Workers from all industries join professional associations to stay up to date on industry news, make connections, and advocate for improvements to the profession. But what happens when these associations stop living up to their promises?
The nursing profession deals with many issues that are affected by politics, such as standards of practice, workplace safety, and patient health and privacy. And bedside nurses have a front row seat to how related legislation plays out in the real world.
With the onset of COVID-19, many issues nurses already face began to compound. Nurses were asked to work optional or mandatory overtime without being provided sufficient personal protective equipment (PPE). AS PPE began to dwindle and hospitals filled up with critical patients, nurses spoke out on social media to alert the public.
With no sense of urgency from the federal government, nurses looked to professional associations like the American Nurses Association (ANA) to speak up for them. But instead, nurses say the organization sat back and stayed neutral.
“[The ANA] made a statement here or there, but they were not really advocating strongly enough,” says Erin Hartnett, founder of Nurses for America, a grassroots group that educates nurses on relevant political legislation.
Of the countless nursing organizations that exist today, the ANA is the oldest and most prominent, describing itself as the “voice of nursing.” For more than one hundred years, it has claimed to be the central hub for nurses to learn about and discuss professional issues. But when the time came for the ANA to actually represent the needs of nurses, nurses felt abandoned.
“They tried to stay nonpartisan instead of making it clear that what was going on was unsafe for nurses,” Hartnett says.
As a result, nurses have begun to increasingly question whether or not traditional professional nursing organizations like the ANA are living up to their own principles.
The Tipping Point
Before the pandemic, nurses were already grappling with workplace issues. One of the most pressing issues is insufficient nurse-to-patient ratios. So, when the chaos ensued in March 2020, many nurses were already burnt out and fed up.
As hospitals began to exceed capacity and healthcare workers began to fall sick with COVID-19 themselves, the existing staffing shortage turned into a crisis.
“Nurses didn’t feel safe. They were like scrambling for basic resources like PPE. I was home sewing masks and sending them into all my friends in the different hospitals,” Hartnett says. “Nobody was speaking out for us … and there was no guidance for what to do.”
Meanwhile, then-president Donald Trump was still making statements that undermined the severity of the situation and dismissing healthcare workers’ and hospitals’ pleas for supplies.
Despite advocacy from health and government officials, Trump’s administration refused to use the Defense Production Act, which allows the government to skip the line to buy supplies during emergencies, to get PPE in the hands of nurses who desperately needed it.
In this context, press releases from the ANA, such as one from May 4, 2020, came across as trivial and tone deaf. In it, the ANA declared that it was extending nurses’ week from seven days to one month “to honor our nation’s nurse heroes,” and suggested that nurses should focus on self-care.
These remarks were not received well by nurses who were risking their lives each day at work and sleeping at hotels between shifts to avoid infecting their family members.
“People are justifiably upset and then they post these things [and] your chin just drops and you’re like, ‘Oh my God, I can’t believe you just said that online. Did you not have anybody that is a media expert read this before you posted it?'” Roberta Lavin, a professor at University of New Mexico ‘s College of Nursing says.
“Throughout the pandemic, their attitude has been, ‘We need to work on resiliency.’ No, you need to work on hospitals and the way they treat nurses,” she says.
Turning a Blind Eye
Outrage reached a new height when leaders of major nurse organizations, including the president of the ANA, Ernest Grant, Ph.D., and the president of the American Association of Nurse Practitioners, Sophia Thomas, attended an event at the White House on May 6, 2020.
Not only were nurses dumbfounded by the image of Grant, Thomas, Trump, and other nursing organization leaders standing shoulder to shoulder without wearing masks, they felt it was another failure by nursing associations to spotlight the dire circumstances that nurses were currently facing.
“They did not stand up. They had the president of the ANA standing behind Trump, who was anti-vax, anti-mask, anti-everything that a science organization should stand for,” Lavin says. “And they stood behind him along with a bunch of other nursing organizations … That was shameful.”
Those holding out hope that the ANA would finally denounce the president’s bungled response to COVID were let down, again, when the association didn’t endorse a candidate in the 2020 presidential election. This would be the first time it hadn’t done so in decades.
For many, the ANA’s choice to stay silent – especially in light of the unprecedented situation – was the ultimate statement. Hartnett, who had been working on the Biden campaign prior to the start of the pandemic, sent a letter to the ANA to express her disappointment in the decision.
“This was the middle of a pandemic where [everyone was] really struggling … if there was ever a time to speak up, that would have been it, but they didn’t,” she says.
Mounting Betrayals Estrange Members
The ANA has position statements on 10 topics that concern the nursing profession. Outwardly, it comes off as very progressive in its viewpoints. For example, on its website, the ANA acknowledges the staffing crisis and claims that it has “continued working to address unsafe nurse staffing levels” for more than two decades.
But back in 2018, when a bill that would have regulated nurse-to-patient ratios in Massachusetts was defeated, the then-president of the ANA, Pamela Cipriano, said she was “pleased” with the result, flying in the face of the nurses who worked tirelessly to get such legislation on ballots.
Capriano said that “the rigid, one-size-fits-all approach proposed by the ballot initiative failed to acknowledge the complexities of staffing and undermined nurses’ professional autonomy and decision-making in determining staffing on their units.”
Many nurses were surprised and betrayed by the statement, including Lorie Brown, a nurse, attorney, and founder of EmpoweredNurses.org.
