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ANA Official Position Statements

The American Nurses Association (ANA) develops positions relevant to nursing practice, health policy, and social concerns impacting the health of patients and families. Position statements guide the profession, amplify the views of nursing, and educate consumers and decision makers.

One important process used for the development of a position statement is:

  1. When a relevant topic has been approved by the ANA Board of Directors, an ANA Professional Issues Panel is appointed to research and come up with a draft position.
  2. Once the panel has completed its work on the new position statement, a draft of the proposed position statement is then posted on ANA's website for public comment.
  3. Following public comment, the statement is revised if necessary and approved by the ANA Board of Directors, making it an established ANA position. 

This process allows each and every nurse to voice their views and opinions on the various dimensions of the issue at hand. The current position statements are as follows:

Abuse of Prescription Drugs

ANA Position Statement - Approved 4/5/91

ANA opposes fraudulent or incompetent prescribing activities by health care providers and the misuse of prescribed drugs by nurses themselves.

The association encourages comprehensive pharmacology education for nurses practicing in all settings to ensure safe and appropriate prescription of drugs. The association believes education for nurses with prescription privileges should include, but not be limited to: 

  • education on the misuse, abuse and addictive potential of prescription drugs. 
  • vulnerabilities of special populations which place them at higher risk for drug dependence, i.e. newborns, adolescents, preadolescents, elders, and individuals with chronic illnesses, including substance dependency and mental illness. 
  • legal provisions for accountability of the nurse for assessment, intervention, and evaluation in relation to prescription, illicit and legal drugs (alcohol). 
  • education in prescription practice and management for metabolic altering natural substances such as steroids and growth hormone.  

Background Information (PDF, 250KB)

Bloodborne and Airborne Diseases

HIV Exposure from Rape/Sexual Assault

ANA Position Statement - Approved 4/2/93

ANA supports:

  • access to immediate physical and psychological health care,
  • access to appropriate HIV testing and prophylactic treatment,
  • the provision of accurate information about risk of transmission of HIV disease,
  • access to survivor focused services which includes the recommended follow-up monitoring for HIV disease,
  • the right of every person to confidential HIV testing with pre and post test counseling,
  • research to identify
    1. the risk of HIV transmission through rape/sexual assault
    2. the effects of early intervention and treatment
    3. the incidence of rape/sexual assault in specific populations (children, men, same sex), and
  • community level Rape Crisis Centers and other agencies which provide counseling and support services for rape/sexual assault survivors.

Background Info (Members Only)

HIV Disease and Correctional Inmates

ANA Position Statement - Approved 9/11/92

The American Nurses Association (ANA) believes that the issues of HIV disease are varied and complex and that the health care, psychological support and management of inmates in all instances related to HIV disease should parallel that offered in the free community. The following position is recommended.

Background Info (Members Only)

HIV Infection and Nursing Students

ANA Position Statement - Approved 4/3/92

The American Nurses Association (ANA) supports comprehensive education regarding AIDS/HIV infection for all nursing students. Nursing curriculum should include AIDS/HIV infection content including patient treatment, transmission, mechanisms for protection while delivering care to persons with AIDS/HIV infection and Hepatitis B (HBV) infection, instruction in universal precautions and occupational health and safety issues. ANA believes that the HBV vaccine should be a required component of each nursing student's pre-clinical evaluation and that schools of nursing should demonstrate 1) the availability of a post-exposure program for students who sustain exposures to AIDS/HIV and HBV infection in the clinical setting and 2) the mechanism for students to have access to healthcare services while enrolled. Schools of nursing should develop a mechanism for disability coverage for students who contract HIV or HBV infection through exposure in the clinical setting. Finally, nursing students should be assured clinical setting protections consistent with those of employees covered under the Occupational Health and Safety Act.

Background Info (Members Only)

Education and Barrier Use for Sexually Transmitted Diseases and HIV Infection

ANA Position Statement - Approved 9/6/91

The American Nurses Association (ANA) believes sexually transmitted diseases are a major health problem in the United States. ANA supports condom advertising in the mass media as a means to prevent and control the spread of STDs. Further, ANA continues to work with the U.S. Public Health Service and other groups to educate the public on preventive measures.

Background Info (Members Only)

Equipment/Safety Procedures to Prevent Transmission of Bloodborne Diseases

ANA Position Statement - Approved 9/6/91

The American Nurses Association (ANA) urges immediate and ongoing research and evaluation of devices and equipment intended to reduce risk of injury from sharps and of personal protective equipment designed to reduce exposure. In order to reduce the risk of exposure to bloodborne pathogens, ANA supports the consistent and strict use of universal precautions; the availability of proven safety measures; the standardization of methods to assure equipment is safe; and the continued evaluation and modification of work practices to assure optimum safety in the workplace.

Background Info (Members Only)

Personnel Policies and HIV in the Workplace

ANA Position Statement - Approved 9/6/91

The American Nurses Association (ANA) has a long-standing position of advocating for the rights of nurses in the workplace. ANA supports development of personnel policies which create a maximally safe and healthful environment for all workers, patients/ clients, students, and volunteers. Personnel polices should address all aspects of HIV in the workplace; protect against social and economic discrimination; reflect the most current scientific and epidemiological knowledge; and incorporate sound principles of supervision and management.

Background Info (Members Only)

Post-Exposure Programs in the Event of Occupational Exposure to HIV/HBV

ANA Position Statement - Approved 9/6/91

The American Nurses Association (ANA) encourages the prompt access to confidential post-exposure evaluations, counseling, and follow-up by knowledgeable clinicians. These procedures should be considered the standard of care by any healthcare agency. A comprehensive post-exposure program should be in place to assure that employees receive accurate information, guidance, reassurance, and supportive care

Background Info (Members Only)

HIV Testing

ANA Position Statement - Approved 9/6/91

The American Nurses Association (ANA) opposes perpetuation of the myth that mandatory testing and mandatory disclosure of HIV status of patients and/or nurses is a method to prevent the transmission of HIV disease, and therefore does not advocate mandatory testing or mandatory disclosure of HIV status. ANA supports the availability of voluntary anonymous or confidential HIV testing which is conducted with informed consent and pre- and post-test counseling. ANA continues to support education regarding the transmission of HIV/AIDS and the use and monitoring of universal precautions to prevent HIV/AIDS transmission.

Background Info (Members Only)

Needle Exchange and HIV

ANA Position Statement - Approved 4/2/93

The American Nurses Association (ANA) supports the availability of needle exchange programs which include:

  • The adherence to public health and infection control guidelines
  • Education about the transmission of HIV disease
  • Confidential HIV testing with pre & post-test counseling
  • Access for referral of injection drug users (IDUs) to treatment and rehabilitation services
  • Access to needle exchange programs at the local community level
  • The development of public policy to support needle exchange programs with access to health screening and drug treatment services
  • The utilization of qualified health care providers, including nurses, as resources for quality, cost-effective program outcomes
  • Continued research of the effectiveness of needle exchange programs which include access to primary health care screening and drug treatment.

