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RN as circulator gets backing in new Medicare regs
RN as circulator gets backing in new Medicare regs There is good news for operating room nurses from Washington. The registered nurse as circulator is recognized in the new proposed “Conditions for Participation of Hospitals” for Medicare and Medicaid programs. The new draft of the Medicare regulations, published Jan 4 in the Federal Register, specifies that “only qualified registered nurses may perform circulating duties in the operating room.” The new regs also state that the operating room must be supervised by an experienced professional registered nurse. This is a victory for AORN and its members who have fought a Medicare proposal that would have permitted technicians and licensed vocational (practical) nurses to circulate. The proposal was first made in 1977 and published as a notice of proposed rulemaking (NPRM) in theFederal Register in June 1980. (That NPRMwas never completed because of regulatory reform in the Department of Health and Human Setvices.) In response to that NPRM, AORN members flooded Washington with letters. AORN filed a brief supporting the RN as circulator prepared by Joseph Radzius, attorney and former consumer member of the AORN Board. AORN is grateful to the many organizations that supported its position including the American Nurses’ Association, the American College of Surgeons, and many specialty nursing organizations. Washington heard the message. In a preamble accompanying the proposed regula-
tions, Carolyne Davis, RN, administrator of the HealthCare FinancingAdministration (HCFA), acknowledgesthe large number of comments receivedon this issue. She goes on to say that “while many of the functions of the circulator are task oriented and may be performed by personnel of lesser training, the responsibility for assessing various patient signs, symptoms, and responses requires registered nurse qualifications.” This recognitionwill reinforce the professional role of the registered nurse in the operating room. If would be nice if every victory were clear and final, but that rarely happens. The original proposal to permit technicians to circulate originated with the technicians. Hospital administrators supported it because hiring lesser prepared personnel for the operating room could save money. There will be a 60-day comment period on the new draft, and HCFA anticipates comments from both technicians and hospital administrators. Of some concern to AORN is that the preambleto the proposedregs provides an excep tionto the RNcirculator requirement. If a hospital shows the RN requirement is a hardship and that noncompliance would not adversely affect patient health and safety, HCFA can make an exception. This waiver had appeared in a draft of the regulations that circulated in late summer. In this draft, the waiver was in the regulations itself. But when the regulationswere published in January, the waiver did not appear in the regs but in the preliminary remarks that accompanied them. AORN was still concerned about the significance of the waiver and had questions about its legal status. In response to inquiries from AORN, a spokesman for HCFA told AORN Executive Director CliffordJordan,
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RN, that the inclusion of the waiver even in the preamble was in error. A correction will be issued. In the final publication of the regs, HCFA does not intend to make provision for any exception to the requirement that a registered nurse must circulate. As you may recall, Medicare regs apply directly only to hospitals not accredited through the voluntary process of the Joint Commission on Accreditation of Hospitals (JCAH). The voluntary JCAH standards currently require registered nursesto circulate. The Veterans Administration continues its firm policy requiring the circulator to be a registered nurse. Clearly, professional registered nurses have an important function in the operating room. Duringthe past five years, others looking at the proposed revision questioned whether nurses would be phased out of the operating room.
Student nurses expressed reluctance to go into operating room nursing because of the uncertain future. After these Medicare rules are in final form, OR nurses will be reassured that their professionalism is recognized by government officials as well as colleagues. Who made it happen?AORN members with the help of their Association can take credit for getting the message to Washington. But it was the professional practice of perioperative nurses that convinced Washington officials that nursesare indeed needed in the operating room You each did that.
