect the quality of nursing care to reinforce nurses rights as professional employees information sharing has become a third vital component of the economic and general welfare program Ana has initiated Nationwide studies to compile needa data on Nurse Manpower it has also encouraged governmental agencies to compile employment data on the entire healthcare industry it was due to Ana's insistence over 20 years ago that the Bureau of Labor Statistics began to include hospitals in its wage survey program Ana has launched Nationwide campaigns to alert the public about nursing's role in the Health Care system and about the socioeconomic concerns of Nursing in the 1960s the association launched a national public information campaign operation speak up for nursing the purpose was to build public awareness of substandard salaries and employment conditions of nurses in the 1970s Ana launched the year of the nurse to inform the public of the role of the nurse and to emphasiz nursing's contributions to healthcare this public relations effort generated much attention from the media and greatly enhanced public awareness of the valuable role nurses Play It's called family centered nursing it's working in Milwaukee and it can work for you Ana produces a wealth of Labor Relations resource materials these tools enable nurses to deal more effectively with economic and employment concerns since 1950 the association has set forth minimum employment standards contract guidelines and other Publications to Aid nurses in a variety of employment settings through research data Gathering and policy analysis Ana keeps nurses informed on socioeconomic issues working through its state associations Ana has provided economic and general welfare training for thousands of nurses it presents workshops to implement Professional Standards in the workplace to heighten awareness of such issues as health hazards in the workplace to increase knowledge of labor law and Health economics to enhance individual abilities in conflict resolution verbal skills in negotiations and grievance handling in 1982 the association launched a series of local unit leadership development workshops an Ong I think it's very important that we attend these workshops basically for the support that you can develop between each other uh sharing common problems and resolutions that we've we've all experienced I think it allows for professional type of sharing that needs to take place among nurses because we all share common concerns and it's nice to hear that we're all fighting the same battle and that we're all United as one and it it's very exciting to see that happen and it's good to hear Ana's uh concern for our concerns bargain Advocate Lobby litigate inform key words in Ana's economic and general welfare program since 1946 the program has been successful beyond our wildest dreams I'm sure Shirley would say that what we did at the very beginning has been much worthwhile today there is every indication that the program will continue to play a key role in Ana's efforts to protect nurses welfare and to ensure the highest quality of nursing care one of the more effective themes that has had as its recent conventions was the theme challenges and choices the theme was chosen because indeed this period introduces both challenges and choices we've got the kinds of challenges of demonstrating that nursing services are cost effective and necessary it's an era in which there are shrinking resources we are no longer talking about more resources being available to nursing but rather how nursing is going to effectively demonstrate the comparable worth of its work we know about surpluses of medical Manpower and yet we know that there are shortages of nursing person power and how we make those kinds of statements clear to a public that sees nursing as essentially a part of medicine is one of the challenges that we have but there are great opportunities aging people need us the poor need us mothers and children need us our patients need us what we have to do is organize to deliver those services in a new kind of an environment healthc care delivery is now in a period of dramatic change ways that Health Services have been organized and delivered are being revised or replaced the need to reduce health care costs has intensified competitive market strategies multihospital systems continue to grow increasingly hospitals are expanding into non-traditional Health Care Services the independent nonprofit short-term hospital is under extreme pressure to merge with other institutions to diversify into new business areas health professionals are increasingly competing with each other for patience and dollars Physicians are extending office hours and establishing freestanding no appointments necessary clinics in convenient locations in medical technology the emphasis is Shifting to simpler more mobile less costly less tertiary care oriented Technologies by the year 2000 the the healthcare industry is likely to resemble many other Industries in the United States a few large firms will control a significant share of the market for a wide range of Health Services many smaller more specialized businesses will engage in other health rated Ventures as the population continues to age the healthc care industry will undergo even greater change by the year 2025 some 60 million people will be over the age of 65 as the numbers of elderly grow dramatically so will the demands for long-term care and the need for alternatives to institutional nursing home care in the past nurses have organized to deliver their services in essentially two sites one in the hospital or institutional setting nursing home setting I'm also including in that Arena and in the community setting I think what we're going to see in the future is something quite different in an era of high tech the high touch car care and attention provided by nurses will take on new meaning and value nurses will begin to care for new patient populations in new and different settings and agencies we're going to see larger and larger conglomerates and bigger and bigger structures of nurses on the one hand and on the other hand a whole evolving plethora of small single service kind of agencies that are Contracting with those big conglomerate structures to provide certain kinds of services nurses are going to have to learn to practice in a different kind of way in that large conglomerate Arena and how to enter the power and decision-making structures as well as the clinical structures in those settings and are going to have to learn to become competitive with other providers with nurse manage centers with uh nurses coming together to contract for services to other Arenas a whole series of new ways in which we need to learn to organize and learn to to manage the delivery of our services is evolving whatever we know is that the future is not going to be like the past dramatic professional challenges and choices await the nursing profession with these opportunities will come new and different economic and employment issues as in the past Ana through its economic and general welfare program will be ready to address these issues ready to undertake the necessary measures to ensure working conditions conducive to the highest quality of Nursing Care ready to protect and Advance nursing's economic and general [Music] welfare a