AMERICAN NURSES ASSOCIATION Congress on Nursing Practice and Economics Sunday September 17 (Orientation), Monday September 18 and Tuesday September 19, 2006 SUMMARY Congress Members Present: Chairperson, Kathleen M. White, PhD, RN, CNAA, BC; Esther Acree, RN, MSN, SpCl.NSG, BC-FNP; Carolyn Baird, MBA, M.Ed, RNC (INSA); Mary L. Behrens, RN, MSW, FNP-C; Carola M. Bruflat, RNC, MSN, WHNP/FNP (AWHONN); Virginia Burggraf, DNS, RN, FAAN; Sally Burrows-Hudson, MS RN CNN (ANNA); Myra C. Carmon, EdD, CPNP,RN; Thomas Ray Coe, RN, MS, CNAA, FACHE; Stephanie Davis Burnett, MSN, RN, FNP, CRRN (ARN); John F. Dixon, MSN, RN, CAN, B (AACN-West); Emma L. Doherty, MA, RN; William R. Donovan, MA, RN; Bette M. Ferree, MSN, RN, APRN, BC; Susan Foster, MSN, APRN; Irmatrude Grant, MS, RN; Janet Y. Harris, RN, MSN, CNAA , BC; Kimberly A. Hickey, MSN, APRN, BC; Debra Hobbins, MSN, APRN; Patricia Leo Holloman, BSN, RN, CNOR; Bette K. Idemoto, PhD, RN, CCRN, CS; Sandra Gracia Jones, PhD, ARNP, CS, FAAN; Beverly Jorgenson, RNC, MSN, NNP; Patricia L. Keller, MSN, RN,BC; Patrick E. Kenny, EdD, RN, ACRN, CAN, BC, C; Jane Kirschling, DNS (AACN-East); Pamela A. Kulbok, DNSc, APRN, BC; Patricia Kunz Howard, PhD, RN, CEN (ENA); Kathleen G. Lawrence, MSN, RN, CWOCN; Carla A. B. Lee, PhD, ARNP, BC, FAAN; Karen Leone-Natale, BSN, RN; Lori Lioce, MSN, RN; Jennifer H. Matthews, PhD, APRN , BC; Peter T. Mitchell, RN, CNP, MSN; Pamela Sue Neal, MSN-NA, RN, C-FNP; Catherine E. Neuman, MSH, RN, CNAP; Anne Mabe Newman, DSN, APRN, BC; Ann M. O'Sullivan, RN, MSN, CAN; Jackie R. Pfeifer, RN, BSN, CCRN-CSC; Theresa Ann Posani, MS, RN, CNS;; Cheryl-Ann Resha, MSN, EdD, RN; Linda Riazi-Kermani, BSN, RN, CEN; Pauline F. Robitaille, RN, MSN, CNOR (AORN); Patricia Schlosser, RN; Cheryl K. Schmidt, PhD, RN; Sue Sendelbach, PhD, RN, CCNS (NACNS) (Day 1); Nancy Shirley, PhD, RN; Joanne Sikkema, MSN, ARNP; Karen J. Stanley, RN, MSN, AOCN, FAAN (ONS); Jeanne Surdo, RN, BSN, MA; LaTonia Denise Wright, JD, RN; and, Mary Mason Wyckoff, MSN, APRN, BC , CCNS Congress Members Absent:

Vice-Chairperson. Karen Ballard, MA, RN; Susan A. Albrecht, PhD, RN, FAAN; David M. Keepnews, PhD, JD, RN, FAAN; Elizabeth Poster, PhD, RN, FAAN; Robin R. Potter-Kimball, RN, MS, CNS, BC; Sue Sendelbach, PhD, RN, CCNS (NACNS) (Day 2); Brian Thorson, MA, CRNA 1

Congress Liaisons Present:

Sara A. McCumber, APRN,BC, (American Nurses Credentialing Center [ANCC]) (Day 1); Maureen Ann Nalle, PhD, RN; (Center for American Nurses [CAN]); and, Jean Ross, RN, (United American Nurses [UAN])

Congress Liaisons Absent:

Sara A. McCumber, APRN,BC, (American Nurses Credentialing Center [ANCC]) (Day 2)

ANA/CAN Staff:

Linda J. Stierle, MSN, RN, CNAA,BC; Alice Bodley, Esq.; Laurie Badzek, JD, RN (by phone) Nancy Hughes, RN, BSN; Mary Jean Schumann MSN, RN, MBA, CPNP; Wylecia Harris, MBA;; Carol Bickford, PhD, RN,BC; Vernell DeWitty, MBA, MSN, RN; Rita Munley Gallagher, PhD, RN; Cheryl Peterson, MSN, RN; Vernice Woodland; Isis Montalvo; Marion Condon; Cynthia Haney, Esq.; Patricia Rowell, PhD, RN

Guests:

Rebecca M. Patton, MSN, RN, CNOR; Lillee S. Gelinas RN, MSN, VHA, Inc. Vice President – Clinical Performance (by phone); Judith J. Warren, PhD, RN, C, FAAN, FACMI, Associate Professor, University of Kansas, School of Nursing (by phone); Joyce Sensmeier, MS, RN, BC, Director of Professional Services, Healthcare Information and Management Systems Society (HIMSS) (by phone)

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Sunday, September 17, 2006

Item I. Welcome & Introductions II. ANA Overview

Discussion Action The orientation began with a welcome and introductions by Kathleen M. White, PhD, RN, CNAA,BC, Chairperson of the Congress on Nursing Practice & Economics and Linda J. Stierle, MSN, RN, CNAA,BC, Chief Executive Officer of the American Nurses Association CEO Stierle provided an organizational overview of ANA which is a Global Enterprise, caring for those who care. ANA’s overarching goal is that Nursing will be the acknowledged unifying force advancing quality health for all. This will be evidenced by the following outcomes: 9Nurses are universally valued as central to optimal health. 9Nurses are a recognized political force with a prominent seat at health policy tables. 9Nurses are actively shaping safe and secure practice environments. 9Nurses, nursing organizations, and the public value ANA as the indispensable primary voice of nursing and builder of coalitions for health advocacy. 9Every nurse has a connection to ANA. 9Nursing is among the most frequently chosen careers. 2005-2006 Strategic Imperatives 1. Professional Practice Excellence 9ANA successfully champions professional nursing excellence through standards, code of ethics, and professional development, such as credentialing and lifelong learning. 2.

Healthcare & Public Policy 9ANA is an acknowledged leader in the formulation of effective healthcare and public policy as they affect the profession and the public.

3.

Knowledge & Research 9ANA is the recognized source for accurate, comprehensive health policy information based on knowledge from research.

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4.Unification 9ANA facilitates unification and advancement of the profession. 5.Advocacy for Workforce & Workplace Issues 9ANA with its partners and through its organizational relationships is the leader in promoting improved work environments and the value of nurses as professionals, essential providers and decisions makers in all practice settings. 6.Organizational Effectiveness 9ANA improves its organizational structure and resources to pursue its vision, achieve its mission, and address the needs of its constituents, structural units, related entities, associate organizational members and organization affiliates. ANA’s Cornerstone Work

●Code of Ethics for Nurses ANA’s commitment to advance the profession’s foundational work revolves around ethics and standards. In this role, the ANA owns and promotes the Code of Ethics for Nurses With Interpretive Statements and develops and maintains standards of practice. ●Scope and Standards of Practice The new Nursing: Scope and Standards of Practice is a complete revision of the 1998 edition and delineates the professional activities and accountabilities of all practicing registered nurses in any care settings. ●Social Policy Statement Describes the social contract between society and the profession of nursing; includes definition of nursing and describes scope of practice and nursing roles; and discusses regulation of nursing practice. ANA’s Core Issues ●Nursing Shortage ANA actively addresses the complex factors that affect the supply and demand of nurses. ANA is initialing strategies to retain and recruit nurses by improving work environments, increasing educational opportunities, increasing compensation and advocating for laws that strengthen the profession. ●Appropriate Staffing ANA leads the way in research, policy and practice, and workplace strategies to ensure that the number and mix of staff are appropriate – protecting patients and nurses. ●Workplace Rights ANA protects, defends and educates nurses about their rights as employees under the law. ●Workplace Health and Safety ANA fights for a safer workplace by addressing the growing number of occupational hazards that threaten nurses, such as 4

needle-stick injuries, latex sensitivity, back injuries and violence.

