Delegates debate and approve a record number of proposed position statements during the Congress business sessions

Business Sessions

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Delegates debate and approve a record number of proposed position statements during the Congress

business sessions Monday, March 20, to Thursday, March 23, 2006

D

elegates were kept especially busy this year, with two Bylaws amendments and 11 proposed position statements to discuss and debate. All of the amendments and position statements, some with minor modifications, were approved by the House of Delegates. The position statements presented in this article are the final versions approved by the House.

FIRST FORUM President Sharon McNamara, RN, MS, CNOR, convened the first Forum on Monday morning at 8 AM. Topics included the proposed bylaws amendments related to member-at-large status and specialty assembly representation and proposed position statements on environmental responsibility, creating a patient safety culture, and pediatric medication safety. Attendees also heard reports from the Perioperative Professional Excellence Criteria Task Force, the CMS Informed Consent Task Force, the National Legislative Committee, and AORN’s chief nursing officer. MEMBER-AT-LARGE STATUS. Pat Hercules, RN, BSN, MS, chair of the Member at Large (MAL) Task Force explained that the task force’s charge was to evaluate the criteria for MAL membership. As a result of their investigation, the task force members proposed changing the AORN Bylaws Article III, Section 3, B, to strike the words “to eChapter or consistent access to a local” from the definition of an MAL. The section would read as follows.

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Member at Large: A registered professional nurse who supports the mission of AORN and does not have access to a chapter. Hercules explained that with the wording change, members would not be limited to a geographical traditional chapter or the currently recognized eChapter. She noted that the MAL numbers have declined since member access has changed, and many MALs are choosing to join chapters when they renew their membership. SPECIALTY ASSEMBLY REPRESENTATION. Mary Jo Steiert, RN, BSN, CNOR, chair of the Specialty Assembly Futures Task Force, and Lorraine Butler, RN, BSN, MSA, CNOR, spoke about the proposed Bylaws amendment on specialty assembly (SA) representation. Specialty assemblies support the mission of AORN and provide another venue to recruit members and leaders. The Specialty Assemblies Futures Task Force held focus groups at AORN conferences and conducted an online survey; 66.4% of respondents believed that SAs should have representation in the House of Delegates. The task force proposed amending Bylaws Article VI, Section A, 2, as follows. d) Specialty Assemblies shall be allocated two delegates per Specialty Assembly. (May not serve as a chapter delegate). The task force feels this “would ensure that all AORN members have an

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opportunity to have a voice and vote, no matter which venue they choose to connect to the Association.” From the floor, Debi Brown, RN, CNOR, Kalamazoo, Mich, expressed concern that very active chapter members often are very active SA members. Giving them another venue from which to vote could pull them away from the chapter. ENVIRONMENTAL RESPONSIBILITY. Susan Banschbach, RN, BSN, CNOR, and Cynthia Spry, RN, MSN, MA, CNOR, chair of the Environmental Task Force, introduced the proposed “Position statement on environmental responsibility” (Table 1) by discussing the issue of excess waste generated in heath care facilities, particularly in the OR. Nurses have an ethical responsibility and are in a position to influence environmental practices. Resource conservation includes preserving natural resources; managing waste and hazardous agents; recycling; reprocessing single-use devices (SUDs) according to local, state, and federal regulations; repairing, restoring, and refurbishing appropriate devices and instruments; and conserving and managing supplies. Speaking on behalf of her chapter, Jan Schultz, RN, MSN, Parker, Colo, supported the position statement but objected to the inclusion of single-use devices. “We are not speaking to the safety and efficacy of this practice, only to the lack of evidence regarding the overall environmental impact of reprocessing single-use devices.” She pointed out that Health Care Without Harm and other organizations do not include reuse of SUDs as a strategy in waste reduction, and including this strategy in the position statement “puts the Association ahead of the evidence.” PATIENT SAFETY CULTURE. Linda Groah, RN, MSN, CNOR, CNAA, FAAN, member of the Presidential Commission on Patient Safety Task Force, and Kate

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O’Toole, RN, BS, BSN, CNOR, served as resources for the proposed “Position statement on creating a patient safety culture” (Table 2). Organizations must strive to create a just culture in which errors are openly discussed and system problems are corrected. Groah stressed that accountability still must be established because a just culture is not a blame-free culture. Commitment must be articulated at all levels of the organization or safety initiatives will fail. Safety must be valued as a top priority at the expense of production, and appropriate resources must be allocated. PEDIATRIC MEDICATION SAFETY. In explaining the rationale for the proposed “Position statement on pediatric medication safety,” (Table 3) Patrick Voight, RN, BSN, MSA, CNOR, said that medication errors are the most common type of errors in health care facilities, and pediatric pharmacological research has been limited. Numerous medications lack dosing guidelines and implications for pediatric patients. Donna Watson, RN, MSN, CNOR, ARNP, FNP, chair of the Presidential Commission on Patient Safety Task Force, emphasized that nurses must have a sound understanding of the indications for the medications they administer, and it is vital that they be aware of differences in pediatric patients’ age, weight, pathology, and physiology. “A pediatric patient is not a small adult,” Watson said. April Davis, RN, MSN, CNOR, Charlotte, NC, commented that there are many disparities between men and women and people of different ages and races. She questioned whether the position statement should be expanded to include medication safety in all patient populations. PROFESSIONAL EXCELLENCE CRITERIA. Trish Seifert, RN, MSN, CNOR, CRNFA, FAAN, chair, and Charlotte Guglielmi, RN, BSN, CNOR, presented the report AORN JOURNAL •

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TABLE 1

AORN Position Statement on Environmental Responsibility Preamble Health care facilities generate in excess of two million tons, or four billion lbs, of general waste annually.1 Approximately 85% of this general waste is noninfectious, with a large portion being generated in the operating room.2 Used sterilizing, disinfecting, and cleaning agents are products that contribute to the waste stream. Inpatient facilities spend more than $5 billion a year on energy, more than any other type of building per square foot of space. Energy demands are increasing to support new and existing technology.3 Water used for sterilizing, heating, cooling, and hand sanitization contributes to excessive consumption of the natural resource. The volume of waste generated through energy and water consumption has a profound impact on consumers and health care providers and significantly affects the environment and the global economy. Nurses, a large single group of health care providers, are in a position to positively promote ecological environmental responsibility. Protection of the environment has been a concern of the nursing profession since the 1800s; Florence Nightingale once stated, “No amount of medical knowledge will lessen the accountability of nurses to do what nurses do, that is, manage the environment to promote positive life processes.”4 Nurses have an ethical responsibility to actively protect the environment, promote and participate in resource conservation, and seek to understand the political, economic, and public health components of environmental health.5 There are multiple environmentally responsible initiatives the perioperative nurse can initiate. These include, but are not limited to, • initiating potentially infectious and noninfectious tissue and waste management programs following local, state, and federal regulations by • meticulous segregation of potentially infectious and noninfectious waste; • correct disposal of chemicals, tissue, hazardous materials, and infectious waste; and • consideration and initiation of incineration alternatives; • practicing recycling; • conserving resources such as • electricity, • natural gas, • water, • paper, and • plastic; • initiating supply conservation and management practices by • opening only necessary supplies, equipment, medical devices, and implants; • supply management, to include purchase and selection of environmentally friendly products, equipment, and devices; • proactive maintenance, repair, and refurbishing of instruments and equipment; and • reprocessing of single use devices according to FDA guidelines; and • construction for efficiency and conservation following green building codes.6,7 For more information on strategies to promote environmental responsibility, consult the “AORN guidance statement: Environmental responsibility.”8 Position statement AORN believes the perioperative registered nurse should serve as a steward of the environment by being knowledgeable about environmental issues affecting perioperative practice and by actively promoting and participating in resource conservation. Resource conservation includes, but is not limited to, preservation of natural resources; waste and hazardous agent management; recycling; reprocessing of single-use devices according to local, state, and federal regulations; repair/restoration/refurbishment of appropriate medical devices and instruments; and supply conservation and management. Regardless of initiatives undertaken, consideration must be given to the overall environmental impact of practice and purchasing decisions.

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TABLE 1

AORN Position Statement on Environmental Responsibility (continued) Glossary General waste. Potentially infectious and noninfectious waste combined. Green building codes. Codes used during the design of buildings requiring the buildings to be energy efficient and water conserving, have low environmental impact, and have high indoor air quality, among other things. Noninfectious waste. Materials with no inherent hazard or infectious potential (eg, packaging materials, paper).9 Potentially infectious waste. The definition of potentially infectious waste varies from state to state, but for the purposes of this document, potentially infectious waste is waste that is capable of producing infectious diseases (eg, blood, body fluids, sharps).10 Waste stream. Flow of discarded materials and fluids that eventually return to the land, water system, or air. Notes 1. “Medical waste: The issue,” Health Care Without Harm, http://www.noharm.org/medicalWaste/issue (accessed 8 Oct 2005). 2. A Melamed, “Environmental accountability in perioperative settings,” AORN Journal 77 (June 2003) 11571168. 3. B Scrantom, “Health care: New paths to energy savings,” Building Operating Management (January 2003) http://www.facilitiesnet.com/bom/article.asp? id=1522 (accessed 8 Oct 2005). 4. “Nurses can make a difference: Environmentally responsive health care,” The Nightingale Institute for Health and the Environment, http://www.nihe.org (accessed 8 Oct 2005). 5. B Sattler, “Pioneering the environmental health frontier,” Maryland Nurses Association, http://www .marylandrn.org/documents/Pioneering%20Environmental%20Health.doc (accessed 22 Nov 2005). 6. G Vittori, Green and Healthy Buildings for the Health Care Industry (Austin, Tex: Center for Maximum Potential Building Systems, 2002). 7. “Is green building budding?” The Washington Post (April 16, 2005), USGBC in the News, http://www .usgbc.org/News/usgbcinthenews_details.asp?ID =1485& CMSPageID=159 (accessed 9 Oct 2005). 8. “AORN guidance statement: Environmental responsibility,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2006) 243-250. 9. R Garcia, “Effective cost-reduction strategies in the management of regulated medical waste,” American Journal of Infection Control 27 (April 1999) 165-175. 10. W A Rutala, R L Odette, G P Samsa, “Management of infectious waste by US hospitals,” JAMA 262 (September 1989) 1635-1640. Resources Bisson, C I; McRae, G; Shaner, H. An Ounce of Prevention—Waste Reduction Strategies for Health Care Facilities (Chicago: American Society for Health Care Environmental Services of the American Hospital Association, 1993). McVeigh, P. “OR nursing and environmental ethics: Medical waste reduction, reuse, and recycling,” Today’s OR Nurse 15 (January/February 1993) 13-18. Phillips, N, ed. Berry & Kohn’s Operating Room Technique, 10th ed (St Louis: Mosby, 2004). “Recommended practices for product selection in perioperative practice settings,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 433-436. Reeder, R. The Case Against Mercury: Rx for Pollution Prevention (Washington, DC: The Terrene Institute, 1995). Spry, C, et al. “A report on infectious and noninfectious surgical waste disposal and its relation to the overall waste problem,” AORN Journal 53 (April 1991) 905-916. Thornton, J, et al. “Hospitals and plastics: Dioxin prevention and medical waste incinerators,” Public Health Reports 111 (July/August 1996) 299-313.

