Governmental Affairs
Anne Halliday, BSN, RN, CPAN
Anne Halliday, BSN, RN, CPAN
Debt crisis means hard choices
As I write this, with an August first Mayflower deadline looming, the debt crisis debate is still swirling in Washington
DC. Like ASPAN and other nursing organizations, I am in favor of Title VIII funding for nursing education. However,
the present fiscal crisis involves other areas of the federal budget that are important to me. Hopefully, I can
summarize a positive solution of this politically-charged economic debate in my fall Governmental Affairs column.
Massachusetts News
Hospitals feel financial squeeze
An article on the front page of the Sunday July 10, 2011 Boston Globe caught my attention. Entitled “Hospitals in
Massachusetts Feel Financial Squeeze” by Robert Wiseman, this piece related that Medicare and Medicaid
payments have been reduced. The author states that these reimbursements account for about 60% of revenue at the
average Massachusetts hospital.
Mergers and closures in 1990s
In the early 1990s, another period of difficulty for Boston hospitals that I remember well, many hospitals (such as
Massachusetts General and Brigham and Women’s) formed affiliations and others closed their doors. Mr. Wiseman
notes that the number of Massachusetts hospital licenses dropped from 95 in the 1980s to 65 today.
Trend continues today
This article also discussed the recent bankruptcy filings by Quincy Medical Center and North Adams Regional
Hospital. Quincy Medical Center has agreed to be purchased by Steward Health Care System of Boston while North
Adams Regional Hospital is restructuring. Also, Milton Hospital is being purchased by Beth Israel Deaconess.
MNA Convention
At the Massachusetts Nurses Association convention I attended a year and a half ago a speaker mentioned that
tough times were ahead for nurses. This seems to be coming true with the creative methods hospitals are using to
lower costs, such as merging or closing units and increasing the use of unlicensed assistive personnel. I’m sure
MASPAN members could swap stories with me about this!
As I write this, with an August first Mayflower deadline looming, the debt crisis debate is still swirling in Washington
DC. Like ASPAN and other nursing organizations, I am in favor of Title VIII funding for nursing education. However,
the present fiscal crisis involves other areas of the federal budget that are important to me. Hopefully, I can
summarize a positive solution of this politically-charged economic debate in my fall Governmental Affairs column.
Massachusetts News
Hospitals feel financial squeeze
An article on the front page of the Sunday July 10, 2011 Boston Globe caught my attention. Entitled “Hospitals in
Massachusetts Feel Financial Squeeze” by Robert Wiseman, this piece related that Medicare and Medicaid
payments have been reduced. The author states that these reimbursements account for about 60% of revenue at the
average Massachusetts hospital.
Mergers and closures in 1990s
In the early 1990s, another period of difficulty for Boston hospitals that I remember well, many hospitals (such as
Massachusetts General and Brigham and Women’s) formed affiliations and others closed their doors. Mr. Wiseman
notes that the number of Massachusetts hospital licenses dropped from 95 in the 1980s to 65 today.
Trend continues today
This article also discussed the recent bankruptcy filings by Quincy Medical Center and North Adams Regional
Hospital. Quincy Medical Center has agreed to be purchased by Steward Health Care System of Boston while North
Adams Regional Hospital is restructuring. Also, Milton Hospital is being purchased by Beth Israel Deaconess.
MNA Convention
At the Massachusetts Nurses Association convention I attended a year and a half ago a speaker mentioned that
tough times were ahead for nurses. This seems to be coming true with the creative methods hospitals are using to
lower costs, such as merging or closing units and increasing the use of unlicensed assistive personnel. I’m sure
MASPAN members could swap stories with me about this!
Previous Governmental Affairs Columns ~ May be Edited for Space Restrictions
Visit Archives for Previous Columns
Visit Archives for Previous Columns
Mayflower Summer 2011 Volume 22 Issue 3
Governmental Affairs
Anne Halliday, BSN, RN, CPAN
MARN Legislative Action Forum
Due to a snow delay earlier in February, I was able to attend the Massachusetts Association of Registered Nurses
(MARN) Forum at the Massachusetts State House on February 24, 2011. The title of “Health Care Payment Reform –
The Future Role of Nursing” intrigued me. I enjoyed being in the Great Hall with flags from all the communities in the
Commonwealth hanging on the walls. The flag from my hometown of Marlborough was right over the speakers’
podium.
Health & Human Services
The morning’s sessions began with Dr. JudyAnn Bixby who oversees seventeen Massachusetts state agencies as
Secretary of the Office of Health and Human Services. It is worth noting that a handout we received showed that
52.3% of the 2011 Massachusetts budget is reserved for Dr. Bixby’s area. The Secretary has been a primary care
physician and a Harvard Medical School professor. Dr. Bixby discussed a bill entitled An Act Improving the Quality of
Health Care and Controlling Costs by Reforming Health Systems and Payments which Governor Deval Patrick had
filed seven days prior to this forum.* Dr. Bixby stated that:
“While our present system rewards volume over quality and hospitals are paid to keep their beds filled, the goal of this
bill is to convert the emphasis from hospital to keeping patients healthy. This model differs from the capitations of the
1980s where the goal was to manage cost rather than care”
Dr. Bixby had a poignant story about a practice in the 1980s being nearly bankrupted by one patient having a serious
accident or cancer diagnosis.
Statehouse impacts
The second speaker and moderator, Mary Grant MS, RN, who was a Massachusetts State Representative for eight
years, cautioned that what happens at the Statehouse does affect us in our clinical settings. She also said that a lot of
NON-nurses are having conversations about how care is delivered and the future of care. This reminded me of the
editorials in the April 2011 issue of JoPAN where both editors urged perianesthesia nurses to educate themselves
and to be at the table for the future of nursing.
Change is in the air
The next speaker, James W. Hunt, Jr., President and CEO of the Massachusetts League of Community Health
Centers and a professor at Suffolk University, predicted that “change is in the air.” He began by reading headlines
from the Boston Globe and the Wall Street Journal concerning health care systems being required to cut costs. Mr.
Hunt said that health care organizations need to work together to decrease health care costs. He further stated that
hospitals should not be demonized, but there will be a 4% drop in hospital admissions. Also if it is true that 50% of ER
visits by Medicaid patients are unnecessary, then these patients need to have a place they can call or visit to seek
healthcare 24/7.
