- Email: [email protected]
Nursing organizations discuss nursing's role in health care reform, nursing practice standards and guidelines
FEBRUARY 1991, VOL. 53, NO 2
AORN JOURNAL
Nursing Organization Liaison Forum Meeting
N
ursing organizations discuss nursing’s role in health care reform, nursing practice standards and guidelines
November 1990
T
he Nursing Organization Liaison Forum (NOLF) met in Kansas City, Mo, Nov 16 and 17, 1990. The NOLF is part of the American Nurses’ Association (ANA) formal structure and is made up of representatives from national nursing specialty organizations and ANA councils. After receiving input from other nursing organizations, the NOLF chairperson and vice-chairperson make recommendations to the ANA board of directors. AORN has been a member of NOLF since its first meeting in 1983. It was represented by Mark Phippen, RN, MN, CNOR, President; Jean Reeder, RN, PhD, President-elect, and Lola Fehr, RN, MS, executive director. Forty-two other nursing organizations were represented. Carol Applegeet, RN, MSN, CNOR, CNAA, NOLF vicechairperson, presided over the meeting. Other members of the NOLF executive committee are Lucille Joel, RN, EdD, FAAN, ANA president and NOLF chairperson, and S. Ann Evans, RN, MS, MBA, president of the American Association of CriticalCare Nurses (AACN) and NOLF member-at-large. The following is a summary of the major topics addressed at the meeting. 334
Health Cure Reform
I
n the report from the ANA president, Dr Joel discussed the “Health Care Reform: An Agenda for Action.” The ANA has spent two years developing a plan that it hopes will become organized nursing’s plan for health care reform in the United States. The plan does not mention specifichealth policy or legislative goals for nursing because the ANA does not want to present a self-serving document. The content is consistent with longrange goals of nursing, however. The following are the four basic principles of the reform plan. a All citizens and legal residents of the United States must have equitable access to basic health care. a Health care services must be improved through a system that focuses on consumers, promotes health, and uses appropriate providers, settings, and delivery arrangements. a Financing for basic health services must be equitable and affordable and include contributions from individuals, employers, and government. a The costs of health services
must be made more predictable, and motivations for cost-effective behaviors must be enhanced. The plan also calls for a focus on pregnant women, infants, and children and targets schools and workplaces as sites for primary care. The document was sent to all state nurses associations and NOLF members for review and comments. Once the document is approved, it will be sent to Congress and the ANA will “become invisible” except to help push it through, according to Dr Joel. “We mean business with this,” Dr Joel said. “It is not a piece of rhetoric.” In general, NOLF members praised the document. A representative of The Organization for Obstetric, Gynecologic, and Neonatal Nurses thanked the ANA for targeting pregnant women and children. Susan Lordi, RN, MS, SNP, president of the National Association of School Nurses said using schools as primary care sites would strengthen family care. A representative of the Emergency Nurses Association reported that many people go to the emergency department, instead of a physician’s office, for primary care. She applauded the
FEBRUARY 1991, VOL. 53, NO 2
AORN JOURNAL
Carol Applegeet (lej) and Lucille Joel listen to a NOLF member’s concern at the eighth annual meeting.
agenda for action and believes new primary health care sites will help. She said the public has to be educated that the emergency department is not an appropriate place for primary care. Some people were concerned about limiting health care reform to US citizens and legal residents. A representative of the National Association of Hispanic Nurses said that illegal residents contribute to the economy and cannot be left out. Dr Joel responded that “we can’t afford everything for everybody.” She said that separate government organizations should provide for these people. Phippen moved that the NOLF members support the concept and principle of the document. That motion passed. The plan was presented to the ANA board of directors in December along with comments and suggestions from NOLF members. The board will make editorial revisions and have a professional writer develop a 336
version of the plan for presentation to Congress and a different version, with the same intent but without nursing jargon, for presentation to the general public.
