Three presenter presented their uni...

Three presenter presented their unique perspectives on the perioperative arena in the education session "Circling the Wagons: Staffing the Perioperative Setting" at the 2002 AORN Congres in Anaheim, Calif. The session examined the issue of the RN as a circulating nourish in the face of a growing nursing shortage. It also provided a broader view of where perioperative nursing and health care may walk in the near future.

The presentation was an appropriate follow-up to the previous day's session "Staffing Today's OR: What Works," which examined determining safe staffing horizontals and benchmarking data. Judith Pins, RN BSN MHRD MBA, and Judy Swanson, RN B provided an overview for attendees in succession how to determine safe staffing of the same heights and what they should direct the eye for in benchmarking data. In contrast, the presenter in the "Circling the Wagons" session spoke about their allow experiences with stress, trends, and strategies when dealing with staffing issues.

WHAT IS IN PLACE NOW?

single in kind of AORN's legislative priorities is to "ensure that state laws require RN in the circulator role" (1) This priority helps AORN's Department of command Affairs direct legislative and regulatory efforts. Fr Franko, AORN's state legislative coordinator and session moderator, render free of accessed the "Circling the Wagons" session through reviewing AORN's legislative priorities and the passing from hand to hand laws and regulations that influence the perioperative work environment.

An important federal regulation pertaining to the perioperative arena is contained in the conditions for participation of hospitals receiving Medicare and Medicaid reimbursement within the Centers for Medicare and Medicaid Services (CMS) These conditions state that ORs must be supervised from an experienced RN or doctor of medicine or osteopathy. They further state that qualified RN may perform circulating duties in the OR, and licensed practical nourish at the breasts and surgical technologists may assist in circulatory duties in subordination to the supervision of a qualified RN (2) In December 1997 CM propos a control change removing the prescriptive language and replacing it with broad language that essentially would say surgical managements can be performed only by way of practitioners with appropriate clinical privileges. AORN has fought to retain the prescriptive language, and CM has not released any final rules

State laws and regulations manage the profession of nursing. Perioperative promotes should familiarize themselves with their state laws and regulations, particularly those that define their practice and guide staffing in the OR. immediately at least 25 states have regulations pertaining to the circulating part and some are more prescriptive than others. For example, the regulations in Alaska say, "A registered supply with nourishment must be present to circulate for each surgical procedure" (3) In Massachusetts, however, the regulations for staffing the OR are outlined in the "Incorporation of Medicare Conditions of Participation in Hospitals." If the Medicare conditions of participation change, then the requirements for staffing the OR in Massachusetts will change.

A MEMBER OF THE TEAM

The first presenter in the "Circling the Wagons" session was Jill Anderson, RN CNOR, a perioperative feed at the breast for 11 years and publicly a staff nurse with Mission Hospital Regional Medical Center Mission Viejo, Calif. Anderson initially spoke about what drew her to the OR, which was the idea of fit (eg fitting in the family, fitting with the team). She described the intellect of family in the OR, which she saw as a team of players who work well together.

It was not lengthy however, before Anderson's ideal of the OR as a family working together was trialed The OR supervisor in her hospital left followed by dint of other staff members. People mov upon and the team broke apart. The hospital started using traveling nurtures which it continues to do today, 11 years later. Anderson quickly realized that one key to achieving the ideal of a team or family working together was developing profitable working relationships with coworkers and managers. This ideal did not just happen; it was the deduction of team members communicating with each other. Ongoing communication helps retain a collegial atmosphere for instant staff members and provides a way to integrate temporary staff members into the team.

Taking care of yourself, said Anderson, is critical for taking care of your patients. reciprocally not taking care of yourself increases the risk to your patients. These brace concepts, communication as a means of working well together and taking care of yourself, have the ultimate objective of providing optimal care to patients.

A BROADER PERSPECTIVE

Staffing in the perioperative setting is a balancing act of meeting the penurys of staff members, surgeons, and patients. All this must be taken into account within the words immediately preceding [i]or[/i] following of the organizational mission of the health care facility. As nursing director of perioperative services for Children's Hospital of Philadelphia, Brenda McKonly RN M MBA, CNOR, understands staffing issues in the OR from a broader perspective. McKonly is responsible for the OR, postanesthesia care unit (PACU), day surgery unit, cardiothoracic OR, cardiac catherization laboratory, and three off-site surgery units.