No funding behind insurance
Michael E. Sroczynski, Esq., Vice President, Government Advocacy of Massachusetts Hospital Association, pointed
out that Massachusetts is insuring its population but hasn’t put the funding behind it yet. Mr. Sroczynski reiterated
that providers must work together and that insurers need to help with simplification in the health care system. This
speaker says that Massachusetts Hospital Association is working with MARN and Massachusetts Organization of
Nursing Executives (MONE) trying to get nurses to the right areas.
Reality check
The final speaker, Benjamin Day, is Executive Director of Mass-Care which is an advocacy group for a single payer
system. Mr. Day is not optimistic that the Governor’s cost reform bill will control costs. He also stated that our system
has a lot of administrative waste.
Making our voices heard
The final portion of the forum was entitled Implications and Opportunities for Nursing Practice and Making the Voices
of Nurses Heard and was moderated by Gino Chisari MSN, RN. The attendees were given time at their tables to
answer the following three questions:
Identify 3-5 implications that have an impact on your ability to perform in your practice
What opportunities exist to improve patient outcomes and nursing outcomes?
How will you add your voice?
It’s interesting that many of the attendees were students and their table spokespersons spoke mainly about staffing
ratios and things to help the staff nurse at a clinical level. My group consisted of a school nurse in school for her
masters, two ICU nurses one of whom was a nursing instructor, an NP student with a psychiatric focus and me. I was
spokesperson for the group and summarized our discussion as follows:
Inform the patients and the public about what nurses do
Focus on clinical communication with patients and other nurses through things like hourly rounding and preparation
for transfer of care
Add your voice by joining your specialty organization, American Nurses Association (ANA) / MARN; keep up to date
with news through the newspapers and other sources; speak with your legislators about issues important to nursing
Future plans
I ended my presentation by encouraging the nurses and students in the room to attend Nurse Internship in
Washington (NIWI) because it was such a powerful experience for me.
In the future, I plan to attend the Citizen’s Legislative Seminar which is run by the Massachusetts Senate. Care to join
me?
*To see the full 15-page bill being proposed by Governor Patrick, go to www.mass.gov and click on the Governor’s
website, click on legislation and click on the top item
Governmental Affairs
Mayflower Spring 2011 Volume 22 Issue 2
Anne Halliday, BSN, RN, CPAN
National
Nurses in Congress
The American Association of Colleges of Nursing (AACN) reports that the 2010 midterm elections added three nurses
to the House of Representatives. They are Ann Marie Buerkle (R-NY), who is also an attorney, Renee Ellmers (R-
NC), and Diane Black (R-TN). See www.aacn.nche.edu.
Omnibus Spending Bill
Although the Omnibus Spending Bill wasn’t passed by the lame duck Congress, a Current Resolution (temporary
budget) was passed to maintain the 2010 budget until the 112th Congress convenes this month (January) in
Washington. This means that the Title VIII funding for nursing education, which my fellow Nurse Internship in
Washington (NIWI) attendees and I lobbied for last March, will remain funded at 2010 levels. See www.aacn.nche.
edu.
Health Care Plan
After the recent tragic shooting in Tucson, Arizona, the discussion in the new Congress about the Patient Protection
and Affordable Care Act (aka “Obamacare”) has been placed on hold for now. Multiple sources predict that the Act
may be repealed in the House, now under Republican control, but will not pass in the Senate and can be vetoed by
President Obama as well. It will be interesting to see if some compromises are made concerning this issue.
Massachusetts
Safe Patient Handling
Have you ever hurt your back lifting a patient? Both American Nurses Association (ANA) on the national level and the
Massachusetts Nurses Association (MNA) have been sponsoring bills regarding this for many years. See www.
anasafepatienthandling.org for further information. The MNA supported HB2026 in 2009 as well as bills filed in 2007
and 2008 addressing this problem. The Massachusetts legislature convenes on January 18th and a new bill will most
likely be filed regarding this issue. See www.massnurses.org.
MARN Conference
The Massachusetts Association of Registered Nurses (MARN) is sponsoring a conference in the Great Hall of the
Boston State House on February 3. 2011 entitled Health Care Reform – The Future Role of Nursing. I hope to attend
this conference and am very interested in the main topics:
Current health care payment reform models legislation and regulations and their effect on the future of nursing
Implications and opportunities for nursing practice and making the voice of nurses heard
See www.MARNonline.org.
I will plan to report on this conference in my next Mayflower column.
Anne Halliday
Governmental Affairs
Mayflower Winter 2011 Volume 22 Issue 1
Anne Halliday, BSN, RN, CPAN
No Report
Governmental Affairs
Mayflower Fall 2010 Volume 21 Issue 4
Anne Halliday, BSN, RN, CPAN
National News
Title VIII Spending
When my fellow Nurse in Washington Internship (NIWI) attendees and I went to Capitol Hill this spring, we were
asking for $267.3 million for Title VIII spending. This request has just passed through the Senate LHHS
Appropriations Subcommittee, representing Labor, Health and Human Services, Education, and related agencies, and
the following amounts were approved:
Advanced Education Grants: $74.438 million ($10 million more than last year)
Nursing Workforce Diversity: $16.107 million (equal to last year)
Nurse Education Practice and Retention: $50 million (25% higher than last year)
Loan Repayment and Scholarship : $93.864 million (equal to last year)
Nurse Faculty Loan Program : $53.3 million (114% HIGHER than last year)
Comprehensive Geriatric Education: $4.567 (equal to last year)
The total is $292.276 for Title VIII in FY 2011; this is $25 million MORE than our NIWI ask!! Stay tuned to see what
happens to these figures in the final budget. Even though the nursing shortage crisis hasn’t really hit Massachusetts
yet, it will be here before we know it so funding for nursing education is most important.
MNA in Washington
Massachusetts Nursing Association (MNA) members were in Washington, DC in May for the National Staff Nurse
Assembly. While they were there, these nurses met with their Congressmen and Senators to discuss bills concerning
RN staffing ratios and Safe Patient Handling. The latter would provide for equipment and training to help RNs lift
patients safely, thus decreasing the number of back injuries that nurses sustain. See www.massnurse.org for more
details.1
National Nurse Act of 2010
David Kay, Chair of the ASPAN Governmental Affairs (GA) Committee, has asked for several committee members to
research views regarding HR4601, a bill called “The National Nurse Act of 2010.” So far, ASPAN has not endorsed
this bill but over 30 other nursing organizations have endorsed it. In my initial research, I have learned that Congress
will designate a Chief Nurse Officer (CNO) of the US Public Health Service (USPHS), who also serves as the Assistant
Surgeon General, be elevated to become a full time position within the Office of the Surgeon General and to be titled
‘The National Nurse for Prevention.’