Nursing Practice Standards and Guidelines
A
n investigation of nursing practice standards reveals a lack of consistency with which the profession develops standards, a proliferation of standards with a wide range of intent, format, and scope, and a number of divergent approaches used which limits their use. In response to these and other concerns, the ANA cabinet on nursing practice appointed a task force on nursing practice standards in August 1989. The task force believes that ANA and specialty nursing groups should collaborate to develop, maintain, and use standards of nursing practice and practice guidelines. The task force
met with representatives of specialty nursing organizations to discuss the role, nature, and purpose of practice standards. It defined the nature and purpose of standards and developed a framework that included standards and guidelines for nursing practice. The task force again met with members of specialty nursing organizations to discuss the role of guidelines in developing standards of nursing practice. The ANA cabinet on nursing practice appointed a committee on nursing practice standards and guidelines to continue the work done by the task force. The committee is charged with monitoring health care effectiveness initiatives and the implications for nursing practice standards and guidelines and providing strategic planning and oversight for the development of standards of nursing practice, universal practice guidelines, and specialty practice guidelines.
FEBRUARY 1991, VOL. 53, NO 2
AORN JOURNAL
specialties. The ANA encourages organizations that do so to contact ANA about incorporating the information into a uniform nursing data base. Specialty organizations also can seek ANA endorsement for their guidelines and standards. For specialty organizations that develop and publish standards and guidelines in collaboration with the ANA, the committee on nursing practice standards and guidelines has presented three Susan L. Dean-Barr discusses options on sharing costs and profits of development and pronursing standards and duction. The options, along with guidelines. the opportunity to develop standSusan L. Dean-Barr, RN, MS, ards and guidelines indepenCRRN, member of the ANA dently, seemed agreeable to most congress of nursing practice and NOLF members. cochairperson of the task force on nursing practice standards, Payment Reform explained the development of the definition, purpose, and format of s efforts to change payment mechanisms, organizational standards and guidelines. Standards and guidelines differ structures, and health care delivin scope and function, she said. ery continue, the ANA and other Standards represent an acceptable groups are calling for a shift in level of client care, are broad, and focus. The focus should no longer apply to all nurses. Guidelines, on be on highly technical, curative the other hand, are specific medical interventions; it should recommendations for care, she be on preventive, functional, and maintenance health services. said. A motion was made that the According to Ellen Sanders, RN, NOLF support the definition, MS, chairperson of the ANA purpose, and framework pre- congress on nursing economics, pared by the task force. The nurses are capable of providing motion was passed. This will such interventions but must make allow for a common set of sure ,they are recognized as standards for all nursing essential care providers. In 1986, the federal governpractice. Dean-Barr also discussed pub- ment created the physician paylication of nursing practice stand- ment review commission (PPRC) ards and guidelines. Specialty to examine physician payment organizations retain the right to and practice related to Medicare develop and publish standards and propose cost-containing and guidelines regarding their measures. Resulting legislation
A
338
includes statements that payments for the same procedures will be the same, regardless of the specialist performing the procedure, unless the work effort put forth is different. The ANA agrees with this underlying principle of “equal value for equal work effort.” This does not necessarily mean equal pay, because the PPRC considers value and payment separately. Value is related to the work effort and time required to perform a service, and payment is based on value, overhead costs, and malpractice insurance costs. Therefore, the value of equivalent services performed by a nurse practitioner and a physician should be the same, although the payment may be different. This brings up several issues for nursing, Sanders said. Should nursing services be valued in the same manner as medical services? Can the practice of reimbursing nurses at a percentage of a physician’s payment be reconciled under the equal value for equivalent services principle? Will the legislators and general public understand the difference between value and payment? Will they understand that nurses are not necessarily asking for the same payment as physicians? Would organized nursing support the equal value for equivalent service as it could apply to technicians, licensed practical nurses, and other providers? Nursing can reformulate its policies regarding reimbursement but must look at the whole picture, not just RNs who can provide certain services in place of a physician.
AORN JOURNAL
FEBRUARY 1991. VOL. 53, NO 2
NOLF members, she said the congress of nursing practice hopes the data base eventually will be tied to payment for health care services.
Data Base on Licensed Nurses
C
Linda Cronenwett explains general concepts behind a data base on nursing practice.
