White Paper

The beginning:

White Paper on Workplace Advocacy in Arkansas/Louisiana (1997)

Introduction

The Arkansas Nurses Association (ArNA) and the Louisiana State Nurses Association (LSNA) believe that clients and families deserve quality, cost-effective, accessible healthcare services. We hold that nurses are a vital part in delivering these services, and have a long history advocating for clients and families. The ethical norms of the profession, the Standards of Clinical Nursing Practice, and the nurse practice acts validate the nurse's professional obligation to provide quality care and protect clients and families. ArNA and LSNA maintain that the workplace environment affects the ability of the nurse to do so. Nurses deliver their services in collaboration with other healthcare providers, respecting the unique talents and skills of each member. We support that all must work together to foster a healthcare environment that enables nurses and other providers to adhere to their professional standards and code of ethics, to ensure that safe, quality care is delivered.

Workplace issues are gravely concerning to nursing because they directly affect the quality and safety of patient care. Restructuring and managed care are changing how health services are delivered, and major efforts have been made to cut costs. Early predictions indicate that the reengineering movement has reduced costs, but concerns have arisen that cost containment pressures are impacting the quality and safety of care. The rapid changes have placed a heavy burden on nurses. Study after study of nurses' job satisfaction has found that the quality of the work life is much more related with satisfaction than are salary and benefits (Blegen, 1993; Debark & Cohen, 1996; Hansen, 1995; Irvine & Evans, 1992; Knox & Irving, 1997; Zautron, Eklen, & Reynolds, 1994). Stress, burnout and ethical ramifications are a growing concern among nurses because these conditions jeopardize their abililty to fulfill their commitment to quality client care.

Workplace advocacy has been, is and always will be a central mission of the American Nurses Association (ANA). As constituent members of ANA, ArNA and LSNA are committed to developing a workplace program that addresses the client's health and safety, the professional development of nurses, and the economic and general welfare of nurses. We recognize that the healthcare system must undergo changes. We support that nurses must work in collaboration with employers and other healthcare providers to facilitate a positive work environment. The ArNA/LSNA Workplace Advocacy Program is a proactive methodology to educate and empower nurses to help make changes in the workplace that will enhance the quality of their work environment. It is intended to facilitate strategies for employers, nurses and healthcare providers to work collectively toward safe, quality, cost-effective client care.

Background Information

In early 1996, ArNA convened a regional conference with other state nurses associations (SNAs) to address the spread of union activities among nurses throughout the nation. Six "right-to-work" SNA Presidents and Executive Directors, the ANA Executive Director, and several key ANA staff met to discuss how they could help nurses with workplace issues through options other than collective bargaining or labor unions. The concerned states believed that a proactive workplace advocacy program would be more beneficial, less antagonistic, and more appropriate for their own specific state member needs.

Throughout 1996, the ArNA and LSNA continued to meet and plan how they could move forward together. In late 1996, ANA provided a bi-state grant to assist in the development of a workplace advocacy program for the nurses of both states. In March, 1997, facilitated by the grant award, ArNA and LSNA conducted a random sample survey of all registered nurses in each state (every sixth licensed registered nurse) to identify workplace needs. Six thousand surveys were mailed to Louisiana nurses and four thousand were mailed to Arkansas nurses. A total of 2,312 acceptable surveys were returned (1,577 from Louisiana and 735 from Arkansas). The ArNA and LSNA conducted a joint board meeting in July, 1997, to discuss the survey results, establish goals, and develop an initial workplace advocacy program. In October, 1997, both boards provided this information to their memberships at their annual conventions and received positive feedback from members.

Initial Workplace Advocacy Program

The survey data validated that the two most immediate goals that ARLA (Arkansas/Louisiana) must direct its resources involved education and communication. The ArNA and LSNA Boards of Directors, over the course of several months, developed the definition and purpose of the Workplace Advocacy Program through rigorous literature review, market analysis, and joint meetings. Further work resulted in the development of program goals which are outlined in the complete version of this paper. The most immediate task that was identified to achieve goal expectations was the dissemination and explanation of the definition of Workplace Advocacy to the professional nurses in both states. The concise, simple definition of workplace advocacy will be advertised throughout various mediums to raise awareness of ARLA's intent to support the professional registered nurse with this program.

The next step of the initial workplace advocacy initiative was to develop an intake procedure for receiving complaints from registered nurses about workplace concerns.

Last, short-term goals were identified as important to the future implications of this initiative.

WORKPLACE ADVOCACY DEFINITION
ArNA/LSNA's Workplace Advocacy Program is a planned, organized system of services and resources designed to support the professional nurse in the workplace environment.

WORKPLACE ADVOCACY PURPOSE
The purpose of the workplace advocacy program is to provide a program that will facilitate the professional nurse in creating a safe, uncompromised work environment in which to deliver safe, quality patient care.

Conclusion

There are many environmental forces currently driving major health care changes. ArNA and LSNA concur that these changes have and will continue to influence the ability of professional nurses to provide safe, quality care to patients and families. As the professional nursing association, we must help the nurse address workplace issues. The workplace program developed over the past 13 months by both states is but a beginning. It is an attempt to respond positively, working with our members and other health care providers and employers to proactively develop a positive work environment. ANA believes this initiative is so critical it has awarded a second bi-state grant to ArNA/LSNA. In 1998, we will continue to seek input from professional nurses, their employers, and other key entities to evaluate the success of the program and make improvements. With collaboration, education, and empowerment, ArNA and LSNA will assume the leadership in workplace advocacy.