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Advocating for nursing
JULY 2001, VOL 74, NO 1 P R E S I D E N T ‘ S M E S S A (i E
Advocating for nursing
I
n July, I tend to reflect on the heroes of the past who did not lose sight of the goal of freedom, the heroes of the present who strive to maintain that freedom, and the heroes of the future who will preserve our freedom. Policy making and politics play an influential role in our perioperative practice. They are not unsavory endeavors to avoid; instead, they are the tools we can use to enhance our influence in the health care arena. According to AORN past President Ellen Murphy, RN, MS, JD, FAAN, “One of our primary roles as perioperative nurses is patient advocacy.”’ By participating in policy and political arenas, we can advocate for our patients, as well as our nursing colleagues. Health care has adopted such business practices as downsizing, skimping on maintenance, and hiring less experienced workers who may contribute to profits but who also may affect patient safety.> Nurses must seize the opportunity to participate, sit at the policy table, and advocate for what we believe. “Obstacles are those frightful things you see when you take your eyes off your goal.”) We must mobilize our powers of persuasion. We use these powers every day as we greet patients in the preoperative area and allay their fears. We use them in the OR when we convince surgeons that our suggestion is the perfect one and make them think that they thought of it. We have been silent about the extraordinary
work we do for entirely too long. Every day we help patients cope, bring new life into the world, and provide support to help patients die with dignity. The public needs to understand the power of nurses, and it is our responsibility to be the collective voice to articulate that value. Consequently, AOR”s strategic plan addresses the issues of safety and advocacy for perioperative nurses and patients.
INVOLVEMENT IN PUBLIC POLICY Our participation in the policy and political arenas must be consistent and reliable. Hippocrates said, “A wise man ought to realize that health is his most valuable pos~ession.”~ Nurses hold the highest rating in surveys related to professionals that the public trusts.’ We should take advantage of that fact. Americans seem to be caught in a downward spiral of cost competition and profit management. For health care to work, cost-based competition must be balanced with competition for compassion, competence, and care? We must talk about our work, promote our vision, and refuse to take “no” for an answer. We must take every opportunity to tell our stories and articulate our value as nurses. We make a difference to perioperative patient care by the very nature of our practice. The essence of nursing is care. We have the expertise to educate our patients and our legislators. That education is the key to our success. Politicians pay atten8
A O R N JOURNAL
tion to numbers because when you are sitting at the policy table, numbers count. Mary Wakefield, RN, PhD9FAAN, SHEllA L M E N director of the Center for Health Policy, Research, and Ethics at George Mason University, Fairfax, Va, and former chief of staff to Sen Kent Conrad (D-SD) characterizes it best when she says, “If you want to run with the big dogs, you’ve got to get off the porch.’“ This colorful encouragement reminds us that we will have to “run with the big dogs” if we ever expect to write policy in a manner that serves perioperative nursing and our patients.
WORKING TOGETHER In December 1997, the Health Care Financing Administration (HCFA) proposed a rule change in the conditions of participation for hospitals and ambulatory surgery centers that are reimbursed by Medicare. The change in the rule would allow these facilities to determine their own staffing patterns for surgical services. It would replace the prescriptive rules that currently require that a physician, osteopathic physician, or RN must supervise an OR. AORN members, with the assistance of A 0 R ” s Government Affairs Department staff members, rallied to keep the current
JULY 2001, VOL 74, NO 1
I
language in place. They wrote letters and called HCFA and their legislators to support the current rule. AORN past Presidents Ruth P. Shumaker, RN, BSN, CNOR, and Patricia C. Seifert, RN, MSN, CNOR, CRNFA, FAAN, joined multidisciplinary groups that met with representatives from HCFA to talk about this rule change. AORN staff members havegathered data and information to address the questions and concerns of HCFA officials. To date, no final decision has been made, and the debate related to this controversial change continues.’ The environmental threat to perioperative nurses from surgical smoke plume has resulted in combined efforts by AORN members, staff members, professional colleagues, and industry partners to address the issue. In January 1996, AORN gathered an alliance of professionals for a round table discussion. This group agreed that surgical smoke from lasers and electrosurgical units is similar, and smoke from both deserves the same level of concern regarding evacuation. This group investigated the hazards of smoke to OR personnel, and a coalition of perioperative nurses and industry representatives was formed in the spring of 1996 to write a white paper to provide a central core of information on the hazards of smoke plume. The National Institute of Occupational Safety and Health (NIOSH) released the Hazards Control Alert, which called for certain ventilation and work practices, including smoke evacuation. The Institute called for additional research to develop guidelines into working recommendations. A second smoke round table