Data Base on Nursing Practice he Agency for Health Care TPolicy and Research (AHCPR) sponsored the “Effectiveness and Outcomes of Health Care Services: Implications for Nursing” conference in May 1990. Key nursing leaders and presidents and executive directors of state nurses associations and specialty nursing organizations attended to learn about developments regarding the effectiveness and appropriateness of health care services and how to pay for them. Specific goals included defining nursing’s role and clarifying methods for producing standards and guidelines. Recommendations that came about after the conference related to incorporating nursing data into national health care data bases and developing nursing data bases. There is no classification system that describes nursing assessments, diagnoses, interven-
tions, and outcomes. In response, the ANA is soliciting funding to develop a classification system that would describe nursing practice in terms of the nursing process and implement a professional consensus model for critical analysis, revision, dissemination, and use of the classification system in nursing practice, education, research, and administration. According to Linda Cronenwett, RN, PhD, FAAN, chairperson of the ANA congress of nursing practice, the project could potentially revise the provision, evaluation, and reimbursement of health care. A uniform nursing practice classification system would provide a consistent data base for research on nursing interventions. In her report to
arolyn Yocom, RN, PhD, director of research services for the National Council of State Boards of Nursing, Chicago, discussed the implementation of a national data base of all licensed nurses. To express the need for such a data base, she asked nurses who were licensed in more than one state to raise their hands. The hands of most NOLF members quickly went into the air. That is the problem, she said. Statistics on the number of nurses in the United States actually are statistics on the number of nursing licenses in the country. There has been no way to prevent nurses from being represented more than once if they have more than one license. The proposed nurse information system (NIS) would obtain more accurate data on the number of nurses licensed, both as RNs and practical nurses, and
Vivien DeBack describes the success of the National Commission on Nursing Implementation Project.
d) 339
AORN JOURNAL
would provide an unduplicated list of those nurses. It would have to address the problems of women who change their names and who do not provide accurate social security numbers or dates of birth. With funding from the Robert Wood Johnson Foundation, Princeton, NJ, the ANA, and other sources, the National Council of State Boards of Nursing is conducting a feasibility study on the proposed project. All nurses who renewed their licenses last fall in Georgia, Nebraska, and South Carolina were asked to provide their name, address, social security number, date of birth, original state and year of nursing license, and type of basic nursing education program and date of graduation. The feasibility study is being done to determine whether all information required to unduplicate the lists can be obtained at the renewal process.
Nursing Image
M
any nurses have seen the advertisements developed by the Advertising Council of New York and the National Commission on Nursing Implementation Project. Vivien DeBack, RN, PhD, project director, updated NOLF members on the two-year public service campaign. The McMurphy Project is well underway, and more than 17,000 public junior high and high schools have received videotapes featuring Dana Delany of television’s “China Beach.” In addition, public service announcements with the message “if caring were enough, anyone could be a nurse” 342
FEBRUARY 1991, VOL. 53, NO 2
with a surplus of applicants and those that still face a shortage was to be available in January.
Thunder Project
I
Wanda Roberts Johanson provides NOLF members details of the Thunder Project undertaken by the AACN.
have been televised and received in 80% to 90% of American homes. Requests have been made, and advertisements produced in Spanish are scheduled to begin this month. All advertisements feature an 800-number anyone can call for information on nursing school or a nursing career. More than 60,000 calls have been placed to the number. The success has created a problem in certain locales, Dr DeBack said. Some schools have received more applications than they can accommodate. She said that a fact sheet that identifies geographic areas
n response to numerous calls for information on standard care for flush solutions and arterial pressure lines, the AACN has instituted the “Thunder Project” to research the issue. The research will evaluate the effect of heparinized and nonheparinized flush solutions on the patency of arterial pressure lines. The AACN is currently recruiting site coordinators to implement the project in health care facilities nationwide. Site coordinators would act as formal liaisons between the institution and the Thunder Project task force and would be responsible for overseeing data collection. The goal is to have a total of 11,000 patients involved in the study. Nurses interested in becoming site coordinators must be registered nurses. The AACN prefers that the RN have a master’s degree, but will approve significant research background as a substitute. For more information, nurses can write to the AACN Thunder Project, PO Box 30008, Laguna Niguel, CA 92607.
