Nursing Network

ANA Massachusetts is the premier organization representing the interests of the Commonwealth's more than 130,000 registered nurses. We are the largest voluntary professional nursing organization in the state, with members who practice in settings ranging from acute care to community health, from the bedside to the boardroom. Since 1896, ANAMASS members have helped define, regulate, and improve nursing to the benefit of nurses and patients in Massachusetts.

On July 1st, I officially began my two-year term as ANAMASS President. I am deeply honored and humbled by the opportunity to lead this valued organization and serve the dedicated nurses of Massachusetts.

Allow me to share a bit about my background and experience. I have been a Registered Nurse for over 30 years, a journey that has continually opened new doors and opportunities. I graduated with a BSN from Boston College on an Army ROTC scholarship and served in the Army Nurse Corps for five years at Walter Reed Army Medical Center in Washington, DC. Following my service, I worked as a Travel Nurse in Boston and DC, eventually settling at MGH and Tufts Medical Center. I earned a Master's in Nursing Administration from Northeastern University in 2005 and a Doctor of Philosophy from Endicott College in 2022. My career has included roles in Quality & Safety and Professional Development over the past 20 years. In 2022, I became the Nurse Director for Quality, Safety, & Professional Development at Newton-Wellesley Hospital, and my role has since expanded to Senior Director for Nursing Education, Quality, Research, and Innovation for the Mass General Brigham Community Hospital Division. I am board certified in Professional Development and as an Advanced Nurse Executive. None of this would have been possible without the unwavering support of my husband Pete and our two children, Megan and Jamie. I am also deeply grateful to the incredible mentors who have guided me along the way.

I joined ANAMASS in 2022 after attending the Spring Conference in Sutton, MA, where I presented my dissertation in a poster presentation. My research focused on health-promoting self-care practices among nurses and their perceived incidence of presenteeism. The health and wellbeing of nurses, and their ability to be authentically present and cognitively engaged in patient care, remain foundational to my professional practice. Inspired by the incredible ANAMASS team and the organization's offerings, I quickly became involved in the Professional Development Committee and the Board of Directors.

Over the past year as President-elect, I have attended the American Nurses Association (ANA) Leadership Summit, ANA Hill Day/Membership Assembly, and worked alongside Silda Melo, who transitioned from President to Immediate Past President. These experiences, combined with my background as an Army Nurse, Clinical Nurse, Nursing Professional Development Specialist, and Nurse Leader, have prepared me well for this role.

On behalf of ANAMASS, I would like to express deep gratitude to President Melo for her contributions to advancing nursing in Massachusetts. President Melo began her involvement in ANAMASS as a newly graduated RN Director, one of two New Grad positions on the Board of Directors, and advanced to the role of President. During her tenure, she lobbied, advocated, and testified for numerous issues critical to our nursing workforce across the Commonwealth. Through her dedicated leadership and years of advocacy, Massachusetts became one of 43 states in the US to approve the Nurse Licensure Compact (NLC). When Governor Healey signed the legislation adopting the NLC in November 2024, it enhances nurses' mobility to practice across state lines, increases access to care, and improves patient protection through standardized licensing requirements. I applaud President Melo for her hard work in achieving this monumental accomplishment.

The nursing profession is facing challenging times, with many legislative challenges ahead. ANAMASS Health Policy Committee Members and Membership Assembly participants spent a full day on Capitol Hill meeting with Massachusetts legislators and their aides, lobbying and advocating to ensure they fully understood the impacts of the proposed Medicaid reforms outlined in the Big Beautiful Bill. Despite leaving over 450 stethoscopes as reminders, the Senate and House of Representatives passed the bill, which was signed into law on July 4th. As a result, reduced Medicaid funding will undoubtedly impact healthcare jobs, wages, and uncompensated care, while potentially increasing nursing workloads by caring for patients with higher acuity. Currently, Medicaid funding supports the demand for nurses, sustains jobs in home care, long-term care, and community settings, and provides payment for safety net hospitals where many Massachusetts nurses are employed. This is where the power of nurses, the power of our voices and our advocacy---to do what we know is best for patients, families, and communities---becomes critically important.