Background Info (Members Only)

Care Coordination and Registered Nurses’ Essential Role

ANA Position Statement - Approved 06/2012

The American Nurses Association recognizes and promotes the integral role of registered nurses in the care coordination process to improve healthcare consumers’ care quality and outcomes across patient populations and health care settings, while stewarding the efficient and effective use of health care resources.

  • Patient-centered care coordination is a core professional standard and competency for all registered nursing practice. Based on a partnership guided by the healthcare consumer’s and family’s needs and preferences, the registered nurse is integral to patient care quality, satisfaction, and the effective and efficient use of health care resources. Registered nurses are qualified and educated for the role of care coordination, especially with high risk and vulnerable populations.
  • In partnership with other healthcare professionals, registered nurses have demonstrated leadership and innovation in the design, implementation, and evaluation of successful team-based care coordination processes and models. The contributions of registered nurses performing care coordination services must be defined, measured and reported to ensure appropriate financial and systemic incentives for the professional care coordination role.

Read the Full Position Statement (PDF, 400KB)

Delegation

Joint ANA and National Council of State Boards of Nursing Position Statement - 2005

The topic of delegation has never been timelier. Delegation is a process that, used appropriately, can result in safe and effective nursing care. Delegation can free the nurse for attending more complex patient care needs, develop the skills of nursing assistive personnel and promote cost containment for the healthcare organization. The RN determines appropriate nursing practice by using nursing knowledge, professional judgment and the legal authority to practice nursing. RNs must know the context of their practice, including the state nurse practice act and professional standards as well as the facility/organization’s policies and procedures related to delegation. Facing a shortage of epic proportions, the nursing community needs to plan how we can continue to accomplish nursing care while assuring the public access to safe, competent nursing care. RNs are urged to seek guidance and appropriate direction from supervisors or mentors when considering decisions about delegation. Mastering the skill and art of delegation is a critical step on the pathway to nursing excellence.

Drug and Alcohol Abuse

Drug Testing for Health Care Workers

ANA Position Statement - Approved 12/8/94

ANA opposes random drug tests for healthcare workers. It gives qualified consent to testing where there is reason to believe drugs or alcohol is affecting the work of the employee and proper restrictions are applied.

Background Info (Members Only)

Abuse of Prescription Drugs

ANA Position Statement - Approved 4/5/91

ANA opposes fraudulent or incompetent prescribing activities by health care providers and the misuse of prescribed drugs by nurses themselves.

The association encourages comprehensive pharmacology education for nurses practicing in all settings to ensure safe and appropriate prescription of drugs. The association believes education for nurses with prescription privileges should include, but not be limited to:

  1. education on the misuse, abuse and addictive potential of prescription drugs.
  2. vulnerabilities of special populations which place them at higher risk for drug dependence, i.e. newborns, adolescents, preadolescents, elders, and individuals with chronic illnesses, including substance dependency and mental illness.
  3. legal provisions for accountability of the nurse for assessment, intervention and evaluation in relation to prescription, illicit and legal drugs (alcohol)
  4. education in prescription practice and management for metabolic altering natural substances such as steroids and growth hormone.

Background Info (Members Only)

Electronic Health Record

ANA Position Statement - Approved 12/11/09

Statement of ANA Position: The ANA believes that the public has a right to expect that health data and healthcare information will be centered on patient safety and improved outcomes throughout all segments of the healthcare system and the data and information will be accurately and efficiently collected, recorded, protected, stored, utilized, analyzed, and reported. Principles of privacy, confidentiality, and security cannot be compromised as the industry creates and implements interoperable and integrated healthcare information technology systems and solutions to convert from paper-based media for documentation and healthcare records to the newer format of electronic health records (EHRs), including individual personal health record (PHR) products.

ELECTRONIC HEALTH RECORD 2 The ANA strongly supports efforts to further refine the concept and requirements of the patient-centric EHR, including the creation of standards-based electronic health records and supporting infrastructures that promote efficient and effective interprofessional and patient communications and decision-making wherever care is provided. Similar attention must address the secondary uses of data and information to generate knowledge that leads to improved and effective decision tools.

All stakeholders, including nurses and patients, must be integral participants in the design, development, implementation, and evaluation phases of the electronic health record. This effort requires the attention and action of nurses, the professional and specialty nursing organizations, and the nursing profession to ensure the EHRs are designed to facilitate and support critical thinking and decision making, such as in the nursing process, and the associated documentation activities. It is ANA’s position that the registered nurse must also be involved in the product selection, design, development, implementation, evaluation and improvement of information systems and electronic patient care devices used in patient care settings. 

Background Info (Members Only)

Emergency Care Psychiatric Clinical Framework

ANA Position Statement - Approved 3/01/10

In order to provide competent and accountable emergency psychiatric care, hospitals need to provide a consistent practice model for patient care regardless of facility or time of day. Our collective goal for the provision of psychiatric and substance use disorder treatment in the emergency department, is to provide care that meets the Institute of Medicine’s Six Quality Aims of safe, effective, timely, efficient, equitable, and patient-centered care. 

Background Info (Members Only)

Ethics and Human Rights Position Statements

Environmental Health

Pharmaceutical Waste

ANA Position Statement - Approved 12/9/10

The American Nurses Association (ANA) supports disposal of pharmaceutical waste in a manner that will minimize and ultimately stop the diversion and misuse of pharmaceuticals that are expired, unused or no longer needed; and the direct or incidental release of pharmaceuticals into the environment.

Background Information (Members Only)

Immunizations

ANA Position Statement - Approved 7/21/15

This position statement supersedes the Position Statement on Mercury in Vaccines, June 21, 2006.

PURPOSE 
Historically, ANA has strongly supported immunizations to protect the public from highly communicable and deadly diseases such as measles, mumps, diphtheria, pertussis, and influenza (ANA, 2014; ANA, 2006), and has supported mandatory vaccination policies for registered nurses and health care workers under certain circumstances. However, in light of a recent and significant measles outbreak in the United States, ANA has reviewed current and past position statements for clarity and intent, and current best practices and recommendations from the broader health care community. Based on that review, it was determined that a revised position statement is needed to clarify ANA’s position and incorporate current best practices.

STATEMENT OF ANA POSITION
To protect the health of the public, all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). All health care personnel (HCP), including registered nurses (RNs), should be vaccinated according to current recommendations for immunization of HCP by the CDC and Association for Professionals in Infection Control and Epidemiology (APIC).

ANA supports exemptions from immunization only for the following reasons:

  1. Medical contraindications
  2. Religious beliefs

All requests for exemption from vaccination should be accompanied by documentation from the appropriate authority to support the request. Individuals who are exempted from vaccination may be required to adopt measures or practices in the workplace to reduce the chance of disease transmission. Employers should ensure that reasonable accommodations are made in all such circumstances.