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TABLE 2

AORN Position Statement on Creating a Patient Safety Culture Preamble Since the Institute of Medicine (IOM) report was released in 1999, the vast majority of patient safety initiatives have focused on micro issues, such as medication errors and wrong-site surgery, with little emphasis on the macro issue of culture. A culture change is necessary to ensure that safety innovations, procedural checklists, and other measures have an opportunity to improve patient safety. Lucian Leape, adjunct professor of health policy, Harvard School of Public Health, Harvard University, Boston, has stated that the single greatest impediment to error prevention is that “we punish people for making mistakes.”1 Medical errors are grossly unreported across the country; only 2% to 3% of major errors are reported,1 and when reported, they do not create stories or generate action.2 Analytical methods such as root cause analysis (RCA) and failure mode and effects analysis (FMEA) will not work in detecting the causes of errors if health care workers • are bound by a “code of silence,” • fear retribution, or • feel uncomfortable revealing imperfection in a process for which they are responsible.3 Position statement AORN believes that all health care organizations must strive to create a culture of safety. Such a culture will provide an atmosphere where perioperative team members can openly discuss errors, process improvements, or system issues without fear of reprisal.4 AORN further believes in the following precepts. • A commitment to safety must be articulated at all levels of the organization. • Most patient safety initiatives will fail in the absence of a viable safety culture. • Safety should be valued as the top priority, even at the expense of productivity. • Health care organizations should allocate an appropriate amount of resources and provide the necessary incentives or rewards to promote a healthy patient safety culture. • Health care organizations must adopt a responsible and accountable environment to promote a culture that freely reports errors. • Health care organizations should value learning and respond to a medical error with a focus on process improvement rather than individual blame. • Errors and mistakes must be evaluated in a manner such that contributing factors are reviewed first and then accountability is determined in relation to actions. • Each perioperative team member has an ethical obligation to perform his or her role and responsibilities with appropriate competencies and with the highest level of personal integrity. • A just culture is an environment where actions are 5analyzed to ensure that individual accountability is established and appropriate actions are taken. It is not a blame-free environment. • A learning culture is demonstrated by the organization’s willingness and ability to draw the correct conclusion from safety data and the responsibility to implement the needed strategies for reform. Evidence-based practices and continued safety research contribute to an environment that fosters learning. Learning is enhanced by an open, interdisciplinary discussion of untoward events by all members of the perioperative team. • Patients and their family members are essential partners, and including them in appropriate aspects of care is necessary to develop a safe perioperative culture. the benefits of a learning culture with the need to retain person• Disciplinary policies must balance al accountability and discipline.5 Tools should be created to assist perioperative leaders in investigating and determining accountability when an error has occurred. James Reason, professor of psychology at the University of Manchester, United Kingdom, has proposed a model of culpability

from the Perioperative Professional Excellence Criteria Task Force. In collaboration with the American Nurses Credentialing Center (ANCC), the task force used the ANCC’s 14 Forces of Magnetism to write articles that exemplify how perioperative excellence can be obtained using these forces. Articles

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on forces one through seven currently are available on AORN’s web site at http://www.aorn.org/education/magnet/ magnetforces.pdf. Contact hours will be available for the Magnet series. INFORMED CONSENT. Beverly Kirschner, RN, BSN, CNOR, CASC, reported that the charge of the CMS Informed

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AORN Position Statement on Creating a Patient Safety Culture (continued) that provides one example of a tool that can be used to determine when disciplinary actions should be taken.6(p k1) • Disruptive behavior is an impediment to communication and cannot be tolerated in any member of the perioperative team. All members of the team, including perioperative leaders, should immediately confront the individual and implement strategies to de-escalate the situation and manage behaviors. This position statement articulates AORN’s position regarding creating a patient safety culture based upon available research. AORN supports further research that is directed toward creating and maintaining a patient safety culture. It is the responsibility of each facility to establish its own safety culture and policies of accountability. Notes 1. D Marx, “Patient safety and the ‘just culture’: A primer for health care executives,” Medical Event Reporting System for Transfusion Medicine, http:// www.mers-tm.net/support/Marx_Primer.pdf (accessed 2 Dec 2005). 2. “The IOM medical errors report: 5 years later, the journey continues,” The Quality Letter for Healthcare Leaders 17 (January 2005) 2-10. 3. V F Nieva, J Sorra, “Safety culture assessment: A tool for improving patient safety in healthcare organizations,” Quality and Safety in Health Care 12 suppl 2 (December 2003) ii17-23. 4. “Principles of a fair and just culture,” Dana-Farber Cancer Institute, http://www.dana-farber.org/abo /news/tools/justculture.asp (accessed 2 Dec 2005). 5. “Just culture toolkit,” The Risk Management and Patient Safety Institute, http://www.rmpsi.com/educa tion/liveprograms/JustCultureToolkit.pdf (accessed 2 Dec 2005). 6. J Reason, Human Error (New York: Cambridge University Press, 1990). Resources Barach, P; Small, S D. “Reporting and preventing medical mishaps: Lessons from non-medical near miss reporting systems,” BMJ 320 (March 18, 2000) 759-763. Carroll, J S; Quijada, M A. “Redirecting traditional professional values to support safety: Changing organisational culture in health care,” Quality and Safety in Health Care 13 suppl 2 (December 2004) ii16-21. Davies, H T; Nutley, S M; Mannion, R. “Organisational culture and quality of health care,” Quality in Health Care 9 (June 2000) 111-119. Hofstede, G H; Hofstede, G J. Cultures and Organizations: Software of the Mind, second ed (New York: McGraw Hill, 2005). Kowalczyk, L. “Hospitals study when to apologize to patients,” Boston Globe, July 24, 2005. Also available at http://www.boston.com/tools/archives (fee required; accessed 2 Dec 2005). Krumberger, J M. “Building a culture of safety,” RN 64 (January 2001) 32ac2-32ac3. “Safety climate survey (IHI tool),” Institute for Healthcare Improvement, http://www.ihi.org/IHI/Topics /PatientSafety/SafetyGeneral/Tools/Safety+Climate+Survey+%28IHI+Tool%29.htm (accessed 2 Dec 2005). Schein, E H. “Culture: The missing concept in organization studies,” Administrative Science Quarterly 41 (June 1996) 229-240. Schein, E H. “Three cultures of management: The key to organizational learning,” MIT Sloan Management Review 38 (Fall 1996) 9-20. Also available at http://sloanreview.mit.edu/smr/issue/1996/fall/1 (accessed 2 Dec 2005). Wachter, R M; Shojania, K G. Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes, second ed (New York: Rugged Land, 2005).

Consent Task Force was to review and interpret Centers for Medicare and Medicaid Services (CMS) guidelines for obtaining consent from patients or their representatives. The interpretation must meet the spirit of the CMS guidelines and be practical to implement in the perioperative setting. Some of the ele-

ments of the informed consent include identifying all practitioners who are performing parts of the procedure, enumerating procedures performed by the assistant at surgery, identifying residents who are present, and notifying patients if any part of the procedure is done when the surgeon is not present. AORN JOURNAL •

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AORN Position Statement on Pediatric Medication Safety Preamble Medication errors constitute the single most common type of medical error occurring in facilities. Many pharmaceutical companies manufacture medications with the intention of treating only adults. Pediatric pharmacology research has been limited, drawing attention to the deficiencies in evolving knowledge for the pediatric population. Merely adjusting the recommended adult medication dose can be hazardous to the pediatric patient. Numerous medications lack formal licensing from the US Food and Drug Administration (FDA) for pediatric indications and dosing guidelines. The lack of established guidelines increases the potential for error and is directly related to the significant differences in error frequency rates between the pediatric population (47% of errors) and adult populations (28%).1 Errors can occur at any stage in the medication use process (ie, prescribing, dispensing, administering, documenting) and while monitoring for desired effects or adverse events. The administration of medications for the pediatric patient during surgical or invasive procedures poses additional challenges. A comprehensive study by United States Pharmacopoeia (USP) identified improper dose (quantity), omission, and wrong time as the top three medication errors affecting pediatric patients. “The 2001 MEDMARX data summary report” (USP 2002) analyzed 105,603 medication error records submitted by 368 voluntary facilities. The two major contributing factors involving medication errors were noted as distractions (47%) and staffing issues (43%).”2 The perioperative setting is a highly stressful and complex work environment. The hurried pace of the perioperative environment, inherent patient complexity, and human-technology interfaces have been identified as contributing to error potential in operative and procedural settings.3-5 Additional factors contributing to overall medication errors include health care provider fatigue, patient transition between departments, and inadequate or incomplete communications between health care providers.6 Position statement Regardless of the health care setting, the perioperative registered nurse administering medications to the pediatric patient must have a sound knowledge of the • medication(s) intended, • therapeutic effect(s), • side effects, • contraindications, and • pharmacology calculations prior to administration. Furthermore, it is vital for perioperative registered nurses caring for infants and children to be aware of age dependent factors such as • weight (in kilograms), • underlying pathology, • physiologic differences, • developmental stage, • growth and development, and • psychosocial and cultural dynamics of the patient’s family. Any or all of these factors may influence the efficacy and safety of medications used for pediatric patients.