●Patient Safety/Advocacy ANA advances its ultimate goal, quality patient care, by effecting positive change around issues that are critical to nursing and its future. Today’s environment demands action to ensure that patient safety and quality are priorities. RELATED ENTITIES • American Nurses Foundation (ANF) • American Academy of Nursing • American Nurses Credentialing Center STRUCTURAL UNITS • Congress on Nursing Practice and Economics • ANA Political Action Committee • Ethnic and Minority Fellowship Program • Ethics and Human Rights Advisory Board PARTNERS IN ACTION • Center for American Nurses • United American Nurses, AFL-CIO • National Student Nurses Association • International Council of Nurses • Tri-Council • Organizational Affiliates American Association of Colleges of Nursing American Association of Critical-Care Nurses American Association of Nurse Anesthetists American Nephrology Nurses’ Association American Psychiatric Nurses Association Association of Nurses in AIDS Care Association of periOperative Registered Nurses Association of Rehabilitation Nurses Association of Women’s Health, Obstetric & Neonatal Nurses Emergency Nurses Association International Nurses Society on Addictions National Association of Clinical Nurse Specialists National Association of School Nurses 5

III. CNPE Overview

IV. CNPE Processes

Oncology Nursing Society Preventive Cardiovascular Nurses Association Wound, Ostomy and Continence Nurses Society • The Alliance (Nursing Organization Alliance) Mary Jean Schumann, MSN, RN, MBA, CPNP, Director of the Department of Nursing Practice and Policy noted that CNPE is an organized, deliberative body which brings together the diverse experiences and perspectives of ANA members. The Congress focuses on establishing nursing’s approach to emerging trends within the socioeconomic, political and practice spheres of the health care industry by identifying issues and recommending policy alternatives to the Board of Directors. Rita Munley Gallagher, PhD, RN, Senior Policy Fellow in the Department of Nursing Practice and Policy provided an overview of CNPE and its processes. Officers include

•Chairperson

–designated by the ANA Board of Directors for a two year term –may serve no more than two consecutive terms

•Vice Chairperson

–Elected by CNPE –may serve no more than two consecutive terms CNPE Meetings may be

•Face to face •Regularly scheduled conference call •Ballot by referendum –a vote by

•e-mail •fax •surface mail A ballot by referendum includes –Due date/time –Motion –Voting Options •Approve •NOT approve •Approve with comments 6

•Abstain •Call

for CNPE discussion via conference call Response due within 10 business days A Quorum is a simple majority of CNPE (including either the Chairperson or Vice Chairperson. CNPE actions are adopted by a majority vote of those present and voting and are recorded on the CNPE Report Card. Absence from two consecutive meetings shall be cause for declaring a vacancy in the position. Such vacancy shall be determined by a majority of the Board of Directors. Absences excused by the CNPE Chairperson will not be counted in declaring a vacancy; will be recorded on the Report Card. CNPE are included among reviewers to which Calls for Comments are disseminated. They frequently reflect the work of JCAHO and NQF. Calls require response prior to the stated deadline to be considered. However, they are NOT included in the Report Card. Meetings are scheduled well in advance. The notice is issued by Vernice Woodland. CNPE members are asked to note meeting particulars; respond promptly; and, observe deadlines. Travel includes on-line booking using resX (https://www.resx.com). Members are to book 14-21 days in advance. Airfare is billed directly to ANA. ANY exceptions require prior approval. Shuttle arrangements are also made by ANA. The form is to be faxed AFTER travel is confirmed to Vernice Woodland (301-628-5349). Shuttle charges are billed directly to ANA. Hotel arrangements are made by ANA. CNPE members are asked to fax the hotel form by stated deadline to Vernice Woodland (301-628-5349). Accommodations will also be billed directly to ANA. Attendees are responsible for incidental charges at checkout; early departure fees; and/or no show charges unless room is canceled prior to the hotel’s deadline. The travel voucher with per diem included is posted on the CNPE website and should be returned, with receipts, within 14 days of the meeting. The CNPE WorkGrid • Reflects CNPE activity –Safe Connections –School Nursing –Nursing Assistive Personnel and Scope of Practice Principles –Fatigue –Pay for Performance (P4P) –Environmental Health Principles –Position Statement Review •Updated by WorkGroup Chairs –Immediately following meetings –As work is completed –Pro re nata 7

V. Standards and Guidelines Overview

Carol Bickford, PhD, RN,BC, Sr. Policy Fellow from the Department of Nursing Practice and Policy provided and overview of the role and responsibilities of the Committee on Nursing Standards and Guidelines. She detailed the definition of nursing which states: Nursing is the •protection, promotion, and optimization of health and abilities, •prevention of illness and injury, •alleviation of suffering through the diagnosis and treatment of human response, and •advocacy in the care of individuals, families, communities, and populations. Nursing’s Social Policy Statement, Second Edition (2003) •Describes the social contract between society and the profession of nursing •Includes definition of nursing and describes scope of practice and nursing roles •Discusses regulation of nursing practice •Reference book for students and practicing nurses She reflected on the seminal documents which include the Code of Ethics for Nurses With Interpretive Statements (2001) which: •Provides a reference for ethical decision making •Interpretive statements guide nurses to understand their obligations to patients •Examination of accountability with expanded nursing roles She called attention to the Code of Ethics for Nurses With Interpretive Statements: An Independent Study Module which is available at http://nursingworld.org/mods/mod580/code.pdf Nursing: Scope and Standards of Practice (2004) that consists of Six Standards of Practice and Accompanying Measurement Criteria: • Assessment • Diagnosis • Outcomes Identification • Planning • Implementation • Evaluation and Nine Standards of Professional Performance and Accompanying Measurement Criteria: • Quality of Practice • Education • Professional Practice Evaluation 8

• • • • • •

Collegiality Collaboration Ethics Research Resource Utilization Leadership

Nursing: Scope and Standards of Practice addresses scope and standards for: • Generalist Practice by Registered Nurses • Advanced Practice Registered Nurses • Role Specialty CNPE members must become familiar with Recognition of a Specialty, Approval of Scope Statements, and Acknowledgement of Nursing Practice Standards which: outlines ANA standards program and processes. It is made available to specialty nursing organizations engaged in the preparation of specialty scope and standards of practice. In order to be recognized as a nursing specialty, the organization: • Defines itself as nursing • Adheres to overall licensure requirements of the profession • Subscribes to the overall purpose and functions of nursing • Is clearly defined • Is practiced nationally or internationally • Includes a substantial number of nurses who devote most of their practice to the specialty • Can identify a need and demand for itself • Has a well derived knowledge base particular to the practice of the nursing specialty • Is concerned with phenomena of the discipline of nursing • Defines competencies for the area of specialty nursing practice • Has existing mechanisms for supporting, reviewing, and disseminating research to support its knowledge base • Has defined educational criteria for specialty preparation or graduate degree • Has continuing education programs or continuing competence mechanisms for nurses in the specialty • Is organized and represented by a national specialty association or branch of a parent organizations

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Currently there is a significant amount of ANA scope and standards work underway: • Nursing informatics scope and standards workgroup • Home health nursing scope and standards workgroup • College health and professional development scope and standards workgroups ready to begin • Competence, competency, continued competence definitions work • Facilitation of CNS competencies consensus • Participation in APRN stakeholder discussions

VI. Organizational Affiliate Overviews

Practice guidelines are also within the purview of the Committee. However, the bulk of that activity historically has been accomplished by AHCPR’s (Agency for Health Care Policy and Research). A major development initiative in mid 1990’s reflected in establishment of National Guidelines Clearinghouse - http://www.guidelines.gov/ New direction accompanied its name change to Agency for Healthcare Research and Quality (AHRQ). ANA’s Committee on Nursing Practice Standards and Guidelines: •Has established review criteria for specialty practice guidelines that were approved by CNPE •Completed review of two submissions from National Association of Orthopaedic Nurses (NAON) Bickford noted that guideline development needs significant expenditures of time and human resources to conduct the literature review and manage the consensus panels. In closing she asked CNPE the question: How will ANA lead nursing in the next steps to define and support evidence-based practice and the focus on quality outcomes? The organizational affiliate members provided overviews of the activities of their respective organizations.

