ENA Volunteer Group Agreements
Conflict of Interest Disclosure Statement Instructions
- Please read the following Emergency Nurses Association Conflict of Interest Policy Statement before completing the disclosure statement.
- The terms "family relationship" and "immediate family" as used herein, refer to any parent, spouse, domestic partner or child.
- The term "affiliate" means any organization that directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with the Association.
- If any item is inapplicable, answer "none" or "n/a" as appropriate.
- After completing the disclosure statement, you will be directed to the application
Conflict of Interest Policy Statement
- In general, any outside activity or direct or indirect financial interest which might, in any way, adversely influence or appear to influence an individual's judgment in the performance of his duties to ENA or any of its subsidiaries or affiliates, involves a possible conflict of interest.
- ENA recognizes that there are many situations, which give rise to a conflict of interest. It intends to approach each case objectively, giving full recognition to all attendant circumstances.
- Situations in which a conflict of interest would or might arise (and should be reported immediately to ENA) include, but are not limited to, the following:
- Involvement with the ENA's members, sponsors, donors, providers, vendors, consultants or insurers.
- Ownership of a material interest in any member, sponsor, donor, provider, vendor, consultant, insurer or other entity with which ENA, or one of its affiliates or subsidiaries, does business.
- Acting in any capacity, including as a director, officer, partner, consultant, employee, distributor, agent or the like, for any entity which does business with ENA, its affiliates or subsidiaries.
- The acceptance, directly or indirectly, of payments, services or loans from an entity with which ENA or one of its affiliates or subsidiaries does business. This includes gifts, trips, entertainment or other favors, of more than nominal value, but excludes loans for publicly-held insurance companies and commercial or savings banks at normal rates of interest.
- Misuse of information to which an officer or director has access by reason of his or her position.
- Use of such information in a manner, which is or can be detrimental to ENA's interest.
- The disclosure of or other misuse of confidential information of any kind obtained through the individual's connection with ENA.
- Interest in or position with a competitor or potential competitor.
- The ownership, directly or indirectly, by a Covered Person of a material interest in any entity which competes or might compete with ENA, or one of its affiliates or subsidiaries.
- Acting as a director, officer, partner, consultant, employee or agent of any enterprise which is in actual or potential competition with ENA, or one of its affiliates or subsidiaries.
- The Executive Director will review each completed Disclosure Statement and determine which actual, potential or perceived conflicts of interest involving a Covered Person or the editor of the Journal of Emergency Nursing must be disclosed to the board (or other committee) and which, if any, require further management. Any possible further management will be address by the board.
- The board of directors, exclusive of interested members, shall review each conflict in consultation when necessary with ENA's legal counsel, and determine whether any action, other than mere disclosure, is required. The discussion and resolution of each conflict will be recorded in accord with standard procedures for board meeting minutes.
- In some circumstances, full disclosure of the facts by the Covered Person or editor is all that is necessary to enable ENA to protect its interests, and those of its members. Should the board find, however, that proper management of a conflict of interest requires more than disclosure, additional action may be taken, including, when appropriate, recusal or even removal from a position.
- In all instances in which a Covered Person has reported that a potential conflict of interest exists with respect to a proposed transaction under board or committee consideration, that Covered Person will not be entitled to participate in discussions regarding the transaction, except to the extent specifically requested by the board or committee, or to vote. Furthermore, such transaction shall not be approved unless and until (1) the material facts of the transaction the Covered Person's interest or relationship are disclosed or known to the board or committee and (2) the board or committee authorized, approves or ratifies the transaction by the affirmative vote of a majority of disinterested board members (or committee members, as applicable), even though the disinterested board members (or committee members, as applicable) are less than a quorum.
- The presence of the board member, who is directly or indirectly a party to the transaction being considered by the board, or a board member who is otherwise not disinterested, may be counted in determining whether a quorum is present but such person's vote may not be counted when the board of directors or a committee of the board takes actions on the transaction. A board member is "indirectly" a party to a transaction if the other party to the transaction is an entity in which the board member has a material financial interest or of which the board member or a member of the board member's family (parent, spouse, domestic partner or child) is an officer, director, employee or general partner.
- Disclosure Statements are generally confidential but may be disclosed as necessary to protect the interests of ENA, and may not be used by any ENA member for his or her benefit.
I hereby state that I or members of my immediate family have the following affiliations or interests and have taken part in the following transactions that, when considered in conjunction with my position with or relation to the Emergency Nurses Association ("ENA") or any of its affiliates or subsidiaries, might possibly constitute a conflict of interest. (Indicate "none" where applicable.)