The journey ahead is uncertain, but together, nurses have the power to drive change, advocate for those we serve, and be transformative. I look forward to advancing nursing practice across our Commonwealth and am grateful for the opportunity to work alongside all nurses in Massachusetts.

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July 2025 marked the publication of the updated NCPD criteria. The most significant change in the requirements is a new emphasis on standards of practice and related competencies. The concept of competency can cause confusion, as practicing nurses often associate competency development with orientation and annual competency check-off sheets. The NCPD reference to standards and competency, however, refers to professional standards of practice as developed by one of the many nationally recognized professional associations. These standards guide practice and are based on research and peer review.

Competency standards provide a solid foundation for ongoing growth in nursing. They help nurses recognize areas for development and assist in setting clear learning goals, inspiring continuous improvement and excellence in their practice. Both clinical and academic nursing should be rooted in these professional standards; however, many nurses are unaware of their existence. Continuing Nursing Professional Development programs based on such standards promote better practice and support the professional growth of participants.

By fostering a deeper understanding of these standards, nurses are empowered to take ownership of their professional growth and align their ongoing education with the evolving expectations of the field. Embracing these benchmarks not only strengthens individual practice but also improves collaboration within healthcare teams, ensuring that all members work toward a shared vision of excellence.

Furthermore, as healthcare advances and patient needs grow more complex, the ability to adapt practice based on established standards becomes even more essential. Nurse educators and planners are encouraged to integrate competency-based outcomes into professional development activities, ensuring that learning remains relevant and impactful.

Ultimately, this renewed focus on standards positions NCPD as a dynamic, evidence-informed discipline capable of meeting the challenges of modern healthcare while upholding the highest standards of patient care and professional integrity.

The ANA Mass accredited approver unit's annual symposium will offer a platform to review standards from various professional organizations, help nurse planners incorporate these standards into their planning, and provide an opportunity to learn about the documentation requirements for educational programs.

Did you ever think that it would be helpful to have a nurse on the governing board of your hospital or nursing home? Or that some organization needs to work on the growing shortage of nurses in all of our Massachusetts health facilities? Well, your ANAMASS Health Policy Committee also does, which is why we have worked with state legislators to introduce two important bills in the Massachusetts legislature this year. Read on to see how you can help get them passed!

The first is a bill we initially introduced during the last legislative session in 2023 (bills rarely pass on the first go-around, so this was not unusual). It recognizes the critical role that nurses play in not only understanding patients' needs on a day-to-day basis, but the fact that this information should be transmitted directly by a nurse, the best primary source of this information for any governing body of a health care institution. Who better than a RN to inform others making critical decisions about how to best attain optimum patient outcomes? Senate Bill 1572/House Bill 766 requires that a RN participate in "developing the organization's strategic plan, structure, systems, policies and programs". The bill initially passed the first stage of legislative consideration by being passed out of committee last time; this time, it needs to go the whole way to enactment.

The second bill is Senate Bill 1543/House Bill 2397, An Act establishing a nurse workforce center, proposed for the first time this year. Actually, the Nursing Council on Workplace Sustainabilty (NCWS) already exists in our state, but does not have guaranteed funding. The NCWS does remarkable work to engage numerous stakeholders in an effort to retain current nurses in all care settings, facilitate education of new nurses and attract younger persons to the nursing profession. But since its continuation is not guaranteed, all those activities could be at risk without dedicated funding enacted by the legislature. That is the goal of this legislation so continuing work can stabilize the nursing community needed to adequately care for Massachusetts residents. To learn more about NCWS, go to https://www.ncwsma.org/

Although we are waiting for the public hearing so we can verbally advocate for the legislation requiring a RN on the governing board of every acute care hospital and nursing home in the state, the hearing for NCWS dedicated funding just occurred at the time of this writing. Our ANAMASS President, Silda Melo testified along with Jay Prosser, Executive Director of the NCWS and delivered convincing remarks on the need for bill passage. You can view their recorded testimony at https://malegislature.gov/Events/Hearings/Detail/5236 - advance the recording to 1 hour, 14 minutes of the recording as Chairwoman Marjorie Decker introduces the testifying panel..