Task force members met with CMS representatives and the changes are still under internal review by the CMS. When the guidelines are completed, they will be posted on AORN’s Government Affairs web page with an explanation of the changes. LEGISLATIVE COMMITTEE. Bill Duffy, RN, BSN, MJ, CNOR, gave the report of the National Legislative Committee. The committee, in conjunction with AORN’s Government Affairs Department, helped to get legislation passed in both

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Oregon and Texas that contains prescriptive language for keeping the RN in the circulator role. Duffy reported that legislation is close to being passed in Illinois, and the committee is still working with nurses in several other states on proposed legislation. Melissa Goldberg, RN, BSN, CNOR, Seattle, expressed her appreciation to the committee for helping the state of Washington draft language to present to the state board of health. Members from Ohio, Florida, and Virginia also

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AORN Position Statement on Pediatric Medication Safety (continued) Perioperative registered nurses have considerable influence in the prevention of medication errors in the perioperative setting. Application of the nursing process and an understanding of the complex nature of the many variables intrinsic to pediatric patients guides the perioperative registered nurse to implement a plan of care that ensures the safe administration of medications. The “AORN guidance statement: Medication safety across the continuum of care”7 and the Safe Medication Administration Safety Tool Kit8 provide perioperative registered nurses with guidelines to minimize medication errors in the perioperative environment. Glossary Adverse drug event. An adverse drug event (ADE) is an injury resulting from medical intervention related to a medication, which can be attributable to preventable and nonpreventable causes.9 MEDMARX. An Internet-accessible, anonymous, medication error reporting program and quality improvement tool used to track medication errors. MEDMARX is operated by US Pharmacopoeia.10 US Pharmacopoeia (USP). A nongovernment organization that establishes quality standards for medications.11 Notes 1. E R Stucky et al, “Prevention of medication errors in the pediatric inpatient setting,” Pediatrics 112 (August 2003) 431-436. 2. K Stratton, M Blegen, G Pepper, T Vaughn, “Reporting of medication errors by pediatric nurses,” Journal of Pediatric Nursing 19 (December 2004) 385-392. 3. “AORN guidance statement: Safe on-call practices in perioperative practice settings,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 193-195. 4. D H Hickam et al, “The effect of health care working conditions on patient safety,” AHRQ Evidence Report/Technology Assessment Summaries no 74 (May 2003) 1-3. Also available at http://www.ncbi .nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.88485 (accessed 1 Dec 2005). 5. M Rosekind et al, “Managing fatigue in operational settings 1: Physiological considerations and countermeasures,” Hospital Topics 75 (Summer 1997) 23-30. 6. “Joint Commission 2006 National Patient Safety Goals: Implementation expectations,” Joint Commission on Accreditation of Healthcare Organizations, http://www.jcaho.org/accredited+organizations/patient+ safety/06_npsg_ie.pdf (accessed 1 Dec 2005). 7. “AORN guidance statement: Safe medication practices in perioperative settings across the life span,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2006) 321-327. 8. “Safe Medication Administration Tool Kit,” AORN, Inc, http://www.aorn.org/toolkit/safemed (accessed 1 Dec 2005). 9. To Err is Human: Building a Safer Health System, Institute of Medicine, http://www.nap.edu/books /0309068371/html/28.html (accessed 1 Dec 2005). 10. “MEDMARX frequently asked questions,” US Pharmacopeia, http://www.usp.org/patientSafety/med marx/faq.html (accessed 1 Dec 2005). 11. “About USP—An overview,” US Pharmacopeia, http://www.usp.org/aboutUSP (accessed 1 Dec 2005).

praised the committee and the Government Affairs Department for their help with legislative efforts. Michele Hughes, RN, CNOR, Norfolk, Va, said Virginia’s legislation “met its demise in some committee, but we are proud of the work we did, and we’ll keep working.” NURSING OFFICER’S REPORT. Pauline Robitaille, RN, MSN, CNOR, AORN’s chief nursing officer, discussed AORN’s collaboration with other health care agencies. These relationships give AORN more opportunities to promote a

patient safety agenda. She highlighted a series of webinars that have been produced in collaboration with Joint Commission Resources and others produced in collaboration with the Healthcare Financial Management Association. President McNamara adjourned the Forum at 9:30 AM.

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The first House of Delegates convened Monday at 1 PM. Charlotte Guglielmi, chair of the Credentials AORN JOURNAL •

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Committee, reported that 1,223 authorized delegates had registered. A delegate count revealed that 1,171 delegates were present. Guglielmi then called the role by state. Motions were passed to adopt the House of Delegates agenda and rules. TREASURER’S REPORT. Kate O’Toole presented the auditor’s and Treasurer’s report. She said that AORN has had positive income for two years in a row for the first time since 1997. AORN events, manager products, books, and education products are selling well, and Congress attendance was high in New Orleans. AORN subsidiaries also are performing well. PRESIDENT’S ADDRESS. President McNamara’s address focused on the nonmonetary riches of AORN. “AORN is a unique organization in which you, the member, are the owner, the workforce, and the customer. That level of investment is why we are so passionate about our Association.” She focused on the richness of member recruitment, specialty assemblies, chapters, intellectual capital, collegial support, social awareness, international reach, and AORN Foundation support. EXECUTIVE DIRECTOR’S REPORT. Executive Director Tom Cooper, CAE, discussed collaboration with organizations that are looking to AORN for leadership in solving health care problems. AORN representatives sit on two of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) professional and technical advisory committees, which gives AORN input into JCAHO’s decisions and guidelines. He noted that for medication labeling, JCAHO elected to use AORN’s guidelines. AORN also took the lead in establishing a work group within the Nursing Organizations Alliance to study fatigue and safe on-call practices. Other collaborations are occurring with the CMS, the Council on Surgical Patient Safety, the

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Institute for Safe Medication Practices, the American Society for Healthcare Risk Management, the Healthcare Financial Management Association, and industry partners. NOMINATIONS. Tom Macheski, RN, BSN, CNOR, read the names of the candidates for office. No additional nominations were made from the floor. FOUNDATION REPORT. Jane Rothrock, RN, DNSc, CNOR, FAAN, president of the AORN Foundation board of trustees, announced that in the past five years, more than $2.2 million had directly benefited members through scholarships, education efforts, and grants for evidence-based research. She urged members to personally thank vendors for their support of the Foundation and asked members to stop by the Foundation booth to donate to the Funding the Future campaign. PUBLISHING PARTNERSHIP. Tom Cooper; Nancy Girard, RN, PhD, FAAN, editor-in-chief of the AORN Journal; and Patricia Nornhold, vice president of nursing and health professions journals at Elsevier, gave an update on AORN’s new publishing partnership. Cooper explained that the partnership allows AORN to focus on the core competency of creating content. Elsevier was chosen for the company’s expertise and respect and appreciation for nursing. Dr Girard assured members that the AORN Journal will still come monthly as part of membership and will be of the same quality. She announced that the Journal will have an online presence at http://www.aornjournal.org, and AORN members will have access to other Elsevier journals and MEDLINE. Authors also will be able to submit and track their articles electronically Nornhold expressed recognition of AORN’s leadership position among health care organizations. She explained that the Journal will now be part of ScienceDirect, which is a tool used by

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medical and academic hospitals, and Evolve, which is a platform that reaches 250,000 nursing students and 32,000 faculty members. BYLAWS AMENDMENT. The delegates voted to amend the Bylaws Article III, Section 3, B, related to member-at-large status. Ninety-two percent of the delegates voted in favor of the amendment. President McNamara adjourned the meeting at 2:30 PM.

SECOND FORUM The second Forum convened at 8 AM on Wednesday morning with a full agenda. Attendees heard discussion on eight proposed position statements and reports from the On-Call Electronic Task Force, NeXt Generation Task Force, International Resource Committee, and Perioperative Nursing Data Set Task Force. ORIENTATION OF THE SURGICAL TECHNOLOGIST (ST). National Committee on Education member Marilyn Sanderson, RN, BSN, CNOR, explained the proposed “Position statement on orientation of the surgical technologist to the perioperative setting,” (Table 4) saying that a professional RN orientation coordinator should orient surgical technologists to the OR, including determining the scope of and timelines for orientation. For a novice ST, orientation should last at least six months with at least 40 hours in each specialty rotation. An experienced ST should be oriented for at least three months with at least 40 hours in each rotation. Surgical technologists also should receive orientation to off shifts, weekend shifts, and on-call situations. Pat Mews, RN, MHA, CNOR, Scottsdale, Ariz, said many of the ORs in which she consults use experienced STs to train ST students, and RNs are not involved. President McNamara responded that this position statement specifically addresses new employees, not students.

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PERIOPERATIVE CLINICAL LEARNING ACTIVITIES. Sandy Albright, RN, BSN, CNOR, member of the National Committee on Education, reported that the committee reviewed the sunsetting “Position statement on inclusion of perioperative nursing learning activities in the perioperative setting” and revised it as the new proposed “Position statement on the value of clinical learning activities in the perioperative setting in undergraduate nursing curricula” (Table 5). The committee determined that nursing schools are not able to add content to their curricula, but the knowledge, skills, and values needed to practice safe nursing care and patient advocacy can be taught in the perioperative setting. AORN’s ultimate goal is for student nurses to be exposed to the perioperative environment. Perioperative nursing content and clinical skills should be taught by faculty members, preceptors, and mentors who are both academically prepared and clinically experienced. Debi Brown expressed concern that at her facilities the scrub person frequently is an ST and not an RN. She thought that limiting the role of mentors and preceptors to individuals with a BSN would limit the number of clinical sites that would be able to participate. Charlotte Guglielmi clarified that the circulating RN could be considered the mentor or preceptor in this situation. Rebecca Neal, RN, CNOR(e), Cape Coral, Fla, voiced her fear that the BSN requirement would discourage retired nurses who have diplomas from mentoring students. Guglielmi replied that AORN is not looking to eliminate any roles; the intent is to have experienced perioperative nurses working with students. HEALTH CARE INDUSTRY REPRESENTATIVES. The AORN Nursing Practices Committee was charged with reviewing and revising the existing “Position statement on AORN JOURNAL •