Monday, September 18, 2006

Item VII. Welcome, Roll Call, Introductions and Review of Agenda VIII.A Greetings and Presidential Report

Discussion Action The meeting was called to order at 9:02 am EDT by the chair. A quorum was present. The members, liaisons and staff introduced themselves and provided brief background information. It was noted that this is the first meeting of the expanded Congress which has been enriched by the addition of organizational affiliate members as well as a greater number of elected members. Rebecca M. Patton, MSN, RN, CNOR, President, ANA added her welcome to that of the Chair. Ms. Patton noted her remarks were focused in three areas: • The process for selecting and appointment of the congress chair about which she is soliciting feedback • Sharing her vision for the next 2 years • Answering any questions and hearing members’ perspectives. 10

Item

Discussion Action President Patton detailed the process used to select the CNPE Chair. The BOD received nominations from various sources. A small group reviewed nominees. They conducted interviews by phone and created a grid which they shared with the committee on appointments. Discussion ensued as the distribution list for suggestions for nominees. The intention was that it went to all those on CNPE. Patton provided her view of her presidency. Her platform is partnership and balance. It’s meant to be a simple vision. In order to advance the agenda of the profession and associations. The ANA board has started working toward full openness and transparency. Patton noted people are committed to advancing the cause of the profession. This is nursing’s opportunity to advance the profession. ANA’s Big Audacious Goal is to be the unifying force to advance quality health for all. ANA needs to be a unifying force.

IX. Confidentiality and Conflict of Interest Implications

X. Reports to Congress

Discussion ensued regarding ANA’s relationship with AJN. ANA engaged in prolonged negotiation with AJN’s publishers to no avail. ANA let an RFP for a publisher for its new journal: American Nurse Today. Alice Bodley, Esq., General Counsel provided an overview of the confidentiality issues faced by CNPE. Essentially the work CNPE does is advisory in nature. CNPE is a deliberative body which makes recommendations. ANA asks that CNPE members keep discussion and deliberations confidential. In those instances wherein CNPE is a document’s author, essentially CNPE members are giving that creative work to ANA. The intellectual property will belong to ANA as will any copyrights or patents. Conflict of interest – In instances where members, or their organizations, have a financial interest in something in which CNPE is involved, they are asked to disclose the conflict of interest and disqualify themselves. Another way in which a conflict of interest may arise is when a personal viewpoint precludes the member’s from focusing on the benefit to the association. ANA then requests that the member asks the chair for another assignment. Calls for Comments may be shared widely with colleagues for their input. The position statements here are not official statements, until adopted by the board and are not to be disseminated until that time.. Reports to the congress may be shared. Staff were available to answer questions related to the reports which were posted on the CNPE website. ANCC ~ Jeanne Floyd, PhD, RN, CAE Executive Director American Nurses Credentialing Center NCA ~ Karen Horsley Project Manager Nurse Competence in Aging

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Item

Discussion Occupational Health & Safety ~ Nancy L. Hughes, MS, RN Director Center for Environmental Health

Action

Center for American Nurses ~ Wylecia Harris, MBA, CAE Executive Director Center for American Nurses CNPE requested additional information on the Center’s mature nurse initiative. The mature nurse initiative was started in 2003. An on-line survey was conducted that impacted mature nurses. In 2005 a roundtable was hosted to which 60 key-stake holders were invited. Issues were crystallized and the group strategized. Results were sent to the White House Conference on Aging. The Center’s grant is to approach issues that impacted mature nurses – financial issues/retirement, another grant submitted to wiser women for expanding literacy to nurses. The 2nd portion addresses nurse wellness, regarding how they are aging and improve health as they mature. A follow-up survey of nurses who have retired is planned for next year. Concerns were expressed regarding duplication of effort between and among UAN, CAN and ANA. Position statements are posted on the web-site and there is a process which the Center follows to share information with ANA. Most of the work the Center is organized around its framework – work environment, condition. An upcoming conference on workplace design will address the increased complexity for the mature nurse, e.g. technology. Chronic back stress is an area of focus for COEH and ANA. We’ve provided FAQ sheets to increase awareness and awarded grants to Virginia to look at collaborative approach in their state. The kinds of innovations are slightly different but collaborative and supportive of ANA. The Center is also considering a survey about financial literacy – reflecting on earlier work by ANA. NDNQI ~ Isis Montalvo, MBA, MS Project Manager NDNQI How the indicators for NDNQI relate to JCAHO was detailed. NDNQI ‘s strategy has been to adopt the NQF nursingsensitive measures and in fact several of the NDNQI indicators were adopted by NQF. JCAHO sits on the NQF and is committed to the utilization of NQF-endorsed measures where they exist. Hence, ANA’s measures are among those used by JCAHO. The NDNQI National Conference will be held on January 30-31, 2007 in Las Vegas, Nevada. Headliners include Dr. Janet Corrigan, the President and CEO of NQF. Registration will open this month. It was noted that NDNQI has been in discussions with Maine to assist them in obtaining the information they need for reporting. Currently 11 hospitals in Maine participate in NDNQI. Frequently what is highlighted are physician driven quality indicators. NDNQI’s focus continues to be nursing-sensitive indicators. 12

Item

XI. Standards and Guidelines

Discussion Action ANA/ICNM/2007 ANA Quadrennial ~ Cheryl Peterson, MSN, RN Sr. Policy Fellow Nursing Practice & Policy American Nurses Association Cheryl Peterson HOD will be held every other year in DC. The Quadrennial will be every 4 years and be focused on specific issue/area. This coming year it is on disaster preparedness. There will be educational tracks over 3 days. White paper will be written on this issue. All attendees will have the opportunity to react and respond to what is being written. GOVA ~ Rose Gonzalez, PhD(c), RN Director Government Affairs American Nurses Association Carol Bickford reiterated that the Committee on Standards and Guidelines is a standing committee of CNPE which devotes significant personal time in reviewing documents. They have guidelines regarding their workplan.. A number of activities that have been completed since the last meeting in February have been identified. The Congress has been asked to move forward to: 1. Approve the Radiology Nursing Scope of Practice Statement and Acknowledge the Radiology Nursing Standards of Practice 2. Recognize HIV/AIDS nursing as a nursing specialty 3. Approve the HIV/AIDS Nursing Scope of Practice Statement and Acknowledge the HIV/AIDS nursing stands of practice. The process the committee uses to examine the documents was detailed. The committee considers the 14 points whether they are a new or continuing set of standards. They’ve created a matrix that is used to respond to those points and vote similar to the congress. These documents have gone through the extensive review process. They look at the Who, what, Where, Why and How. The committee compares every one of the standards and measurement criteria.

Motion I: I move adoption of the scope and acknowledgment of the standards of radiology nursing. M-O'Sullivan; 2nd-Neuman; Unanimous Motion II: I move recognition of HIV/AIDS nursing as a specialty, approval of the scope of practice and acknowledgement of the standards for HIV/AIDS nursing. M-O'Sullivan; 2nd-Neumann; Unanimous

Currently there are 2 vacant positions on standards since they moved to CNPE and this requires action. 13

Item Discussion of Competency

Discussion Action The workgroup brought forward the document to CNPE in 2005. Committee reworked that content and returned to CNPE for consideration requesting guidance in moving forward. Bickford reiterated the Nursing is... the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. She noted that the Code of Ethics for Nurses With Interpretive Statements, Provision 5 states: The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. Furthermore, the Scope and Standards of Practice: •Describes a competent level of practice and professional performance common to all registered nurses •Includes 15 standard statements and accompanying measurement criteria •Uses terms competence, competency, continued competency The workgroup has offered a proposed definition: A “competency” is an expected level of purposeful performance that results from an integration of knowledge, skills, and personal abilities and characteristics. Likewise, an individual who demonstrates “competence” is performing successfully at an expected level. “Purposeful performance” means action of intent. The integration of knowledge, skills, and personal abilities and characteristics occurs in both formal and informal learning experiences, including reflective learning. Skills include habits of mind; psychomotor, communication and interpersonal skills; and diagnostic and ethical reasoning capabilities. “Habits of mind” reflects a person’s individualized pattern of thinking, problem solving, and decision-making. Personal abilities and characteristics represent those attributes which can affect an individual’s ability to effectively function and include listening ability, honesty, self-knowledge of strengths and weaknesses, positive self-regard, emotional intelligence, and openness to feedback. Purposeful Performance: can be influenced by the nature of the situation, which includes consideration of the setting and the person. Situations can either enhance or detract from the ability to perform. Competent RN contributes to efforts to: –influence factors that facilitate and enhance competent practice. –remove barriers that constrain competent practice. Expected Level of Performance •Should reflect variability when defined using a particular framework. Standards of Practice: •Authoritative statements defined and promoted by the profession by which the quality of practice, service, or education 14

