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To count or not to count
ing and must continue to work for a unity in nursing. With new guidelines, the Federation could be the answer. By a change in the title it would be possible for all registered nursing organizationsto have a voice and a vote in a collective effort for nursing. As I see it, this is nonexistent within any nursing organization, including ANA. We must be cautious, however, and not allow a collective bargaining position statement or political action position statement to originate or be endorsed by this Federation. If this were to take place, I believe we would be back to step one or a further fragmentation of nursing. ANA has made a stand as a union and a political action group. Perhaps it is time for ANA to realize what and where its primary action and concern is now and has been in the past and to take an equal seat in the Federation with all other professional nursing organizations. I feel sure the AORN Board of Directors and Headquarters staff are keeping a watchful eye on this problem, but I want to voice my concern. C Billye Pearson, RN Neurosurgical nurse practitioner Phoenix, Ariz
To count or not to count I would like to thank Muriel Hart, RN, for her excellent Speak out “To count or not to count” (April Journal, 775-779). I wish to add my support to the views expressed in this welldocumented and well-researched article. We have been told by our hospital administration that we must do needle counts, and we have come up with the same conflicts Hart outlines. It is the consensusamong our operating room nurses that our high standard of patient care will be jeopardized by needle counts. Perhaps if enough operating room nurses speak out, AORN will alter its stand on this policy. Carol Poss, RN lnservice coordinator San Antonio (Tex) Community Hospital As a professional nurse and a patient advocate, I must strongly disagree with Muriel Hart’s viewpoint. I have been aware of too
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many litigations to allow her conclusions to be unchallenged. I, along with all members of my staff, firmly support AORN standards. (Ours is a totally professional staff .) When a litigation does arise, what the judicial system analyzes is the standard of care. Granted, rules and regulations or policies and procedures do not in themselves protect the patient from harm. But it is through the diligent adherence to these policies and procedures that the daily practice of professionalnursing is enhanced. We owe the patient the best possible care. Standards defined by a national organization such as AORN, give us the guidelines to devise individual institutional policies and procedures. For this reason, we are grateful AORN has,taken a stand and delineated standards of practice. M Charleen De Louis, RN, CNOR OR/RR clinical instructor North Kansas City Memorial Hospital North Kansas City, Mo
I agree with Muriel Hart that in our changing field one must be prudent and pursue high standards of patient care. But I believe this includes conducting needle counts. A needle count before and after a case is a quick and effective way of knowing if a needle could have been left in the patient. Granted, there are types of cases where needle counts may not be effective, but it does not seem wise to discount the whole idea for those rare exceptions. In almost every instance, it is a good idea to count. Let me give a firsthand example. In training, while observing an open heart surgery from the anesthesiologist’s station, I noticed the surgeon had a needle hanging from his sleeve, which he dragged back and forth across the cavity. No one else seemed to notice. As a student, I hesitated to comment, but as the case continued I was compelled to say something. I quietly mentioned it to the anesthesiologist, and the situation was promptly rectified.One could speculate on the complications had the needle never been accounted for. As Hart indicated, counting may seem to be time consuming, frustrating, and even lead to the slight hazard of an x-ray. Bringing back a patient to remove a foreign object, however,
AORN Journal, July 1980,V o l 3 2 , No 1
can present more hazards than a 15-minute delay and an x-ray. Hart cites the California Hospital Association’s study of 1965-1970, which showed that 12% of foreign body claims were for needles. That sounds significant. I imagine since counts are more widely practiced today, recent statistics would show fewer claims for needles. With all due respect, if St Luke’s Hospital in Phoenix is having difficulty implementing needle counts, perhaps they could ask neighboring hospitals or AORN for assistance in applying efficient counting techniques with a minimum of frustration. Betty D Durkin, RN, CNOR Glendale (Calif) Memorial Hospital Muriel Hart’s “Speak out” shone with good common sense. Needle counts, to my thinking, are an example of the end not justifying the means. Let’s stop distracting our attention from the field. Donna M Walker, RN Riddle Memorial Hospital Media. Pa