Elinor S Schrader Editor
Film review: Fire in the Patient Care Facility In a patient care area, fire is one of the most frightening and lifethreatening emergencies hospital personnel may encounter. Immediate and appropriate action is critical to protect the patient and prevent the flames from spreading. Fire in the Patient Care Facility: Blueprint for Survival provides an excellent introduction to common fire situations. Through the use of a stop and evaluate format, the film allows the viewer to consider the options when confronted with various types of fires. Wastebasket fires, bedcoverings, and mattress fires are illustrated, and the rationale behind the correct course of action is discussed in detail. The file stresses that the nurse in the patient care area is frequently the first person on the scene of a fire and must be well versed in basic fire fighting. He or she must be familiar with the type and location of fire extinguishers and fire alarms, and the correct procedure to be followed in a fire emergency. It is emphasized that health care personnel are not qualified or trained to fight major fires and should not attempt
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to do so. All hospital personnel with access to patient care areas would benefit from viewing this film, not only to increase their knowledge of basic fire-fighting techniques, but also their awareness of the dangers that may result from inappropriate actions. Fire Emergency in a Patient Care Facility, produced by Abbott Laboratories, is available in both %" and Yz" video-cassette format as a long-term lease for $180, or five-day preview for $37. It may be ordered through the American Hospital Association, do USCAN International, Ltd, 110 W Hubbard, Chicago, 111 60610. Stewart Engeman, RN Audiovisual Committee
Future Congress sites Sites and dates for Congress in the next four years are 1%Atlanta, March 4 to 9 1985-Dallas, Feb 24 to March 1 1986-Anaheim, Calif, March 9 to 14 1987-Atlanta, April 5 to 10
AORN Journal, Februury 1983, Vol37, No 2
tions, Carolyne Davis, RN, administrator of the HealthCare FinancingAdministration (HCFA), acknowledgesthe large number of comments receivedon this issue. She goes on to say that “while many of the functions of the circulator are task oriented and may be performed by personnel of lesser training, the responsibility for assessing various patient signs, symptoms, and responses requires registered nurse qualifications.” This recognitionwill reinforce the professional role of the registered nurse in the operating room. If would be nice if every victory were clear and final, but that rarely happens. The original proposal to permit technicians to circulate originated with the technicians. Hospital administrators supported it because hiring lesser prepared personnel for the operating room could save money. There will be a 60-day comment period on the new draft, and HCFA anticipates comments from both technicians and hospital administrators. Of some concern to AORN is that the preambleto the proposedregs provides an excep tionto the RNcirculator requirement. If a hospital shows the RN requirement is a hardship and that noncompliance would not adversely affect patient health and safety, HCFA can make an exception. This waiver had appeared in a draft of the regulations that circulated in late summer. In this draft, the waiver was in the regulations itself. But when the regulationswere published in January, the waiver did not appear in the regs but in the preliminary remarks that accompanied them. AORN was still concerned about the significance of the waiver and had questions about its legal status. In response to inquiries from AORN, a spokesman for HCFA told AORN Executive Director CliffordJordan,
AORN Journal, February 1983. Vol37, No 2
181
RN, that the inclusion of the waiver even in the preamble was in error. A correction will be issued. In the final publication of the regs, HCFA does not intend to make provision for any exception to the requirement that a registered nurse must circulate. As you may recall, Medicare regs apply directly only to hospitals not accredited through the voluntary process of the Joint Commission on Accreditation of Hospitals (JCAH). The voluntary JCAH standards currently require registered nursesto circulate. The Veterans Administration continues its firm policy requiring the circulator to be a registered nurse. Clearly, professional registered nurses have an important function in the operating room. Duringthe past five years, others looking at the proposed revision questioned whether nurses would be phased out of the operating room.
Student nurses expressed reluctance to go into operating room nursing because of the uncertain future. After these Medicare rules are in final form, OR nurses will be reassured that their professionalism is recognized by government officials as well as colleagues. Who made it happen?AORN members with the help of their Association can take credit for getting the message to Washington. But it was the professional practice of perioperative nurses that convinced Washington officials that nursesare indeed needed in the operating room You each did that.
Elinor S Schrader Editor
Film review: Fire in the Patient Care Facility In a patient care area, fire is one of the most frightening and lifethreatening emergencies hospital personnel may encounter. Immediate and appropriate action is critical to protect the patient and prevent the flames from spreading. Fire in the Patient Care Facility: Blueprint for Survival provides an excellent introduction to common fire situations. Through the use of a stop and evaluate format, the film allows the viewer to consider the options when confronted with various types of fires. Wastebasket fires, bedcoverings, and mattress fires are illustrated, and the rationale behind the correct course of action is discussed in detail. The file stresses that the nurse in the patient care area is frequently the first person on the scene of a fire and must be well versed in basic fire fighting. He or she must be familiar with the type and location of fire extinguishers and fire alarms, and the correct procedure to be followed in a fire emergency. It is emphasized that health care personnel are not qualified or trained to fight major fires and should not attempt
182
to do so. All hospital personnel with access to patient care areas would benefit from viewing this film, not only to increase their knowledge of basic fire-fighting techniques, but also their awareness of the dangers that may result from inappropriate actions. Fire Emergency in a Patient Care Facility, produced by Abbott Laboratories, is available in both %" and Yz" video-cassette format as a long-term lease for $180, or five-day preview for $37. It may be ordered through the American Hospital Association, do USCAN International, Ltd, 110 W Hubbard, Chicago, 111 60610. Stewart Engeman, RN Audiovisual Committee
Future Congress sites Sites and dates for Congress in the next four years are 1%Atlanta, March 4 to 9 1985-Dallas, Feb 24 to March 1 1986-Anaheim, Calif, March 9 to 14 1987-Atlanta, April 5 to 10
AORN Journal, Februury 1983, Vol37, No 2