Inclusion of Recognized Terminologies within EHRs and other Health Information Technology Solutions

Adopted By: ANA Board of Directors, March 19, 2015

Purpose: The purpose of this position statement is to reaffirm the American Nurses Association’s (ANA) support for the use of recognized terminologies supporting nursing practice as valuable representations of nursing practice and to promote the integration of those terminologies into information technology solutions. Standardized terminologies have become a significant vehicle for facilitating interoperability between different concepts, nomenclatures, and information systems. (ANA, 2015)

Statement of ANA Position: The American Nurses Association continues to advocate for the use of the ANA recognized terminologies supporting nursing practice within the Electronic Health Record (EHR) and other health information technology solutions. Therefore, in alignment with national requirements for standardization of data and information exchange, ANA supports the following recommendations:

  1. All health care settings should create a plan for implementing an ANA recognized terminology supporting nursing practice within their EHR.
  2. Each setting type should achieve consensus on a standard terminology that best suits their needs and select that terminology for their EHR, either individually or collectively as a group (e.g. EHR user group).
  3. Education should be available and guidance developed for selecting the recognized terminology that best suits the needs for a specific setting.
  4. When exchanging a Consolidated Continuity of Care Document (C-CDA) with another setting for problems and care plans, Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT®) and Logical Observation Identifiers Names and Codes (LOINC®) should be used for exchange. LOINC® should be used for coding nursing assessments and outcomes and SNOMED CT® for problems, interventions, and observation findings.
  5. Health information exchange between providers using the same terminology does not require conversion of the data to SNOMED CT® or LOINC® codes.
  6. Development of a clinical data repository that includes multiple recognized terminologies should be based on the national recognized terminologies of ICD-9 (or 10), CPT, RxNorm, SNOMED CT®, and LOINC®. Background: Nursing terminologies identify, define, and code concepts in an organized structure to represent nursing knowledge. Since 1973, multiple organizations have developed nursing terminologies. ANA created a recognition process beginning in 1989 to identify terminologies (aka classification systems) or data sets that support nursing practice and knowledge generation.

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Incivility, Bullying, and Workplace Violence

Effective Date: July 22, 2015

New Position Statement

Purpose: This statement articulates the American Nurses Association (ANA) position with regard to individual and shared roles and responsibilities of registered nurses and employers to create and sustain a culture of respect, free of incivility, bullying and workplace violence. Registered nurses and employers across the healthcare continuum, including academia, have an ethical, moral, and legal responsibility to create a healthy and safe work environment for registered nurses and all members of the health care team, health care consumers, families, and communities.

Statement of ANA Position: ANA’s Code of Ethics for Nurses with Interpretive Statements states that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect.” Similarly, nurses must be afforded the same level of respect and dignity as others (ANA, 2015a). Thus, the nursing profession will no longer tolerate violence of any kind from any source. All registered nurses and employers in all settings, including practice, academia, and research must collaborate to create a culture of respect, free of incivility, bullying, and workplace violence. Best practice strategies based on evidence must be implemented to prevent and mitigate incivility, bullying, and workplace violence; to promote the health, safety, and wellness of registered nurses; and to ensure optimal outcomes across the health care continuum. This position statement, although written specifically for registered nurses and employers, is also relevant to other health care professionals and stakeholders who collaborate to create and sustain a safe and healthy interprofessional work environment. Stakeholders who have a relationship with the worksite have a responsibility to address incivility, bullying, and workplace violence.

Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks

Effective Date: September 10, 2014

Supersedes: ANA Position Statement (2006): Assuring Patient Safety: The Employers’ Role in Promoting Healthy Nursing Work Hours for Registered Nurses in All Roles and Settings. ANA Position Statement (2006): Assuring Patient Safety: Registered Nurses’ Responsibility in All Roles and Settings to Guard Against Working When Fatigued.

Purpose: This statement articulates the American Nurses Association’s (ANA)
position with regard to the joint responsibilities of registered nurses and employers to
reduce risks from nurse fatigue and to create and sustain a culture of safety, a
healthy work environment, and a work-life balance. Both registered nurses and
employers have an ethical responsibility to carefully consider the need for adequate
rest and sleep when deciding whether to offer or accept work assignments, including
on-call, voluntary, or mandatory overtime.

Statement of ANA Position: Registered nurses and employers in all care settings
must collaborate to reduce the risks of nurse fatigue and sleepiness associated with
shift work and long work hours. Evidence-based strategies must be implemented to
proactively address nurse fatigue and sleepiness; to promote the health, safety, and
wellness of registered nurses; and to ensure optimal patient outcomes.
This document, although written specifically for registered nurses and employers, is
also relevant to other health care providers and stakeholders who collaborate to
create and sustain a safe and healthy interprofessional work environment.
Stakeholders who have a contractual relationship with the worksite and who
influence work hours also have a responsibility to address risks.

Background Info (Members Only)

Nursing Practice

Incivility, Bullying, and Workplace Violence

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Effective Date: July 22, 2015

New Position Statement

Purpose: This statement articulates the American Nurses Association (ANA) position with regard to individual and shared roles and responsibilities of registered nurses and employers to create and sustain a culture of respect, free of incivility, bullying and workplace violence. Registered nurses and employers across the healthcare continuum, including academia, have an ethical, moral, and legal responsibility to create a healthy and safe work environment for registered nurses and all members of the health care team, health care consumers, families, and communities.

Statement of ANA Position: ANA’s Code of Ethics for Nurses with Interpretive Statements states that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect.” Similarly, nurses must be afforded the same level of respect and dignity as others (ANA, 2015a). Thus, the nursing profession will no longer tolerate violence of any kind from any source. All registered nurses and employers in all settings, including practice, academia, and research must collaborate to create a culture of respect, free of incivility, bullying, and workplace violence. Best practice strategies based on evidence must be implemented to prevent and mitigate incivility, bullying, and workplace violence; to promote the health, safety, and wellness of registered nurses; and to ensure optimal outcomes across the health care continuum. This position statement, although written specifically for registered nurses and employers, is also relevant to other health care professionals and stakeholders who collaborate to create and sustain a safe and healthy interprofessional work environment. Stakeholders who have a relationship with the worksite have a responsibility to address incivility, bullying, and workplace violence.

ANA Position Statement on Incivility, Bullying, and Workplace Violence

Immunizations

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ANA Position Statement - Approved 7/21/15

This position statement supersedes the Position Statement on Mercury in Vaccines, June 21, 2006.

PURPOSE 
Historically, ANA has strongly supported immunizations to protect the public from highly communicable and deadly diseases such as measles, mumps, diphtheria, pertussis, and influenza (ANA, 2014; ANA, 2006), and has supported mandatory vaccination policies for registered nurses and health care workers under certain circumstances. However, in light of a recent and significant measles outbreak in the United States, ANA has reviewed current and past position statements for clarity and intent, and current best practices and recommendations from the broader health care community. Based on that review, it was determined that a revised position statement is needed to clarify ANA’s position and incorporate current best practices.

STATEMENT OF ANA POSITION
To protect the health of the public, all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). All health care personnel (HCP), including registered nurses (RNs), should be vaccinated according to current recommendations for immunization of HCP by the CDC and Association for Professionals in Infection Control and Epidemiology (APIC).

ANA supports exemptions from immunization only for the following reasons:

  1. Medical contraindications
  2. Religious beliefs

All requests for exemption from vaccination should be accompanied by documentation from the appropriate authority to support the request. Individuals who are exempted from vaccination may be required to adopt measures or practices in the workplace to reduce the chance of disease transmission. Employers should ensure that reasonable accommodations are made in all such circumstances.