was convened by AORN in February 1997. Since that time, AORN leaders and members have continued to lobby the Occupational Safety and Health Administration (OSHA) to release the guideline document
Working together, we can make a difference to the health of current and future health care personnel. titled “Information for Healthcare Workers Exposed to Laser and Electrosurgery Smoke.” The OSHA guidelines were supposed to be released in 1999. On March 29,2000, AORN past President Brenda C. Ulmer, RN, MN, CNOR, met with OSHA officials who decided to delay the release of the guidelines pending more research on outcomes. AORN’s Smoke Task Force, with Paula R. Graling, RN, MSN, CNOR, serving as chair, now leads current initiatives. Members of the Task Force include AORN members; staff member liaisons; and representatives from NIOSH, the American Association of Occupational Health Nurses, and the American Association of Nurse Anesthetists. Health hazard evaluations currently are being conducted in three facilities across the country. This year, AORN has been granted access to the Harvard Nurses Health Study Database for 10 AORN JOURNAL
Secondary Analysis. Members can assist in the process of providing essential data by continuing to inform regulatory agencies, connecting to occupational health practitioners, and educating hospital administrators about control technology. Working together, we can make a difference to the health of current and future health care personnel.’
COMBINING FORCES IN THE POLITICAL ARENA AORN is a diverse organization. Although we have different political philosophies, we should support candidates who understand nurses’ roles in health care and patients’ need for quality care.l0Candace Romig, director of AORN’s Government Affairs Department, coordinates efforts to accomplish the strategic goals of the organization as they pertain to public policy in the state and federal legislature, administrative agencies, and the judicial branch of the government. She is the point person for the federal agenda as it pertains to legislative priorities that are approved by the AORN Board of Directors each year, and she maintains contact with federal and state lobbyists. Other staff members include Fred Franko, state legislative coordinator and Jim Irwin, legislative assistant. These staff members work collaboratively with all members, as well as with the chair of the Legislative Committee. They also support the efforts of the 50 members of that Committee, along with the efforts of the Legislative Grassroots Network. Our legislative efforts in Washington, DC,are coordinated and championed by our federal liaison, Karen Sealander, JD.
JULY 2001, VOL 74, NO 1
Sealander says she has observed the spirit, dedication, and teamwork of perioperative nurses. Their fundamental objective is education about perioperative nursing and the value this group brings to patient care. She credits members with the initiative to complete goals in a timely manner.” As our federal liaison, Sealander takes AORN’s message to our legislators. She is credible as she articulates our message passionately, knowledgeably, and with conviction. AORN member Melody Mena, RN, CNOR, has proven her creativity and ingenuity many times as she has gained perioperative nurses a legislative champion in Rep Mac Collins (R-Ga). Her efforts and those of her colleagues in Georgia encouraged Collins to sponsor a bill for obtaining Medicare reimbursement for certified RN first assistants in the 106th and now the 107th US
Congress. Collins has not been a passive supporter but a true advocate for perioperative nurses. Mena encourages all perioperative nurses to become involved in policy and political arenas. She says, “We can’t wait until it starts raining to build a boat.”’*The relationships and connections we build with others will be key elements to create positive outcomes from our legislative efforts.
CRAFTING THE MESSAGE Janet Paulson, AORN’s public relations coordinator, seizes every opportunity to share our message with the media in all forms. She has assisted members in crafting letters to the editor about HCFA issues in newspapers in more than 30 cities. She has coordinated contact between magazine editors and AORN members knowledgeable about various topics, including smoke plume, unlicensed assistive per-
NOTES 1. E Murphy, “Time and energy invested in the political process pay dividends for perioperative nurses and our patients,” (President’s Message) AORN Journal 63 (February 1996) 332. 2. S Gordon, “Advocating for Nursing,” in Health Policy and Nursing: Crisis and Reform in the US Health Care Delivery System, second ed, C Hanington, C L Estes, eds (Boston: Jones and Bartlett Publishers, 1997) 429-434. 3. H Ford, American Speaker: Your Guide to Successfif Speaking (Washington, DC: Georgetown Publishing House, Inc, 2000) 45. 4. A Bakshian, American Speaker’s 100 Best Quotes for 2001 (Washington, DC: Georgetown Publishing House, Inc, 2001) 14. 5. “Nurses deemed most trusted professionals in Gallup poll,” AORN Journal 71 (June 2000) 1285. 6. Gordon, Health Policy and Nursing: Crisis and Reform in the US Health Care Delivery System, 429-434.