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AORN Position Statement on Orientation of the Surgical Technologist to the Perioperative Setting Preamble AORN recognizes that facilities come in every size and configuration, and one orientation program will not adequately address every need. There are certain basic components of orientation for the surgical technologist, however, that must be met consistently to ensure optimal patient outcomes. AORN defines a novice surgical technologist as an entry-level practitioner who has recently graduated from an accredited surgical technology program and who has been employed for one year or less.1 Experienced surgical technologists with previous OR experience who have been away for the OR for extended periods will be considered novices. AORN defines an experienced surgical technologist as a technologist with recent OR experience. This technologist should have at least two years of experience in a facility of similar size and patient acuity as the hiring facility. A skills assessment form should be completed to accurately assess competency levels in all specialties. AORN defines the orientation coordinator as a nurse educator, designated perioperative registered nurse, clinical nurse specialist, and/or nurse manager who is a registered professional nurse. Position statement The orientation of the surgical technologist should be completed under the direction of a perioperative registered nurse and individualized to meet the needs of the orientee as well as the facility. The orientee’s baseline knowledge and preferred learning method, and the ability of the facility to accommodate the learning experience, need to be assessed in advance. Orientation timelines and the impact on the budget will vary depending on the capacity of the facility. Teamwork is an essential element in a successful orientation program. Depending on size and resources, facilities should incorporate an experienced surgical technologist, or a group of surgical technologists (eg, an advisory committee), to work with the orientation coordinator to design and implement both the orientation program and the preceptor development program. The scope of orientation should include the following topics based on the Perioperative Nursing Data Set.1 • Domain 1: Safety—In collaboration with the perioperative registered nurse in the circulating role, the surgical technologist will function as a member of the team to maintain an environment that facilitates a safe patient outcome. • Count policy (O2) • Culture of safety (O2-O9) • Electrosurgical safety in the scrub role (O4) • Laser safety in the scrub role (O6) • Safe handling of medication in the scrub role (O9) • Positioning (O5) • Radiation safety (O7) • Smoke evacuation (O6) • Safe handling of specimens in the scrub role (O2) • Time-out procedure (O2) • Tourniquets (O2) • Domain 2: Physiologic response—In collaboration with the perioperative registered nurse in the circulating role, the surgical technologist will function as a member of the team to ensure that the patient’s physiologic responses to surgery are as expected. • Basic life support/code response (O14, O15) • Latex allergy (O3) • Equipment/instrumentation/supplies • Minimally invasive (ie, endoscopic) equipment (O2) • Powered equipment (O10) • Basic instrumentation (O10) • Basic OR equipment (eg, tables, lights, electrosurgical unit, suction) (O5, O2) • Malignant hyperthermia (O12) • Prevention of infection

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TABLE 4

AORN Position Statement on Orientation of the Surgical Technologist to the Perioperative Setting (continued)

•

•

• • • • • • •

Infection control (O10) Surgical attire (O10) Wound management (O10) Instrument processing (ie, care and handling) (O10) Sterilization/disinfection (O10) Skin preps (O10) Scrubbing, gowning, and gloving (O10) Domain 3-B: Behavioral response—The surgical technologist has knowledge regarding ethical care and the rights of the patient and his or her family members. (O26) • Advance directives (O31) • Age-specific policies (O21, O24) • Cultural/population-specific policies (O28) • Compliance with the Health Insurance Portability and Accountability Act (O25) • Patient privacy policies (O25) Domain 4: Health system concerns—The surgical technologist has knowledge regarding the health system environment. • Career advancement • Certification • Code of conduct • Committee participation • Communication • Continuing education • Critical thinking • Disaster planning • Employee rights • Employee safety • Environmental responsibility (eg, hazardous waste, recycling) • Fire safety • Legal issues • Organizational structure • Performance improvement projects • Professional associations • Regulatory issues • Scope of practice • Team roles • Terminology • Vendor policies

Additionally, the orientation process should include orientation to off shifts, weekends, and call situations. This should be accomplished using the preceptor system (ie, having an experienced surgical technologist or perioperative registered nurse serve as an immediate resource for the orientee). A basic orientation for a novice surgical technologist should include every clinical specialty within the technologist’s defined practice area and should be measured by successful competency assessment. The recommended exposure to a clinical specialty is at least 40 hours. Entry into practice for a surgical technologist should be graduation from an accredited surgical technology program. Completion of an individualized orientation program for both the novice and experienced surgical technologist should be measured by successful competency assessment. The recommended time frame for orientation of a novice surgical technologist should require at least six months. The recommended time frame for orientation of an experienced surgical technologist should take a minimum of at least three months. Note 1. S Beyea, ed, Perioperative Nursing Data Set, second ed (Denver: AORN, Inc, 2000). AORN JOURNAL •

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TABLE 5

AORN Position Statement on the Value of Clinical Learning Activities in the Perioperative Setting in Undergraduate Nursing Curricula Preamble AORN advocates for the inclusion of learning activities in the perioperative setting in all undergraduate professional nursing curricula. The perioperative setting is a prime area where the nursing process can be applied. This application can be integrated into the existing curricula of nursing programs and contribute to the desired end-of-program outcomes. The perioperative setting also is an area where there is currently tremendous emphasis on patient safety; therefore, it presents numerous opportunities to explore human factors and communication theories. Position statement AORN is committed to promoting the value of clinical learning activities in the perioperative setting, but recognizes the constraints inherent in nursing curricula. Therefore, AORN affirms the following. • All clinical settings, including the perioperative setting, have the potential to provide opportunities in which the principles of the art and science of professional nursing can be applied; therefore, these settings should be used during the formal education of nurses. The incorporation of perioperative learning activities into existing undergraduate curricula will assist in meeting end-of-program outcomes.1 • Perioperative nursing content and clinical skills should be taught by faculty and cooperating staff (ie, staff serving as preceptors or mentors) who are both academically prepared and clinically experienced. Note 1. Think Tank on Perioperative Learning Experiences in the Nursing Curriculum, AORN and the National League for Nursing, February 2004.

health care industry representatives in the perioperative setting” (Table 6). Kate Moses, RN, CNOR, CPHQ, chair, and Nathalie Walker, RN, BS, MBA, CNOR, explained that exponential growth in technology means perioperative team members frequently need formal training on proper use of equipment from health care industry representatives who have specialized training. It is important that industry representatives understand how to work safely in the OR. Health care industry representatives may provide technical support but should not provide direct patient care or be allowed to function within the sterile field. Alice Erskine, RN, MSN, CNOR, San Lorenzo, Calif, asked about the pacemaker representative who programs the pacemaker. This person’s actions change the patient’s heart rhythm. “Is that considered direct care or technical support?” President McNamara responded that the representative is working under the direction of a cardiologist or surgeon who is directly responsible for the care provided, so the representative is providing only technical support.

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Bill Duffy said he would introduce an amendment to the proposed position statement to clarify that with specialized training and facility approval, industry representatives can participate in a limited role. ONE RN FOR EVERY SURGICAL PATIENT. Moses and Walker also presented information on the “Proposed position statement on one perioperative RN circulator dedicated to every patient undergoing a surgical or other invasive procedure” (Table 7). This document provides support to perioperative nurses and nurse managers to maintain an RN in the circulator role for the provision of safe patient care. Patient care in the perioperative setting is dynamic in nature and depends on the clinical knowledge, judgment, and critical thinking skills that perioperative RNs possess. ADVANCED PRACTICE NURSE. Jacklyn Schuchardt, RN, MSN, CNOR, CNS, chair of the Advanced Practice Nurse Issues Task Force, and Ric Cuming, RN, MSN, CNOR, CPAN, presented the proposed “Position statement on the perioperative advanced practice nurse (APN)” (Table 8). The position statement defines

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TABLE 6

AORN Position Statement on the Role of the Health Care Industry Representative in the Perioperative/Invasive Procedure Setting Preamble AORN recognizes the need for a structured process for education, training, and introduction of procedures, techniques, technology, and equipment to health care professionals practicing within the perioperative/invasive procedure setting. By virtue of their training, knowledge, and expertise, health care industry representatives can provide technical support to the surgical team to expedite the procedure and facilitate desired patient outcomes. Health care industry representatives may function in any of several positions (eg, clinical consultants, sales representatives, technicians, repair/maintenance personnel). The primary responsibility of the perioperative registered nurse is to ensure the safety of patients undergoing operative or other invasive procedures. Core nursing activities that, by licensure, may not be performed by nonnurses are assessment, diagnosis, outcome identification, planning, and evaluation. The surgical setting is one of the most potentially hazardous of all clinical environments and is subject to strict regulations, clinical practice guidelines, and standards of care to preserve patient safety. It is important that the health care industry representative understands how to safely work in the operating room to assist the perioperative team in maintaining the patient’s safety, right to privacy, and confidentiality when a health care industry representative is present during a surgical procedure. Please refer to “AORN guidance statement: The role of the health care industry representative in the perioperative setting” for more specific information and guidelines.1 Position statement AORN supports the education of perioperative team members on new procedures, techniques, technology, and equipment with which personnel are not familiar before their use in a surgical procedure. AORN believes the following. • The RN is accountable for the patient’s nursing care during the procedure and advocates for the patient’s safety, privacy, dignity, and confidentiality. • Health care industry representatives may be permitted in the perioperative setting to provide technical support in accordance with facility policies and local, state, and federal regulations. • Health care industry representatives should not provide direct patient care or be allowed in the sterile field. However, AORN believes the health care industry representative with specialized training and facility approval may perform calibration/synchronization to adjust/program devices (such as, but not limited to, implanted electronic devices, radio frequency devices, and lasers) under the supervision of the physician. • Patients have a right to be informed about the presence of a health care industry representative in the perioperative/invasive procedure setting during a surgical procedure according to local, state, and federal regulations.2 • Health care facilities should incorporate the local, state, and federal regulations regarding health care industry representatives in the perioperative/invasive procedure setting. Notes 1. “AORN guidance statement: The role of the health care industry representative in the perioperative setting,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2006) 261-263. 2. “Standards for privacy of individually identifiable health information; Final rule,” 45 CFR Parts 160 and 164, Federal Register 65 (Dec 28, 2000) 82462. Also available at http://www.cms.hhs.gov/hipaa/hipaa2 /regulations/privacy/finalrule/PvcFR01.pdf (accessed 3 Oct 2005).

a perioperative APN as an RN with a minimum of an MSN concentrated in a recognized area of advanced clinical nursing. The four APN designations recognized by states and national nursing organizations are nurse practitioner, clinical nurse specialist, certified RN anesthetist, and certified nurse mid-

wife. The RN first assistant (RNFA) role is recognized by AORN as an expanded role but not an advanced practice role. Debi Brown asked how the RNFA role would change if the position statement passes. Cuming responded that the role would not change, and RNFAs will not AORN JOURNAL •

