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Nursing Groups Discuss Image, Standards, Certification, Use of Technical Personnel
FEBRUARY 1990, VOL. 51, NO 2
AORN JOURNAL
Nursing Groups Discuss Image, Standards, Certification, Use of Technical Personnel
R
epresentatives from 32 national nursing organizations and 12 American Nurses’ Association councils participated in the Nursing Organization Liaison Forum (NOLF) meeting, which was held in Kansas City, Mo, Nov 17 to 18, 1989. The NOLF is part of the ANA formal structure. It provides a formal mechanism by which national nursing organizations and ANA can discuss concerns about professional issues and national health policy. This 1989 meeting marks the first time representatives of the ANA councils attended as full participants. The purpose of council participation is “to enhance linkages between ANA’s internal and external reference groups on practice standards,” according to ANA. Lucille Joel, RN, EdD, FAAN, ANA president and NOLF chairperson, reiterated the purpose of NOLF in her opening comments by saying, “The purpose of NOLF is to get input and reaction [from nursing groups] so ANA can speak out on behalf of all nurses.” In that respect, it differs from the National Federation for Specialty Nursing Organizations, according to Dr Joel. Recommendations are brought to the ANA board of directors by the chairperson and vice-chairperson of NOLF, as appropriate. Vice-chairperson Patricia McCollom, RN, MS, CRRN, chaired the NOLF meeting. This report summarizes the major topics discussed at the meeting.
Image Campaign
I
n response to the nursing shortage, the governing board of the National Commission on Nursing Implementation Project (NCNIP) and the Advertising Council of New York are coordinating a major two-year public service campaign aimed at improving the public image of nursing. The official kickoff was scheduled to take place in late January. According to Vivien DeBack, RN, PhD, NCNIP executive director and project director, “this campaign has been developed with input
Vivien DeBack discusses the two-year public service campaign aimed at improving the image of nursing. from major nursing organizations and nationally recognized advertising experts. The essential message is that nurses are caring and knowledgeable men and women.” The project is being funded by the W. K. Kellogg Foundation and contributions from medical supply companies, hospitals, medical centers, and nursing associations; AORN is a contributor. The advertising agency of D’arcy, Masius, Benton & Bowles, and the public relations agency, Manning, Selvage & Lee also have volunteered their services. Television advertising will be directed to the general public to try to influence career decisions. The message of the campaign will be that nurses are knowledgeable professionals with decisionmaking and problem-solving skills. The slogan,“if caring were enough, anyone could be a nurse,’’ will appear in all advertisements. 589
AORN JOURNAL
Print and radio advertisements will be specifically targeted to teenagers and second-career adults. These advertisements will include messages about career opportunities into the twenty-first century. They also will include a toll-free number so that interested individuals may call for additional information about nursing practice, nursing education, and career opportunities. The NOLF participants had the opportunity to preview some of the television advertisements. Some representatives gave suggestions about adjusting the more clinical material, but the overall reaction was positive. “An image campaign is not going to solve all of nursing’s problems,” Dr DeBack said. “All of you are working on improving working conditions, and surely within that context a national nursing image campaign fits,” according to Dr DeBack. The NCNIP public service campaign is being coordinated with the TriCohncil’s two-year media project, “Nurses of America,” which is aimed at educating the public about nursing’s contributions to cost-effective quality care by encouraging accurate portrayals of nurses in the media. The TriCouncil is comprised of the ANA, the American Association of Colleges of Nursing, the American Organization of Nurse Executives, and the National League for Nursing.