ANA Position Statement on Immunizations

Academic Progression to Meet the Needs of the Registered Nurse, the Health Care Consumer, and the U.S. Health Care System

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Statement of ANA and OADN Joint Position 

All nurses must have access to seamless academic progression through high-quality, accredited nursing education programs that will meet the anticipated demand for qualified nurses over the next several decades. The Organization for Associate Degree Nursing (OADN) and American Nurses Association (ANA) commit to partnering with nursing and health care leaders, state legislatures and regulatory agencies, universities, colleges, and other stakeholders in supporting and adopting innovative and emerging strategies to achieve that goal.

Purpose

This document identifies current evidence-based strategies that promote seamless academic progression with an emphasis on reaching the Institute of Medicine's (IOM's) Future of Nursing report-recommended goal that 80% of nurses be educated to the Bachelor of Science in Nursing (BSN) degree level by 2020.

Joint Position Statement on Academic Progression to Meet the Needs of the Registered Nurse, the Health Care Consumer, and the U.S. Health Care System

Inclusion of Recognized Terminologies within EHRs and other Health Information Technology Solutions

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Adopted By: ANA Board of Directors, March 19, 2015

Purpose: The purpose of this position statement is to reaffirm the American Nurses Association’s (ANA) support for the use of recognized terminologies supporting nursing practice as valuable representations of nursing practice and to promote the integration of those terminologies into information technology solutions. Standardized terminologies have become a significant vehicle for facilitating interoperability between different concepts, nomenclatures, and information systems. (ANA, 2015)

Statement of ANA Position: The American Nurses Association continues to advocate for the use of the ANA recognized terminologies supporting nursing practice within the Electronic Health Record (EHR) and other health information technology solutions. Therefore, in alignment with national requirements for standardization of data and information exchange, ANA supports the following recommendations:

  1. All health care settings should create a plan for implementing an ANA recognized terminology supporting nursing practice within their EHR.
  2. Each setting type should achieve consensus on a standard terminology that best suits their needs and select that terminology for their EHR, either individually or collectively as a group (e.g. EHR user group).
  3. Education should be available and guidance developed for selecting the recognized terminology that best suits the needs for a specific setting.
  4. When exchanging a Consolidated Continuity of Care Document (C-CDA) with another setting for problems and care plans, Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT®) and Logical Observation Identifiers Names and Codes (LOINC®) should be used for exchange. LOINC® should be used for coding nursing assessments and outcomes and SNOMED CT® for problems, interventions, and observation findings.
  5. Health information exchange between providers using the same terminology does not require conversion of the data to SNOMED CT® or LOINC®codes.
  6. Development of a clinical data repository that includes multiple recognized terminologies should be based on the national recognized terminologies of ICD-9 (or 10), CPT, RxNorm, SNOMED CT®, and LOINC®. Background: Nursing terminologies identify, define, and code concepts in an organized structure to represent nursing knowledge. Since 1973, multiple organizations have developed nursing terminologies. ANA created a recognition process beginning in 1989 to identify terminologies (aka classification systems) or data sets that support nursing practice and knowledge generation.

Inclusion of Recognized Terminologies within EHRs and other Health Information Technology Solutions (Members Only)

Standardization and Interoperability of Health Information Technology: Supporting Nursing and the National Quality Strategy for Better Patient Outcomes

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Effective Date: June 11, 2014

ANA Position: The American Nurses Association (ANA) believes that electronic health records (EHRs) and other HIT solutions used to document, manage, and report nursing care in all phases and settings should promote the accurate capture and standardized representation of nursing knowledge, data collected by nurses in the context of patient care, and contributions to outcomes across the nursing process.

Further, these systems should be interoperable within and among all vendors’ products. Achievement of such standardization and interoperability will improve patient outcomes, enhance nurse work satisfaction, support the exchange and use of nursing knowledge, and promote nursing participation in the development, growth, and maturation of a continuous rapid learning health care system.

In order to achieve this, ANA will work with the nursing informatics community, Office of the National Coordinator for Health Information Technology, and the EHR and health IT vendor community to:

  1. Promote the adoption and implementation of standardized nursing data capture within all vendor products.
  2. Advocate for standardized nursing data capture throughout the nursing process and across all settings of care.
  3. Promote standardization of installed vendor products as a strategic imperative to support interoperability.
  4. Advocate for a feedback loop to inform direct care interventions.

Position Statement Background Information (Members Only)

Criminal Background Checks (CBCs) for Nurse Licensure

ANA Position Statement approved April, 2013

Purpose: Of the nation’s 55 boards of nursing (excluding U.S. territories), 40 boards conduct state and federal criminal background checks. Fourteen states, AL, CO, CT, HI, ME, MA, MN, MT, NE, NY, PA, VT, VA, & WI do not conduct CBCs. 4 The National Council of State Boards of Nursing (NCSBN) is conducting a major initiative to assist boards in adoption of state and federal criminal background checks. Their goal is to have all states enact requirements for state and federal CBCs by 2015.

ANA Position: The American Nurses Association (ANA) supports the use of criminal background checks as a part of the RN licensure process as one means of enhancing public safety, as long as the criminal background check does not unnecessarily burden the applicant nor interfere with due process.

Position Statement Background Information (Members Only)

Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks

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Effective Date: September 10, 2014

Supersedes: ANA Position Statement (2006): Assuring Patient Safety: The Employers’ Role in Promoting Healthy Nursing Work Hours for Registered Nurses in All Roles and Settings. ANA Position Statement (2006): Assuring Patient Safety: Registered Nurses’ Responsibility in All Roles and Settings to Guard Against Working When Fatigued.

Purpose: This statement articulates the American Nurses Association’s (ANA) position with regard to the joint responsibilities of registered nurses and employers to reduce risks from nurse fatigue and to create and sustain a culture of safety, a healthy work environment, and a work-life balance. Both registered nurses and employers have an ethical responsibility to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including on-call, voluntary, or mandatory overtime.

Statement of ANA Position: Registered nurses and employers in all care settings must collaborate to reduce the risks of nurse fatigue and sleepiness associated with shift work and long work hours. Evidence-based strategies must be implemented to proactively address nurse fatigue and sleepiness; to promote the health, safety, and wellness of registered nurses; and to ensure optimal patient outcomes. This document, although written specifically for registered nurses and employers, is also relevant to other health care providers and stakeholders who collaborate to create and sustain a safe and healthy interprofessional work environment. Stakeholders who have a contractual relationship with the worksite and who influence work hours also have a responsibility to address risks.

Background Info (Members Only)

Nurse Practitioner Perspective on Education and Post-Graduate Training

ANA Endorsed Recommendations from the NP Roundtable – 2014

“The following recommendations are based on forty years of patient outcomes and clinical research that have demonstrated that NPs consistently provide high quality, competent care.