Item

Discussion

Action

can be evaluated. •Each standard is a descriptive statement of the expected level of purposeful performance of a competent RN for that nursing process or professional performance category. •Each measurement criterion is a behavioral, cognitive, or motor competency required to be able to function in accordance with each standard

XII. CNPII

XIII. Discussion: Setting the StageHealth Care Information Technology Initiatives and Nursing Role as member of AHIC Q&A

Role as member of NCVHS HL7 and other

Discussion ensued regarding the use of the verbiage “purposeful action.” The composition of the workgroup was discussed. Carol Bickford highlighted CNPII background information noting there were no action items to bring forward to CNPE. The CNPII has been responsible for dealing with the nursing terminologies, e.g. NANDA. They have been meeting monthly to come up with criteria, similar to guidelines for scopes & standards work. It’s important that standard nursing language to be part of the standard terms. This group has been struggling with environment and federal mandates. There are inconsistencies in standard initiates. Nurses think about nursing and patient centered activities. CNPII is working to: - Establish nursing leadership in the field - Convene invitational conference to figure out next steps for new terminologies. SnoMED is not helpful for RNs in clinical practice. ANA resources have not been available to fully find this activity. Members of the committee doing presentations through their own institutions and self financing so there is a RN presence. Carol Bickford began the presentation by noting the almost ubiquitous nature of computers •ATMs •E-bay •Automobiles •Smart toilets •Dishwashers •Handheld games •Amazon.com and e-Bay •Netflix •Distance learning •Medication Dispensers •PDAs •Patient monitors •Telehealth •Simulation laboratories 15

Item initiatives

Q&A CNPE Discussion

Discussion

Action

•Webcasts •Cinahl, PubMed •Online journals, books, digital library •Decision support Nursing exists within such a world and engages in patient centered care that includes context, health, and whole person. Standardized nursing languages are not well integrated into practice and information systems. Notable exceptions include: –PNDS in perioperative systems –OMAHA System in home health and visiting nurse applications Federal initiatives which are changing the landscape include: •HIPAA •DHHS Secretary Thompson’s electronic health record (EHR) initiatives •President Bush established Office of National Coordinator for Health Information Technology (ONCHIT, now ONC) •DHHS Secretary Leavitt established American Health Information Community (AHIC) In addition, there are Federal, State, and Local issues of concern: •Population health, emergency preparedness, and biosurveillance activities •Regional health information organizations (RHIOs) and interoperability •E-prescribing •Interstate practice by clinicians •Increasing healthcare costs, uninsured, safety net •Quality and evidence-based practice All of the aforementioned give rise to a series of questions: • Who Advocates for the Healthcare Consumer? • Where Are the Nurses? • Who Represents Nursing at the Many, Many Decision-making Tables? Bickford then went on to introduce the distinguished members of the panel. Lillee S. Gelinas RN, MSN, VHA ([email protected]) Vice President – Clinical Performance Office of the National Coordinator for Health Information Technology (ONC) Gelinas began with a disclaimer acknowledging that any comments made during this webinar represent her own views and 16

Item

Discussion Action opinions and not those of the community or electronic health record workgoup. All materials discussed during the presentation are available to the public at www.hhs.gov/healthit. She then provided an overview of VHA – noting they’re not the VA (Veterans Health Administration! - 175,000 physicians - 25% of total employed RNs in the U.S. - 1.1 million employees - 9.8 million admissions - 1.2 million births - 7.7 million surgeries - 2200+ health care organizations - 20% of all U.S. healthcare organizations - 30% of all U.S. healthcare revenue Gelinas iterated a number of issues of concern: - The Nursing Shortage - The Clinical Quality Gap (we have to stop killing people – healthcare’s 45% defect rate) - CNO and nursing manager turnover – 40% across VHA - Aligning the healthcare industry to prevent duplication, reduce costs and efforts - How to help hospitals improve their clinical and economic performance – “Building the Case for Clinical Improvement” About 100 people in the US die each day because the current paper base health care system introduces errors or delays treatment or limits what health care professionals know (Hudak, October 2005). Extensive financial hemorrhaging is taking place in all health care venues. US healthcare system invests over $1.7 trillion annually- yet still has inefficiency & poor quality. Annual savings from increased efficiency of health care systems would be $77 billion or more. Implementation would cost around $8 billion per year, assuming adoption by 90% of hospitals & doctor’s offices over 15 years. Obstacles include market disincentives: generally those who pay for health Information technology (HIT) do not receive related savings. Health & safety benefits could double savings while decreasing illness & prolonging life. Increased safety comes largely from alerts & reminders from CPOE. If all hospitals had HIT with CPOE, around 200,000 adverse drug events could be eliminated each year, annual savings would be about $1 billion. Gelinas also called attention to Federal activities: • American Health Information Community. • President Bush’s Presidential Decree April 2004: 17

Item

Discussion • •

Action

Executive Order: Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator. http://www.whitehouse.gov/news/releases/2004/04/20040427-4.html#

Breakthroughs are places where using health IT produces a tangible and specific value to the health care consumer and that can be realized within a 2-3 year period. The potential breakthroughs include: - Consumer Empowerment - Health Improvement - Public Health Protection AHIC is working to realize those breakthroughs in a series of workgroups: Electronic Health Record - Chronic Care - Bio-surveillance - Consumer Empowerment - Quality - Confidentiality, Privacy and Security AHIC’s vision is developing a nationwide interoperable health information technology infrastructure that…. - Ensures that appropriate information to guide medical decisions is available at the time and place of care; - Improves health care quality, reduces medical errors, and advances the delivery of appropriate, evidence-based medical care; - Reduces health care costs resulting from inefficiency, medical errors, inappropriate care, and incomplete information; - Promotes a more effective marketplace, greater competition, and increased choice through the wider availability of accurate information on health care costs, quality, and outcomes; - Improves the coordination of care and information among hospitals, laboratories, physician offices, and other ambulatory care providers through an effective infrastructure for the secure and authorized exchange of health care information; and - Ensures that patients' individually identifiable health information is secure and protected. AHIC Members include: - HHS Secretary Michael Leavitt, Chair - Scott P. Serota, President and CEO, Blue Cross Blue Shield Association - Douglas E. Henley, M.D., Executive VP, American Academy of Family Physicians 18

Item -

Discussion Action Lillee Smith Gelinas, R.N., MSN, FAAN, Vice President, VHA Inc. Charles N. Kahn III, President, Federation of American Hospitals Nancy Davenport-Ennis, CEO, National Patient Advocate Foundation Steven S. Reinemund, CEO and Chairman, PepsiCo Kevin D. Hutchinson, CEO, SureScripts Craig R. Barrett, Chairman, Computer Systems Policy Project E. Mitchell Roob, Secretary, Indiana Family and Social Services Administration Mark B. McClellan, M.D., Administrator, Centers for Medicare and Medicaid Services Julie Louise Gerberding, M.D., Director, Centers for Disease Control and Prevention Jonathan B. Perlin, M.D., Under Secretary for Health, Department of Veterans Affairs William Winkenwerder Jr., M.D., Assistant Secretary of Defense, Department of Defense Mark J. Warshawsky, Assistant Secretary for Economic Policy, Department of Treasury Linda M. Springer, Director, Office of Personnel Management Michelle O’Neill, Acting Under Secretary for Technology, Department of Commerce

AHIC Working Groups have been charged to make recommendations to the Community within one year; Quarterly milestones for each group have been defined. I. Consumer Empowerment - - Consumer empowerment breakthroughs will help individuals manage their health care and advocate for themselves as they use health care services. - My Personal Health Record - My Medication History - The need for medication history was highlighted by the high interest in the KatrinaHealth.org web tool. - Having a complete electronic medication list would also prevent drug-to-drug interactions when subsequent prescriptions are written. - My Health Record Locator - My Registration Information II. Health Improvement - Health improvement breakthroughs will help physicians and hospitals deliver safe and timely therapy and keep up with medical advances and innovation. - Electronic Health Record - E-Prescribing. - Quality Monitoring and Reporting - Chronic Disease Monitoring - Childhood Immunization Record 19

Item

Discussion Action - Employee Empowerment Tool III. Public Health Protection - Public health protection breakthroughs allow for monitoring and management of public health threats that result from episodic or unexpected events that affect whole populations. - Emergency Information Network - Biosurveillance and Pandemic Surveillance - Adverse Drug Event Reporting and Notification Gelinas closed by noting ways in which nurses can be involved: - Attend AHIC meetings in Washington, DC – open to the public - Call into workgroup meetings and comment during public comment portion of the agenda - Do your part in addressing barriers to health IT adoption that may exist in your organization - Let us know your success stories! - Feed Gelinas information, issues, successes, areas to address.

