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Health Care Industry

Focus on RN-as-circulator legislation

AORN Journal, Sept, 2005 by Catherine A.G. Sparkman

At a November 2004 meeting, the AORN Board of Directors charged the Government Affairs Department with the job of campaigning to secure passage of statutory language that would ensure the presence of an RN in the circulator role in the OR for every surgical procedure. In spring 2005, Government Affairs Department personnel pursued RN-as-circulator legislation and regulation in five states (ie, Georgia, New York, Oregon, Texas, Virginia). To date, RN-as-circulator bills have passed in Oregon (HB 2800) and Texas (HB 1718).

AORN's proposed RN-as-circulator bill in Georgia has several house and senate sponsors, including nurse and physician legislators. It is due to be filed when the Georgia legislature reconvenes in 2006.

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In New York, AORN petitioned the department of health for regulations requiring an RN in the circulator role and concurrently undertook an effort to introduce parallel legislation in the New York state assembly and senate. The assembly bill (A 7837) was introduced in late spring by Eileen Gunther, RN. The bill has 16 cosponsors, including several members of the health committee. The bill will carry over to the 2006 legislative session, and a senate companion bill will be introduced in January 2006.

In Virginia, proposed regulations are under consideration by both the board of health and the board of medicine. The regulations address perioperative staffing in hospitals, ambulatory surgery centers, and physicians' offices. The regulations are in the comment period and currently are on a fast track for review by the various regulatory bodies.

The charge given by AORN President Sharon McNamara, RN, MS, CNOR, to the 2005-2006 Legislative Committee is to evaluate and recommend additional states in which to introduce RN-as-circulator legislation or regulation. The process to recommend states began with a careful examination of the legislative and regulatory landscape in each state.

CRITERIA

Legislative Committee members and Government Affairs Department personnel developed the following criteria to determine which states were conducive to launching RN-as-circulator initiatives.

* What are the data and demographics related to health care access, delivery, and use?

* Are there currently any legislative or regulatory activities involving medical issues, such as health care liability reform, the nursing shortage, staffing, mandatory overtime, workplace safety, practice issues, and whistle-blower protection?

* Are there committed and engaged AORN members who have the time and energy to work closely with Government Affairs Department staff members, the initiative's grassroots champion, and a professional lobbyist to press for passage of the legislation?

* Are there peer organizations that could support, supplement, and add synergy to the grassroots organization and initiative?

* Does the organization have the necessary lead time to individualize the strategy to fit the unique aspects of the state's respective legislative calendar and procedures?

* Will the state support successful legislative initiatives in subsequent years?

After careful deliberation, the Legislative Committee identified seven states on which to focus AORN's 2006 public policy advocacy and energy: Florida, Maryland, North Carolina, Ohio, Pennsylvania, South Carolina, and Washington. The Legislative Committee also determined that legislative initiatives should continue in the three states (ie, Georgia, New York, Virginia) where RN-as-circulator regulations and bills already are underway. Of these 10 states, six (ie, Maryland, North Carolina, Ohio, Pennsylvania, South Carolina, Washington) have no RN-as-circulator statutory or regulatory language at all; the remaining four (Florida, Georgia, New York, Virginia) have weak or extremely narrow provisions. None have a legislative mandate to ensure that an RN performs the circulator responsibilities in every OR.

The Legislative Committee identified initiative coordinators in each of these states to champion the effort and serve as the vital link between Government Affairs Department staff members, lobbyists, grassroots members, and elected officials. In some cases, AORN's state legislative coordinators will serve in this capacity. In others, members who have participated in previous initiatives have volunteered to serve. Table 1 lists the state initiative coordinators.

INITIATIVE TIMELINE

The Government Affairs Department has developed a tentative timeline and calendar to support the RN-as-circulator initiative. Work is underway to identify the grassroots contacts and connections needed to roll out the initiative in the identified states. A communication process to support the initiative is being drafted and refined. When the plan is fully functional, it will be sent with the grassroots implementation strategy to state councils and chapters.

The first step is to decide whether the RN-as-circulator language should be carried forward as legislation or regulation. After that determination has been made, Government Affairs Department staff members, state initiative and legislative coordinators, and Legislative Committee members will evaluate the determination, and if advisable, will select a professional lobbyist to assist in developing appropriate strategies tailored to the specific state.

Health Care Industry

Focus on RN-as-circulator legislation

AORN Journal, Sept, 2005 by Catherine A.G. Sparkman

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