California bill blow to professional esteem Concerning the article, “New California bill threat to nurses” (AORN Journal, May 1980, 1133), I have just had another defeating blow to my professional self-esteem. Although I am a registered nurse from a diploma school of nursing, I firmly believe in the baccalaureateas entry into nursing practice. Now after six years of hospital critical-care area nursing, I started school in June for my BS in nursing. To be a professional you must have a basic education from which to grow. Other professionals-lawyers, teachers, engineers,and even medical laboratory technologists-all start out in their jobs with this educational base. To upgrade the nursing profession, the nurse must also be intellectually educated. This provides a base for new ideas and information that will be learned on the job during the training period. Otherwise nursing becomes a technician’s job with no insight, just a job of “following orders.” I am appalled at the consequences of the California Assembly Bill 2434. If nurses’ aides can become licensed vocational nurses
124
(LVNs), and LVNs can become RNs with little additional education or work experience, then why is the California legislature bothering to “set the pace” of nursing education with mandatory continuing education? If aides can become RNs that easily, then it is logical to assume that the RNs (also with very little additional education or work experience) will move up and become physicians. After all, there is also a shortage of physicians in some states. Patricia Price, RN Vidor, Tex Editor’s note: After the May Journal went to press, AB 2434 was withdrawn from consideration by its sponsor, California Assemblyman Carmen Perino. Nurses in the state fear the issue may resurface due to Gov Jerry Brown’s philosophy of “career mobility” and the nursing shortage.
Apaches still consult native practitioners We read with interest the article in the May Journal about otitis media and how the children are prepared for surgery. All of the staff in our Community Health Nursing Department read the article and had favorable comments. In my judgment, it is an outstanding article, done with sensitivity. Our Apache Community Health nurse did feel, however, that the statement on page 1011 that not many people now use medicine men was not accurate. She feels, and I agree, that a good number of people still consult native practitioners. Thank you for sending extra copies; I plan to include the article in our orientation folder. Virginia Jackson, RN Director of Community Health Nursing PHS Indian Hospital Whiteriver, Ariz The AORN Journal welcomes letters from its readers on subjects of interest to OR nurses. Letters should be typed and should include the writer’s name, full title, and address. The Journal reserves the right to edit all letters.
AORN Journal, July 1980,Vol32, No 1
To count or not to count I would like to thank Muriel Hart, RN, for her excellent Speak out “To count or not to count” (April Journal, 775-779). I wish to add my support to the views expressed in this welldocumented and well-researched article. We have been told by our hospital administration that we must do needle counts, and we have come up with the same conflicts Hart outlines. It is the consensusamong our operating room nurses that our high standard of patient care will be jeopardized by needle counts. Perhaps if enough operating room nurses speak out, AORN will alter its stand on this policy. Carol Poss, RN lnservice coordinator San Antonio (Tex) Community Hospital As a professional nurse and a patient advocate, I must strongly disagree with Muriel Hart’s viewpoint. I have been aware of too
122
many litigations to allow her conclusions to be unchallenged. I, along with all members of my staff, firmly support AORN standards. (Ours is a totally professional staff .) When a litigation does arise, what the judicial system analyzes is the standard of care. Granted, rules and regulations or policies and procedures do not in themselves protect the patient from harm. But it is through the diligent adherence to these policies and procedures that the daily practice of professionalnursing is enhanced. We owe the patient the best possible care. Standards defined by a national organization such as AORN, give us the guidelines to devise individual institutional policies and procedures. For this reason, we are grateful AORN has,taken a stand and delineated standards of practice. M Charleen De Louis, RN, CNOR OR/RR clinical instructor North Kansas City Memorial Hospital North Kansas City, Mo
