June 23, 2010, 1:36 pm

An Open Letter to the ANA

To the American Nurses Association,

I am a member of the American Nurses Association and a dedicated supporter of HR 4601 The National Nurse Act.

For the life of me, I cannot understand ANA’s reluctance to endorse the National Nurse Act.

The infrastructure already exists, in fact the position already exists. The Act seeks to have the Chief Nursing Officer of the US Public Health Service designated as the National Nurse.

There is nothing political about this – the nominating procedure for the position does not change. It is not a presidential appointment, nor is it a Cabinet position.

And it costs nothing to implement – it’s already funded. It takes no resources away from other nursing initiatives; it competes with no other nursing organization.

But more importantly, it gives the public a visible nurse leader as our health care delivery system transitions to one that focuses on health and the prevention of disease.

And yet, the ANA does not endorse the Chief Nurse Officer of the US Public Health Service being known as the National Nurse.



I sit here holding a copy of the ANA Social Policy Statement for Nursing (Second Edition).  The Office of National Nurse promotes every aspect of our social policy.

From the ANA  “Definition of Nursing”:

Nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury…(p.6)

From the ANA “Knowledge Base for Nursing Practice”:

Nurses partner with individuals, families, communities, and populations to address issues such as…healthcare systems and their relationships with access to and quality of healthcare…the environment and prevention of disease (p. 7)

From the ANA “Values and Assumptions of Nursing’s Social Contract”:

Public policy and the healthcare delivery system influence the health and well-being of society and professional nursing (p.3)

These are the very foundation of the National Nurse Act.

Imagine the impact of a focus on disease prevention and health promotion at the national level. Imagine the Medical Reserve Corps gearing up with nurses who volunteer in their own communities – think of the impact on health disparities, on social inequities. Imagine patient education on a national scale.

Imagine the public understanding what nursing is…what we do.


HR 4601 was introduced on February 4th. Fifteen members of Congress support it. Four state legislatures are on board and over 100 organizations and prominent individuals are supporting it.

But not the ANA.

I want to know why.

No cost, no politics and an existing infrastructure ready to go…what more do you want?

Because from where I sit, the National Nurse Act seems to blend beautifully with the ANA.

So, speaking as a card-carrying-dues-paying member of the ANA, we need to get onboard.

We need to support HR 4601 The National Nurse Act.

Thank you.

Kim McAllister, RN, BSN


(Further information can be found at The National Nurse.)


American Nurses Association (2003). Nursing’s social policy statement (2nd ed.). Silver Spring, MD: nursebooks.org.


  • alysa hilton

    June 23, 2010 at 3:04 pm

    Thank you Kim for voicing strong sentiment in support of the National Nurse. We need to be more visible and have our voices heard at the national level. Now is absolutely the time to make this happen!

  • Joachim Voss

    June 23, 2010 at 3:06 pm

    HR 4601 was introduced on February 4th. Eleven members of Congress support it. Four state legislatures are on board and over 100 organizations and prominent individuals are supporting it.

    The National Nurse Act is in strong support of the ANA and we need the support from ANA especially when 32 million new patients are at the door steps of our clinics and in our communities waiting for nursing care. We need a unified voice and not the current infighting.

    As a paying member of ANA I encourage the leadership to come on board and support HR 4601 The National Nurse Act.

    Bless you,

    Joachim Voss, RN, PhD

  • Anne Nowlin BSN.

    June 23, 2010 at 3:55 pm

    Not an ANA member, but that’s irrelevant. First and foremost, I’m a nurse and that’s all that matters. I want to see the advancement of nursing as a profession and see the healthcare of this nation improved.

    I agree with all the posters: For the life of me, I can’t understand the ANA’s reluctance to endorse the National Nurse initiative (HR 4601). Ever since I spoke with Michelle Artz some years ago in referencing the ANA’s position on the National Nurse before writing an article, I’ve been truly befuddled!