  • NPs are prepared to be fully licensed providers at graduation.  No added academic clinical or supervisory hours are necessary for safe patient care.  Mandating a formal program after graduation  is not necessary and would create new, costly bottlenecks to building the provider workforce.
  • NP graduates are highly competent clinicians with consistently strong patient outcomes.  There is no evidence to justify additional delays or costs to taxpayers to support mandatory post-graduate training or to impose ADDITIONAL regulatory constraints to the new NP upon entry into practice.  The new NP graduate is competent and legally-recognized to practice upon attainment of licensure, which is linked to completion of an educational program and successful certification in a particular population focus in primary care or acute care.
  • Post-graduate orientation may offer opportunities to support transitions between practice settings, for both new graduates and seasoned clinicians in all health disciplines.  Post-graduate orientation cannot substitute for formal education preparation.  An individual cannot use post-graduate training to move into a new population focus area or practice or to move between acute and primary care practice.
  • The NP Roundtable promotes the use of the term “fellowship” for post-graduate preparation to define the existing programs in the VA and other similarly proposed programs.  This would help clarify that licensure is not contingent on completing these offering and would prevent confusion with the medical model in which a residency is required for specialization and licensure.
  • NPs currently provide nearly one-fifth of all primary care services in the US and represent the fastest growing segment of the primary care workforce.  In 2013, over 14,000 new NP graduates completed formal graduate-level educational programs and joined the other 189,000 NPs in the health care workforce.  Over two-thirds of NPs have received educational preparation in primary care, and collectively NPs positively impact access, quality, and cost-effectiveness of primary and acute health care of the nation.”

Background Information (Members Only)

The Role of Registered Nurse in Ambulatory Care

ANA Endorsed Position Statement from the American Academy of Ambulatory Care Nursing - 2012

It is the position of the American Academy of Ambulatory Care Nursing that:

  • RNs enhance patient safety and the quality and effectiveness of care delivery and are thus essential and irreplaceable in the provision of patient care services in the ambulatory setting.
  • RNs are responsible for the design, administration, and evaluation of professional nursing services within an organization in accordance with the framework established by state nurse practice acts, nursing scope of practice, and organizational standards of care.
  • RNs provide the leadership necessary for collaboration and coordination of services, which includes defining the appropriate skill mix and delegation of tasks among licensed and unlicensed health care workers.
  • RNs are fully accountable in all ambulatory care settings for all nursing services and associated patient outcomes provided under their direction.

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One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure

ANA Endorsed Position Statement from the Association of Operating Room Nurses Official Statement - 4/2014

The Association of periOperative Registered Nurses(AORN’s) Position Statement, One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure, maintains that AORN is committed to the provision of safe perioperative nursing care by ensuring that every patient undergoing a surgical or other invasive procedure is at a minimum cared for by a registered nurse in the circulating role, regardless of the setting.

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Care Coordination and Registered Nurses’ Essential Role

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ANA Position Statement - Approved 06/2012

The American Nurses Association recognizes and promotes the integral role of registered nurses in the care coordination process to improve healthcare consumers’ care quality and outcomes across patient populations and health care settings, while stewarding the efficient and effective use of health care resources.

    1. Patient-centered care coordination is a core professional standard and competency for all registered nursing practice. Based on a partnership guided by the healthcare consumer’s and family’s needs and preferences, the registered nurse is integral to patient care quality, satisfaction, and the effective and efficient use of health care resources. Registered nurses are qualified and educated for the role of care coordination, especially with high risk and vulnerable populations.
    2. In partnership with other healthcare professionals, registered nurses have demonstrated leadership and innovation in the design, implementation, and evaluation of successful team-based care coordination processes and models. The contributions of registered nurses performing care coordination services must be defined, measured and reported to ensure appropriate financial and systemic incentives for the professional care coordination role.

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Competencies for Nurse Practitioners in Emergency Care

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ANA Endorsed Position Statement from Emergency Nurses Association - Endorsed 2008

Nurse practitioners have been practicing in emergency care for nearly five decades. Until now, competencies were not established to verify nurse practitioner ability to perform in the emergency setting. The National Organization of Nurse Practitioner Faculties (NONPF) established entry-level core competencies for all nurse practitioners (NONPF, 1995, 2000, 2002, 2006). The Emergency Nurses Association (ENA) recognizes these core competencies as the foundation for all nurse practitioner practice. In 2006, the ENA established a Nurse Practitioner Validation Work Team to explore and delineate the behaviors, knowledge, and skills necessary for a nurse practitioner to competently practice in emergency care.

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The Doctor of Nursing Practice: Advancing the Nursing Profession

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ANA Position Statement - Revised 4/20/2011

The Doctor of Nursing Practice (DNP) is a practice-focused doctoral degree to prepare nurses for advanced nursing practice roles. The DNP provides expanded knowledge through the formulation and interpretation of evidence-based practice (Chism, 2010). The DNP prepares the graduate for multiple roles including health policy development, leadership, administration, advanced clinical practice, and information technology in an environment of inter-professional collaboration. Educating the next generation of health care providers is a critical step for increasing access to quality health care and improving health care outcomes. While supportive of the DNP, the ANA continues to endorse both master’s and doctoral preparation as entry into APRN practice.

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Emergency Care Psychiatric Clinical Framework

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ANA Position Statement - Approved 3/01/10

In order to provide competent and accountable emergency psychiatric care, hospitals need to provide a consistent practice model for patient care regardless of facility or time of day. Our collective goal for the provision of psychiatric and substance use disorder treatment in the emergency department, is to provide care that meets the Institute of Medicine’s Six Quality Aims of safe, effective, timely, efficient, equitable, and patient-centered care.

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Electronic Health Record

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ANA Position Statement - Approved 12/11/09

Statement of ANA Position: The ANA believes that the public has a right to expect that health data and healthcare information will be centered on patient safety and improved outcomes throughout all segments of the healthcare system and the data and information will be accurately and efficiently collected, recorded, protected, stored, utilized, analyzed, and reported. Principles of privacy, confidentiality, and security cannot be compromised as the industry creates and implements interoperable and integrated healthcare information technology systems and solutions to convert from paper-based media for documentation and healthcare records to the newer format of electronic health records (EHRs), including individual personal health record (PHR) products.

ELECTRONIC HEALTH RECORD 2 The ANA strongly supports efforts to further refine the concept and requirements of the patient-centric EHR, including the creation of standards-based electronic health records and supporting infrastructures that promote efficient and effective interprofessional and patient communications and decision-making wherever care is provided. Similar attention must address the secondary uses of data and information to generate knowledge that leads to improved and effective decision tools.

All stakeholders, including nurses and patients, must be integral participants in the design, development, implementation, and evaluation phases of the electronic health record. This effort requires the attention and action of nurses, the professional and specialty nursing organizations, and the nursing profession to ensure the EHRs are designed to facilitate and support critical thinking and decision making, such as in the nursing process, and the associated documentation activities. It is ANA’s position that the registered nurse must also be involved in the product selection, design, development, implementation, evaluation and improvement of information systems and electronic patient care devices used in patient care settings.

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Electronic Personal Health Record

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ANA Position Statement - Approved 10/17/12

Statement of ANA Position: The American Nurses Association supports the development of a robust and secure electronic personal health record (PHR) maintained and kept current by the healthcare consumer or proxy. This PHR will help improve the continuity and coordination of care. The PHR will also help the healthcare consumer in making informed health decisions. This support comes with concerns that the PHR be a secure entity, only available to the consumer or their designated healthcare providers. The issues of concern include security, privacy, literacy, and the ability of the information to be accessed in different healthcare settings. These conditions must be addressed to make the PHR a useful tool in the provision of health care.