This National Nurse’s three main foci would be to:
Support the Surgeon General’s focus on prevention
Develop nurses as Community Health Advocates
Promote Professional Nursing
I will continue to update MASPAN members concerning this proposed position.
Karen Daly, ANA President
Finally, in national news, Karen Daly RN of Massachusetts has just been named the new President of the American
Nurses’ Association (ANA). She has been both President of MNA and MARN (Massachusetts Association of
Registered Nurses). Because of her personal experience, she lobbied for needle-less products for nurses and other
health care professionals. This work culminated with her being present in the White House when President Clinton
signed the law pertaining to this. I have heard her speak at ASPAN National and hope that she might speak to
MASPAN in the future.
Massachusetts News
In my last column, I discussed three bills that MNA is currently supporting regarding preventing violence in hospitals
against nurses and other health care workers. On July 2, 2010, Governor Patrick signed HB1696 into law. According
to the official web site of the Governor of Massachusetts:
“This bill amends existing law to create enhanced penalties for the existing crimes of assault and assault and battery
on an EMT/ambulance professional acting in the line of duty, to include ALL health care providers, such as doctors,
nurses and social workers. The bill also mandates a minimum of 90 days up to 2.5 years or a minimum fine of $500
(up to $5000) but does not prohibit a suspended sentence.”1
Our fellow nurses in emergency and psychiatric areas are at particular risk of being assaulted. But we in
perianesthesia nursing are also at risk of assault because our patients and families are often stressed.
References
1. Massachusetts Nurses Association. Facts about Washington Rally and visits to legislators as well as
Massachusetts HB1696 being signed into law. Available at: www.massnurses.org/legislation-and-politics. Accessed
September 3, 2010.
Governmental Affairs
Mayflower Summer 2010 Volume 21 Issue 2
Anne Halliday, BSN, RN, CPAN
Mrs. Halliday Goes to Washington
Nurse Internship in Washington (NIWI)
I have been a member of the ASPAN Governmental Affairs Committee for several years and had heard about Nurse
Internship in Washington (NIWI) from Maureen McLaughlin and others. After ASPAN National in Washington in the
spring of 2009, I finally made the decision to apply for the ASPAN NIWI Scholarship. In August, after learning that I
had been awarded the scholarship, I began to make plans to go to NIWI in March 2010.
Forum to Advance the Nursing Profession
As noted on its web site, The Nursing Organizations Alliance (NOA), the NIWI sponsor, is “open to any nursing
organization whose focus is to address current and emerging nursing and health care issues. NOA provides a forum
for identification, education and collaboration building on issues of common interest to advance the nursing
profession.” The NIWI coordinators at NOA sent informative emails and also held two conference calls to answer
questions about what would happen at the internship.
Planning Ahead
Because of the potential for bad weather in March, I planned to arrive Saturday. The Affinia Hotel is located two
blocks from Union Station and two blocks from Capitol Hill. It was great to be close enough to walk to our meetings
on “the Hill.” I was also so glad to have a bit of time to visit the Library of Congress on Saturday and the Botanical
Garden on Sunday, before the sessions started. It was fun to see the orchids with Kim Kraft who is our new ASPAN
President!
Setting the Stage
Sunday afternoon and all day Monday, we were in sessions where we heard from Hill staffers about their work and
what makes a good meeting. Nurses from many specialty organizations in addition to ASPAN were present: AACN
(critical care), Nephrology, School Nurses, Pediatrics, Maternal Child Health, Medical Surgical Nurses, OR, Hospice
and Nurse Practitioners. In addition to Kim Kraft and me, ASPAN was also represented by Jenny Kilgore from
Mississippi.
We were fully briefed on the issues to be presented to our Senators and Representatives regarding Nursing
Education funding. I was glad that we had specific “asks” to present, especially in light of the furor regarding the
Health Care bill coming before the House while we were there.
Massachusetts Reunion
Monday afternoon, we were placed in state groups because our Senate visits were to be group visits. There were five
of us from Massachusetts and I renewed my acquaintance with Judith Gross from Gloucester, whom I had met at the
MNA convention on Cape Cod last November. I also had a connection to Diane Welsh from Weston who teaches at
Regis College with MASPAN Evidenced-based Practice guru Kathy DeLeskey. Diane also knew that I had precepted
a Regis student in the fall. The other two members of the Massachusetts delegation were Donna Fitman, a school
nurse from Worcester and Carla Roberts, a young pediatric nurse. We enjoyed role-playing how our group would
speak at the Senate meeting and where we would meet to arrive at the Rayburn Senate Office Building on time. In
spite of our differing specialties and years of experience, we were all fairly nervous because this would be a new
experience for all but one member of our group.
Ability to Speak to Issues and Photo Ops
Our meetings on Tuesday went very well. The young staffers for Senators Kerry and Brown made us feel so
comfortable. Each member of the group was able to speak to the nursing issues we were bringing and we had our
photos taken with Senator Kerry’s staffer Megan and with Senator Scott Brown.
Fascinating Experience
Donna Fitman and I realized we had the same Representative so we both went to the earlier of our appointments.
This worked well for the busy schedules of Representative James McGovern and his staffer. Donna and I were glad
Mr. McGovern posed for a photo with us. We enjoyed lunch at a café recommended by the staff and were thrilled to
use the Gallery tickets we were given to listen to 30 minutes of the debate in the House after lunch. It is what you can
see on CSPAN every day, but is fascinating in person, especially as the health care bill was being passionately
debated.
Wrap up and Recommendations
At the end of the day, we had a wrap up back at the hotel. It was interesting to hear that most of the Hill meetings
were positive but a few were not.
Looking back at this experience, my favorite things about NIWI are:
Spending time with Kim Kraft and Jenny Kilgore from ASPAN
Meeting nurses from other specialties and areas of the country
Learning more about how things work in DC
Enjoying the splendor of DC, one of my favorite places to visit
I highly encourage other MASPAN members to become involved in Governmental Affairs and to make attending NIWI
a personal goal.