    There is no duplication of services, like someone before me so eloquently stated, “The infrastructure already exists.”

    This is not the a political issue, in fact, organizers have been quite careful from the get go not to make it one. It is a patient-driven, United States of America health care (not disease-care) issue.

    I mentioned earlier that I am not a member of the ANA and that the reason was irrelevant. However, if I were a practicing nurse, thinking about joining the ANA, it’s non-endorsement of HR 4601 (The National Nurse Act) would be cause for great pause.

    What is that one thing that prevents the nation’s nursing representative organization (ANA) from furthering the cause of nursing?

  • Elizabeth McPhee Graduate Nurse

    June 23, 2010 at 5:02 pm

    As of today HR4601 now has 15 co-sponsors. Now is the perfect time to enact this legislation. The seven most common, AND PREVENTABLE, chronic illness continues to rise and is costing our country trillions of dollars annually in lost productivity and treatment costs. Milkin Institute studies have proven that even modest efforts in health promotion and early prevention can save us $1.1 trillion annually and avoid 40 million cases of chronic disease by the year 2023.
    Nurses should be at the helm of this movement! Education is the cornerstone of our practice.
    The National Nurse position is not a role that deals with nursing workforce issues, it is for promoting the health and wellness of our country.
    Let’s show the public what nurses really do!
    Call your district Representative and tell him you are a constituent and you support this bill then ask him to become a co-sponsor!

  • katiebird

    June 23, 2010 at 5:38 pm

    What I don’t get is why the “opposition” — I’ve been in politics my whole life and I’ve never seen a situation like this. Why would having a National Nurse be a controversial issue?

  • Karen Reynolds

    June 23, 2010 at 5:55 pm

    The National Nurse Act is supportive of a nurse for all Americans. A collaborative approach is what is needed to mend our fragmented health care. For the National Nurse to collaborate with the Surgeon General on the forefront of our nations health prevention and promotion benefits all Americans. Every American deserves a nurse!

  • K. Walker, RN

    June 23, 2010 at 6:14 pm

    Kim, great post! Thanks!

    I am a registered nurse and a strong supporter of the National Nurse Campaign. It is quite unfortunate that the ANA continues to oppose a National Nurse. Establishing this visible leadership for nursing is not only ideal, but long overdue.

    Through an Office of the National Nurse, nurses across the US can be united in teaching the message of prevention to curb the current rise in preventable disease. A full time position working with the Surgeon General will help to promote and strengthen the role of nurses in modern healthcare.

    Nurses are the largest group of health professionals. We are on the front lines of patient care and patient education. We are educated, skilled and trusted professionals.

    We should have a visible nurse leader to unite all nurses across the country. A nurse that brings us together to focus on prevention. A nurse that promotes our profession.

    Nurses make a difference every day…. imagine what we can do together!

    We need a National Nurse!

  • Anne Llewellyn

    June 23, 2010 at 7:07 pm

    I also am curious about ANA’s lack of interest/response to this grassroots effort. Hope this article brings a written response. It would be great if for once, we (NURSES) could work together for a common cause vs. being fragmented and territorial.

    Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
    Editor, Dorland Health

  • Lily

    June 23, 2010 at 10:07 pm

    Well said. We need a National Nurse, and we need the ANA to step up to the plate. Nurses out there: We need to hold the ANA accountable! ANA stonewalling is not an option.

  • Beth Ann

    June 24, 2010 at 2:14 am

    Well written and so true. America does need a National Nurse!

  • Susan Sullivan

    June 24, 2010 at 4:35 am

    There is huge support for the concept of having a National Nurse who will promote nurses in every community to take part in prevention efforts. HR4601 will provide a National Nurse to guide available nurses, including students and retirees, to become active advocates for health promotion in their local communities. ANA has new leadership, supporters of having a National Nurse would like ANA to revisit their position and embrace this popular vision for nursing. This concept has the potential to bring more unification to our profession and to improve health outcomes for our society…seems like a win-win for nursing.