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Additional Access To Care: Supporting Nurse Practitioners In Retail-Based Health Clinics

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ANA Position Statement - Approved 12/11/09

ANA supports the delivery of primary care and other health care services by nurse practitioners (NPs) in retail-based health clinics. Peer-reviewed studies continue to add evidence confirming that NPs offer high quality care in the primary care setting. In addition to their education and expertise in diagnosis and treatment, NPs’ proficiency in providing health education and prevention services makes them skilled managers and service providers in retail-based clinics. Retail-based clinics provide an additional innovative entry point for patients to access affordable, high-quality health care, thus helping to address some of the system’s more pressing problems.

The American Nurses Association (ANA) supports the American Academy of Nurse Practitioners’ (AANP) position statement, “Standards for Nurse Practitioner Practice in Retail-based Clinics”. The AANP position statement offers guiding principles and standards for Nurse Practitioners practicing in retail-based clinic settings.

ANA also applauds the fundamental values and safeguards articulated in the American College of Nurse Practitioners’ (ACNP) white paper entitled “Convenience Care Clinics: The Future of Accessible Health Care”. The ACNP white paper documents the benefits ADDITIONAL ACCESS TO CARE 2 of convenience care clinics staffed by NPs, such as the high quality and lower cost associated with nurse practitioner care, and the increased access to care by community members.

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Determining a Standard Order of Credentials for the Professional Nurse

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ANA Position Statement - Approved 12/11/09

In the nursing profession, the use of credentials is an essential component to designate levels of attained education and licensure, certification, and professional achievement. The listing of credentials when identifying a nurse ensures credibility and competence to the consumers of nursing care. Standardized use strengthens a unified understanding of credentials among nurses, within the healthcare delivery system, and for healthcare consumers. In an effort to establish a recognizable and understandable credential usage process across all spectrums of nursing, the following order of credentials is recommended: Highest earned degree, mandated requirements (i.e. licensure), state designations or requirements, national certifications, awards and honors, other certifications.

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Promoting Safe Medication Use in the Older Adult

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ANA Position Statement - Approved 3/12/09

To promote safe medication use in the older adult, the American Nurses Association supports:

  • Ongoing evaluation and monitoring of the older adult’s medication profile to encourage safe medication use
  • Clear communication of medication information to patients, family members, caregivers, the next healthcare professional and/or organization providing care
  • Reconciliation of medications each time an older adult experiences a transition in care.
  • Research on pharmacodynamics, pharmaceutics, and pharmacotherapeutics in the older adult with co-morbid conditions and varying levels of function and cognition across the continuum of care
  • Research on clinical interventions to test the effects of specific interventions related to care of aging populations, medication prescribing and administration, clinical settings and staffing, and interdisciplinary approaches to safety and quality of care

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Safe Practices for Needle and Syringe Use

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American Association of Nurse Anesthetists Position, endorsed by ANA - 1/09

Standard IX of the American Association of Nurse Anesthetists (AANA) Standards for Nurse Anesthesia Practice states that Certified Registered Nurse Anesthetists (CRNAs) shall take precautions "to minimize the risk of infection to the patient, the CRNA, and other healthcare providers.'?' Further, the AANA Code ofEthics states that every member of the AANA "has a personal responsibility to uphold and adhere,,2 to the ethical standards contained within the Code of Ethics document. Specifically, item number 3.2 of the AANA Code ofEthics states that the "CRNA practices in accordance with the professional practice standards established by the profession." The AANA historically has taken a strong stance concerning infection control behaviors, and the AANA's Infection Control Guide3 has served as a valuable resource to CRNAs on this issue for many years.

Position Statement Background Information: Post-Exposure Programs in the Event of Occupational Exposure to HIV/HBV

Position Statement Background Information: Equipment/Safety Procedures to Prevent Transmission of Bloodborne Diseases

Position Statement Background Information: Needle Exchange and HIV

Professional Role Competence

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ANA Position Statement - Reaffirmed 11/12/2014

The public has a right to expect registered nurses to demonstrate professional competence throughout their careers. ANA believes the registered nurse is individually responsible and accountable for maintaining professional competence. The ANA further believes that it is the nursing profession’s responsibility to shape and guide any process for assuring nurse competence. Regulatory agencies define minimal standards for regulation of practice to protect the public. The employer is responsible and accountable to provide an environment conducive to competent practice. Assurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders.

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Procedural Sedation Consensus Statement

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ANA Position Statement - Approved 3/20/08

The immediate availability of interventions including procedural sedation is critical to serving the needs of our patients. Preserving life, restoring health, and alleviating suffering have been fundamental to the practice of nursing and medicine for centuries. We are challenged as health care professionals to provide this care in a manner that meets the Institute of Medicine’s Six Quality Aims of safe, effective, timely, efficient, equitable, and patient centered care. Patients with emergency medical conditions frequently experience significant treatable pain and anxiety. There is ample evidence to support the routine use of procedural sedation by appropriately trained and credentialed emergency nurses and physicians.

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Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders

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ANA Position Statement - Revised 3/14/08

In order to establish a safe environment of care for nurses and patients, the American Nurses Association (ANA) supports actions and policies that result in the elimination of manual patient handling.

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Safety Issues Related to Tubing and Catheter Misconnections

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ANA Position Statement - Approved 10/10/07

The ANA supports the inclusion of policies and processes that address tubing and catheter connections as part of the healthcare delivery system and the prevention of tubing and catheter misconnections as a National Patient Safety Goal (The Joint Commission, 2006a). The ANA also advocates collaborative investigation with nurses, manufacturers and product engineers to eliminate tubing and catheter misconnections by creating a universal design specific to the function of the tube.

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Assuring Safe, High Quality Health Care in Pre-K Through 12 Educational Settings

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ANA Position Statement - Approved 3/16/07

Students’ health and health needs must be addressed in schools to achieve optimum learning. The American Nurses Association (ANA) supports a collaborative school health model which best protects the fundamental public health and educational priority our nation’s children represent. Based in part on the success of public health planning, it requires the cooperation and participation of health care professionals, teachers, school administrators and staff, students, families, and the community.

In such a model, the school nurse serves in the role of coordinator of care, information, education, personnel and resources to take best advantage of schools’ unique position in addressing students’ safety and health care needs. As with any professional registered nurse, the school nurse’s role also includes direct care, as well as educating and delegating health care activities to others (both healthcare and non-healthcare personnel) under various guidelines and protocols, as permitted by each state’s Nurse Practice Act.

To that end, ANA supports the assignment and daily availability of a registered school nurse for the central management and implementation of school health services at the recommended ratio of one nurse for every 750 students, with an ultimate goal of at least one nurse in every school. If the school nurse is assigned to more than one facility, the total number of students that the nurse serves should not exceed 750. Furthermore, ANA supports and recommends a modified ratio of fewer students per nurse, dependent upon the number and severity of disabilities within the student population.