Uniform Nursing Practice Standards
0
ne hundred five sets of standards exist in nursing today, and not one is really used in public policy, according to Norma Lang, RN, PhD, FAAN, cochairperson, ANA task force on nursing practice standards. “They are used in nursing only, and sometimes they create conflict,” Dr Lang said. The task force was developed under the auspices of the ANA cabinet on nursing practices. Its goal is to “define the nature of standards of practice for nursing and the relationship of quality assurance activities and standards of practice to nursing specialization, credentialing, and . . . nursing information systems.” The first meeting of the task force was held Aug 15, 1989. AORN sent two representatives, and they also are 590
FEBRUARY 1990, VOL. 51, NO 2
Norma Lang speaks in favor of a more universal set of nursing standards. scheduled to attend the second meeting, which was scheduled to take place in January. The need for more universal standards in nursing stems from the need to identify and measure quality care and cost-effectiveness, according to Dr Lang. The eventual goal, according to Dr Lang, is for nursing groups to agree on a common set of standards that could be incorporated into nursing information systems and governmental data bases. To have a credible quality assurance program, one must have standards of practice, Dr Lang said. Because hospital accreditation, and in some cases reimbursement, is being tied to issues of quality care and patient outcomes, many groups, both private and governmental, are becoming more involved in quality assurance activities. A report circulated to the NOLF participants gave many examples of such activities. For example, the Health Care Financing Administration (HCFA) is mandating peer review organizations (PROS) to include review of quality in their activities. Medicare data may undergo research that would examine appropriateness and effectiveness of various procedures. The results will
AORN JOURNAL
FEBRUARY 1990, VOL. 51, NO 2
Estelle McPhail (standing) leads the discussion on assistive personnel. Joining her are (sitting from left) Carol Applegeet, Patricia McCollom, Suzanne White, and Lucille Joel. be communicated to physicians by the PROS. The Joint Commission on Accreditation of Healthcare Organizations is developing clinical indicators to be used to assess clinical performance and patient outcomes. The American Medical Association (AMA) has 40 full-time employees involved in quality assurance issues, according to Dr Lang. It believes that physicians are put at a disadvantage by the absence of consistent standards against which the courts can weigh alleged malpractice, according to the report. The AMA prefers the term parameters to describe the quality assurance guidelines or standards because parameters are seen as less constricting. The AMA’s announcement that it was developing “practice parameters” came at a time when 15 of 24 medical specialties with board-certified members had established standards (ranging from advisory guidelines to performance thresholds), according to the AMA Council of Medical Specialty Societies. Dr Lang stressed that a universal set of nursing standards is necessary if nursing data are to become “visible” in quality data systems.
an interim report on the committee’s progress. The committee’s goal is to create a national board for nursing specialties to work toward some common certification criteria. According to Dr Hartshorn, there are 35 different certification programs, all with different requirements. Some nurses are certified in more than one specialty, and often they value one certification more than another, she said. The committee is composed of representatives from specialty nursing organizations and certification organizations. A draft document concerning the purpose, function, and design of the board was sent to the nursing community in November 1989. Those who had written the committee with concerns about the document were scheduled to meet with the committee in December 1989, according to Dr Hartshorn. Dr Hartshorn said that there is general support of the concept. The committee must still define membership categories (eg, consumers, certifiers, assoC;ates), establish costs, clarify its purpose and function,and deal with legal issues (eg, antitrust issues).
Role of Assistive Personnel National Board of Nursing Specialties
T
he Josiah M. Macy Foundation has provided funding to the nursing community to establish a board of nursing specialties. Jeanette C. Hartshorn, RN, PhD, project director, committee for the national board of nursing specialties, gave
M
any specialty nursing groups at this NOLF meeting work with nonRNs in the delivery of patient care. AORN President Carol Applegeet, RN, MSN, CNOR, CNAA, and Estelle McPhail, RN, MS, CEN, CNA, president of Emergency Nurses Association, led a discussion on the education and employment of technical personnel. 59 1
AORN JOURNAL
Applegeet gave the history of the role of surgical techniciansin the operating room. She summarized AORNs role in getting the technicians started and discussed both the current Medicare rules and regulations and the Commission standard that requires RN supervision of the technician in the operating room. McPhail discussed the roles of emergency medical technicians and paramedics. “They work under different guidelines [from RNs] and usually in the prehospital setting,” she said. She discussed the different training of each group, and opened the topic for discussion from the participants. Many specialty nursing groups are concerned about erosion of their nursing practice, but many groups also acknowledge the need for assistive personnel. For example, Dr Joel said that nurses have to be realistic in home care and long-term care. “There’s a lot of work that can be done by someone else,” she said. Dr Joel informed the group that the TriCouncil is working on a statement on assistance for nurses that will be realistic, and will distinguish between nonnursing and assistive care. The statement also will make it clear that nurses are in charge and that they are responsible for those to whom they assign or delegate certain tasks, according to Dr Joel. The group discussed use of dialysis technicians, critical care technicians, and home health and school health aides.