  • Laura F.

    June 24, 2010 at 5:54 am

    I’m in agreement with everyone else here (great post, BTW!). I’m also an ANA member, and can’t for the life of me figure out why they are so opposed to this Office. I’m wondering if they believe they’ll lose some kind of political power, if this position is enacted. Personally, I believe if they don’t get it together and start promoting nurses/nursing according to their mission, they’re going to suffer even more membership loss, and disinterest from potential new members. Get it together, ANA!

  • Peggy RN, MS, CEN, CNE

    June 24, 2010 at 1:38 pm

    Thank you for all the thoughtful comments. I, like most of you, am a supporter of the National Nurse. It just makes sense. Why not enhance the available system to promote healthy living? The public health nursing is doing what they can and doing it admirably, but they need help. Help from volunteers that can be in more places and improve the effectiveness of the message. This is not a replacement, but an enhancement. Why the reluctance? Healthy People 2020 is soon to emerge and I can’t imaging that the expectations on nursing will be smaller. The National Nurse can help!

    I was, but am no longer,an ANA member.

  • Tamara Gedrose

    June 24, 2010 at 4:01 pm

    The National Nurse Act would do so much good for this country. More and more, individuals are trying to be proactive about their health. This is a great trend and a National Nurse would lend positive, accessible support to this effort. In turn, this would lead improved health for all and make limited health care resources available to those who need them. I like what Peggy says: “It just makes sense.”

  • MB Rosenstiel, RN, DNP

    June 24, 2010 at 6:29 pm

    Unfortunately, the ANA no longer seems to truly speak for the majority of nurses in this country. Their membership is dwindling and perhaps that is because the voice of working nurses is no longer important at the national level, or is simply being ignored. For far too many years nurses have bickered, quarreled, and disputed important issues so vehemently that we end up chasing our tails and failing to move forward, and fall short of being seen as true ‘professionals’ by other professions such as medicine, dentistry, pharmacy, law, and education, to name a few; all because we can’t seem to come together as a strong cohesive group to speak with one VOICE.
    Having a National Nurse will give emphasis to how nurses impact healthcare, prevention and education everyday in all they do. Then, conceivably, nurses will be invited to the ‘table’ when local and national healthcare issues are discussed and decisions made. Perhaps then nurses, the largest body of healthcare workers in the U.S. will come together and work to assure that every single person living in this great country receives healthcare and prevention services. Only when we speak as a united voice, and not a multitude of disparate rumblings, will we have the power and might to create change for the future.
    Nursing has a holistic vision of wellness and care aimed at working ‘with’ individuals, families, and communities. Now is the time for us to come together and view ourselves holistically, work together, and create an Office of the National Nurse where long awaited dreams can begin to come true, for this profession and those we care for and about. Passage of HR4601 is but one step in the right direction.

  • Cynthia feinberg

    June 24, 2010 at 7:10 pm

    The time has come for this bill to pass. Im so grateful for the nurses that put it together, Teri & alyssa. I just celebrated my 5th year as a RN and am certain that time for bill passage is NOW!!!

  • […] of nurse bloggers, Kim at Emergiblog has An Open Letter to the ANA about that nursing organization’s reluctance to endorse the National Nurse Act, a […]

  • RehabRN

    June 26, 2010 at 10:06 am

    Thanks for the post Kim!

    I’ve linked to it and included the link to the ZIP lookup.

    If every person who reads your blog takes a minute to e-mail his/her congressional representative and tells friends, think of what may happen!

    If Betty White can get on Saturday Night Live…the nursing blogosphere (and its readers) could make a profound impact on US healthcare.

    Keep up the good work.

  • […] Emergiblog is encouraging the ANA to support the National Nurses Act-Hope she has better luck with that than I have with the American Medical Association. […]

  • Kathy Quan RN BSN

    June 27, 2010 at 11:53 am

    Great thoughts. Hopefully the new administration at the ANA will take a serious look. Meanwhile there are 15 sponsors in the Congress who can actually help push this legislation through.

