Translate the moral force into effective action - Health Policy Issues

AORN Journal, Sept, 2003 by Frederick P. Franko

Communicating regularly with members of Congress about AORN's legislative priorities is an important activity for perioperative nurses. Grassroots lobbying at the state level also is important, given the state's responsibility for regulating the profession. What advantages do perioperative nurses have over other professions when they work with federal and state legislators and regulators?

In his book Giant Killers, Michael Pertschuk describes public interest lobbying as "the hitching of a citizen movement to the skills needed to translate the moral force and energy of that movement into effective action." (1) As guardians of patient health and safety, perioperative nurses enjoy prominent community standing and can claim the moral force.

RESPECT FOR THE PROFESSION

Public opinion research confirms that both health care professionals and the public recognize the care nurses provide and view nurses positively. In 2002, the Kaiser Family Foundation and Harvard School of Public Health conducted an opinion poll regarding medical errors. In its survey of 831 physicians and members of the public, the group found 53% of physicians believe that one of the leading causes of preventable medical errors is under-staffing of hospital nurses. In addition, a majority of physicians see only two proposals as effectively addressing the prevention of medical errors: requiring hospitals to develop systems to avoid medical errors and increasing the number of hospital nurses. (2) This poll shows that perioperative nurses can view physicians as allies in promoting the nursing profession and issues important to perioperative nursing.

Research from The Gallup Organization found a positive view of nurses among members of the public. According to the organization's 2002 annual ratings of the honesty and ethics of various professions, nursing was most highly rated, ranking well ahead of the clergy. (3) A third survey, conducted by Vanderbilt University Medical Center's School of Nursing and Health Services Research on behalf of Johnson & Johnson, found that 97% of Americans view nurses and the nursing profession favorably. In the same survey, 93% of respondents agreed that the nursing shortage jeopardizes the quality of health care in the United States. (4)

ACTIVATING THE MORAL FORCE

Perioperative nurses' moral force is latent potential unless members of the profession leverage this force into an advocacy action plan to achieve legislative and regulatory success. As they lobby on behalf of issues such as keeping the RN in the OR and requiring a circulating nurse in the OR, nurses can call upon recent research that documents the immense importance of nurses in helping to ensure patient health and safety.

In one such study, researchers examined the relationship between the amount of care that nurses provided in a hospital and patient outcomes. The study showed that among surgical patients, a lower rate of urinary tract infections was associated with a higher proportion of RN hours, and a lower rate of failure-to-rescue was associated with a higher number of RN hours per day. (5(p118)) The study concluded that

   A higher proportion of hours of
   nursing care provided by registered
   nurses and a greater
   number of hours of care
   by registered nurses per
   day are associated with
   better care for hospitalized
   patients. (5(p115))

In another study, researchers found that in hospitals with high patient-to-nurse ratios, surgical patients experienced higher risk-adjusted, 30-day mortality and failure-to-rescue rates than in hospitals with lower patient-to-nurse ratios. (6) Patricia Grady, MD, director of the National Institute of Nursing Research, made these comments on the findings

   This research underscores
   the nurse's importance as
   a key member of the health
   care team. The effectiveness
   of nursing care
   depends on close proximity
   and observation of
   patients, astute interactions,
   and effective, timely
   action when problems
   occur. Policy makers,
   administrators, and health
   care professionals of all
   disciplines must work
   together to ensure that
   high quality care is the
   norm in our country. (7)

Such research should be brought to the attention of busy state legislators and regulators, who might have a narrow view of nursing and, therefore, little understanding of nurses' work. Unless nurses educate lawmakers, lack of familiarity with perioperative nursing might lead legislators to consider the issues of keeping the RN in the OR and requiring a circulating nurse in the OR as mere turf battles.

Perioperative nurses are responsible for educating legislators about nurses' roles and activities, the education and skills necessary to fill those roles, and the need for nursing activities to be performed by RNs.

Respect from the community and their colleagues give nurses the moral force to advocate effectively in legislative and regulatory forums. They should apply their passion and energy for their profession by reminding others of their role in providing quality patient care.