Anne Halliday
MASPAN Governmental Affairs Chair
Governmental Affairs
Mayflower Spring 2010 Volume 21 Issue 1
Anne Halliday, BSN, RN, CPAN
Winter-Spring 2010
Health Care Bills
Unless you were vacationing on the moon, you are aware of the election of Massachusetts Senator Scott Brown to the
U.S. Senate. As a Republican, his vote has the potential to change the Democratic majority in Congress. This week,
in a conference call about the Nurse in Washington Internship (NIWI), I heard the health care bills called a “moving
target.” Pundits from all sides are debating what will happen next. It will be a VERY intriguing time to go to NIWI next
month and I will report back about it in the next Mayflower.
National Nurses Union
National Nurses’ Union (NNU) delegates met in Phoenix, Arizona December 7-9, 2009. Many topics were discussed in
the first meeting for this union but I was especially interested in one nurse’s comment that “recent technological
changes are often designed to make nurses ‘responsive to the machine’.” The consensus was that “every contract
needs language that technology will not be used to supersede the nurse’s professional judgment.” I wonder about the
efficiency experts questioning why my gastric bypass spends more time in PACU than another nurse’s. The future of
electronic charting will be interesting.
A Nurse is Not a Punching Bag
The Massachusetts Nurses Association (MNA) has developed three bills to be filed in the Massachusetts legislature
to address the issue of workplace violence:
SB988, filed by Rep. Michael Costello and Senator James Timilty, would require healthcare employers to perform an
annual risk assessment and based on those findings, develop and implement programs to prevent violence in the first
place.
HB1696/SB1753, filed by Rep. Michael Rodriguez and Sen. Michael Moore, would enhance penalties for
patients/clients who assault nurses and healthcare professionals who are providing treatment to patients.
HB1931, filed by Rep. Patricia Haddad, would create a “Difficult to Manage” unit for women within the Department of
Mental Health and reinstate the “Difficult to Manage” unit for men.
See www.massurses.org for more information
Anne Halliday
Governmental Affairs
Mayflower Winter 2010 Volume 21 Issue 1
Anne Halliday, BSN, RN, CPAN
National Health Care Reform Bills
I have pushed back my deadline for this article while awaiting results of a Senate vote. Finally, on Saturday November
21, the Senate cleared the way for debate to start on November 30, 2009 on a bill which will be a compromise
between two committee passed versions. Predictions have been made saying that this debate may take several
months.
Meanwhile, also in an unusual Saturday session on October 29, 2009, Health Care reform Bill #3962 was passed in
the House of Representatives by a vote of 220-215. It will be interesting to see what is in the final version of a health
care reform bill. So much can be buried in the greater than 1500 pages of each of these pieces of legislation. Heavy
lobbying has been done by such groups as unions, Catholic clergy, health insurance companies and the
pharmaceutical industry.
A New Super Union for Nurses
On September 30 and October 1, 2009, I attended the Massachusetts Nurses Association (MNA) meeting at Ocean’s
Edge Resort in Brewster, Massachusetts. What a fascinating two days in a lovely place.
The first day was devoted to labor issues, headlined by Bill Fletcher who spoke about organizing into a national union
being a way to fight more effectively for our patients and our profession. Phil Ni Sheaghdha, from the Irish Nurses
Organisation, told about the struggle in Ireland to build a strong nurses’ union. There are 4 million people in Ireland
and 40,000 nurses are members of this union! Linda Silas, from the Canadian Federation of Nurses Unions,
concluded the morning session. She spoke about how the provincial nurses’ organizations joined the National
Federation of Nurses.
The second day, after two educational sessions in the morning, all 521 attendees were credentialed (similar to the
Representative Assembly at an ASPAN meeting) and were seated in two venues connected by video feed. After a
business meeting including the President’s address and the financial report, discussion about joining the National
Nurses’ Union (NNU) began. After several hours of the pro and con views of this issue, the vote was taken and
passed 321-200.
Since the conference, there was a Boston Globe article about some MNA members who are not in support of this
affiliation. I wondered if the ballot vote for a dues increase would pass, but found that on November 11, 2009, this
measure did pass.
Going Forward
“National Nurses United (NNU), unifying the 23,000 member MNA with the 86,000 member California Nurses
Association/National Nurses organizing Committee (CNA/NNCO) and the 45, 000 member United American Nurses, is
scheduled to hold its founding convention December 7 and 8 in Phoenix, Arizona. The new union will be comprised of
more than 150,000 front-line nurses working in 22 states.” See www.massnurses.org for this and more information
It will be an interesting winter watching how things unfold with health care reform and the new nurses “super-union.”
Governmental Affairs
Mayflower Fall 2009 Volume 20 Issue 4
Anne Halliday, BSN, RN, CPAN
Health Care Reform and a Super Union?
Health Care Reform
As I write this, Congress is on summer recess hearing from concerned constituents about HR3200, The Health Care
Reform Act Bill. Please note that there are really three bills in the House of Representatives and two in the Senate
regarding this complicated and important topic. By the time you read this, Congress will be back in session debating
what should happen next.
As a member of ASPAN’s Governmental Affairs (GA) Committee, I am receiving frequent emails from David Kay, Chair
of the ASPAN GA Committee. There are also numerous articles in newspapers and magazines and television time
devoted to health care reform. The AMA, insurance and pharmaceutical companies, unions, AARP and other strong
organizations all have their points of view which they are lobbying heavily to members of Congress and to the public.
What is a PeriAnesthesia Nurse to Do?
I recommend:
Read and listen to what you can and consider different points of view.
Look at HR3200 at www.thomas.gov or Goggle where there are many choices to view it.
Gather your thoughts and make a short list of what is most important to you.
Call your Senator and Congressman at 1-877-264-4226 (a toll free number). Press 1 to speak to your Senator and
Press 2 to speak to your Representative. Enter your zip code when prompted.
The outcome will certainly be interesting and will affect every American.
Super Union for Nurses
If you are not a member of the Massachusetts Nurses’ Association (MNA) or working in a facility with MNA
representation, you may not be aware of the potential for the creation of a new National Nurses’ Union. Once again, I
am being bombarded by information, this time from MNA.
Some History
In 2001, there was a meeting of MNA member nurses in Worcester where a vote disaffiliating MNA from American
Nurses Association (ANA) passed. At this meeting, members stated that ANA “didn’t adequately represent staff
nurses on the national stage” and a resolution for the formation of a national nurses’ union was adopted.