OrganizationalAffiliate Status
S
uzanne White, RN, MN, CCRN, memberat-large, is the NOLF representative to the ANA task force to develop criteria for organizational affiliates, which was scheduled to meet in early 1990. She encouraged the NOLF representatives to discuss their perceptions of the role of organizational affiliation within the new ANA structure.Suggested criteria will be presented to the ANA house of delegates in June 1990. As it stands now, each organizational affiliate will be allowed one RN participant in the ANA house of delegates. That participant can make reports, but he or she cannot vote. The “voicebut-no-vote’’ status is a legal issue, according to Dr Joel. “You can’t have a vote unless you have 592
FEBRUARY 1990, VOL. 51, NO 2
Newly elected officers of NOLF are Carol Applegeet, vice-chairperson (lefl) and S. Ann Evans, member-at-large.
the same tax levied on your organization as the state nurses associations,” Dr Joel said. Some representatives voiced concern about the benefit of organizational affiliate status, given the no-vote status.
New Officers
A
pplegeet was elected NOLF vice-chairpenon for the 1990-1991 term.Her duties will include serving as charpenon of the NOLF executive committee, reporting recommendations of NOLF to the ANA board, collaborating with officers in preparing the agenda for the annual meeting, and serving as contact person for participating organizations to discuss their concerns. S. Ann Evans, RN, MS, MBA, presidentelect of the American Association of Critical-Care Nurses, was elected NOLF member-at-large for the 19901991 term. She will maintain records, cerhfy the list of participating organizations, and compile the ballot for election of officers.Together with the ANA president, who serves as the charperson, the vicechairperson and member-at-large constitute the NOLF executive committee. The next NOLF meeting is scheduled for Nov 16 to 17,1990, in Kansas City, Mo. PATNIESSNER PALMER,RN, MS EDUOR
AORN JOURNAL
Nursing Groups Discuss Image, Standards, Certification, Use of Technical Personnel
R
epresentatives from 32 national nursing organizations and 12 American Nurses’ Association councils participated in the Nursing Organization Liaison Forum (NOLF) meeting, which was held in Kansas City, Mo, Nov 17 to 18, 1989. The NOLF is part of the ANA formal structure. It provides a formal mechanism by which national nursing organizations and ANA can discuss concerns about professional issues and national health policy. This 1989 meeting marks the first time representatives of the ANA councils attended as full participants. The purpose of council participation is “to enhance linkages between ANA’s internal and external reference groups on practice standards,” according to ANA. Lucille Joel, RN, EdD, FAAN, ANA president and NOLF chairperson, reiterated the purpose of NOLF in her opening comments by saying, “The purpose of NOLF is to get input and reaction [from nursing groups] so ANA can speak out on behalf of all nurses.” In that respect, it differs from the National Federation for Specialty Nursing Organizations, according to Dr Joel. Recommendations are brought to the ANA board of directors by the chairperson and vice-chairperson of NOLF, as appropriate. Vice-chairperson Patricia McCollom, RN, MS, CRRN, chaired the NOLF meeting. This report summarizes the major topics discussed at the meeting.
