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AORN is proactive in defining the advanced perioperative practice role
AORN JOURNAL
AUGUST 1993, VOL 58, NO 2
President’s Message AORN is proactive in defining the advanced perioperative practice role
0
acknowledged as a leader among nursing organ three occasions recently, AORN has nizations. been asked to send a representative to At all three meetings, representatives of the Washington to meet with members of the federClinton Administration repeatedly emphasized al task force that is charged with national health the President’s belief that nursing is an undercare reform. On the first occasion, I joined utilized resource in health care. Nursing will do leaders from the American Association of well and will take giant strides forward, espeCritical-Care Nurses, Emergency Nurses cially in achieving direct reimbursement for Association, American Association of Nurse services, when health care reform becomes a Anesthetists, and the National Association of reality, the administration officials promised. Pediatric Nurse Associates and Practitioners to My response to this prediction is both “yes” discuss proposed increases in the use of nurse and “no.” Yes, nurses in advanced practice practitioners, the effect this will have on health roles will do well. Nurses will have opportunicare delivery and costs, the role of nursing in ties as never before to be front-line caregivers preventive care, the educational needs that with all the privileges that should accompany nurses will experience as a result of restructurthis responsibility (eg, prescriptive authority, ing and work redesign, and the need for educafreedom from required physician supervision). tion funds for nurses whose roles may change State boards of nursing finally may have the or cease to exist. opportunity to define nursing’s scope of pracIn early May, AORN President-elect Jane C. tice without being restricted by medical boards Rothrock, RN, DNSc, CNOR, and I attended a who often choose to identify nursing as a delehealth care briefing at which White House gated medical function over which they exerHealth Care Advisor Ira Magaziner outlined cise a modicum of control. Yes, President Clinton’s proposed nurses finally may have an opporreforms. This briefing was foltunity to do what we do best-to lowed by a reception in the White fill the void in wellness promotion House Rose Garden where we met and illness prevention services in with President Clinton. Also in other than underserved areas. May, Board member Vicki J. Fox, Direct reimbursement to advanced RN, MSN, CNOR, CRNFA, practice nurses surely will increase attended a task force meeting at significantly. All of these changes which state barriers to independent will heighten our affirmation of nurse practice were addressed. In worth-a development that we addition to the personal pride we have long awaited. This is an excitexperienced, we were proud that ing time to be a nurse. our Association once again was Cynthia C. Spry 196
AORN JOURNAL
When Washington officials say that nurses will do well under health care reform, they are referring to advanced practice nurses who are master’s prepared, certified, and have highly specialized skills. Not all nurses, however, are advanced practitioners, nor have all nursing organizations defined advanced practice roles. I am concerned that many nurses will not do as well in a reformed health care system because their specialties have not defined advanced practice roles into which they can choose to move. Nurse practitioners and clinical nurse specialists are recognized advanced practitioners. AORN has not defined either of these advanced practice roles for the perioperative nurse. Although AORN has defined the role of the RN first assistant, this role does not meet the standard criteria for advanced practice (ie, an advanced degree, certification, specialized skills). It is imperative that our Association define an advanced practice role and that this task be given high priority. For this reason, the Board of Directors has charged the Nursing Practices Committee to define an advanced perioperative practice role. The Board is committed to providing an opportunity for perioperative nurses to qualify as advanced practitioners and to be reimbursed for their work. There is growing recognition in Washington that advanced practice nurses provide high quality care and offer an effective, appropriate alternative to higher-paid physicians. Opportunities for direct reimbursement for advanced practice nurses will increase significantly during the next decade. I am excited about the charge to the Nursing Practices Committee, This Committee can provide an additional practice role for perioperative nurses and an opportunity for our members to stand with the few nursing specialists who will receive direct reimbursement. Once again, AORN is demonstrating a proactive stance. This kind of proactivity is what makes our organization a leader and why it is only appropriate that we be present at the Washington task force meetings. CYNTHIA C. SPRY,RN, MA, MSN, CNOR PRESIDENT 198
AUGUST 1993, VOL 58, NO 2
Treatment Reduces Diabetic Blindness Recommended treatments to prevent diabetesconnected blindness are more effective than previously thought, according to an analysis of 40 years’ research reported in an article in the March 10, 1993, issue of the Journal of the American Medical Association. For many decades, people with diabetes have become blind from diabetic retinopathy. Proliferative diabetic retinopathy (PDR) involves damage to the retina and the blood vessels that serve it, Blood vessel hemorrhage into the eye’s vitreous gel, fibrous tissue growth, and retinal detachment can result in the permanent loss of vision. Sight-saving treatments, however, are now available. Current recommendations for treating PDR include careful follow-up, scatter photocoagulation for eyes that approach or reach high-risk PDR, focal photocoagulation for most eyes with clinically significant macular edema, and vitrectomy when necessary for severe PDR or vitreous hemorrhage. Data suggest that 50% of patients with PDR who are not treated become legally blind within five years compared to only 5% of patients who receive early treatment. Use of the currently recommended treatment strategies reduces the risk of blindness for patients with PDR. This makes full implementation of recommended treatments for PDR imperative, the article states. Both the National Eye Institute and the American Academy of Ophthalmology have developed programs to ensure that people with diabetes are screened and, when necessary, treated for diabetic retinopathy.
