ANA’s Presidential Engagement Policy and what YOU can DO!!


Ginna Betts chaired the ANA Presidential Endorsement Taskforce and guest authors today’s Capitol Beat Blog to provide her perspective into ANA’s move to a Presidential Engagement process.

The 2020 U.S. Presidential election cycle is one that is generating strong opinions and even stronger feelings from every corner of the United States. The American Nurses Association (ANA) has not been exempted from the fervor as, notably, for the first election cycle since 1984, ANA chose not to endorse (based on a 2019 Membership Assembly (MA) decision) a presidential candidate. For those members who may not have been following ANA’s internal policy processes closely and for others who (like me) have always highly valued ANA’s political and policy leadership roles, let me catch you up on how the Association reached the decision in 2019 to not continue endorsing in presidential elections and then describe what ANA would like YOU, our politically active and passionate members, to do: ENGAGE.

Since the 1988 presidential election, the ANA Political Action Committee (PAC) and the ANA Board (BOD) have implemented a rigorous process to select then endorse a candidate for the president of the USA. Presidential endorsements were followed by ANA encouraging and facilitating its membership to participate in political events in support of the endorsed candidate. Making the candidate selection and then advocating for ANA’s choice has always been fraught with controversy— especially when ANA’s endorsed candidate did not win the election. Letters to the ANA President and BOD with threats to drop memberships seemed to lessen (but not totally) when ANA endorsed winning candidates (such as Clinton/Gore and Obama/Biden). The upside of the endorsement of winning candidates was that nurse leaders were named to key posts in the federal government; ANA increased its presence at the national policymaking table; and ANA’s policy agenda and professional principles were imbedded in US executive policy initiatives. That upside was certainly my own experience as ANA president 1992-1996!

However, the political climate in the Nation has changed enormously and has rapidly become more and more contentious and polarized. Political campaigns have become wildly expensive. All of these variables are difficult to manage in the context of a professional association of members who hold widely diverse political views and a PAC whose coffers are limited. Even as the 2016 PAC Board voted unanimously to recommend the endorsement of Secretary Hillary Clinton for president with her long history of support for ANA, nursing, and health care, there was angst within the PAC about whether or not endorsement was the best way forward for the Association. The PAC debated many complex questions and concerns about the impact of endorsement of any presidential candidate, then elevated the issues to ANA’s BOD and Membership Assembly (MA). The 2018 MA held a comprehensive Policy Dialogue that included a report on the Association’s history of endorsement and outlined the current political environment after which the endorsement issue was sent back to the ANA Board of Directors for development of a definitive proposal urging in-depth exploration of multiple factors.

In the Summer of 2018, Pam Cipriano, ANA’s then president, appointed an eleven member Task Force (TF) on ANA’s Presidential Endorsement policy and process and (knowing of my unwavering belief in and commitment to nursing, policy, and political action) asked me to chair. The TF was charged to study ANA’s Presidential Endorsement process, its implementation, and its impact over more than a two-decade period and to submit a report to the BOD with recommendations. The TF was comprised of a geographically diverse group of politically engaged nursing leaders holding varied personal and political perspectives, and we were charged to serve the interests of ANA and its entire membership utilizing our political and policy passion and savvy.

The TF studied numerous ANA political and policy materials developed over time; held robust discussions and debates; engaged in rich conversations with external consultants to seek a keen understanding of professional associations’ best practices in their political activities; and sought input from Constituent/State Nurses Associations and ANA members across the United States. From our expert consultants, we became aware of some very important facts that certainly weighed heavily in our deliberations and recommendations. Included among these: (1) the impact of the advent of vast amounts of unregulated money into U.S. politics post the Supreme Court Citizens United case; (2) current candidates are more likely to seek significant financial contributions than other kinds of support; (3) increasingly, candidates did not respond to ANA’s questionnaires or agree to interviews by the PAC; (4) all of our other peer non-unionized health professional associations do not endorse presidential candidates; (5) membership surveys indicated that ANA’s membership over time had become more evenly balanced between the two major political parties; and (6) ANA can take positions on policy and political issues without endorsing a particulate candidate.

