The only game in town

AORN Journal,  Dec, 2002  by Donna S. Watson

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Some interesting words describe politics, including influence, power, prestige, and wealth. There are other metaphors, but I have chosen the high road for this message. On multiple occasions, I have heard politics in Washington, DC, and at the state level referred to as "the game." I find that reference a bit disturbing because this game involves influencing and making decisions about the values of people on the receiving end of the political game. These decisions affect us as individuals. Issues such as health care, education, social security, taxes, national defense, budgets, environment, and violence are not and should not be taken lightly. As an Association, it is critical that AORN use its influence by participating in the political process.

AORN has a rich history of taking part in the political process at both the national and state levels. This participation has helped policy makers make more informed decisions because of the education we provide them. Every day, AORN members see the effects of a health care system that is fraught with problems. As perioperative nurses, we are members of the largest group of health care providers in the nation. There are approximately 2.7 million professional RNs. (1) That number gives us influence and power; but we also have to recognize the rules in the game of politics. Those who learn the rules and play by them usually are the better players and more likely to succeed. Unfortunately the rules often are not fair, and the playing field is uneven.

As an Association, AORN has always participated in politics. This results from members' involvement at the local level, where they use their influence in the workplace environment and to improve patient care. Nurses influence scope of practice through state boards of nursing or their equivalents, and they influence policy makers at both the state and national level. This year, the AORN Board of Directors unveiled the Association's updated and expanded legislative priorities for 2002-2003. These include

* patient safety,

* scope of practice,

* professional nursing environment, and

* reimbursement.

PATIENT SAFETY

AORN advocates for professional RNs who are working to put patient safety first by supporting federal legislation to improve patient safety. AORN will strategize to monitor and introduce state and federal legislation as appropriate in areas such as correct site surgery, reducing medical errors in the perioperative setting, smoke evacuation, and needle sticks, as well as other areas.

SCOPE OF PRACTICE

At the federal level, AORN continues to oppose any change to prescriptive language requiring RNs in the OR in the Centers for Medicare and Medicaid Services' (CMS') hospital conditions of participation. The Centers for Medicare and Medicaid Services first announced the proposed elimination of the prescriptive language in December 1997. AORN activated an aggressive campaign to retain the prescriptive language. There has been no indication from Tom Scully, CMS administrator, or anyone else at CMS that this issue will be considered further in the near future. We will continue to monitor this issue.

AORN promotes basic education standards for assistive personnel, such as surgical technologists (STs) and surgical assistants (SAs). AORN supports registration or certification of STs and SAs that is under the authority of the state board of nursing or its equivalent. AORN members are active participants in the political process in states where this is a legislative issue (eg, Indiana, New York, Tennessee, Virginia).

PROFESSIONAL NURSING ENVIRONMENT

AORN acknowledges that the national nursing shortage is a public health crisis and collaborates with other organizations and nursing associations to address and influence corrective strategies. AORN supports the federal Nurse Reinvestment Act. This act has been passed into law, but funds still must be appropriated. AORN affirms, as stated in the "AORN statement on nurse-to-patient ratios" that

   ... whenever invasive procedures are performed, the minimum
   nurse-to-patient ratio is one professional perioperative registered nurse
   dedicated to each patient during that patient entire intraoperative
   experience. (2)

REIMBURSEMENT

On Aug 15, 2002, the AORN Board of Directors reaffirmed promoting the Medicare Certified Registered Nurse First Assistant Direct Reimbursement Act of 2001 (ie, HR 822) and the bill's current language. Members of the Board are aware of increased discussion among AORN members related to the wording of HR 822. A document with proposed modified language was circulated to the Board. This resulted in reaffirmation of the language as it is stated in the current bill. The RN First Assistant Specialty Assembly Governing Council also has gone on record in support of the bill's current language. The Board is aware of the complex issues surrounding reimbursement for RN first assistants (RNFAs). One of the most contentious areas of concern related to HR 822 is the potential negative implications the federal bill may have on state legislation for noncertified RNFAs. It is feared that if federal legislation is passed for certified RNFAs, the states may follow and require certification for reimbursement.