At MNA’s 2008 convention, a vote passed authorizing MNA leadership to “participate as architects of an independent
national nurses union run by and for nurses.” *source: www.massnurses.org
The California Nurses Association (CNA) left ANA in 1995 and eventually formed the National Nurses Organizing
Committee (NNOC). In 2008, the United American Nurses (UAN) and labor arm of ANA which is affiliated with the AFL-
CIO also disaffiliated from ANA.
In October, MNA members will vote whether to join CNA/NNOC and UAN to form a new national nurses union which
would have 150,000 members.
Five Core Objectives
The five objectives of this super union would include:
To build a movement to defend and advance the interests of direct care nurses and patients everywhere.
To unite and organize all direct care nurses into a single organization capable of exercising maximum influence over
the health care industry, governments and employers.
To win health care justice: accessible, quality health care for all, as a human right.
To provide effective collective bargaining representation to UAN/NNOC members and support to UAN/NNOC affiliates
to promote the economic and professional interests of direct care nurses.
To advocate for direct care nurses and patients on all public policy matters related to safe care and nursing practice,
including safe nurse-to-patient ratios and patient advocacy rights.
Even if you are not working in an MNA-represented facility, you should be aware of this potential new Super union. It
has been said by author Suzanne Gordon and others that nurses do not publicize what they do or use their potential
power as a group. This union could change that.
Please see www.massnurse.org for the source for this article as well as for further information.
Governmental Affairs
Anne Halliday, BSN, RN, CPAN
MARN Legislative Action Forum
Due to a snow delay earlier in February, I was able to attend the Massachusetts Association of Registered Nurses
(MARN) Forum at the Massachusetts State House on February 24, 2011. The title of “Health Care Payment Reform –
The Future Role of Nursing” intrigued me. I enjoyed being in the Great Hall with flags from all the communities in the
Commonwealth hanging on the walls. The flag from my hometown of Marlborough was right over the speakers’
podium.
Health & Human Services
The morning’s sessions began with Dr. JudyAnn Bixby who oversees seventeen Massachusetts state agencies as
Secretary of the Office of Health and Human Services. It is worth noting that a handout we received showed that
52.3% of the 2011 Massachusetts budget is reserved for Dr. Bixby’s area. The Secretary has been a primary care
physician and a Harvard Medical School professor. Dr. Bixby discussed a bill entitled An Act Improving the Quality of
Health Care and Controlling Costs by Reforming Health Systems and Payments which Governor Deval Patrick had
filed seven days prior to this forum.* Dr. Bixby stated that:
“While our present system rewards volume over quality and hospitals are paid to keep their beds filled, the goal of this
bill is to convert the emphasis from hospital to keeping patients healthy. This model differs from the capitations of the
1980s where the goal was to manage cost rather than care”
Dr. Bixby had a poignant story about a practice in the 1980s being nearly bankrupted by one patient having a serious
accident or cancer diagnosis.
Statehouse impacts
The second speaker and moderator, Mary Grant MS, RN, who was a Massachusetts State Representative for eight
years, cautioned that what happens at the Statehouse does affect us in our clinical settings. She also said that a lot of
NON-nurses are having conversations about how care is delivered and the future of care. This reminded me of the
editorials in the April 2011 issue of JoPAN where both editors urged perianesthesia nurses to educate themselves
and to be at the table for the future of nursing.
Change is in the air
The next speaker, James W. Hunt, Jr., President and CEO of the Massachusetts League of Community Health
Centers and a professor at Suffolk University, predicted that “change is in the air.” He began by reading headlines
from the Boston Globe and the Wall Street Journal concerning health care systems being required to cut costs. Mr.
Hunt said that health care organizations need to work together to decrease health care costs. He further stated that
hospitals should not be demonized, but there will be a 4% drop in hospital admissions. Also if it is true that 50% of ER
visits by Medicaid patients are unnecessary, then these patients need to have a place they can call or visit to seek
healthcare 24/7.
No funding behind insurance
Michael E. Sroczynski, Esq., Vice President, Government Advocacy of Massachusetts Hospital Association, pointed
out that Massachusetts is insuring its population but hasn’t put the funding behind it yet. Mr. Sroczynski reiterated
that providers must work together and that insurers need to help with simplification in the health care system. This
speaker says that Massachusetts Hospital Association is working with MARN and Massachusetts Organization of
Nursing Executives (MONE) trying to get nurses to the right areas.
Reality check
The final speaker, Benjamin Day, is Executive Director of Mass-Care which is an advocacy group for a single payer
system. Mr. Day is not optimistic that the Governor’s cost reform bill will control costs. He also stated that our system
has a lot of administrative waste.
Making our voices heard
The final portion of the forum was entitled Implications and Opportunities for Nursing Practice and Making the Voices
of Nurses Heard and was moderated by Gino Chisari MSN, RN. The attendees were given time at their tables to
answer the following three questions:
Identify 3-5 implications that have an impact on your ability to perform in your practice
What opportunities exist to improve patient outcomes and nursing outcomes?
How will you add your voice?
It’s interesting that many of the attendees were students and their table spokespersons spoke mainly about staffing
ratios and things to help the staff nurse at a clinical level. My group consisted of a school nurse in school for her
masters, two ICU nurses one of whom was a nursing instructor, an NP student with a psychiatric focus and me. I was
spokesperson for the group and summarized our discussion as follows:
Inform the patients and the public about what nurses do
Focus on clinical communication with patients and other nurses through things like hourly rounding and preparation
for transfer of care
Add your voice by joining your specialty organization, American Nurses Association (ANA) / MARN; keep up to date
with news through the newspapers and other sources; speak with your legislators about issues important to nursing
Future plans
I ended my presentation by encouraging the nurses and students in the room to attend Nurse Internship in
Washington (NIWI) because it was such a powerful experience for me.
In the future, I plan to attend the Citizen’s Legislative Seminar which is run by the Massachusetts Senate. Care to join
me?
*To see the full 15-page bill being proposed by Governor Patrick, go to www.mass.gov and click on the Governor’s
website, click on legislation and click on the top item
Governmental Affairs
Mayflower Spring 2011 Volume 22 Issue 2
Anne Halliday, BSN, RN, CPAN
National
Nurses in Congress
The American Association of Colleges of Nursing (AACN) reports that the 2010 midterm elections added three nurses
to the House of Representatives. They are Ann Marie Buerkle (R-NY), who is also an attorney, Renee Ellmers (R-
NC), and Diane Black (R-TN). See www.aacn.nche.edu.