ANA Relocation, Certification
E
unice Cole, RN, BS, updated NOLF members on the progress of the ANA capital campaign. Applegeet advised the members about the proposal to require a baccalaureate degree for
AORN J O U R N A L
FEBRUARY 1991. VOL 53. NO 2
general certification. Relocation. The “Nursing on the Move” campaign has received more than $600,000 in pledges; the goal is $1.5 million. Moving AN A‘s headquarters to Washington, DC, will result in nursing “being closer to the scene of action and will facilitate nursing’s participation in decision making,” Cole said. “The ultimate success depends on participation of everyone here,” she added. Cole acknowledged generous gifts from the AACN, the Philippine Nurses Association of America (PNA), and the American Academy of Nursing. She also quoted Phippen’s statements from the 1990 ANA convention about nursing being one house and each nursing specialty being a room within that house when she acknowledged AORN’s contribution of $10,000 to the capital campaign. Certification. In tune with advocating a baccalaureate preparation for entry into professional nursing practice, the ANA is committed to a baccalaureate
Eunice Cole reports success in raising money for the ANA’s move to Washington, DC.
requirement for generalist certification. It recognizes the need for nurses with diplomas or associate degrees to prepare and thus proposes that the requirement begin seven years after it is made known. Nurses with current certification would maintain that certification provided they do not let it lapse. Recommendations regarding the requirement were given to the ANA board of directors in December 1990.
National Nursing Theme
D
r Joel said there was some sense that a logo or theme for nursing would serve a purpose. “This is a dilemma I am bringing to you for some opinion,” she said. The goal would be to bring nursing together under an “over arching” theme to shape the image of the profession. Phippen proposed keeping the theme “Nursing on the Move” but changing the logo after the ANA completes its move to Washington, DC. Another member said that “on the move” has negative connotations with which she would not want nurses to be associated.
Specialv Concerns
S
ome specialty nursing organization representatives spoke about concerns directly related to
Newly elected NOLF officers are Mark Phippen and Wanda Roberts Johanson.
AORN JOURNAL
their specialties. These include testing for foreign nurses, school nursing, and overcrowding in the emergency room. Foreign nurses. Remedios A. Solarte, RN, MSN, spoke on behalf of the PNA. The Commission on Graduates of Foreign Nursing Schools (COGFNS) examination is required for nurses in the United States with H1 working visas. Solarte requested that foreign nurses who are in the United States under other visas not be required to take the COGFNS as a prerequisite to the National Council Licensure Examination (NCLEX). The original purpose of the COGFNS was to prevent the exploitation of foreign nurses, she said. Often, foreign nurses who failed the NCLEX took lowpaying jobs. The PNA still supports the COGFNS as a method of helping foreign nurses pass the NCLEX but says there is no valid reason for the COGFNS to be a prerequisite because foreign nurses are required to pass the NCLEX.
FEBRUARY 1991, VOL. 53, NO 2
School nurses. The National is continuing its attempts to reach Association of School Nurses is Congress for additional funding. concerned about school teachers Dr Joel remarked that it is being required to perform health “ludicrous” that people would use care when they were not pre- the emergency room instead of pared. The association developed a physician’s office and that the guidelines for the delineation of public needs to be educated. roles and responsibilities for the Many services could be provided safe delivery of specialized health by nursing centers. She recomcare in the educational setting. mended that Fadale and other Lordi discussed the guidelines. emergency room nurses “pull Most in attendance shared the together . . . colleagues around concern about the current prac- the issue. This provides the tice. A representative of the opportunity to bring nursing to American Society for Parenteral the public,” she said. and Enteral Nutrition offered to share the society’s standards and New Officers guidelines regarding children who require such nutrition. hippen was elected NOLF Emergency room overvice-chairperson for the crowding. Several nurses reiter- 1991- 1992 term. Wanda Roberts ated the concern of overcrowding Johanson, RN, MN, president of and misuse of emergency rooms. the AACN was elected memberJoanne M. Fadale, RN, CEN, at-large. The two new officers, president of the Emergency along with Dr Joel, make up the Nurses Association, said that NOLF executive committee. patients who need critical care are The next NOLF meeting will lined up in emergency depart- be held Nov 15 and 16, 1991, ments because there are no critical in Kansas City, Mo. care beds available. “It is a major LAURIED. CRUZ crisis,” she said. The association ASSOCIATE EDITOR
P
AORN Journal Writer’s Contest All articles written by at least one AORN member and published in the AORN Journal are considered for the annual Writer’s Contest. To be eligible for this year’s awards, the article must be have been published in 1990. Categories for the contest are clinical/ambulatory, management, and research/education. AORN Journal editors and members of the Editorial Board rate the articles and the top articles are then judged by editors of other nursing publications and other members of the nursing profes344
sion unaffiliated with AORN. Johnson & Johnson Medical, Inc, sponsors the contest and provides cash prizes of $600 for first-place and $400 for second-place winners in each category. Winners will be announced in the Congress News and awards will be distributed at an awards reception during Congress.