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TABLE 7

AORN Position Statement on One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing a Surgical or Other Invasive Procedure Preamble Perioperative nursing is a specialized area of nursing practice. The perioperative nurse is a registered nurse who plans, coordinates, delivers, and evaluates nursing care to patients whose protective reflexes or self-care abilities are potentially compromised during surgical or other invasive procedures. Although the perioperative registered nurse works collaboratively with other perioperative professionals (eg, surgeons, anesthesia care providers, surgical technologists) to meet patient needs, the perioperative registered nurse is accountable for the patient outcomes resulting from the nursing care provided during the surgical or invasive procedure. Possessing clinical knowledge, judgment, and critical-thinking skills based on scientific principles, the perioperative nurse plans and implements nursing care to address the physical, psychological, and spiritual responses of the patient having a surgical or invasive procedure. The goal of perioperative nursing practice is to assist patients, their families, and significant others to achieve a level of wellness equal to or greater than that which they had before the procedure. The perioperative registered nurse may delegate certain patient care tasks to suitably trained and competent allied health providers and assistive personnel, but retains accountability for the outcome of perioperative nursing care. Core nursing activities that, by licensure, may not be delegated are assessment, diagnosis, outcome identification, planning, and evaluation.1 In conjunction with the escalating changes in health care, there is a continuous need to provide optimal care that is high quality, safe, accessible, cost effective, and affordable for patients undergoing invasive procedures in any setting. Evolving models of health care delivery are affecting perioperative nursing practice across diverse settings where surgical or other invasive procedures are performed. Past staff reengineering attempts that were part of cost-savings initiatives have not demonstrated improvement, and may in fact have a deleterious effect on patient care outcomes. Health care systems have unsuccessfully attempted to replace registered nurses with allied health providers and assistive personnel who lack the education and critical-thinking skills to provide quality patient outcomes. Studies have demonstrated that patient-centered outcome measures are more positive when there are higher numbers of registered nurses to care for patients. Better outcomes are inversely proportional to cost. In other words, better outcomes equals lower cost for the health care system.2 The aging of the population has resulted in patients who are more acutely ill upon admission to health care facilities. Despite the decreased lengths of stay in acute care facilities, patients continually require more sophisticated care to maintain their health. This situation has been further complicated by an absence of standardized, mandatory public reporting of data that could objectively quantify the effects of altered staffing configurations. National use of the AORN Perioperative Nursing Data Set (PNDS) will provide perioperative leaders with a standardized means of gathering reliable and valid data to make informed decisions regarding staffing, scheduling, and purchasing.3 Registered nurses are familiar with anecdotal reports of health care errors resulting in patient injuries and even death. The media has continued to fuel the health care controversy with many of these stories. In 1999, the Institute of Medicine (IOM) published its report To Err Is Human: Building a Safer Health System, which opened the issue of medical errors to public debate and identified national, state,

be required to have an MSN. The position statement supports the American Nurses Association’s definition of advanced practice nurse. Julie Mower, RN, MSN, CNS, CNOR, Denver, indicated that she would bring two amendments to this proposed statement to the House. ALLIED HEALTH CARE PROVIDERS AND ASSISTIVE PERSONNEL. Michelle Burke, RN, MSA, CNOR, chair of the Allied Health Care Providers and Assistive Personnel Task

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Force, and Nathalie Walker served as resources for the discussion on the proposed “Position statement on allied health care providers and support personnel in the perioperative practice setting” (Table 9). They emphasized that RNs, allied health care providers, and assistive personnel have diverse roles that need to be clearly identified. Activities that require a nurse’s skills should not be delegated to nonnurses. Of

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TABLE 7

AORN Position Statement on One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing a Surgical or Other Invasive Procedure (continued) and local policy directions for a safer health care system capable of reducing medical errors and improving patient safety.4 To improve patient safety, the provision of one perioperative registered nurse circulator dedicated to every patient undergoing a surgical or other invasive procedure must include awareness of community needs and the needs of the population served and must provide for appropriate perioperative nursing staff to meet those needs. The economic situation of the provider organization should not serve as the sole basis for determining services offered. At no time should economic concerns supersede the priority for patient safety. Since its 1999 report, the IOM’s Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes has begun to illustrate the relationship between nurse staffing, patient outcomes, and cost of care.5 This report acknowledges that patient care provided by a registered nurse does affect patient outcomes and has a positive impact on cost of care.5 The Code of Federal Regulations “Conditions of participation for hospitals” (42 CFR §482) sets forth national staffing standards for hospitals receiving Medicare reimbursement. Under these regulations, the health care organization must have adequate numbers of qualified registered nurses to provide nursing care, which includes circulating duties.6 The Centers for Medicare and Medicaid Services interpretive guidelines in §482.51(a)(3) states, “The circulating nurse must be an RN.” If a licensed practical nurse or surgical technologist assists with delegated circulating duties, in accordance with local, state, and federal regulations, they must be supervised by a registered nurse who is physically present in the operating room for the entire procedure.7 Several states have legislation requiring a registered nurse as circulator.8 Perioperative registered nurses should know their individual state statutes regarding the role of the registered nurse as the circulator in the perioperative setting. Administrators, directors, and managers responsible for providing staff for perioperative services should refer to the “Statement on mandate for the registered professional nurse in the perioperative practice setting,”9 “AORN position statement: Operating room staffing skill mix for direct caregivers,”10 and “AORN guidance statement: Perioperative staffing.”11 Position statement AORN is committed to the provision of safe perioperative nursing care by ensuring that every patient undergoing a surgical or other invasive procedure is, at a minimum, cared for by a registered nurse in the circulating role, regardless of the setting.9 To this end, AORN believes the following. • At a minimum, one perioperative registered nurse circulator should be dedicated to each patient undergoing a surgical or other invasive procedure and is present during that patient’s entire intraoperative experience.11 • Patient care in the perioperative setting is dynamic in nature and depends on the clinical knowledge, judgment, and critical-thinking skills possessed by the perioperative registered nurse. • The foundation of perioperative nursing practice is based on both the art and science of nursing, including evidence-based practice and patient advocacy. • A practice environment that acknowledges the unique education of a registered nurse supports

key importance are accountability, coordination of care, supervision, education, and competency. ERGONOMICS. Nurses have a high incidence of work-related back injuries and other musculoskeletal injuries, according to Deborah Spratt, RN, MPA, CNAA, CNOR, chair of the Workplace Safety Task Force, who presented the proposed “Position statement on ergonomically healthy workplace practices” (Table 10)

with Lorraine Butler. Contributing factors include the duration, frequency, and magnitude of ergonomic stressors (eg, repetitive motion, awkward or static posture, moving or lifting patients). Pain and fatigue make nurses less productive, more prone to causing errors, and more likely to sustain injuries. Organization leaders must create a culture of ergonomic safety and identify and develop riskreduction strategies for injury prevention. AORN JOURNAL •

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TABLE 7

AORN Position Statement on One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing a Surgical or Other Invasive Procedure (continued) • • •

perioperative nurses to provide the highest quality of patient care in the surgical arena. Scientific research and the identification of nursing quality indicators, such as those found in the language of the PNDS, are the best means to monitor the relationship between appropriate nurse staffing and patient outcomes in the surgical setting. Having a practice environment with one perioperative registered nurse circulator dedicated to each patient undergoing a surgical or other invasive procedure will provide for safe, quality patient care in the surgical arena. Administrative and collegial support, as well as effective relationships with physicians and surgeons, contributes to the perioperative nurse’s ability to provide safe, quality patient care.

Furthermore, AORN affirms support for ongoing research to determine proper nurse staffing to sustain safe quality patient outcomes; • continued collaboration with all organizations endeavoring to reduce and eliminate health care errors; and • adequate staffing as an essential element of error prevention.

•

Notes 1. “Perioperative patient focused model,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 13-16. 2. J Needleman et al, “Nurse-staffing levels and the quality of care in hospitals,” The New England Journal of Medicine 346 (May 30, 2002) 1715-1722. 3. S Beyea, ed, Perioperative Nursing Data Set, second ed (Denver: AORN, Inc, 2002) 7. 4. L T Kohn, J M Corrigan, M S Donaldson, “Errors in health care: A leading cause of death and injury,” in To Err Is Human: Building a Safer Health System (Washington, DC: National Academy Press, 2000) 26-48. 5. Institute of Medicine, “Maximizing workforce capability,” in Keeping Patients Safe: Transforming the Work Environment of Nurses (Washington, DC: National Academies Press, 2004) 171. 6. “Conditions of participation for hospitals,” 42 CFR §482, Centers for Medicare and Medicaid Services, http://frwebgate3.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=4568225784+1+0+0 &WAIS action=retrieve (accessed 4 Oct 2005). 7. “Conditions of participation for hospitals; surgical services,” 42 CFR §482.51(a)(3), Centers for Medicare and Medicaid Services, http://frwebgate3.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=4568225784+1 +0+0&WAISaction=retrieve (accessed 4 Oct 2005). 8. B Beu, A Riera, “A summary of AORN’s 2004 legislative activities,” (Health Policy Issues) AORN Journal 80 (December 2004) 1135. 9. “Statement on mandate for the registered professional nurse in the perioperative practice setting,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 230. 10. “Statement on operating room staffing skill mix for direct caregivers,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2006) 383-384. 11. “AORN guidance statement: Perioperative staffing,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2005) 209-218.

