In her June 15th address to the 2012 American Nurses Association (ANA) House of Delegates meeting, ANA president Karen Daley noted that it was on a June day 119 years ago that a small group of U.S. nursing school superintendents agreed to establish the American Society of Superintendents of Training Schools for Nurses. A few years later, this group merged with the Nurses Associated Alumnae to become the American Federation of Nurses, the precursor to the ANA. The rest, as they say, is history.
Nurses have never stopped organizing. But unlike our predecessors who sought to unify nurses, modern nurses often seem bent on subdividing themselves among ever-narrowing factions. In the United States, nursing has branched into more than 200 specialty and subspecialty groups, many with their own chapters, certification programs, and lobbying groups. And that doesn't include the labor unions, which divide us according to our functional roles (staff nurses versus nurse managers). Many of us choose to ignore our commonalities and focus on our peculiarities. When we only participate in those specialized groups or entities that directly affect us, this dilutes our profession's potential for "strength in numbers."
Over the past century, the ANA has survived even as various groups have peeled off and gone their separate ways. Like many large organizations, the ANA has at times undergone transformation. The last significant reorganization occurred in 1982, when the House of Delegates voted to change the ANA's structure from an association based on individual membership (with options to join at the local, state, or national level) to a federation of state associations. Now, with coffers tight from decreasing membership and both the national and state associations hard-pressed to operate effectively, the federation model no longer serves. Daley explained, "Despite the decline in total membership, our governance structure has stayed the same size and pace, consuming a significant percentage of our revenue, and preventing ANA from responding quickly and efficiently." The organization seeks to streamline itself, moving away from this cumbersome model in order to become "more nimble and efficient. The proposed changes included making individuals, rather than state associations, the members; installing a smaller board of directors as the ANA's governing body; and replacing the House of Delegates and the Constituent Assembly with a smaller Membership Assembly. (For a more detailed report on the meeting, see In the News.) Daley called on the house to "have the courage to change."
Well, it almost happened. While the house did pass four of five proposed bylaws, it balked at changing the organization's structure, saying that more information was needed. Daley's eloquent address and statements of support from past presidents weren't enough to convince the majority of delegates to make that change; for now, the ANA will remain a federation of state associations.
It's at times like this that the ANA seems to me to be entrenched in the status quo, although, to be fair, such critical decisions do require careful deliberation. Perhaps it's a question of trust. While public polls repeatedly show that nursing is the most trusted profession, it seems we ourselves lack some elemental trust in each other, trust that we will make good decisions for the profession as a whole. We've become parochial in our concerns, worrying mostly about matters closer to home, such as how a forthcoming change might affect our home state, particular specialty, or unit. Over 100 years ago, several nursing associations relinquished their separate identities and merged to form one unified, professional group devoted to furthering the causes of the profession. I can't imagine that happening today.
The ANA is the only forum in which all of us can share our professional values and work together for nursing, and we need it to be our collective voice. Whether you're a nurse manager or a staff nurse, working in community health or the ICU, serving in the military or teaching in a nursing school, this should matter to you. Writing on the ANA's 75th anniversary in 1971, AJN's former editor Thelma Schorr said, "The American Nurses Association is nursing's organic community. It is the means by which a million nurses can, if they will, use the force of their numbers to influence the changes that a protesting society is demanding and a political government is promising to effect." If they will.