AORN JOURNAL
Nursing Organization Liaison Forum Meeting
N
ursing organizations discuss nursing’s role in health care reform, nursing practice standards and guidelines
November 1990
T
he Nursing Organization Liaison Forum (NOLF) met in Kansas City, Mo, Nov 16 and 17, 1990. The NOLF is part of the American Nurses’ Association (ANA) formal structure and is made up of representatives from national nursing specialty organizations and ANA councils. After receiving input from other nursing organizations, the NOLF chairperson and vice-chairperson make recommendations to the ANA board of directors. AORN has been a member of NOLF since its first meeting in 1983. It was represented by Mark Phippen, RN, MN, CNOR, President; Jean Reeder, RN, PhD, President-elect, and Lola Fehr, RN, MS, executive director. Forty-two other nursing organizations were represented. Carol Applegeet, RN, MSN, CNOR, CNAA, NOLF vicechairperson, presided over the meeting. Other members of the NOLF executive committee are Lucille Joel, RN, EdD, FAAN, ANA president and NOLF chairperson, and S. Ann Evans, RN, MS, MBA, president of the American Association of CriticalCare Nurses (AACN) and NOLF member-at-large. The following is a summary of the major topics addressed at the meeting. 334
Health Cure Reform
I
n the report from the ANA president, Dr Joel discussed the “Health Care Reform: An Agenda for Action.” The ANA has spent two years developing a plan that it hopes will become organized nursing’s plan for health care reform in the United States. The plan does not mention specifichealth policy or legislative goals for nursing because the ANA does not want to present a self-serving document. The content is consistent with longrange goals of nursing, however. The following are the four basic principles of the reform plan. a All citizens and legal residents of the United States must have equitable access to basic health care. a Health care services must be improved through a system that focuses on consumers, promotes health, and uses appropriate providers, settings, and delivery arrangements. a Financing for basic health services must be equitable and affordable and include contributions from individuals, employers, and government. a The costs of health services
must be made more predictable, and motivations for cost-effective behaviors must be enhanced. The plan also calls for a focus on pregnant women, infants, and children and targets schools and workplaces as sites for primary care. The document was sent to all state nurses associations and NOLF members for review and comments. Once the document is approved, it will be sent to Congress and the ANA will “become invisible” except to help push it through, according to Dr Joel. “We mean business with this,” Dr Joel said. “It is not a piece of rhetoric.” In general, NOLF members praised the document. A representative of The Organization for Obstetric, Gynecologic, and Neonatal Nurses thanked the ANA for targeting pregnant women and children. Susan Lordi, RN, MS, SNP, president of the National Association of School Nurses said using schools as primary care sites would strengthen family care. A representative of the Emergency Nurses Association reported that many people go to the emergency department, instead of a physician’s office, for primary care. She applauded the
FEBRUARY 1991, VOL. 53, NO 2
AORN JOURNAL
Carol Applegeet (lej) and Lucille Joel listen to a NOLF member’s concern at the eighth annual meeting.
agenda for action and believes new primary health care sites will help. She said the public has to be educated that the emergency department is not an appropriate place for primary care. Some people were concerned about limiting health care reform to US citizens and legal residents. A representative of the National Association of Hispanic Nurses said that illegal residents contribute to the economy and cannot be left out. Dr Joel responded that “we can’t afford everything for everybody.” She said that separate government organizations should provide for these people. Phippen moved that the NOLF members support the concept and principle of the document. That motion passed. The plan was presented to the ANA board of directors in December along with comments and suggestions from NOLF members. The board will make editorial revisions and have a professional writer develop a 336
version of the plan for presentation to Congress and a different version, with the same intent but without nursing jargon, for presentation to the general public.
Nursing Practice Standards and Guidelines
A
n investigation of nursing practice standards reveals a lack of consistency with which the profession develops standards, a proliferation of standards with a wide range of intent, format, and scope, and a number of divergent approaches used which limits their use. In response to these and other concerns, the ANA cabinet on nursing practice appointed a task force on nursing practice standards in August 1989. The task force believes that ANA and specialty nursing groups should collaborate to develop, maintain, and use standards of nursing practice and practice guidelines. The task force
met with representatives of specialty nursing organizations to discuss the role, nature, and purpose of practice standards. It defined the nature and purpose of standards and developed a framework that included standards and guidelines for nursing practice. The task force again met with members of specialty nursing organizations to discuss the role of guidelines in developing standards of nursing practice. The ANA cabinet on nursing practice appointed a committee on nursing practice standards and guidelines to continue the work done by the task force. The committee is charged with monitoring health care effectiveness initiatives and the implications for nursing practice standards and guidelines and providing strategic planning and oversight for the development of standards of nursing practice, universal practice guidelines, and specialty practice guidelines.