Image Campaign
I
n response to the nursing shortage, the governing board of the National Commission on Nursing Implementation Project (NCNIP) and the Advertising Council of New York are coordinating a major two-year public service campaign aimed at improving the public image of nursing. The official kickoff was scheduled to take place in late January. According to Vivien DeBack, RN, PhD, NCNIP executive director and project director, “this campaign has been developed with input
Vivien DeBack discusses the two-year public service campaign aimed at improving the image of nursing. from major nursing organizations and nationally recognized advertising experts. The essential message is that nurses are caring and knowledgeable men and women.” The project is being funded by the W. K. Kellogg Foundation and contributions from medical supply companies, hospitals, medical centers, and nursing associations; AORN is a contributor. The advertising agency of D’arcy, Masius, Benton & Bowles, and the public relations agency, Manning, Selvage & Lee also have volunteered their services. Television advertising will be directed to the general public to try to influence career decisions. The message of the campaign will be that nurses are knowledgeable professionals with decisionmaking and problem-solving skills. The slogan,“if caring were enough, anyone could be a nurse,’’ will appear in all advertisements. 589
AORN JOURNAL
Print and radio advertisements will be specifically targeted to teenagers and second-career adults. These advertisements will include messages about career opportunities into the twenty-first century. They also will include a toll-free number so that interested individuals may call for additional information about nursing practice, nursing education, and career opportunities. The NOLF participants had the opportunity to preview some of the television advertisements. Some representatives gave suggestions about adjusting the more clinical material, but the overall reaction was positive. “An image campaign is not going to solve all of nursing’s problems,” Dr DeBack said. “All of you are working on improving working conditions, and surely within that context a national nursing image campaign fits,” according to Dr DeBack. The NCNIP public service campaign is being coordinated with the TriCohncil’s two-year media project, “Nurses of America,” which is aimed at educating the public about nursing’s contributions to cost-effective quality care by encouraging accurate portrayals of nurses in the media. The TriCouncil is comprised of the ANA, the American Association of Colleges of Nursing, the American Organization of Nurse Executives, and the National League for Nursing.
Uniform Nursing Practice Standards
0
ne hundred five sets of standards exist in nursing today, and not one is really used in public policy, according to Norma Lang, RN, PhD, FAAN, cochairperson, ANA task force on nursing practice standards. “They are used in nursing only, and sometimes they create conflict,” Dr Lang said. The task force was developed under the auspices of the ANA cabinet on nursing practices. Its goal is to “define the nature of standards of practice for nursing and the relationship of quality assurance activities and standards of practice to nursing specialization, credentialing, and . . . nursing information systems.” The first meeting of the task force was held Aug 15, 1989. AORN sent two representatives, and they also are 590
FEBRUARY 1990, VOL. 51, NO 2
Norma Lang speaks in favor of a more universal set of nursing standards. scheduled to attend the second meeting, which was scheduled to take place in January. The need for more universal standards in nursing stems from the need to identify and measure quality care and cost-effectiveness, according to Dr Lang. The eventual goal, according to Dr Lang, is for nursing groups to agree on a common set of standards that could be incorporated into nursing information systems and governmental data bases. To have a credible quality assurance program, one must have standards of practice, Dr Lang said. Because hospital accreditation, and in some cases reimbursement, is being tied to issues of quality care and patient outcomes, many groups, both private and governmental, are becoming more involved in quality assurance activities. A report circulated to the NOLF participants gave many examples of such activities. For example, the Health Care Financing Administration (HCFA) is mandating peer review organizations (PROS) to include review of quality in their activities. Medicare data may undergo research that would examine appropriateness and effectiveness of various procedures. The results will
AORN JOURNAL
FEBRUARY 1990, VOL. 51, NO 2
Estelle McPhail (standing) leads the discussion on assistive personnel. Joining her are (sitting from left) Carol Applegeet, Patricia McCollom, Suzanne White, and Lucille Joel. be communicated to physicians by the PROS. The Joint Commission on Accreditation of Healthcare Organizations is developing clinical indicators to be used to assess clinical performance and patient outcomes. The American Medical Association (AMA) has 40 full-time employees involved in quality assurance issues, according to Dr Lang. It believes that physicians are put at a disadvantage by the absence of consistent standards against which the courts can weigh alleged malpractice, according to the report. The AMA prefers the term parameters to describe the quality assurance guidelines or standards because parameters are seen as less constricting. The AMA’s announcement that it was developing “practice parameters” came at a time when 15 of 24 medical specialties with board-certified members had established standards (ranging from advisory guidelines to performance thresholds), according to the AMA Council of Medical Specialty Societies. Dr Lang stressed that a universal set of nursing standards is necessary if nursing data are to become “visible” in quality data systems.
