1. Myers, Carole R. PhD, RN, FAAN


The organization determines candidate endorsement is no longer beneficial.


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The landscape related to U.S. presidential elections has changed significantly since the House of Delegates of the American Nurses Association (ANA) adopted a presidential candidate endorsement resolution in 1984. The endorsement process initially paid dividends in terms of access, engagement, and visibility to nurses and the nursing profession. But over time these dividends diminished, prompting calls by state nursing associations for an examination of the ANA's experience with the endorsement process and its alignment with the organization's mission and national policy agenda.



The resolution passed by the 1984 ANA House of Delegates required the ANA to develop a procedure for endorsing presidential candidates and report back to the 1985 House of Delegates. The procedure adopted in 1985 stipulated that an endorsement process be conducted every four years, with the board of trustees of the ANA political action committee (ANA-PAC) recommending to the ANA board of directors whether to endorse a presidential candidate. The board of directors was not obligated to make an endorsement. However, the ANA did endorse a candidate in every presidential election from 1984 through 2016.1 (Its first presidential endorsement was of the Democratic Mondale-Ferraro ticket, which preceded development of the endorsement procedure because of the unprecedented appearance of a woman on a major party presidential ticket and a sense of urgency about several policy issues.)


Benefits of the policy. The ANA presidential endorsement process was designed to be nonpartisan and to serve the ANA's interests in several ways:


* by providing each candidate a questionnaire that included aspects of the association's policy priorities


* by fostering policy alignment between the ANA and the endorsed candidate


* by enhancing relationships with the endorsed candidate, campaign staff, and the future administration, thereby providing an avenue for nurse appointments to key federal posts


* by increasing the ANA's visibility and members' engagement in federal elections and policy making



During this time period, there were nine presidential elections. ANA-endorsed candidates prevailed in four.



Over time, several factors have altered the value of the ANA presidential candidate endorsement process.


A smaller ANA, plus a shift in member party affiliations. The disaffiliation from the ANA of state nursing organizations in states like California with a strong nursing union presence has resulted in a significant loss of members, decreasing ANA-PAC contributions and involvement in presidential elections.2 Partly as a result, the overall profile of ANA members' party affiliation has shifted; now the ANA as well as its state associations have more members who identify as Republican than Democrat. This demographic shift is particularly relevant considering that all U.S. presidential candidates endorsed by the ANA have been Democrats. While these endorsements have been made based on candidates' support of ANA policy positions and not party affiliation, the ANA's endorsement track record has caused discord in recent years.


Relaxation of campaign finance laws. In addition, U.S. campaign finance laws and practices have changed dramatically since the Supreme Court's 2010 Citizens United decision, which removed limits on independent campaign spending by corporations and unions.3 A subsequent decision in 2014 eliminated limits on allowable contributions from individuals.4 This, in turn, paved the way for the ascendency of Super PACs-which are permitted unlimited political spending independently of individual campaigns-resulting in a major shift in the dynamics of presidential elections. Because candidates have shifted their campaign focus to high-donor individuals and organizations, the ANA can no longer compete in this new high-contribution environment. This has been evidenced by declining ANA-PAC contributions and increasing difficulty in getting candidates to respond to ANA requests for information or meetings.



The 1984 ANA Presidential Endorsement Policy was rescinded by a vote of the 2019 Membership Assembly (the successor to the ANA's House of Delegates) and replaced by a new ANA Presidential Election Engagement Policy.5 The ANA is not retreating from promoting engagement in presidential elections. This policy recognizes the ANA's responsibility and commitment to providing easily accessible, fact-based information on each presidential candidate. The goal is to enable nurses, nurse advocates, and the public to make informed voting decisions. Resources, including getting-out-the-vote information, will be made available and the ANA will continue use of the successful #NursesVote Action Center ( In addition, presidential candidates will be informed about the ANA and the organization's policy, regulatory, and legislative priorities, and the ANA will facilitate grassroots advocacy and outreach related to these priorities.


A new way forward. The new ANA Presidential Election Engagement Policy acknowledges the ANA's changing political processes and positions the organization to be relevant today and in the future while also promoting good organizational stewardship. The new policy emphasizes the ANA's commitment to the provision of dedicated resources and recognizes the plurality of ANA members and the nursing workforce. To be relevant, policy must be dynamic, responsive, and evidence based.




1. Underwood PR, Agnos IC. A historic endorsement. Am J Nurs 1984;84(10):1199-1200. [Context Link]


2. Fracture and reunion as nurses unions shift alignments. 2013 Apr 3. [Context Link]


3. SCOTUSblog, Supreme Court of the United States blog. Citizens United v. Federal Election Commission. 2019. [Context Link]


4. Supreme Court of the United States. McCutcheon et al. v. Federal Election Commission. April 4, 2014. Washington, DC 2014. [Context Link]


5. American Nurses Association. Immunization, human trafficking, ethics among top issues at ANA Membership Assembly [press release]. 2019 Jun 22. [Context Link]