Identify any position held by yourself or a member of your immediate family in any outside concern from which ENA or any of its subsidiaries or affiliates secures goods or services or that provides services competitive with ENA or any of its subsidiaries or affiliates.
List and describe, with respect to yourself or a member of your immediate family, all investments that might be considered a "material financial interest", as described below:
- Capital stock, obligations, or a combination of both, of any concern the capital stock or obligation of which are listed on any nationally recognized securities exchange, having an aggregate value in excess of $500,000; or
- Any interest in any other outside concern, with the exception of the holding of indebtedness; or
- Holding of indebtedness of any outside concern, other than those mentioned in subparagraph A above, in any amount in excess of $100,000.
List any other activities in which you or your immediate family are engaged that might be regarded as constituting a conflict of interest, giving particular attention to activities rendered as a director, manager, consultant or employee of any outside concern that does business with or competes with ENA or any of its subsidiaries or affiliates, and to activities in which it would be possible to disclose or use information relating to ENA or any of its subsidiaries or affiliates for your advantage or of that of a member of your immediate family.
Gifts, Gratuities and Entertainment
List and describe any gifts, gratuities or entertainment that you or members of your immediate family have received from any person or outside concern that does business, hopes to do business, or competes with ENA or any of its subsidiaries or affiliates. (If you have received such benefits, please approximate their value. Do not list gifts or entertainment of nominal value.)
I hereby agree to report to the ENA Executive Director any changes in the response to each of the foregoing questions which may result from changes in circumstances before completion of my next Conflict of Interest Disclosure Statement.
I have read, understand and agree to the terms of ENA's Conflict of Interest Policy. To the best of my knowledge and belief, the information reported is complete and accurate, and I am not aware of any other personal or professional position(s) or interest(s) or activities in which I am, or am about to be, engaged that reasonably may be anticipated to conflict with the interests of ENA.
In the event I am appointed to a committee, I understand that the charges of this committee may include preparing documents, articles, presentations, or other materials which will be used to illustrate on behalf of ENA the topic of this committee. Any work product from the committee is to be used to further ENA's mission.
I agree that any materials prepared by me while fulfilling the obligations of this committee assignment are and shall remain the sole property of the Emergency Nurses Association, to be used in any way by them or on their behalf, in any format, and I hereby assign to ENA all ownership rights, including copyright, in the work product produced as a committee member. I also agree that any work I submit for the committee will not contain works protected by copyright that have been used without the written consent of the copyright owner or that I have provided ENA with copies of all such required written consents. Should I wish to reuse the materials, I may do so only with the written permission of the Emergency Nurses Association.
This copyright assignment will help ensure that ENA has the rights it needs to use the committee work product.
In the event I am appointed to a committee, I agree that I will maintain custody and security over confidential information and materials.
I understand that I may be privy to confidential information relative to the business of this committee. I agree not to divulge information that has been identified as confidential.
ENA Committee Code of Conduct
- I will maintain my focus on the committee charges and have no personal agenda.
- I will be mindful to advocate for ENA members and all emergency nurses.
- I will treat my colleagues as professionals, with respect and consideration.
- I will critique ideas and not individuals, praising in public, criticizing in private.
- I will engage in thoughtful discussion during meetings and take accountability for my ideas by using I statements.
- I will imagine the possibilities, remain curious, listen for alternatives and remain open of others.
- I may disagree with colleagues respectfully, but look for common ground and consensus, demonstrating a united front and supporting the ultimate decision made by the committee.
- I will not betray confidences, including the details of confidential information shared during the meetings.
- I will maintain confidentiality regarding votes, specific details and conversations.
- I will treat ENA staff with respect and expect the same in return.
- I will convey concerns related to staff to the executive director and inform the ENA president. I will convey concerns about committee members to the board liaison and/or ENA president.
- I will respect my colleagues right to receive appropriate notice of committee meeting agenda and materials a week before meetings take place.
- I will use e-mail for simple, informational and non-controversial exchanges of information.
- I will use oral, phone and preferably, in-person communication for issues that may be controversial and that might be perceived as confrontational.
- I will only engage in the respectful use of electronic devices.
- I will be respectful and courteous to my colleagues and give them the respect of listening when they speak. I will refrain from sidebar conversations during the meeting.
- I will make every effort to seek a private setting for conference calls to avoid distraction, competing conversations, public address announcements, the sound of wind/traffic, etc, and use the mute button if some noise is unavoidable.