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Virginia Board of Nursing allows RNs as first assistants
Virginia Board of Nursing allows RNs as first assistants The Committee of the Joint Boards of Medicine and Nursing of the Commonwealth of Virginia has adopted a policy that “registered nurses may serve as first assistant in surgery in cases compatible with their preparation and experience.”’ The document issued by the Virginia State Board of Nursing goes on to say that hospitals instituting such policies should include qualifications of nurses, types of surgical procedures in which they may act in this capacity, and prohibitions. Nurses as physician’s assistants have been historically opposed by AORN. In 1971 at the AORN Congress in Las Vegas, Nev, the House of Delegates passed a resolution regarding physician’s assistants as they relate to the surgeon in the operating room.a In that resolution, AORN supported the concept of the assistant to the surgeon who is an individual experienced in operating room technology, trained to function as first or second assistant to the surgeon during an operative procedure, and approved by an appropriate hospital credentials committee. AORN asserted in the same resolution that it supported the concept of the development of health care workers to provide assistance when and where needed, but that the professional operating room nurse practices nursing in an expanding role and there was
concern of the inordinate utilization of operating room nurses in the role of assistant to the surgeon. In a paper entitled “The American Nurses’ Association views the emerging physician’s assistant” issued in December 1971, ANA stated, “The term ‘physician’s assistant’ should not be applied to any of the nurse practitioners being prepared to function in an extension of the nursing ~018.”~ The US Department of Health, Education, and Welfare’s Conditions of Pafiicipation, Hospitals, says “In any procedure with unusual hazard to life, there is present and scrubbed as first assistant a physician designated by the credentials committee as being qualified to assist in major ~urgery.”~ The next regulation says that nurses may first assist at lesser operations if deemed sufficiently trained to properly and adequately assist at such procedures. The nurse acting as first assistant raises some questions. Who defines major and minor surgery? Is minor surgery deemed not hazardous to patients? Are nurses acting as first assistants to be compensated on the same fee basis as physicians? Or is this a bid for “cheaper” labor? Does the nurse’s liability insurance cover her if she is acting as first assistant? Is the OR nursing staff to be augmented to provide more nurses to first assist? Who takes over on an operative procedure if the surgeon faints or has a heart attack? (This is not without precedent.) I trust the OR nurses in Virginia have been informed of this action and consider its implementation in view of these questions and
AORN Journal, September 1976, Vol.24, No 3
411
factors. Because nurses are on duty 24 hours a day, they often take on the responsibilities of other disciplines. After 6 pm, they at times become the administrator, the pharmacist, the dietician, the engineer, or the housekeeper. Are they now to become the surgeon’s assistant because of a shortage of surgeons? What of the nursing shortage? This tends to compromise an already depleted supply of qualified OR nurses. Give it some serious thought, RNs.
Jerry G Peers, RN Executive Director Notes 1. Commonwealth of Virginia, State Board of
Dual water supply systems proposed Dual water supply systems may be the solution to diminishing pure water sources in the United States, according to Daniel A Okun, professor of environmental engineering at the University of North Carolina School of Public Health. Okun suggests one system for potable water and the other for recycled wastewater. In an article in the American Journal of Public Health, Okun points out that: 0 numerous synthetic organic chemicals of uncertain health consequences are polluting the nation’s water sources; 0 conventional water treatment methods are only partially effective in removing these chemical compounds; about one-third of the nation’s population gets its drinking water from polluted sources; 0 nearly 50 million people not served by public water supplies are dependent upon individual water systems which are frequently unreliable and often unsafe. Water sources in many urban areas are being exhausted, Okun said, because they are “squandered on uses that can be met with waters of much lower quality” available from polluted rivers or reclaimed wastewaters. These uses include lawn, park, and other urban irrigation; industry; toilet-flushing; and other similar uses that do not require the high quality that is necessary for drinking water.
412
Nursing, “Directors of nursing service, schools of nursing, hospital administrators, related health agencies and organizations,” Richmond, Va, June 30, 1976. 2.“ AORN Congress, 1971,” AORN Journal 13 (March 1971) 46. 3. American Nurses’ Association Board of Directors, “The American Nurses’ Association views the emerging physician’s assistant,” Kansas City, Mo, December 17, 1971. 4. US Department of Health, Education, and Welfare, Conditions of Participation, Hospifal Federal Health Insurance for the Aged (Washington, DC: US Department of Health, Education, and Welfare, 1967) 405.1031(a).
Only 10% to 20% of the total public water supply is required for drinking, cooking, and other uses that demand high purity, Okun said. Using polluted rivers or reclaimed wastewaters for nonpotable purposes in a planned water resource program would be far less expensive than developing additional high-quality fresh water sources. Additionally, it would relieve the current demand on potable water sources so that these can serve larger populations and would eliminate the risk to people of life-long ingestion of the contaminants in polluted waters. Okun states that there are presently 40,000 public water supply systems in the United States, half of which serve fewer than 1,000 persons. These smaller systems lack resources to provide proper service and surveillance. He says that the Safe Drinking Water Act of 1974, which represents an important step in improving the quality of public water supply, actually aggravates the water problem by defining public water supply systems to also include highway rest stops, hotels, recreation centers, and other installations with their own systems serving the general public, thus requiring surveillance of an additional 200,000 smaller systems. He also recommends integrating water resource and water pollution control authorities and the development of regional authorities “that would encompass areas large enough to be self-sufficient in resources of water of adequate quality, qualified people to manage the systems, and adequate funds to provide the needed services.”