MENTORING. Anita Shoup, RN, MSN, CNOR, cochair of the Mentoring Task Force, and Patrick Voight presented the “Proposed position statement on responsibility for mentoring” (Table 11). Mentoring is a nurturing activity that can promote career development and leadership in nursing. AORN believes that perioperative RNs will actively seek opportunities to mentor inexperienced

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nurses and managers and will model professional behavior that demonstrates commitment to nursing. ON-CALL ISSUES. Trudy Kenyon, RN, CNOR, chair, and Rosie Schroeder, RN, BSN, CNOR, presented the report of the On-call Electronic Task Force. The committee’s charges are to investigate and implement methodology for safe work/on-call practices and develop a

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TABLE 8

AORN Position Statement on the Perioperative Advanced Practice Nurse Preamble The registered nurse practicing as an advanced practice nurse (APN) builds on the foundation and core values of the nursing domain. The APN practices autonomously to design, implement, and evaluate patient-specific and population-based programs of nursing care. The APN practices in many roles and arenas. The purpose of this document is to define the role of the perioperative APN. Position statement The perioperative APN is, first and foremost, a registered professional nurse who is competent in the use of specialized perioperative nursing knowledge and skills in the care of patients and families undergoing operative and other invasive procedures. The APN possesses a minimum of a master’s degree in nursing, concentrated in a recognized area of advanced clinical nursing practice (ie, nurse practitioner [NP], clinical nurse specialist [CNS], certified registered nurse anesthetist [CRNA], or certified nurse-midwife [CNM]), which forms the foundation for an advanced practice role. A hallmark of the APN’s skills are the autonomy and expertise in diagnosing and treating complex responses of clients (ie, patient, family, community) to actual and potential health problems that are related to the prospect of or the performance of operative or other invasive procedures. The perioperative APN fosters patient advocacy and patient safety. Formulating clinical decisions in managing acute and chronic illnesses by assessing, diagnosing, and prescribing treatment modalities that may include pharmacological agents are all inherent in the perioperative APN role. In addition, the perioperative APN promotes wellness, and does this primarily by conducting comprehensive health assessments. The perioperative APN integrates clinical practice, education, research, management, leadership, and consultation into a single, but multifaceted, role. Because the focus of this role is care of surgical patients, the perioperative APN continually functions in a collegial relationship with nurses, physicians, health care organizations, and systems that influence care of the surgical patient. Resources American Nurses Association. “Scope of nursing practice: Advanced practice registered nurses,” in Nursing: Scope and Standards of Practice (Washington, DC: Nursesbooks.org, 2004) 14-16. Coalition of Nurse Practitioners. Agenda item 12.2.5, presented at the Coalition of Nurse Practitioners Constituent Assembly, Dec 2-3, 1993. Hamric, A B, et al, eds. “A definition of advanced practice nursing,” in Advanced Practice Nursing: An Integrative Approach, third ed (St Louis: Saunders, 2005) 85-108. Mirr, M P. “Advanced clinical practice: A reconceptualized role,” AACN Clinical Issues in Critical Care Nursing 4 (November 1993) 599-602. “Patient safety,” Joint Commission on the Accreditation of Health Care Organizations, http://www.jcaho .org/accredited+organizations/patient+safety/npsg.htm (accessed 9 Oct 2005). “Perioperative advanced practice nurse competency statement,” in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2006) 97-124.

communication strategy about these practices. The task force members created an online survey for AORN members that was conducted for six weeks. Among the findings were that 77% of nurses take call with an average of 85 hours per month. About 30% of the respondents were dissatisfied with their on-call schedules, and 68% had experienced negative effects of sleep deprivation. Ninety-one percent of managers responded that they had sent nurses home when they were too tired to work after being on call. The task force is planning to create a survey for creative ideas

on managing call strategies. NEXT GENERATION. Kay Ball, RN, MSA, CNOR, FAAN, chair, and members of the NeXt Generation Task Force gave yoyos and candy to the Board before presenting their report. They stated that last year, 9.3% of AORN’s membership was younger than age 35, and they challenged members to go out and recruit younger generation nurses. They suggested recruiting new nurses by inviting students to the OR to learn what perioperative nurses do and to emphasize the career portability of being a nurse. Next Generation nurses will stay in the health AORN JOURNAL •

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TABLE 9

Position Statement on Allied Health Care Providers and Support Personnel in the Perioperative Practice Setting Preamble Today’s complex health care environment requires a health care workforce composed of individuals in a widely diverse and broad mix of roles with varying levels of education. Perioperative registered nurses demonstrate leadership by selecting nursing activities that may be safely and legally delegated to competent allied health care providers and support personnel. The allied health care provider and support personnel provide support for the delivery of safe patient care and are valued members of the perioperative care team. Concern for patient safety mandates that perioperative registered nurses examine and understand their roles and responsibilities for appropriate delegation and supervision of these individuals and the delegated nursing tasks they perform. Perioperative registered nurses coordinate patient care and direct the activities of the perioperative care team with respect for the individual and recognition of the important contribution each team member makes to the patient’s well-being. Effective perioperative care teams consist of multiskilled care providers working in a collaborative partnership to achieve expected patient outcomes and satisfaction. The circulating nurse during a surgical or invasive procedure will be a registered professional nurse. Team members must perform patient care activities consistent with the needs of the patient and the team member’s education, scope of practice, and skills to ensure patient safety. AORN recognizes that the key to understanding the roles and responsibilities of the perioperative registered nurse and the allied health care providers and support personnel is the clarification of professional nursing care delivery and the activities that can be delegated within the domain of nursing. Delegation is the transfer of responsibility for the performance of an activity from one person to another while retaining accountability for the outcome.1 Delegation requires the perioperative registered nurse to use professional judgment based on the concept of patient safety; individual needs of the patients; patient acuity; complexity of technology; the education, experience, and skill of the allied health care provider and support personnel; and the extent of supervision required. The National Council on State Boards of Nursing states that “Delegation is the act of transferring to a competent individual the authority to perform a selected nursing task in a selected situation, the process for doing the work.”2 Delegation of tasks should be within the defined role functions and documented competency of the individual. Delegation must be consistent with applicable law, regulation, and accrediting agency standards. Any nursing intervention that requires independent, specialized nursing knowledge, skill, or judgment cannot be delegated.3 Position statement Perioperative registered nurses are accountable for patient outcomes resulting from the nursing care provided during the perioperative experience.4 To ensure that patients receive the highest quality and standard of care, the circulator must always be a perioperative registered nurse. Perioperative registered nurses plan, direct, and coordinate the care of every patient undergoing operative and other invasive procedures. The perioperative registered nurse is responsible for supervision of the appropriate performance and completion of delegated nursing tasks. Supervision of allied health care providers and support personnel is a function of the perioperative registered nurse. Delegation of tasks should be within the defined role functions and documented competency of the individual. Delegation must be consistent with applicable law, regulation, and accrediting agency standards. Skilled and competent allied health care providers and support personnel are valued members of the perioperative care team, contributing to safe patient care and positive patient outcomes. Allied health care providers should be graduates of accredited education programs and/or have successfully completed a national specialty certification process. Allied health care providers in the perioperative setting include, but are not limited to, • anesthesia technologists and technicians, • biomedical technicians, • certified medical assistants,

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Position Statement on Allied Health Care Providers and Support Personnel in the Perioperative Practice Setting (continued) • • • • •

certified nursing assistants, endoscopy technicians, materials management personnel, sterile processing technicians, and surgical technologists. Support personnel should have the appropriate education and documented competency required to perform the defined role functions. Support personnel include, but are not limited to, • administrative and clerical staff, • building service personnel, • patient transporters, and • surgery schedulers. The perioperative registered nurse should participate in the education and utilization of allied health care providers and support personnel who provide direct and indirect patient care. Definitions The following are operational definitions of terms used in the statement. Anesthesia technician and technologist. Provides assistance to the licensed anesthesia provider in various settings. The anesthesia technician performs duties under the direction of the perioperative registered nurse and/or licensed anesthesia provider. The anesthesia technician provides support of the anesthesia provider by assisting in the preparation and maintenance of patient equipment and anesthesia delivery systems. The technician performs first level maintenance on anesthesia machines and cleans, sterilizes, and maintains routine anesthesia equipment.5 Anesthesia technicians and technologists can achieve certification. Biomedical technician or biomedical equipment technician (BMET). One who is knowledgeable in the theory of operation, the underlying physiological principles, and the safe clinical application of biomedical equipment. The BMET applies electrical, electronic, mechanical, chemical, optical, and other engineering principles to perform maintenance, service, repairs, and overhaul of medical equipment and medical systems. Examples of equipment may include imaging, hemodialysis, physiological monitoring systems, EKGs, lasers, sterilizers, dental equipment, etc. Due to the diversity of the equipment, specialization is sometimes required.6 ICC Certification for Biomedical Equipment Technicians (BMETs) is a formal recognition by the International Certification Commission for Clinical Engineering and Biomedical Technology (ICC) that individuals have demonstrated excellence in theoretical as well as practical knowledge of the principles of biomedical equipment technology.7 Building service personnel. Ensures that the operating room environment has been cleaned as per policy and procedure. Cleans fixed and movable equipment and the physical environment according to policy and procedures that have been approved by the facility infection control department. Certified nursing assistant. Performs delegated nursing tasks and functions within the range of functions authorized in the state Nurse Practice Act and rules governing nursing. Nursing assistive personnel work under the supervision of a perioperative registered nurse.8 Competency. The knowledge, skills, and abilities required to fulfill patient care activities in the perioperative setting. Delegation. Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.9 Endoscopy technician. Provides delegated patient care activities after demonstrating competency and within the following limits: • assists in collecting data (eg, vital signs); • assists the perioperative registered nurse with the implementation of the plan of care; • assists the physician and the perioperative registered nurse during diagnostic and therapeutic procedures; and • cleans and maintains equipment according to standards and infection control policy and procedures.10 Materials management personnel. Responsible for inventory management to include both stock and nonstock supplies. Procures stock, nonstock, and specialty supplies and equipment as needed. Effectively and efficiently manages inventory to prevent stock overload and out of stock situations. Monitors utilization for contribution to the budget process. AORN JOURNAL •