FEBRUARY 1991, VOL. 53, NO 2
AORN JOURNAL
specialties. The ANA encourages organizations that do so to contact ANA about incorporating the information into a uniform nursing data base. Specialty organizations also can seek ANA endorsement for their guidelines and standards. For specialty organizations that develop and publish standards and guidelines in collaboration with the ANA, the committee on nursing practice standards and guidelines has presented three Susan L. Dean-Barr discusses options on sharing costs and profits of development and pronursing standards and duction. The options, along with guidelines. the opportunity to develop standSusan L. Dean-Barr, RN, MS, ards and guidelines indepenCRRN, member of the ANA dently, seemed agreeable to most congress of nursing practice and NOLF members. cochairperson of the task force on nursing practice standards, Payment Reform explained the development of the definition, purpose, and format of s efforts to change payment mechanisms, organizational standards and guidelines. Standards and guidelines differ structures, and health care delivin scope and function, she said. ery continue, the ANA and other Standards represent an acceptable groups are calling for a shift in level of client care, are broad, and focus. The focus should no longer apply to all nurses. Guidelines, on be on highly technical, curative the other hand, are specific medical interventions; it should recommendations for care, she be on preventive, functional, and maintenance health services. said. A motion was made that the According to Ellen Sanders, RN, NOLF support the definition, MS, chairperson of the ANA purpose, and framework pre- congress on nursing economics, pared by the task force. The nurses are capable of providing motion was passed. This will such interventions but must make allow for a common set of sure ,they are recognized as standards for all nursing essential care providers. In 1986, the federal governpractice. Dean-Barr also discussed pub- ment created the physician paylication of nursing practice stand- ment review commission (PPRC) ards and guidelines. Specialty to examine physician payment organizations retain the right to and practice related to Medicare develop and publish standards and propose cost-containing and guidelines regarding their measures. Resulting legislation
A
338
includes statements that payments for the same procedures will be the same, regardless of the specialist performing the procedure, unless the work effort put forth is different. The ANA agrees with this underlying principle of “equal value for equal work effort.” This does not necessarily mean equal pay, because the PPRC considers value and payment separately. Value is related to the work effort and time required to perform a service, and payment is based on value, overhead costs, and malpractice insurance costs. Therefore, the value of equivalent services performed by a nurse practitioner and a physician should be the same, although the payment may be different. This brings up several issues for nursing, Sanders said. Should nursing services be valued in the same manner as medical services? Can the practice of reimbursing nurses at a percentage of a physician’s payment be reconciled under the equal value for equivalent services principle? Will the legislators and general public understand the difference between value and payment? Will they understand that nurses are not necessarily asking for the same payment as physicians? Would organized nursing support the equal value for equivalent service as it could apply to technicians, licensed practical nurses, and other providers? Nursing can reformulate its policies regarding reimbursement but must look at the whole picture, not just RNs who can provide certain services in place of a physician.
AORN JOURNAL
FEBRUARY 1991. VOL. 53, NO 2
NOLF members, she said the congress of nursing practice hopes the data base eventually will be tied to payment for health care services.
Data Base on Licensed Nurses
C
Linda Cronenwett explains general concepts behind a data base on nursing practice.
