The International Nurses Society on Addictions (IntNSA) believes that nurses are key to improving the well-being of individuals affected by problematic substance use, including their families and friends and the society within which they live. It is essential that nurses are able to effectively influence change at local, organizational, systems, national, regional, and international levels. Historically, IntNSA has drawn its membership from within the United States, reflective of its origins as a national organization (i.e., National Nurses Society on Addictions). However, in recognition of the potential for a wider international impact, members voted to formally expand its membership and status to international in 2000. In 2014, when members elected its first international member to the Board, the international work of the Board increased in momentum with the establishment of an International Development Task Force, which was given the following mandate:
- 1. Explore IntNSA's international position with respect to membership outside North America, including IntNSA's branding as it relates to a wider global audience, and perception of IntNSA's role and offer to the wider global nursing community.
- 2. Position IntNSA to widen its membership and growth to include chapters that are outside North America specifically.
- 3. Support IntNSA to develop a long-term and sustainable model/framework that supports Objectives 1 and 2.
The above mandate was approved by the IntNSA Board at its annual retreat in 2015, with an overarching objective and ambition to increase opportunities for nurses across the world with an interest in addictions care, education, research, and policy to share, network, and collaborate and, by doing so, “change and shape” the response to addictions prevention, treatment, and recovery approaches at local, national, and international levels. At its annual strategic planning retreat in April 2019 in Atlanta, IntNSA's Board reviewed progress on the above and developed consensus for further ensuring that IntNSA can achieve its mission.
DEVELOPMENTS BETWEEN 2015 AND 2019
Since 2015, IntNSA has increased its “footprint” globally with the following country chapters established:
- Ireland (2015)
- The Netherlands (2015)
- Brazil (2016)
- Canada (2016)
- United Kingdom (2018)
- Nigeria (2019)
- Portugal (2019)
- Tanzania (2019)
On the international level, IntNSA has reached out and is currently in negotiations with India, Oman, the Philippines, South Africa, and Thailand. In addition, IntNSA is currently negotiating Memoranda of Agreement with other addictions nursing groups, including the Drug and Alcohol Nurses of Australasia (https://www.danaonline.org/about/) and the Japanese Society for Study in Addiction Nursing (http://plaza.umin.ac.jp/~jaddictn/index.html). Although both of these groups have an established history in representing addictions nursing in their geographical areas, they also recognize the value of strength in numbers and have indicated interest in working with IntNSA to magnify the “global voice” of addictions nursing.
The above developments are running in parallel with ongoing efforts to increase U.S. State Chapters. We are fortunate to have launched three new chapters in 2018, now bringing the number of U.S. State Chapters up to 11:
- California (2018)
- Florida (2018)
- Minnesota and Western Wisconsin
- North Carolina
- Southeastern Pennsylvania
- Tri-State (Ohio, Indiana, and Kentucky)
- West Virginia (2018)
Drug and alcohol problems are prevalent in rich and poor countries alike, and other forms of behavioral problems including gaming, gambling, sex, and food also have severe consequences. How these problems present and are responded to (politically, economically, socially, and medically) varies from country to country and region to region. Therefore, in building a “membership model” that will reflect members' interests, IntNSA acknowledges the need to recognize and maintain cultural, political, economic, and environmental profiles, which characterize where IntNSA members are practicing. Hence, IntNSA has decided to map to the World Health Organization's (WHO's) six regional groups:
- African Region
- Region of the Americas
- Southeast Asia Region
- European Region
- Eastern Mediterranean Region
- Western Pacific Region
In 2018, IntNSA launched the European Region (its first region) at the 10th ICN Nurse Practitioner and Advanced Practice Nurses Congress in Rotterdam (https://www.intnsa.org/news/launching-intnsa-europe/).
PARTNERSHIPS THAT GROW THE MEMBERS' VOICE
As IntNSA grows globally, so does the voice of its membership. This is an exciting opportunity and important next step for IntNSA. As an organization, IntNSA has moved to establish direct relationships with key groups that share IntNSA's vision and mission, including the American Nurses Association (ANA; https://www.nursingworld.org/ana/) and the International Council of Nurses (ICN; https://www.icn.ch; see Table 1).