Omnibus Spending Bill
Although the Omnibus Spending Bill wasn’t passed by the lame duck Congress, a Current Resolution (temporary
budget) was passed to maintain the 2010 budget until the 112th Congress convenes this month (January) in
Washington. This means that the Title VIII funding for nursing education, which my fellow Nurse Internship in
Washington (NIWI) attendees and I lobbied for last March, will remain funded at 2010 levels. See www.aacn.nche.
edu.
Health Care Plan
After the recent tragic shooting in Tucson, Arizona, the discussion in the new Congress about the Patient Protection
and Affordable Care Act (aka “Obamacare”) has been placed on hold for now. Multiple sources predict that the Act
may be repealed in the House, now under Republican control, but will not pass in the Senate and can be vetoed by
President Obama as well. It will be interesting to see if some compromises are made concerning this issue.
Massachusetts
Safe Patient Handling
Have you ever hurt your back lifting a patient? Both American Nurses Association (ANA) on the national level and the
Massachusetts Nurses Association (MNA) have been sponsoring bills regarding this for many years. See www.
anasafepatienthandling.org for further information. The MNA supported HB2026 in 2009 as well as bills filed in 2007
and 2008 addressing this problem. The Massachusetts legislature convenes on January 18th and a new bill will most
likely be filed regarding this issue. See www.massnurses.org.
MARN Conference
The Massachusetts Association of Registered Nurses (MARN) is sponsoring a conference in the Great Hall of the
Boston State House on February 3. 2011 entitled Health Care Reform – The Future Role of Nursing. I hope to attend
this conference and am very interested in the main topics:
Current health care payment reform models legislation and regulations and their effect on the future of nursing
Implications and opportunities for nursing practice and making the voice of nurses heard
See www.MARNonline.org.
I will plan to report on this conference in my next Mayflower column.
Anne Halliday
Governmental Affairs
Mayflower Winter 2011 Volume 22 Issue 1
Anne Halliday, BSN, RN, CPAN
No Report
Governmental Affairs
Mayflower Fall 2010 Volume 21 Issue 4
Anne Halliday, BSN, RN, CPAN
National News
Title VIII Spending
When my fellow Nurse in Washington Internship (NIWI) attendees and I went to Capitol Hill this spring, we were
asking for $267.3 million for Title VIII spending. This request has just passed through the Senate LHHS
Appropriations Subcommittee, representing Labor, Health and Human Services, Education, and related agencies, and
the following amounts were approved:
Advanced Education Grants: $74.438 million ($10 million more than last year)
Nursing Workforce Diversity: $16.107 million (equal to last year)
Nurse Education Practice and Retention: $50 million (25% higher than last year)
Loan Repayment and Scholarship : $93.864 million (equal to last year)
Nurse Faculty Loan Program : $53.3 million (114% HIGHER than last year)
Comprehensive Geriatric Education: $4.567 (equal to last year)
The total is $292.276 for Title VIII in FY 2011; this is $25 million MORE than our NIWI ask!! Stay tuned to see what
happens to these figures in the final budget. Even though the nursing shortage crisis hasn’t really hit Massachusetts
yet, it will be here before we know it so funding for nursing education is most important.
MNA in Washington
Massachusetts Nursing Association (MNA) members were in Washington, DC in May for the National Staff Nurse
Assembly. While they were there, these nurses met with their Congressmen and Senators to discuss bills concerning
RN staffing ratios and Safe Patient Handling. The latter would provide for equipment and training to help RNs lift
patients safely, thus decreasing the number of back injuries that nurses sustain. See www.massnurse.org for more
details.1
National Nurse Act of 2010
David Kay, Chair of the ASPAN Governmental Affairs (GA) Committee, has asked for several committee members to
research views regarding HR4601, a bill called “The National Nurse Act of 2010.” So far, ASPAN has not endorsed
this bill but over 30 other nursing organizations have endorsed it. In my initial research, I have learned that Congress
will designate a Chief Nurse Officer (CNO) of the US Public Health Service (USPHS), who also serves as the Assistant
Surgeon General, be elevated to become a full time position within the Office of the Surgeon General and to be titled
‘The National Nurse for Prevention.’
This National Nurse’s three main foci would be to:
Support the Surgeon General’s focus on prevention
Develop nurses as Community Health Advocates
Promote Professional Nursing
I will continue to update MASPAN members concerning this proposed position.
Karen Daly, ANA President
Finally, in national news, Karen Daly RN of Massachusetts has just been named the new President of the American
Nurses’ Association (ANA). She has been both President of MNA and MARN (Massachusetts Association of
Registered Nurses). Because of her personal experience, she lobbied for needle-less products for nurses and other
health care professionals. This work culminated with her being present in the White House when President Clinton
signed the law pertaining to this. I have heard her speak at ASPAN National and hope that she might speak to
MASPAN in the future.
Massachusetts News
In my last column, I discussed three bills that MNA is currently supporting regarding preventing violence in hospitals
against nurses and other health care workers. On July 2, 2010, Governor Patrick signed HB1696 into law. According
to the official web site of the Governor of Massachusetts:
“This bill amends existing law to create enhanced penalties for the existing crimes of assault and assault and battery
on an EMT/ambulance professional acting in the line of duty, to include ALL health care providers, such as doctors,
nurses and social workers. The bill also mandates a minimum of 90 days up to 2.5 years or a minimum fine of $500
(up to $5000) but does not prohibit a suspended sentence.”1
Our fellow nurses in emergency and psychiatric areas are at particular risk of being assaulted. But we in
perianesthesia nursing are also at risk of assault because our patients and families are often stressed.
References
1. Massachusetts Nurses Association. Facts about Washington Rally and visits to legislators as well as
Massachusetts HB1696 being signed into law. Available at: www.massnurses.org/legislation-and-politics. Accessed
September 3, 2010.
Governmental Affairs
Mayflower Summer 2010 Volume 21 Issue 2
Anne Halliday, BSN, RN, CPAN
Mrs. Halliday Goes to Washington
Nurse Internship in Washington (NIWI)
I have been a member of the ASPAN Governmental Affairs Committee for several years and had heard about Nurse
Internship in Washington (NIWI) from Maureen McLaughlin and others. After ASPAN National in Washington in the
spring of 2009, I finally made the decision to apply for the ASPAN NIWI Scholarship. In August, after learning that I
had been awarded the scholarship, I began to make plans to go to NIWI in March 2010.
