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Advocacy: A lifetime commitment


Leading nurses through crisis, disaster, and everyday practice.

Texas Nurses Association (TNA) CEO Cindy Zolnierek, PhD, RN, CAE, started her nursing career at a small rural hospital in northern Michigan, served as a full-time professor, and held leadership positions in hospitals in Michigan and California. At every step of her career, she took on volunteer advocacy roles with nursing organizations. The American Nurses Association (ANA) spoke with Zolnierek about her commitment to advocacy.

How did your career path lead you to advocacy?

In nursing school at Mercy College (now the University of Detroit Mercy), I took a course called women, policy, and power that had a big influence on me. I believe that we, as nurses, have a responsibility to our profession. That’s why I’ve always been active in my professional associations.

I got involved with TNA as director of practice in 2007. In that role, I had the opportunity to influence the care given by every licensed nurse in the state. As nurses, that’s what we hold near and dear; we want to make a difference in people’s lives. When the long-time executive director of TNA retired, I was selected as executive director in 2013, then became chief executive officer (CEO) in 2018. I feel like it’s the perfect culmination of my career.

What leadership lessons did you take away from the Ebola crisis and Hurricane Harvey?

The lesson I learned during the Ebola crisis is that when the community is afraid, the media frequently will look for someone to blame. The Dallas nurse who saw our first Ebola patient noted in the electronic health record (EHR) that the patient had traveled to a country where Ebola was present. Unfortunately, that data didn’t appear when the physician looked at the EHR, so the patient was released.

In a live interview I gave on a national network about that situation, the interviewer kept suggesting that it was the nurse’s fault. I had to be very mindful to stay on message. It’s not useful to blame the nurse for not doing more when it was the EHR system that failed.

During Hurricane Harvey, our efforts were largely focused on directing nurses who wanted to volunteer to the state’s emergency response registry so they could be sent to where they were needed. Some of these nurses were stranded at their hospital work sites for days, unable to care for their own loved ones and property while caring for others. To help support them, the Texas Nurses Foundation raised money with small to large donations from all over the country.

How can nurses develop their advocacy muscle to advance professional practice?

Nurses understand patient advocacy but may not see the importance of applying their advocacy skills to the policy realm. But that’s how you improve patient care—by improving the nursing practice environment through broader advocacy.

The best opportunity for nurses to get involved is through their professional associations. I recommend that nurses attend their state association’s lobby day or Hill Day at the U.S. Capitol. That’s a pivotal event that inspires nurses to champion issues such as workplace violence and full practice authority.

What can leaders do to foster growth in their Constituent and State Nurses Association (C/SNA)?

Nurse leaders should talk about the specific value their C/SNA brings to the profession. Nurses have certain protections because of their state association’s advocacy. In Texas, we constantly work to strengthen our practice act and have fought against harmful changes that others wanted to make. I tell nurses they should belong to both specialty and umbrella organizations. ANA and state associations together take care of things that affect all RNs.

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