IntNSA is an “Organizational Affiliate” of the ANA (a specialty nursing organization with organizational-level membership). This allows IntNSA to maintain its autonomy as a specialty nursing organization, while addictions nurses and the patients we serve benefit from the “shared voice” of the ANA, one of the largest professional nursing organizations in the world. Founded in 1896, the ANA represents 4 million registered nurses in all 50 states and U.S. territories. Our relationship with the ANA provides a shared platform for speaking on behalf of health care issues and opportunities to share information and collaborate to improve quality and find solutions for our specialty of addictions nursing (https://www.nursingworld.org/ana/org-affiliates/).
As an Organizational Affiliate of the ANA, IntNSA has an application pending to become a “Specialist Affiliate” of the ICN for addictions nursing (https://www.icn.ch). The ICN is a federation of more than 130 national nurses' associations, representing more than 20 million nurses worldwide. Founded in 1899, the ICN is the world's widest reaching international organization for health professionals. Operated by nurses and leading nurses internationally, the ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and a worldwide presence of a respected nursing profession and a competent and satisfied nursing workforce.
Specialist Affiliation status with the ICN will enable IntNSA to collaborate with nurses from all over the world and will provide opportunities for IntNSA to have ICN representation with other organizations on the international stage, such as the WHO and the United Nations. Importantly, Specialty Affiliation status with the ICN will help IntNSA to fulfill its vision of truly being “a global leader in addictions nursing.”
As part of IntNSA's launch of the European Region in 2018, the European Specialist Nurses Organization (ESNO) formally invited IntNSA to become a member of its network, which promotes and contributes to the health and well-being of Europeans by facilitating and enabling the political voice of specialist nurses. Through collaboration with key stakeholders, the professional status and evidence-based practice of nursing specialties are strengthened. ESNO aims to secure the recognition of specialist nursing in the European Union (EU) and greater Europe (https://www.esno.org/index.html).
These relationships are significant “game changers” for IntNSA, as they open a formal dialogue channel, with key nurse leaders who are working to shape health policies, and influence nurses' educational preparation, regulations, and professional practice. As an Organizational Affiliate of the ANA, a Specialist Affiliate of the ICN (the first in the area of addictions nursing), and a member of ESNO, IntNSA will have greater opportunities to advocate for policies that directly impact on communities of practice. IntNSA's membership in these organizations amplifies these effects, draws members to our organization, infuses our Society with new ideas and approaches, improves our cultural competence, and helps IntNSA to realize change.
There are two categories of chapters: (a) national chapters and (b) state chapters. a “national chapter” acts as a single point of access and coordination for a single country (e.g., The Netherlands, United States). However, in the case of a country that is geographically large and/or diverse, the national chapter can agree to exercise an option to have state chapters that meet and represent local needs. These local/state chapters will be governed under the auspices of the national chapter.
It is recognized that, as IntNSA is in “transition,” countries with “state chapters” (e.g., currently only the United States) will require a time to adjust. For example, historically, it has not been a requirement that state chapter members be full members of IntNSA. The IntNSA Board has voted and agreed that, going forward, members of new chapters (irrespective of being at the state or national level) will be required to become members of the main IntNSA organization. To ensure that existing state chapters are “fit for purpose,” IntNSA will be moving into a period of consultation with current state chapter presidents to explore how this alignment can be facilitated.
Ensuring regional representation, each national (country) chapter will be “allocated” to their corresponding region, as described above. Once IntNSA's regions reach a critical mass, national chapters will be invited to establish a Regional Board, which will represent the interests of each national chapter that operates within that regional boundary. In the case of the European Region, representatives from the national chapters (e.g., The Netherlands, Republic of Ireland, United Kingdom, Portugal) would sit on the Regional Board and determine through nominations who would act and speak on the region's behalf (e.g., through a Regional President). Similarly, in the case of the region called “the Region of the Americas,” which currently is composed of the United States, Canada, and Brazil, the Region of the Americas will determine the membership of their Regional Board and will nominate and elect their Regional President.