AORN Journal, September 1976, Vol24, No 3
concern of the inordinate utilization of operating room nurses in the role of assistant to the surgeon. In a paper entitled “The American Nurses’ Association views the emerging physician’s assistant” issued in December 1971, ANA stated, “The term ‘physician’s assistant’ should not be applied to any of the nurse practitioners being prepared to function in an extension of the nursing ~018.”~ The US Department of Health, Education, and Welfare’s Conditions of Pafiicipation, Hospitals, says “In any procedure with unusual hazard to life, there is present and scrubbed as first assistant a physician designated by the credentials committee as being qualified to assist in major ~urgery.”~ The next regulation says that nurses may first assist at lesser operations if deemed sufficiently trained to properly and adequately assist at such procedures. The nurse acting as first assistant raises some questions. Who defines major and minor surgery? Is minor surgery deemed not hazardous to patients? Are nurses acting as first assistants to be compensated on the same fee basis as physicians? Or is this a bid for “cheaper” labor? Does the nurse’s liability insurance cover her if she is acting as first assistant? Is the OR nursing staff to be augmented to provide more nurses to first assist? Who takes over on an operative procedure if the surgeon faints or has a heart attack? (This is not without precedent.) I trust the OR nurses in Virginia have been informed of this action and consider its implementation in view of these questions and
AORN Journal, September 1976, Vol.24, No 3
411
factors. Because nurses are on duty 24 hours a day, they often take on the responsibilities of other disciplines. After 6 pm, they at times become the administrator, the pharmacist, the dietician, the engineer, or the housekeeper. Are they now to become the surgeon’s assistant because of a shortage of surgeons? What of the nursing shortage? This tends to compromise an already depleted supply of qualified OR nurses. Give it some serious thought, RNs.
Jerry G Peers, RN Executive Director Notes 1. Commonwealth of Virginia, State Board of
Dual water supply systems proposed Dual water supply systems may be the solution to diminishing pure water sources in the United States, according to Daniel A Okun, professor of environmental engineering at the University of North Carolina School of Public Health. Okun suggests one system for potable water and the other for recycled wastewater. In an article in the American Journal of Public Health, Okun points out that: 0 numerous synthetic organic chemicals of uncertain health consequences are polluting the nation’s water sources; 0 conventional water treatment methods are only partially effective in removing these chemical compounds; about one-third of the nation’s population gets its drinking water from polluted sources; 0 nearly 50 million people not served by public water supplies are dependent upon individual water systems which are frequently unreliable and often unsafe. Water sources in many urban areas are being exhausted, Okun said, because they are “squandered on uses that can be met with waters of much lower quality” available from polluted rivers or reclaimed wastewaters. These uses include lawn, park, and other urban irrigation; industry; toilet-flushing; and other similar uses that do not require the high quality that is necessary for drinking water.
412
Nursing, “Directors of nursing service, schools of nursing, hospital administrators, related health agencies and organizations,” Richmond, Va, June 30, 1976. 2.“ AORN Congress, 1971,” AORN Journal 13 (March 1971) 46. 3. American Nurses’ Association Board of Directors, “The American Nurses’ Association views the emerging physician’s assistant,” Kansas City, Mo, December 17, 1971. 4. US Department of Health, Education, and Welfare, Conditions of Participation, Hospifal Federal Health Insurance for the Aged (Washington, DC: US Department of Health, Education, and Welfare, 1967) 405.1031(a).
Only 10% to 20% of the total public water supply is required for drinking, cooking, and other uses that demand high purity, Okun said. Using polluted rivers or reclaimed wastewaters for nonpotable purposes in a planned water resource program would be far less expensive than developing additional high-quality fresh water sources. Additionally, it would relieve the current demand on potable water sources so that these can serve larger populations and would eliminate the risk to people of life-long ingestion of the contaminants in polluted waters. Okun states that there are presently 40,000 public water supply systems in the United States, half of which serve fewer than 1,000 persons. These smaller systems lack resources to provide proper service and surveillance. He says that the Safe Drinking Water Act of 1974, which represents an important step in improving the quality of public water supply, actually aggravates the water problem by defining public water supply systems to also include highway rest stops, hotels, recreation centers, and other installations with their own systems serving the general public, thus requiring surveillance of an additional 200,000 smaller systems. He also recommends integrating water resource and water pollution control authorities and the development of regional authorities “that would encompass areas large enough to be self-sufficient in resources of water of adequate quality, qualified people to manage the systems, and adequate funds to provide the needed services.”
AORN Journal, September 1976, Vol24, No 3