Resolution on the Current Crisis in Care: Beating Back Crisis Standards of Care is Necessary to Securing Holistic Registered Practice to Protect WHEREAS, the purpose of California Nurses tical corporations, and other powerful eco- Association/National Nurses Organizing nomic institutions and interests which today Committee (CNA/NNOC) is “to foster high seek to control the availability, access, and standards of nursing practice, promote the quality of health care services for purposes professional advancement of nurses, and pro- of profit and surplus revenue generation mote and safeguard the welfare of nurses to against the interest of patients and health the end that all people may have better health care consumers”; and care services”; and WHEREAS, restructuring is the corporate WHEREAS, CNA/NNOC establishes essential model of reorganizing a company with goals of principles of RN conduct to “foster high stan- achieving greater efficiency and productivity, dards of nursing practice and promote quality thereby increasing profit with little regard for care,” including: patient safety and outcomes; and » Participating in “efforts to implement and WHEREAS, the health care industry has aimed advance the nurse’s role of patient and to end the right of RNs to advocate in the consumer advocate.” exclusive interest of the patients for over three decades through restructuring schemes, and » Providing health care services “with respect seeks to further this goal by making registered for human dignity and the individual unique nurses accomplices by coopting them through needs of the patient unrestricted by con- industry-promoted schemes such as magnet siderations of social or economic status, status, corporate colonization of education, and nature of health problems, age, color, creed, undermining of educational standards; by pro- disability, gender, lifestyle, nationality, race, moting disdain for the direct-care RN role and religion, or sexual orientation.” distance from the role; and » Recognizing “the importance of collective by endorsing lack of leadership and respect patient and social advocacy to the public for direct-care RNs from nurse academics and health and the integrity of professional nurse executives; and nursing standards of care, and participating WHEREAS, the health care industry aim in necessary and appropriate actions and has been to increase profits through clinical exercises of collective patient advocacy to restructuring and deskilling of the nursing protect public health and safe patient care process specifically by inappropriately pushing standards against erosion, restructuring, care to the lowest-cost and least-regulated set- degradation, deregulation, and abolition by ting, including retail clinics, outpatient surgery the large health care corporations, centers, and the patient’s home; and chains, insurance companies, pharmaceu-

13 WHEREAS, the attack on nursing practice and patient advocacy includes displacing RNs and RN professional judgment with health infor- mation technology, automation, and remote monitoring tools and, ultimately, abandoning the patient by leaving complex clinical care to be provided in the home by the family or even by the patient alone; and WHEREAS, health and human care services are in danger of being redefined from human touch to electronic virtual “care” where RN skill and independent professional judgment are replaced with so-called smart technologies, such as artificial intelligence and algorithmic programs, and RN hands-on patient care is WHEREAS, the current COVID-19 pandemic replaced with a virtual presence through the has revealed the health care industry’s utter control centers of e-, e-ICUs, and disregard for registered nurses and other front- e-home care, enabled by remote patient mon- line health care workers’ safety and well-being, itoring technology, mobile health apps, and as evidenced by a lack of planning and prepa- other information management systems; and ration to mitigate the spread and effects of, and WHEREAS, the health care industry and its treat the victims of, a predictable and expected allies aim to accelerate the preferential hiring pandemic, thereby putting frontline health care of the BSN RN over the ADN and diploma workers in grave danger as evidenced by the graduates and, ultimately, to designate the number of frontline health care workers both BSN degree as the entry level into the nursing contracting and tragically dying of COVID-19; profession in order to promote divisions among as further evidenced by the American Hospital nurses based on class, race, and socioeconomic Associations lobbying to lower standards of status; escalate RN dependency on and com- personal protective equipment against scien- pliance with hospital management through a tific evidence, despite the hospital industry constantly upgraded entry-level-into-practice receiving more than $100 billion in government requirement and the correlated increased stu- bailout funds; and dent debt, and create an additional source of WHEREAS, during the COVID-19 pandemic, revenue for the ANA and other industry-allied the disposability of nurses under the current entities by replacing CEs with frequent com- economic system can be plainly observed as petency testing as a condition of licensure and health industry employers, among many other employment, preferential treatment for winning things, refuse to provide necessary personal Magnet designation, and similar schemes as a protective equipment, mandate endless shifts, method of avoiding government regulation and refuse sick or quarantine leave and pay, refuse accountability; fill industry-created expanded COVID-19 tests for health care workers, demand roles including encroachment of nursing and nurses work even if they have been exposed to medical practice; and supplant holistic nursing COVID-19, and discipline nurses who speak out care and clinical competency with RN mastery about unsafe conditions for workers and their of technology; and patients; and