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Credentialing and Privileging of Advanced Practice Registered Nurses

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ANA Position Statement - 10/11/06

ANA supports nursing peer review in the clinical credentialing and privileging of Advanced Practice Registered Nurses based on established principles that would guide the process. 

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Promoting Safe Medication Use in the Older Adult

ANA Position Statement - Approved 3/12/09 

To promote safe medication use in the older adult, the American Nurses Association supports:

  • Ongoing evaluation and monitoring of the older adult’s medication profile to encourage safe medication use
  • Clear communication of medication information to patients, family members, caregivers, the next healthcare professional and/or organization providing care
  • Reconciliation of medications each time an older adult experiences a transition in care.
  • Research on pharmacodynamics, pharmaceutics, and pharmacotherapeutics in the older adult with co-morbid conditions and varying levels of function and cognition across the continuum of care
  • Research on clinical interventions to test the effects of specific interventions related to care of aging populations, medication prescribing and administration, clinical settings and staffing, and interdisciplinary approaches to safety and quality of care

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Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment

ANA Position Statement - Approved 3/12/09 

The American Nurses Association (ANA) upholds that registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. The professional obligations of the registered nurse to safeguard patients are grounded in the Nursing’s Social Policy Statement (ANA, 2003), Code of Ethics for Nurses with Interpretive Statements (ANA, 2001b), Nursing: Scope and Standards of Practice (ANA, 2004), and state laws, and rules and regulations governing nursing practice. 

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Privacy and Confidentiality

Effective Date: June 2015

Status: Revised Position Statement

Written By: ANA Center for Ethics and Human Rights

Adopted By: ANA Board of Directors

PURPOSE 
Ongoing advances in technology, including computerized medical databases, telehealth, social media and other Internet-based technologies, have increased the likelihood of potential and unintentional breaches of private/confidential health information. The purpose of this position statement is to speak to the role of nurses in protecting privacy and confidentiality and provide recommendations to avoid a breach.

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Professional Role Competence

ANA Position Statement - Reaffirmed 11/12/2014 
The public has a right to expect registered nurses to demonstrate professional competence throughout their careers. ANA believes the registered nurse is individually responsible and accountable for maintaining professional competence. The ANA further believes that it is the nursing profession’s responsibility to shape and guide any process for assuring nurse competence. Regulatory agencies define minimal standards for regulation of practice to protect the public. The employer is responsible and accountable to provide an environment conducive to competent practice. Assurance of competence is the shared responsibility of the profession, individual nurses, professional organizations, credentialing and certification entities, regulatory agencies, employers, and other key stakeholders.
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Social Causes and Health Care

Fluoridation of Public Water Drinking Systems

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Effective Date: March 18, 2016

The American Nurses Association recognizes the public health benefits of fluoridation of public drinking water systems and supports its use when the following conditions are met:

  • The concentration of fluoride in the public drinking water is in accordance with the most current Public Health Service Recommendations for safe and optimal prevention of dental caries.
  • State and local governments have carefully considered whether to fluoridate the public drinking water based on the existing water supply’s naturally occurring fluoride concentration.
  • The most current, evidence-based, sound research supports the benefits of public water fluoridation and does not indicate harmful risks.

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Promoting Tobacco Cessation in Pharmacies

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ANA recognizes that tobacco use in the US is the largest cause of preventable death1 and that tobacco cessation is the single most important action an individual can take for their health 2. Early surveys show that when pharmacies stop selling tobacco products, tobacco use decreases in surrounding areas. Just as health care facilities across the nation have become tobacco-free campuses, pharmacies and other drug store retailers must follow suit. Registered nurses and advanced practice registered nurses, typical health care professionals employed in pharmacies, are dedicated to promoting healing and better health. Although it is abhorrent to the nursing profession to work where tobacco products are advertised and sold daily, pharmacies often offer affordable, convenient, and accessible health care to surrounding communities. Pharmacies and drug stores must be invested in promoting public health. To that end, ANA recommends that all pharmacies and drug store retailers stop selling tobacco and electronic cigarette products. Furthermore, ANA recommends that health care providers employed by pharmacies and drug store retailers receive tobacco cessation education and training to support customers. In closing, ANA applauds the one national retailer who has acted on these critical public health actions, CVS.

1CDC. Fast Facts Tobacco and Smoking Cessation (2014) www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/

2American Cancer Society. Guide to Quitting Smoking

Reproductive Health

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ANA Position Statement - Approved 3/10

The American Nurses Association (ANA) has historically advocated for the healthcare needs of all patients, including services related to reproductive health. ANA believes that healthcare clients have the right to privacy and the right to make decisions about personal health care based on full information and without coercion. Also, nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client's life is in jeopardy, nurses are obligated to provide for the client's safety and to avoid abandonment.

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Elimination of Violence in Advertising Directed Toward Children, Adolescents and Families

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ANA Position Statement - Approved 7/13/07

Based on the current level of evidence, the American Nurses Association (ANA) takes the position that, television advertising should contain no violent content since it poses unacceptable risks to children, adolescents, and families.

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Violence Against Women

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ANA Position Statement - 3/24/00

The American Nurses Association (ANA) supports education of nurses, healthcare providers and women in skills necessary for prevention of violence against women; assessment of women in healthcare institutions and community settings; and research on violence against women. ANA believes there is a critical need for attention to and increased awareness of the problems of violence against women by all healthcare providers in order to reduce immediate and long term physical and psychological injuries that are associated with this crime. Through knowledge and clinical skills, nurses can engage in the assessment, intervention and prevention of sexual assault and domestic violence. Further, ANA supports a coordinated, interdisciplinary community-based focus using Healthy People 2010 objectives and other research that promote surveillance, prevention and intervention for violent behavior as priority issues for the nation.

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Adolescent Health

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ANA Position Statement - Approved 9/30/00

The American Nurses Association (ANA) supports:

  • Education of nurses about the complex nature of adolescence;
  • Education of nurses about the scientific, ethical, and practical issues that impact the health status of adolescents;
  • Development of culturally sensitive, linguistically and literacy appropriate programs for nurses working directly or indirectly with adolescents;
  • Identification of adolescent health care issues that focus on societal expectations, environmental impacts, access, and delivery of quality health care services;
  • Interdisciplinary approach to caring for the adolescent client/patient;
  • Nursing research in adolescent health issues and services
  • Legislation that recognizes the roles of the registered nurse (RN) and
  • advanced practice registered nurse (APRN) as providers of health care
  • services for adolescents and reimbursement for such services;
  • Funding of government programs aimed at improving access to care, including: 
    Title X Children’s Health Insurance Program (CHIP) coverage of reproductive health benefits, school-based health clinics and Title V Maternal Child Health 
    (MCH) block grants;
  • Development and maintenance of school health services and reimbursement for such services.

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Placebos for Pain Management in Patients with Cancer

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ANA Position Statement - 12/1996

The position of The Oncology Nursing Society and endordes by ANA is that Placebos should not be used 1) to assess or manage cancer pain, 2) to determine if the pain is "real," or 3) to diagnose psychological symptoms, such as anxiety associated with pain. Nurses should not administer placebos in these circumstances even if there is a medical order.