Judith J. Warren, PhD, RN, C, FAAN, FACMI ([email protected]) Associate Professor University of Kansas, School of Nursing Director of Nursing Informatics, KU Center for Healthcare Informatics Member, National Committee on Vital and Health Statistics (NCVHS) Warren’s remarks focused on the National Committee on Vital and Health Statistics and its implications for ANA. NCVHS serves as the statutory public advisory body to the Secretary of Health and Human Services and Congress in the area of health information. The Committee provides advice and assistance to the Department and serves as a forum for interaction with interested private sector groups on a variety of key health data issues. The purposes of NCVHS include: zAccelerate the evolution of public and private health information systems zUniform shared data standards zProtecting privacy and security zEncourage the evolution of the NHII zViable, credible, timely, and comparable health data zProvide scientific –technical guidance zDesign and operation of health statistics and information systems zCoordination of health data requirements 20

Item

Discussion zAdvise on implementation HIPAA and MMA

Action

Meetings are open to public and broadcast on the Internet (www.ncvhs.hhs.gov). the Committee hears testimony on selected topics. There is an open microphone time at every hearing. The Committee sends letters of recommendation to the Secretary of the Department of Health and Human Services. NCVHS is composed of the following individuals from the private sector who have distinguished themselves in the field of healthcare information: zSimon Cohn, MD, MPH zJeffery Blair, MBA zJustine Carr, MD zRichard Harding, MD zJon Houston, JD zStanley Huff, MD zRobert Hungate zRussell Localio, Esq zCarol McCall zHarry Reynolds zMark Rothstein, JD zWilliam Scanlon, PhD zDonald Steinwachs, PhD zEugene Steuerle, PhD zPaul Tang, MD zKevin Vigilante, MD zJudith Warren, PhD, RN Staff and Liaisons to NCVHS Include: zCenter for Medicare and Medicaid Services zAgency for Healthcare Research and Quality zNational Library of Medicine zCenters for Disease Control and Prevention zNational Institutes of Health zIndian Health Service zOffice of Civil Rights zNational Center for Health Statistics 21

Item

Discussion zFood and Drug Administration zVeterans Health Administration zHealth Resources and Services Administration zOffice of the National Coordinator for Health Information zOffice of the Secretary of HHS

Action

Technology

There are a number of Subcommittees of NCVHS zExecutive http://www.ncvhs.hhs.gov/execmemb.htm zNational Healthcare Information Infrastructure Workgroup http://www.ncvhs.hhs.gov/wg-nhii.htm zStandards and Security http://www.ncvhs.hhs.gov/sssmemb.htm zPrivacy and Confidentiality http://www.ncvhs.hhs.gov/pvcmemb.htm zPopulations http://www.ncvhs.hhs.gov/popsmemb.htm zQuality Workgroup http://www.ncvhs.hhs.gov/wg-qual.htm The National Healthcare Information Infrastructure Work Group zImprove patient safety zImprove healthcare quality zBioterrorism detection zInform and empower health care consumers regarding their own personal health information zUnderstand health care costs zhttp://aspe.hhs.gov/sp/nhii zhttp://www.ncvhs.hhs.gov/040908lt.htm Subcommittee on Populations • Socioeconomic Position • Race and Ethnicity definitions • Worked with NIH, NCHS, and Board of Scientific Counselors, not Labor Board • Income measures • Data Council will determine new metrics • Resources for Federal Health Data Repositories • Gateway website provides access www.hhs-stat.net Subcommittee on Populations: Future • How should race, ethnicity, financial statues be collected for use in federal health databases 22

Item

Discussion • • • •

Action

What are appropriate methodologies for research using large federal databases What are appropriate uses of GIS (geographical information systems) in health care What should be in population quality indicators Review of the vision for health statistics in 21st century

Quality Workgroup • Measuring Health Care Quality: Obstacles and Opportunities, May 2004 • Assessing and improving health care and health outcomes • Reducing disparities in health and health care for minority populations • Building the data infrastructure to support quality assessments and improvement • Balancing patients’ interests in privacy protection and protection of their health and safety • Working with AHRQ on quality indicators http://www.ncvhs.hhs.gov/040531rp.pdf Subcommittee on Privacy & Confidentiality • Privacy rule (HIPAA) and Common rule (research) • Issues concerning marketing and fundraising • Patient issues • Unique identifiers for providers • DEA number • National Provider Identifier (NPI) • Developed by CMS • To be implemented in 2007 • Used by provider organizations and individual clinicians Subcommittee on Privacy and Confidentiality: Future • Report on Privacy and Confidentiality for the National Healthcare Information Network, 2006 • What are the best practices for risk assessment and mitigation • What are the threats to and within operating systems of medical devices when they communicate to other systems Subcommittee on Standards and Security • Health Insurance Portability and Accountability Act of 1996 (HIPAA) http://www.ncvhs.hhs.gov/adminsip6.pdf • Consolidated Healthcare Informatics (CHI) Initiative http://www.ncvhs.hhs.gov/040129lt.pdf • Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) 23

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Discussion http://www.ncvhs.hhs.gov/040902lt2.htm http://www.ncvhs.hhs.gov/050304lt.pdf

Action

Subcommittee on Standards and Security • MMA and e-Prescribing • Pilots studies to test process and feasibility of using recommended standards • What medical and medication history needs to be messaged with the prescription • What new standards need to be developed • E-Signatures for authentication and non-repudiation • Matching patients to their records • Secondary use of health information Consolidated Healthcare Informatics Initiative, which is also known as CHI, includes: • Department of Veterans Affairs • Department of Defense • Centers for Disease Control • Department of Indian Affairs • Department of Prisons • Presidential mandate to create interoperable electronic health records http://www.whitehouse.gov/omb/egov/c-3-6chi.html Office of the National Coordinator Health Information Technology (ONCHIT) • National Healthcare Information Network • Use cases from AHIC lead to identification of functional requirements which the NCVHS task force distilled to minimum but essential set • IHE testimony concerning clinical document templates • Health Information Security and Privacy Collaboration (HISPC): 34 state initiatives • Certification Commission for Healthcare Information Technology • American National Standards Institute-Healthcare Information Technology Standards Panel • http://www.os.hhs.gov/onchit Federal Enterprise Architecture (http://www.hhs.gov/fedhealtharch/index.html ) is part of FEA. It is 1 of 5 Lines of Business supporting the President's Management Agenda goal to expand electronic government. FHA will create a consistent federal framework to facilitate communication and collaboration among all health care entities to improve 24

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Discussion citizen access to health-related information and high-quality services.