So, what can you do? First, acquaint yourself with the bills at the state legislative sites - https://malegislature.gov/Bills/194/H766 and https://malegislature.gov/Bills/194/H2397. Then, contact your state Representative and Senator and urge them to support and vote to enact these bills when they reach the House and Senate floors. If you feel that you need help to complete these tasks, join us at the Statehouse on September 30th when we will be sponsoring our Lobby Day to accompany groups of Massachusetts nurses as we visit several state Representatives and Senators or their staffs in person. We always come away from Lobby Day enthused and proud of our efforts to advance nursing and the health of our co-citizens when the day is over. Register at the ANAMASS website HERE. We look forward to seeing you!

For as long as I can remember, I wanted to be a nurse. My aunt was a Neonatal ICU nurse and lived in California, so her life seemed fascinating to me. I have a picture of me holding the toy nurse's kit I received for Christmas when I was about eight years old! My closest friend also wanted to be a nurse, and we were accepted into the same college. We commuted together throughout my first year, and we thought we could continue our relaxed summer of '73 lifestyle into the academic year. I got B's and C's during that first year, and my friend couldn't continue in the program. I decided to buckle down and give it my all, so I applied to live on campus. By the time I reached my senior year, my fellow students referred to me as a "grade monger." I wanted only A's and was passionate about my profession.

My favorite specialty was also the class with the toughest professor. She used the Nelson Textbook of Pediatrics like a bible, and she lectured on each specialty area and illness in detail. I took copious notes, and after class, I reviewed them, underlining the important points. When it was time for our clinical placement, we all went into the hospital the night before, read our assigned patient's chart thoroughly, and made a list of every medication they were being given. Once I returned to the dorm, I looked up each medication so that I could give a concise summary of the patient's nursing needs and answer every conceivable question she could ask me.

I graduated from college with the certainty that Pediatric Nursing would be my area of specialization. I was also confident that Psychiatry would be the last field that I would ever work in. My first job was on a small pediatric unit, and I began caring for an infant who was under a year old who had severe Hydrocephalus. His head had become so enlarged from the condition that it was difficult to hold him for feeding. I became attached and also realized that his prognosis was not good. Then we admitted a seven-year-old boy who was diagnosed with a serious type of Leukemia. The very idea that these beautiful children were going to die shocked me. I was so young and just couldn't handle the emotions welling up in me. I had been accepted into graduate school for the next semester, specializing in Pediatric/Maternal Health Nursing, so I sought a part-time night shift job on the weekends.

The hospital where I found that job was very close to my home, and I had never known it existed. It was Bradley Hospital, a child psychiatric hospital tucked into a wooded section of East Providence, Rhode Island, and one of the few in the country. Eventually, I became uncertain about my chosen specialty, left graduate school, and started working there full-time on the day shift, with rotating evening shifts. With the mentorship of the Director of Nursing, I realized that child psychiatry was a great specialty for me. I returned full-time to graduate school and got my degree in another two years. I was soon a blossoming child and family therapist and worked in that specialty for a year and a half, when an opportunity of a lifetime presented itself.

I joined a friend of mine who was traveling around the world for what turned out to be a four-month trip through India. When I returned, I needed a job, and there was nothing available for a child therapist at the time. After much deliberation, I approached the recruiter at Boston Children's Hospital to ask about working on a medical-surgical unit during the interim. I met with a wonderful Nurse Manager named Sally Pasternak, who was impressed with my credentials but said she only had a staff nurse position. I explained that I would be incredibly happy with that and explained what had happened the last time I worked in Pediatrics. I told her I felt I was more emotionally mature and able to manage the stress of working on her medical unit, one that focused on the treatment of children with Cystic Fibrosis (CF). I was honest and said I would need to learn some medical skills, and I couldn't give her a long-term commitment. I knew that if a position in my specialty became available, I would need to leave, but would work diligently to be of value to the unit while I waited for that. We agreed, and I started working day-night rotations, which were grueling.