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Position Statement on Allied Health Care Providers and Support Personnel in the Perioperative Practice Setting (continued) Medical assistant. Unlicensed person who provides administrative, clerical, and technical support to the physician. Most medical assistants are found in physicians’ offices.11 Sterile processing technician. Provides practical knowledge in sterile processing and the distribution of manufactured supplies and equipment. They have seven technical responsibilities: reprocessing, decontamination, disinfection, preparation, packaging, sterilization, and distribution. Sterile processing technicians can achieve certification.12 Supervision. The active process of directing, guiding, and influencing the outcome of an individual’s performance of an activity. Surgery scheduler. Member of the perioperative team whose primary responsibility is to schedule procedures and data entry of required information. The surgery scheduler ensures that the procedure is scheduled in an appropriate block of time; ensures that special needs are communicated to the appropriate staff. Surgical technologist. Possesses expertise in the theory and application of sterile and aseptic technique and combines the knowledge of human anatomy, surgical procedures, and implementation tools and technologies to facilitate a physician’s performance of invasive, therapeutic, and diagnostic procedures.13 Surgical technologists can achieve certification. Transporter. The OR transporter is responsible for ensuring the safe transportation of the patient to and from the operating rooms. The transport personnel also ensure that the transport vehicle is safe, in good repair, and clean and ensure that the transport vehicle is appropriate for the specified mode of transport. Notes 1. American Nurses Association, Compendium of American Nurses Association Position Statements, Registered Nurse Utilization of Unlicensed Assistive Personnel (Washington, DC: American Nurses Association, 1996) 213-215. 2. “Working with others: A position paper,” National Council of State Boards of Nursing, http://www .ncsbn.org/pdfs/Working_with_Others.pdf (accessed 13 December 2005). 3. “State operations manual. Appendix A—Survey protocol, regulations and interpretive guidelines for hospitals” (Rev. 1, 05-21-04) §482.51, Centers for Medicare & Medicaid Services, http://www.cms.hhs.gov /manuals/107_som/som107ap_a_hospitals.pdf (accessed 7 October 2005). 4. “Standards of perioperative nursing,” in Standards, Recommended Practices and Guidelines (Denver: AORN, Inc, 2005) 247-276. 5. The American Society of Anesthesia Technologists and Technicians Standards of Practice, 1997. 6. “What is a BMET?” Association for the Advancement of Medical Instrumentation, http://www.aami.org /resources/BMET/whatis.html (accessed 7 October 2005). 7. “What is certification?” Association for the Advancement of Medical Instrumentation, http://www.aami .org/certification/about.html (accessed 7 October 2005). 8. “Draft model language: Nursing assistive personnel,” National Council of State Boards of Nursing, http:// www.ncsbn.org/pdfs/Model_Language_NAP.pdf (accessed 12 October 2005). 9. “Delegation concepts and decision-making process National Council position paper, 1995,” National Council of State Boards of Nursing, http://www.ncsbn.org/regulation/uap_delegation_documents_delega tion.asp#Acceptable%20Use%20of%20the%20Authority%20to%20Delegate (accessed 13 December 2005). 10. “Role delineation of assistive personnel,” The Society of Gastroenterology Nurses and Associates, http://www.sgna.org/Resources/statements/statement8.cfm (accessed 7 October 2005). 11. American Medical Association, Health Professions Career and Education Directory, 2005-2006 (American Medical Association: 2005) 237. 12. J Ninemeirer, Central Service Technical Manual, fifth ed (International Association of Healthcare Central Service Material Management, 1998) 4. 13. “Surgical technology,” Commission on Accreditation of Allied Health Education Programs, http://www .caahep.org/programs.aspx?ID=careers (accessed 7 October 2005).

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care environment if they have opportunities for career advancement and are mentored into leadership positions. INTERNATIONAL EFFORTS. Brenda Ulmer, RN, MN, CNOR, chair, presented the report from the International Resource Committee. The committee’s purpose is to support AORN in becoming the global leader in perioperative nursing through collaborative international ventures. The AORN Latin American Conference in Panama in 2004 was a great success, and although the 2005 conference in Mexico was cancelled because of Hurricane Wilma, the committee is well on its way to planning for the Guatemala conference in 2006. PERIOPERATIVE NURSING DATA SET (PNDS). Carol Petersen, RN, MAOM, CNOR, presented the PNDS Task Force report. The PNDS Dashboard web site portal is free to AORN members who want to compare their facility data for certain clinical outcomes with those of similar facilities nationally. The task force has increased the number of dashboard participants by streamlining the application process and creating a list of frequently asked questions and answers on the web site. More information about the dashboard is available at http://www.aorn .org/pndsdashboard.htm. President McNamara announced that the parliamentarian would be available to help draft amendments to the proposed position statements. She adjourned the meeting at 9:30 AM.

SECOND HOUSE

OF

DELEGATES SESSION

The second House of Delegates session convened Thursday at 1:30 PM. President McNamara announced that because of an effort spearheaded by eChapter, Congress attendees had donated more than 1,900 prepaid telephone cards that will be sent to individuals serving in the military in Iraq. Charlotte Guglielmi reported that 1,251 delegates were registered for Congress,

and a delegate count determined that 1,146 were in attendance at the House. Seven position statements were approved without any amendments and without further discussion. These included the proposed position statements on • creating a patient safety culture, • orientation of the surgical technologist to the perioperative setting, • the value of clinical learning activities in the perioperative setting in undergraduate nursing curricula, • one perioperative registered nurse circulator dedicated to every patient undergoing a surgical or other invasive procedure, • allied health care providers and support personnel in the perioperative practice setting, • ergonomically healthy workplace practices, and • responsibility for mentoring. ENVIRONMENTAL RESPONSIBILITY. The first order of business was to vote on the “Proposed position statement on environmental responsibility.” On behalf of AORN of Denver, Jan Schultz proposed adding the sentence, “Regardless of initiatives undertaken, consideration must be given to the overall impact of practice and purchasing decisions.” Cynthia Spry pointed out that any initiative undertaken to protect the environment also can have environmental implications (eg, chemical use, water use). The amendment was approved, and the amended position statement was approved. MEDICATION SAFETY. Donna Watson spoke to a member’s concern that creating a position statement on medication safety for pediatric patients seemed to be favoring one population over others. Watson cited a study that found that medication errors occur in pediatric populations 47% of the time compared to 28% in adult populations. She said the task force wanted to be proactive for this particularly vulnerable population. The position statement was approved. AORN JOURNAL •

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AORN Position Statement on Ergonomically Healthy Workplace Practices Preamble Perioperative registered nurses, along with other health care professionals, are routinely faced with a wide array of occupational hazards that place them at risk for work-related musculoskeletal injuries. “Musculoskeletal disorders represent one of the most frequently occurring and costly occupational issues in nursing.”1 Multiple occupational hazards create a risk of musculoskeletal injuries that include, but are not limited to, muscles, nerves, tendons, ligaments, joints, cartilage, and spinal discs.2 Contributing factors that can bring about injury include duration, frequency, and magnitude of ergonomic stressors. Examples of ergonomic stressors encountered during patient handling tasks include • forceful tasks (eg, pushing a stretcher and patient up a ramp); • repetitive motion (eg, passing instruments, opening suture packets, typing); • awkward posture (eg, holding retractors during a surgical procedure, lifting or holding patient extremities); • static posture (eg, standing for long periods of time in one position); • moving or lifting patients and equipment (eg, lifting without assistance); • carrying heavy instruments and equipment (eg, removing a sterilized tray of instruments from the autoclave); and • overexertion (eg, protecting a combative patient emerging from anesthesia). Among occupations at risk for strains and sprains, in April 2002 the Bureau of Labor Statistics ranked nursing aides, orderlies, and attendants as number two and registered nurses as number six. “The rate of overexertion injuries among hospital nurses almost doubles that of workers in private industry. In 1990, the national goal was to decrease these injuries in nursing personnel from 12.7 injuries per 100 full-time nurses annually to nine. According to one source, however, the rate actually had increased to 17.8 injuries per 100 nurses by 1995.”3 “Among nurses, back, shoulder, and neck injuries are the most prevalent musculoskeletal disorders (MSDs). In 2001, nurses in the private sector had 11,800 MSDs, most of which (ie, almost 9,000) were back injuries. Likewise, more than a third (36%) of the injuries requiring time away from work were back injuries. Studies of back-related workers’ compensation claims show that nursing personnel have the highest claim rates of any occupation or industry. A recent study found that slightly more than half of all nurses (52%) complain of chronic back pain. According to an older study, 12% of nurses who intended to leave the profession cited back injuries as either a main or contributing factor.”4 Cumulative trauma disorders (CTDs) most often affect upper extremities (eg, wrists, fingers, shoulders, elbows). Cumulative trauma disorders, also known as repetitive strain injuries, are physical problems affecting joints and soft tissues (eg, muscles, tendons, nerves). Limited range of motion or a reduction in the ability to grip objects can occur if a CTD is left untreated. Discomfort, swelling, or muscle fatigue that does not disappear with rest are the beginning signs of a CTD. The aching muscle may feel as if it has been strained or overused. Another sign is tingling or numbness. All these symptoms may become chronic for perioperative registered nurses and can result in muscle weakness and nerve problems.5 Perioperative registered nurses with these symptoms may have difficulty providing patient care and performing specific activities (eg, opening supplies, passing instruments, computer documentation, lifting instrument pans). Perioperative registered nurses also are prone to pain and fatigue from static posture during surgical procedures. Static posture puts an increased load or force on muscles and tendons that impedes the flow of blood needed to bring nutrients and carry away waste products of metabolism. The longer the posture must be maintained, the more the potential for fatigue and muscle-tendon strain.6 Pain and fatigue can be the result of standing in one place for long periods of time. Employees that experience pain and fatigue are • less productive, • less attentive, • more prone to make consistent mistakes, • more susceptible to injury, and

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AORN Position Statement on Ergonomically Healthy Workplace Practices (continued) •

more likely to affect the health and safety of others. Research from the University of Pittsburgh has shown that there is a direct relationship between safety and productivity in the workplace.6

Position statement AORN is committed to the attainment and maintenance of an ergonomically healthy workplace to protect all employees in the perioperative setting. Therefore, AORN believes that every organizational perioperative setting should be ergonomically safe to decrease or prevent injury to the health care worker. Safe working conditions must be a top priority for all health care organizations. Each organization’s leadership team should assess, identify, develop, and implement risk-reduction strategies for injury prevention using an ergonomic approach. AORN supports research that is directed toward creating and maintaining equipment and work tasks to conform to the capability of the perioperative health care worker. AORN further supports collaboration with the National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Association (OSHA), and state and local regulations to promote ergonomic safety in the perioperative environment. AORN believes that risk-reduction strategies in the following areas should be considered when developing a plan for an ergonomically healthy perioperative environment. Administrative Controls • Develop a culture of ergonomic safety. • Develop and implement a policy for manual patient handling. • Develop and implement patient care ergonomic assessment protocols. • Limit the weight of instrument trays. • Educate and train staff in the use of patient-handling devices and strategies to prevent musculoskeletal injury. • Design and implement ergonomic work stations. Engineering Controls Maintain adequate room lighting. Have available appropriate assistive patient-handling equipment. Adapt workstations, tools, and equipment for ergonomic safety.

• • •

Behavioral Controls Have available ergonomic clinical advisors and/or resources. Wear nonskid footwear. Remove or eliminate clutter. Keep cabinet doors and room doors closed. Clean up spills or debris immediately. Cover equipment cables across the floor. Use lift teams to handle patients. Inspect furniture wheels frequently for buildup of debris. This position statement articulates AORN’s position regarding ergonomic safety in the perioperative environment based on available research at this time.