Action

Implications and Importance • Nursing perspective • Patient, Profession, Organization • National quality efforts • National information efforts • Equality of viewpoints • Preparing for participation in NCVHS • Skills • Reputation • Patient-centric view Joyce Sensmeier MS, RN, BC, CPHIMS, FHIMSS ([email protected]) Vice President, Informatics Healthcare Information and Management Systems Society The vision of the Healthcare Information and Management Systems Society (HIMSS) is advancing the best use of information and management systems for the betterment of healthcare. HIMSS has • >300 Corporate Members • 20,000 Individual Members (700 in Europe) • 43 Chapters • Over 130 Staff (part time staff in Europe) • 2 Locations: Chicago, IL; Ann Arbor, MI; Washington, DC HIMSS’ Member Profile •Professional level ~CIOs/senior management ~Director/dept head ~Senior staff/managers ~Other •Work site ~Providers

46% 25% 19% 10% 80% 25

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Discussion ~Vendors ~Consultants

Action

11% 9%

The Nursing Community includes: •>2000 individual nurse members •Nursing Informatics Committee •Nursing Informatics Task Force – 80+ members •Workgroups ~Audioconference, Awareness, Education/Web Site •Current Activities ~Co-sponsor the Alliance for Nursing Informatics ~Host Annual Nursing Informatics Symposium ~Provide NI 101presentation ~Implement Survey on IT and interdisciplinary communication HHS Health IT Strategy is focused on standards harmonization - one element of interoperability •The Community serves as the hub for identifying breakthrough opportunities •CCHIT is developing a mechanism for certification of health care IT products •HITSP brings together all relevant stakeholders to identify appropriate IT standards •HISPC is addressing variations in business policy and state law that affect privacy and security •NHIN is focusing on interoperability pilots starting in 2006 The Community formed workgroups to focus on the specific charge for each of the four breakthrough areas: •Biosurveillance -- Transmit essential ambulatory care and emergency department visit, utilization, and lab result data to authorized public health agencies within 24 hours •Consumer Empowerment -- Deploy a pre-populated, consumer-directed and secure electronic registration summary •Electronic Health Record Exchange -- Deploy secure solutions for accessing current and historical laboratory results and interpretations •Chronic Care –widespread use of secure messaging between clinicians and patients about care delivery HITSP guides, informs, and enables the standards harmonization process. The Healthcare Information Technology Standards Panel (HITSP) is sponsored by the American National Standards Institute (ANSI) in partnership with HIMSS and ATI. The Panel’s goal is to ensure the broadest possible participation of all affected parties, in order to stand up and maintain a standards harmonization entity capable of achieving readily-implemented, consensus-based outcomes for 26

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Discussion Action interoperability. The HITSP process is an open, inclusive, and collaborative process. The Community selects breakthrough areas to be worked across ONC contracts. The HITSP then charters Technical Committees to address each break through to: ~Identify a pool of standards for a general breakthrough area ~Identify gaps and overlaps for a specific context, ~Make recommendations to the HITSP for resolution of gaps and overlaps ~Develop instructions for using the selected standard for a specific context ~Test the interoperability specifications for using the standard HITSP receives Use Cases and Harmonization Requests from external sources, such as AHIC and ONC. The Use Case or Request defines scenarios, business actors, and business and functional/interoperability requirements. HITSP develops Interoperability Specifications supporting the Use Cases: technical actors, transactions, content and terminology. HITSP identifies constructs which are logical groupings of base standards that work together, such as message and terminology. These constructs can be reused like building blocks. While reuse is a HITSP goal, it is established in the context of a use case and its functional/interoperability requirements. HITSP constructs are version controlled and, if reused, will be uniquely identified. Integrating the Healthcare Enterprise: ~An initiative that improves patient care by harmonizing healthcare information exchange. ~Provides a common standards-based framework for seamlessly passing health information among care providers, enabling local, regional and national health information networks. ~Promotes the coordinated use of established standards–HL7, ASTM, DICOM, W3C, IEEE, etc.—to address specific clinical needs IHE Contributors & Participants are sponsored by: • Professional Societies Representing Healthcare Segments ~RSNA, HIMSS, ACC, ACP, ACCE, AACC, other Professional Societies… Participants are: •Users ~Clinicians, Medical Staff, Administrators, CIOs, … •Information Systems & Equipment (e.g. imaging) Vendors •Consultants •In addition, active liaison with Standards Development Organizations (SDOs) 27

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Discussion ~HL7, DICOM, NCCLS, ASTM, ISO, others

Action

Standards are critical but alone are not enough. Standards offer generality, ambiguity and alternatives. Standard Implementation Guides are focused on a single standard. The Technical Framework is in the public domain. Connecting standards to care: •Care providers work with vendors to coordinate implementation of standards to meet their needs ~Care providers identify the key interoperability problems they face ~Drive industry to develop and make available standards-based solutions ~Implementers follow common guidelines in purchasing and integrating systems that deliver these solutions Four Steps of the IHE Process •Identify Interoperability Problems ~Clinicians and IT experts work to identify common interoperability problems. •Specify Integration Profiles ~Healthcare IT professionals identify relevant standards and define how to apply them to address the problems, • Test Systems at the Connectathon ~Vendors implement IHE integration profiles in their products and test their systems for interoperability at the annual IHE Connectathon •Publish Integration Statements for use in RFPs. ~Vendors publish IHE integration statements to document the IHE integration profiles their products support.

•Results

~Over 3000 attendees visited the HIMSS RHIO Showcase ~37 vendors demonstrated 48 systems ~700 attendees created and tracked their own health record ~63 educational sessions were presented ~5 International delegations ~3 VIP tours ~16 clinical scenarios were demonstrated The International Organization of Standardization is engaged in: 28

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Discussion Action •Standardization in the field of information for health, and Health Information and Communications Technology (ICT) to achieve compatibility and interoperability between independent systems •To ensure compatibility of data for comparative statistical purposes (e.g. classifications) •To reduce duplication of effort and redundancies There is a Technical Committee dealing with Health Information topics: ~Data Structure ~Data Interchange ~Semantic Content ~Security ~Healthcards ~Pharmacy ~Devices ~Business requirements for an EHR Countries involved include: •Asia: Korea, Japan, Malaysia •Oceania: Australia and New Zealand •North America: Canada and United States •Europe: Austria, Belgium, Czech Republic, •Denmark, Finland, France, Germany, Israel, Italy, Netherlands, Norway, Serbia, Spain, Sweden, Turkey and United Kingdom U.S. Delegation = U.S. TAG U.S. Technical Advisory Group

•52 members from industry, the government and standards development organizations (SDO’s) •Meet to decide the U.S. position on all documents and political issues •Develop new or adapt current U.S. standards for ISO adoption Alliance for Nursing Informatics The 2006 Strategic Plan focuses on: •Communication ~Maintain and increase communication channels 29

Item

Discussion

Action

~Increase

membership and expand links beyond nursing and informatics, both locally and nationally •Education ~Encourage education ~Share expertise •Public Policy ~Increase awareness ~Increase involvement ~Increase leadership •Professional Practice ~Promote and enhance nursing informatics professional practice ~Support nursing informatics research ~Outreach

Sensmeier closed by encouraging CNPE members to: • Understand and embrace these initiatives • Get involved with Use Case development • Respond to public comment opportunities • HITSP, CCHIT, IHE • Attend educational workshops • Attend demonstrations and include standards and IHE Integration Profiles in your RFP’s and integration projects. • Consider participation in HITSP Technical Committees, ISO/TC 215 U.S. TAG

XIV. Potential Areas for CNPE Attention

Web Sites: www.himss.org www.allianceni.org www.ihe.net www.hitsp.org General discussion ensued as to potential activities for CNPE • Long Term Care ~ NCA report provides overview of 5 year grant and potential future grant to develop center of aging at ANA. • Nursing shortage of educators ~ Tri-council is addressing. • Recruiting International Nurses ~ ANA work legislatively. Migration conferences are pending • Patient Safety? Agency Hours ~ NDNQI provides skill mix and breakdown of hours worked with RNs, unlicensed personnel, etc. The COEH addresses some patient safety. 30

Item

Discussion • • • • • • • • • • • • • •

XV. Recess

Action

Palliative Care in the ICU Older and domestic abuse. Change Fatigue Utilization of credentials by RNs First responders Disaster planning Avian flu. Nurse Faculty shortage and workload. HPVE vaccine. Gay & lesbian health issues Hepatitis C among nurses. Complexity, compression. How fast change is occurring in various areas of nursing. Shift in paradigm from research to evidence based practice Principles for evaluating or implementing an EHR.

Discussion of workgroups took place - new congress, subsequently new workgroups - identify chairs - identify members in writing, obtain e-mails - beginning goals - establishment of workplan - criteria for conference calls The chair recessed the meeting at 5:08 pm EDT.