AUGUST 1993, VOL 58, NO 2
President’s Message AORN is proactive in defining the advanced perioperative practice role
0
acknowledged as a leader among nursing organ three occasions recently, AORN has nizations. been asked to send a representative to At all three meetings, representatives of the Washington to meet with members of the federClinton Administration repeatedly emphasized al task force that is charged with national health the President’s belief that nursing is an undercare reform. On the first occasion, I joined utilized resource in health care. Nursing will do leaders from the American Association of well and will take giant strides forward, espeCritical-Care Nurses, Emergency Nurses cially in achieving direct reimbursement for Association, American Association of Nurse services, when health care reform becomes a Anesthetists, and the National Association of reality, the administration officials promised. Pediatric Nurse Associates and Practitioners to My response to this prediction is both “yes” discuss proposed increases in the use of nurse and “no.” Yes, nurses in advanced practice practitioners, the effect this will have on health roles will do well. Nurses will have opportunicare delivery and costs, the role of nursing in ties as never before to be front-line caregivers preventive care, the educational needs that with all the privileges that should accompany nurses will experience as a result of restructurthis responsibility (eg, prescriptive authority, ing and work redesign, and the need for educafreedom from required physician supervision). tion funds for nurses whose roles may change State boards of nursing finally may have the or cease to exist. opportunity to define nursing’s scope of pracIn early May, AORN President-elect Jane C. tice without being restricted by medical boards Rothrock, RN, DNSc, CNOR, and I attended a who often choose to identify nursing as a delehealth care briefing at which White House gated medical function over which they exerHealth Care Advisor Ira Magaziner outlined cise a modicum of control. Yes, President Clinton’s proposed nurses finally may have an opporreforms. This briefing was foltunity to do what we do best-to lowed by a reception in the White fill the void in wellness promotion House Rose Garden where we met and illness prevention services in with President Clinton. Also in other than underserved areas. May, Board member Vicki J. Fox, Direct reimbursement to advanced RN, MSN, CNOR, CRNFA, practice nurses surely will increase attended a task force meeting at significantly. All of these changes which state barriers to independent will heighten our affirmation of nurse practice were addressed. In worth-a development that we addition to the personal pride we have long awaited. This is an excitexperienced, we were proud that ing time to be a nurse. our Association once again was Cynthia C. Spry 196
AORN JOURNAL
When Washington officials say that nurses will do well under health care reform, they are referring to advanced practice nurses who are master’s prepared, certified, and have highly specialized skills. Not all nurses, however, are advanced practitioners, nor have all nursing organizations defined advanced practice roles. I am concerned that many nurses will not do as well in a reformed health care system because their specialties have not defined advanced practice roles into which they can choose to move. Nurse practitioners and clinical nurse specialists are recognized advanced practitioners. AORN has not defined either of these advanced practice roles for the perioperative nurse. Although AORN has defined the role of the RN first assistant, this role does not meet the standard criteria for advanced practice (ie, an advanced degree, certification, specialized skills). It is imperative that our Association define an advanced practice role and that this task be given high priority. For this reason, the Board of Directors has charged the Nursing Practices Committee to define an advanced perioperative practice role. The Board is committed to providing an opportunity for perioperative nurses to qualify as advanced practitioners and to be reimbursed for their work. There is growing recognition in Washington that advanced practice nurses provide high quality care and offer an effective, appropriate alternative to higher-paid physicians. Opportunities for direct reimbursement for advanced practice nurses will increase significantly during the next decade. I am excited about the charge to the Nursing Practices Committee, This Committee can provide an additional practice role for perioperative nurses and an opportunity for our members to stand with the few nursing specialists who will receive direct reimbursement. Once again, AORN is demonstrating a proactive stance. This kind of proactivity is what makes our organization a leader and why it is only appropriate that we be present at the Washington task force meetings. CYNTHIA C. SPRY,RN, MA, MSN, CNOR PRESIDENT 198
AUGUST 1993, VOL 58, NO 2
Treatment Reduces Diabetic Blindness Recommended treatments to prevent diabetesconnected blindness are more effective than previously thought, according to an analysis of 40 years’ research reported in an article in the March 10, 1993, issue of the Journal of the American Medical Association. For many decades, people with diabetes have become blind from diabetic retinopathy. Proliferative diabetic retinopathy (PDR) involves damage to the retina and the blood vessels that serve it, Blood vessel hemorrhage into the eye’s vitreous gel, fibrous tissue growth, and retinal detachment can result in the permanent loss of vision. Sight-saving treatments, however, are now available. Current recommendations for treating PDR include careful follow-up, scatter photocoagulation for eyes that approach or reach high-risk PDR, focal photocoagulation for most eyes with clinically significant macular edema, and vitrectomy when necessary for severe PDR or vitreous hemorrhage. Data suggest that 50% of patients with PDR who are not treated become legally blind within five years compared to only 5% of patients who receive early treatment. Use of the currently recommended treatment strategies reduces the risk of blindness for patients with PDR. This makes full implementation of recommended treatments for PDR imperative, the article states. Both the National Eye Institute and the American Academy of Ophthalmology have developed programs to ensure that people with diabetes are screened and, when necessary, treated for diabetic retinopathy.