All Regional Presidents will subsequently take a place on IntNSA's International Board. This Board will be the overall governing board with an elected International President and will interface at the level of the ICN, WHO, United Nations, and other similar international organizations. Membership of the International Board will be via elections involving each of the Regional Boards (see Figure 1, which offers an example of how the different levels will work and interact with each other, and Table 2, which lists ways this global expansion plan may be operationalized at the national chapter and regional/international levels).
RECONSIDERATION OF MEMBERSHIP DUES: NEW INTERNATIONAL FEE STRUCTURE ADOPTED
One of the key drivers for any organization to grow globally is to ensure that membership is accessible and equitable. To date, IntNSA membership dues have been aligned with fees charged to nurses working within the United States. Reflecting the overall financial stability and success of IntNSA, in 2019, the IntNSA Board voted to reduce the regular membership rate from $200 to $150.
However, because IntNSA has begun to grow internationally, IntNSA members have shared that current fees/dues have the potential to unintentionally prohibit nurses who reside in countries in which nursing salaries are considerably lower from joining. Thus, at its April 2019 annual strategic planning retreat, the Board made a decision to introduce a new membership fee structure, adopting new membership rates based on gross national income per capita (in current US$) calculated by the World Bank or International Monetary Fund gross domestic product per capita data when a country is not included in World Bank gross national income data. These data are used by other nursing organizations, such as Sigma Theta Tau (see Table 3).
While the above changes will offer a significant incentive for new members from lower income countries, the Board has received feedback addressing concerns of members residing in “high-income countries” (e.g., United States, Ireland, Canada), who, because of stage of career, qualifications, nursing position, personal circumstances and/or interests, may only be interested in some of the benefits offered through membership (e.g., networking/connecting with like-minded addictions nurses). The Board acknowledges that further work is required to explore additional changes to the fee structure that will align with a range of membership benefits. Therefore, the Board is currently conducting a risk analysis to explore the impact of introducing a stratified fees/dues structure that offers different levels of membership benefits.
Branding/image is singularly one of the most important activities going forward so that the benefits of IntNSA membership are known and understood. IntNSA has invested in this area and will continue to do so, in redesigning the IntNSA Web site, our social media platforms, and our branding. This is to ensure that our brand is reflective of our focus (i.e., international) and maximizes the benefits of the digital age and our ability to outreach, connect online, and build a more inclusive and active online “community of practice” (e.g., using social media tools).
FUTURE STEPS FOR INTNSA
In 2019–2020, the IntNSA Board will continue to work on operationalizing the above structure. The current actions are underway:
- IntNSA will explore and risk assess the membership fees associated with the sector membership model before moving forward.
- Current state chapter members are not mandated to be IntNSA members. The IntNSA Board will be engaging in discussion with all state chapter presidents on how the benefits of membership can be aligned so that all members will become IntNSA members.
- IntNSA will explore cost implications for expanding the subscription of the Journal of Addictions Nursing to countries outside its current distribution zones.
- IntNSA will revise its bylaws, specifically those addressing membership categories and fees, as influenced by (a)–(c) above.
- IntNSA will progress with its application to become a “Specialist Affiliate” of the ICN.
- IntNSA will continue to ensure and safeguard “buy-in” from other existing addictions nursing groups that have an established organization with members in their region/country and explore the “push/pull” factors from the perspective of these organizations to join/align with IntNSA.
We believe that these described strategies will ensure that IntNSA will achieve its stated vision “to be a global leader in addictions nursing” and accomplish its mission “to advance excellence in addictions nursing practice through advocacy, collaboration, education, research and policy development” (www.intnsa.org).
We will continue to use the Journal of Addictions Nursing's Policy Watch column to provide transparency about IntNSA's annual strategic planning efforts and updates about its future accomplishments. Our aim is to keep current and potential IntNSA members, our agency partners and interdisciplinary colleagues, and nurses in all specialties, including addictions nurses, informed about this important work. To fully appreciate these efforts, please check out our new Web site and https://www.intnsa.org/ and a short film on how “addiction nurses save lives” (https://www.youtube.com/watch?v=t5hwUGf1fA8\).