an interim report on the committee’s progress. The committee’s goal is to create a national board for nursing specialties to work toward some common certification criteria. According to Dr Hartshorn, there are 35 different certification programs, all with different requirements. Some nurses are certified in more than one specialty, and often they value one certification more than another, she said. The committee is composed of representatives from specialty nursing organizations and certification organizations. A draft document concerning the purpose, function, and design of the board was sent to the nursing community in November 1989. Those who had written the committee with concerns about the document were scheduled to meet with the committee in December 1989, according to Dr Hartshorn. Dr Hartshorn said that there is general support of the concept. The committee must still define membership categories (eg, consumers, certifiers, assoC;ates), establish costs, clarify its purpose and function,and deal with legal issues (eg, antitrust issues).
Role of Assistive Personnel National Board of Nursing Specialties
T
he Josiah M. Macy Foundation has provided funding to the nursing community to establish a board of nursing specialties. Jeanette C. Hartshorn, RN, PhD, project director, committee for the national board of nursing specialties, gave
M
any specialty nursing groups at this NOLF meeting work with nonRNs in the delivery of patient care. AORN President Carol Applegeet, RN, MSN, CNOR, CNAA, and Estelle McPhail, RN, MS, CEN, CNA, president of Emergency Nurses Association, led a discussion on the education and employment of technical personnel. 59 1
AORN JOURNAL
Applegeet gave the history of the role of surgical techniciansin the operating room. She summarized AORNs role in getting the technicians started and discussed both the current Medicare rules and regulations and the Commission standard that requires RN supervision of the technician in the operating room. McPhail discussed the roles of emergency medical technicians and paramedics. “They work under different guidelines [from RNs] and usually in the prehospital setting,” she said. She discussed the different training of each group, and opened the topic for discussion from the participants. Many specialty nursing groups are concerned about erosion of their nursing practice, but many groups also acknowledge the need for assistive personnel. For example, Dr Joel said that nurses have to be realistic in home care and long-term care. “There’s a lot of work that can be done by someone else,” she said. Dr Joel informed the group that the TriCouncil is working on a statement on assistance for nurses that will be realistic, and will distinguish between nonnursing and assistive care. The statement also will make it clear that nurses are in charge and that they are responsible for those to whom they assign or delegate certain tasks, according to Dr Joel. The group discussed use of dialysis technicians, critical care technicians, and home health and school health aides.
OrganizationalAffiliate Status
S
uzanne White, RN, MN, CCRN, memberat-large, is the NOLF representative to the ANA task force to develop criteria for organizational affiliates, which was scheduled to meet in early 1990. She encouraged the NOLF representatives to discuss their perceptions of the role of organizational affiliation within the new ANA structure.Suggested criteria will be presented to the ANA house of delegates in June 1990. As it stands now, each organizational affiliate will be allowed one RN participant in the ANA house of delegates. That participant can make reports, but he or she cannot vote. The “voicebut-no-vote’’ status is a legal issue, according to Dr Joel. “You can’t have a vote unless you have 592
FEBRUARY 1990, VOL. 51, NO 2
Newly elected officers of NOLF are Carol Applegeet, vice-chairperson (lefl) and S. Ann Evans, member-at-large.
the same tax levied on your organization as the state nurses associations,” Dr Joel said. Some representatives voiced concern about the benefit of organizational affiliate status, given the no-vote status.
New Officers
A
pplegeet was elected NOLF vice-chairpenon for the 1990-1991 term.Her duties will include serving as charpenon of the NOLF executive committee, reporting recommendations of NOLF to the ANA board, collaborating with officers in preparing the agenda for the annual meeting, and serving as contact person for participating organizations to discuss their concerns. S. Ann Evans, RN, MS, MBA, presidentelect of the American Association of Critical-Care Nurses, was elected NOLF member-at-large for the 19901991 term. She will maintain records, cerhfy the list of participating organizations, and compile the ballot for election of officers.Together with the ANA president, who serves as the charperson, the vicechairperson and member-at-large constitute the NOLF executive committee. The next NOLF meeting is scheduled for Nov 16 to 17,1990, in Kansas City, Mo. PATNIESSNER PALMER,RN, MS EDUOR