Four state affiliates of the United American Nurses, AFL-CIO (UAN)-New York, Ohio, Oregon, and Washington-severed ties with the national group in late December 2007. They will collectively remove approximately 55,000 nurses, leaving the UAN with approximately 40,000 members.

A critical factor in the split is dissatisfaction with what the state affiliates say is a top-down, unilateral decision-making process. As Scott Palmer, communications specialist for the Oregon Nurses Association, stated, "We joined the UAN believing it would be democratic and inclusive and operate with transparency, but that's not what is happening and the states are being ignored[horizontal ellipsis]. We do recognize the value of a national voice for nurses, but [the] UAN isn't that voice."

In a letter sent to the UAN November 16, the four state associations charge that the UAN has "strayed from the principles of democracy, professionalism, and representation" and question the "integrity and judgement of current UAN leadership." The letter also put forth six demands, including the immediate dismissals of the executive director and the law firm and an audit of the union's finances. The UAN responded November 30, rejecting the letter's demands and asking for parties to attend a "unity meeting" of all affiliates on December 6 to discuss issues. According the UAN, representatives of the four states walked out of the meeting.

A spokesperson for the UAN was unavailable for comment, but in a prepared statement to AJN, UAN executive director Susan Bianchi-Sand noted, "By splitting [from the UAN], leaders in these four states are abandoning a coordinated, powerful national staff nurse voice-which is exactly what is needed right now to fix our health care system."

Maureen Shawn Kennedy, MA, RN, news director