As a TF, we sought a way to have ANA and nurses participate in the presidential election process that was both relevant and doable in today’s complex and ever-changing political environment. Thus, the TF considered the pros and cons of (1) continuing with the historic endorsement process; (2) modifying endorsement activities; and/or (3) proposing an alternate approach to presidential election activity. The TF chose the latter and brought our preliminary recommendations to the BOD in December 2018 and a final report in Spring 2019 for consideration, review, feedback, and action.

Our recommendation was that ANA move away from presidential endorsement and adopt a policy of strong ANA supported political engagement during each presidential election cycle. We very much wanted to encourage ANA’s membership and all 4.2 million nurses throughout the USA to VOTE and be supported to fully engage in political activism for their candidate of choice. We saw ANA assuming a vital leadership role in the political arena by equipping professional nurses with accurate and current information about the candidates’ relevant positions and statements; the political parties’ platforms; and importantly how each candidate compared to ANA and nursing’s principles, positions, and policies. Prior to the MA vote, the TF and ANA hosted a webinar reviewing the TF’s work followed by an onsite MA forum held prior to official membership action. The debate at the 2019 MA was robust, positive, and transparent. Elected MA representatives were focused on making an informed, future-focused decision that would position ANA to be successful with its entire advocacy agenda. By an 87% positive vote, the Presidential Engagement policy replaced the Presidential Endorsement policy. The policy then moved forward for implementation just as the 2020 election “season” begin to heat up.

Then… a perfect storm that stoked more anxiety, controversy, and angst. The first iteration of Presidential Engagement IMPLEMENTATION is occurring during a time of a global pandemic posing a significant threat to nurses and their families; a national reckoning with racism as a second national public health crisis; heightened hyperbolic political rhetoric and a presidential impeachment; and significant city and street protests/and violence. This unprecedented time in history that will call for a deliberate review of what worked, what did not work, and what the ANA Presidential Engagement policy should look like when we get back to what will be a “new normal.”

TODAY, I think we all agree that this year’s elections are among the most consequential in our lifetimes calling for every nurse to consider engaging in the political process. Just as we together are celebrating the 100th anniversary of the 19th Amendment granting women the right to vote; the WHO Year of the Nurse and Midwife; and Florence Nightingale’s 200th birthday, we can also do so much together with other nurses to be politically engaged.

You may have seen that I, along with seven of my past president colleagues, have embraced ANA’s Presidential Engagement process to support the candidate we believe most aligns with our political views [LINK]. We made our choice by comparing ANA’s policies, principles, and values to the candidates’ past positions and actions.

The eight of us are working tirelessly to get our chosen candidate elected. We are working with the media. We are using social media. We are organizing nurse activists in the battleground states to work with their media partners, to participate in outreach work with other nurses, and to share nurses’ beliefs with their members of their communities. Please join us in engaging nurses to VOTE and to speak out about what nursing stands for and what nurses need. By doing so, ANA and the nursing profession will be stronger, more powerful, and more valued for years to come. With over 4.2 million nurses in the United States – our engagement can make an impact in this coming election. I encourage each of you to actively participate in the political process.

Thank you. I hope to see you on the campaign trail!

Virginia (Ginna) Trotter Betts, RN, MSN, JD, FAAN
ANA Past President 1992-1996
Task Force Chair on Presidential Endorsement Policy

ANA maintains neutrality in the presidential elections. The views expressed in this blog post do not necessarily reflect ANA’s.

An Open Letter to the ANA Membership


Dear Member:

As you are probably aware by now, the ANA Board of Directors recently made the decision to uphold the 2019 Membership Assembly (MA) vote that rescinded the 1985 Presidential Endorsement Process and replaced it with a Presidential Engagement Policy. Whether to uphold the will of ANA’s highest governing body, which voted overwhelmingly to end the endorsement process, or endorse a presidential candidate in this year’s election, was one of the most important and toughest decisions this board has made.