I stayed on that unit for six months before a friend called me and let me know about a position working at a youth guidance clinic in Framingham. During my time at Children's, I mastered a lot of medical skills such as administering IV antibiotics, helping respiratory therapists, and watching for signs and symptoms of CF complications and adverse reactions to medications. One day, I was able to identify an obscure side effect of a gastrointestinal medication, a dystonic reaction, because it was one that is common in Psychiatry. It felt great to be able to give back to my nursing colleagues who had taught me so much (and I liked the fact that they were all impressed and wondered how I recognized it!). Most of all, I spent many, many hours at the bedside of young people whose CF had shifted into end-stage disease. I talked with them about impending death, prayed with them, and faced the fears that had sidelined me earlier in my career. I have supported the CF Foundation since I had that experience and am pleased that many who have the illness today can expect much longer life spans than they did in the 1980s.

I have often heard nurses speak in absolute terms about nursing roles, seeming to elevate or denigrate various experiences and positions. Some said medical-surgical experience was essential, and some quickly judged that certain specialties were "not their thing." I thought that psychiatric nursing wasn't for me, and that turned out to be quite mistaken. I am glad I chose the specialty that I did and pleased that I had the courage to seek out an experience that frightened me. I'm so grateful that I was given the opportunity to go back for a "do over" and felt that I achieved a level of mastery over my fears of working with terminally ill children. It was an experience that helped me greatly as I moved forward in my career.

Janet Ross, MS, RN, PMHCNS-BC

The New England League for Nurse Educators (NELNE) is pleased to announce the awarding of this scholarship to Danielle Tortora, MS, RN.

Danielle earned her baccalaureate degree in nursing from the Boston College Connell School of Nursing (2017) and an MS in Nursing Education (May 2025) from Emmanuel College Maureen Murphy Wilkens School of Nursing & Clinical Sciences, Boston.
A registered nurse since 2017, Danielle began her nursing career at Brigham and Women’s Hospital, Boston, on a thoracic surgery step-down unit. Most recently, she accepted a Clinical Nurse Educator position at Lahey Hospital and Medical Center, Burlington, while continuing part-time employment as a clinical and lab instructor at Emmanuel College, Maureen Murphy Wilkens School of Nursing & Clinical Sciences, Boston.

We recently had the pleasure of talking with Danielle about her MS in Nursing Education, and how the NELNE scholarship supported her education. In reading this transcript, it is evident that Danielle is a dedicated nurse educator who is most deserving of this scholarship.

When asked about the moment she decided to pursue a Master of Science in Nursing Education, and what may have been the driving force behind this decision, Danielle responded:

“I didn’t really see myself going back for graduate studies, but after COVID, in about 2022, I felt like I wanted to do something more. I loved patient care, and really enjoyed teaching, and my favorite part of the job was precepting new nurses, teaching my patients, and really simplifying things that might otherwise be difficult for someone to understand. I had always been told that I was able to make complex concepts comprehendible, so I decided to pursue a master’s degree in nursing education.”

In exploring the significance of this scholarship, Danielle was asked what she thought the scholarship committee saw in her that supported their belief in her potential as a nurse educator?

Danielle agreed that receiving this scholarship was a personal achievement, and responded, “I think in reading my application narrative, they recognized I was multifaceted, and a very well-rounded nurse educator who was eager to learn. I also think the letter of support written by
Dr. Carol Femia, Chairperson of the BSN program at Emmanuel College Maureen Murphy Wilkens School of Nursing & Clinical Sciences, Boston, was influential. She has been such a guiding light for me by supporting my first education roles as clinical and simulation lab instructor and recognizing my commitment to mentoring and educating nursing students.”

When asked how she envisioned this advanced degree impacting her long-term career goals and contribution to the nursing profession, Danielle responded:

“Well, I’ve just started a new position as a nurse educator at Lahey Hospital and Medical Center, Burlington, on the night shift. This is a great opportunity to join a team of nurse educators who serve as a resource to nurses on all shifts, every day. I also see myself becoming more involved with research, conducting quality improvement projects, and maybe even research studies in the future. In the long term, I may consider continuing my nursing education with a DNP or PhD, but for now, I want to support nurses in their practice.”