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Promotion and Disease Prevention

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ANA Position Statement - 7/2/95

Nursing must expand its efforts to design and implement interventions which support promotion of health and prevention of disease/illness and disability. Preventing illness and staying well involve complex, multidimensional activities focused not only on the individual, but also on families, groups and populations. Approaches to prevention should be comprehensive, encompass primary, secondary and tertiary levels of prevention and involve consumers in their formulation. Prevention strategies are more likely to be adopted by citizens who participate in influencing and developing such strategies.

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Lead Poisoning and Screening

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ANA Position Statement - Approved 4/8/94

ANA supports lead poisoning prevention activities to reduce children's blood lead levels to <10 micrograms per deciliter of whole blood. Childhood lead poisoning is the most common preventable pediatric health problem in the United States.

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Reproductive Health

ANA Position Statement - Approved 3/10

The American Nurses Association (ANA) has historically advocated for the healthcare needs of all patients, including services related to reproductive health. ANA believes that healthcare clients have the right to privacy and the right to make decisions about personal health care based on full information and without coercion. Also, nurses have the right to refuse to participate in a particular case on ethical grounds. However, if a client's life is in jeopardy, nurses are obligated to provide for the client's safety and to avoid abandonment.

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The Role of Registered Nurse in Ambulatory Care

ANA Endorsed Position Statement from the American Academy of Ambulatory Care Nursing - 2012

It is the position of the American Academy of Ambulatory Care Nursing that:

  • RNs enhance patient safety and the quality and effectiveness of care delivery and are thus essential and irreplaceable in the provision of patient care services in the ambulatory setting.
  • RNs are responsible for the design, administration, and evaluation of professional nursing services within an organization in accordance with the framework established by state nurse practice acts, nursing scope of practice, and organizational standards of care.
  • RNs provide the leadership necessary for collaboration and coordination of services, which includes defining the appropriate skill mix and delegation of tasks among licensed and unlicensed health care workers.
  • RNs are fully accountable in all ambulatory care settings for all nursing services and associated patient outcomes provided under their direction.

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Workplace Advocacy

Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks

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Effective Date: September 10, 2014

Supersedes: ANA Position Statement (2006): Assuring Patient Safety: The Employers’ Role in Promoting Healthy Nursing Work Hours for Registered Nurses in All Roles and Settings. ANA Position Statement (2006): Assuring Patient Safety: Registered Nurses’ Responsibility in All Roles and Settings to Guard Against Working When Fatigued.

Purpose: This statement articulates the American Nurses Association’s (ANA)
position with regard to the joint responsibilities of registered nurses and employers to
reduce risks from nurse fatigue and to create and sustain a culture of safety, a
healthy work environment, and a work-life balance. Both registered nurses and
employers have an ethical responsibility to carefully consider the need for adequate
rest and sleep when deciding whether to offer or accept work assignments, including
on-call, voluntary, or mandatory overtime.

Statement of ANA Position: Registered nurses and employers in all care settings
must collaborate to reduce the risks of nurse fatigue and sleepiness associated with
shift work and long work hours. Evidence-based strategies must be implemented to
proactively address nurse fatigue and sleepiness; to promote the health, safety, and
wellness of registered nurses; and to ensure optimal patient outcomes.
This document, although written specifically for registered nurses and employers, is
also relevant to other health care providers and stakeholders who collaborate to
create and sustain a safe and healthy interprofessional work environment.
Stakeholders who have a contractual relationship with the worksite and who
influence work hours also have a responsibility to address risks.

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Just Culture

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ANA Position Statement - Approved 1/28/10

The American Nurses Association (ANA) supports the Just Culture concept and its use in health care to improve patient safety. The ANA supports the collaboration of state boards of nursing, professional nursing associations, hospital associations, patient safety centers and individual health care organizations in developing regional and state-wide Just Culture initiatives.

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Nursing Staffing Requirements to Meet the Demands of Today’s Long Term Care Consumer Recommendations from the Coalition of Geriatric Nursing Organizations (CGNO)

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Position Statement Endorsed by ANA 11/12/2014

The CGNO proposes that the following minimum staffing levels be adopted, funded, implemented, and publicly reported for nursing homes:

  • A registered nurse be present in the nursing home at all times for oversight of resident care, resident assessment, supervision of licensed nursing staff and delegation to certified nursing assistants.
  • The Director of Nursing be either prepared at the baccalaureate level or certified in nursing administration by one of the CGNO associations. 
  • The hours of direct nursing care for each resident be at least 4.1 hours per resident day with minimum 30% of that consisting of licensed nurses.
  • Administrative RN positions such as the Director of Nursing and Assistant Director of Nursing not be counted as direct nursing hours for resident care.
  • Skilled nursing facility residents have licensed staffing based on clinical acuity, which may necessitate more than the 4.1 hours per resident minimum. 

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Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment

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ANA Position Statement - Approved 3/12/09

The American Nurses Association (ANA) upholds that registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. The professional obligations of the registered nurse to safeguard patients are grounded in the Nursing’s Social Policy Statement (ANA, 2003), Code of Ethics for Nurses with Interpretive Statements (ANA, 2001b), Nursing: Scope and Standards of Practice (ANA, 2004), and state laws, and rules and regulations governing nursing practice.

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Registered Nurses' Rights and Responsibilities Related to Work Release During a Disaster

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ANA Position Statement - Approved 6/24/02

The American Nurses Association, which represents the 2.7 million registered nurses in the United States, recommends that registered nurses use the following guidelines to clarify the process of release from work for the purpose of addressing a disaster. A companion position statement entitled "Work Release During a Disaster - Guidelines for Employers" offers guidance for healthcare employers in establishing work release policies and procedures during a disaster. The American Nurses Association strongly believes that nurses should be released as part of organized medical teams; however, individual nurses may still want to respond and should be given due consideration.

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Work Release During a Disaster - Guidelines for Employers

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ANA Position Statement - Approved 6/24/02

The American Nurses Association, which represents the 2.7 million registered nurses in the United States, recommends that employers adopt the following work release policy to guide the process of releasing registered nurses from work for the purpose of addressing a disaster. A companion position statement entitled: "Registered Nurses' Rights and Responsibilities Related to Work Release During a Disaster" clarifies the role of the Registered Nurse who wishes to participate in disaster relief work. ANA strongly believes that registered nurses should be released as part of organized medical rescue teams during disasters, however individual nurses may still want to respond and should be given due consideration.

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Sexual Harassment

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ANA Position Statement - Approved 4/2/93

ANA is deeply committed to the principles of civil rights and opposes any form of discrimination against individuals or groups of individuals based on sex, race, age, national origin, religion, disability, or sexual orientation. ANA believes that nurses and students of nursing have a right to and responsibility for a workplace free of sexual harassment. Sexual harassment has an adverse impact on the healthcare environment.

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Positions and Resolutions

The American Nurses Association Membership Assembly and the Board of Directors are charged with setting policy in health care, the workplace, patient care, and many other areas where nurses are engaged. When a hot topic arises or there are various views and opinions about current events, the Membership Assembly and/or the Board of Directors may address these concerns by way of a position statement or resolution. 

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