• • • • • • • •

Glossary Administrative controls. Administrative or management control of workplace practices (eg, providing adequate staffing levels).7 Awkward posture. Tilting the head downwards for long periods of time; twisted, hyperextended, or flexed back and neck positions.8 Cumulative trauma disorder (CTD): Cumulative trauma disorders are physical problems affecting joints and soft tissues such as muscles, tendons, and nerves. Cumulative trauma disorders most often affect the wrists and can damage fingers and elbows.5 Engineering controls. Designing equipment and workplaces to prevent or reduce the incidence of injury to the worker.7 AORN JOURNAL •

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AORN Position Statement on Ergonomically Healthy Workplace Practices (continued) Ergonomics. “The science of fitting the job to the worker. When there is a mismatch between the physical requirements of the job and the physical capacity of the worker, worker-related musculoskeletal disorders (MSDs) can result. Ergonomics is the practice of designing equipment and work tasks to conform to the capability of the worker; it provides a means for adjusting the work environment and work practices to prevent injuries before they occur.”8 “Ergonomics places an emphasis on work practices, biomechanics, work environment, and tool use.”9 Repetitive motion injury. “Tissue damage caused by repeated trauma, usually associated with writing, painting, typing, or use of vibrating tools or hand tools. Almost any form of activity that produces repeated trauma to a particular area of soft tissue, including tendons and synovial sheaths, may cause this type of injury. Carpal tunnel syndrome, other nerve compression syndromes, and shin splints are examples of repetitive motion injuries.”10 Static posture. “Continuously standing in one position during lengthy surgical procedures, causing muscle fatigue and pooling of blood in the lower extremities. Standing on hard work surfaces such as concrete creates trauma and pain to feet.”8 Work-related musculoskeletal disorder (WRMD). Conditions that affect muscles, nerves, tendons, ligaments, joints, cartilage, or spinal discs. WRMDs, also referred to as cumulative trauma disorders or repetitive strain injuries, do not include injuries resulting from slips, trips, falls, or similar accidents. Notes 1. D Smith, P A Leggat, “Musculoskeletal disorders in nursing,“Australian Nursing Journal 11 (July 2003). 2. National Institute for Occupational Safety and Health, Elements of Ergonomics Program, publ 97-117 (Cincinnati: US Department of Health and Human Services, 1997). 3. B Owen, “Preventing injuries using an ergonomic approach,” AORN Journal 72 (December 2000) 1031-1036. 4. A Converso, C Murphy, “Winning the battle against back injuries,” RN 67 (February 2004) 52-58. 5. “Q&A on RSIs, ergonomics, etc,” FAQ Typing Injury, CTD Resource Network, http://www.tifaq.com/ information.html (accessed 9 Oct 2005). 6. “Static postures,” Iowa State University Department of Environmental Health and Safety, http//www.ehs .iastate.edu/oh/static.htm (accessed 9 Oct 2005). 7. A L Nelson, ed, Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement (Tampa, Fla: Veterans Administration Patient Safety Center of Inquiry, 2001). 8. “Healthcare wide hazards module: Ergonomics,” Hospital eTool, Occupational Safety and Health Administration, http://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html (accessed 9 Oct 2005). 9. J T Bielecki, “Dimensions of back care: Injuries in health care workers,” Occupational Health Tracker 5 (Summer 2002). 10. D Venes, ed, Taber’s Cyclopedic Medical Dictionary, 20th ed (Philadelphia: FA Davis Company, 2005). Resource National Research Council and Institute of Medicine. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities (Washington, DC: National Academy Press, 2001). Online resources “Advancing occupational and environmental health and safety globally,” handouts from the American Industrial Hygiene Conference and Exposition (May 2004), http://www.aiha.org/aihce04/handouts/po 102courtney.pdf (accessed 9 Oct 2005). “Handle With Care” ergonomic campaign, American Nurses Association, http://www.nursingworld.org /handlewithcare (accessed 9 Oct 2005). “OSH answers: Ergonomics,” Canadian Centre for Occupational Health and Safety, http://www.ccohs.ca /oshanswers/ergonomics (accessed 9 Oct 2005). “A California nonprofit corporation providing information and assistance to the RSI community,” CTD Resource Network, http://www.ctdrn.org (accessed 9 Oct 2005). GMB: Britain’s General Union, http://www.gmb.org.uk (accessed 9 Oct 2005). “NIOSH safety and health topic: Ergonomics and musculoskeletal disorders,” National Institute for Occupational Safety and Health, http://www.cdc.gov/niosh/topics/ergonomics (accessed 9 Oct 2005). National Safety Council, http://www.nsc.org (accessed 9 Oct 2005).

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AORN Position Statement on Responsibility for Mentoring Preamble The specialty of perioperative nursing is practiced within a setting characterized by rapidly changing technology as well as economic and cultural forces that require continuous adaptation. To meet the needs of this demanding environment, perioperative registered nurses are required to acquire complex knowledge and skills through formal educational programs. However, the demand for perioperative nurses outweighs the supply due to several factors, including increased educational needs and lack of teaching programs to provide this education. “Currently, despite the nursing shortage, not all applicants to nursing schools are accepted due to insufficient faculty, admissions seats filled, and insufficient teaching space. Perioperative nursing is still not always offered in the curriculum except as an elective or a one-day observation.”1 Despite these challenges, practicing perioperative registered nurses have the opportunity to encourage interested individuals to enter the nursing profession through formal and informal mentoring activities and behaviors. The importance of mentoring within nursing is gaining acceptance and support. The Nurse Reinvestment Act of 2002 provides funding to advance nursing education and nursing workforce diversity and to promote mentoring, cultural competencies, and collaborative efforts to increase the involvement of nurses in organizational and clinical decision making. Perioperative registered nurses entering clinical, management, and leadership roles, as well as student nurses, need a support system, role models, and guidance to advance the practice of perioperative nursing. Perioperative registered nurses are involved in life-long learning to maintain a current body of perioperative knowledge. Professionalism in perioperative nursing is demonstrated by participation in professional organizations, legislative and regulatory initiatives influencing perioperative nursing practice, and active interest in global health care issues affecting the practice of perioperative nursing. Perioperative registered nurses have a responsibility to strengthen and advocate for an environment that promotes career development and leadership and to create an environment where active mentoring is supported and encouraged. Position statement • AORN believes mentors will work to create a culture that is mutually respective and inclusive of individual diversity; • AORN believes that perioperative registered nurse mentors will seek to build mutually supportive professional relationships in all areas of practice to facilitate growth and professional development; • AORN believes that perioperative registered nurses will actively seek opportunities to mentor novice perioperative nurses engaged in clinical practice, inexperienced perioperative nurse managers, emerging leaders in the perioperative nursing milieu, as well as students and other persons interested in exploring perioperative nursing as a career; and • AORN believes that the perioperative registered nurse mentor will model professional behavior and demonstrate a commitment to perioperative nursing by participating in professional organizations, supporting practice-related legislative and regulatory initiatives impacting perioperative nurses and nursing, and maintaining an awareness of global health care issues affecting the practice of perioperative nursing. Note 1. New Data Confirms Shortage of Nursing School Faculty Hinders Efforts to Address the Nation’s Nursing Shortage (news release, Washington, DC: American Association of Colleges of Nursing, March 8, 2005).

BYLAWS AMENDMENT. Mary Jo Steiert stated the motion to amend the bylaws by allowing SAs to have two delegates per assembly. Those delegates may not also serve as chapter delegates. Sharon Robinson, RN, MS, CNOR, Glen Falls,

NY, expressed her confusion over this proposal because the chapters currently are unable to fill 1,500 delegate seats, and members who want to vote can act as surrogate delegates. Ruth Shumaker, RN, BSN, CNOR, Germantown, Tenn, AORN JOURNAL •

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spoke in favor of the motion, and said she hoped the Association would continue to look at additional ways members could vote because “every member deserves a vote.” Linda Savage, RN, BS, CNOR, Ft Myers, Fla, also spoke in favor of the amendment, but did not agree that every member should be able to vote. She recommended encouraging members to attend business sessions to learn about the issues. After the vote was called, the amendment was approved. HEALTH CARE INDUSTRY REPRESENTATIVES. Bill Duffy moved that the third bullet of the “Proposed position statement on the role of the health care industry representative in the perioperative setting” be amended to read, Health care industry representatives should not provide direct patient care or be allowed in the sterile field. However, AORN believes the health care industry representative with specialized training and facility approval may perform calibration/ synchronization to adjust/program devices (such as, but not limited to, implanted electronic devices, radio frequency devices, and lasers) under the supervision of a physician. He pointed out that this wording had been left in the guidance statement but not in the position statement. The amendment to the statement was adopted. Duffy then proposed a second amendment to have the words “invasive procedure” inserted after the word “perioperative” in the title and in several other places in the document. A debate ensued among several delegates as to whether the word “interventional” was more appropriate than the word “invasive.” A motion to amend the amendment by changing the wording to “interventional” did not pass. The amendment to add the word “invasive” was approved and subsequently, the position statement was approved as amended. ADVANCED PRACTICE NURSES. Julie Mower made a motion to amend the “Proposed

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position statement on the perioperative advanced practice nurse” by adding AORN’s “Perioperative advanced practice nurse competency statement” to the resources list and making some minor wording changes. Jacklyn Schuchardt also asked the delegates to accept these editorial changes. The amendment was adopted, and the amended position statement was approved. OTHER BUSINESS. Jane Rothrock reported that the AORN Foundation had received nearly $39,000 in individual members’ donations during the week. She called this “stunning, stellar, and most appreciated.” Della Williams, RN, Atlanta, proposed that AORN engage in a dialogue with the Surgeon General’s office to identify ways to support his initiative to provide care to marginalized populations. She further asked for a report on this matter to the House of Delegates at the 2007 Congress. A number of other delegates spoke in favor of this proposal, and the motion was approved. Election results. Tom Macheski presented President McNamara with the election results. • Members elected to the Nominating Committee are • Elizabeth (Lynette) Gentz, RN, BSN, CNOR; • Marion McCall, RN, BBA, CNOR; and • Linda Timmons, RN, BA, CNOR. • Members elected to the Board of Directors are • Anne Marie Herlehy, RN, MS, CNOR; • Debra Spratt, RN, BSN, MPA, CNOR, CNAA; and • Patrick Voight, RN, BSN, MSA, CNOR. • The new Secretary is Jane Flowers, RN, MSN, CNOR. • The new Vice President is Charlotte Guglielmi, RN, BSN, CNOR. • The new President-elect is Mary Jo Steiert, RN, BSN, CNOR. The meeting was adjourned at 3 PM.❖ LIZ COWPERTHWAITE MANAGING EDITOR