14 WHEREAS, the current COVID-19 pandemic has become permanent, shifting care to less-regu- been exacerbated by three decades of previ- lated or unregulated settings such as self- ous restructuring of clinical care efforts by the service with personal technology, ambulatory health care industry and has afforded them an surgery centers, or the home, and substituting opportunity to cynically accelerate their push unsupervised, unlicensed, and family caregivers to deregulate health care and health care pro- for direct, hands-on patient care from an RN; fessionals by implementing crisis standards of and care, such as the reintroduction of “team nurs- BE IT FURTHER RESOLVED, that CNA/NNOC ing,” rapid expansion of programs, will vigorously oppose all the following: emergency competencies and suspension of nurse-to-patient ratios, which they are aggres- » All technology that is used to replace, over- sively lobbying to retain post COVID-19; and ride, or undermine the professional judg- ment of RNs or otherwise compromise RNs’ WHEREAS, the current COVID-19 pandemic ability to care for patients using the nursing has put into stark relief the already existing process; disparities in health care access and outcomes suffered by marginalized communities as » The use of electronic surveillance, record evidenced by the disproportionate rates of keeping, and data collection methods that positive COVID-19 cases and deaths in African are designed to capture additional charges American, Latinx, Indigenous, Asian American for patient care delivery and increase prof- and Pacific Islander, unhoused, and incarcer- its under the pretense of improving care ated communities. or reducing medical errors, often at the expense of patient safety; THEREFORE, BE IT RESOLVED, that CNA/ NNOC engage in an aggressive and sustained » The practice of utilizing other licensed collective fight-back campaign against profit- professionals and unlicensed technicians, driven health care restructuring to secure holis- assistants, paramedical personnel, and vol- tic registered nursing practice and promote, unteers in expanded roles as a substitute for protect, and preserve our right to provide care licensed registered nurses in the provision and advocate in the exclusive interest of the of patient care; patient; and » Attempts to replace simulated clinical expe- BE IT FURTHER RESOLVED, that CNA/NNOC rience with computerized virtual learning will, in conjunction with likeminded groups and centers and private, for-profit industry organizations, continue to work to ensure that education models that deprive student and health care delivery in the and graduate nurses of hands-on, experiential globally provides health care services “with learning; respect for human dignity and the individual » The push to exploit new graduate nurses unique needs of the patient unrestricted by through licensed nurse residency programs, considerations of social or economic status, often unpaid, as a substitute for in-house nature of health problems, age, color, creed, preceptor and mentor programs that facil- disability, gender, lifestyle, nationality, race, itate the development of clinical expertise, religion, or sexual orientation”; and professional judgment, critical-thinking skills BE IT FURTHER RESOLVED, that CNA/NNOC and support the demonstrated competency continue to engage in public awareness cam- and validation of skills by experienced staff paigns about the potential for life-threatening nurses at the bedside; consequences should crisis standards of care

15 » All legislation and regulatory proposals that BE IT FURTHER RESOLVED, that CNA/NNOC promote the attack on nursing practice, the will actively educate, organize, and mobilize nursing profession, and safe patient care CNA/NNOC members and other registered delivery; nurses as individual, collective, and social advo- cates to control the conditions of our work and » All attempts to degrade RN staffing stan- our practice, in our facilities and communities, dards under the pretense of COVID-19 crisis in order to protect our patients’ and the pub- such as telehealth/, team nurs- lic’s health, both locally and globally, in accor- ing, nurse extenders, and other schemes dance with our organizational values of caring, to remove direct-care nurses from their compassion, commitment, and courage; and patients; BE IT FURTHER RESOLVED, that CNA/NNOC » The expansion of the enhanced nurse licen- will continue to promote the social, economic, sure compact effort to additional states and political value and good public health which is a direct threat to the nursing pro- policy benefits of care designed, planned, fession, nursing practice, and safe patient implemented, and evaluated by direct-care care standards; registered nurses. » All forms of harassment and retaliation by nurse executives, nurse managers, industry consultants, other health care executives, and their allies against nurses who advocate for patients and colleagues in challenging the health care industry’s profit-maximizing, market-driven agenda that motivates the deskilling, fragmentation, routinization, digi- tization, automation, and robotization of the art and science of RN professional practice, as well as profit- or budget-focused cuts in patient services; and BE IT FURTHER RESOLVED, that CNA/NNOC will continue to confront, contest, and expose those employers who are using surveillance technology and audits to promote fear, intim- idation, and coercion as a method to promote adoption of industry partnership schemes that endorse algorithms, digitized staffing and acuity tools, scripting, rounding, self-service computerized patient menus, telemedicine, virtual “visits,” and remote monitoring technol- ogies as a substitute for the presence of direct- care registered nurses and their ability to use their professional judgment to plan and provide individualized patient care; and

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