Tuesday, September 19, 2006 Item XVI. Reconvene XVII. Selection of CNPE Vice-Chair Liaison Selection

Discussion The chair reconvened the meeting at 9:04 am EDT President Patton noted she had previously provided feedback on the process for selection of the chair. She noted that in the past CNPE actually would not have been involved in the selection of the chair. She then moved on to discussion of the Vice-Chair. Some were nominated by others. The group had 7 names submitted. There were 2 individuals involved in the interview – Susan Foley-

Action Motion III: Support nomination of Karen Ballard as Vice Chair of the Congress of Nursing Practice. I move that we proceed with the election. M-Burggraf; 2nd-Lee 31

Item

XVIII. Position Statement Review

Discussion Pierce and Kathy Player. They created a grid and presented it to the committee on appointments. They did not act on it because it is the role of the congress. She then shared the recommendations of the appointment committee. The candidate recommended was Karen Ballard. Support for the nominee was offered by a number of those present. Privacy and Confidentiality ~ Laurie A. Badzek, RN, MS, JD, LLM Director, Center for Ethics & Human Rights ~ Eight comments were received and incorporated it into the new documents. Most recent draft is August 30, 2006. This is the work of a sub-group and the entire advisory board did approve the changes.

Assuring Patient Safety: The Employers’ Role in Promoting Healthy Nursing Work Hours ~ Cheryl Peterson, MSN, RN and Cynthia Haney, JD ~ Background was provided by ANA BOD member Susan Foley-Pierce, former CNPE member and chair of the workgroup who noted that there were 2 documents that came at the direction of the HOD: one assuring patient safety from the employers’ responsibility and one indicating the RN’s responsibility to guard against working when fatigued. Three additional changes came in towards the end of August which were incorporated. Discussion ensued regarding the need for inclusion of language addressing advanced practice registered nurses. ANA has been consistent in the language of appropriate staffing, not necessarily sufficient staffing. There are many documents that have “appropriate”. A correction was made to read “sufficient compensation and appropriate staffing. Accepted language: “Sufficient compensation and appropriate staffing systems that create an environment in which the nurse does not feel compelled to seek supplemental income through overtime, extra shifts, and other practices that contribute to worker fatigue. The statement applies to all nurses. A statement that recognizes that this is applicable to “all nurses” was added. . It was noted that this position statement is only to address fatigue and ADO’s perhaps need to be addressed separately in detail.

Action Unanimous

Motion IV: I make a motion that we approve the "Privacy and Confidentiality" Final Draft Position Statement. M-Jones; 2nd-Kenny Unanimous

Motion V: Move that the CNPE approve and forward to the ANA Board of Directors the position statement "The Employers' Role in Promoting Health Nursing Work Hours" as amended. M-Robitaille; 2nd-Lioce Unanimous

Motion VI To add the phrase to healthy nursing work hours “for all nurses in all settings” in the title of the position statement. M-Hobbins; 2nd Foster Unanimous

Motion VII; Add on page 7, under employers…#8, that employers have a system in place for evaluating instances of nurses rejecting an assignment in order to evaluate causes 32

Item

Discussion

Assuring Patient Safety: The Registered Nurses’ Responsibility to Guard Against Working When Fatigued ~ Cheryl Peterson, MSN, RN and Cynthia Haney, JD ~ This title will be edited to be consistent with previous position statement.

Action and effectiveness of staffing patterns. M-Nalle; 2nd-Matthews 34-YES; 14-No; 0-Abstain

Motion VIII: Move that the CNPE approve and forward to the ANA Board of Directors the position statement "Assuring patient safety: The Registered Nurses' responsibility to guard against working when fatigued" with addition to change the word "consider" to "use." M-Surdo; 2nd-Lee Unanimous

Motion IX: Clarification: The Nurses' Responsibility to Guard Against Working in All Roles and Settings when fatigued. M-Wyckoff; 2nd Wright Unanimous

Credentialing and Privileging of Advanced Practice RNs ~ Patricia A. Rowell, PhD, RN, Senior Policy Fellow, Department of Nursing Practice and Policy It was noted that one of documents sent out in Sept had to do with a JCAHO standards regarding credentialing and privileging. This position statement seems in direct contradiction to JCAHO standard. ANA has membership on each of technical advisory committees. Potential for conflict- so ANA reps can be advised of this and they can speak to ANA’s position in an attempt to modify JCAHO’s standard. The call for comments still open. ANA comments reflect what we receive from reviewers and standing ANA policy. JCAHO

Motion X: I move approval by the CNPE of A Position Statement for the Credentialing and Privileging of Advanced Practice RNs. M-Lee; 2nd-Mitchell Unanimous

33

Item

Discussion credentialing process reflects licensed individual practitioners, including APRNs and MDs. ANA fought hard for parameters for APRNs credentialing to be exactly the same way as medical staff. In Position statements, we put out there what profession thinks Is appropriate. ANA uses as part of our advocacy efforts to move communities of organizations along. Preventing Transmission of Bloodborne Pathogens in Health Care Settings; Preventing Transmission of Bloodborne Diseases Through Injection Drug Use; Barrier Use for Prevention of HIV Infection and Sexually Transmitted Diseases ~ Kristen Welker-Hood, ScD, RN, Senior Policy Fellow, Center for Occupational and Environmental Health These were combined from a lot of position statements that were outdated. Principles of Environmental Health for Nursing Practice This is a “Principles” document. Will become a companion to other Principles documents ANA currently has.

Cheryl Peterson advised the group that ICN has a position statement on cultural and linguistic competence currently in the field for review. Others in review include a number on aids care, cloning, impact of HIV aids on nursing and on armed conflict. All documents are on NursingWorld until October 16th

XIX. Appointment of Nominating Committee XX. Workgroup Reports

Action

Motion XI: Please post the following on NursingWorld for comment for 60 days: • Preventing Transmission of Bloodborne Pathogens in Health Care Settings • Barrier Use for Prevention of HIV Infe and Sexually Transmitted Diseases • Preventing Transmission of Bloodborne Diseases through Injection Drug Use M-Newman; 2nd-Nalle Unanimous

Motion XII: To have the Environmental Health Principles posted for comment for 60 days. M-Acree; 2nd-Doherty Unanimous

Volunteers for nominating committee included Patrick Kenny; Carla Lee; and Teresa Posani. They were appointed by acclamation. Posani will serve as chair. Safe Connections s~ L. Riazi*; K. Lawrence; J. Pfeifer; ANA Staff: N. Hughes ~ Comprehensive review of the safety and quality issues in accessing external connections in tubings and catheters. Analyze information for the purpose of developing ANA Position Statement. Develop draft ANA Position Statement Disseminate information. Analyze current manufacturing process for nursing input on patient safety issues. Review JCAHO Sentinel Event Alert. Review references provided by the JCAHO Sentinel Event Alert. Contact Texas Nurses Association, authors of the Reference Proposal ANA 34