sonnel, and sterilization issues.
GOING FORWARD Michelangelo said, “The greater danger for most of us is not that our aim is too high, and we m i s s it; but that it is too low, and we reach it.’’’>We should not be seduced by the notion that there can be danger in aiming too high. In fact, it is our hopes that drive us to create our masterpieces as Michelangelo created his. We are limited only by our dreams. By combining hard work at the grassroots level with information from our partners at Headquarters and in industry, we can craft our message, get off the porch, and create the future we want. SHEILA 1. ALLEN RN, BSN, CNOR, CRNFA PRESIDENT President Allen can be contacted by e-mail at slal/[email protected] by fax at (425)
740-9269.
7. M Wakefield, “The role of government commissions/committees in influencing health policy: The Institute of Medicine Quality of Healthcare in America Committee,” presented at the Nurses in Washington Internship Program,Washington, DC, 28 Feb 2000. 8. C Romig, “Legislative update,” Surgical Services Management 6 (January 2000) 49-52. 9. P R Graling, personal communication with the author, Baton Rouge, La, March, 2001. 10. Murphy, “Time and energy invested in the political process pay dividends for perioperative nurses and our patients,” 332. 11. M Mena, K Sealander, C J Welter, “A public policy update,” presented at the 48th AORN Congress, Dallas, I1 March 2001. 12. [bid. 13. M Buonarotti, “Hope,” Poems of Universal Truths, http://www.ainsleelodge.com.au/-brentmor/poems/poems . h t d (accessed 15 May 2001).
11 AORN JOURNAL
Advocating for nursing
I
n July, I tend to reflect on the heroes of the past who did not lose sight of the goal of freedom, the heroes of the present who strive to maintain that freedom, and the heroes of the future who will preserve our freedom. Policy making and politics play an influential role in our perioperative practice. They are not unsavory endeavors to avoid; instead, they are the tools we can use to enhance our influence in the health care arena. According to AORN past President Ellen Murphy, RN, MS, JD, FAAN, “One of our primary roles as perioperative nurses is patient advocacy.”’ By participating in policy and political arenas, we can advocate for our patients, as well as our nursing colleagues. Health care has adopted such business practices as downsizing, skimping on maintenance, and hiring less experienced workers who may contribute to profits but who also may affect patient safety.> Nurses must seize the opportunity to participate, sit at the policy table, and advocate for what we believe. “Obstacles are those frightful things you see when you take your eyes off your goal.”) We must mobilize our powers of persuasion. We use these powers every day as we greet patients in the preoperative area and allay their fears. We use them in the OR when we convince surgeons that our suggestion is the perfect one and make them think that they thought of it. We have been silent about the extraordinary
work we do for entirely too long. Every day we help patients cope, bring new life into the world, and provide support to help patients die with dignity. The public needs to understand the power of nurses, and it is our responsibility to be the collective voice to articulate that value. Consequently, AOR”s strategic plan addresses the issues of safety and advocacy for perioperative nurses and patients.