Data Base on Nursing Practice he Agency for Health Care TPolicy and Research (AHCPR) sponsored the “Effectiveness and Outcomes of Health Care Services: Implications for Nursing” conference in May 1990. Key nursing leaders and presidents and executive directors of state nurses associations and specialty nursing organizations attended to learn about developments regarding the effectiveness and appropriateness of health care services and how to pay for them. Specific goals included defining nursing’s role and clarifying methods for producing standards and guidelines. Recommendations that came about after the conference related to incorporating nursing data into national health care data bases and developing nursing data bases. There is no classification system that describes nursing assessments, diagnoses, interven-
tions, and outcomes. In response, the ANA is soliciting funding to develop a classification system that would describe nursing practice in terms of the nursing process and implement a professional consensus model for critical analysis, revision, dissemination, and use of the classification system in nursing practice, education, research, and administration. According to Linda Cronenwett, RN, PhD, FAAN, chairperson of the ANA congress of nursing practice, the project could potentially revise the provision, evaluation, and reimbursement of health care. A uniform nursing practice classification system would provide a consistent data base for research on nursing interventions. In her report to
arolyn Yocom, RN, PhD, director of research services for the National Council of State Boards of Nursing, Chicago, discussed the implementation of a national data base of all licensed nurses. To express the need for such a data base, she asked nurses who were licensed in more than one state to raise their hands. The hands of most NOLF members quickly went into the air. That is the problem, she said. Statistics on the number of nurses in the United States actually are statistics on the number of nursing licenses in the country. There has been no way to prevent nurses from being represented more than once if they have more than one license. The proposed nurse information system (NIS) would obtain more accurate data on the number of nurses licensed, both as RNs and practical nurses, and
Vivien DeBack describes the success of the National Commission on Nursing Implementation Project.
d) 339
AORN JOURNAL
would provide an unduplicated list of those nurses. It would have to address the problems of women who change their names and who do not provide accurate social security numbers or dates of birth. With funding from the Robert Wood Johnson Foundation, Princeton, NJ, the ANA, and other sources, the National Council of State Boards of Nursing is conducting a feasibility study on the proposed project. All nurses who renewed their licenses last fall in Georgia, Nebraska, and South Carolina were asked to provide their name, address, social security number, date of birth, original state and year of nursing license, and type of basic nursing education program and date of graduation. The feasibility study is being done to determine whether all information required to unduplicate the lists can be obtained at the renewal process.
Nursing Image
M
any nurses have seen the advertisements developed by the Advertising Council of New York and the National Commission on Nursing Implementation Project. Vivien DeBack, RN, PhD, project director, updated NOLF members on the two-year public service campaign. The McMurphy Project is well underway, and more than 17,000 public junior high and high schools have received videotapes featuring Dana Delany of television’s “China Beach.” In addition, public service announcements with the message “if caring were enough, anyone could be a nurse” 342
FEBRUARY 1991, VOL. 53, NO 2
with a surplus of applicants and those that still face a shortage was to be available in January.
Thunder Project
I
Wanda Roberts Johanson provides NOLF members details of the Thunder Project undertaken by the AACN.
have been televised and received in 80% to 90% of American homes. Requests have been made, and advertisements produced in Spanish are scheduled to begin this month. All advertisements feature an 800-number anyone can call for information on nursing school or a nursing career. More than 60,000 calls have been placed to the number. The success has created a problem in certain locales, Dr DeBack said. Some schools have received more applications than they can accommodate. She said that a fact sheet that identifies geographic areas
n response to numerous calls for information on standard care for flush solutions and arterial pressure lines, the AACN has instituted the “Thunder Project” to research the issue. The research will evaluate the effect of heparinized and nonheparinized flush solutions on the patency of arterial pressure lines. The AACN is currently recruiting site coordinators to implement the project in health care facilities nationwide. Site coordinators would act as formal liaisons between the institution and the Thunder Project task force and would be responsible for overseeing data collection. The goal is to have a total of 11,000 patients involved in the study. Nurses interested in becoming site coordinators must be registered nurses. The AACN prefers that the RN have a master’s degree, but will approve significant research background as a substitute. For more information, nurses can write to the AACN Thunder Project, PO Box 30008, Laguna Niguel, CA 92607.
ANA Relocation, Certification
E
unice Cole, RN, BS, updated NOLF members on the progress of the ANA capital campaign. Applegeet advised the members about the proposal to require a baccalaureate degree for
AORN J O U R N A L
FEBRUARY 1991. VOL 53. NO 2
general certification. Relocation. The “Nursing on the Move” campaign has received more than $600,000 in pledges; the goal is $1.5 million. Moving AN A‘s headquarters to Washington, DC, will result in nursing “being closer to the scene of action and will facilitate nursing’s participation in decision making,” Cole said. “The ultimate success depends on participation of everyone here,” she added. Cole acknowledged generous gifts from the AACN, the Philippine Nurses Association of America (PNA), and the American Academy of Nursing. She also quoted Phippen’s statements from the 1990 ANA convention about nursing being one house and each nursing specialty being a room within that house when she acknowledged AORN’s contribution of $10,000 to the capital campaign. Certification. In tune with advocating a baccalaureate preparation for entry into professional nursing practice, the ANA is committed to a baccalaureate
Eunice Cole reports success in raising money for the ANA’s move to Washington, DC.