We did not take this responsibility lightly. Each of us read every communication sent to us and as a group, we relitigated the debate that occurred at the 2019 Membership Assembly regarding the pros and cons of each option. I trust that you can appreciate the anguish that each board member experienced in making a decision. As an elected leader, could you ignore the will of the majority who, after debating this issue for two years, has already spoken through their vote at Membership Assembly, or send a message that ignores that result even if legally permitted to do so? I believe that you would agree that to undertake such a move sends a message that the ANA board ignores the ANA member governing body.

In making this decision, board members had the tough responsibility of detaching from their personal political views and experiences to act in the best interest of the association. ANA represents the interests of 4.2 million registered nurses with diverse political views. As a board, we could not ignore this fact given we are in the middle of one, if not the most, divisive election in history. The decision of the board, like that of the Membership Assembly, was evidence-based, and it underscored our belief in the critical thinking of each registered nurse.  

As a professional organization, ANA does not have a vote in national, state or local elections – but individually, you and I do. ANA’s Presidential Engagement Policy encourages each nurse to not only get out and vote – but to get other nurses and nurse advocates out to the polls as well. As ANA’s president, I know ANA benefits through its work with members of both parties to promote the profession before Congress and with the administration. As a Black man, who has spoken out against racism and the current political temperament fomenting hate and divisiveness, I pledge to personally get out the vote for the candidate that I believe will best represent my own values and priorities for a safe, equitable, just and compassionate country. 

I urge you to vote, engage and campaign for the candidates, from those running for president, down the ballot to members of Congress and state and local offices, who most align with your own political views – informed by your personal values and experiences and your professional responsibilities, guided by the Code of Ethics for Nurses.  This November and beyond, we must always fight for what is right for nurses, our patients and the public.

Sincerely yours,

Ernest J. Grant, PhD, RN, FAAN


American Nurses Association

Safe and Sound Week – August 10-16


What makes a nurse safe at work? The American Nurses Association (ANA) supports and promotes nurse safety in its many aspects, which include use of personal protective equipment (PPE), preventing workplace violence, avoiding injury in handling patients, and having staff capacity that is appropriate for quality outcomes and nurse safety.

To draw attention to safety in healthcare settings, ANA partners every August with the Occupational Safety and Health Administration (OSHA) during Safe and Sound Week, which is now under way (August 10-16). The national week of activity is meant to recognize the successes of workplace health and safety programs, and share ideas on how to keep America’s workers safe.

This year, the COVID-19 pandemic has shown dramatically that nurse safety needs to be a priority 24/7, 52 weeks a year. The pandemic has tragically taken lives, including nurses’ lives, and challenged all corners of the healthcare system. ANA has been active in public and behind the scenes to advocate for all possible steps to ensure nurses are Safe and Sound at work, so they can continue to care for patients and educate the public about the pandemic. We must safeguard nurses’ and other frontline providers’ well-being and heed their invaluable insights so that the nation can recover faster and stronger.

As ANA President Ernest Grant said recently in impassioned testimony before Congress, “It is both a moral and strategic imperative for our nation’s leaders to do everything possible to arm and protect nurses and other critical responders as we work to combat the pandemic and prepare for future public health crises.”

For Safe and Sound Week in the year of COVID-19, PPE and workplace violence are of special concern to ANA.

Personal Protective Equipment. Access to appropriate PPE has been one of ANA’s main legislative priorities during COVID-19. Below are some talking points we have made to legislators and thought leaders, that you can also share with your elected officials:

  • PPE shortages continue to persist throughout the healthcare system. At one point this year, three out of four nurses said they are required to reuse their N95 respirators, or are encouraged to do so.
  • Many nurses have reported they do not feel safe using PPE that has been through a decontamination process.
  • Decontaminated respirators may not fit properly or may have other deficiencies.
  • When nurses voice their concerns about unsafe PPE, they should not be subject to retaliation. At ANA’s urging OSHA encourages workers to report such incidences.
  • A solution to addressing safety issues with PPE is to return to OSHA standards and pre-COVID guidelines as soon as possible.
  • ANA also supports creation of an OSHA standard specifically addressing risks of infection disease transmission.