“When your own main organization that’s supposed to lobby for you and be there for you is happy when mandatory minimum staffing laws don’t get passed, that’s where I drew the line and I quit. I withdrew my membership,” Brown says.
On its website, the ANA states that instead of safe staffing ratios, it supports “a legislative model incorporating nurse-driven staffing committees because this approach encourages flexible staffing levels.”
“But my thinking is, if hospitals were to have a committee and do that, wouldn’t they have already done it?” Brown says. “The reason why we need legislation is because they’re not doing it.”
“I believe that nurses have the answer to the problems that are happening in healthcare today, but they’re just not asked or they’re not listened to,” she adds.
This laissez-faire approach to policy only became more apparent during COVID, begging many to wonder where the ANA and other large professional organizations’ loyalties truly lie.
Barriers for Bedside Nurses
The ANA may be taking a nonpartisan approach to cater to an evolving demographic of membership, one where bedside nurses are less represented.
“It used to be the case that most of the ANA was practicing nurses,” Lavin says. But bedside nurses’ involvement in professional associations appears to be decreasing for a few reasons.
First, the baby boomer generation of nurses is retiring and naturally ending their memberships. And new entrants to the profession may be forgoing involvement due to membership dues. It costs about $200 per year to be a member of the ANA, not including the cost to attend industry events, which can reach well into the thousands when accounting for travel expenses.
“That’s just not doable for the average working nurse,” Lavin says.
A young nurse with a below-average salary and student loans may only have the money to join one organization, if any. So, state or specialty associations that are more relevant and connected to their members may be more appealing.
Bedside nurses are also being overshadowed at larger professional organizations due to increasing membership from other parties within the profession, like academics.
Many universities strongly encourage their nursing instructors to maintain membership at prominent professional organizations. This is because school ranking sites like the U.S. News & World Report factor this data into their rankings when evaluating the quality of an institution’s professors.
“So the problem is that to our universities, where we work, and to our deans, it’s a big deal to be a member,” Lavin says. “If you don’t do it, it harms your university.”
As a result, a significant portion of the membership at large professional organizations is made up of people who are not necessarily active frontline workers – but professors, deans, hospital executives, and politicians.
And it’s not just the membership body that is lacking bedside nurses; the lack of representation is reflected in leadership. Many of the ANA’s board members haven’t worked at the bedside in years but have more recently worked in executive positions at hospitals.
But Are Professional Organizations Meant to Be Political?
Not all nurses agree with the backlash against professional associations. In every online forum or comment section debating this topic, there is usually a nurse that defends professional associations. Their justification is often based on the idea that such organizations are prohibited from making political statements, which is a common misconception.
While there are limitations on 501(c)(3) organizations’ political activities, the ANA is a 501(c)(6). This means there are no limits on how much money it can spend on lobbying or rules preventing it from publicly endorsing or denouncing candidates for public office.
The IRS’ rules state that 501(c)(6)’s engagement in political activities should not constitute the organization’s “primary” activity, which is why many professional organizations, including the ANA, have a separate organization dedicated to political action.
However, many misinterpret this to mean professional associations must stay completely politically neutral, which is untrue of 501(c)(6) organizations.
As the ANA states in its own Code of Ethics, Provision 9.4: “Professional nursing organizations must actively engage in the political process, particularly in addressing legislative and regulatory concerns that most affect – positively and negatively – the public health and the profession of nursing.”
Nurses like Hartnett want professional associations like the ANA to honor these declarations by using their platform to advocate and engage politically.
“Our healthcare really depends on what laws get passed. So if nurses don’t know or understand the whole political arena … then they can’t advocate,” she says. “We’re more than nurses at the bedside. We really want to promote health for the whole population.”
While many nurses have understandably withdrawn their memberships, Hartnett, who remains a member of the ANA, encourages others to reach out to association leadership to express their dissatisfaction.
“I think if the pandemic taught us anything, it’s that the people in power are the ones who control our health,” she says. “And if we don’t put the people in power that are going to be helpful to nurses and our patients, we will suffer.”
Meet Our Contributors
Roberta Lavin, Ph.D., MA, RN, FNP-BC, FAAN
Roberta Lavin is a family nurse practitioner, professor, researcher, and disaster management expert. She started out her nursing career in public health service, working with populations experiencing mental illness and homelessness. After moving to Washington D.C., she began working in leadership roles at government organizations and rose to become the director of the Office of Human Services Emergency Preparedness and Response. Later, she transitioned to academia and currently teaches and researches at the University of New Mexico.
Lorie A. Brown, MN, JD, RN
Lorie Brown has been practicing law for over 21 years, but her first career was nursing. Brown gained her BSN in 1982 and then attended the University of California at Los Angeles’ School of Nursing and completed a master’s degree. She has worked in medical-surgical nursing, gynecology, urology, neurosurgery, orthopedics, general surgery, and home healthcare. She founded EmpoweredNurses.org to help nurses protect their licenses, but she maintains her nursing license and works as a camp nurse every summer.
Erin Hartnett, NP, PPCNP-BC, CPNP, FAAN
Erin Hartnett is the founder of Nurses for America and a long-time pediatric nurse practitioner. She has clinical experience in pediatric primary care, adolescent medicine, and chestfeeding. She gained her doctor of nursing practice from New York University, where she later became the program director for nursing college’s oral health programs. In 2012, she received the New York Times Nurse Innovator Award. Today, she dedicates her time to highlighting the voices of nurses and influencing policy through Nurses for America.