requirement for generalist certification. It recognizes the need for nurses with diplomas or associate degrees to prepare and thus proposes that the requirement begin seven years after it is made known. Nurses with current certification would maintain that certification provided they do not let it lapse. Recommendations regarding the requirement were given to the ANA board of directors in December 1990.
National Nursing Theme
D
r Joel said there was some sense that a logo or theme for nursing would serve a purpose. “This is a dilemma I am bringing to you for some opinion,” she said. The goal would be to bring nursing together under an “over arching” theme to shape the image of the profession. Phippen proposed keeping the theme “Nursing on the Move” but changing the logo after the ANA completes its move to Washington, DC. Another member said that “on the move” has negative connotations with which she would not want nurses to be associated.
Specialv Concerns
S
ome specialty nursing organization representatives spoke about concerns directly related to
Newly elected NOLF officers are Mark Phippen and Wanda Roberts Johanson.
AORN JOURNAL
their specialties. These include testing for foreign nurses, school nursing, and overcrowding in the emergency room. Foreign nurses. Remedios A. Solarte, RN, MSN, spoke on behalf of the PNA. The Commission on Graduates of Foreign Nursing Schools (COGFNS) examination is required for nurses in the United States with H1 working visas. Solarte requested that foreign nurses who are in the United States under other visas not be required to take the COGFNS as a prerequisite to the National Council Licensure Examination (NCLEX). The original purpose of the COGFNS was to prevent the exploitation of foreign nurses, she said. Often, foreign nurses who failed the NCLEX took lowpaying jobs. The PNA still supports the COGFNS as a method of helping foreign nurses pass the NCLEX but says there is no valid reason for the COGFNS to be a prerequisite because foreign nurses are required to pass the NCLEX.
FEBRUARY 1991, VOL. 53, NO 2
School nurses. The National is continuing its attempts to reach Association of School Nurses is Congress for additional funding. concerned about school teachers Dr Joel remarked that it is being required to perform health “ludicrous” that people would use care when they were not pre- the emergency room instead of pared. The association developed a physician’s office and that the guidelines for the delineation of public needs to be educated. roles and responsibilities for the Many services could be provided safe delivery of specialized health by nursing centers. She recomcare in the educational setting. mended that Fadale and other Lordi discussed the guidelines. emergency room nurses “pull Most in attendance shared the together . . . colleagues around concern about the current prac- the issue. This provides the tice. A representative of the opportunity to bring nursing to American Society for Parenteral the public,” she said. and Enteral Nutrition offered to share the society’s standards and New Officers guidelines regarding children who require such nutrition. hippen was elected NOLF Emergency room overvice-chairperson for the crowding. Several nurses reiter- 1991- 1992 term. Wanda Roberts ated the concern of overcrowding Johanson, RN, MN, president of and misuse of emergency rooms. the AACN was elected memberJoanne M. Fadale, RN, CEN, at-large. The two new officers, president of the Emergency along with Dr Joel, make up the Nurses Association, said that NOLF executive committee. patients who need critical care are The next NOLF meeting will lined up in emergency depart- be held Nov 15 and 16, 1991, ments because there are no critical in Kansas City, Mo. care beds available. “It is a major LAURIED. CRUZ crisis,” she said. The association ASSOCIATE EDITOR
P
AORN Journal Writer’s Contest All articles written by at least one AORN member and published in the AORN Journal are considered for the annual Writer’s Contest. To be eligible for this year’s awards, the article must be have been published in 1990. Categories for the contest are clinical/ambulatory, management, and research/education. AORN Journal editors and members of the Editorial Board rate the articles and the top articles are then judged by editors of other nursing publications and other members of the nursing profes344
sion unaffiliated with AORN. Johnson & Johnson Medical, Inc, sponsors the contest and provides cash prizes of $600 for first-place and $400 for second-place winners in each category. Winners will be announced in the Congress News and awards will be distributed at an awards reception during Congress.