For more information about ANA advocacy on PPE, visit the COVID-19 resources on Nursing World and share your voice with congress to let them know that more PPE is needed immediately.

Workplace Violence. Workplace violence by patients, family members, peers, and external individuals, including intimate partners, is a serious safety issue in healthcare settings, affecting nurses and patients. Yet violence and other abuses toward nurses are not well tracked and analyzed. One reason is that many nurses do not report incidents of violence, perhaps in the belief that their experience will not be acted upon effectively. The COVID-19 emergency has revealed unique threats that could arise in future emergency or high-stress periods, posing risks to nurses and to patient care. For instance, there have been times when family frustration about patient isolation has led to threats and violence. Nurses and other healthcare workers have also felt unsafe in their own communities, because of stigma and unfounded fears about exposure to the virus from healthcare workers specifically.

ANA believes workplace violence can and must be addressed. Our #End Nurse Abuse campaign is raising awareness about risks as well as ways to prevent violence and abuse in healthcare settings. ANA supports legislative and regulatory reform, such as OSHA standards for prevention programs, and collecting national data with effective reporting systems.

Safe and Sound Week is a good reminder that nurse safety is the responsibility of policymakers, employers, the nursing profession, and nurses themselves. Here are more ANA resources that can help keep nurses safe at work:

Safe Patient Handling and Mobility. In the HealthyNurse Survey 58 percent of nurses said they have experienced musculoskeletal pain at work in the past year. This pain is typically caused by the repetitive motions of transporting, mobilizing, repositioning, or ambulating patients. Musculoskeletal pain is not new to healthcare workers, and for the past 20 years ANA has advocated for safer practices and eliminating injuries for all professionals across the care continuum. For critically ill COVID-19 patients, proning procedures have been used to reposition patients, adding patient-handling risks for nurses.

In 2013, ANA developed the Safe Patient Handling and Mobility (SPHM) Interprofessional National Standards to assist organizations in creating SPHM policies and implementing and sustaining SPHM programs. Creating a culture of safety is the foundation for the standards. Without a commitment from staff and leadership, as well as the necessary financial resources, a successful SPHM policy cannot happen, and an SPHM program cannot be maintained. Other aspects of patient care are also addressed by safely handling patients including falls, pressure ulcers, skin injuries, and aggression among patients.

Mental Health.  Some nurses have become sick with COVID-19, but many others will suffer from anxiety, fear, anger, loss, isolation, loneliness, depression, stress, grief, or bereavement because of the pandemic. This is especially true for those who had pre-existing mental health conditions, or those serving on the front line. For all of us, mental health screenings, learning to build resilience, and getting the mental help needed immediately are key. Please see this blog and these webpages on nurse mental health and combating stress for further resources.

Self-Care. An empty plate has nothing to offer. If nurses are not rested, safe, well-nourished, fit, and satisfied with their work-life balance, then they may suffer personally and not be able to give the best care to their patients and families. That’s why self-care is so important. As difficult as this might be in the era of COVID-19 work and meal breaks, at least 7 hours of sleep daily, physical exercise, healthy food, and restorative “down time” need to be non-negotiable items in nurses’ routines. Healthy Nurses Healthy Nation has a plethora of blogs on self-care and stories of inspirational nurses.

Now more than ever, nurses, alongside other health professionals and their employers, need to focus on wellness and occupational health and safety. Nurses cannot do it alone; safe, respectful, and just workplace cultures are everyone’s responsibility. To learn more about occupational health and safety for nurses and health professionals, including immunizations, COVID-19, (see also CDC COVID-19 HCP guidance) staffing and more, visit For additional resources on self-care and nurse wellness, visit