You, the federal system of government, and AORN's legislative priorities - Health Policy Issues - Association of Operating Room Nurses

AORN Journal,  Feb, 2002  by Frederick P. Franko

• E-mail
• Print
• Link

To those who are not familiar with the political system of the United States, our government can be a bewildering maze of legal terminology, confusing processes, and intimidating personalities. What makes this even more complicated is that the political system is slightly different in every state. Fortunately, however, our political system is relatively stable after decades of tinkering. The system stays much the same, even as the personalities change.

What is the political system in which we live and work? This article presents a general overview of the US political system, including federal and state levels of government. More importantly for our members, this system will be viewed in the context of AORN's legislative priorities.

AORN'S PRIORITIES

What are AORN's legislative priorities and where do they fit with the US political system? In October 2000, the AORN Board of Directors approved four priorities recommended by AORN's Legislative Committee.

* Ensure the supervisory presence of the professional RN in the perioperative arena by promoting AORN's position that "Every surgical patient deserves a perioperative nurse," and ensuring that all state laws and regulations require an RN only to circulate.

* Medicare reimbursement for certified RN first assistants (CRNFAs) and third-party reimbursement for RN first assistants (RNFAs) in the states.

* Supervision and regulation of assistive personnel. AORN supports the establishment of basic educational standards for surgical technologists (STs). In addition, AORN suspends opposition to the registration or certification of STs, as long as it is under the state nursing board or equivalent.

* Patient and personnel health and safety in the perioperative arena.

THE FEDERAL SYSTEM

American federalism, as defined in the US Constitution, divides government between the national and state levels. (1) Both levels of government interact with the people and have certain powers over the people. The Constitution also provides for the separation of power between the executive, legislative, and judicial branches of government. This diffuse and complex system does not lend itself to easy summation; (2) however, it does help prevent tyranny in the hands of any one individual, branch of government, or institution.

The United States also is a democracy, a government by the people through either direct or indirect elections. As a citizen and a voter, you and the other voters in your political district are constituents of elected officials at several levels of government. For national office, you vote for a president indirectly through the Electoral College system and directly vote for US representatives and senators. Likewise, each eligible citizen can vote for a governor, senator, and representative at the state level. Citizens also elect representatives at the local level and within special districts.

As an AORN member and a potential political activist, it is important that you know the basics of our political system. Understanding this system provides a means of influencing decisions that affect the nursing profession. With this knowledge, you can begin to develop an effective political advocacy strategy. Political activist and author Joel Blackwell refers to this as the "ARM" strategy (ie, attitude, relationship, message). (3)

Blackwell and other political consultants emphasize that individuals possess the personal political power to affect political change. An even more powerful influence is found, however, by working with others on a common issue. As Blackwell points out, "Most often, political goals are achieved through an association of people, either formal or informal [as in a coalition]." (4)

THE NATIONAL LEVEL

Within the executive branch of the US government, and under the leadership of the president, there is a vast federal bureaucracy. (5) This bureaucracy is made up of 14 cabinet-level departments that oversee hundreds of bureaus, services, administrations, divisions, and regulatory agencies.

The Centers for Medicare and Medicaid Services (CMS) (formerly the Health Care Financing Administration) is located under the umbrella of the US Department of Health and Human Services. The CMS operates both the federal Medicare program and funds the federal portion of the Medicaid program, which is administered by individual states. Medicare provides health insurance to individuals age 65 and older. Medicaid provides health care coverage to low income families and individuals. (6)

RNs in the OR. One of AORN's legislative priorities is to ensure the supervisory presence of the professional RN in the OR. In December 1997, CMS proposed a rule change to remove prescriptive language requiring RNs in the OR. (7) This rule change would apply to hospitals and ambulatory surgery centers that receive Medicare and Medicaid reimbursement. AORN members and Headquarters staff members responded directly to CMS regarding this proposed rule change and requested that the agency keep the prescriptive language. Although CMS stated that a decision would be issued in 2000, no final rule has been released to date. (8)