INVOLVEMENT IN PUBLIC POLICY Our participation in the policy and political arenas must be consistent and reliable. Hippocrates said, “A wise man ought to realize that health is his most valuable pos~ession.”~ Nurses hold the highest rating in surveys related to professionals that the public trusts.’ We should take advantage of that fact. Americans seem to be caught in a downward spiral of cost competition and profit management. For health care to work, cost-based competition must be balanced with competition for compassion, competence, and care? We must talk about our work, promote our vision, and refuse to take “no” for an answer. We must take every opportunity to tell our stories and articulate our value as nurses. We make a difference to perioperative patient care by the very nature of our practice. The essence of nursing is care. We have the expertise to educate our patients and our legislators. That education is the key to our success. Politicians pay atten8
A O R N JOURNAL
tion to numbers because when you are sitting at the policy table, numbers count. Mary Wakefield, RN, PhD9FAAN, SHEllA L M E N director of the Center for Health Policy, Research, and Ethics at George Mason University, Fairfax, Va, and former chief of staff to Sen Kent Conrad (D-SD) characterizes it best when she says, “If you want to run with the big dogs, you’ve got to get off the porch.’“ This colorful encouragement reminds us that we will have to “run with the big dogs” if we ever expect to write policy in a manner that serves perioperative nursing and our patients.
WORKING TOGETHER In December 1997, the Health Care Financing Administration (HCFA) proposed a rule change in the conditions of participation for hospitals and ambulatory surgery centers that are reimbursed by Medicare. The change in the rule would allow these facilities to determine their own staffing patterns for surgical services. It would replace the prescriptive rules that currently require that a physician, osteopathic physician, or RN must supervise an OR. AORN members, with the assistance of A 0 R ” s Government Affairs Department staff members, rallied to keep the current
JULY 2001, VOL 74, NO 1
I
language in place. They wrote letters and called HCFA and their legislators to support the current rule. AORN past Presidents Ruth P. Shumaker, RN, BSN, CNOR, and Patricia C. Seifert, RN, MSN, CNOR, CRNFA, FAAN, joined multidisciplinary groups that met with representatives from HCFA to talk about this rule change. AORN staff members havegathered data and information to address the questions and concerns of HCFA officials. To date, no final decision has been made, and the debate related to this controversial change continues.’ The environmental threat to perioperative nurses from surgical smoke plume has resulted in combined efforts by AORN members, staff members, professional colleagues, and industry partners to address the issue. In January 1996, AORN gathered an alliance of professionals for a round table discussion. This group agreed that surgical smoke from lasers and electrosurgical units is similar, and smoke from both deserves the same level of concern regarding evacuation. This group investigated the hazards of smoke to OR personnel, and a coalition of perioperative nurses and industry representatives was formed in the spring of 1996 to write a white paper to provide a central core of information on the hazards of smoke plume. The National Institute of Occupational Safety and Health (NIOSH) released the Hazards Control Alert, which called for certain ventilation and work practices, including smoke evacuation. The Institute called for additional research to develop guidelines into working recommendations. A second smoke round table
was convened by AORN in February 1997. Since that time, AORN leaders and members have continued to lobby the Occupational Safety and Health Administration (OSHA) to release the guideline document
Working together, we can make a difference to the health of current and future health care personnel. titled “Information for Healthcare Workers Exposed to Laser and Electrosurgery Smoke.” The OSHA guidelines were supposed to be released in 1999. On March 29,2000, AORN past President Brenda C. Ulmer, RN, MN, CNOR, met with OSHA officials who decided to delay the release of the guidelines pending more research on outcomes. AORN’s Smoke Task Force, with Paula R. Graling, RN, MSN, CNOR, serving as chair, now leads current initiatives. Members of the Task Force include AORN members; staff member liaisons; and representatives from NIOSH, the American Association of Occupational Health Nurses, and the American Association of Nurse Anesthetists. Health hazard evaluations currently are being conducted in three facilities across the country. This year, AORN has been granted access to the Harvard Nurses Health Study Database for 10 AORN JOURNAL
Secondary Analysis. Members can assist in the process of providing essential data by continuing to inform regulatory agencies, connecting to occupational health practitioners, and educating hospital administrators about control technology. Working together, we can make a difference to the health of current and future health care personnel.’
COMBINING FORCES IN THE POLITICAL ARENA AORN is a diverse organization. Although we have different political philosophies, we should support candidates who understand nurses’ roles in health care and patients’ need for quality care.l0Candace Romig, director of AORN’s Government Affairs Department, coordinates efforts to accomplish the strategic goals of the organization as they pertain to public policy in the state and federal legislature, administrative agencies, and the judicial branch of the government. She is the point person for the federal agenda as it pertains to legislative priorities that are approved by the AORN Board of Directors each year, and she maintains contact with federal and state lobbyists. Other staff members include Fred Franko, state legislative coordinator and Jim Irwin, legislative assistant. These staff members work collaboratively with all members, as well as with the chair of the Legislative Committee. They also support the efforts of the 50 members of that Committee, along with the efforts of the Legislative Grassroots Network. Our legislative efforts in Washington, DC,are coordinated and championed by our federal liaison, Karen Sealander, JD.