    Have posted a link to your blog from mine. (http://www.thenursingsiteblog.com/2010/06/national-nurse-act-needs-ana-support.html) Hopefully our combined readership will help nudge the ANA as well.


  • Chris [The Man-Nurse Diaries]

    June 27, 2010 at 7:50 pm

    I don’t get it either. Ever since hearing our local state’s nursing association’s arguments against patient ratios, I have a feeling that more than one state and national organization is unduly influenced by other lobbies/interests than those of nurses. Maybe these are unrelated issues, but I feel more comfortable in general with a national office over a private lobby or organization.

  • […] An Open Letter to the ANA (emergiblog.com) Leave a Comment […]

  • Debi Onken

    June 29, 2010 at 7:08 am

    I allowed my ANA membership to lapse this year. They called to ask me why. I told them. The ANA has become a political animal that simply no longer represents my view as a nurse. Their failure to endorse the National Nurse Act was the final straw for me. I believe that the ANA has lost its way and forgotten its noble purpose. There are plenty of other nursing organizations out there who will now get my dues.

  • Patti

    June 29, 2010 at 4:46 pm

    All though I am new to the nursing profession, I am disappointed in the lack of support by the ANA on this issue. With the current state of the healthcare system, now is an important time for the National Nurse Act to be put in place. Why the hesitancy?? This change only serves to improve the communications needed for healthcare & preventive diseases in this country.

  • Anne Nowlin BSN.

    June 29, 2010 at 6:03 pm

    It’s clear from these posts that the nursing community is in agreement about the ANA’s non-endorsement of the National Nurse bill, HR 4601.

    The next step for us is to launch a campaign to contact the ANA and question their position.

    I don’t have them right now, but if I can locate them, I’ll post the e-mails of contact people in the ANA. We can also write letters that state our positions.

    We need to do more than say what is wrong; we need to act.

  • […] of people can hear you-Nurse Kim, a long time nurse blogger at Emergiblog, has recently written a rant about the controversy of having a National Health Nurse post developed.  Many others have commented on her stance.  She earned the right to be heard, by having […]

  • KatieBeeRN

    June 30, 2010 at 9:14 am

    Have you read the nursing community’s letter of concern? The Chief of the Public Health Nursing Section of the United State Public Health Service should be doing just that – not trying to get people to be nurses. And do we really want the government to be the lead voice of nursing?

    Also, this legislation will require funding, and it will be taken out of the Title VIII funding for nursing education – including nurses and new faculty. As hard as it is to squeeze a few more dollars out of the budget for this type of funding every year, there is no way a new appropriation will be set aside for Office of the National Nurse stationary and other silly things that will need to be purchased.

    ANA is probably busier trying to ensure that nurses get a big piece of the action from the Patient Protection and Affordable Care Act. There are numerous opportunities for nurses to lead in primary care, and to be leading prevention and wellness programs and pilots. They are also busy trying to pass Safe Staffing legislation, as well as Safe Patient Handling. I would think that nurses on the job would benefit from those laws much more than an Office of the National Nurse.

  • Jamie Davis, the Podmedic

    July 1, 2010 at 10:11 am

    Wow, Kim, we should definitely cover this one on the next episode of the InsightsinNursing.com show. This position would serve us all. Thanks for speaking out on this issue.

  • Elizabeth McPhee Graduate Nurse

    July 1, 2010 at 2:24 pm

    KatieBee– Thank you for raising some very important misconceptions about this initiative to allow us to clarify. Yes, supporters of the National Nurse campaign have read the ANA’s letter of concern. The National Nursing Network Organization worked painstakingly with the Office of Earl Blumenauer to include the ANA’s critical points into the carefully crafted bill. We can rest assure that the CNO will retain all of their current responsibilities while addressing the health care crisis America is experiencing in the soaring cases of chronic disease through prevention and early intervention efforts. A role that a nurse is perfectly positioned for. Education is the cornerstone of our practice.