In closing, Danielle was asked what she anticipates as the greatest challenge she will face as a nurse educator, whether in academia or a practice setting. Danielle responded:

“In my new nurse educator position, I am challenged to adapt to a new hospital. Although I am an experienced nurse, I am learning new policies and procedures and have created a reference binder for easy access. This is also a good way for nurses to know that I am also learning, and it’s okay not to know everything, that I think it’s important to ask questions and to continue learning.”

We congratulate Danielle Tortora on receiving this NELNE scholarship, and in completing her MS in Nursing Education from Emmanuel College Maureen Murphy Wilkens School of Nursing & Clinical Sciences, Boston.

A State Board of Nursing (SBON) complaint can be filed against a nurse by a patient, resident, colleague, employer, and/or regulatory agency. Complaints are subsequently investigated by the SBON, with Practicing outside the scope of license for a registered nurse, Failure to maintain an accurate results ranging from no action against the nurse to revocation of the license to practice nursing. This case study involves a registered nurse, who was employed as the registered nurse for a home healthcare agency to provide case management and in-home nursing.

Total Incurred: Greater than $7,500

*Monetary amounts represent the legal expenses paid solely on behalf of the insured registered nurse.

Summary

Our insured registered nurse (RN) was working for a home healthcare agency. The RN had orders from a primary care provider (PCP) to provide skilled home healthcare treatment for a patient with a variety of healthcare concerns (e.g., medication management for new diagnosis of Type 2 diabetes mellitus, congestive heart failure, nutritional education and support, and monitoring vital signs and weight). The insured was scheduled to visit the patient three times a week for 30 days. Over time, the RN developed a close friendship with the patient and patient's family and gave them her personal mobile telephone number to contact her, if needed.

The patient and family began contacting the RN with various healthcare related concerns, sometimes daily, and requests that she come to the home to assess and/or provide treatment to the patient. The RN was providing various nursing treatments and care nearly seven days a week but would only document the treatment she provided at his scheduled visits.

Over a weekend, the patient experienced an acute episode of urinary retention and sought care in a local emergency department (ED). The patient had a history of benign prostate hyperplasia (BPH) and had been taken off of his BPH medications due to his recent diagnosis of congestive heart failure. After attempting three different types of urinary catheters, the ED staff was finally successful with placing a urinary catheter into patient's bladder. The patient was discharged from the ED with instructions to restart BPH medications and to keep the urinary catheter until he followed up with his urologist. After the patient arrived home, the family contacted the insured RN and asked if she could come to check on the patient. When the RN arrived, she suggested removing the urinary catheter placed by the ED as it didn't appear to be draining properly. The patient and his family informed the RN about the difficulty the ED staff had with inserting the urinary catheter but agreed with trying a new catheter, if the insured thought it was necessary. The RN used supplies she kept in her car for home healthcare patients. The ED urinary catheter was removed, but when the RN attempted to insert a new catheter, resistance was encountered with advancing the catheter. After several attempts were made to advance the catheter past the resistance, the RN instructed the patient to go back to the ED.

The patient went to back to the ED and underwent an emergency transurethral resection of the prostate (TURP) procedure by a urologist. The ED staff contacted the insured RN's employer and informed them of the RN's actions of removing the patient's urinary catheter and of attempting to place a new catheter without an order. The ED staff felt that the RN's actions of removing the catheter were outside her scope of practice and caused further injury to the patient that necessitated an emergency TURP with hospitalization.

The supervisor noted that the RN provided skilled nursing care for over 90 days, despite the PCP's for only 30 days of skilled care. There was no documentation of a request for the PCP to update the plan of care to provide additional skilled nursing services. The RN's supervisor learned that the RN had been:

Providing skilled nursing services without a provider's order which included:
- Removing a urinary catheter and attempting to place a new catheter; and
- Treating a pressure injury that was not reported to the PCP.
Failing to document all treatment provided to the patient in the healthcare information record.
Providing meals and household supplies to the patient, which was not allowed by the employer's policies and procedures.
Checking the patient's blood sugars and administering insulin injections, despite the patient being mentally and physically able to do so himself.