JULY 2001, VOL 74, NO 1
Sealander says she has observed the spirit, dedication, and teamwork of perioperative nurses. Their fundamental objective is education about perioperative nursing and the value this group brings to patient care. She credits members with the initiative to complete goals in a timely manner.” As our federal liaison, Sealander takes AORN’s message to our legislators. She is credible as she articulates our message passionately, knowledgeably, and with conviction. AORN member Melody Mena, RN, CNOR, has proven her creativity and ingenuity many times as she has gained perioperative nurses a legislative champion in Rep Mac Collins (R-Ga). Her efforts and those of her colleagues in Georgia encouraged Collins to sponsor a bill for obtaining Medicare reimbursement for certified RN first assistants in the 106th and now the 107th US
Congress. Collins has not been a passive supporter but a true advocate for perioperative nurses. Mena encourages all perioperative nurses to become involved in policy and political arenas. She says, “We can’t wait until it starts raining to build a boat.”’*The relationships and connections we build with others will be key elements to create positive outcomes from our legislative efforts.
CRAFTING THE MESSAGE Janet Paulson, AORN’s public relations coordinator, seizes every opportunity to share our message with the media in all forms. She has assisted members in crafting letters to the editor about HCFA issues in newspapers in more than 30 cities. She has coordinated contact between magazine editors and AORN members knowledgeable about various topics, including smoke plume, unlicensed assistive per-
NOTES 1. E Murphy, “Time and energy invested in the political process pay dividends for perioperative nurses and our patients,” (President’s Message) AORN Journal 63 (February 1996) 332. 2. S Gordon, “Advocating for Nursing,” in Health Policy and Nursing: Crisis and Reform in the US Health Care Delivery System, second ed, C Hanington, C L Estes, eds (Boston: Jones and Bartlett Publishers, 1997) 429-434. 3. H Ford, American Speaker: Your Guide to Successfif Speaking (Washington, DC: Georgetown Publishing House, Inc, 2000) 45. 4. A Bakshian, American Speaker’s 100 Best Quotes for 2001 (Washington, DC: Georgetown Publishing House, Inc, 2001) 14. 5. “Nurses deemed most trusted professionals in Gallup poll,” AORN Journal 71 (June 2000) 1285. 6. Gordon, Health Policy and Nursing: Crisis and Reform in the US Health Care Delivery System, 429-434.
sonnel, and sterilization issues.
GOING FORWARD Michelangelo said, “The greater danger for most of us is not that our aim is too high, and we m i s s it; but that it is too low, and we reach it.’’’>We should not be seduced by the notion that there can be danger in aiming too high. In fact, it is our hopes that drive us to create our masterpieces as Michelangelo created his. We are limited only by our dreams. By combining hard work at the grassroots level with information from our partners at Headquarters and in industry, we can craft our message, get off the porch, and create the future we want. SHEILA 1. ALLEN RN, BSN, CNOR, CRNFA PRESIDENT President Allen can be contacted by e-mail at slal/[email protected] by fax at (425)
740-9269.
7. M Wakefield, “The role of government commissions/committees in influencing health policy: The Institute of Medicine Quality of Healthcare in America Committee,” presented at the Nurses in Washington Internship Program,Washington, DC, 28 Feb 2000. 8. C Romig, “Legislative update,” Surgical Services Management 6 (January 2000) 49-52. 9. P R Graling, personal communication with the author, Baton Rouge, La, March, 2001. 10. Murphy, “Time and energy invested in the political process pay dividends for perioperative nurses and our patients,” 332. 11. M Mena, K Sealander, C J Welter, “A public policy update,” presented at the 48th AORN Congress, Dallas, I1 March 2001. 12. [bid. 13. M Buonarotti, “Hope,” Poems of Universal Truths, http://www.ainsleelodge.com.au/-brentmor/poems/poems . h t d (accessed 15 May 2001).
11 AORN JOURNAL