Forum to Advance the Nursing Profession
As noted on its web site, The Nursing Organizations Alliance (NOA), the NIWI sponsor, is “open to any nursing
organization whose focus is to address current and emerging nursing and health care issues. NOA provides a forum
for identification, education and collaboration building on issues of common interest to advance the nursing
profession.” The NIWI coordinators at NOA sent informative emails and also held two conference calls to answer
questions about what would happen at the internship.
Planning Ahead
Because of the potential for bad weather in March, I planned to arrive Saturday. The Affinia Hotel is located two
blocks from Union Station and two blocks from Capitol Hill. It was great to be close enough to walk to our meetings
on “the Hill.” I was also so glad to have a bit of time to visit the Library of Congress on Saturday and the Botanical
Garden on Sunday, before the sessions started. It was fun to see the orchids with Kim Kraft who is our new ASPAN
President!
Setting the Stage
Sunday afternoon and all day Monday, we were in sessions where we heard from Hill staffers about their work and
what makes a good meeting. Nurses from many specialty organizations in addition to ASPAN were present: AACN
(critical care), Nephrology, School Nurses, Pediatrics, Maternal Child Health, Medical Surgical Nurses, OR, Hospice
and Nurse Practitioners. In addition to Kim Kraft and me, ASPAN was also represented by Jenny Kilgore from
Mississippi.
We were fully briefed on the issues to be presented to our Senators and Representatives regarding Nursing
Education funding. I was glad that we had specific “asks” to present, especially in light of the furor regarding the
Health Care bill coming before the House while we were there.
Massachusetts Reunion
Monday afternoon, we were placed in state groups because our Senate visits were to be group visits. There were five
of us from Massachusetts and I renewed my acquaintance with Judith Gross from Gloucester, whom I had met at the
MNA convention on Cape Cod last November. I also had a connection to Diane Welsh from Weston who teaches at
Regis College with MASPAN Evidenced-based Practice guru Kathy DeLeskey. Diane also knew that I had precepted
a Regis student in the fall. The other two members of the Massachusetts delegation were Donna Fitman, a school
nurse from Worcester and Carla Roberts, a young pediatric nurse. We enjoyed role-playing how our group would
speak at the Senate meeting and where we would meet to arrive at the Rayburn Senate Office Building on time. In
spite of our differing specialties and years of experience, we were all fairly nervous because this would be a new
experience for all but one member of our group.
Ability to Speak to Issues and Photo Ops
Our meetings on Tuesday went very well. The young staffers for Senators Kerry and Brown made us feel so
comfortable. Each member of the group was able to speak to the nursing issues we were bringing and we had our
photos taken with Senator Kerry’s staffer Megan and with Senator Scott Brown.
Fascinating Experience
Donna Fitman and I realized we had the same Representative so we both went to the earlier of our appointments.
This worked well for the busy schedules of Representative James McGovern and his staffer. Donna and I were glad
Mr. McGovern posed for a photo with us. We enjoyed lunch at a café recommended by the staff and were thrilled to
use the Gallery tickets we were given to listen to 30 minutes of the debate in the House after lunch. It is what you can
see on CSPAN every day, but is fascinating in person, especially as the health care bill was being passionately
debated.
Wrap up and Recommendations
At the end of the day, we had a wrap up back at the hotel. It was interesting to hear that most of the Hill meetings
were positive but a few were not.
Looking back at this experience, my favorite things about NIWI are:
Spending time with Kim Kraft and Jenny Kilgore from ASPAN
Meeting nurses from other specialties and areas of the country
Learning more about how things work in DC
Enjoying the splendor of DC, one of my favorite places to visit
I highly encourage other MASPAN members to become involved in Governmental Affairs and to make attending NIWI
a personal goal.
Anne Halliday
MASPAN Governmental Affairs Chair
Governmental Affairs
Mayflower Spring 2010 Volume 21 Issue 1
Anne Halliday, BSN, RN, CPAN
Winter-Spring 2010
Health Care Bills
Unless you were vacationing on the moon, you are aware of the election of Massachusetts Senator Scott Brown to the
U.S. Senate. As a Republican, his vote has the potential to change the Democratic majority in Congress. This week,
in a conference call about the Nurse in Washington Internship (NIWI), I heard the health care bills called a “moving
target.” Pundits from all sides are debating what will happen next. It will be a VERY intriguing time to go to NIWI next
month and I will report back about it in the next Mayflower.
National Nurses Union
National Nurses’ Union (NNU) delegates met in Phoenix, Arizona December 7-9, 2009. Many topics were discussed in
the first meeting for this union but I was especially interested in one nurse’s comment that “recent technological
changes are often designed to make nurses ‘responsive to the machine’.” The consensus was that “every contract
needs language that technology will not be used to supersede the nurse’s professional judgment.” I wonder about the
efficiency experts questioning why my gastric bypass spends more time in PACU than another nurse’s. The future of
electronic charting will be interesting.
A Nurse is Not a Punching Bag
The Massachusetts Nurses Association (MNA) has developed three bills to be filed in the Massachusetts legislature
to address the issue of workplace violence:
SB988, filed by Rep. Michael Costello and Senator James Timilty, would require healthcare employers to perform an
annual risk assessment and based on those findings, develop and implement programs to prevent violence in the first
place.
HB1696/SB1753, filed by Rep. Michael Rodriguez and Sen. Michael Moore, would enhance penalties for
patients/clients who assault nurses and healthcare professionals who are providing treatment to patients.
HB1931, filed by Rep. Patricia Haddad, would create a “Difficult to Manage” unit for women within the Department of
Mental Health and reinstate the “Difficult to Manage” unit for men.
See www.massurses.org for more information
Anne Halliday
Governmental Affairs
Mayflower Winter 2010 Volume 21 Issue 1
Anne Halliday, BSN, RN, CPAN
National Health Care Reform Bills
I have pushed back my deadline for this article while awaiting results of a Senate vote. Finally, on Saturday November
21, the Senate cleared the way for debate to start on November 30, 2009 on a bill which will be a compromise
between two committee passed versions. Predictions have been made saying that this debate may take several
months.
Meanwhile, also in an unusual Saturday session on October 29, 2009, Health Care reform Bill #3962 was passed in
the House of Representatives by a vote of 220-215. It will be interesting to see what is in the final version of a health
care reform bill. So much can be buried in the greater than 1500 pages of each of these pieces of legislation. Heavy
lobbying has been done by such groups as unions, Catholic clergy, health insurance companies and the
pharmaceutical industry.