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Discussion Action HOD 2006, for additional information, clarification of TNA intent, issues and concerns and action needed. Conduct literature search for additional tubing misconnection events and identify the safety and quality concerns for Extended Care Facility and Home Health. Review pertinent ANA documents, including those on patient safety, fatique and the Scope and Standards of Practice. Report to CNPE February 2007. Position Statement Review ~ A. Newman;* V. Burgraff*; S. Gracia Jones; P. Keller; P. Kenny; C. Lee; P. Neal; K. Stanley M. Wyckoff ; ANA Staff: R. Gallagher. Comprehensive review and analysis of existing ANA position statements. Revision of position statements to reflect current practice and ANA policies and initiatives. Submit revisions for CNPE review and approval. Forward to ANA BOD. Goal #1 1. Conduct preliminary review of existing position statements for accuracy, currency relevance, and need for revision/sunset. 2. Evaluate extent of work needed and develop preliminary timeline. Goal #2 1.Begin process with determination of position statements in need of archiving or sunsetting 2. Institute process based on priority areas of current CNPE /ANA work. 3. Update Citations 4. Identify and utilize ANA staff and outside content experts as necessary. 5. Identify relevant supportive documents from other professional groups. Competence-Competency ~ A. O’Sullivan*; P. Mitchell, E. Doherty; M. Nalle; E. Acree; J. Surdo; P. Kulbok; L. Wright; ANA Staff: M. Seiler, C. Bickford ~ ANA will lead role in defining competence by: 1. Develop a position paper which defines competence and provides background information. 2. Determine appropriate ways to disseminate the information on competence. 3. Educate nurses about the ANA position and definition of competence. Action: 1. Review current literature about competence. 2. Determine breadth and depth of essential definition and background information. 3. Develop suggestions of possible ways and documents to include this definition in. 4. Decide on most appropriate vehicles for distribution. 5. Develop educational strategies for nurses and others, i.e., published articles, presentations at national, state, and local seminars. Environmental Health Principles~ K. Ballard*; ANA Staff: M. Condon ~ To develop a list of principles of environmental health for nursing practice in response to the 2004 HOD Action Report on the development of such principles. Work with consultants such as: Nancy Hughes from ANA Occupational Health and Safety, Laurie Badzek from ANA’s Center for Ethics and Human Rights and HCWH experts such as Susan Wilburn, Barbara Sattler, Brenda Afzal and Marjorie Buchanan. As appropriate, use public health nursing specialty-specific principles as developed by the APHA’s Nursing Section to serve as a guide for the development of principles on environmental health nursing for all nurses. Consider a format for the Principles document that would include: History, Purpose, Policy Statements, the Principles, Practice Strategies, Education, Definitions, References, Listings of Environmental Health Resources (organizations, web sites). Share the draft of the Principles of Environmental Health Nursing Practice with representatives of AORN, AAOHN, AACN, ANA and APHA’s Nursing Section via a conference call(s) in March and/or April, 2005. After the conference calls, place a draft of the Principles on ANA’s web site for comment in April and/or May 2005 for general input from the nursing community. Prepare a revised Principles document for presentation at a forum to the ANA-HOD for its input. Finalize the Principles document for publication by Fall 2006. CNPE workgroup appointed as of 12/05 and conference call held. Another call is scheduled for March 6th. The following outside of ANA experts have been invited to participate in conference calls and meetings when they are available: S. Wilburn, B. Sattler, B. Afzal and M. Buchanan. The workgroup has reviewed the draft APHA environmental health principles 35

Item

Discussion Action School Nursing ~ M. Carmon; *C. Schmidt; L. Lioci; S.Foster; C. Resha; ANA Staff: C. Haney ~ To review and analyze the present position statement ”Providing Safe Health Supervision and Care for Children in the School Setting.” To revise or redraft the position statement “Providing Safe Health Supervision and Care for Children in the School Settings “ or prepare another document that is reflective of ANA Policies and initiatives. Submit revised or redrafted document/paper for CPNE review and approval. Present the need for additional position paper (s) or documents if determined appropriate by the group Present to CPNE for approval and Forwarding to ANA Board. Goal #1 Conduct review of the present position statement. Review public opinion statements previously submitted (done at CPNE in September) The present position statement and public comments were distributed to members of the group for review and discussion during the Sept. CPNE meeting. Goal #2 Begin the revision process by: Conducting a literature review for the content area and Identifying and reviewing related position papers in non-nursing groups (NSBN, AAP, AFT, etc). Reviewing ANA documents related to School Nursing: 1) Principles for Delegation (2005); 2) Nursing’s Social Policy Statement; 3)School Nurse Scope & Standards of Practice. The chair of the group will send a draft document to the members of the group within the next 10 days for review & comments. Literature review (October 15th) and review of the position papers and ANA materials will be completed by November 1. A conference call will be scheduled for the first week of November & the first week of December after members have sent proposed changes to the chair and the members have reviewed the literature to: discuss the groups recommendations as to their position and direction for proposed changes and/or; drafting /redrafting position paper or other document proposed by the group. Goal #3 Submit redrafted position paper to ANA staff . Position Paper will be submitted to ANA staff by January 18, 2007. Goal #4 Make recommendations to CPNE if further documents are needed on school nursing. Goal #5 Resend the revised or redrafted position paper to CPNE for approval and forwarding to ANA Board. Submit the Position Paper to the CPNE February 2007. Make revisions as recommended by CPNE. Replacement of RNs with Nursing Assistive Personnel ~ S. Burnett,* J. Matthews, C. Bruflat, R. Coe, D. Hobbins, I. Grant, J. Sikkema; ANA Staff: C. Peterson ~ The previous group recommended development of a "Principles of Workforce Restructuring" document. 1. Develop a new relevant position statement for RN utilization of NAPs to incorporate current situations and evaluate recent trends; 2. Recommend sun-setting the current position statements-RN Utilization of UAP, RN Education related to utilization of UAPs. Review current documents from the Center, NCSB 2005 “Working with other”; 3.Review resources relevant to NAPs utilization; 4. Integrate ANA’s Principles of Delegation. Transforming the Work Environment of Nurses ~ J. Dixon/P. Schlosser;* J. Ross ANA Staff: C. Peterson ~ Goal #1 - provide endorsement of AACN HWE standards Review; make recommendation to CNPE to endorse the document, CNPE to forward to BOD for final approval by the Feb CNPE mtg (document if any must be in to ANA by January 18th so can be posted on CNPE website). Goal #2 - review/redo 95' Assignment Despite Objection; Present updated / revised position statement to CNPE for approval to be posted for 60 days for public comments, then back for CNPE to approve and forward to BOD for approval by Feb CNPE mtg. Pay for Performance (P4P) ~ K. Hickey;* K. White; B Ferree; P. Holloman; S. Burrows-Hudson; J. Kirschling; K. LeoneNatale; C. Neuman; S. McCumber; D. Keepnews ANA Staff: I. Montalvo ~ Define Pay for Performance in its many 36

Item

Discussion Action venues. Assess potential or present impact of Pay for Performance on Nursing. Explore what role ANA should have in P4P. Assess various definitions of P4P in varying practice settings and with several possible stakeholders; Oct-Dec, 2006. Compare and contrast the definitions and scopes of P4P; Jan 2007. Grid to be developed to facilitate comparisons. Possible Conference Call before Feb 2007 CNPE meeting. Report to CNPE Feb 2007

XXI. Announcements

XXII. Winter 2007 Meeting XXIII. Fall 2007 Meeting XXIV. Adjournment Drafted: Revised:

Electronic Health Record ~ B. Donovan*; M. Behrens; J. Harris; B. Idimoto; T. Posani; P. Robitaille; S. Sendelbach; N. Shirley ; ANA Staff: C. Bickford; Y.Humes ~ To develop resource materials for use by nurses in the electronic transformation of the healthcare environment. To develop a checklist of questions for nurses to use during selection and implementation of new equipment and software. To review the ANA scope and standards documents on Nursing Informatics. To review the ANA position statements on electronic records This resources document will include: History/overview; selection of equipment and software; implementation of new systems; competency of all levels of nurses; involvement with external groups patient rights , privacy and advocacy. Each member was , assigned a section of this resource. They will share the literature searches with the workgroup by November 6, 2006. This checklist will be developed from the above resource document. The scope and standards documents will be mailed by ANA staff to the members of this group. The chair will distribute the policies to the workgroup by 10/3 Violence in Advertising ~ Howard;* C. Baird; B. Jorgenson; ANA Staff: P. Rowell ~ Develop strategies to heighten the awareness of the negative impact of violence in advertising on children, adolescents, and families. Review existing relevant documents to formulate a white paper on this issue. Disseminate information contained in white paper through: • Web page statements • Journal articles • Letters to advertising sponsors and producers regarding the negative effects of violence NIH has granted $14 million to 4 medical centers on wound healing, regardless of type of wound. The focus is innovative therapies: microbiologist, dermatologist and physicians are part of group but not nurses. Looking for comments regarding the number of nurses who are in this forum. CDC collaborative with ASTDN for Public Health Nurses. They are in their 2nd year of development. 1st time meeting with CDC and public health nurses in July 2006. The meeting will be held on February 9-10, 2007 at the ANA Headquarters in Silver Spring, MD. The meeting will be held on September 16-17, 2007 at the ANA Headquarters in Silver Spring, MD. The meeting was adjourned at 2:10 pm EDT by the chair.

September 18-19, 2006 September 21, 2006 September 23, 2006 37

September 25, 2006 September 27, 2006 September 28, 2006 September 30, 2006 October 3, 2006

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