    No money will be taken away from Title VIII funding. Congress has a new commitment towards funding specifically for prevention. On March 19, 2010 the US Department of Health and Human Services announced awards of $372 million dollars in wellness and prevention grants. First Lady Michelle Obama was reported as calling this effort an “unprecedented level of commitment to prevention” and that “investing in local communities will build a healthier America.”

    There is no where in the bill language that calls for the CNO to “get people to be nurses”. This position would provide a positive and real role model for nursing, someone that has not existed since Florence Nightingale and Clara Barton. This is just a benefit to our profession and inconsequential to what this role has the potential for providing the public.

    The National Nurse will not be the “lead voice of nursing” The role is specific to engaging nurses and other health professionals to become engaged in health promotion programs to replicate their success and help curb the cost of chronic, preventable conditions that are bankrupting our country.

    We strongly support the efforts and endeavors of the ANA . It is not necessary to make this an either/or debate.

    Please click on the Kim’s link above and read the bill and I am sure you will agree that putting nurses at the forefront of improving public health makes common sense.

  • Anne Nowlin BSN.

    July 6, 2010 at 7:21 am

    We nurses are trained to identify and treat a problem. Oftentimes the treatment comes after a doctor’s order to treat. In this instance, we don’t need the doctor’s order to treat.

    The treating here comes in the form of writing or calling our Congressmen or contacting their regional office to set up an appointment to promote HR 4601, focusing on the pros of this plan.

    Then, received orders to do what should and happen and why. Until we complete such a project we should NOTE that nurses haven’t completely backed themselves.

  • KatieBeeRN

    July 8, 2010 at 12:13 pm

    Elizabeth – Federal grants, or even appropriated funds for FY2010 do not translate into congressional funding for FY2011. Everything in DC comes with a price tag…

    I’d encourage focusing on elements of PPACA that address wellness and prevention. There will be a huge amount of work done in this area as a result of the law, including the National Prevention, Health Promotion and Public Health Council – which has almost $12 billion in guaranteed appropriations. This council will have an advisory group, and nurses could very well be a part of it.

    And I will respectfully reiterate that ANA is using its political capital best to advocate for Safe Staffing legislation (S. 3491/H.R. 5527). And recall that I was not referring to ANA’s letter of concern, but rather the Nursing Community letter of concern, which has been signed by 2 former CNOs of the USPHS.

    For me, this is debatable.

  • Experienced PH Nurse

    July 12, 2010 at 1:36 pm

    KatieBee, to me, your points seem to highlight how practical and important it would be to have a National Nurse working in conjunction with an active ANA (just as physicians have both the AMA and a Surgeon General!) The work of the ANA to promote safe staffing is critically important and should continue, However, this would not negate having a National Nurse to address the need for a unified voice across all nursing specialties to guide nurses who are willing to get more involved in prevention efforts. As you point out, there are elements of PPACA that will address prevention and wellness, and in myh opinion, the National Prevention, Health Promotion and PH Council with it’s $12 billion in appropriations certainly SHOULD have many nurses including the National Nurse in their advisory group. What other faction on that council would represent a workforce of more than 3 million persons ? This is the time for nurses to take charge and move front and center to assure nurses have many places at the Asvisory Group table…because nurses have the public trust and nurses can be relied upon to advocate for the public’s health needs and nurses will take appropriate actions to move the agenda of the new health reform. And this is why having a National Nurse at this time is so very critical to establish nursing’s future roles in healthcare.
    Public Health has a way of being fragmented among many disciplines… but PH nursing is alwaysthe tie that binds policies and programs with patients. A National Nurse will only strengthen PH nursing networks at State and Regional levels something that is very needed.

    An Experienced and often disillusioned PH Nurse

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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