I agree with Muriel Hart that in our changing field one must be prudent and pursue high standards of patient care. But I believe this includes conducting needle counts. A needle count before and after a case is a quick and effective way of knowing if a needle could have been left in the patient. Granted, there are types of cases where needle counts may not be effective, but it does not seem wise to discount the whole idea for those rare exceptions. In almost every instance, it is a good idea to count. Let me give a firsthand example. In training, while observing an open heart surgery from the anesthesiologist’s station, I noticed the surgeon had a needle hanging from his sleeve, which he dragged back and forth across the cavity. No one else seemed to notice. As a student, I hesitated to comment, but as the case continued I was compelled to say something. I quietly mentioned it to the anesthesiologist, and the situation was promptly rectified.One could speculate on the complications had the needle never been accounted for. As Hart indicated, counting may seem to be time consuming, frustrating, and even lead to the slight hazard of an x-ray. Bringing back a patient to remove a foreign object, however,
AORN Journal, July 1980,V o l 3 2 , No 1
can present more hazards than a 15-minute delay and an x-ray. Hart cites the California Hospital Association’s study of 1965-1970, which showed that 12% of foreign body claims were for needles. That sounds significant. I imagine since counts are more widely practiced today, recent statistics would show fewer claims for needles. With all due respect, if St Luke’s Hospital in Phoenix is having difficulty implementing needle counts, perhaps they could ask neighboring hospitals or AORN for assistance in applying efficient counting techniques with a minimum of frustration. Betty D Durkin, RN, CNOR Glendale (Calif) Memorial Hospital Muriel Hart’s “Speak out” shone with good common sense. Needle counts, to my thinking, are an example of the end not justifying the means. Let’s stop distracting our attention from the field. Donna M Walker, RN Riddle Memorial Hospital Media. Pa
California bill blow to professional esteem Concerning the article, “New California bill threat to nurses” (AORN Journal, May 1980, 1133), I have just had another defeating blow to my professional self-esteem. Although I am a registered nurse from a diploma school of nursing, I firmly believe in the baccalaureateas entry into nursing practice. Now after six years of hospital critical-care area nursing, I started school in June for my BS in nursing. To be a professional you must have a basic education from which to grow. Other professionals-lawyers, teachers, engineers,and even medical laboratory technologists-all start out in their jobs with this educational base. To upgrade the nursing profession, the nurse must also be intellectually educated. This provides a base for new ideas and information that will be learned on the job during the training period. Otherwise nursing becomes a technician’s job with no insight, just a job of “following orders.” I am appalled at the consequences of the California Assembly Bill 2434. If nurses’ aides can become licensed vocational nurses
124
(LVNs), and LVNs can become RNs with little additional education or work experience, then why is the California legislature bothering to “set the pace” of nursing education with mandatory continuing education? If aides can become RNs that easily, then it is logical to assume that the RNs (also with very little additional education or work experience) will move up and become physicians. After all, there is also a shortage of physicians in some states. Patricia Price, RN Vidor, Tex Editor’s note: After the May Journal went to press, AB 2434 was withdrawn from consideration by its sponsor, California Assemblyman Carmen Perino. Nurses in the state fear the issue may resurface due to Gov Jerry Brown’s philosophy of “career mobility” and the nursing shortage.
Apaches still consult native practitioners We read with interest the article in the May Journal about otitis media and how the children are prepared for surgery. All of the staff in our Community Health Nursing Department read the article and had favorable comments. In my judgment, it is an outstanding article, done with sensitivity. Our Apache Community Health nurse did feel, however, that the statement on page 1011 that not many people now use medicine men was not accurate. She feels, and I agree, that a good number of people still consult native practitioners. Thank you for sending extra copies; I plan to include the article in our orientation folder. Virginia Jackson, RN Director of Community Health Nursing PHS Indian Hospital Whiteriver, Ariz The AORN Journal welcomes letters from its readers on subjects of interest to OR nurses. Letters should be typed and should include the writer’s name, full title, and address. The Journal reserves the right to edit all letters.
AORN Journal, July 1980,Vol32, No 1