The employer terminated the RN and reported the termination and internal investigation findings to the SBON.

Risk Management Comments

After reviewing the e-report and allegations made by the employer, the SBON alleged the following against the insured RN:

The RN's conduct was in violation of general duty, consisting of negligence or failure to exercise due care, including negligent delegation to or supervision of employees or other individuals, whether or not injury results (Count I).
The RN's conduct was a departure from, or failure to conform to, minimal standards of acceptable and prevailing practice for the health profession, whether or not actual injury to an individual occurs, and accordingly, incompetence (Count II).
The RN's conduct evidences practicing outside the scope of an RN's license (Count III).
The RN's conduct evidences a failure to keep and maintain a record for each patient for whom the RN has provided medical services, including a full and complete record of tests and examinations performed, observations made, and treatments provided (Count IV).

Resolution

The SBON dismissed Counts II, III, and IV against the RN. The SBON found sufficient evidence for Count I and placed the RN on probation for a minimum of one year, not to exceed three years. The terms of the insured's probation included the following:

Employer Reports:
- The nurse must provide any and all employers during the probation period with copies of the SBON consent order.
- The nurse must ensure that all employers submit a quarterly report to the SBON. The nurse's immediate supervisor is required to submit quarterly reports to the SBON on the RN's work performance, and, if at any time fails to comply with minimal standards of acceptable and prevailing practice or appears unable to practice with reasonable skill and safety, the supervisor must contact the SBON immediately.
- The nurse must be supervised at all times by a licensed health professional.
Employment Change:
- The nurse must report all employment changes to the SBON within 15 days of change.
- The nurse must make all new employers aware of the SBON required reports and provide a copy of the consent order.
Continuing Education Credits (CEUs):
- Within 180 days of the effective date of the consent order, the nurse must successfully complete 15 hours of CEUs. The course hours will not count toward the number of credit hours required for license renewal. The courses include:
  - Ethics and Professionalism in Nursing
  - Critical Thinking Skills in Nursing
  - Clinical Documentation in Nursing

The SBON matter took almost a year to resolve, and expenses incurred to defend the insured nurse in this matter exceeded $7,500.

Risk Management Recommendations

Know and comply with your facility's policies, procedures and protocols. Unfamiliarity to established policies and protocols is not a defense, especially if a clinician has acknowledged receiving education on such policies and protocols.
Ensure healthcare information record documentation is complete, objective, and consistently and accurately reflects clinical assessment and care provided as well as the patient's responses to that care.
Document your patient care assessments, observations, communications and actions in an objective, timely, accurate, complete, appropriate and legible manner. Home healthcare nursing documentation should specify:
- The reason skilled nursing is needed.
- Any recent new diagnosis, exacerbation, or hospitalization.
- Changes in the treatment regimen.
- Skilled assessments, actions taken, and treatments performed.
- Specific education provided (what was taught, to whom, learner comprehension, changes to the plan of care).

Disclaimer

The information, examples and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. This material is for illustrative purposes and is not intended to constitute a contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. Certain coverages may be provided by a surplus lines insurer. Surplus lines insurers do not generally participate in state guaranty funds, and insureds are therefore not protected by such funds. The claims examples are hypothetical situations based on actual matters. Settlement amounts are approximations. Certain facts and identifying characteristics were changed to protect confidentiality and privacy. "CNA" is a registered trademark of CNA Financial Corporation. Certain CNA Financial Corporation subsidiaries use the "CNA" trademark in connection with insurance underwriting and claims activities. This material is not for further distribution without the express consent of CNA. Copyright © 2025 CNA. All rights reserved.

"It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change."

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Title: "On the Frontlines: Addressing Workplace Violence in Health Care"

Title: "Preserving the Power of Antibiotics: Practical Strategies for Antimicrobial Stewardship"

Summary

Risk Management Comments

Resolution

Risk Management Recommendations