A New Super Union for Nurses
On September 30 and October 1, 2009, I attended the Massachusetts Nurses Association (MNA) meeting at Ocean’s
Edge Resort in Brewster, Massachusetts. What a fascinating two days in a lovely place.
The first day was devoted to labor issues, headlined by Bill Fletcher who spoke about organizing into a national union
being a way to fight more effectively for our patients and our profession. Phil Ni Sheaghdha, from the Irish Nurses
Organisation, told about the struggle in Ireland to build a strong nurses’ union. There are 4 million people in Ireland
and 40,000 nurses are members of this union! Linda Silas, from the Canadian Federation of Nurses Unions,
concluded the morning session. She spoke about how the provincial nurses’ organizations joined the National
Federation of Nurses.
The second day, after two educational sessions in the morning, all 521 attendees were credentialed (similar to the
Representative Assembly at an ASPAN meeting) and were seated in two venues connected by video feed. After a
business meeting including the President’s address and the financial report, discussion about joining the National
Nurses’ Union (NNU) began. After several hours of the pro and con views of this issue, the vote was taken and
passed 321-200.
Since the conference, there was a Boston Globe article about some MNA members who are not in support of this
affiliation. I wondered if the ballot vote for a dues increase would pass, but found that on November 11, 2009, this
measure did pass.
Going Forward
“National Nurses United (NNU), unifying the 23,000 member MNA with the 86,000 member California Nurses
Association/National Nurses organizing Committee (CNA/NNCO) and the 45, 000 member United American Nurses, is
scheduled to hold its founding convention December 7 and 8 in Phoenix, Arizona. The new union will be comprised of
more than 150,000 front-line nurses working in 22 states.” See www.massnurses.org for this and more information
It will be an interesting winter watching how things unfold with health care reform and the new nurses “super-union.”
Governmental Affairs
Mayflower Fall 2009 Volume 20 Issue 4
Anne Halliday, BSN, RN, CPAN
Health Care Reform and a Super Union?
Health Care Reform
As I write this, Congress is on summer recess hearing from concerned constituents about HR3200, The Health Care
Reform Act Bill. Please note that there are really three bills in the House of Representatives and two in the Senate
regarding this complicated and important topic. By the time you read this, Congress will be back in session debating
what should happen next.
As a member of ASPAN’s Governmental Affairs (GA) Committee, I am receiving frequent emails from David Kay, Chair
of the ASPAN GA Committee. There are also numerous articles in newspapers and magazines and television time
devoted to health care reform. The AMA, insurance and pharmaceutical companies, unions, AARP and other strong
organizations all have their points of view which they are lobbying heavily to members of Congress and to the public.
What is a PeriAnesthesia Nurse to Do?
I recommend:
Read and listen to what you can and consider different points of view.
Look at HR3200 at www.thomas.gov or Goggle where there are many choices to view it.
Gather your thoughts and make a short list of what is most important to you.
Call your Senator and Congressman at 1-877-264-4226 (a toll free number). Press 1 to speak to your Senator and
Press 2 to speak to your Representative. Enter your zip code when prompted.
The outcome will certainly be interesting and will affect every American.
Super Union for Nurses
If you are not a member of the Massachusetts Nurses’ Association (MNA) or working in a facility with MNA
representation, you may not be aware of the potential for the creation of a new National Nurses’ Union. Once again, I
am being bombarded by information, this time from MNA.
Some History
In 2001, there was a meeting of MNA member nurses in Worcester where a vote disaffiliating MNA from American
Nurses Association (ANA) passed. At this meeting, members stated that ANA “didn’t adequately represent staff
nurses on the national stage” and a resolution for the formation of a national nurses’ union was adopted.
At MNA’s 2008 convention, a vote passed authorizing MNA leadership to “participate as architects of an independent
national nurses union run by and for nurses.” *source: www.massnurses.org
The California Nurses Association (CNA) left ANA in 1995 and eventually formed the National Nurses Organizing
Committee (NNOC). In 2008, the United American Nurses (UAN) and labor arm of ANA which is affiliated with the AFL-
CIO also disaffiliated from ANA.
In October, MNA members will vote whether to join CNA/NNOC and UAN to form a new national nurses union which
would have 150,000 members.
Five Core Objectives
The five objectives of this super union would include:
To build a movement to defend and advance the interests of direct care nurses and patients everywhere.
To unite and organize all direct care nurses into a single organization capable of exercising maximum influence over
the health care industry, governments and employers.
To win health care justice: accessible, quality health care for all, as a human right.
To provide effective collective bargaining representation to UAN/NNOC members and support to UAN/NNOC affiliates
to promote the economic and professional interests of direct care nurses.
To advocate for direct care nurses and patients on all public policy matters related to safe care and nursing practice,
including safe nurse-to-patient ratios and patient advocacy rights.
Even if you are not working in an MNA-represented facility, you should be aware of this potential new Super union. It
has been said by author Suzanne Gordon and others that nurses do not publicize what they do or use their potential
power as a group. This union could change that.
Please see www.massnurse.org for the source for this article as well as for further information.
Governmental Affairs
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Governmental Affairs Director
Anne Halliday, BSN, RN, CPAN
Welcome to the Governmental Affairs web page.
The mission of this web page is to keep
members and viewers informed about state
legislative activities.
The governmental affairs articles that are
published in the Mayflower will be posted here
as well.
In addition, there is a link to the ASPAN
governmental affairs web site, which will contain
legislative activities at the federal level.
www.aspan.org
To go to ASPAN Governmental Affairs:
click on "Resources" then "Legislative Resources" near the
bottom of the pull-down menu.
Governmental Affairs Archived Page - Maureen McLaughlin
Governmental Affairs Archived Pages
Anne Halliday, BSN, RN, CPAN
Welcome to the Governmental Affairs web page.
The mission of this web page is to keep
members and viewers informed about state
legislative activities.
The governmental affairs articles that are
published in the Mayflower will be posted here
as well.
In addition, there is a link to the ASPAN
governmental affairs web site, which will contain
legislative activities at the federal level.
www.aspan.org
To go to ASPAN Governmental Affairs:
click on "Resources" then "Legislative Resources" near the
bottom of the pull-down menu.
Governmental Affairs Archived Page - Maureen McLaughlin
Governmental Affairs Archived Pages
Mayflower Fall 2011 Volume 22 Issue 4